Postural stability and handicap of dizziness after preoperative vestibular ablation and vestibular prehabilitation in patients undergoing vestibular schwannoma resection.

BACKGROUND: Surgical treatment of vestibular schwannoma (VS) leads to acute ipsilateral vestibular loss if there is residual vestibular function before surgery. To overcome the sequelae of acute ipsilateral vestibular loss and to decrease postoperative recovery time, the concept of preemptive vestibular ablation with gentamicin and vestibular prehabilitation before surgery has been developed ("vestibular prehab"). OBJECTIVE: Studying postural stability during walking and handicap of dizziness over a 1-year follow-up period in VS patients undergoing vestibular prehab before surgical treatment of VS. METHODS: A retrospective review of consecutive patients with a diagnosis of a VS undergoing surgical therapy from June 2012 to March 2018 was performed. All patients were included with documentation of the length of hospital duration and the Dizziness Handicap Inventory (DHI) and the Functional Gait Assessment (FGA) assessed preoperatively as well as 6 weeks and 1 year postoperatively. RESULTS: A total 68 VS patients were included, of which 29 patients received preoperative vestibular ablation by intratympanic injection of gentamicin. Mean VS diameter was 20.2 mm (SD 9.4 mm) and mean age at surgery was 49.6 years (SD 11.5 years). Vestibular prehab had no effect on DHI and FGA at any time point studied. CONCLUSIONS: We found no effect of vestibular prehab on postural stability during walking and on the handicap of dizziness. These findings add to the body of knowledge consisting of conflicting results of vestibular prehab. Therefore, vestibular prehab should be applied only in selected cases in an experimental setting.

Detection of Helicobacter pylori in patients with head and neck cancer: Results from a prospective comparative study combining serology, polymerase chain reaction, and rapid urease test.

BACKGROUND: The purpose of this study was to evaluate prospectively the presence and impact of the gastric carcinogen Helicobacter pylori (H. pylori) in the upper aerodigestive tract. Previous studies suggested it could represent a risk factor for head and neck squamous cell carcinoma (HNSCC). METHODS: Serology, rapid urease test, and quantitative polymerase chain reaction (qPCR) for H. pylori were performed in patients with head and neck cancer (N = 56) and cancer-free controls (N = 90). Comparison between groups was done using logistic regression analysis. RESULTS: Rates of positive serology and rapid urease test did not differ between the 2 groups in logistic regression analysis (p = .677 and p = .633, respectively). Birth in a developing country and age above 50 years old were predictors of positive serology (p < .001 and p = .040, respectively). Using qPCR, no biopsy showed the presence of H. pylori. CONCLUSION: This study challenges the concept that H. pylori may be a risk factor for HNSCC.

Helicobacter pylori detected in pharyngeal and laryngeal pathologies in patients with proven gastric colonization.

BACKGROUND: Helicobacter pylori is known to cause gastric cancer. Presence and carcinogenicity in the upper aerodigestive system is doubtful. This study examined the prevalence of Helicobacter pylori and related factors in biopsies from the upper aerodigestive tract (UADT) in patients with gastric colonization by Helicobacter pylori. METHODS: In a case series study, 26 patients with histopathologically confirmed gastric colonization were identified. A polymerase chain reaction (PCR) was performed on matched formalin-fixed and paraffin-embedded tissues of the stomach and the oral cavity, pharynx, or larynx. RESULTS: Helicobacter pylori was found in 38% of the samples from the oral cavity, pharynx, and larynx. An association with malignancies in these regions or possible risk factors, such as age, smoking, or alcohol, was not found. CONCLUSION: The upper aerodigestive system seems to be an additional reservoir in a significant percentage of patients presenting with Helicobacter pylori gastritis.