Outcomes of transoral laser microsurgery and transoral robotic surgery in oropharyngeal squamous cell carcinoma

ObjectiveTransoral robotic surgery (TORS) has evolved to a standard therapy modality for oropharyngeal carcinoma, especially in T1/ T2 tumors involving the base of the tongue due to its advantages compared with open surgery. However, knowledge about its benefits compared with transoral laser microsurgery (TLM) are scarce. This study compares oncological and functional results of TLM or TORS in the treatment of oropharyngeal squamous cell carcinoma (OPSCC).MethodsThis retrospective analysis comprises all patients with OPSCC treated with TLM (n = 30) or TORS (n = 24) between April 2003 and May 2018 (follow-up 43 ± 38.3 months). Both treatment groups (TLM and TORS) were comparable in terms of the stage of the disease, prognosis-determining factors, and adjuvant therapy modalities.ResultsThere were no significant differences regarding to the resection status (p = 0.272), the rate of local- (p = 0.834) and distant- recurrence (p = 0.416), with a disease-free survival of 86.7 % and 87.5 %, respectively (p = 0.892). In addition, we could not confirm any differences regarding to operating time (p = 0.860), intraoperative blood loss (p = 0.660), inpatient stay (p = 0.585) and postoperative bleeding rate (p = 0.245). The frequency of tracheostomy and percutaneous endoscopic gastrostomy between both groups is comparable, with a longer duration of tube feeding in patients who have received TLM (p = 0.030).ConclusionIn conclusion, TORS allows for similar oncological outcomes compared with TLM at comparable perioperative risks. The postoperative swallowing function may benefit from TORS.     

Apheresis for idiopathic sudden hearing loss: reviewing the evidence

Plasmapheresis has been used for various conditions for a number of years. Recently, its application for idiopathic sudden hearing loss (ISHL) has met with increasing interest. ISHL affects about 10-20 per 100,000 persons per year, impairing not only their hearing but also their ability to interact socially and their quality of life. ISHL is thought to be a sequela of an underlying microvascular disorder caused by a local hyperviscosity syndrome in the cochlear vessels. Plasmapheresis can effectively lower plasma and whole blood viscosity, improve erythrocyte elasticity, and reduce aggregability. Thus, it may be effectively employed in the treatment of ISHL. This article will briefly outline the background against which apheresis procedures are used in the treatment of ISHL and review studies done to date. Furthermore, a broader basis for the use of apheretic applications in the treatment of ISHL will be suggested, correlating age-adjusted ISHL incidence and age-adjusted levels of macromolecular plasma proteins such as fibrinogen. In conclusion, plasmapheresis is a promising new treatment for ISHL but more basic data on ISHL, and on apheresis applications for ISHL, are needed to safely assess treatment outcomes and possible future applications.     

Idiopathic sudden hearing loss: contradictory clinical evidence, placebo effects and high spontaneous recovery rate--where do we stand in assessing treatment outcomes?

Idiopathic sudden hearing loss (ISHL) has an estimated incidence of 10-20/100,000 per year, impairing not only patients' hearing but also their ability to interact socially and their quality of life. Confronted with patients who demand successful treatment, physicians need to judge potential treatment options with regard to their reported efficiency, as well as their suitability for the individual patient. The dilemma of assessing treatment outcomes and options in ISHL will be discussed regarding a lack of knowledge of the disease's etiology, contradictory clinical evidence, high spontaneous recovery rate, and possible placebo effects. In conclusion, there is a dearth of structured research adhering to a common protocol, which makes comparison of trials and assessment of potential treatment outcomes difficult. Further research is warranted, taking some key recommendations into consideration.     

Spiradenokarzinom der Stirn

Spiradenocarcinomas are rare malignant tumors that originate from the sweat glands of the skin and demonstrate aggressive growth. We report the case of an 86-year-old female patient presenting with a growth on the forehead which had been apparent for 2 years. After surgical removal of the tumor, histological workup culminated in the diagnosis of a spiradenocarcinoma. Surgical margins were free of tumor on pathological examination. Metastasis was excluded by positron-emission tomography–computed tomography (PET-CT). Due to the advanced age of the patient and the absence of metastatic disease, no adjuvant therapy was performed. Six months postoperatively there is no evidence of relapse.     

Lesbarkeit von medizinischen Texten im Internetangebot deutscher HNO-Universitätskliniken

Background

A certain proportion of the population has limited literacy skills; therefore, it is important that any patient information published on the internet is readable to the majority of patients for whom the information is intended.

Materials and methods

Texts for 10 representative ear nose and throat (ENT) topics were extracted from each website of the 36 German ENT university hospitals. The texts were systematically analyzed by use of the German version of the Flesch ease of reading index. The texts of two topics were additionally analyzed with four more readability tools for the German language. Texts were analyzed in relation to the topic and to the geographical region.

Results

On average the texts of 185 websites consisted of 34 sentences and 401 words. Comparably, texts on cochlear implants showed the best readability scores and texts on middle ear pathology the worst. The results of the reading ease index and of the other reading analysis tools showed that all texts require a relatively high literacy level.

Conclusions

To fulfil the ambition of informing the general population about medical issues in an adequate way, a revision of most medical texts on websites of German ENT departments at university hospitals is recommended.     

Endoscopic laser-assisted diverticulotomy without versus with wound closure in the treatment of Zenker’s diverticulum

The aim of the present study was to compare the modifications of endoscopic laser-assisted diverticulotomy regarding closure of mucosal wound at the cricopharyngeal bridge. The results of 62 cases after endoscopic laser-assisted diverticulotomy without and with wound closure were retrospectively compared. After laser-assisted transection of the cricopharyngeal bridge, the mucosa wound was left open (OW) in 35 cases (56 %), whereas a closure of the mucosa wound (CW) with sutures and fibrin glue was performed in 27 patients (44 %). Duration of hospitalization, residual diverticular sac rate and occurrence of complications did not differ significantly between the two groups. Mean surgical time was significantly less in the OW cases. According to these results, it can be assumed that readapting and sealing the wound after transecting the cricopharyngeal bridge does not significantly reduce the complication rate. It does, however, extend the length of surgery and increases the cost of the procedure.     

Comparison of digital volume tomography and high-resolution computed tomography in detecting superior semicircular canal dehiscence – a temporal bone study

Conclusion: In detecting a thin bony coverage of a superior semicircular canal (SSC), digital volume tomography (DVT) scans in Poeschl projection seem to be superior to high-resolution computed tomography (CT) scans. Still, a definite diagnosis of SSC dehiscence (SSCD) is not possible with any radiologic imaging technique. Objective: To compare CT and DVT to find out whether DVT is equal, better or worse in showing a thin bony layer on top of an SCC. Methods: In 11 human temporal bone specimens, the SSC was microscopically blue-lined leaving a thin bony coverage on top of it. All specimens were assessed with both high-resolution CT and DVT. After reconstructing the images in Stenvers and Poeschl projections, all images were evaluated by five independent examiners experienced in radiologic imaging of the temporal bone using a four-point ordinal scale, from 1 (distinct dehiscence) to 4 (distinct coverage). Results: The mean score for all CT scans was 2.58 compared with 3.22 for DVT scans (p = 0.000). Poeschl projection showed a mean score of 3.25 compared with 2.55 for Stenvers projection (p = 0.000). The best imaging modality was found to be DVT scans in Poeschl projections, with a mean score of 3.60.