Respuesta al artículo «Ajustar el enfoque en cirugía robótica transoral» / Repply to the article «Adjusting the focus of transoral robotic surgery»

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Análisis crítico de la cirugía robótica laríngea / Critical analysis of robotic surgery for laryngeal tumours

Recientemente se ha introducido en el bagaje quirúrgico del otorrinolaringólogo el empleo del robot Da Vinci para tratar tumores laríngeos con la justificación de mejorar los resultados funcionales y estéticos sin comprometer la supervivencia. En esta revisión se describen las ventajas de la cirugía robótica transoral (TORS), aunque las desventajas de la misma, principalmente su elevado coste, nos hacen preferir otras modalidades terapéuticas, principalmente la cirugía láser transoral. Se esperan en el futuro inmediato mejoras técnicas importantes en la cirugía robótica, con aparatos más pequeños, ergonómicos, de nueva generación, mejor adaptados al área cervicofacial (AU)

In recent years, transoral robotic surgery (TORS) with the Da Vinci robot has been used for the removal of laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. The advantages of TORS are described in this article. However, its disadvantages, mainly high cost amongst others, do not make robotic surgery the current treatment of choice for laryngeal tumours; transoral laser surgery is superior in most cases. Major technical improvements are expected. Smaller, more ergonomic, new-generation robots better adapted to the head and neck will probably be available in the near future (AU)

Critical analysis of robotic surgery for laryngeal tumours.

In recent years, transoral robotic surgery (TORS) with the Da Vinci robot has been used for the removal of laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. The advantages of TORS are described in this article. However, its disadvantages, mainly high cost amongst others, do not make robotic surgery the current treatment of choice for laryngeal tumours; transoral laser surgery is superior in most cases. Major technical improvements are expected. Smaller, more ergonomic, new-generation robots better adapted to the head and neck will probably be available in the near future.

Acute-phase inflammatory response in idiopathic sudden deafness: pathogenic implications.

The acute-phase inflammatory response in the peripheral bloodstream can be an expression of transient cerebral ischaemia in idiopathic sudden deafness. For this, a neurological and otorhinolaryngological examination of each patient, performing tests on audiometry, and tympanometry, haemogram, and cranial magnetic resonance were performed. The acute-phase inflammatory response manifests as an increased neutrophil/lymphocyte ratio that is detected 48-72 hours after the appearance of sudden deafness. This study shows that there is an acute-phase response in the peripheral bloodstream with an increased neutrophil/lymphocyte ratio as an expression of an inflammatory process that can be caused by transient cerebral ischaemia in sudden deafness. In addition, the increased neutrophil/lymphocyte ratio can rule out a viral origin of sudden deafness, since a viral infection lowers the neutrophil count and increases the lymphocyte count, thus reducing the neutrophil/lymphocyte ratio. These findings aid in understanding the pathogenic mechanisms involved in sudden deafness and offer better treatment to the patient.

Terapia sonora en sordera súbita / Sound therapy in sudden deafness

Introducción y objetivos: La hipoacusia neurosensorial súbita idiopática es un trastorno auditivo de causa desconocida. El índice de recuperación espontánea puede variar, según la literatura, en un rango del 50-75% de los pacientes. Experimentos científicos mediante terapia sonora en animales hipoacúsicos avalan el presente estudio en pacientes con sordera súbita tratados con sonidos. Pacientes y métodos: Estudio sin aleatorización de una serie retrospectiva de casos. Durante el período 2003-2009, pacientes con hipoacusia neurosensorial súbita idiopática fueron tratados con corticosteroides, piracetam y antioxidantes, en presencia y ausencia de terapia sonora de música y palabra. Resultados: Cuando se comparan los resultados de los pacientes tratados con medicación(n = 65) y los tratados con medicación más terapia sonora (n = 67), se observa que los segundos tienen mayor recuperación. En este grupo, 25 (37%) se recuperaron completamente, 28 (42%) tuvieron buena recuperación, 11 (16%) ligera recuperación y 3 (5%) pobre recuperación o ninguna recuperación. Conclusión: El 54% de los pacientes del grupo con medicación ha recuperado más de la mitad de la audición perdida y el 79% del grupo que recibió medicación y terapia sonora. La recuperación auditiva no sufrió alteraciones, al menos, en los siguientes 12 meses del tratamiento(AU)

Introduction and goals: Idiopathic sudden sensorineural hearing loss is a hearing disorder of unknown cause. The spontaneous recovery rate ranges from 50 to 75% of the patients. Scientific experiments on animals support the present study in patients with sudden deafness treated with sounds. Patients and methods: During the period 2003-2009, patients with idiopathic sudden sensorineural hearing loss were administered steroids, piracetam and antioxidants, together with the addition of sounds by means of music and words. Results: Comparing the results of patients treated with medication (n = 65) and those treated with medication and sounds (n = 67), it was observed that patients treated with medication and sounds had higher recovery. Within the group of patients treated with medication and sounds,25 (37%) experienced complete recovery, 28 (42%) good recovery, 11 (16%) slight recovery and3 (5%) poor or no recovery .Conclusion: The patients who recovered more than half of their audition accounted for 54% in the group treated with medication and for 79% in the group of patients receiving medication and sounds. Auditory recuperation showed no alterations, at least up to 12 months after therapy(AU)

Medición de acúfenos con audiómetro convencional versus audiómetro de alta frecuencia / Tinnitus measurement with conventional audiometer versus high-frequency audiometer

Introducción y objetivos: Las determinaciones de las características psicoacústicas del acúfeno (frecuencia e intensidad) son válidas para el diagnóstico, tratamiento, seguimiento y fines de investigación. El objetivo de este estudio es conocer si se encuentran diferencias entre las determinaciones de la frecuencia e intensidad del acúfeno con metodología convencional o metodología de alta frecuencia. Métodos: Se utiliza audiómetro convencional (rango de frecuencias: 125-12.000Hz) y audiómetro de alta frecuencia (rango de frecuencias: 125-18.000Hz) para medir la frecuencia e intensidad de los acúfenos en 47 pacientes con acúfenos continuos en forma de pitidos. Resultados: Se han encontrado diferencias estadísticamente significativas entre las determinaciones de la frecuencia del acúfeno efectuadas con audiómetro convencional y audiómetro de alta frecuencia, así como correlación entre los acúfenos de alta frecuencia y las molestias manifestadas por los pacientes. Conclusiones: 1) La frecuencia del acúfeno determinada con audiómetro de alta frecuencia es mayor que la frecuencia determinada con audiómetro convencional; 2) cuanto mayor es la frecuencia del acúfeno, más molestias manifiesta el paciente; y 3) no hay relación entre la intensidad y la molestia producida por el acúfeno(AU)

Introduction and objectives: Determinations of the psychoacoustic characteristics of tinnitus (frequency and intensity) are valid for diagnosis, treatment, monitoring and research purposes. The aim of this work is to compare the frequency of the tinnitus measured with a standard audiometer and a high frequency audiometer. Methods: We used a conventional audiometer (frequency range: 125-12 000Hz) and a high-frequency audiometer (frequency range: 125-18 000Hz) to measure the frequency and intensity of tinnitus in 47 patients with tinnitus as a continuous ringing. Results: We found statistically-significant differences between the determination of the frequency of tinnitus made with conventional and high-frequency audiometers, as well as a correlation between high-frequency tinnitus and distress expressed by patients. Conclusions: 1) The frequency of tinnitus determined by high-frequency audiometer is greater than the frequency determined by conventional audiometer; 2) the higher the frequency of tinnitus, the more discomfort the patient manifests; and 3) there is no relationship between the intensity and discomfort caused by tinnitus(AU)

[Tinnitus measurement with conventional audiometer versus high-frequency audiometer]. / Medición de acúfenos con audiómetro convencional versus audiómetro de alta frecuencia.

INTRODUCTION AND OBJECTIVES: Determinations of the psychoacoustic characteristics of tinnitus (frequency and intensity) are valid for diagnosis, treatment, monitoring and research purposes. The aim of this work is to compare the frequency of the tinnitus measured with a standard audiometer and a high frequency audiometer. METHODS: We used a conventional audiometer (frequency range: 125-12,000 Hz) and a high-frequency audiometer (frequency range: 125-18,000 Hz) to measure the frequency and intensity of tinnitus in 47 patients with tinnitus as a continuous ringing. RESULTS: We found statistically-significant differences between the determination of the frequency of tinnitus made with conventional and high-frequency audiometers, as well as a correlation between high-frequency tinnitus and distress expressed by patients. CONCLUSIONS: 1) The frequency of tinnitus determined by high-frequency audiometer is greater than the frequency determined by conventional audiometer; 2) the higher the frequency of tinnitus, the more discomfort the patient manifests; and 3) there is no relationship between the intensity and discomfort caused by tinnitus.

[Sound therapy in sudden deafness]. / Terapia sonora en sordera súbita.

INTRODUCTION AND GOALS: Idiopathic sudden sensorineural hearing loss is a hearing disorder of unknown cause. The spontaneous recovery rate ranges from 50 to 75% of the patients. Scientific experiments on animals support the present study in patients with sudden deafness treated with sounds. PATIENTS AND METHODS: During the period 2003-2009, patients with idiopathic sudden sensorineural hearing loss were administered steroids, piracetam and antioxidants, together with the addition of sounds by means of music and words. RESULTS: Comparing the results of patients treated with medication (n=65) and those treated with medication and sounds (n=67), it was observed that patients treated with medication and sounds had higher recovery. Within the group of patients treated with medication and sounds, 25 (37%) experienced complete recovery, 28 (42%) good recovery, 11 (16%) slight recovery and 3 (5%) poor or no recovery. CONCLUSION: The patients who recovered more than half of their audition accounted for 54% in the group treated with medication and for 79% in the group of patients receiving medication and sounds. Auditory recuperation showed no alterations, at least up to 12 months after therapy.

Calpain 10 gene and laryngeal cancer: a survival analysis.

BACKGROUND: Laryngeal carcinoma is a common upper respiratory tract cancer with different environmental and genetic factors involved in its development. Calpains are Ca2+-dependent cysteine proteases that modulate cellular function. A novel association between calpain 10 (CAPN10) haplotypes and laryngeal cancer has been found recently. Therefore, the goal of this study was to analyze the contribution of CAPN10 alleles to laryngeal cancer survival. METHODS: Patients were recruited from southern Spain. Genotypes were determined using pyrosequencing technology. We analyzed CAPN10 UCSNP-44, UCSNP-43, UCSNP-19, and UCSNP-63 allelic distributions in 199 patients with unrelated laryngeal cancer. Survival curves were calculated from the date of the intervention to the date of death. Multivariate analyses were done using the Cox proportional risk model. RESULTS: UCSNP-19, UCSNP-43, and UCSNP-44 were unrelated to survival in both univariate and multivariate analyses. However, for UCSNP-63 genotype 12 a significant relationship was observed in multivariate analysis (hazard ratio [HR] = 2.73; 95% confidence interval [CI], 1.21-6.20). CONCLUSION: CAPN10 UCSNP-63 genotype 12 seems to be related with a worse prognosis in laryngeal cancer.

Resultados de la preservación de órgano en los carcinomas de cavidad oral y orofaringe / Results of organ preservation in carcinomas of the oral cavity and oropharynx

Para los tumores T1 N0-1 y la mayoría de los tumores T2N0-1 de orofaringe, tanto la cirugía como la radioterapia son opciones válidas de tratamiento. Para las neoplasias clasificadas como T3-4a o N2, la quimiorradioterapia concomitante (QRC) se considera la terapia estándar debido al elevado riesgo de recidiva locorregional o metástasis a distancia. Aunque no hemos podido encontrar estudios que comparen la cirugía (y reconstrucción) sobre primario y cuello con la QRC, la mayoría de los especialistas que manejan pacientes con cáncer avanzado de orofaringe considera los datos existentes suficientes para recomendar este abordaje alternativo de preservación de órgano en los casos con enfermedad locorregional avanzada. No obstante, siguen habiendo controversias en el caso del cáncer de la cavidad oral(AU)

Surgery and radiotherapy are valid treatment options in toth T1 N0-1 tumors and most T2 N0-1 tumors of the oropharynx. For T3-4.ª and N2 neoplasms, concomitant chemoradiotherapy is considered the standard therapy due to the high risk of locoregional recurrence or distant metastases. Although we have found no studies comparing surgery (and reconstruction) on primary and neck tumors with concomitant chemoradiotherapy, most specialists managing patients with advanced oropharyngeal cancer consider the existing data to be sufficient torecommend this alternative organ preserving approach in patients with advanced locoregional disease. Nevertheless, controversies remain in the case of oral cavity cancer(AU)