Simultaneous cochlear implantation with early endoscopic surgery in small acoustic neuroma.

Objectives: The exclusive endoscopic transcanal transpromontorial approach (EETTA) has recently been developed for the removal of small-sized acoustic neuromas in the labyrinth (intralabyrinthine schwannoma [ILS]) or internal auditory canal (IAC). Although small tumors that meet the indications for EETTA are also good candidates for cochlear implantation (CI), there are few reports on CI after schwannoma removal using EETTA. Here we present an outcome of patients who underwent simultaneous EETTA and CI. Methods: Five patients (two with IAC fundus tumors and three with ILS) who underwent simultaneous EETTA and CI between 2020 and 2022 were retrospectively enrolled. Their medical charts and test results were reviewed. Results: After at least 12 months of follow-up, there were no severe surgical complications such as meningitis, infection, or skin necrosis. Four of the five patients responded to auditory stimulation. Three out of four auditory-responsive patients scored >80% on sentence recognition. Conclusion: Simultaneous EETTA and CI are feasible for the treatment of ILS and IAC fundus tumors. Preservation of the cochlear nerve and modiolus is important for favorable CI outcomes. Therefore, ILS and IAC fundus tumors in patients with nonserviceable hearing should be surgically removed as early as possible to enable proper hearing rehabilitation with CI. Level of Evidence: Level 4.

Diagnostic-to-treatment interval and disease progression among head and neck cancer patients undergoing surgery

OBJECTIVE: To determine whether the interval from pathological diagnosis to treatment is significantly delayed, and the presence or absence of disease progression occurring in those with, and without treatment delay, among head and neck cancer patients in our institution.METHODS:Design: Retrospective Chart ReviewSetting: Tertiary Government HospitalParticipants: Medical records of 70 patients with newly diagnosed head and neck cancer who underwent primary surgery from January 2011 to December 2015 were retrieved and available data were extracted.RESULTS: A total of 28 patients were included in this study. Majority of the cancers were in the larynx (42.9%) and oral cavity (42.9%). The mean diagnostic-to-treatment interval (DTI) was 54 days but 5 (17.8%) out of the 28 had a DTI of more than 60 days. Four (80%) with a DTI more than 60 days had an upstage during surgery while 4 (17.4%) patients with DTI less than or equal to 60 days also had an upstage. 2 (60%) patients with treatment delay had tumor progression compared to 5 (21.7%) of those without treatment delay. Only 1 (20%) out of the 5 patients with treatment delay had increased nodal metastasis in contrast to 8 (34.8%) of those who did not have treatment delay.CONCLUSION: A number of patients undergoing surgery in our institution experienced delay to initiate treatment of more than 60 days and majority of these patients were noted to have disease progression. However, even patients with treatment prior to 60 days had increases in tumor stage, which may suggest that the interval aimed for should be shorter than 60 days.