Comparison of functional and oncological treatment outcomes after transoral robotic surgery and open surgery for supraglottic laryngeal cancer.

OBJECTIVE: To compare functional and oncological treatment outcomes among patients with supraglottic laryngeal cancers who underwent transoral robotic supraglottic laryngectomy and open supraglottic laryngectomy. METHODS: A retrospective chart review was conducted of 17 patients treated by transoral robotic supraglottic laryngectomy and 20 patients treated by open supraglottic laryngectomy. RESULTS: No tracheostomy or prolonged intubation was needed in the transoral robotic surgery group. Furthermore, that group had a shorter oral feeding time, hospitalisation and recovery period. There was no difference between groups in terms of complications. There were no differences in overall survival time and disease-specific survival time between groups. CONCLUSION: Transoral robotic supraglottic laryngectomy for supraglottic laryngeal cancer is an oncologically safe and functional procedure with better results when compared to conventional open surgery.

Laryngocoele as an unusual complication of supracricoid partial laryngectomy: evaluation of 62 cases.

BACKGROUND: This study sought to evaluate the incidence, aetiology, clinical features and treatment modalities for laryngocoele formation after supracricoid partial laryngectomy. METHODS: The medical charts of 62 patients who had undergone supracricoid partial laryngectomy were reviewed. RESULTS: Three patients developed laryngocoele, giving an incidence of 4.8 per cent. Two of these patients presented with a cervical mass, dyspnoea and fever. The mobility of the arytenoids was disturbed on the involved side. The third patient was admitted complaining only of a compressible cervical mass. In all patients, diagnosis was made by computed tomography scan. The transcervical surgical approach was preferred for resection. CONCLUSION: Laryngocoele can occur as a late complication of supracricoid partial laryngectomy. Remnants of the laryngeal ventricle may be the cause of laryngocoele formation. The integrity of the laryngeal ventricle in the resected specimen should be routinely checked in order to avoid this rare complication. Clinicians should be aware that, following supracricoid partial laryngectomy, a cervical mass presenting with dyspnoea and disturbance of arytenoid mobility does not always indicate tumour recurrence.

The site of the hearing loss in Refsum's disease.

Refsum's disease is a disorder of lipid metabolism with pigmentary retinopathy, demyelinating neuropathy, ataxia, and hearing loss. Previous histological studies have located the site of hearing impairment in the inner ear, but it has never been confirmed audiologicaly in the literature. In this reported case of Refsum's disease, despite hearing loss and absence of response in ABR, robust otoacoustic emissions were measured. Together with these and other audiological findings, we conclude that our case might be the first reported case of Refsum's disease with auditory neuropathy. The site of the hearing abnormality in Refsum's disease may be 'post-outer hair cells' in some cases as in the current case. Because of their limited benefits and risk of noise-induced damage to outer hair cells, the use of hearing aids before otoacoustic emission measurements should be considered cautiously in Refsum's disease.

Malignant triton tumour of the parapharyngeal space.

We report the clinical course in a 25-year-old male patient of neurofibromatosis with malignant triton tumour (MTT). Triton tumour is a peripheral nerve sheath tumour with rhabdomyoblastic differentiation. This is relatively rare tumour of head and neck region and only 26 cases have been reported to date. The present case is the first reported MTT of parapharyngeal space, one of the most aggressive course among all head and neck MTTs, resulting in the death of the patient within three months following surgical resection. The aggressive nature of this tumour necessitates adjuvant therapeutic measures in addition to radical surgery in order to obtain better survival rates.

Temporal bone imaging findings in Waardenburg's syndrome.

OBJECTIVE: (a) To report computed tomography findings of eight new cases with Waardenburg's syndrome (WS) type I and review reported temporal bone radiographic and histopathological findings in WS with hearing loss; (b) To determine the frequency of inner ear pathologies that may contraindicate cochlear implantation. METHODS: A review of 1166 pediatric patients with sensorineural hearing loss revealed 12 cases (1%) with WS, whose family screenings disclosed additional 12 subjects with the same disorder. Among these 24 cases, eight had WS type I and were subjected to computed tomography scanning of temporal bone. Imaging findings of 28 cases reported previously in English literature were evaluated together with our eight patients. RESULTS: Malformation of the inner ear was found in none of the nine WS type I cases evaluated here, while the frequency of internal acoustic canal malformation was 11%. Regardless of the subtypes of the syndrome, 6 of 36 cases (17%) had radiological abnormality of the inner ear. Malformation and/or absence of the semicircular canals were the most common congenital abnormality of the inner ear. Hypoplasia of the cochlea was present in 3 of 36 cases (8%). CONCLUSIONS: Abnormality of bony labyrinth in WS with congenital deafness is not a frequent finding, particularly in WS type I. Therefore, the otologist and audiologist must keep in mind that most of these cases are suitable for cochlear implantation regarding inner ear anatomy.

Audiometric manifestations of Waardenburg's syndrome.

We studied 23 patients (from 11 families) who had Waardenburg's syndrome. Patients were evaluated by conventional audiometric methods and by distortion-product otoacoustic emissions to determine the penetrance and the degree and type of hearing loss. Twelve of the patients had the type I form of the syndrome and 11 had type II. Overall, we found hearing loss in 19 of the 23 patients (83%); hearing loss affected nine type I patients (75%) and 10 type II patients (91%). Five type I patients (42%) and eight type II patients (73%) had a hearing loss of > 100 dB. Bilateral symmetrical hearing loss was the most common type of loss, as it was seen in six of the type I patients (50%) and eight of the type II patients (73%). At lower frequencies, distortion-product otoacoustic emission amplitudes were found to be significantly above the noise floor in five of the 11 patients whose hearing thresholds were 60 dB HL or worse by click auditory brainstem response testing. These findings led us to conclude that it is necessary to use otoacoustic emissions in patients with Waardenburg's syndrome in order to provide optimum fitting of hearing aids, especially in children.

Influence of spontaneous otoacoustic emissions on distortion product otoacoustic emission amplitudes.

Although the influence of the levels and ratios of the primary stimulus on the amplitude of distortion product otoacoustic emissions (DPOAEs) has been studied intensely, the influence of the presence of spontaneous otoacoustic emissions (SOAEs) has been investigated less thoroughly. The present investigation analysed whether the unilateral presence of 58 SOAEs in 43 normal-hearing adults was related to larger DPOAEs in the ear with SOAEs compared to the contralateral ear having no SOAEs. The study was designed such that the only factor that could influence the amplitude of DPOAEs was the presence of SOAEs. Input/output (I/O) functions were collected in response to primary tones that were presented in 5-dB steps from 70 to 40 dB SPL at the frequency of the unilaterally recorded SOAE of each subject. The primary outcome was the demonstration of statistically significant (P < 0.05) larger DPOAEs in ears exhibiting SOAEs than in ears without measurable SOAEs, except at the highest stimulus level of 70 dB SPL. These results suggest that SOAEs play an additive role in the measurement of DPOAEs. The enhancing effect of the unilateral presence of SOAEs on DPOAEs was statistically significant for 65 dB SPL and lower levels of primary tones. The authors speculate that passive cochlear properties begin to participate in the generation of DPOAEs at primary-stimulus levels greater than 65 dB SPL.