Is endoscopic neck surgery the future direction in neck treatment?

The aim of the paper is to present the minimally invasive endoscopic video-assisted surgery for the neck on the basis of current literature. The different techniques include pure endoscopic procedures, open video-assisted approach and mini-access. The preliminary material constitute of three patients who undergone endoskopic sentinel lymph node biopsy and one with colli lipoma. The authors describe the operating technique, instrumentation, indications, contraindications and advantages of this method. The endoscopic surgery offered a valuable approach for chosen lesions of the neck (solitary parathyroid adenoma, thyroid nodules less then 35 mm, submandibular gland sialolithiasis or tumors). The advantages include lower pain intensity within first hours following surgery, lower analgesia request rate, shorter scar length, higher early cosmetic satisfaction.     

Cranionasal fistula in pediatric population: is endonasal endoscopic approach effective?

PURPOSE: To study the efficacy and safety of endoscopic endonasal repair of CSF leak in pediatric population. STUDY DESIGN: A prospective study in a tertiary care center. PATIENTS AND METHODS: All the cases with a age of less than 14 years with a diagnosis of CSF rhinorrhoea were included in the study. These were subjected to detailed examination, radiological evaluation using computed tomographic cisternography and MRI if required. These cases were then subjected to endoscopic endonasal repair of the fistula using the technique described in the text. RESULTS: There were 25 cases in the study with a male predominance and trauma responsible for 22 of these and spontaneous leak in 3 of the cases. The majority of these leaks were from cribriform plate area. After the repair, there was no leak in 24 of these cases and 1 case with recurrence did well after second surgery. DISCUSSION: The prior work on the entity of CSF rhinorrhoea in children consists of a few case reports only and ours is the largest series on endoscopic repair of the CSF leak in children showing it to be safe and effective with a success rate of 96%. CONCLUSION: Endoscopic closure of the cranio nasal fistula is associated with a high degree of success (96% in our series) and has significantly less morbidity and mortality when compared with the craniotomy approach. Hence it can be concluded that it is the standard of care for the pediatric population as well.     

Is there a role for the otolaryngologist in PFAPA syndrome? A systematic review

AIMS: To define the role of medical or surgical treatment in patients with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA syndrome). METHODS: A Medline search was performed using the terms PFAPA, periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis, treatment. A systematic review of the English literature was performed. Papers on pyrexia of unknown origin in the pediatric population were excluded; this was because the clinical entities included in the differential diagnosis of pyrexia of unknown origin share many clinical characteristics with PFAPA, and may be ill defined. RESULTS: Twenty-seven papers have been published since 1989, of which 20 were in English language. There were five single case reports and two papers involving two patients each. There were 6 retrospective reviews of case notes, involving 5-94 patients over a 3-10 year review period. Given that current evidence on the effectiveness of tonsillectomy in PFAPA is extremely weak (level of evidence V), tonsillectomy should not be performed. CONCLUSIONS: PFAPA usually resolves without any long-term adverse effect, and as such, there is no role for tonsillectomy in these patients.     

Is endoscopic inspection necessary to detect residual disease in acoustic neuroma surgery?

European Archives of Oto-Rhino-Laryngology - To analyze how and when the endoscope is used in vestibular schwannoma surgery and identify the benefits of using endoscopy in this type of surgery. It...     

Mitomycin C and endoscopic sinus surgery: where are we?

PURPOSE OF REVIEW: Mitomycin C has been used successfully in various ophthalmologic and, more recently, otolaryngologic procedures. Its modulation of fibroblast activity allows for decreased scarring and fibrosis. Several recent trials have examined the efficacy of mitomycin C in reducing synechia and stenosis following endoscopic sinus surgery. RECENT FINDINGS: Basic science studies using fibroblast cell lines have demonstrated a dose-dependent suppression of activity with the use of mitomycin C. This is further supported by animal studies that have shown lower rates of maxillary ostial restenosis following application of mitomycin C. No human trial, however, has demonstrated a statistically significant impact of mitomycin C on the incidence of postoperative synechia or stenosis following sinus surgery. The limitations of the literature are discussed. SUMMARY: The antiproliferative properties of mitomycin C may theoretically decrease the incidence of synechia and stenosis following endoscopic sinus surgery. Although this is supported by basic science studies and its successful use in other fields, the clinical evidence to date has not shown the application of mitomycin C to be effective in preventing stenosis after endoscopic sinus surgery. Future prospective studies are required before definitive conclusions can be made.     

Is there a higher prevalence of human papillomavirus infection in Chinese laryngeal cancer patients? A systematic review and meta-analysis

Accumulating evidence suggests that persistent human papillomavirus (HPV) infection is closely related to the risk of certain types of head and neck squamous cell carcinoma types, including laryngeal cancer (LC). Some reports indicated a higher HPV prevalence in Chinese LC patients, which remains to be established due to small study sample sizes. The aim of this study was to estimate the HPV infection rate in Chinese LC patients and assess the LC risk conferred by high-risk subtype HPV infection by meta-analysis. We searched MEDLINE, the Embase Database, Chinese National Knowledge Infrastructure, Wanfang Database, and VIP Database for studies published in either English or Chinese up to October 2013, and systematically reviewed 28 original research articles that met the inclusion criteria. Both the HPV infection rate in the LC group (all 28 studies) and the LC risk from high-risk HPV infection (a subgroup of 12 case–control studies) were analyzed by R 3.0 software. Overall HPV, HPV-16/18, and HPV-6/11 infection rates were 32 % (95 % CI 22–44 %), 30 % (95 % CI 24–37 %), and 12 % (95 % CI 9–17 %), respectively. There was a strong association between high-risk HPV-16/18 infection and LC (P < 0.01; OR = 8.07, 95 % CI 5.67–11.48). Our research indicates that there is a higher HPV prevalence in Chinese LC patients compared to LC patients outside of China and that HPV infection significantly increases LC risk.     

Is human papillomavirus and p16 expression associated with survival outcomes in nasopharyngeal cancer?: A systematic review and meta-analysis

Introduction

Human papillomavirus (HPV) is a known prognostic indicator in oropharyngeal cancer. Not much is known about the prognostic role of HPV in Nasopharyngeal cancer (NPC). Here, we performed a systematic review and meta-analysis of the literature to investigate if HPV status was a prognostic factor for NPC.

Corticosteroid therapy during endoscopic sinus surgery in children: is there a need for a second look?

OBJECTIVE: To determine whether intravenous administration of dexamethasone during endoscopic sinus surgery in children will decrease scarring and edema during a second-look procedure. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: University medical center. PATIENTS: Forty-eight children undergoing endoscopic sinus surgery for chronic sinusitis. INTERVENTION: Twenty-four children received intravenous dexamethasone and 24 received placebo intraoperatively before the start of the procedure. MAIN OUTCOME MEASURES: The status of the ethmoid cavity, the status of the mucosa in the maxillary sinuses, and the patency of the maxillary sinus ostium during the second-look procedure performed 2 to 3 weeks after the primary procedure. RESULTS: Children who received intravenous dexamethasone had significantly less maxillary sinus mucosal edema, less ethmoid scarring, and a lower incidence of closure of the maxillary ostium (P = .02). During the second-look procedure, 62% of children in the noncorticosteroid group had abnormal findings vs 29% in the corticosteroid group. Patients with asthma, lower computed tomography scores, and no exposure to smoking had a significantly lower incidence of scarring with use of corticosteroids. Children older than 6 years benefited from intravenous corticosteroid therapy vs children 6 years and younger. CONCLUSIONS: Treatment with intravenous dexamethasone during endoscopic sinus surgery was safe and was helpful in reducing scarring and swelling noted during the second-look procedure. Use of corticosteroids was particularly helpful in children with asthma, lower computed tomography scores, and no exposure to smoking and in children older than 6 years.     

Risk stratification in endoscopic airway surgery: is inpatient observation necessary?

PurposeTo compare post-operative complication rates between inpatient and outpatient endoscopic airway surgery in patients with laryngotracheal stenosis. Secondary objectives included characterization of a cohort of patients with this disease.MethodsRetrospective review of patients with laryngotracheal stenosis in a tertiary care laryngology practice over a 5-year period.ResultsNinety-one patients underwent 223 endoscopic airway surgeries. Of 114 outpatient interventions, 1 patient (0.8%) sought emergent medical care following discharge for respiratory distress. Of 109 procedures resulting in admission, no patients required transfer to a higher level of care, endotracheal intubation or placement of a surgical airway. There was no statistically significant difference in complication rates between patients treated as outpatients or inpatients (p = 0.33, chi square). There were no cardiopulmonary events. There were no pneumothoraces despite frequent use of jet ventilation. The most common etiologic category was idiopathic (58%), followed by granulomatosis with polyangiitis (16%) and history of tracheotomy (12%). Most patients with idiopathic disease were female (p < 0.001, Fisher's exact test).ConclusionPatients undergoing endoscopic surgery for airway stenosis rarely have post-operative complications, and outpatient surgery appears to be a safe alternative to post-operative admission and observation.     

Is antenatal corticosteroids exposure associated with hearing loss in preterm infants? A systematic review and meta-analysis

PurposeTo perform a systematic review and meta-analysis of clinical studies exploring the association between antenatal corticosteroids exposure and hearing loss in preterm infants.MethodPubMed, Cochrane library, and EMBASE databases from the inception dates to December 22, 2020 without language restriction. Key search terms included hearing loss, cortisol steroid, and antenatal. Included studies were case control or cohort studies examining preterm (<37 weeks' gestation) or very low-birth-weight (<1500 g) infants and reporting primary data that could be used to explore the association between antenatal corticosteroids exposure and the development of hearing outcomes. This meta-analysis follows the reporting guidelines (MOOSE) for observational studies. Data were independently extracted by 2 researchers. A fixed effects model was used to calculate odds ratios (OR) and 95 % CI. Subgroup analysis was conducted according to different types of antenatal steroids exposure (dexamethasone vs betamethasone) and subgroup analyses based on betamethasone and betamethasone combined with magnesium sulfate (betamethasone vs betamethasone combined with magnesium sulfate).ResultsA total of 110 potentially relevant studies were found, of which 7 met the inclusion criteria (A total of 8130 preterm infants were included. 5337 preterm infants were exposed to antenatal corticosteroids, and 2793 preterm infants were not exposed to antenatal corticosteroids.). Meta-analysis showed that antenatal corticosteroids exposure was significantly associated with hearing loss in preterm infants. (OR, 0.64; 95 % CI, 0.48–0.87; P = 0.004) In addition, significant differences were found between antenatal betamethasone exposure and antenatal dexamethasone exposure. (OR, 0.27; 95 % CI, 0.10–0.77; P = 0.01) Betamethasone and betamethasone combined with magnesium sulfate showed that the difference was no statistically significant. (OR, 1.34; 95 % CI, 0.74–2.43; P = 0.33).ConclusionThe results of this study confirm that among preterm infants, exposure to antenatal corticosteroids exposure is associated with a lower risk of developing hearing impairment.Systematic review registration numberPROSPERO 2021 CRD42021255665.     

Current state of evidence for endolymphatic sac surgery in Menière’s disease: a systematic review

Abstract

Background: Endolymphatic sac surgery is an invasive procedure recommended to patients with Menière’s disease.

Aims/Objectives: To provide an overview and quality assessment of the existing evidence and to provide an updated assessment of the utility of endolymphatic sac surgery in Menière’s disease.

Material and Methods: We performed a systematic literature search for systematic reviews and randomized controlled trials (RCTs). The AMSTAR tool was used to assess the quality of systematic reviews and the Cochrane risk of bias tool for RCTs. The overall certainty of effects for the individual outcomes was evaluated using the GRADE approach.

Results: One systematic review of high quality matched the inclusion criteria, and included three RCTs. An updated literature search from the last search date of the included review provided no further relevant RCTs. The identified RCTs individually reported a positive effect of both the placebo and active treatment groups following surgery, strongly indicative of a placebo effect. The overall certainty of the effect was very low.

Conclusions and significance: There is still a lack of high-quality research suggesting that endolymphatic sac surgery provides a significant amount of symptomatic relief for Menière’s patients.     

Is glutathione-S-transferase-pi expression a reliable predictor of chemoradiation response in cancer of the head and neck?

PURPOSE: Concurrent radiation and chemotherapy is being evaluated as an alternative treatment to surgery for patients with advanced squamous cell carcinoma of the head and neck, because organ preservation maybe possible without compromising survival. However, the response to concurrent chemoradiation treatment varies from patient to patient, and there is currently no available molecular predictor of response for this particular treatment modality. There is some evidence to indicate that glutathione S-transferase-pi (GST-pi), which is one of the drug detoxifying enzymes, may decrease the effectiveness of platinum-based chemotherapy in the treatment of a variety of tumor types. This study was performed to investigate whether GST-pi expression was correlated with response to concurrent chemotherapy and radiotherapy in patients with advanced squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: Diagnostic biopsy specimens of 36 patients who underwent concurrent chemoradiotherapy for the treatment of advanced squamous cell carcinoma of the head and neck were examined for GST-pi expression by using immunohistochemistry with polyclonal antihuman GST-pi antibodies. GST-pi expression scores were compared among responders and nonresponders. RESULTS: Although the staining rate with antiGST-pi was slightly lower in the responder group in comparison with the nonresponders (82% vs 100%), the difference was not statistically significant. CONCLUSION: GST-pi expression is unlikely to be a valuable predictor of response to concurrent chemotherapy and radiation treatment in patients with advanced squamous cell carcinoma of the head and neck.