Bottom line: The mean improvement recorded in the steroid group at T1 shows a significant therapeutic benefit for first-line intratympanic steroid therapy.
Explore this issue:March 2013
Citation: Filipo R, Attanasio G, Russo FY, Viccaro M, Mancini P, Covelli E. Intratympanic steroid therapy in moderate sudden hearing loss: a randomized, triple-blind, placebo-controlled trial. Laryngoscope. 2013;123:774-778.
—Reviewed by Amy Eckner
TORS Total Laryngectomy Effective for Salvage Surgery
Is transoral robotic surgery a feasible procedure for total laryngectomies to treat advanced larynx cancer?
Background: Procedures for total laryngectomies have remained largely unchanged for more than 100 years, and many physicians now use the procedure primarily as a salvage surgery following chemotherapy and radiology. However, because salvage laryngectomies are often performed on compromised tissues, they are complex and require more resources due to an increase in pharyngocutaneous fistulae. The use of transoral robotic surgery (TORS) has allowed for more complex transoral procedures. Unlike previous studies, this series uses TORS in a salvage setting.
Study design: Multinational, prospective consecutive case series.
Setting: Multinational institutions.
Synopsis: Seven patients underwent the procedure, six of whom had previously received chemotherapy and/or radiation therapy and needed the procedure to manage recurrence or treatment sequelae, and one of whom required a total laryngectomy to manage complications following long-term intubation and multiple surgical failures. Each patient presented with a unique set of circumstances and comorbidities. Two additional patients were unable to participate because proper robotic access to the larynx was limited. This minimally invasive TORS procedure was developed in cadaver models using the daVinci Surgical System (Intuitive Surgical Inc., Sunnyvale, Calif.) and evaluated on an institutional board-approved protocol. Detailed review of surgical technique in the study includes approach to the airway, positioning of equipment and assistant, resection, removal of the larynx and closure. Fistulaes occurred in two patients due to low tracheotomies and distal access issues.
Exact indications and limitations of this procedure are not yet defined, and adequate visualization and high surgical skill are required. Although this series is very limited, it does show TORS feasibility in salvage surgery with standard oncologic results. A larger series is needed to confirm a decreased need for routine flap use. The authors believe this procedure is best used for salvage when there is no need for a concomitant neck dissection.
Bottom line: TORS total laryngectomies are feasible and reproducible across facilities, but the procedure is in its infancy, and exact indications and patient selection remain unclear.