Prognostic Factors and Clinical Outcome in the Treatment of External Auditory Canal Malignancies

External auditory canal (EAC) malignancies are rare and often difficult to treat. The objective of this study is to evaluate the outcome of tumors of the EAC treated with temporal bone resection (TBR). A retrospective chart review between 2000 and 2011 was performed on all patients who had TBR for EAC tumors. Outcomes were analyzed by means of survival analysis with respect to the Pittsburgh staging system, the status of frozen and final surgical margins, and adjuvant XRT. Of the patients studied, pathology included squamous cell carcinoma (SCC), basal cell carcinoma (BCC), adenoid cystic carcinoma (ACC), chondrosarcoma, chondroblastoma, and rhabdomyosarcoma. The series 5-year overall survival (OS) and disease-free survival (DFS) were analyzed. For SCC, DFS for Pittsburgh stages 1 and 2 combined was compared with combined Pittsburgh stages 3 and 4. The 5-year DFS for those with SCC and negative final surgical margins was compared with those with SCC and positive final margins .The outcome of treatment for EAC carcinoma, namely recurrence or survival, was correlated with positive final surgical margins and positive frozen sections margins. Recurrence was correlated with Pittsburgh stage for SCC of the EAC, which includes patients with less than 5-year follow-up. The effect of radiotherapy on the treatment outcome was analyzed for patients with advanced disease (stage III and IV or positive margins)[KEG1]

Conservative management of vestibular schwannoma: Predictors of growth and hearing

To describe the clinical outcomes of patients undergoing serial observation for vestibular schwannoma (VS) and identify factors that may predict tumor growth or hearing loss. Retrospective review. A retrospective review was conducted of patients seen at a tertiary care medical center between 2002 and 2013 with an International Classification of Diseases-9 diagnosis code of 225.1. Patients electing observation as initial management, with at least two documented imaging results, were included. Exclusion criteria comprised bilateral VS, diagnosis of neurofibromatosis type 2, and neoplasms other than VS. Decline in serviceable hearing, tumor growth, and changes in management strategy were recorded. Survival analysis to assess median time to outcomes and multiple logistic regression analyses were performed. A total of 94 patients met inclusion criteria. While undergoing observation, 22.3% of patients underwent a change in management strategy to microsurgical excision or stereotactic radiotherapy. For patients with initial serviceable hearing, 24.3% observed a decline to a nonserviceable level. No significant clinical factors were identified to predict changes in hearing. Survival analysis revealed that an estimated 69.1% of patients electing observation as initial management continued to do so at 5 years. Imbalance or disequilibrium at presentation was found to be associated with an increased adjusted odds ratio (OR) (OR 2.96; 95% confidence interval, 1.03-8.50; P = 0.04) for tumor growth. Serial observation of VS is a viable treatment strategy for selected patients, with two-thirds of patients electing to continue this management option after 5 years. Disequilibrium as a presenting symptom may be associated with subsequent tumor growth. 4

Efficacy of L-N-Acetyl Cysteine in the Prevention of Gentamicin Vestibulotoxicity in Rats

Objectives: Determine the effect of L-N-acetylcysteine (LNAC) on gentamicin (GM) initiated vestibulotoxicity. Methods: Wistar rats were divided into 4 groups: Group A (n = 7) had intratympanic (IT) GM (20 mg in 40 µL); group B (n = 6) had IT GM and intraperitoneal (IP) LNAC (350 mg/kg) at 24 hours and 1 hour before GM administration; group C (n = 6) had IT GM and IT LNAC (5 mg in 40 µL); and group D (n = 6) had only IT saline (40 µL). Rats were tested by ABR and cervical vestibular evoked myogenic potentials (VEMP) pretreatment, and at 1 week and 1 month posttreatment. Morphological analysis of the inner ears was performed at 1 month. Main outcome measures were the mean change in VEMP P1 latency at sound stimulation from 80 to 110 dB SPL, and hair cell count in the saccule. Results: Rats treated with IT LNAC exhibited the least change in mean VEMP latencies, although the intergroup differences were not statistically significant except for 80 dB stimulation at 1 week posttreatment. IP and IT LNAC resulted in preservation of the VEMP response in all rats, whereas 42% of rats not receiving LNAC had absent responses. Morphological analysis of the saccule revealed lower mean hair cell counts in rats not receiving LNAC. Conclusions: Systemic and IT administration of LNAC of rats treated with GM resulted in minimal variations in VEMP latencies and greater preservation of vestibular hair cells. The protective effect of LNAC in GM-initiated vestibulotoxicity is promising and warrants further research