The history and evolution of vestibular schwannoma surgery: a comprehensive review

Vestibular schwannoma (VS) surgery has had a compelling historical evolution. This article aimed to provide a detailed narrative historical review of the chronological progression and conception of surgical VS management. Acknowledgment of the development, revision, and transformation of VS surgery over the decades facilitate a comprehensive understanding of current clinical practice and the scope for further procedural evolution. Following the commencement of VS surgery in the late 18th century, procedures and management have been perpetually revised and augmented, culminating in drastically improved surgical outcomes. This article draws upon the primary source material to provide augmented acuity into the principal pioneers and landmark cases that define the surgery’s trajectory. Moreover, the article includes original interpretive artwork by the first author along with a detailed timeline to facilitate enhanced perspicacity of this unique and salient constituent in surgical history

Does recreational drug use influence survival and morbidity associated with laryngeal cancer

Background: The use of opioids is considered a risk factor for laryngeal cancer. A retrospective study was performed to explore the relationship between recreational drug exposure and laryngeal cancer.Methods: Patients diagnosed between the 1st of January 2013 and the 31st of December 2017 using ICD-10 CD-32 coding were identified from the Head and Neck Multidisciplinary Team database. We divided the study population into two cohorts (RD and non-RD) and compared the demographics, morbidity, and outcomes of these two populations. In addition, we performed case-matched analysis to control for potential confounding factors including gender, alcohol use and cigarette smoking.Findings: 329 patients in Glasgow, Scotland were included with a mean age of 64.96 ± 10.94 and a follow-up of 24 ± 13.91 months. Of these, 39 reported recreational drug use (RD). RD was associated with younger age (53.0 vs. 66.6, p<0.001) at diagnosis with laryngeal cancer. A greater proportion of tumours occurred in the supraglottic subsite (p=0.041). Furthermore, these patients were more likely to undergo tracheostomy (RR=2.50, 95% CI: 1.41-4.44, p=0.008) and laryngectomy (RR=2.25, 95% CI: 1.57-3.21, p<0.001). Recreational drug users were more likely to require enteral feeding support (RR= 1.44, 95% CI: 1.13-1.84, p=0.02) during oncological treatment. No survival differences were noted at 1, 2, or 3-years (plog-rank=0.83). Case matched analysis correcting for smoking, alcohol and gender confirmed that recreational drug users were younger at diagnosis with a predilection for the supraglottic subsite.Conclusion: Recreational drug use is associated with an increased burden of disease and morbidity in laryngeal cancer. We suggest that clinicians view recreational drug exposure as a red flag in those with suspected laryngeal cancer regardless of patient age

Six-canal video-Head-Impulse-Test in patients with labyrinthine and retro-labyrinthine pathology: detecting vestibulo-ocular reflex deficits

Background: Abnormal gains in six-canal video-Head-Impulse-Test (vHIT) are attributed to semicircular canal deficits. However, as vHIT responses are linked to vestibulo-ocular reflex (VOR), we hypothesized that abnormal gains can be due to VOR pathway deficits. Methods: We compared vHIT gains and correlations between them (Mann-Kendall trend test) in 20 patients with superior semi-circular canal dehiscence (SSCD; labyrinthine cause) and 20 side and gender-matched patients with vestibular schwannomas (VS, retrolabyrinthine cause). Results: VS but not SSCD was significantly associated with abnormal lateral (OR: 9.00 (95% CI:1.638;49.44), p:0.011) and posterior canal status (OR: 9.00 (95% CI: 2.151;37.659), p:0.003). In VS we found a statistically significant degree of dependence between all ipsilesional canal vHIT gains; such dependence was not observed in SSCD. Conclusions: VOR gains differ in patients with labyrinthine and retrolabyrinthine disease, suggesting that abnormal gains can indicate not only deficits in the semi-circular canals but also elsewhere along the VOR pathway

A narrative review of flutamide in juvenile nasopharyngeal angiofibroma

The detection of androgen receptors within Juvenile Nasopharyngeal Angiofibroma (JNA) has prompted investigation of the role of Flutamide. The aim of this review is to evaluate Flutamide as a possible neo-adjuvant treatment for JNA. Literature searches were conducted using MEDLINE, EMBASE and Web of Science. The Joanna Briggs Institute (JBI) checklist was used to assess risk of bias. The Oxford Centre of Evidence-Based Medicine (OCEBM) Levels of Evidence was used to stratify the evidence level. Literature searches were conducted using MEDLINE, EMBASE and Web of Science. Flutamide as neo-adjuvant treatment potentially causes a reduction in JNA tumor volume by ≥ 25%. Based on the current limited evidence, Flutamide has a limited role in JNA management and further research is required. Its utilization should only follow discussion with the patient, their families, and within the multidisciplinary team