Endoscopic carbon dioxide laser diverticulostomy versus endoscopic staple-assisted diverticulostomy to treat Zenker's diverticulum

BACKGROUND

The 2 most frequently used endoscopic methods to treat Zenker's diverticulum are staple-assisted and CO(2) laser esophagodiverticulostomy.

METHODS

The study centered around a retrospective evaluation of 107 patients with Zenker's diverticulum who were treated endoscopically by CO(2) laser (n = 72) or staple-assisted diverticulostomy (n = 35).

RESULTS

Patients in the staple-assisted group had a shorter duration of postoperative hospitalization, attributed to earlier oral intake, than patients in the CO(2) laser group. There were no serious postoperative complications in either group. Postoperative fever and emphysema in the neck or mediastinum occurred more frequently in the CO(2) laser group, but this did not lead to any complications. Most patients reported partial or complete relief of their symptoms and there was no significant difference in the number of reoperations between the 2 treatment groups.

CONCLUSIONS

Zenker's diverticulum was treated safely and effectively by the 2 endoscopic techniques, but the staple-assisted method seemed to be the most favorable.

Profound Mixed Hearing Loss: Bone-Anchored Hearing Aid System or Cochlear Implant?

Objectives:

We evaluated 5 patients who were changed over from a Baha Cordelle to a cochlear implant (CI). Moreover, the level of phoneme score was determined at which a Baha Cordelle user was better helped with a CI.

Methods:

We offer descriptive case reports and a retrospective evaluation of speech recognition in Baha Cordelle users and CI users.

Results:

In the CI users with noncompromised cochleas, the 10th percentile of the aided phoneme score in quiet at 65 dB sound pressure level (PS65) was 42%. We consider this PS65 as the cutoff level for switching from a Baha Cordelle to a CI. When patients with mixed hearing loss were using the Baha Cordelle, the PS65 of 42% was obtained at a mean sensorineural hearing loss component of about 70 dB hearing level (HL). This 70–dB HL component was used to consider Baha Cordelle users for cochlear implantation. The results of the 5 patients support these transition criteria.

Conclusions:

A CI is a valuable option in patients with mixed hearing loss when the sensorineural hearing loss component exceeds 70 dB HL or when the PS65 with a Baha Cordelle is less than about 40%. In such patients, the implantation procedure should be individualized on the basis of the clinical findings in the middle ear and mastoid cavity.

[Subglottal stenosis as the first symptom of Wegener's granulomatosis]

A 51-year-old woman presented with a sore throat, hoarseness and difficulty in swallowing. On physical examination she was found to have stridor. Laryngoscopy revealed a subglottal stenosis. Infection was thought to be the cause but this was not confirmed by sputum or laryngeal cultures. Because of the clinical course and the presence of antineutrophil cytoplasmic proteinase-3 antibodies, Wegener's granulomatosis was diagnosed. Immunosuppressive therapy led to improvement. At 4-year follow-up the patient had scleritis but no ENT problems. Wegener's granulomatosis should always be considered in a patient with a subglottal stenosis; it can be the first symptom of this disease.