Aetiologic diagnosis of hearing loss in children identified through newborn hearing screening testing

With the implementation of universal newborn hearing screening (UNHS) programmes and early diagnosis and treatment of hearing problems, the need has clearly emerged to implement and carry out a systematic and coordinated protocol for the aetiological diagnosis of permanent hearing impairment (PHI). Within the framework of the Italian Ministry of Health project CCM 2013 “Preventing Communication Disorders: a Regional Program for early Identification, Intervention and Care of Hearing Impaired Children”, it has been decided to consider the problems relative to aetiological diagnosis of child PHI within UNHS programmes. The specific objective was to apply a shared diagnostic protocol that can identify the cause in at least 70% of cases of PHI. For this part of the project, four main recommendations were identified that can be useful for an efficient aetiological diagnosis in children affected by PHI and that can offer valid suggestions to optimise resources and produce positive changes for third-level audiologic centres

Cavernous Sinus Hemangioma: Diagnosis and Treatment

Cavernous hemangiomas of the maxillary sinus are rare. Here, we describe the management of a rare case of this vascular tumor of the maxillary sinus. We propose that an effective treatment can be achieved by performing endoscopic sinus surgery, preceded by a pre-operative embolization

A New Surgical Approach for Direct Acoustic Cochlear Implant: A Temporal Bone Study

The direct acoustic cochlear implant (DACI) is among the latest developments in the field of implantable acoustic prostheses. The surgical procedure requires a mastoidectomy and a posterior-inferior tympanotomy, with access to the facial recess at the level of the oval window, in a complex and lengthy surgical approach. Here, we report a new and considerably shorter surgical approach

Idiopathic sensorineural hearing loss in the only hearing ear

A retrospective chart review was used for 31 patients with sudden, progressive or fluctuating sensorineural hearing loss (SHL) in the only hearing ear who had been consecutively evaluated at the ENT, Audiology and Phoniatrics Unit of the University of Pisa. The group of patients was evaluated with a complete history review, clinical evaluation, imaging exam (MRI, CT), audiologic tests (tone and speech audiometry, tympanometry, study of stapedial reflexes, ABR and otoacoustic emission) evaluation. In order to exclude genetic causes, patients were screened for CX 26 and CX30 mutations and for mitochondrial DNA mutation A1555G. Patients with sudden or rapidly progressive SHL in the only hearing ear were treated with osmotic diuretics and corticosteroids. In patients who did not respond to intravenous therapy we performed intratympanic injections of corticosteroid. Hearing aids were fitted when indicated and patients who developed severe to profound SHL were scheduled for cochlear implant surgery. The aim of this study is to report and discuss the epidemiology, aetiopathogenesis, therapy and clinical characteristic of patients affected by SHL in the only hearing hear and to discuss the issues related to the cochlear implant procedure in some of these patients, with regard to indications, choice of the ear to implant and results

Cochlear implant in incomplete partition type I

In this investigation, we report on 4 patients affected by incomplete partition type I submitted to cochlear implant at our institutions. Preoperative, surgical, mapping and follow-up issues as well as results in cases with this complex malformation are described. The cases reported in the present study confirm that cochlear implantation in patients with incomplete partition type I may be challenging for cochlear implant teams. The results are variable, but in many cases satisfactory, and are mainly related to the surgical placement of the electrode and residual neural nerve fibres. Moreover, in some cases the association of cochlear nerve abnormalities and other disabilities may significantly affect results

Battery Lifespan of an Implantable Middle Ear Device

Background: The Carina system (Cochlear Ltd., Sydney, Australia) is a totally implantable device providing acoustic amplification in adult patients with moderate-to-severe sensorineural or mixed hearing loss. One of the main concerns about such a totally implantable device has been represented by the subcutaneous battery lifespan. The aim of this article is to report the analysis of battery performances in a series of Carina-implanted patients after a long follow up. Methods: In this retrospective study, the technical data of a series of patients implanted with the Carina middle ear implant in our clinic have been analysed, extracting the data from the log of telemetric measures. Results: The mean lifespan cutback was 0.43 h/years (from 0 to 0.71 h/year), with a strong negative significant correlation between the follow-up period and the percentage of battery residual lifespan. Conclusion: The lifespan of the Carina’s battery seems consistent with the manufacturer statement of a pluri-decennial lifespan, avoiding the need of an early surgical substitution and providing a full day of use of the system even after up to 12 years from the implantation

Early care in children with permanent hearing impairment

The implementation of regional protocols for newborn hearing screening and early audiologic diagnosis represent the first step of the entire diagnostic, rehabilitative and prosthetic programme for children with permanent hearing impairment. The maximum benefit of early diagnosis can indeed be obtained only by prompt rehabilitation aimed at fostering the child’s communicative, linguistic and cognitive development. Within the framework of the CMM 2013 project of the Ministry of Health entitled “Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children”, the problems concerning the promotion of the global development of children with PHI throughan early rehabilitation project based on shared knowledge and scientific evidence. In this project, our specific aim was to define the features and modes of access to a precise and specialised rehabilitation project for the small hearing-impaired child within three months from audiologic diagnosis. Three main recommendations relative to assessment and rehabilitation aspects of early care emerged from the study

Bone Anchored Hearing Aids for the Treatment of Asymmetric Hearing Loss

OBJECTIVES: Asymmetric hearing loss is generally defined as a moderate-to-profound hearing loss in the poorer ear and a mild-to-moderate hearing loss in the better ear. Application of a bone conduction hearing aid is one of the possible treatments for the poorer ear in asymmetric hearing loss. However, the device essentially stimulates the contralateral better ear, precluding true binaural hearing. The aim of this paper is to evaluate the application and utility of bone-anchored hearing aids in the treatment of asymmetric hearing loss. MATERIALS and METHODS: We retrospectively evaluated 215 implanted subjects in our clinic and extracted a series of 27 patients affected by asymmetric hearing loss and treated with bone-anchored hearing aids. All 27 subjects had a mixed hearing loss after middle ear surgery. The preoperative and postoperative audiological data of these patients were collected and analyzed. RESULTS: The audiological tests showed an improvement in the performance of hearing perception of sound and speech in quiet and noise.Moreover, the subjects have positively answered the questionnaires administered to evaluate subjective benefits. All subscales of the abbreviated profile of hearing aid benefit and speech, spatial, and qualities of hearing scale showed a significant improvement with the device. CONCLUSION: Bone-anchored hearing aids are a suitable treatment for asymmetric hearing loss. When other devices cannot be utilized or are not indicated, the bone conduction devices may allow good audiological results

Evaluation of the Incidence and Potential Mechanisms of Tracheal Complications in Patients With COVID-19

Full-thickness tracheal lesions and tracheoesophageal fistulas are severe complications of invasive mechanical ventilation. The incidence of tracheal complications in ventilated patients with coronavirus disease 2019 (COVID-19) is unknown

Nanomaterials-based strategies for piezoelectric cochlear implants

Nanomaterials-based strategies for piezoelectric cochlear implant