Inner Ear Active Hearing Device in Non-Otosclerotic, Severe, Mixed Hearing Loss

OBJECTIVE: To verify the efficacy of a powerful active hearing device in a patient different from far-advanced otosclerosis, specifically when the stapes footplate is mobile. PATIENT: A patient with severe-to-profound mixed hearing loss, who was not benefiting from the use of a conventional hearing aid, was selected for an inner ear active implant. This was justified by a bone conductive threshold above 60 dB, which had discouraged any other rehabilitative solutions such as a bone conductive implant, or an active middle ear implant (AMEI). INTERVENTION: The hearing device was surgically applied using a combined transmastoid/transcanal approach. During surgery, a mobile stapes were found and was perforated for the insertion of a piston prosthesis, crimped on the new-incus of the device. MAIN OUTCOME MEASURE: The bone conduction threshold was assessed postoperatively to identify any possible surgery-related hearing deterioration. Pure tone audiometry was conducted in a sound field, and a speech reception threshold test was performed with the contralateral ear masked. The hearing outcome was assessed soon after the implant activation (6 weeks after surgery), and 6 months after surgery. RESULTS: Upon activation of the device, a PTA of 45 dB was obtained (at 0.5, 1, 2 and 4 kHz). At 6 months after surgery, the speech discrimination score reached 90% at 80 dB SPL. CONCLUSION: The application of the Codacs device has shown to be compatible with a mobile stapes footplate, as demonstrated in this report. The footplate perforation did not cause any further hearing deterioration, and has allowed to achieve a favorable auditory outcome

Transitions in auditory rehabilitation with bone conductive implant (bci)

Background: The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI). Materials and Methods: The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation. Results: Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects. Conclusions: Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary. Significance: The role of BCI for rehabilitation in middle ear pathology may be extremely important

Cone beam computed tomography after round window vibroplasty. do the radiological findings match the auditory outcome?

Conclusion: The CBCT imaging technique has proved to be reliable for assessing the appropriate positioning of the FMT in the round window niche. However, when considering specific imaging parameters, such as lack of bony contacts and appropriate inferior support, they would not seem essential for achieving a satisfactory functional outcome. Objectives: To evaluate the value of some imaging parameters derived from a Cone Beam Computed Tomography of the temporal bone for predicting a good functional outcome after Round Window Vibroplasty (RW-VP). Method: A CBCT imaging has been carried out at certain time after RW-VP surgery in a homogenous group of patients who presented with a mixed-type hearing loss after open tympanoplasty for a cholesteatoma. Three arbitrary radiological parameters have been considered for the purpose: the FMT/RW membrane contact; eventual FMT bony contacts; appropriatmess of inferior FMT support. The audiological assessment has taken into consideration the PTA4 (500-4000 Hertz), the PTA2 (125.250 Hertz), the WRS in quiet and in noise (SNR=+10). A comparison between the unaided and the RW-VP aided condition has been performed

Intralabyrinthine Vestibular Schwannoma Responsive to Intratympanic Gentamicin Treatment

Intralabyrinthine schwannoma (ILS) is a rare benign tumor that affects the ends of cochlear and vestibular nerves. In a majority of the cases, it occurs with unilateral progressive sensorineural hearing loss. Less frequent symptoms include tinnitus, imbalance, vertigo, or fullness. The advent of magnetic resonance imaging allows early diagnosis and enables an appropriate therapeutic protocol. This report describes a case of intravestibular schwannoma, with fluctuating hearing loss and intractable vertigo, treated with intratympanic gentamicin. The patient was a 28-year-old woman with intractable vertigo and fluctuating left-side hearing loss caused by left intravestibular schwannoma. Because surgery was temporarily rejected by the patient, a single dose of intratympanic gentamicin was administered. Following this, the patient showed a significant improvement in the symptoms. However, moderate to flat sensorineural hearing loss was also observed. Intratympanic gentamicin infiltration is a valid therapeutic option for patients with ILS, affected by intractable vertigo, when the patient refuses surgery

La Vegetazione arbustiva di un settore costiero dell'adriatico centrale italiano

The shrubby vegetation in a coastal sector of italian central adriatic sea. The results of the phytosociological analysis concerning the shrubby vegetation of a sector of the italian adriatic coast, of around 20 Kms, situated in the Rrgional natural park of Conero, are presented. It deals with mountainous coasts of two main lithomorphological typologies: marly-arenaceous and calcareous formations. On the first formation, in correspondence to marly rocks, the new Lonicero etruscae-Cornetum sanguineae association, belonging to the edapho-hygrophilous meso and submediterranean pre-apennine series of the elm (Symphyto bulbosi-Ulmeto minoris sigmetum), develops. On the contrary, on sand stones, constituted by superimposed levels and intercalated to marlstones, develops a xerophilous vegetation which stops at the maquis stadium, referred to the new Coronillo emeroidis-Rhamnetum alaterni association in the new loniceretosum etrusca e sub-association. On the calcareous cliffs of the warmest slopes, a maquis vegetation develops, referred to the same association but in the most thermophilous subassociation viburnetosum tini, colonising partially consolidated screes, which represents an element of the mesomediterranean italian-tyrrhenian and amphiadriatic calcicolous series of the holm-oak (Fraxino orni -Querceto ilicis sigmetum). Finally, on the steep slopes of the compact limestones of the warmest sectors of the South-East side of M. Conero (Valley ofthe Vellare), the new ampelodesmetosum mauritanici sub-association ofthe Coronillo emeroidis-Euphorbietum dendroidis association is described. It differentiates from the latter for the presence of more temperate elements and for the loss of some thermomediterranean species

Vegetazione e paesaggio vegetale dell'arcipelago di La Maddalena (Sardegna nord-orientale)

We present here a phytosociological study of the vegetation and plant landscape of the La Maddalena archipelago, which is situated in the Bocche di Bonifacio, between north-eastern Sardinia and southern Corsica. The lithological substratum of the archipelago is mainly made up of granite from plutonic intrusions, of the Superior Permian Carboniferous period. The area is part of the Mediterranean macrobioclimate, pluviseasonal-oceanic bioclimate, upper thermomediterranean thermotype, low dry ombrotype. On the basis of published data, the flora of the archipelago includes 986 taxa, of which 51 are endemic. The dominant life form is of therophytes, which represent around 50% in all. The plant communities identified through the phytosociological analyses are presented in groups according to their ecological and structural characteristics. Moreover, these communities are presented in an overall syntaxonomic scheme. Twenty new associations are described: Agrostio stoloniferae- Cyperetum badii, Alismo lanceolatae-Gratioletum officinalis, Allio commutati-Lavateretum arborae, Anthoxanto aristati-Agrostietum salmanticae, Apio crassipi-Isoetetum tigulianae, Arenario balearicae-Menthetum requienii, Baldellio ranunculoidis-Eleocharitetum palustris, Bellio bellidioidis- Arenarietum balearicae, Callitrico stagnalis-Glycerietum spicatae, Catapodio marini-Silenetum beguinotii, Exaculo pusilli-Lythretum portulae, Isoeto istrici-Montietum amporitanae, Junco acuti-Oenanthetum crocatae, Myrto communis-Salicetum atrocinereae, Polypogono subspathacei- Parapholidetum filiformis, Romuleo requienii-Bellidetum bellidiodis, Romuleo requienii-Colchicetum corsicae, Rubo ulmifolii-Myrtetum communis, Salicornio patulae-Crypsidetum aculeatae, Sileno nummicae-Malcomietum ramosissimae. The interpretation of the dynamic relationships between the plant communities has allowed seven vegetation series to be recognised: two climatophilous (Prasio majoris-Querco ilicis Σ phillyreetosum angustifoliae and Galio scabri-Querco suberis Σ quercetosum suberis), two edaphoxerophilous (Erico arboreae-Junipero turbinatae Σ and Oleo sylvestris-Junipero turbinatae Σ), one edaphohygrophilous (Oleo sylvestris-Junipero turbinatae Σ), one riparian (Populo albi Σ) and one marshy (Myrto communis-Salicio atrocinereae Σ). The landscape units (geosigmeta) have been identified through the integration of the vegetation series with the environmental factors. Since the territory has geological and bioclimatic characteristics that are fairly uniform, the resulting vegetal landscape can be included mainly in the Holm oak series geosigmetum (Prasio majoris-Querco ilicis Σ phyllireetosum angustifoliae), and to a minimal extent in the Cork oak series geosigmetum (Galio scabri-Querco suberis Σ quercetosum suberis). However, this uniformity is only apparent, since by passing to a greater level of detail, the analyses have allowed a high degree of phytocoenotic biodiversity to be revealed, linked to the micromorphological, microedaphic and microclimatic variations (microgeosigmeta). Among these very particular microenvironments there are, for example, those that can be found inside the tafonies, in the rock fissures, in the temporary ponds, in the fragile sand ecosystems and in the therophytic grasslands, where there are communities characterised by endemic species and with an ecology often defined by intermediate conditions of microecotonal character. The problems concerning the management of the plant landscape are stressed in the conclusions from the point of view of a management model that guarantees the conservation of the natural resources in a way that is compatible with the socio-economic development of the territory and its potential for exploitation

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report

Ménière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results

Su alcune formazioni a <i>Olea europaea</i> L. var. <i>sylvestris</i> Brot. della Sardegna

On the Olea europaea L. var. sylvestris Brot. woodlands in Sardinia.The phytosociological analysis of Olea europaea. var. sylvestris woodlands occurring in Sardinia are here presented. The following sintaxa are described for the first time: Cyclamino repandi-Oleetum sylvestris and Myrto communis-Oleetum sylvestris are referred to the Quercion ilicis alliance while Asparago acutifolii-Oleetum sylvestris and Asparago albi-Oleetum sylvestris are referred to the Oleo-Ceratonion alliance

Delayed Effect of Active Pressure Treatment on Endolymphatic Hydrops

OBJECTIVE: To identify eventual correlations between the effect of low-pressure treatment and endolymphatic hydrops in Ménière patients. MATERIAL AND METHODS: The study group consisted of subjects affected by definite Ménière disease (2015) and a severe degree of disability, who received a ventilation tube with or without a low-pressure treatment before undergoing a surgical procedure (vestibular neurectomy). After the placement of the ventilation tube, the subjects were either left alone with the tube or received 1 month of self-administered low-pressure therapy with a portable device. In all subjects, an electrocochleography (ECochG) was performed and specific questionnaires - Dizziness Handicap Inventory (DHI) and Functional Scale Level (FSL) - were completed before starting either arm of treatment, at the end of treatment, and then 3 and 6 months later. RESULTS: All selected subjects presented with an ECochG pattern that was indicative of endolymphatic hydrops before starting either treatment. At the end of pressure treatment, 80% showed symptomatic improvement while maintaining the hydropic ECochG pattern. At the 3-month control stage, the hydropic pattern resulted normalized (<0.5) in all the improved subjects. CONCLUSIONS: Although 1 month of low-pressure treatment provided a positive symptomatological outcome, normalization of the hydropic ECochG parameters occurred only at a later time. Therefore, it is possible to assume that endolymphatic hydrops could be concurrent with a non-symptomatic stage of Ménière disease, and that the anti-hydropic effect of the low-pressure treatment, if any, would present with a certain delay after its completion