On the role of depletive tests. a review analysis

An overview of the diagnostic role of depletion tests for staging Meniere’s disease, especially in the first phase of the disease, is reported. Pros and cons, as well reliability and specificity of this diagnostic procedure is thoroughly analysed

Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments

Early assessment of vestibular function after unilateral cochlear implant surgery

Introduction : Cochlear implantation (CI) has been reported to negatively effect on the vestibular function. The study of the vestibular function has variably been conducted by different types of diagnostic tools. The combined use of modern, rapidly performable diagnostic tools could reveal useful for standardizing the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video Head Impulse Test (vHIT), the cervical Vestibular Evoked Myogenic Potentials (cVEMPS) and the short-form of Dizziness Handicap Inventory (DHI) questionnaire were investigated pre-operatively and post-operatively (implant on and off) in both the implanted and the contralateral, non-implanted ear. All surgeries were performed with a round window approach (RWA), except for three otosclerosis cases were the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed a pre-operative vestibular involvement in nearly 50% of the cases, whilst the three canals were contemporarily affected in only 14% of them. In all the hypo-functional subjects, cVEMPs were absent. A low VOR gain in all the investigated SSCC was found in 4 subjects (14%). In those subjects, (21.7%) in whom cVEMPs were pre-operatively present and normal in the operated side, absence of response was post-operatives recorded. Discussion/Conclusion: The vestibular protocol applied for the study showed to be appropriate for distinguishing between the CI operated and the non-operated ear. In this regard, cVEMPs showed to be more sensitive than vHIT for revealing a vestibular sufferance after CI, although without statistical significance. Finally, the use of the RWA surgery was apparently not avoiding signs of vestibular impairment to occur

Individualised headband simulation test for predicting outcome after percutaneous bone conductive implantation.

Trans-cutaneous bone conduction (BC) stimulators, when coupled to the HB (BC-HB), are generally used to predict the results that could be achieved after bone conductive implant (BCI) surgery, and their performance is generally considered inferior to that provided by the definitive percutaneous system. The aim of the present study was to compare the performances between BC-HB and BCI of the same typology, when the former's sound processor is fitted in accordance to the individual auditory situation. Twenty-two patients selected for surgical application of a BCI were evaluated and the same audiological protocol was used to select the candidate and assess the final outcome. The BC-HB was properly fitted based on individual hearing loss and personal auditory targets, and tested as primary step of the protocol to obtain the most reliable predictive value. The BAHA Divino and BP100 sound processors were applied in 12 patients with conductive/mixed hearing loss (CMHL) and in 10 subjects with single sided deafness (SSD). Audiometric evaluation included the pure tone average (PTA3) threshold between 250-1000 Hz; the PTA thresholds at 2000 and 4000 Hz; intelligibility scores as percentage of word recognition (WRS) in quiet and in noise; and subjective evaluation of perceived sound quality by a visual analogue scale (VAS). Statistical evaluation with a student's t test was used for assessment of efficacy of BC-HB and BCI compared with the unaided condition. Spearman's Rho coefficient was used to confirm the reliability of the BC-HB simulation test as a predictor of definitive outcome. The results showed that the mean PTA difference between BCI and BC-HB ranged from 2.54 to 8.27 decibels in the CMHL group and from 1.27 to 3.9 decibels in the SSD group. Compared with the BC-HB, BCI showed a better WRS both in CMHL (16% in quiet and 12% in noise) and in SSD (5% in quiet and a 1% in noise) groups. Spearman's Rho coefficient, calculated for PTA, WRS in quiet and in noise and VAS in the two aided conditions, showed a significant correlation between BC-HB and BCI, between PTA and VAS and between WRS in quiet and VAS. It is possible to conclude that the headband test, when the sound processor of the selected bone conductive implant is fitted and personalised for individual hearing loss and auditory targets of the candidate, may provide highly predictive data of the definitive outcome after BCI implant surgery

Bone conductive implantation in asymmetric hearing loss (AHL)

Background: Bone conductive implants (BCI) represent one possible solution for rehabilitation of single sided deafness (SSD), being able to restore a pseudo-stereophonic hearing when the hearing threshold of the contralateral ear is normal. Objectives: The aim of the present study was to verify the efficacy of bone conduction implantation in subjects with unilateral severe-to-profound hearing loss and contralateral mild-to-moderate hearing loss, i.e. asymmetric hearing loss (AHL), and to compare it with known indications for SSD. Method: Twenty-one subjects, 9 females and 12 males, with a mean age of 55.6 years received BCI for either SSD or AHL. All of the subjects underwent a battery of audiological tests, including free-field pure tone audiometry (PTA) and free-field speech audiometry in quiet and in noise and under unaided and aided conditions. All subjects were administered subjective evaluation tests regarding quality of sound (QoS) and life (QoL), along with 2 questionnaires: the Glasgow Benefit Inventory (GBI) and the General Satisfaction for Bone Anchored Hearing Aids (proposed by the former manufacturer). Data were collected and statistically evaluated within and between the SSD group and the AHL group. Results: A PTA threshold gain was observed in AHL patients. The speech audiometry test in quiet showed an improvement in speech recognition of between 10% and 18% in AHL patients and of less than 10% in SSD patients. The speech audiometry test in noise showed improved values only in AHL patients. The two visual-analogue-scale evaluations (QoL and QoS) and the GBI showed significantly better scores in AHL patients compared to SSD patients

Concomitant dehiscences of the temporal bone: a case-based study

Otic capsule dehiscences create a pathological third window in the inner ear that results in a dissipation of the acoustic energy consequent to the lowered impedance. Superior semicircular canal dehiscence (SSCD) was identified by Minor et al. in 1998 as a syndrome leading to vertigo and inner ear conductive hearing loss. The authors reported the relation between the dehiscence and pressure- or sound-induced vertigo (Tullio phenomenon). The pathophysiology of this entity still remains controversial. Prevalence rates of SSCD in anatomical studies range from 0.4 to 0.7 % with a majority of patients being asymptomatic. The observed association with other temporal bone dehiscences, as well as the propensity toward a bilateral or contralateral near-dehiscence, raises the question of whether a specific local bone demineralization or systemic mechanisms could be considered. The present report regards a case of a patient with a previous episode of meningitis, with a concomitant bilateral SSCD and tegmen tympani dehiscence from the side of meningitis. The patient was affected by dizziness, left moderate conductive hearing loss and pressure/sound-induced vertigo. Because of disabling vestibular symptoms, the patient underwent surgical treatment. A middle cranial fossa approach allowed to reach both dehiscences on the symptomatic side, where bone wax and fascia were used. At 6 months from the procedure, hearing was preserved and the vestibular symptoms disappeared

Epidemiology of Bell’s palsy in an Italian Health District: incidence and case-control study

The incidence of Bell’s palsy has been estimated in a health district of a major Italian city, taking also into consideration the potential risk factors that might influence the occurrence of Bell’s palsy. A matched case-control was therefore designed, by collecting data from the Emergency Departments of four Hospitals belonging to the same Health District in Rome (Italy), coordinated by a tertiary referral centre University Hospital. All patients affected by Bell’s palsy within the health district and four controls for each case were included. Controls were selected from other ENT patients, and were matched for hospital admission, week of disease onset, and climate conditions. Information regarding possible risk factors was collected using standardized telephone interviews. The resulting dataset was analyzed using multiple conditional logistic regression. The study group comprised 381 patients with acute, unilateral, peripheral facial palsy, clinically diagnosed as Bell’s palsy observed between 1st January 2006 and 31st December 2008. The cumulative incidence of Bell’s palsy was found to be 53.3/100.000/year. Among the risk factors, age was found to influence onset of Bell’s palsy, with an odds ratio of 2% for each one-year increase in age, with a linear trend (95% CI = 1-3%; p = 0.005). Bell’s palsy was found to occur with an annual incidence close to previous reports. Among the possible known risk factors (diabetes, pregnancy, etc.), only aging was found to play a significant role

Ruolo della riabilitazione Kabat nella paralisi del nervo facciale: studio randomizzato su casi severi di paralisi di Bell

La terapia della paralisi di Bell, incentrata su farmaci steroidei e/o antivirali, può ancora far esitare nei soggetti affetti sequele disfiguranti per un recupero incompleto. Le diverse procedure riabilitative non si sono dimostrate al giorno d'oggi in grado di giocare un ruolo favorevole in questo senso. Scopo di questo lavoro è stato quello di mettere a confronto i risultati funzionali di pazienti affetti da forme severe di paralisi di Bell, quando trattati con solo cortisone con quelli nei quali al cortisone è stata affiancata una terapia riabilitativa secondo Kabat. Lo studio prospettico ha incluso 94 soggetti con paralisi di Bell di grado IV e V secondo House-Brackmann (HB) a loro volta suddivisi in due gruppi: (a) trattato con terapia steroidea; (b) trattato con terapia steroidea e riabilitazione Kabat. Il trattamento medico è consistito di 60 mg di prednisolone al giorno per 15 giorni; la terapia riabilitativa è consistita nel trattamento di facilitazione neuromuscolare propiocettiva secondo Kabat. Percentuale, grado e tempi di recupero sono stati comparati utilizzando l'analisi statistica Mann-Whitney e il test di regressione logistica multivariata (Ward test). I pazienti Kabat (gruppo b) hanno avuto 20 volte di più la possibilità di migliorare di 3 o più gradi HB (OR = 17,73, 95% IC = 5,72 a 54,98, p < 0,001) rispetto a quelli di gruppo a. La velocità media di recupero nel gruppo b è risultata la metà di quella registrata nel gruppo a. Nessuna differenza è stata invece riscontrata sull'incidenza di sincinesie. Si può dunque concludere che la terapia steroidea permette un migliore e più rapido recupero dei casi severi di paralisi di Bell, quando associata a terapia riabilitativa Kabat

An objective, markerless videosystem for staging facial palsy

Background: The clinical classification of unilateral peripheral facial palsy (UPFP) is still based on subjective conventional methodology, leaving several missing points for an exact depiction of face deformity. Aim of the study: To propose a new objective, video recording method that relies on mathematical algorithms allowing the software to recognize numerical points on the face surface that would be indicative of facial nerve impairment, without positioning of markers on the face. Material and methods: Patients with UPFP of different House-Brackman (HB) degrees, from II to V, have been evaluated after video recording during two selected facial movements (forehead frowning and smiling) by a software trained to recognize the face points as numbers. Numerical parameters in millimeters have been obtained as indicative values of the shifting of the face points, and the shifting ratio between the healthy (denominator) and the affected side (numerator), i.e. the asymmetry index for the two movements taken into consideration. Results: For each HB grade, specific ranges of asymmetry index have been identified with a positive correlation for shift differences and negative correlation for asymmetry indexes. Conclusions: The use of the present objective system enabled the identification of numerical ranges of asymmetry index between the healthy and the affected side, that were found to be consistent with the outcome from the subjective methods currently in use