Observational study on risk factors determining residual dizziness after successful benign paroxysmal positional vertigo treatment: The role of subclinical BPPV

After successful treatment for benign paroxysmal positional vertigo, many patients may complain of residual dizziness. Possible explanations may be the persistence of otolith into canal insufficient to provoke noticeable nystagmus, utricular dysfunction and undiagnosed coexisting vestibular disorder. We conducted a prospective observational case-control study, focusing on the role of risk factors in determining residual dizziness after BPPV treatment. In the present study, 148 patients were recruited and residual dizziness was documented in the 57.5% of the cohort. Among patients with residual dizziness 36 had subclinical BPPV and after retreatment, although nystagmus was not clinically evident, there was resolution of dizziness. We conclude that residual otoliths may play a role in determining post-maneuver residual dizziness that is often linked to subclinical BPPV; this conclusion is also supported by the high prevalence of BPPV recurrence in patients with residual dizziness, as confirmed by our analysis. The main cause appears to be linked with dispersed otolith in semicircular canals

Prevalence and risk factors for sensorineural hearing loss: Western Sicily overview

The objective of this work was to evaluate the prevalence of sensorineural hearing loss (SNHL) and distribution of the main risk factors associated to it focusing on their role in the development of deafness and their interaction. We performed a global audiological assessment (through TEOAE, tympanometry and ABR) in 508 infants at risk studying the main risk factors reported by Joint Committee on Infant Hearing (2007). Fifty-one infants (10.03 %) were diagnosed with SNHL (45 bilateral and 6 unilateral) with a mean hearing threshold of 87.39 \ub1 28.25 dB HL; family history of hearing impairment (HI) and TORCH infections indicated independent significant risk factors (P < 0.00001 and P = 0.024, respectively). High SNHL percentages were evidenced also in NICU babies, due to the various pathologies and risk factors presented by these infants, and among newborns who suffered from hyperbilirubinemia (11.97 and 9.52 %, respectively). The mean degree of hearing loss for children with family history of HI (>100 dB HL) emphasizes the necessity of an early diagnosis to avoid the consequences of auditory deprivation. Craniofacial abnormalities and syndromes associated to HI showed an important relationship (P < 0.00001) with conductive hearing loss. A progressive increase was evidenced in SNHL incidence as the number of risk factors rises (from 5.12 for 2 risk factors to 28.5 % for 5 or more) with a significant difference among the groups (P = 0.049); multiple risk factors showed an additional cofactor for HL (r2 = 0.93). Considering the high SNHL prevalence (10.03 %) in infants at risk, this study highlights the necessity to implement a neonatal hearing screening program in Western Sicily

The role of atopy in otitis media with effusion among primary school children: audiological investigation

Objective of this study is to value the role of atopy in otitis media with effusion (OME) in children attending primary school in Western Sicily focusing on the audiological characteristics among atopic and non atopic subjects suffering from OME. 310 children (5-6 years old) were screened by skin tests and divided into atopics (G1) and non atopics (G2). The samples were evaluated for OME by pneumatic otoscopy, tympanogram and acoustic reflex tests. The parameters considered were: documented persistent middle ear effusion by otoscopic examination for a minimum of 3 months; presence of B or C tympanogram; absence of ipsilateral acoustic reflex and a conductive hearing loss greater than 25 dB at any one of the frequencies from 250 Hz through 4 kHz. 56 children (18.06%) resulted atopics while 254 were non atopics. OME was identified in 24 atopic children and in 16 non atopic children for a total number of 40 children; the overall prevalence rate was 12.9% (42.85% for G1 and 6.30% for G2). OME was bilateral in 28 children (70%), with a significative difference between G1 (79.17%) and G2 (56.25%). The prevalence of B tympanogram was 70.59%, corresponding to 79.07% for G1 and 56% for G2. The mean air conduction pure tone was respectively 31.97 dB for G1 and 29.8 dB for G2. The prevalence value of OME in atopics children, also supported by the higher predominance of bilaterality, B tympanogram and hearing loss among this group, could suggest the important role of allergy in the pathogenesis of OME

Profilo familiare ed individuale come fattore predittivo delle performances verbo-acustiche pre impianto cocleare: esperienza personale

RAZIONALE L\u2019impianto cocleare \ue8 oramai il trattamento di scelta in tutti quei casi di sordit\ue0 preverbale severa/profonda permettendo di ottenere a distanza di 12 mesi una soglia uditiva amplificata integralmente all\u2019interno dello spettro acustico del parlato. Se ci\uf2 \ue8 dimostrato ampiamente dalla letteratura, \ue8 comunque vero che le aspettative familiari e le performances verbo/acustiche sono altamente variabili. Lo scopo del presente lavoro \ue8 quello di identificare tramite un accurato studio del profilo familiare ed individuale, tutte le possibili variabili in grado di influenzare i risultati. MATERIALI E METODI Le variabili oggetto del presente studio sono state suddivise in familiari ed individuali; tra le prime si \ue8 valutato: numero di familiari, titolo di studio, livello economico, attivit\ue0 lavorativa, aspettativa familiare; tra i fattori individuali: et\ue0 al momento della diagnosi di sordit\ue0, lunghezza della sordit\ue0, patologie associate, utilizzo delle protesi acustiche, terapia riabilitativa (sanitaria/privata), et\ue0 al momento dell\u2019impianto, tipo di impianto, strategia utilizzata, uso quotidiano dell\u2019impianto cocleare, stimolazione mono/bimodale. RISULTATI Le risposte ottenute dai tracciati audiometrici e dai questionari sulle capacit\ue0 percettive verbali messe in relazione con il profilo familiare ed individuale hanno evidenziato una correlazione significativa tra alto livello economico, terapia riabilitativa privata, uso quotidiano dell\u2019impianto cocleare e IT-MAIS, CAP e SIR (p>0.05). Di contro, a queste variabili familiari ed individuali sono corrisposte le aspettative familiari pre-impianto pi\uf9 elevate con il rischio pertanto di \u2018false aspettative\u2019. CONCLUSIONI Lo studio del profilo familiare e le caratteristiche individuali di un candidato all\u2019impianto cocleare possono essere uno strumento in pi\uf9 da utilizzare come fattori predittivi per non creare delle false aspettative in termini di performance uditive e di intelligibilit\ue0 nelle famiglie dei soggetti affetti da ipoacusia neurosensoriale bilaterale severa/profonda e candidati all\u2019impianto cocleare

E-ABR in patients with cochlear implant: A comparison between patients with malformed cochlea and normal cochlea

OBJECTIVES: This study aims to compare the electrical auditory brainstem response (EABR) following cochlear implant (CI) surgery in pediatric subjects with cochlear malformation and a normal cochlea, in order to assess the sensitivity of EABR and to evaluate the surgery outcome. MATERIALS and METHODS: A total of 26 pediatric subjects who were deaf and scheduled for CI surgery were enrolled into this case control study. Group A (n=20) included subjects with a normo-conformed cochlea. Group B (n=6) included subjects with cochlear malformation. Subjects were evaluated with EABR immediately (T0) and 6 months (T1) post-CI surgery. The EABR Waves III and V average amplitude and latency were compared across time, separately for each group, and across groups, separately for each time. RESULTS: Auditory brainstem response (ABR) could only be recorded in Group A. We were able to record EABR from all subjects at T0 and T1, and waves III and V were present in all the recorded signals. There were no statistically significant differences between T0 and T1 in EABR Waves III and V in terms of average amplitude and latency in neither group. When comparing Groups A and B, the only statistically significant difference was the average amplitude of wave V, both at T0 and T1. CONCLUSION: EABR is a valid tool to measure the auditory nerve integrity after CI surgery in patients with a normal and malformed cochlea, as shown by its ability to measure waves III and V when ABR is absent. The EABR testing should be performed before and after CI surgery, and EABR should be used as a measure of outcome, especially in patients with a malformed cochlea

Surgical management of retraction pockets: Does mastoidectomy have a role?

Introduction Retraction pocket is a condition in which the eardrum lies deeper within the middle ear. Its management has no consensus in literature. Objective To assess the role of mastoidectomy in the management of retraction pockets added to a tympanoplasty. Methods Prospective study of patients with retraction pocket and referred to surgery. The patients were randomly assigned to two groups: one managed with tympanoplasty and mastoidectomy and the other group with tympanoplasty only. The minimum follow-up considered was 12 months. The outcomes were: integrity of eardrum, recurrence, and hearing status. Results This study included 43 patients. In 24 cases retraction occurred in the posterior half of the eardrum, and in 19 patients there was clinical evidence of ossicular interruption. The two groups of treatment were composed by: 21 patients that underwent tympanoplasty with mastoidectomy and 22 patients had only tympanoplasty. One case of the first group had a recurrence. In 32 cases patients follow up was longer than 48 months. The average air-bone gap changed from 22.1 dB to 5 dB. The percentage of air-bone gap improvement was assessed at 60% in those patients treated with mastoidectomy, and 64.3% in those without it (p > 0.5). Conclusion Tympanoplasty and ossiculoplasty should be considered to treat atelectatic middle ear and ossicular chain interruption. Mastoidectomy as a way to increase air volume in the ear seems to be a paradox; it does not add favorable prognostic factor to management of retraction pockets

Frequenza e fenotipo delle mutazioni GJB2 in pazienti con ipoacusia neurosensoriale non-sindromica congenita: analisi di una coorte della Sicilia Occidentale

Circa il 60% delle ipoacusie congenite sono associate a cause genetiche nei paesi sviluppati. La sordit\ue0 genetica \ue8 classificata in sindromica (30%) e non sindromica (70%), quest\u2019ultima riconducibile in pi\uf9 del 50% dei casi a mutazioni del gene GJB2. Tale gene, espresso nella coclea, codifica per la proteina gap junction \u201cConnessina 26\u201d, la cui funzione \ue8 cruciale per la comunicazione intercellulare. L\u2019obiettivo del nostro lavoro \ue8 stato quello di stimare la frequenza delle mutazioni GJB2 e la loro correlazione con il fenotipo audiologico in 102 pazienti siciliani affetti da sordit\ue0 neurosensoriale congenita non sindromica (NSHL) bilaterale e portatori di almeno una mutazione del gene GJB2. Tutti i soggetti sono stati sottoposti a test genetici (per individuare la presenza di mutazioni dei geni GJB2 e GJB6) ed esame audio-impedenzometrico. Nella coorte studiata sono stati identificati 15 mutazioni differenti e 17 genotipi. Nel 64.72% dei pazienti si \ue8 evidenziata una perdita uditiva di grado profondo (media PTA0.25-4kHz= 88.82\ub126.52 dB HL ). L\u201981.37% dei soggetti \ue8 risultato portatore di almeno un allele c.35delG; le mutazioni c.167delT e c.-23+1G>A sono state identificate nel 10.78% e nel 9.8% dei pazienti rispettivamente. Il genotipo omozigote per la mutazione c.35delG \ue8 risultato associato ad una pi\uf9 severa perdita uditiva e a valori medi di PTA0.25-4kHz pi\uf9 elevati (96.79\ub121.11 dB HL) rispetto ai genotipi c.35delG/non-c.35delG e c.35delG/Wt (P<0.05) Il nostro studio evidenzia il ruolo di c.35delG, c.167delT e c.-23+1G>A come cause principali di NSHL in Sicilia. La variabilit\ue0 del profilo audiologico associato ad un determinato genotipo \ue8 riconducibile all\u2019azione di geni e fattori ambientali in parte non ancora individuati

Stapedotomia V.S. Stapedectomia: nostra esperienza

RAZIONALE La chirurgia della staffa ha visto negli ultimi anni molte innovazioni nel trattamento chirurgico dell'otosclerosi. In particolare, la stapedectomia \ue8 stata sostituita sempre pi\uf9 dalla stapedotomia prima con metodo classico e successivamente con metodica invertita, in quanto si ritiene che tali varianti chirurgiche consentano una maggiore riduzione del gap tra via ossea e via aerea per le alte frequenze, una migliore discriminazione vocale oltre che minori complicanze intra e post operatorie. Lo scopo del presente studio \ue8 stato quello di confrontare i risultati della stapedotomia con la stapedectomia nei pazienti affetti da otosclerosi e in particolare il miglior recupero uditivo e l'insorgenza di complicanze intra e post-operatorie. MATERIALI E METODI Le variabili oggetto del nostro studio sono state: il sesso, l'et\ue0, la familiarit\ue0. I pazienti sono stati sottoposti a timpanometria e a audiometria tonale pre-operatoria e post-operatoria a distanza di 2 mesi dall'intervento. Le soglie uditive per la via aerea sono state ottenute per le frequenze 250-8000 Hz, mentre le soglie uditive per la via ossea sono state ottenute per le frequenze 250-4000 Hz. La soglia media (PTA) \ue8 stata calcolata per le frequenze 0.5, 1, 2, e 4 kHz ed \ue8 stato calcolato il gap tra la soglia media della via aerea e ossea. Infine si \ue8 valutata la presenza di acufeni e vertigini post-operatorie. Il confronto tra le due tecniche chirurgiche \ue8 stato eseguito tramite test \u3c72 a un livello di significativit\ue0 P < 0.05 per ognuna di queste variabili. RISULTATI I pazienti trattati con stapedotomia dimostrano risultati in termini di valori audiometrici migliori per la frequenza 4 kHz per la via aerea ed una riduzione del gap tra la via aerea e la via ossea per la stessa frequenza (p < 0.05) . L' insorgenza di acufeni e vertigini post-operatorie \ue8 ridotta in seguito a intervento di stapedotomia, anche se i risultati ottenuti non sono statisticamente significativi, probabilmente perch\ue8 la presenza di queste due complicanze dipende anche dai materiali protesici utilizzati e dall'esperienza del chirurgo. CONCLUSIONI La stapedotomia, attualmente, sembra essere l'intervento di scelta rispetto alla stapedectomia, non solo per i migliori risultati audiometrici ottenuti per la frequenze acute ma anche per la minore incidenza di complicanze post-operatorie. Di contro la stapedectomia \ue8 un intervento imprescindibile qualora vi sia una totale compromissione della staffa o frattura della platina intraoperatoriamente

Management of laryngeal precancerous lesions

Objective: The identification of precancerous lesions is the basis of an early diagnosis, and of a treatment that allows, in the great part of cases, the preservation of organ functions. The aims of this study were: the evaluation of the less invasive treatment for precancerous lesion of the larynx to minimize the recurrences, the estimation of number of further operation required. Methods: A prospective study was clone on patients with clinical diagnosis of laryngeal precancerosis. The patients were treated by a transoral endoscopic approach with direct microlaryngoscopy (DML) doing an excision-biopsy with cold blade, consisting in excision of the whole visible lesion with vocal ligament preservation. Results: A recurrence of a clinically evident precancerous lesion was present in 13.2% of patients that had a laryngeal intraepithelial lesion (LIN) 1 lesion and in 28.95% of patients that had a LIN 2 lesion. Conclusion: In order to achieve a control of a precancerous lesion, we suggest: excisional biopsy/subepithelial cordectomy (type 1 cordectomy) for LIN 1 lesions and subligament cordectomy (type 2 cordectomy) in case of LIN 2 cases. In case of recurrences of LIN 1 lesion we suggest directly a type 2 cordectomy