High total cholesterol in peripheral blood correlates with poorer hearing recovery in idiopathic sudden sensorineural hearing loss

Idiopathic sudden sensorineural hearing loss (ISSHL) is a common otologic emergency whose cause is still unclear. The importance of blood lipids in the pathogenesis of ISSHL is widely reported in literature. In fact elevated levels of low density lipoprotein cholesterol (LDL), total cholesterol (TC) and apolipoprotein B (Apo-B) have been proposed as risk factors for this pathology. No correlation has been described between serum lipid parameters and the prognosis of ISSHL. Aim of the present study was to identify prognostic factors associated with hearing recovery in a group of patients affected by ISSHL. Ninety-four patients with the diagnosis of ISSHL hospitalized between March 2013 and October 2014 were included in this study. Patients' blood sampling and hearing assessments were carried out. Patients were divided into two groups as "recovered" and "unrecovered", according to their response to the treatment. We found a statistically significant higher level of total cholesterol in the unrecovered group compared to the recovered one (p = 0.03). None of the other routine laboratory parameters have shown a statistically significant difference between the patients successfully treated and patients with poor outcomes. Total cholesterol concentrations may be a prognostic factor for recovery in ISSHL and should be assessed together with routine tests in patients with this condition. The other routine laboratory parameters seem to have no effect on the development and prognosis of this pathology

Age-related hearingimpairment and frailty in Alzheimer’s disease: interconnected associations and mechanisms

Among potentially modifiable age-related conditions linked to dementia, Alzheimer’s disease (AD),and late-life cognitive disorders, age-related hearing impairment (ARHI) or resbycusis is themost widely diffused sensory disorder and one of the principal causes of chronic disability inolder adults (Gates and Mills, 2005). The impairments of peripheral (sensory or strial) and central(predominantly neural) auditory pathways, diagnosed with different procedures, are often variouslyimbricated in determining ARHI, with mixed clinical findings (Gates and Mills, 2005). A growingbody of epidemiological evidence linking ARHI with late-life cognitive disorders (Panza et al.,2015a) suggested the potential for correcting hearing loss so that elders can function better alsofrom a cognitive point of view with appropriate treatment.ARHI is also a substantial marker for frailty in older age, another age-related clinical conditionfor identifying older persons at elevated risk for numerous adverse health outcomes such asfalls, institutionalization, hospitalization, disability, and death (Rodríguez-Mañas, 2013). Frailtyis as a multidimensional syndrome characterized by a nonspecific state of vulnerability, reducedmultisystem physiological reserve, and decreased resistance to stressors (Rodríguez-Mañas, 2013).Although there is no consensus regarding the operational definition of frailty, in general, twoare the most frequently used approaches: the first is the physical or “phenotypic” model offrailty, while the second is based on deficit accumulation, measured with the so called frailtyindexes, and defined as an accumulation of health-related deficits and disorders (Rodríguez-Mañas,2013). However, also psychological, cognitive and social factors are part of this multidimensionalsyndrome, with great influence on its definition and treatment. Cognition has already beensuggested as a possible component of frailty with increased risk of adverse outcomes. Therefore, theprevention of cognitive-related adverse outcomes including delirium (Eeles et al., 2012) and late-life cognitive disorders (Robertson et al., 2013; Panza et al., 2015b) may be possible also throughfrailty prevention

Hearing results using titanium ossicular replacement prosthesis in intact canal wall tympanoplasty for cholesteatoma

CONCLUSIONS: Titanium proved to be a valuable alternative to ossicles in ossiculoplasty procedures. Complication rates are comparable to those obtained by other authors with titanium and nontitanium prostheses. Hearing results were worse compared with other reports; however, no conclusion can be drawn on the basis of the literature because of the heterogeneity of the populations studied. OBJECTIVES: To evaluate the results and complications of total (TORP) and partial (PORP) titanium ossicular replacement prostheses in middle ear cholesteatoma. METHODS: Fifty-seven patients affected by acquired cholesteatoma of the middle ear undergoing titanium ossiculoplasty during second stage intact canal wall tympanoplasty were evaluated. Postoperative hearing gain, complication rate, and revision rate were analyzed. RESULTS: Average postoperative gain was 13.6 dB HL for PORP and 17.9 dB HL for TORP. After ossicular reconstruction the mean postoperative ABG was 24.1 dB HL in PORPs and 27.2 dB HL in TORPs. The difference in air-bone gap (ABG) between the two groups after ossiculoplasty was not significant. The number of patients with an ABG > 30 dB was higher in the TORP group compared with the PORP group (p = 0.024) after ossicular reconstruction. The total extrusion rate was 5.2% and the total revision rate was 10.5%

When sneezing indicates the cell type

BACKGROUND: Nasal hyperreactivity is the symptomatic expression of vasomotor rhinitis. This study describes a typical nasal reaction, represented by a "volley of sneezes" found in some patients during nasal endoscopy, and to assess the possible correlation between hyperreactivity and a particular clinical and cytological condition. METHODS: We studied 671 rhinological subjects, 344 male, mean age 35.7 ± 13.76 standard deviation (SD) years. All were submitted to medical histories and clinical and instrumental investigations (skin prick test, nasal endoscopy, and nasal cytology). While performing endoscopy, particular attention was paid to the possible signs of nasal hyperreactivity, in particular "volley of sneezes" both during and immediately after the diagnostic procedure. RESULTS: Out of 671 endoscopies performed, 130 (17.1%) patients presented signs of hyperreactivity during and/or immediately after nasal endoscopy. The ratio of positive vasomotor reaction was 10.6% in the nasal polyposis (NP) group, 19% in the allergic rhinitis (AR) group, 70.6% (p < 0.01) in nonallergic rhinitis with mast cells (NARMA), 76% (p < 0.01) in nonallergic rhinitis with eosinophils and mast cells (NARESMA), and 83% (p < 0.01) in nonallergic rhinitis with eosinophils (NARES). In the AR subjects hyperreactivity was more frequent during the pollen season, compared to the period of absence of pollen (87.5% vs 12%). CONCLUSION: The onset of hyperreactivity (sneezing) can be considered an important "sign" in nasal symptomatology, whose sensitivity and specificity for nonallergic "cellular" rhinitis are 79% and 93%, respectively

Intranasal sodium hyaluronate on the nasal cytology of patients with allergic and nonallergic rhinitis.

BACKGROUND: Rhinitis is an extremely common medical problem characterized by nasal congestion, clear rhinorrhea, sneezing, and itching. Hyaluronate is an endogenous compound that has an important role in mucociliary clearance by the epithelial surface of the nasal passages and in mucosal surface healing and repair. The objective of this work was to determine the effects of intranasal administration of sodium hyaluronate on nasal cytology in patients with allergic and nonallergic rhinitis. METHODS: In a single-center, randomized, blinded trial, 78 patients received intranasal mometasone and oral desloratadine plus either intranasal sodium hyaluronate or saline for 1 month. Nasal cytology was performed and the change from baseline in the numbers of neutrophils, eosinophils, mast cells, lymphocytes, and infective species was determined. Other outcomes included changes in symptoms and the endoscopic appearance of the nasal mucosa, and tolerability. RESULTS: Patients receiving sodium hyaluronate experienced a significant decrease in the median neutrophil count seen on nasal cytology compared with controls (p = 0.001). Sodium hyaluronate was associated with significant improvements in sneezing, rhinorrhea, and nasal congestion, and on exudate seen on endoscopy at 1 month compared with baseline. Intranasal sodium hyaluronate received better tolerability scores than saline over the 1-month treatment period. CONCLUSION: The addition of sodium hyaluronate to intranasal corticosteroid and systemic antihistamine reduced the neutrophil count seen on nasal cytology in patients with allergic and nonallergic rhinitis and improved several clinical and endoscopic parameters while being well tolerated. These data provide encouraging evidence of the efficacy of sodium hyaluronate in the treatment of this common disease