Cochlear injury and adaptive plasticity of the auditory cortex

Growing evidence suggests that cochlear stressors as noise exposure and aging can induce homeostatic/maladaptive changes in the central auditory system from the brainstem to the cortex. Studies centered on such changes have revealed several mechanisms that operate in the context of sensory disruption after insult (noise trauma, drug-, or age-related injury). The oxidative stress is central to current theories of induced sensory-neural hearing loss and aging, and interventions to attenuate the hearing loss are based on antioxidant agent. The present review addresses the recent literature on the alterations in hair cells and spiral ganglion neurons due to noise-induced oxidative stress in the cochlea, as well on the impact of cochlear damage on the auditory cortex neurons. The emerging image emphasizes that noise-induced deafferentation and upward spread of cochlear damage is associated with the altered dendritic architecture of auditory pyramidal neurons. The cortical modifications may be reversed by treatment with antioxidants counteracting the cochlear redox imbalance. These findings open new therapeutic approaches to treat the functional consequences of the cortical reorganization following cochlear damage

Pseudo-aneurysm of the external carotid artery: report of a case

The authors report a case of left otorrhagia in a 1-year-old male infant in the presence of a mass involving the parotideal and upper cervical regions, which had appeared after an infection of the upper airways. Non-invasive techniques, such as echography and CT scan, provided useful but contradicting information. Surgery allowed us to define the diagnosis of mycotic aneurysm of the external carotid artery. The authors, after pointing out the extreme rarity of such a pathology, discuss the ethiopathogenetic theories, the clinical features, the diagnosis and the surgical and medical treatment of the disease. Concerning surgery ligation of the external carotid artery is the treatment of choice, since distally the blood flow is provided by a conspicuous collateral circle and because a possible postoperative septic dissemination is avoided

Oncological and functional outcome of conservative surgery for primary supraglottic cancer

The aim of this study was to verify the oncological and functional outcome of conservative surgical treatment of primary supraglottic squamous cell carcinoma (SGSCC) and related neck disease in order to verify the effectiveness of supraglottic laryngectomy (SL) and the validity of an "observation" policy in the control of clinically negative (NO) necks. Of a total of 252 consecutive patients affected by primary SGSCC seen between 1975 and 1990 at the Department of Otolaryngology of the University of Perugia (1975-1987) and the Catholic University of the Sacred Heart of Rome (1988-1990), a subset of 132 patients treated with classical SL was evaluated after presenting sufficient clinicopathological data and a follow-up period of at least 5 years. Tumors were staged according to the 1992 UICC TNM classification and grouped into stages I-II (n = 94) and III-IV (n = 38). Comprehensive neck dissections were performed only in the clinically positive (N+) necks (25/132 cases), while in the clinically NO ones (107/132 cases) an "observation" policy under strict follow-up conditions was adopted. After primary surgery, the 5-year relapse-free survival (RFS) was 74%. The RFS was 80% for T1-2 disease and 65% for T3. The RFS was 80% for stages I-II tumors and 71% for stages III-IV. The actual 5-year overall survival (OS) was 89% for T1-T2 tumors and 67% for T3 disease or 93% for stages I-II and 69% for stages III-IV. The OS was 89% for NO neck and 73% for N+. The 5-year-metastasis-free survival (MFS) was 83% for NO patients, 74% for N+, 84% for T1-T2 NO, 71% for T1-T2 N+, 81% for T3 NO and 68% for T3 N+. In all, SL was found to be highly effective in the management of primary SGSCC. In the presence of clinically NO neck "observation" under strict follow-up with therapeutic comprehensive neck dissection for delayed nodal recurrence, SL was suitable for controlling the neck cancer, as well as for salvaging recurrent disease. Bilateral elective, selective or functional neck dissection in every instance of supraglottic cancer was best performed only in those SGSCC patients who were more likely to have occult nodal disease on the basis of biological factors and imaging data

Clinical approach and treatment of benign and malignant parotid masses, personal experience

Parotid gland tumours account for 80% of all salivary gland neoplasms, 20% of these are malignant, but in daily clinical practice most parotid masses are operated on before obtaining the final histological diagnosis. This clinical setting further complicates the critical point of parotid surgery, which is the management of the facial nerve. In the present study, data were evaluated referring to 540 patients who underwent parotidectomy for a mass which was discovered to be a benign (470 cases) or a malignant (70 cases) neoplasm, between November 1994 and December 2007, at our Institution. The most significant single parameter in this series of malignancies regarding disease specific survival was the clinical involvement of the facial nerve at diagnosis (p = 0.006). Also for this reason, as there is no evidence that liberal VIIth nerve sacrifice improves prognosis, when it is not clinically involved, every attempt is made to dissect and preserve it. At present, the most complicated situation concerning nerve preservation may be, on the other hand, recurrence of a benign tumour, in particular pleomorphic adenoma, which, in our series, has a higher incidence (8.3%) of permanent facial dysfunction, than surgery with nerve preservation for malignancy (3.7%)

Research on the meaning of the enzymatic systems (GPI and PGM) as parameters for the definition of varieties (Vitis sp.): The Italian case of Cabernet franc

Several studies carried out at Davis and Conegliano showed that isozyme analysis of the GPI and PGM enzymatic systems agrees with the conventional definition of the variety in ampelography. Differences were reported among varieties but not among biotypes of the same varieties. The only exception recorded was in the population of Cabernet franc in which GPI and PGM reveal two different types (A - the traditional type encountered in France and B - type encountered in the Italian region of Veneto). Further ampelographic, ampelometric, phenological and chemical studies on the polyphenolic and aromatic substances in fruits have shown considerable differences between the two types. Such differences demonstrate that the type B is a different variety and not a clone of Cabernet franc. Preliminary ampelographic analysis and the equality in GPI and PGM patterns lead to the conclusion that the type B very probably is Carmenère.Therefore, the hypothesis of variety discrimination based on the analysis of GPI and PGM is valid and this method is useful to help to characterize the varieties

Antioxidant treatment with coenzyme Q-ter in prevention of gentamycin ototoxicity in an animal model

Aminoglycosides, such as gentamycin, are well known ototoxic agents. Toxicity occurs via an activation process involving the formation of an iron-gentamycin complex with free radical production. Antioxidants like Q-ter (a soluble formulation of coenzyme Q10, CoQ10), can limit or prevent cellular ototoxic damage. The present study was designed to investigate the possible protective effects of Q-ter on gentamycin ototoxicity in albino guinea pigs (250-300 g). Animals were divided into five experimental groups: I, a sham control group given an intra-peritoneal (I.P.) injection of 0.5 ml saline (SHAM); II, gentamycin group (GM), treated with an injection of gentamycin (100 mg/ kg); III, gentamycin + Q-ter group (GM+Q-ter), treated with gentamycin (same dose as group II) and an I.P. injection of coenzyme Q10 terclatrate (Q-ter) at 100 mg/kg body weight; IV, injected with gentamycin (100 mg/kg) plus saline; V, treated with Q-ter alone (100 mg/ kg). All animals were treated for 14 consecutive days. Auditory function was evaluated by recording auditory brainstem responses (ABR) at 15 and 30 days from the beginning of treatment. Morphological changes were analyzed by rhodamine-phalloidine staining. Gentamycininduced progressive high-frequency hearing loss of 45-55 dB SPL. Q-ter therapy slowed and attenuated the progression of hearing loss, yielding a threshold shift of 20 dB. The significant loss of outer hair cells (OHCs) in the cochlear medio-basal turn in gentamycin-treated animals was not observed in the cochleae of animals protected with Q-ter. This study supports the hypothesis that Q-ter interferes with gentamycin-induced free radical formation, and suggests that it may be useful in protecting OHC function from aminoglycoside ototoxicity, thus reducing hearing loss

L’analisi della curva di apprendimento della chirurgia dell’otosclerosi può aiutare a predirre i risultati funzionali?

Il numero di interventi per otosclerosi è progressivamente diminuito nel corso degli ultimi 20 anni. Questa riduzione crea difficoltà sia al chirurgo esperto ma soprattutto a quello giovane che inizia il suo percorso di formazione. Abbiamo analizzato in maniera retrospettiva i risultati funzionali ottenuti dopo stapedotomia effettuati da un giovane chirurgo presso la Clinica Otorinolaringoiatrica del Policlinico “A. Gemelli” di Roma. La tecnica impiegata è quella della stapedotomia con laser COe utilizziamo una protesi in teflon e titanio. I risultati funzionali sono stati valutati come riduzione della ipoacusia trasmissiva sulle frequenze comprese tra 250 e 4000 Hz all’ultimo esame eseguito durante il follow-up. L’analisi dei dati non ha evidenziato un momento in cui la curva di apprendimento possa essere considerata conclusa poiché ottimi risultati con una riduzione pressoché completa della ipoacusia trasmissiva si sono alternati con altri i cui risultati funzionali non sono stati altrettanto ottimi. In nessun caso si è comunque registrata una coclearizzazione dell’ipoacusia. Questa analisi supporta l’esistenza di una curva di apprendimento della chirurgia dell’otosclerosi senza però individuare un punto dopo il quale si possa prevedere che i risultati funzionali saranno tutti ottimi. La chirurgia dell’otosclerosi non dovrebbe essere effettuata all’inizio della pratica della chirurgia otologica, data l’aspettativa funzionale che il paziente ripone nell’intervento e la mancanza delle capacità chirurgiche necessarie

Impact of COVID-19 and post-infectious course on the olfactory function: "Restitutio ad integrum" or permanent deficit?

The experience of our center with patients who, after having overcome the SARS-CoV19 infection, manifested olfactory disorders includes 1952 patients who were evaluated, according to the protocol established in multidisciplinary agreement with internal medicine and infectious disease specialists, through ENT physical examinatio, questionnaires, olfactometry and gustometry (before and after treatment). Our goal was to evaluate: the prevalence of smell and taste disorders in patients affected by SARSCoV19, the resolution of the mentioned disorder based on the treatment protocols and eventually a possible correlation with patients not affected by the SARS-CoV19 infection. Our evaluation method included: Chemosensory Complaint Score, three VAS scales for olfactory and gustatory dysfunction and nasal obstruction symptoms, full ENT evaluation (rhinoscopy, oropharyngoscopy, evaluation of larynx and tympanic membranes). In the context of the DH PostCovid, an olfactory deficit was observed in 24.3% of cases; the questionnaire submitted to the patients during the acute phase of the infection tended to overestimate the incidence of the symptoms, but this data is likely related to the psychological impact of the disease itself during the early stages of the pandemic. In a period ranging from 2 to 9 months (M 5.5 months), we found a subjective and olfactometrically detected recovery of the olfactory function in almost all patients (98.6%); in only one case the recovery was obtained 13 months after the first evaluation. Among these patients, 65% of them regained the olfactory function during the first 3 months of therapy. Our therapy protocol consisted of: either topical use of glyceritic acid plus mannitol for topical use in case of inflamed nasal mucosa or crosslinked ialuronic acid for topical use in case of atrophic rhinitis together with citicoline 1000mg per os and olfactory rehabilitation. Once having obtained these data, and keeping in mind that the therapy was personalized and modulated on the basis of the conditions found at the physical evaluation for each patient (presence or absence of significant nasal dryness, allergic rhinitis, etc.), and although the "unpredictability" of this pandemic imposes a certain caution on us, we can affirm that it is not frequent, in our series of cases, the persistence of the olfactory deficit in patients with previous SARS-CoV19 infection and that indeed the restitutio ad integrum is the most frequent of the eventualities

Preliminary experiences with contact endoscopy of the larynx

Nine patients with laryngeal polyps, four with Reinke’s edema, three with leukoplakia, one with papilloma and one with malignant tumor were studied by means of laryngeal contact endoscopy during microlaryngoscopy. This technique allowed in vivo and in situ visualization of the superficial layer of the laryngeal epithelium after staining with methylene blue. Cell structures evaluated were the size and color of the nuclei, the nucleus/cytoplasm ratio, nuclear and cytoplasmic contours, the presence of nucleoli, mitoses and keratoses, as well as the microvascular network of the mucosa and superficial cellular changes from normal to pathological. The normal squamous epithelium of the vocal cord showed a homogeneous cellular population with regular nuclear and cytoplasmic morphological characteristics and a uniform nucleus-to-cytolasm ratio. Specific cellular epithelial pat- terns and several alterations of the vascular distribution were found in different pathological conditions. Cytological pictures obtained at contact endoscopy were consistent with histological findings in all the patients studie

Midfacial fractures: our experience.

Authors report their experience in the treatment of midfacial fractures in 201 patients, 177 of whom underwent surgery for reduction and fixation of the fracture. Since no functional or aesthetic deficits were present, surgery was not performed in the remaining 24 cases. Of the 177 patients, the maxillary complex was involved in 70 (classified as central and centro- lateral fractures), the zygomatic-maxillary-orbital complex in another 70, isolated fractures of the orbital floor blow-out in 18, and. isolated fractures of the zygomatic arch in 19. The re- sults obtained and the degree of satisfaction were evaluated in 90 patients with clinical visits, as well as by telephone inter- view. A total of 88 patients expressed complete satisfaction with the results of the surgical outcome, while the remaining 2 patients were not satisfied with the aesthetic outcome. All pa- tients were operated within 24-48 hours post-trauma in the case of incarceration of extrinsic ocular muscles, and within 10 days in other types of trauma, even in those patients in inten- sive care. The importance of clinical and radiological pre-op- erative diagnosis is stressed as well as the choice of the most suitable therapeutic approach for the different types of frac- tures, considering recent tendencies towards minimally inva- sive procedures to achieve better cosmetic results. The latest developments in fixation techniques with reference to titanium mini- and/or micro-plates that may eventually be substituted with absorbable materials are discussed