3,255 research outputs found

    A 1-year follow-up study with C-VEMPs, O-VEMPs and video head impulse testing in vestibular neuritis

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    The aim of this paper was to evaluate prospectively, in a group of patients affected by VN, a diagnostic protocol employing C-VEMPs, O-VEMPs and vHIT together. The diagnosis of vestibular neurolabyrinthitis was based on the clinical history, absence of associated auditory or neurological symptoms, and a neuro-otological examination with an evaluation of lateral semicircular canal function using the Fitzgerald-Hallpike caloric vestibular test and ice test. Our series revealed an incidence of 55 % of superior and inferior vestibular neurolabyrinthitis, 40 % of superior vestibular neurolabyrinthitis and 5 % of inferior vestibular neurolabyrinthitis. These data, however, comprised different degrees of vestibular involvement considering the evaluation of each single vestibular end-organ with potential different prognosis. Four patients had only deficits of the horizontal and superior semicircular canals or their ampullary nerves. The implementation of C-VEMPs, O-VEMPs and vHIT in a vestibular diagnostic protocol has made possible to observe patients with ampullary VN, unidentifiable with other types of vestibular exams. The effect of age seems to have some impact on the recovery. When recovery firstly involves the utricular and saccular nerves and subsequently the ampullary nerves, it may be reasonable to expect a more favorable and successful outcome

    Giant petrous bone cholesteatoma: combined microscopic surgery and an adjuvant endoscopic approach

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    Petrous bone cholesteatomas (PBCs) are epidermoid cysts, which have developed in the petrous portion of the temporal bone and may be congenital or acquired. Cholesteatomas arising in this region have a tendency to invade bone and functional structures and the middle and posterior fossae reaching an extensive size. Traditionally, surgery of a giant PBC contemplates lateral transtemporal or middle fossa microscopic surgery; however, in recent years, endoscopic surgical techniques (primary or complementary endoscopic approach) are starting to receive a greater consensus for middle ear and mastoid surgeries. We report the rare case of an 83-year-old Caucasian male affected by a giant cholesteatoma that eroded the labyrinth and the posterior fossa dura and extended to the infralabyrinthine region, going beyond the theca and reaching the first cervical vertebra. The giant cholesteatoma was managed through a combined approach (microscopic and, subsequently, complementary endoscopic approach). In this case report, we illustrate some advantages of this surgical choice

    A Methodological Approach to Determine Sound Response Modalities to Coastal Erosion Processes in Mediterranean Andalusia (Spain)

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    Human occupation along coastal areas has been greatly increasing in recent decades and, in many places, human activities and infrastructures are threatened by erosion processes that can produce relevant economic and human losses. In order to reduce such impacts and design sound management strategies, which can range from the "no action" to the "protection" option, coastal managers need to know the intrinsic coastal sensitivity and the potential vulnerability and value of land uses. In this paper, in a first step, coastal sensitivity was determined by calculating the following: (i) the spatial distribution at the coast of the wave forcing obtained by using the ERA5 wave dataset and defined as the energy associated with the 50-year return period storm. Two storm conditions were considered, that is, one for the eastern and one for the western parts of the Andalusia Mediterranean coast, respectively, characterized by a height of 8.64-7.86 m and 4.85-4.68 m and (ii) the existence of a buffer zone, namely the dry beach width expressed as a multiple of the 20-year predicted shoreline position that was calculated using a dataset of aerial photographs covering a time span from 1956 to 2016. Coastal sensitivity values were divided into five classes with class 1 indicating the lowest sensitivity (i.e., the presence of a wide buffer zone associated with low wave energy flux values) and class 5 the highest sensitivity (i.e., a narrow buffer zone associated with very high wave energy flux values). In a second step, land uses were obtained from the official Land Use Map of the Andalusia Region, based on the results of the "Coordination of Information on the Environment" (CORINE) European Project. Such uses were divided into five classes from class 1 including natural areas (typologies "A" and "B" of the CORINE Project) to class 5 including very capital land uses (typologies "E1" and "E2"). In a third step, information concerning coastal sensitivity and land uses was crossed to determine the best mitigation strategies to cope with erosion processes. The "no action" option was observed at the westernmost area of Cadiz Province and at some areas from the west coast of Almeria Province, where both coastal sensitivity and land use classes show low values; the "adaptation" option was recorded along more than one half of the coast studied, essentially at natural areas with high sensitivity and at urbanized areas with low sensitivity; and the "protection" option was observed especially at some areas from the center and eastern part of Malaga Province and at the easternmost areas of Almeria Province, where both coastal sensitivity and land use classes presented high values
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