EVALUATION OF AUDITORY CORTICAL PLASTICITY FROM FIRST AMPLIFICATION TO ONE YEAR OF HEARING AID USE: THE RELATIONSHIP BETWEEN AIDED CORTICAL AUDITORY EVOKED POTENTIALS (ACAEPs) AND SPEECH PERCEPTION OUTCOMES AMONG HEARING-IMPAIRED ADULT PATIENTS

Over the last decade, aided cortical auditory evoked potentials (ACAEPs) have continued to be a focus of interest due to the lack of adequate tools to objectively assess cortical auditory activity in response to amplified stimuli. The majority of authors have investigated the direct relationship between behavioral thresholds and ACAEPs and the evolution of ACAEP waves among children with sensorineural hearing loss (SNHL) undergoing rehabilitation. In contrast, scarce data are available regarding changes in ACAEPs over time in adult hearing aid users, particularly in relation to speech perception outcomes. The main goal of this project was to investigate the relationship between ACAEPs and speech perception capability over time in post-lingual SNHL adult patients who were first-time hearing aid users. We hypothesized that, in patients with better speech understanding, a modification of the P1-N1-P2 complex could be expected as a result of neuroplastic changes due to hearing aid amplification. A longitudinal prospective clinical study was conducted on 72 new hearing aid users suffering from symmetrical, sloping SNHL. Patients were assessed at three different time points: baseline (T0), 6 months after the initial assessment (T6), and 12 months after the initial assessment (T12). All the participants went through the same evaluation protocol, which included pure-tone audiometry, speech audiometry tests, ACAEPs recorded with two different stimuli (1000 Hz and 2000 Hz) and questionnaires assessing hearing aid benefit. Analysis of amplitude values at the three different time points demonstrated an increasing tendency for all waves in both experimental conditions (p<0.01). Latencies seemed to become shorter from T0 to T12 for each wave and in the case of 1 kHz and 2 kHz stimuli. (p<0.05). Linear regression analysis found that only P2 amplitude showed a statistically significant increase in its variation while matrix sentence test (MST) and speech intellection threshold (SIT) decreased in both experimental conditions, even when the analysis was adjusted for age and daily hearing aid use (p<0.05). The data collected in this study provide new evidence regarding the relationship between ACAEPs and the speech recognition capability of adults who are new hearing aid users. In both experimental conditions, we observed larger P2 amplitude in patients with better speech perception outcomes. It should be underlined that, even though P2 may reflect auditory processing beyond sensation, its increase could be an expression of neural activity associated with the acquisition process driven by exposure to sounds and speech. The observation that P2 amplitude tended to improve as SIT and MST scores decreased might be, in the future, a further object of investigation to assess its reliability as a marker of speech perception improvement; it may assist hearing aid dispensers and audiologists as a source of feedback in the evaluation of listening benefits in hard-to-test patients

Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis

Introdução: A atresia de coanas é uma malformação congênita rara da cavidade nasal caracterizada pela obliteração completa da coana posterior. Nos 67% dos casos a atresia coanal é unilateral, acometendo principalmente (71%) a cavidade nasal direita. Diferentemente da forma unilateral, a atresia coanal bilateral é uma condição com risco de vida, frequentemente associada a angústia respiratória com alimentação e cianose intermitente exacerbada pelo choro. O tratamento cirúrgico permanece como a única opção terapêutica. Objetivo: Relatar a nossa experiência no uso de uma abordagem endoscópica transnasal com a técnica de retalho articulado de um lado só sem colocação de stent para o tratamento cirúrgico da atresia coanal. Método: Análise retrospectiva de 5 anos dos desfechos cirúrgicos de 18 pacientes tratados para atresia coanal com uma técnica transnasal com um único retalho de articulação lateral, sem colocação de stent. Todos os indivíduos foram avaliados no pré-operatório com uma endoscopia nasal e um exame de tomografia computadorizada maxilofacial. Resultados: Dez homens e oito mulheres com idade média no momento da cirurgia de 20,05 ± 11,32 anos foram submetidos a cirurgia para atresia de coanas. Tratamento cirúrgico de atresia de coana com abordagem endoscópica transnasal com técnica de retalho único e articulacão lateral sem colocac ¸ão de stent: análise retrospectiva de 5 anos. Quinze pacientes (83,33%) apresentaram placa atrésica óssea, enquanto 3 (26,77%) apresentaram uma placa atrésica ósseo-membranosa mista. Dois e dezesseis casos sofriam de atresia coanal bilateral e unilateral, respectivamente. Não foram observadas complicações intra e/ou pós-operatórias precoces. Entre 2 e 3 meses após a cirurgia dois casos (11,11%) de restenose parcial foram encontrados. Apenas um deles apresentou uma recidiva da obstrução nasal e, portanto, foi reparado com sucesso com um segundo procedimento endoscópico. Conclusão: A técnica cirúrgica descrita segue os requisitos básicos de cirurgia corretiva e possibilita boa visualização, avaliação e tratamento da placa atrésica e do terço posterior do septo, a fim de criar a nova abertura coanal. Pensamos que a utilização de um stent não é necessária, tal como recomendado no caso de outras técnicas cirúrgicas que envolvem o uso de mais retalhos de mucosas.Choanal atresia is a rare congenital malformation of the nasal cavity characterized by the complete obliteration of the posterior choanae. In 67% of cases choanal atresia is unilateral, affecting mainly (71%) the right nasal cavity. In contrast to the unilateral form, bilateral choanal atresia is a life-threatening condition often associated with respiratory distress with feeding and intermittent cyanosis exacerbated by crying. Surgical treatment remains the only therapeutic option. Objective To report our experience in the use of a transnasal endoscopic approach with stentless single side-hinged flap technique for the surgical management of choanal atresia. Methods A 5 year retrospective analysis of surgical outcomes of 18 patients treated for choanal atresia with a transnasal technique employing a single side-hinged flap without stent placement. All subjects were assessed preoperatively with a nasal endoscopy and a Maxillofacial computed tomography scan. Results Ten males and eight females with a mean age at the time of surgery of 20.05&nbsp;±&nbsp;11.32 years, underwent surgery for choanal atresia. Fifteen subjects (83.33%) had a bony while 3 (26.77%) a mixed bony-membranous atretic plate. Two and sixteen cases suffered from bilateral and unilateral choanal atresia respectively. No intra- and/or early postoperative complications were observed. Between 2 and 3 months after surgery two cases (11.11%) of partial restenosis were found. Only one of these presented a relapse of the nasal obstruction and was subsequently successfully repaired with a second endoscopic procedure. Conclusion The surgical technique described follows the basic requirements of corrective surgery and allows good visualization, evaluation and treatment of the atretic plate and the posterior third of the septum, in order to create the new choanal opening. We believe that the use of a stent is not necessary, as recommended in case of other surgical techniques involving the use of more mucosal flaps

Sudden sensorineural hearing loss: is there a relationship between routine haematological parameters and audiogram shapes?

Objective: To investigate the relationship between haematological routine parameters and audiogram shapes in patients affected by sudden sensorineural hearing loss (SSNHL). Design: A retrospective study. All patients were divided into four groups according to the audiometric curve and mean values of haematological parameters (haemoglobin, white blood cell, neutrophils and lymphocytes relative count, platelet count, haematocrit, prothrombin time, activated partial thromboplastin time, fibrinogen and neutrophil-to-lymphocite ratio) of each group were statistically compared. The prognostic role of blood profile and coagulation test was also examined. Study sample: A cohort of 183 SSNHL patients without comorbidities. Results: With a 48.78% of complete hearing recovery, individuals affected by upsloping hearing loss presented a better prognosis instead of flat (18.36%), downsloping (19.23%) and anacusis (2.45%) groups (p = 0.0001). The multivariate analysis of complete blood count values revealed lower mean percentage of lymphocytes (p = 0.041) and higher platelet levels (p = 0.015) in case of downsloping hearing loss; with the exception of fibrinogen (p = 0.041), none of the main haematological parameters studied resulted associated with poorer prognosis. Conclusions: Our work suggested a lack of association between haematological parameters and a defined audiometric picture in SSNHL patients; furthermore, only fibrinogen seems to influence the prognosis of this disease

Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report

Introduction: To date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity. Case presentation: An 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms. Conclusions: The occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment

Factors influencing the development of otitis media among Sicilian children affected by upper respiratory tract infections

Introduction: Upper respiratory tract infection is a nonspecific term used to describe an acute infection involving the nose, paranasal sinuses, pharynx and larynx. Upper respiratory tract infections in children are often associated with Eustachian tube dysfunction and complicated by otitis media, an inflammatory process within the middle ear. Environmental, epidemiologic and familial risk factors for otitis media (such as sex, socioeconomic and educational factors, smoke exposure, allergy or duration of breastfeeding) have been previously reported, but actually no data about their diffusion among Sicilian children with upper respiratory tract infections are available. Objective: To investigate the main risk factors for otitis media and their prevalence in Sicilian children with and without upper respiratory tract infections. Methods: A case-control study of 204 children with upper respiratory tract infections who developed otitis media during a 3 weeks monitoring period and 204 age and sex-matched healthy controls. Seventeen epidemiologically relevant features were inventoried by means of standardized questionnaires and skin tests were performed. Univariate analysis and multivariate logistic regression analysis were used to examine the association between risk factors and occurrence of otitis media. Results: Otitis media resulted strongly associated to large families, low parental educational attainment, schooling within the third years of life (p &lt;. 0.05); children were more susceptible to develop otitis media in the presence of asthma, cough, laryngopharyngeal reflux disease, snoring and apnea (p &lt;. 0.05). Allergy and urban localization increased the risk of otitis media in children exposed to smoke respectively of 166% and 277% (p &lt;. 0.05); the joint effect of asthma and presence of pets in allergic population increased the risk of recurrence of 11%, while allergy, cough and runny nose together increased this risk of 74%. Conclusions: Upper respiratory tract infections and otitis media are common childhood diseases strongly associated with low parental educational attainment (p = 0.0001), exposure to smoke (p = 0.0001), indoor exposure to mold (p = 0.0001), laryngopharyngeal reflux disease (p = 0.0002) and the lack of breast-feeding (p = 0.0014); an increased risk of otitis media recurrences was observed in the presence of allergy, persistent cough and runny nose (p = 0.0001). The modification of the identified risk factors for otitis media should be recommended to realize a correct primary care intervention

Essential of audiology: screening and postscreening

Newborn hearing screening is a type of screening test for the early detection of hearing loss. It can recognize with good accuracy newborns affected by hearing impairment allowing an early diagnosis and intervention and avoiding cognitive and linguistic deficits [1-6]. The incidence of bilateral sensorineural hearing loss (SNHL) in Sicily is 2.35 cases per 1000 newborns; this value increases to 2.95 if we consider also unilateral SNHL [2,3] and to 10 cases per 1000 births among infants at risk [7-9]. A correct newborn hearing screening programme is based on different protocols depending on the presence/ absence of audiologic risk factor

Distribution and phenotype of GJB2 mutations in 102 Sicilian patients with congenital non syndromic sensorineural hearing loss

Objective: To evaluate the frequency of GJB2 mutations and their correlation with phenotype in Sicilian non-syndromic sensorineural hearing loss (NSHL) patients. Design: Sequencing of the coding region, basal promoter, exon 1, and donor splice site of the GJB2 gene; screening for the presence of the two common GJB6 deletions. Study sample: A cohort of 102 Sicilian NSHL patients. Results: Fifteen different mutations in GJB2 and seventeen different genotypes were detected. No GJB6 mutations were found. The hearing impairment was profound in the 64.72% of probands (mean PTA 0.25 – 4 kHz of 88.82 26.52 dB HL). A total of 81.37% of patients harboured at least one c.35delG allele; c.167delT and c.-23 1G A were identifi ed in 10.78% and the 9.8% of patients respectively; c.35delG homozygotes presented more severe hearing impairment (75.59% of profound hearing loss) and a higher mean PTA 0.25 – 4 kHz (96.79 21.11 dB HL) with respect to c.35delG/non-c.35delG and c.35delG/Wt patients (P 0.05). Conclusions: This work underlines the role of c.35delG, c.167delT and c.-23 1G A as the most frequent causes of NSHL in Sicily. The c.35delG frequency found is similar to those reported in other populations of the Mediterranean area. The analysis of genetic and audiologic data confi rmed a variability in the phenotype associated to a single genotype

Determinants of Failure in the Reconstruction of the Tympanic Membrane: A Case-Control Study

Introduction: The recurrence rate after tympanoplasty is variable between 0% and 50%. The causes of failure may be different and frequently interrelated, making the surgical choice difficult and the prognosis not always favourable. In this study, we analysed recurrence rate and the possible causes of failure of tympanoplasty in the treatment of tympanic perforations.   Materials and Methods: This prospective case-control study was carried out on patients undergoing tympanoplasty. The main outcome was closure of the tympanic membrane.   Results: Among the studied 72 patients, the overall recurrence rate was 19.4%. The average follow-up was 28 months; no recurrence was observed over 12 months of follow-up. We observed a recurrence of 30.7% (OR 2.9) in near total perforations. In 32 subjects with a perforation of over half size of the membrane, a recurrence rate of 31.2% was noted (OR 4.09; P< 0.05). In 22 out of the 72 patients, there was a bilateral chronic otitis where the rate of recurrence was 27.2% (OR 1.9). During the postoperative period, 10 patients contracted infection of the middle/external ear, and in all of these cases failure of the surgical intervention was recorded (

Clinical observations and risk factors for tinnitus in a Sicilian cohort

The aims of this study were to determine the distribution of risk factors associated with tinnitus analysing their role in the development of tinnitus and the effects of their interaction; to evidence the importance of a suitable and adequate clinical and audiologic assessment to avoid those modifiable risk factors responsible for cochlear dysfunction and tinnitus onset. 46 subjects with tinnitus and 74 controls were studied according to: age, sex, Body Mass Index (BMI), neck circumference, tobacco smoking, feeling fatigue or headache, self reporting snoring, hypertension, diabetes, coronary heart disease, and/or hyperlipidemia, and laboratory finding as lipid profile and levels of reactive oxygen metabolites (d-ROM). Audiological assessment was performed by multi-frequency audiometry (PTA0.5–16 kHz) and transient-evoked otoacoustic emissions (TEOAE diagnostic). Univariate analysis was performed to examine the association between determinants and occurrence of tinnitus; Mantel–Haenszel test (G.or) was used to investigate the joint effect of determinants on tinnitus. Tinnitus was more frequent among males with age [50 years; BMI[30 kg/m2, neck circumference[40 cm, headache, hypertension, hypercholesterolemia resulted significant risk factors for tinnitus (P.0001). Tinnitus group had more comorbidity (P.0001) and worse audiometric thresholds (60.87 Vs 21.62 % hearing loss; P.0001) with respect to control group. The interaction between hypertension–BMI C 30 kg/m2 (G.or = 8.45) and smoking–hypercholesterolemia (G.or = 5.08) increases the risk of tinnitus (P.0001). Our results underline that several factors either individually or jointly contribute to tinnitus onset; a comprehensive knowledge about tinnitus risk factors and associated clinical conditions could contribute to minimizing this disorder

Audiologic profile of OSAS and simple snoring patients: the effect of chronic nocturnal intermittent hypoxia on auditory function

The objective of this work was to study the effect of nocturnal intermittent hypoxia on auditory function of simple snoring patients and subjects affected by OSAS; we compared the audiologic profile with the severity of OSAS to detect early signs of cochlear damage. One hundred-sixty patients underwent overnight polysomnography, micro-otoscopy, multi-frequency audiometry, acufenometry, TEOAE recording and d-ROMs test. All subjects were divided in four groups, based on presence/absence of AHI (simple snoring without OSAS, mild OSAS, moderate OSAS, severe OSAS). Sixty (37.5&nbsp;%) patients were not affected by OSAS, 58 (36.25&nbsp;%) presented a mild OSAS, 18 (11.25&nbsp;%) a moderate OSAS and 24 (15&nbsp;%) a severe OSAS; the 57.14&nbsp;% of moderate to severe OSAS suffered from tinnitus with respect to the 31.03&nbsp;% of mild OSAS (P&nbsp;=&nbsp;0.024). A higher percentage (41.66&nbsp;%) of hearing loss was found among individuals with moderate to severe degree of OSAS (P&nbsp;&lt;&nbsp;0.0001). All groups were characterized by a mean hearing threshold&nbsp;&lt;25&nbsp;dB HL for 0.25–3&nbsp;kHz frequencies and a progressive decrease in hearing sensitivity, particularly for 6–16&nbsp;kHz frequencies (P&nbsp;&lt;&nbsp;0.05). The analysis of otoacoustic emissions SNR mean values evidenced a significant difference between simple snoring and severe OSAS individuals for 3 and 4&nbsp;kHz frequencies (P&nbsp;&lt;&nbsp;0.05). d-ROM levels resulted higher in patients with severe OSAS with respect to simple snoring subjects (P&nbsp;=&nbsp;0.004). Our data underline the key role of chronic nocturnal intermittent hypoxia in the development of an early cochlear damage and a more marked high-frequency hearing loss in case of severe OSAS (P&nbsp;&lt;&nbsp;0.05)