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

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

Efficacy and pharmacological appropriateness of cinnarizine and dimenhydrinate in the treatment of vertigo and related symptoms

Vertigo is not itself a disease, but rather a symptom of various syndromes and disorders that jeopardize balance function, which is essential for daily activities. It is an abnormal sensation of motion that usually occurs in the absence of motion, or when a motion is sensed inaccurately. Due to the complexity of the etiopathogenesis of vertigo, many pharmacological treatments have been tested for efficacy on vertigo. Among these drugs, cinnarizine, usually given together with dimenhydrinate, appears to be the first-line pharmacotherapy for the management of vertigo and inner ear disorders. Based on these considerations, the present non-interventional study aimed to investigate the clinical efficacy and tolerability of a fixed combination of cinnarizine (20 mg) and dimenhydrinate (40 mg) in patients suffering from vertigo-related symptoms. To this end, we enrolled 120 adults—70 males, and 50 females—with an average age of 64 years. Before beginning pharmacological treatment, all patients were screened for the intensity of vertigo, dizziness, and concomitant symptoms through the Visual Scale of Dizziness Disorders and Dizziness Handicap Inventory scales. At the end of the anamnestic evaluation, patients received the fixed-dose combination of cinnarizine (20 mg) plus dimenhydrinate (40 mg) 3 times daily, for 60 days. The results of this study provide further insight regarding the efficacy of the fixed combination when used to reduce symptoms of vestibular vertigo of central and/or peripheral origin, after both the 15-and 60-day therapies. Independent of the type of vertigo, the fixed combination was able to reduce dizziness-and vertigo-associated symptoms in more than 75% of all patients treated, starting from 15 days of therapy, and improving 60 days after starting the therapy. Interestingly, we also found differences between male and female patients in the framework of the pharmacological effects of therapy. This study provides further details concerning the therapeutic efficacy of the fixed combination of cinnarizine and dimenhydrinate, and also focuses attention on the possibility that these drugs could act in a gender-specific manner, paving the way for further research

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

FOLLOW-UP AFTER PEDIATRIC MYRINGOPLASTY: OUTCOME AT 5 YEARS

Aim. The aim of this paper was to evaluate anatomical and functional outcomes 5 years after myringoplasty in children affected by perforated eardrum. To analyze the main differences in the frequency of postoperative complications between patients under and over 9 years of age. Methods. One hundred and thirty-two children, aged from 4 to 15 years, who underwent myringoplasty with or without mastoidectomy, were followed for a five-year period after surgery. The cohort was divided in two groups: children from 4 to 9 years old (G1) and patients older than 9 years (G2); all subjects underwent a pre- and post-operatively clinical exam and were evaluated through audiometry and impedenzometry. Adenoidectomy, if necessary, was performed three months before myringoplasty. Results. Of the total 132 children of our cohort, the 32.58% were from 4 to 9 years old (G1) and the 67.42% were older than 9 years (G2). Twenty-five (58.13%) G1 and 2 (2.24%) G2 patients underwent adenoidectomy before myringoplasty (P<0.0001); in 18 (41.86%) G1 and 23 (25.84%) G2 subjects a mastoidetomy was associated to myringoplasty (P=0.062). The main postoperative complications observed were respectively retraction pockets (9.3%) and recurrent seromucous otitis (9.3%) in G1 group and myringosclerosis (4.4%) in G2 group. The GAP index (IG) resulted >2 (good-excellent degree) in the 89.36% of G1 and 91% of G2 children (P>0.5). Conclusion. Nevertheless good audiologic outcomes in patients under and over 9 years of age, our study evidenced a different percentages of success after myringoplasty in G1 and G2 groups (P=0.0024). Thus, considering the higher percentage of postoperative complications in children with less than 9 years of age, myringoplasty should be considered cautiously due to the risk of reperforation and/or cholesteatoma

Psychopathologic disease in patients with tinnitus: a case control of an outpatient cohort

The goal of this work was to study if patients suffering from tinnitus, that affects 14.5% of Italian people, are more susceptible to psychological distress than those who are not affected by tinnitus; to evaluate the prevalence of psychopathological disorders among the cohort, their relationship with the severity of tinnitus and eventual correlation between the distress caused by tinnitus and age of patients. 191 cases and 237 controls were enrolled between 2009-2011. Cases were 80 females and 111 males with mean age of 48.06. Controls were 106 females and 131 males with mean age of 47.09. Overall subjects completed Symptom CheckList-90 R (SCL 90-R) and some brief questionnaire about audiological history while Tinnitus Handicap Inventory (THI) was compiled by cases. Our study indicates that there is a significance correlation between tinnitus and psychopathological disorders, especially with anxiety (\u3c72=8.08; p=0.004) and sleep disturbance (\u3c72=38.85; p=0.0001) and there is a slight correlation between higher THI score and lower age subjects (r=0.76). Especially causing working impairment, the highest correlation resulted for ages 25-50 (r=0.96)

TINNITUS PATIENTS: ETIOLOGIC, AUDIOLOGIC AND PSYCHOLOGICAL PROFILE

Tinnitus represents one of the most frequent symptoms observed in the general population in association with different pathologies, although often its etiology remains unclear. Objective of this work is to evidence the main aspects concerning epidemiology, causes, audiological characteristics and psychological consequences of tinnitus

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&gt;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&lt;0.05) Il nostro studio evidenzia il ruolo di c.35delG, c.167delT e c.-23+1G&gt;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

A Prospective Observational Study on the Role of Immunohistochemical Expression of Orphanin in Laryngeal Squamous Cell Carcinoma Recurrence

To date, histological biomarkers expressed by laryngeal cancer are poorly known. The identification of biomarkers associated with laryngeal squamous cell carcinoma (SCC), would help explain the tumorogenesis and prevent the possible recurrence of the lesion after treatment. For this reason, the aim of this study is to investigate, for the first time, the Orphanin expression in 48 human specimens of laryngeal SCC and evaluate its possible correlation with patients prognosis. We analyzed pathological specimens from 48 patients with laryngeal SCC to detect the presence of Orphanin by using an immunohistochemistry test. We compared the findings with healthy tissue acquired from patients who underwent surgery for mesenchymal benign tumours of the larynx. The specimens were stained with anti-Orphanin monoclonal antibodies. Results were processed through a computerised image analysis system to determine a scale of staining intensity. All the tumoural specimens examined showed a significant immunoreaction for Orphanin when compared with healthy tissues (p &lt; 0.05) but with a different immune reactivity related to clinical-pathological features. A high Orphanin expression was not significantly related to Histological Grading (HG), TNM, and stage (p &gt; 0.05). In the multivariate analysis, the Orphanin expression was significantly related only to the malignant recurrence (p &lt; 0.05). Our study suggests that Orphanin could have a role in tumorigenesis by increasing the recurrence of cancer; therefore, it should be further explored as a possible biomarker for laryngeal cancer

TREATMENT OF TINNITUS AND DIZZINESS ASSOCIATED VERTEBROBASILAR INSUFFICIENCY WITH A FIXED COMBINATION OF CINNARIZINE AND DIMENHYDRINATE

Seventy-eight consecutive subjects, 43 males and 35 females, ranging from 43 to 87 years of age suffering from dizziness and/or tinnitus due to vertebrobasilar insufficiency without other central nervous system diseases were treated with fixed combination of cinnarizine and dimenhydrinate two times a day and for two months. Data were collected considering the following parameters: age, sex, vestibular symptoms (unsteadiness, staggering, tendency to fall, swaying, vertigo due to change of position, bowing, walking, eye movements), headache, tinnitus, impaired hearing and aural fullness. Patients evaluated their vertigo symptoms and/or tinnitus intensities using a graded 3- point visual analog scale ranging from I (no symptoms) to 3 (strong symptoms) and their impact of life with classical tinnitus handicap inventory (THI) and dizziness handicap inventory (DHI) at first appointment, during the treatment and after therapy. The results of THI and DHI evidenced a statistical significant improvement either for tinnitus (t = 3.57; p<0.001) and for vestibular symptoms (t = 4.12; p<0.001); in particular at the final examination, of the 62 patients suffered from tinnitus, the 38.71% (24 cases) did not present the disorder while of the vestibular symptoms; unsteadiness and staggering both evidenced in 65/78 subjects (83.33%) at the beginning of the therapy, disappeared in the 43.08%. In conclusion dual action of the treatment showed improvement of tinnitus and dizziness symptoms, which was confirmed either by symptoms' reduction and by THI and DHI score