Transitions in auditory rehabilitation with bone conductive implant (bci)

Background: The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI). Materials and Methods: The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation. Results: Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects. Conclusions: Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary. Significance: The role of BCI for rehabilitation in middle ear pathology may be extremely important

A case of cavernous hemangioma of the infratemporal fossa causing recurrent secretory otitis media

Secretory otitis media causes aural fullness and hearing loss secondary to Eustachian tube obstruction or incomplete resolution of acute otitis media. Every patient with unilateral middle ear effusion should undergo nasopharyngoscopy to assess the nasopharyngeal space. Expansive lesions at the level of pterygopalatine fossa may cause Eustachian tube compression with tube dysfunction with clinical findings of recurrent unilateral secretory otitis media. In this paper, a 55 years old man presented with a history of hearing loss and fullness in the left ear. Brain MRI scan showed the presence on the left side of a solid mass in the infratemporal masticatory space and the patient underwent endoscopic transnasal resection of the lesion. At 6 months follow-up there was no evidence of disease recurrency. In our opinion, it is important to add an imaging tool to the diagnostic algorithm in all those cases of secretory otitis media lasting more than 3 months that present a negative nasopharyngoscopy evaluation

The Use of Nanoparticles in Otoprotection

The inner ear can be insulted by various noxious stimuli, including drugs (cisplatin and aminoglycosides) and over-acoustic stimulation. These stimuli damage the hair cells giving rise to progressive hearing loss. Systemic drugs have attempted protection from ototoxicity. Most of these drugs poorly reach the inner ear with consequent ineffective action on hearing. The reason for these failures resides in the poor inner ear blood supply, the presence of the blood-labyrinthine barrier, and the low permeability of the round window membrane (RWM). This article presents a review of the use of nanoparticles (NPs) in otoprotection. NPs were recently used in many fields of medicine because of their ability to deliver drugs to the target organs or cells. The studies included in the review regarded the biocompatibility of the used NPs by in vitro and in vivo experiments. In most studies, NPs proved safe without a significant decrease in cell viability or signs of ototoxicity. Many nano-techniques were used to improve the drugs' kinetics and efficiency. These techniques included encapsulation, polymerization, surface functionalization, and enhanced drug release. In such a way, it improved drug transmission through the RWM with increased and prolonged intra-cochlear drug concentrations. In all studies, the fabricated drug-NPs effectively preserved the hair cells and the functioning hearing from exposure to different ototoxic stimuli, simulating the actual clinical circumstances. Most of these studies regarded cisplatin ototoxicity due to the wide use of this drug in clinical oncology. Dexamethasone (DEX) and antioxidants represent the most used drugs in most studies. These drugs effectively prevented apoptosis and reactive oxygen species (ROS) production caused by ototoxic stimuli. These various successful experiments confirmed the biocompatibility of different NPs and made it successfully to human clinical trials

Sudden Hearing Loss Related to COVID‑19 Adenovirus Vector Vaccine?

There are increasing reports connecting the coronavirus disease 2019 (COVID‑19) vaccinations and adverse otological events. These events are mostly explained by the immunological effects or the recorded thrombotic consequences of the vaccinations. The inner ear is liable to be insulted by the thrombosis of the terminal auditory artery causing sudden sensorineural hearing loss (SSNHL). We reported two cases that suffered from SSNHL within 2 weeks after the first dose of the Oxford–AstraZeneca vaccine without any previous hearing problems. These cases showed severe–profound hearing loss in the audiological evaluation. The first case presented with a vestibular hypofunction in the affected ear and received a course of systemic corticosteroids, followed by anticoagulants (heparin). The second case, instead, received six intratympanic injections of corticosteroid, followed by hyperbaric oxygen therapy. The audiological function partially recovered after the treatment in both cases, with complete vertigo recovery in the first case. These results revealed a kind of similarity of the clinical course in COVID‑19‑ and non‑COVID‑19‑associated SSNHL. Hyperbaric therapy showed to be helpful for improving the prognosi

The impact of surgical masks on the nasal function in the COVID-19 era

Background: The Covid-19 pandemics has obliged to using different types of personal protective devices (PPD) for a prolonged time of the day, especially in the Health Centers, with preference of surgical masks (SM) during the first pandemic waves. Aims/Objectives: This study was designed to assess the eventual changes of the nasal respiratory condition during continuous SM wearing. Material and Methods: Fourteen healthcare professionals filled a visual analogue scale (VAS) questionnaire for the detection of eventual nasal breathing impairment or symptoms. Nasal resistance and flow values were obtained via the active anterior rhinomanometry (AAR) that was performed under the basal condition, as well as immediately after wearing the surgical mask (SM) and 3 hours after its continuous use. Results: The increase of inspiratory resistance was significantly correlated to the reduction of the maximum flux, when comparing SM parameters to the basal ones (r=-0.70, p<0.05). At VAS evaluation, SM wearing showed to induce itching in 70% of the subjects, nasal dryness in 55%, nasal blockage in 50%, headache in 39%, watery nasal discharge in 20% and sneezing in 18%. Conclusions and Significance: The SMs do not induce evident physiological variations of the nasal function due to a compensatory respiratory mechanism that, despite a progressive increase of nasal resistances, is not inducing significant changes of the nasal fluxes

The impact of fusion imaging technique on middle ear cholesteatoma surgery. a prospective comparative study

Background: The fusion of computed tomography images with non-echo planner diffusion-weighted magnetic resonance images may overcome the limitations of each individual modality. Objectives: This study aimed to assess the ability of the ’fusion’ technique to predict the location of middle ear cholesteatoma by evaluating Its impact on preoperative surgical planning and postoperative results. Methodology: Eighty-three adults with cholesteatoma underwent preoperative CT scans and non-EPI-DW-MRI with or without the ‘fusion’ technique. We evaluated cholesteatoma localization in both groups, selecting the most appropriate surgical technique, and correlating it with the intraoperative findings. Both groups were compared in terms of residual/recurrent cholesteatoma at one, six and twelve months after surgery. Results: The ‘fusion’ technique’s sensitivity, specificity, and accuracy in predicting the location of cholesteatoma were 97.5. 97.4, and 97.5%, respectively, versus 97.59, 57.69, and 73.21% of CT alone. There was a total operators agreement after the evaluation of the ’fusion’ images with the adopted surgical technique. A statistically significant decrease in residual and recurrence cholesteatoma rates was found in group A. Conclusions: The ’fusion’ technique provides the surgeon with the precise cholesteatoma location, guiding him in making the correct surgical decision, contributing to the decrease in postoperative residual and recurrence rates

Inner ear impairment after stapedotomy. do the cervical vestibular evoked myogenic potentials play a diagnostic role?

Background Otosclerosis is characterized by a bony remodeling process that ends up with stapes fixation. The hearing impairment can be recovered by surgery by replacing the stapes superstructure. Due to the surgical management of the vestibule, the vestibular examination could provide an insight into the correlation between this kind of surgery and vestibular changes. Objectives To evaluate the impact of the stapedotomy on the inner ear. Methods We evaluated pure tone audiometry and the presence of vestibular evoked myogenic potentials (VEMPs) in 41 patients with otosclerosis before and after the stapedotomy operation. Results Air conduction (Ac)-VEMPs were present in 18 cases preoperatively and 31 cases postoperatively. Bone conduction (Bc)-VEMPs were present in 23 cases preoperatively and 33 cases postoperatively. ABG was closed to less than 20 dB in all cases after the operation Conclusions The preoperative Bc-VEMPS had an outstanding capability to predict the type of hearing loss. The postoperative absence of VEMPS despite the closure of ABG indicated the impact of otosclerosis on the saccular cells. The use of Thulium Laser in stapedotomy didn't affect significantly the saccular cells. Significance Integrated use of audiometry and VEMPs was effective to evaluate the changes associated with otosclerosis and the stapedotomy operation

Early non-EPI DW MRI after cholesteatoma surgery

Objective. Middle ear cholesteatoma may display an erosive action on the bony structures of the temporal bone possibly causing intra- and extra-cranial complications. The surgical treatment is mandatory and due to possible residual/recurrent disease, the use of reliable diagnostic methods is essential. Our study aims at evaluating reliability of Non-EPI DW MRI for follow up of cholesteatoma after surgery. Methods. In a study group including 53 consecutive patients who underwent surgery for cholesteatoma at a tertiary University Hospital an imaging protocol has been applied including non-echo planar (EPI) diffusion weighted (DWI) magnetic resonance (MR) at 1 month after surgery and then at six and twelve months after. From the combination of pre-operative assessment and intraoperative findings, the study group was divided into three subgroups: Petrous Bone cholesteatoma (PB), complicated cholesteatoma and uncomplicated cholesteatoma. PB cholesteatoma were treated by a subtotal petrosectomy, while complicated and uncomplicated cholesteatoma were treated either by a canal wall up procedure (CWU) or a retrograde (inside-out) canal wall down technique with bone obliteration (BOT). Results. The results show that patients positive to non-EPI DW MRI one month after surgery had residual cholesteatoma at revision surgery that was performed consequently. All the patients who displayed a negative non-EPI DWI MRI scan at 1-month after surgery did not show presence of the lesion at the 6 and 12-months controls. The six patients who displayed with residual cholesteatoma at 1-month follow-up, presented at primary surgery dehiscence/exposure of the facial nerve canal, mostly at the level of the labyrinthine segment. Conclusion. Non-EPI DW MRI is a useful and reliable tool for following-up cholesteatoma surgery, and when applied early, as it was done in the protocol proposed in the present study, may in a few cases detect the presence of residual cholesteatoma prompting to plan an early revision surgery

The impact of labyrinthine magnetic resonance signal alterations on the treatment of sudden sensory-neural hearing loss

Background: Sudden sensory-neural hearing loss (SSNHL), with positive findings on magnetic resonance imaging (MRI), possibly related to labyrinthine hemorrhage, is a rare condition and difficult to be diagnosed. Objectives: We evaluated the role of MRI in detecting labyrinthine signal changes and the impact of these changes on the prognosis of SSNHL after the intratympanic corticosteroid injection. Methods: A prospective study was held between January and June 2022. We included patients who complained of SSNHL, either idiopathic (30 patients) or labyrinthine signal alterations (14 patients), as diagnosed by MRI performed 15 days after the SSNHL onset. In addition, all patients underwent a course of intratympanic prednisolone injections. Results: 83.3% of the idiopathic group showed a complete or marked improvement after the intratympanic injection. Conversely, most cases of positive MR signal alterations (92.8%) had slight or poor improvement after the therapeutic course. Conclusions: Our study revealed that MRI imaging is essential for assessing any SSNHL case. It can diagnose labyrinthine hemorrhage, whose course and prognosis differ significantly from idiopathic SSNHL. Significance: Intratympanic prednisolone injection was effective in managing idiopathic SSNHL. On the other hand, this therapeutic modality was ineffective in improving SSNHL associated with labyrinthine hemorrhag

Validation of the objective assessment of facial movement with a new software-based system

Background: Most used subjective Unilateral Peripheral Facial Palsy (UPFP) grading systems are characterized by high variability and low reproducibility and doesn’t allow a separate evaluation of single facial regions. Objective: To assess the reliability of a new objective method for classification of UPFP, comparing it with House-Brackmann (HB) and Sunnybrook facial grading (SFGS) systems. Method: Forty-seven patients affected by UPFP of different HB grade were included. Each patient underwent a blinded examination by three different operators, via the two subjective methods (HBGS and SFGS) and a newly proposed objective one, that was obtained from a digital video-analysis, named SMART FACIAL system. Results were converted by validated conversion scales into HBGS grades and statistically compared. Results: In 87,23% (n° 41 pts) consistency was found between the grades obtained with all the three evaluation methods; in 10,41% (n°5 pts), between HBGS and SFGS grade and in 2,08% (n°1 pt) between HBGS grades and SMART-FACIAL system. Statistical analysis showed significant correlation among the three systems (p<0,000). Conclusions: The SMART FACIAL system presents high reliability also in comparison with the most frequently used subjective methods. Significance: This method represents a fast, simple and thorough way to analyze UPFP, especially during physical rehabilitation