Facial nerve schwannoma presenting as mixed hearing loss, tinnitus, and dizziness

Introduction: Facial nerve involvement in skull base tumors is quite a common finding. However, facial nerve tumors are rare. Facial nerve schwannomas can be observed in 75% of facial nerve tumors. They are slowly growing, benign tumors that can arise from any segment of the facial nerve—from the cerebellopontine angle to the parotid gland. The most common clinical presentation in patients with an intratemporal schwannoma is a slowly progressing facial nerve dysfunction. Less frequently, a fluctuating or a sudden facial nerve weakness can be seen. Hearing loss, tinnitus, and dizziness can also be observed in facial nerve schwannomas. Hearing loss can be conductive, sensorineural or mixed, depending on the size and site of the tumor that can extend into the middle ear or erode the cochlea. Tumors of the internal auditory canal or of the cerebellopontine angle usually lead to a retrocochlear sensorineural hearing loss.Case Presentation: The authors present the case of a 19-year-old man suffering from a left-sided hearing loss, tinnitus and dizziness without any facial nerve dysfunction.Results: The patient underwent computed tomography (CT) scan and magnetic resonance imaging (MRI) with gadolinium to investigate the middle ear and internal auditory canal. A left facial nerve schwannoma, involving the geniculated ganglion, was diagnosed.Conclusion: Even if the most common symptoms of facial nerve schwannomas are facial nerve-related symptoms, we should always keep in mind that hearing-related and equilibrium-related symptoms can be the first presenting symptoms

How transformative are community education projects? Meta-analysis of two case studies

Questo contributo è una metanalisi di due casi di educazione comunitaria: una mostra riguardante gli Eelam Tamil (Londra); una passeggiata di attraversamento di una comunità svantaggiata (Sud Africa). L’analisi ha lo scopo valutare questi interventi alla luce di sei categorie fondate sull’apprendimento trasformativo. Il risultato qualitativo più saliente di questo studio riguarda il complesso rapporto tra costruzione di ruoli sociali stabili e raggiungimento dei fini trasformativi comunitari. This paper is a meta-analysis of two community education projects: an exhibition on the Eelam Tamil (London); a transect walk in a vulnerable community (South Africa). The analysis aims to assess such interventions through the lenses of six categories drawn on transformative learning. The most relevant qualitative result obtained by this study deals with the complex relation between construction of stable social roles and the achievement of community transformative goals

Orientamento degli adolescenti svantaggiati nei contesti socioeducativi: Soluzioni dal Friuli Venezia Giulia

Fragile youths are at risk of dropout and the toll of their vulnerability is paid in terms of low employment rates, which, in turn, is a damage to their prospects. In this regard, the positive results of the Friuli Venezia Giulia Region, which rank above the Italian national mean, call for a closer investigation of what is being done in its socio-educational settings. Hence, two guidance strategies are hereby presented, each taking place in a different province: Udine and Gorizia. Among the ensuing solutions: a parental approach to education (also from the point of view of relevant policies), a renewed attention to the value of manual labour, and a reform of the role and duties of social educators.Gli adolescenti fragili sono a rischio di dispersione scolastica e scontano la propria vulnerabilità in termini di collocamento, a danno del loro progetto di vita. In questo senso, i risultati positivi della Regione Friuli Venezia Giulia rispetto alla media nazionale motivano il presente contributo: effettuare una ricognizione delle buone pratiche in atto nei contesti socioeducativi che si occupano dei giovani svantaggiati. Sono quindi presentate due strategie di orientamento, realizzate, rispettivamente, da una realtà socioeducativa della provincia di Udine e una della provincia di Gorizia. Tra le soluzioni emergenti: l’approccio parentale all’educazione (anche dal punto di vista delle policy di riferimento), la rivalutazione dei mestieri manuali e, in generale, la riforma della figura dell’educatore sociale

Approach to residual dizziness after successfully treated benign paroxysmal positional vertigo: effect of a polyphenol compound supplementation

Purpose: To assess if a polyphenol compound supplementation (Vertigoval (R)) could improve residual dizziness earlier after benign paroxysmal positional vertigo (BPPV) and relieve patients from this disabling symptomatology.Methods: In this prospective, multicentric study, 127 patients were randomized in the treatment group (TG), who received a 60-day supplementation, while 131 patients were randomized in the control group (CG), who did not receive any medication. The dizziness handicap inventory (DHI) score, static posturography, and the visual analog scale (VAS) for both dizziness (D-VAS) and nausea/vomit (N/V-VAS) were used as measures of outcome at baseline and after 30 and 60 days. Patients were asked about efficacy and tolerance to the treatment. Side effects were examined.Results: A statistically significant greater decrease was established in the TG for DHI, DVAS, and N/V-VAS compared to the CG. On the other hand, static posturography did not show statistical differences between the two groups, though a better clinical improvement after 60-day supplementation was shown in the TG in comparison to the CG. We counted mild side effects in only 2 patients. Most patients reported an excellent or good efficacy and tolerance to the treatment.Conclusion: Residual dizziness is a frequent condition of unknown origin that manifests as persistent disabling imbalance after successful repositioning maneuvers for BPPV. The decreasing postural control can affect the quality of life, contributing to falling and psychological problems. The supplementation with the polyphenol compound used in our study is safe, manageable, and appeared to be able to reduce subjective symptoms and improve instability earlier, decreasing the risk of potential complications

Effectiveness of Radiomic ZOT Features in the Automated Discrimination of Oncocytoma from Clear Cell Renal Cancer

Background: Benign renal tumors, such as renal oncocytoma (RO), can be erroneously diagnosed as malignant renal cell carcinomas (RCC), because of their similar imaging features. Computer-aided systems leveraging radiomic features can be used to better discriminate benign renal tumors from the malignant ones. The purpose of this work was to build a machine learning model to distinguish RO from clear cell RCC (ccRCC). Method: We collected CT images of 77 patients, with 30 cases of RO (39%) and 47 cases of ccRCC (61%). Radiomic features were extracted both from the tumor volumes identified by the clinicians and from the tumor’s zone of transition (ZOT). We used a genetic algorithm to perform feature selection, identifying the most descriptive set of features for the tumor classification. We built a decision tree classifier to distinguish between ROs and ccRCCs. We proposed two versions of the pipeline: in the first one, the feature selection was performed before the splitting of the data, while in the second one, the feature selection was performed after, i.e., on the training data only. We evaluated the efficiency of the two pipelines in cancer classification. Results: The ZOT features were found to be the most predictive by the genetic algorithm. The pipeline with the feature selection performed on the whole dataset obtained an average ROC AUC score of 0.87 ± 0.09. The second pipeline, in which the feature selection was performed on the training data only, obtained an average ROC AUC score of 0.62 ± 0.17. Conclusions: The obtained results confirm the efficiency of ZOT radiomic features in capturing the renal tumor characteristics. We showed that there is a significant difference in the performances of the two proposed pipelines, highlighting how some already published radiomic analyses could be too optimistic about the real generalization capabilities of the models

Prevention of Recurrent Benign Paroxysmal Positional Vertigo: The Role of Combined Supplementation with Vitamin D and Antioxidants

Benign paroxysmal positional vertigo (BPPV) usually has a favorable course, although it is possible to observe BPPV with a high recurrence rate. Previous studies suggested that vitamin D deficiency might affect BPPV recurrences, and oxidative stress might play a complementary role in BPPV pathogenesis. This multicentric trial aimed to evaluate the effectiveness of oral nutritional supplementation with a compound of alpha-lipoic acid, Carnosine, and Zinc (LICA (R) (Difass International, Coriano (RN), Italy)), vitamins of group B and vitamin D in preventing BPPV recurrences. A total of 128 patients with high recurrence-BPPV were randomized in three arms: Arm 1 consisted of subjects with "insufficient" or "deficient" vitamin D blood levels, treated with daily oral supplementation of LICA (R), vitamins of group B and vitamin D3 (800 UI), Arm 2 included BPPV subjects with "sufficient" vitamin D who did not receive any nutritional support, and Arm 3 included subjects with a "sufficient" serum concentration of vitamin D who received supplementation with a compound of LICA (R) and Curcumin. After six months of follow-up, a significant reduction of BPPV relapses compared to the baseline was found only in Arm 1 (-2.32, 95% CI: 3.41-1.62, p-value < 0.0001). Study results suggested that oral nutritional supplementation with vitamin D3 plus antioxidants can prevent relapses in patients suffering from high recurrence-BPPV

A Clinical Infrared Video-Oculoscopy Suppression Head Impulse (IR-cSHIMP) Test

Background: We propose a Suppression Head IMPulse (SHIMP) test method that provides for equipment only through the use of InfraRed Video-OculoScopy (IR-VOS) and allows horizontal and vertical semicircular canal function evaluation in bedside mode. We therefore named the test InfraRed clinical SHIMP (IR-cSHIMP). Methods: To check IR-cSHIMP diagnostic efficiency, we studied 22 normal subjects, 18 patients with unilateral, and 6 with bilateral deficient vestibulopathy. Each subject first underwent a vestibular examination and, only later, an IRc-SHIMP test. Results: When the IR-cSHIMP test was performed in the horizontal plane, all normal subjects showed anti-compensatory saccades. When the vertical semicircular canal function was evaluated, the same result was obtained in all normal subjects except three, which were considered false positives. In patients with vestibular deficits, the test performed in the horizontal and vertical planes were always pathological, with 100% agreement between clinical and instrumental tests. Conclusions: Our bedside method proved to be fast, simple, and effective in discriminating between healthy and pathological subjects. It required only the same skill as the better-known cHIT. For these reasons, we believe that the IR-cSHIMP should be part of daily clinical practice as a useful tool in the selection of patients to undergo more sophisticated investigations