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

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

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

Augmented virtual reality in vestibular assessment: a dynamic gait application

Introduction: Dizziness is a common complaint affecting up to 23% of the world population. Diagnosis is of utmost importance and routinely involves several tests to be performed in specialized centers. The advent of a new generation of technical devices would make envision their use for a valid objective vestibular assessment. Microsoft HoloLens 2 (HL2) mixed reality headset has the potential to be a valuable wearable technology that provides interactive digital stimuli and inertial measurement units (IMUs) to objectively quantify the movements of the user in response to various exercises. The aim of this study was to validate the integration of HoloLens with traditional methods used to analyze the vestibular function in order to obtain precise diagnostic values. Methods: Twenty-six healthy adults completed the Dynamic Gait Index tests both with a traditional evaluation and while wearing HL2 headset, thus allowing to collect kinematic data of the patients’ head and eyes. The subjects had to perform 8 different tasks, and the scores were independently assigned by two otolaryngology specialists. Results: The maximum of the mean position of the walking axis of the subjects was found in the second task (−0.14 ± 0.23 m), while the maximum value of the standard deviation of the walking axis was found in the fifth task (−0.12 ± 0.27 m). Overall, positive results were obtained in regard to the validity of the HL2 use to analyze kinematic features. Conclusion: The accurate quantification of gait, movement along the walking axis, and deviation from the normality using HL2 provide an initial evidence for its useful adoption as a valuable tool in gait and mobility assessment

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

What is the most appropriate hemostatic material during pediatric adenoidectomy? A prospective comparative randomized double-blinded controlled study

Objectives: To evaluate the effect of different hemostatic materials used in adenoidectomy operations to improve the quality of life with the most negligible hazardous impact on pediatric health. Study design: a prospective, case-series, randomized, controlled, double-blinded study. Setting: All adenoidectomy surgeries were performed between September 2016 to December 2019 at tertiary referral institutions. Patients and methods: 519 patients were included in five groups. Adenoidectomy was performed under general anesthesia, with the following hemostatic procedures: adrenaline, tranexamic acid, hydrogen peroxide, xylo­ metazoline, and saline (as a control group). The five groups were compared regarding the intraoperative blood loss, surgery duration, need for more hemostatic steps, postoperative reactionary and secondary bleedings, postoperative pain and halitosis, and one-year outcome. Results: The four procedures were effective in reducing the blood loss by 19.86%, 11.7%, 30.95%, and 18.91%, respectively, in comparison to the control group. The surgical duration was reduced by 27.65%, 17.86%, 48.11%, and 23.88%, respectively. The need for other hemostatic steps was the least in the hydrogen peroxide group. There was no significant difference between the five groups regarding reactionary bleeding, secondary bleeding, one-week pain, one-month pain, one-month halitosis, and one-year complications. On the other side, hydrogen peroxide had the least one-week halitosis and first-day pain among the five groups. Also, it had the least intraoperative blood loss and surgery duration. Conclusions: Hydrogen peroxide showed to be the best choice to control hemostasis during an adenoidectomy. It can decrease blood loss and surgery duration with less need for other hemostatic steps. It can improve the pa­tient’s quality of life without significant postoperative complications. Xylometazoline was studied for the first time as a hemostatic material during adenoidectomy with good satisfying results

La lastra incisa

Il volume ricostruisce la figura di Luigi Bartolini nella sua produzione poetica ed artistic

Contrasting Fake News in Oncology: The First Declaration of Good Communication

Nowadays, websites, online journals, and social media give access to an extraordinary amount of medical information. Misleading news are often disseminated generating false expectations, exaggerated anxiety, and confusion; in oncology setting, disinformation is perhaps more deleterious than in other fields, with a considerable impact on single patients as well as on families and, more in general, on Public Health. We aimed to promote a better interaction between the health care and the world of communication