Client Oriented Scale of Improvement in First-Time and Experienced Hearing Aid Users: An Analysis of Five Predetermined Predictability Categories through Audiometric and Speech Testing.

Objectives: The aim of our investigation was to explore the relationship between unaided pure-tone and speech audiometry and self-reported aided performance measured according to five predetermined COSI categories among first-time hearing aid users and experienced hearing aid users. Methods: Data from 286 patients were retrospectively evaluated. We divided the sample into first-time hearing aid users (G1) and experienced hearing aid users (G2). The correlation between unaided tonal and speech audiometry and five preliminary selected client-oriented scale of improvement (COSI) categories was studied. Results: A greater percentage of hearing aid users aged >80 years and a higher prevalence of severe-to-profound hearing loss in G2 group were observed (p < 0.05). For the total cohort, a mean hearing threshold of 60.37 ± 18.77 db HL emerged in the right ear, and 59.97 ± 18.76 db HL was detected in the left ear (p > 0.05). A significant statistical difference was observed in the group of first-time hearing aid users for the "Television/Radio at normal volume" item, where patients with a lower speech intellection threshold (SIT) were associated with higher COSI scores (p = 0.019). Studying the relationship between the speech reception threshold (SRT) and the COSI item "conversation with 1 or 2 in noise" evidenced worse speech audiometry in patients who scored ≤2 among experienced hearing aid users (p = 0.00012); a higher mean 4-8 kHz frequencies threshold for the better ear was found within the G2 group among those who scored ≤2 in the COSI item "conversation with 1 or 2 in quiet" (p = 0.043). Conclusions: Our study confirms a poor correlation between unaided tonal and speech audiometry and self-reported patient assessment. Although we included only five COSI categories in this study, it is clear that unaided audiometric tests may drive the choice of proper hearing rehabilitation, but their value in predicting the benefit of hearing aids remains limited.

Functional outcomes for speech-in-noise intelligibility of NAL-NL2 and DSL v.5 prescriptive fitting rules in hearing aid users.

PURPOSE: The primary aim of this research study is to assess whether differences exist in the application of the NAL-NL2 and DSL v.5 prescription formulas in terms of speech-in-noise intelligibility. METHODS: Data from 43 patients, were retrospectively evaluated and analyzed. Inclusion criteria were patients with bilateral conductive, sensorineural, or mixed hearing loss, already using hearing aids for at least 1 year, and aged 18 years or older. Patients were categorized into two groups based on the prescriptive method employed by the hearing aid: NAL-NL2 or DSL v.5. Pure tone audiometry, speech audiometry, free field pure tone and speech audiometry with the hearing aid, and Matrix sentence test were performed. The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire was used to assess the personal audiological benefit provided by the hearing aid. RESULTS: No statistically significant differences were found comparing the free-field pure tone average (FF PTA) and the free-field Word Recognition Score (FF WRS). Comparing the Speech Reception Threshold (SRT) parameter of patients with NAL-NL2 vs DSL v.5, no statistically significant difference was found, thus highlighting a condition of comparability between the two prescription methods in terms of speech-in-noise intelligibility. Comparing the results of the APHAB questionnaire, no statistically significant differences were evident for all subscales and overall benefit. When conducting a comparison between male and female patients using the NAL-NL2 method, no differences were observed in SRT values, however, the APHAB questionnaire revealed a difference in the AV subscale score for the same subjects. CONCLUSION: Our analysis revealed no statistically significant differences in speech-in-noise intelligibility, as measured by the SRT values from the Matrix Sentence Test, when comparing the two prescriptive methods. This compelling result reinforces the notion that, functionally, both methods are comparably effective in enhancing speech intelligibility in real-world, noisy environments. However, it is crucial to underscore that the absence of differences does not diminish the importance of considering individual patient needs and preferences in the selection of a prescriptive method.

Benign paroxysmal positional vertigo and asymmetric hearing loss: is the worst hearing ear likely to suffer from otoconial displacement?

PURPOSE: Benign paroxysmal positional vertigo (BPPV) may be found in patients complaining of hearing disorders. The aim of our investigation was to describe audiological findings in BPPV patients, focusing on subjects with asymmetric hearing loss (AHL), to better understand whether otoconial displacement may occur preferentially in the worst hearing ear. METHODS: A prospective study was performed on 112 BPPV patients. We divided the sample into subjects who suffered from AHL (G1) and patients with did not (G2). Data regarding vestibular symptoms, tinnitus, migraine, antivertigo drug therapy, and vascular risk factors were collected. RESULTS: Out of 30 AHL subjects, 83.33% of them were affected by sensorineural hearing loss (SNHL) in at least one ear, with a significant difference in the distribution of hearing loss type between groups (p = 0.0006). In 70% of cases, the ear affected by BPPV was the one with the worst hearing threshold (p = 0.02); threshold asymmetry predicted BPPV in the worst hearing ear (p = 0.03). The predictability depended neither on the hearing threshold gap between ears nor the severity of the hearing threshold in the worst ear (p > 0.05). No differences in vascular risk factors between groups were observed (p > 0.05). We evidenced a moderate correlation between age and hearing threshold (ρ = 0.43). Age did not result a predictive factor for residual dizziness or BPPV in the worst ear (p > 0.05). CONCLUSIONS: Our study supports the likelihood of an otoconial displacement in the worse hearing ear in BPPV patients. Clinicians should start testing the worst hearing ear when managing AHL patients with suspected BPPV.

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 < 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 > 0.05). In the multivariate analysis, the Orphanin expression was significantly related only to the malignant recurrence (p < 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.

Mastoidectomy in surgical procedures to treat retraction pockets: a single-center experience and review of the literature.

PURPOSE: Retraction pocket (RP) is a common event affecting the middle ear when a negative pressure within it causes a retraction of a single part of the tympanic membrane (TM). Patients can be asymptomatic or can experience hearing loss, fullness feeling and/or ear discharge. RP can be stable or develop a cholesteatoma; aim of the study was to investigate if mastoidectomy may play a role in the surgical management of patients suffering from RP, both reporting our experience and discussing the existing literature. METHODS: Fifty-one patients affected by RP were referred for surgery and randomly divided into two groups. Patients of G1 group underwent tympanoplasty with mastoidectomy, patients of G2 group underwent tympanoplasty only. A systematic review of the literature was then carried out by applying the PRISMA guidelines. RESULTS: The mean follow-up lasted about 36 months. The G1 and G2 groups reached a postoperative mean air-bone gap (ABG) of 7.1 dB HL and 5.1 dB HL, respectively, with a mean ABG improvement of 13.2 dB HL and 12.4 dB HL. An ABG improvement was observed in the 59.7% of the G1 group and in the 63.2% of the G2 group, respectively (p > 0.5). Only one case of long-term complication was recognized in the G1 group. We combined, integrated and analyzed results of our prospective study with results of the literature review. CONCLUSIONS: Based on the combined results of our study and literature review we may conclude that there is no evident benefit in performing mastoidectomy for the treatment of RP. In fact, no differences in ABG improvement or in RP recurrence were reported between the two groups.

Risk Factors for Sensorineural Hearing Loss and Auditory Maturation in Children Admitted to Neonatal Intensive Care Units: Who Recovered?

Background: Newborns admitted to neonatal intensive care units (NICUs) are at higher risk of developing sensorineural hearing loss (SNHL), which may improve over time. The aim of this study was to describe the prevalence of the main risk factors for SNHL in a NICU cohort, focusing on children who underwent auditory maturation. Methods: An observational study of 378 children admitted to NICUs, who were followed for at least 18 months, with periodic audiologic assessments. Results: Out of 378 patients, 338 had normal hearing and 40 were hearing-impaired; we found a higher percentage of extremely preterm (EPT) and extremely low-birthweight (ELBW) infants in SNHL children (p < 0.05). Seventeen infants presented auditory improvement, with a mean maturation time of 6.17 months. A significant difference emerged between patients with stable SNHL and those who improved only in the case of hyperbilirubinemia (p = 0.005). The initial hearing threshold was a predictor of auditory improvement and moderately correlated to the time of auditory maturation (p = 0.02). Conclusions: Our study supports the trend toward recognizing worse prognoses and slower maturation processes among NICU children who suffer from severe to profound SNHL. Caution must be taken when deciding on earlier cochlear implantation.

The prognostic value of subjective nasal symptoms and SNOT-22 score in middle ear surgery.

BACKGROUND: The relationship between nasal functions and middle ear surgery is still under debate. Nasal obstruction is considered as a negative prognostic factor in middle ear surgery. This is based on the theory that it may cause Eustachian tube dysfunction (ETD) by leading to reduced ventilation of the middle ear, as found in several patients with nasal septal deviation, chronic rhinitis and nasal polyps. OBJECTIVES: To assess how the subjective feeling of nasal function, evaluated by a preoperative questionnaire, may be predictive of surgical outcome and/or risk of failure in middle ear surgery. METHODS: We prospectively evaluated data of patients undergoing middle ear surgery for chronic otitis media with and without cholesteatoma. All patients completed the SNOT-22 and ETDQ-7 questionnaires. They underwent surgery for their pathology, as appropriate. RESULTS: The SNOT-22 score was higher in patients with retraction pocket and in patients whose retraction pockets recurred after surgery (p < 0.05). Patients with higher score at SNOT-22 questionnaire, were more likely to show recurrence of atelectasis aftersurgery. CONCLUSIONS: The SNOT-22 questionnaire, administrered before surgical procedure, can help in the identification of patients who are at risk of failure in the post-operative period, as well as ETDQ-7.

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.

Evolution of migraine vertigo in overlapping syndrome with Ménière's disease: prognostic role of instrumental examination.

INTRODUCTION: Migraine vertigo (MV) and Ménière's disease (MD) share several signs and symptoms such as tinnitus, fullness, photophobia, phonophobia, headache and vertigo spells lasting hours. OBJECTIVE: The aim of the present study was to prospectively observe patients with MV with a sporadic audiological symptom evaluated with clinical examination, Vestibular Evoked Myogenic Potentials (VEMPs), ECochG and v-HIT. RESULTS: The finding of VEMP asymmetry, according to our cut-off of 33% of difference between sides, resulted in 20 cases, of which 6 had asymmetry of both c-VEMPs and o-VEMPS, all with development of fluctuating hearing during follow-up. ECochG was positive for endolymphatic hydrops in 12 patients. CONCLUSIONS: The evolution of MV may have a variable course in which some patients may develop symptoms typical of MD. The two diseases may be contextually present at the same time configuring an overlapping syndrome, and asymmetric VEMPs might predict development of fluctuating hearing.

Eustachian Tube Function Assessment after Radiofrequency Turbinate Reduction in Atopic and Non-Atopic Patients.

(1) Background: Inferior turbinates' hypertrophy is often associated with Eustachian tube dysfunction (ETD); radiofrequency turbinate reduction (RTR) may provide a long-term improvement of nasal obstruction and ETD-related symptoms. (2) Aim: The study aimed to compare ETD in atopic and non-atopic patients before and after RTR and to investigate the correlation between tympanometry and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). (3) Methods: Ninety-seven patients, ranging from 33 to 68 years old, were screened by skin tests and divided into atopic (G1) and non-atopic (G2). Eustachian tube function (ETF) was evaluated through tympanometry, William's test and ETDQ-7. (4) Results: A moderate to severe subjective ETDQ-7 was found in the 35.42% of G1 and in the 22.45% of G2 patients before RTR. William's test resulted normal in 141 ears (72.68%), partially impaired in 15 (7.73%), and grossly impaired in 38 (19.59%) before surgery. A grossly ETD was evidenced in the 19.59% of cases before surgery and decreased to 6.18% after surgery with a significant difference among atopic patients (p < 0.001). (5) Conclusion: RTR may be considered a treatment option in patients suffering from ETD and inferior turbinates' hypertrophy; RTR reduced the percentage of grossly impaired ET function (p < 0.001). ETDQ-7 and William's test may represent valuable tools to assess ET function before and after surgery.

Comparison of Electrocochleography and Video Head Impulse Test findings in Vestibular Migraine and Ménière Disease: A Preliminary Study.

OBJECTIVES: To evaluate electrophysiological findings among patients with vestibular migraine (VM) and to compare them with those of patients suffering from definite Ménière disease (MD) without migraine. MATERIALS AND METHODS: Twenty-one consecutive patients suffering from VM were enrolled; all subjects were selected according to the criteria proposed by the Bàràny Society for Neuro-otology. Each patient underwent a careful otological and neurotological examination. After completing a questionnaire regarding migraine and vertigo complaints, they were assessed by audiometric testing, video head impulse test (vHIT), and electrocochleography (EcochG). Data were compared with those of 21 patients who fulfilled the criteria for definite MD. RESULTS: 52.38% of the patients with VM suffered from at least two episodes of migraine per week, with 42.85% of the subjects complaining of migraines lasting ≥24 hours. 57.14% of the patients reported at least four episodes of vertigo per month, whereas 61.9% suffered from symptoms of chronic unsteadiness. No significant difference (p=0.76) resulted from the comparison of vHIT gain between patients with VM and MD. Eleven out of 21 patients (52.38%) with definite MD presented at least one ear with SP/AP >0.4, differently from patients with VM who exhibited SP/AP values suggestive of endolymphatic hydrops (EH) in only three cases (14.28%). CONCLUSION: The present study found a higher proportion of abnormal EcochG in MD than in VM (p=0.02) without any significant difference in the vHIT gain. On the basis of our findings, the identification of EH in some patients with VM cannot be definitely related to the same pathway that triggers MD symptoms. Future research may help in better understanding whether abnormal EcochG findings can predict the occurrence of MD among patients with VM.

Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma / Papel prognóstico da margem de ressecção em cirurgia oncológica aberta de laringe: análise de sobrevida de uma coorte de 139 pacientes com carcinoma de células escamosas

Abstract Introduction: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin. Objective: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis. Methods: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44 ± 28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors. Results: 45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR = 5.043; p = 0.015) and recurrence (HR = 11.586; p = 0.012). Resection margin did not result an independent predictor (HR = 0.757; p = 0.653). Conclusions: Our study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.

Resumo Introdução: O tratamento do carcinoma de células escamosas de laringe necessita de uma estratificação precisa do risco, para a escolha da terapia mais adequada. O significado prognóstico da margem de ressecção ainda é motivo de debate, considerando-se os resultados contraditórios obtidos em vários estudos sobre a taxa de sobrevida de pacientes com margem de ressecção positiva. Objetivo: Avaliar o papel prognóstico da margem de ressecção em termos de sobrevida e risco de recorrência de tumor primário através da análise de sobrevida. Método: Entre 2007 e 2014, 139 pacientes com carcinoma de células escamosas de laringe foram submetidos à laringectomia parcial ou total e foram acompanhados por um tempo médio de 59,44 ± 28,65 meses. O status de margem de ressecção e outras variáveis, como sexo, idade, grau do tumor, pT, pN, técnica cirúrgica adotada e radio- e/ou quimioterapia pós-operatória, foram investigados como fatores prognósticos. Resultados: Dos pacientes, 45,32% foram submetidos à laringectomia total, enquanto os demais foram submetidos à laringectomia parcial. As margens de ressecção em 73,39% das amostras estavam livres, enquanto em 21 pacientes (15,1%) a avaliação anatomopatológica encontrou uma das margens próxima e 16 indivíduos (11,51%) apresentaram margem de ressecção comprometida. Apenas seis pacientes (4,31%) apresentaram recidiva, o que ocorreu em 83,33% desses pacientes no primeiro ano de seguimento. A sobrevida doença-específica foi de 99,24% em um ano, 92,4% em três anos e 85,91% em cinco anos. A análise multivariada de todas as covariáveis mostrou um aumento na taxa de mortalidade apenas em relação à pN (HR = 5,043; p = 0,015) e recidiva (HR = 11,586; p = 0,012). A margem de ressecção não demonstrou ser um preditor independente (HR = 0,757; p = 0,653). Conclusões: Nosso estudo não identificou a margem de ressecção como fator prognóstico independente; a maioria dos artigos publicados anteriormente não tem escolhas metodológicas unânimes e as coortes de pacientes analisados não são fáceis de comparar. Para chegar a uma concordância unânime em relação ao valor prognóstico da margem de ressecção, seria necessário fazer metanálises em estudos que compartilham a definição da margem de ressecção, metodologia e escolhas terapêuticas pós-operatórias.

Is there an association between age at first words and speech sound disorders among 4- to 5-year-old children? An epidemiological cross-sectional study based on parental reports.

OBJECTIVE: To investigate the role of the period of emergence of the first words and its interactions with other risk factors in predicting the development of speech sound disorder (SSD) among 4- to 5-year-old children. METHODS: After 373 children underwent otolaryngology and speech pathology examinations, their parents answered a questionnaire about potential risk factors for speech impairment. The presence of SSD was identified by a speech pathologist who administered Fanzago's Articulation Test to each child. Multivariate logistic analysis was used to explore the relationships between variables and outcomes. RESULTS: Mean age at first words was 17.8 ±â€¯6.5 months of life; 25.7% of patients suffered from SSD, and 3.7% from stuttering. A family history of language impairment was found in 12.9% of the sample, whereas a family history of reading difficulty was reported in only 5.4% of cases. No differences in terms of mean age (p = 0.3) or gestational age (p = 0.16) were found between children affected by SSD and those who were not. Multivariate logistic analysis revealed that male sex (p < 0.001), a family history of language impairment (p < 0.001) and stuttering (p = 0.001) were significantly associated to SSD. Age at first words did not result a predictor of speech impairment. CONCLUSION: In contrast to male sex (p < 0.001), family history of language impairment (p < 0.001) and stuttering (p = 0.001) which resulted significantly associated to SSD, age at first words does not seem to be a predictor of SSD (p = 0.11); however, it remains a useful indicator of language delay and, when considered in association with other language milestones, can be a reason of concern for parents and caregivers about their children's developmental and speech therapy needs.

Prognostic role of resection margin in open oncologic laryngeal surgery: survival analysis of a cohort of 139 patients affected by squamous cell carcinoma.

INTRODUCTION: The treatment of laryngeal squamous cell carcinoma needs accurate risk stratification, in order to choose the most suitable therapy. The prognostic significance of resection margin is still highly debated, considering the contradictory results obtained in several studies regarding the survival rate of patients with a positive resection margin. OBJECTIVE: To evaluate the prognostic role of resection margin in terms of survival and risk of recurrence of primary tumour through survival analysis. METHODS: Between 2007 and 2014, 139 patients affected by laryngeal squamous cell carcinoma underwent partial or total laryngectomy and were followed for mean of 59.44±28.65 months. Resection margin status and other variables such as sex, age, tumour grading, pT, pN, surgical technique adopted, and post-operative radio- and/or chemotherapy were investigated as prognostic factors. RESULTS: 45.32% of patients underwent total laryngectomy, while the remaining subjects in the cohort underwent partial laryngectomy. Resection margins in 73.39% of samples were free of disease, while in 21 patients (15.1%) anatomo-pathological evaluation found one of the margins to be close; in 16 subjects (11.51%) an involved resection margin was found. Only 6 patients (4.31%) had a recurrence, which occurred in 83.33% of these patients within the first year of follow-up. Disease specific survival was 99.24% after 1 year, 92.4% after 3 years, and 85.91% at 5 years. The multivariate analysis of all covariates showed an increased mortality rate only with regard to pN (HR=5.043; p=0.015) and recurrence (HR=11.586; p=0.012). Resection margin did not result an independent predictor (HR=0.757; p=0.653). CONCLUSIONS: Our study did not recognize resection margin as an independent prognostic factor; most previously published papers lack unanimous, methodological choices, and the cohorts of patients analyzed are not easy to compare. To reach a unanimous agreement regarding the prognostic value of resection margins, it would be necessary to carry out meta-analyses on studies sharing definition of resection margin, methodology and post-operative therapeutic choices.

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 (P<0.01). CONCLUSION: The rate of recurrence is closely related to several factors that may be concomitant and therefore, worsen the prognosis. Perforations that affect more than 50% of the tympanic surface are related to a higher rate of failure and are often associated with one of the two conditions previously described. Postoperative infection is the most significant risk factor for recurrence.

Treatment of chronic pain associated with bruxism through Myofunctional therapy.

Temporomandibular disorders such as bruxism may cause painful clinical conditions and over time lead to chronic facial pain. A combination of therapeutic strategies that are usually undertaken by dentists and gnathologists to reduce bruxism episodes and consequently pain, are myofunctional therapy, pharmacological treatment, intraoral interventions and behavioural treatments. The aim of this work was to understand if myofuntional therapy alone can be a useful therapy for the reduction of chronic facial pain. 24 patients, 9 male and 15 female, age ranging between 25 and 45, were treated with a myofunctional therapy for 9 month. Each patient was evaluated through a numeric pain intensity scale ranging from 0 to 10 and the number of bruxism episodes/hour per patient were also recorded; electromyographic examinations of the temporal, masseter, sternocleidomastoid and digastric muscles were performed to evaluate muscle activation. Each patient was tested before (T0) and after (T1) the treatment period. Pain intensity decreased from T0 to T1 (8.13±0.39 vs. 1.75±2.43, respectively, p<0.01). The number of bruxism episodes also significatively decreased between T0 and T1 (24 vs. 9, p<0.01). Electromyographic assessment showed a decrease in the tonic activity of the masseter muscle (T0: 1.88±0.31 vs. T1: 1.4±0.25 µV; p<0.05) and a reduction of the electric activity of the temporal and digastric muscles during serration of the mandible (T0: 167.9±19.6 µV Vs T1: 144.6+16.43 µV; p<0.05 and T0: 58.97+8.38 µV Vs T1: 52.79+7.44 µV; p<0.05, respectively). Myofunctional therapy could be used to reduce facial pain as a consequence of bruxism episodes.

Surgical treatment of choanal atresia with transnasal endoscopic approach with stentless single side-hinged flap technique: 5 year retrospective analysis / Tratamento cirúrgico de atresia de coana com abordagem endoscópica transnasalcom técnica de retalho único e articulação lateral sem colocação de stent: análise retrospectiva de 5 anos

Abstract Introduction: 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 ± 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.

Resumo Introdução: A atresia de coanas é uma malformação congênita rara da cavidade nasal caracterizada pela obliteração completa da coana posterior. Em 67% dos casos a atresia coanal é unilateral, acomete principalmente (71%) a cavidade nasal direita. Diferentemente da forma unilateral, a atresia coanal bilateral é uma condição com risco de vida, frequentemente associada a insuficiência respiratória à alimentação e cianose intermitente exacerbada pelo choro. O tratamento cirúrgico ainda é 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 endoscopia nasal e um exame de tomografia computadorizada maxilofacial. Resultados: Dez homens e oito mulheres com idade média de 20,05 ± 11,32 anos à cirurgia foram submetidos a cirurgia para atresia de coanas. Quinze (83,33%) apresentavam placa atrésica óssea e três (26,77%) placa atrésica ósseo-membranosa mista. Dois e 16 casos tinham 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 identificados. 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 o uso de um stent não é necessário, tal como recomendado no caso de outras técnicas cirúrgicas que envolvem o uso de mais retalhos de mucosas.

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

INTRODUCTION: 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±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.

Factors influencing the development of otitis media among Sicilian children affected by upper respiratory tract infections / Fatores que influenciam a ocorrência de otite media entre crianças sicilianas com infecções de vias aéreas superiores

ABSTRACT 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 < 0.05); children were more susceptible to develop otitis media in the presence of asthma, cough, laryngopharyngeal reflux disease, snoring and apnea (p < 0.05). Allergy and urban localization increased the risk of otitis media in children exposed to smoke respectively of 166% and 277% (p < 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.

RESUMO INTRODUÇÃO: A infecção de vias aéreas superiores é uma denominação inespecífica, empregada na descrição de uma infecção aguda envolvendo o nariz, os seios paranasais, a faringe e a laringe. As infecções de vias aéreas superiores em crianças estão frequentemente associadas à disfunção da trompa de Eustáquio, complicando-se com otite média, um processo inflamatório da orelha média. Já foram relatados vários fatores de risco relacionados à otite média, incluindo os ambientais, epidemiológicos e familiares (p. ex., gênero, fatores socioeconômicos e educacionais, exposição ao tabaco, alergia ou duração do aleitamento materno), entretanto, não dispomos de dados sobre sua ocorrência entre crianças sicilianas com infecções de vias aéreas superiores. OBJETIVO: Investigar os principais fatores de risco para otite média e sua prevalência em crianças sicilianas com e sem infecções de vias aéreas superiores. MÉTODO: Um estudo de caso-controle de 204 crianças com infecções de vias aéreas superiores apresentando otite média durante um período de monitoração de três semanas e 204 controles saudáveis compatíveis em idade e gênero. Foram relacionadas 17 características com relevância epidemiológica por meio da aplicação de questionários padronizados; também foram realizados testes cutâneos. Foram utilizadas análises univariada e de regressão logística multivariada no exame da associação entre fatores de risco e ocorrência de otite média. RESULTADOS: A otite média revelou forte associação com famílias numerosas, baixo nível educacional dos pais e escolaridade no terceiro ano de vida (p< 0,05); as crianças demonstraram maior suscetibilidade para ocorrência de otite média em presença de asma, tosse, doença do refluxo laringofaríngeo, ronco e apneia (p < 0,05). Alergia e localização urbana aumentaram o risco de otite média em crianças expostas ao fumo em 166% e 277% (p < 0,05), respectivamente; o efeito conjunto de asma e presença de animais de estimação na população alérgica aumentou o risco de recidiva em 11%, enquanto que, em conjunto, alergia, tosse e coriza aumentaram esse risco em 74%. CONCLUSÕES: As infecções de vias aéreas superiores e otite média são doenças pediátricas comuns, fortemente associadas a baixo nível educacional dos pais (p = 0,0001), exposição ao fumo (p = 0,0001), exposição domiciliar ao mofo (p = 0,0001), refluxo laringofaríngeo (p = 0,0002) e ausência de aleitamento materno (p = 0,0014). Também foi observado aumento do risco de recidivas de otite média em presença de alergia, tosse persistente e coriza (p = 0,0001). Deve-se recomendar a modificação dos fatores de risco identificados para otite média, para uma correta intervenção terapêutica primária.