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INTRODUCTION: Purpose of our study was to compare two competing methods of performing bisyllabic word speech audiometry for the detection of the 50% speech reception threshold in noise (SRT50). METHODS: Classic method is performed submitting multiple word lists at a fixed signal-to-noise ratio. A newer Fast method - Italian Fast Speech Reception Threshold 50 (IFastSRT50) - is performed by means of program software with a single list of bisyllabic words and noise intensity shifting. RESULTS: Means comparison between SRT50 Classic and IFastSRT50 shows a slight significant correlation (r = 0.263; p = 0.044) and a wide significant difference: SRT50 Classic = -2.763 dB (SD = 4.1) and IFastSRT50 = -7.803 dB (SD = 2.1) (p < 0.0001). There is a high difference between the test execution time means (SRT50 Classic = 11 min, IFastSRT50 = 2 min; p < 0.0001). The correlation between test results and execution times was higher for SRT50 Classic than IFastSRT50. CONCLUSION: IFastSRT50 test is a reliable method to quickly investigate signal-to-noise ratio needed to obtain 50% of recognition scores with bisyllabic words; it allows less execution time than SRT50 Classic method and can avoid patient fatigue and other limitations of different speech discrimination tests in noise as sentences based ones.
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BACKGROUND: Tonsillectomy and adenotonsillectomy are surgical procedures routinely performed worldwide, with various complications, including postoperative bleeding (PTH). Among haemostatic agents, bismuth subgallate (BS) has been employed in the past decades, but its use is controversial in children. OBJECTIVE: This retrospective, multicentre study aims to evaluate the effectiveness and safety of BS in preventing PTH following tonsillectomy and adenotonsillectomy. MATERIALS AND METHODS: Two cohorts of children between 0 and 18 years of age were compared in two different hospitals. The first (active) group of patients included children who underwent tonsillectomy/adenotonsillectomy performed using BS added to gauze swabs, whereas this agent was not administered to the second (control) group. The following variables were analysed: age, gender, degree of tonsillar hyperplasia, length of hospital stay, acute complications (including bleeding and infection), further admissions to the Paediatric Emergency Department (PED), and further hospital admissions in the 30 days postoperatively. RESULTS: Four-thousand- seven hundred forty-four children were included in the study, 2598 in the active group and 2146 in the control group. The cases included in the active treatment group displayed a significantly reduced PTH prevalence, 1.4 versus 2.6 % (p < 0.05). No cases of neurological complications or aspiration pneumonia were detected. CONCLUSIONS: This study supports BS as a safe and reliable option for preventing severe PTH following tonsillectomy/adenotonsillectomy.
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Ácido Gálico/análogos & derivados , Compostos Organometálicos , Tonsilectomia , Criança , Humanos , Tonsilectomia/efeitos adversos , Tonsilectomia/métodos , Estudos Retrospectivos , Adenoidectomia/efeitos adversos , Adenoidectomia/métodos , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controleRESUMO
BACKGROUND: Conventional technique for transcutaneous bone-anchored hearing implants surgery requires the elevation of a large retroauricular skin flap to expose the site of implantation, that may cause a large scar and the interruption of retroauricular vasculature. METHODS: A less invasive, endoscopic-assisted modification of the surgical technique is described, which provides access to the implant site through two small skin incisions and the creation of a pocket in the retroauricular area. CONCLUSION: Endoscopic-assisted bone-anchored hearing implant surgery could be a viable option for transcutaneous bone-anchored hearing implant surgery, especially for pediatric patients.
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Prótese Ancorada no Osso , Auxiliares de Audição , Condução Óssea , Criança , Audição , Testes Auditivos , Humanos , Âncoras de SuturaRESUMO
OBJECTIVE: To predict the impact of face personal protective equipment on verbal communication during the SARS-CoV-2 pandemic. DESIGN: We assessed the effect of common types and combinations of face personal protective equipment on speech intelligibility in quiet and in a simulated noisy environment. RESULTS: Wearing face personal protective equipment impairs transmission of middle-to-high voice frequencies and affects speech intelligibility. Surgical masks are responsible for up to 23.3% loss of speech intelligibility in noisy environments. The effects are larger in the condition of advanced face personal protective equipment, accounting for up to 69.0% reduction of speech intelligibility. CONCLUSION: The use of face personal protective equipment causes significant verbal communication issues. Healthcare workers, school-aged children, and people affected by voice and hearing disorders may represent specific at-risk groups for impaired speech intelligibility.
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COVID-19 , SARS-CoV-2 , Criança , Comunicação , Humanos , Máscaras , Equipamento de Proteção Individual , Inteligibilidade da FalaRESUMO
Recurrent acute otitis media (RAOM) in children is clinically defined as the occurrence of at least three episodes of acute otitis media over a course of 6 months. A further common pathological condition of interest in the context of pediatric otolaryngology is adenotonsillar hypertrophy (ATH), a common cause of obstructive sleep apnea syndrome. Aimed at unraveling the differential modulation of proteins in the two pathologies and at understanding the possible pathways involved in their onset, we analyzed the proteomic profile of the adenoids from 14 RAOM and ATH patients by using two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). The 2-DE coupled with MS allowed us to identify 23 spots with significant (p-value < 0.05) changes in protein amount, recognizing proteins involved in neutrophil degranulation and glycolysis pathways.
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Otite Média/etiologia , Otite Média/metabolismo , Proteoma , Proteômica , Suscetibilidade a Doenças , Eletroforese em Gel Bidimensional , Regulação da Expressão Gênica , Glicólise , Humanos , Espectrometria de Massas , Redes e Vias Metabólicas , Otite Média/patologia , Proteômica/métodos , Recidiva , Transdução de SinaisRESUMO
Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Nucleus 6 sound processor features a data logging system capable of real-time recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1,366 CI patients, as recorded by SCAN. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed.
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Percepção Auditiva/fisiologia , Implante Coclear , Implantes Cocleares , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Ruído , Som , Percepção da Fala/fisiologia , Adulto JovemRESUMO
The authors present the case of a young boy who experienced progressive unilateral hearing loss initially believed to be unrelated to any other medical condition. Methods: The patient received a thorough evaluation, which included a comprehensive battery of audiological tests, a CT scan, and a gadolinium-enhanced MRI. Results: A repeated imaging investigation revealed the presence of a mass that mimicked a vestibular schwannoma (VS), but despite this, the boy was ultimately diagnosed with cerebral manifestations of B-cell acute lymphoblastic leukemia (B-ALL). Conclusions: Cerebral lesions originating from the internal auditory canal are rare in cases of B-ALL. In this case, the initial signs and symptoms of the disease were solely related to the audiovestibular system, making the diagnostic process particularly complicated. Unilateral hearing loss cases may indicate the presence of potentially life-threatening conditions, even if the hearing loss appears to be clinically non-syndromic. For these reasons, unilateral hearing losses necessitate a comprehensive interdisciplinary diagnostic approach from the very start of auditory manifestation and, in particular, if the hearing impairment demonstrates threshold progression.
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PURPOSE: This work presents a new frame-by-frame video analysis method called Child-Caregiver Communication Assessment through Rebesco's Evaluation (CC-CARE), developed in the context of pediatric hearing loss as a rehabilitation tool for assessing children's early communication skills. CC-CARE stems from the commonly used Tait video analysis and extends it by including a new set of parameters aimed at disentangling between hearing-dependent and hearing-independent aspects of communication. METHOD: In this paper, we collected video samples of child-caregiver interactions in a group of 65 normal-hearing children and a group of 165 hearing-impaired children. For each group, we present the CC-CARE method and describe the parameters, their score distributions, correlations and we estimate the adherence of the CC-CARE scores with children's developmental trajectory. Moreover, we compare the results of CC-CARE scores between the two groups having had different development of the auditory system. Finally, a fully-data driven approach was employed to assess the consistency of the communicative efficacy index (CEI), a score aiming to capture a global result of the CC-CARE procedure. RESULTS: Correlations among parameter scores were found in each within-group analysis, revealing CC-CARE's internal consistency in measuring associated but nonoverlapping communication dimensions. For both groups, CC-CARE scores were associated with participants' age. Differences between scores emerged for a between-group analysis, indicating CC-CARE sensitivity to extract communication differences as a function of the hearing status. For both groups, the data analysis revealed that the CEI captures large variance portions across all parameter scores of the CC-CARE method. CONCLUSIONS: Results provide the first evidence that the CC-CARE video analysis method could be a reliable tool capable of highlighting the cascading effects of hearing impairment on children's preverbal communicative efficacy. The CC-CARE method aims to support early rehabilitation of hearing loss by describing a child's communicative efficacy.
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Cuidadores , Comunicação , Perda Auditiva , Humanos , Masculino , Feminino , Pré-Escolar , Criança , Cuidadores/psicologia , Gravação em Vídeo , LactenteRESUMO
BACKGROUND/OBJECTIVES: Otosclerosis is a relatively uncommon condition that causes conductive hearing loss in children. The preferred treatment for adults is stapedotomy, while for individuals under 18 years old, there is an ongoing discussion about the best treatment approach. Thus, the surgical procedure for the stapes in pediatric patients continues to be a subject of debate. This study aimed to evaluate the results of stapes surgery in children, trying to understand, based on our results, whether this is actually the most suitable option. METHODS: The study included 18 patients who underwent surgery between January 2013 and December 2023. The patients' ages ranged from 11 to 18 years, with an average age of 14.7. Out of the total 21 surgeries, three patients opted for bilateral surgery. Pre- and post-operative data were compared, focusing on the mean air conduction (AC) and bone conduction (BC) thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Additionally, pre-operative thresholds and the post-operative air-bone gap (ABG) were examined. RESULTS: After a year, the air-bone gap was effectively reduced to 10 dB or less in 94% of the 21 cases, and to 20 dB or less in 98% of all cases. CONCLUSIONS: Our results and research in the field have consistently shown that stapedotomy, when conducted by skilled otosurgeons, is a reliable and successful procedure for a considerable number of patients. The outcomes it generates are similar to those achieved through the procedure conducted during adulthood.
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Given the crucial role of the personalized management and treatment of hearing loss (HL), etiological investigations are performed early on, and genetic analysis significantly contributes to the determination of most syndromic and nonsyndromic HL cases. Knowing hundreds of syndromic associations with HL, little comprehensive data about HL in genomic disorders due to microdeletion or microduplications of contiguous genes is available. Together with the description of a new patient with a novel 3.7 Mb deletion of the Xq21 critical locus, we propose an unreported literature review about clinical findings in patients and their family members with Xq21 deletion syndrome. We finally propose a comprehensive review of HL in contiguous gene syndromes in order to confirm the role of cytogenomic microarray analysis to investigate the etiology of unexplained HL.
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Deleção Cromossômica , Cromossomos Humanos X , Perda Auditiva , Humanos , Cromossomos Humanos X/genética , Perda Auditiva/genética , Masculino , Síndrome , Feminino , LinhagemRESUMO
OBJECTIVES: Communicating in noisy settings can be difficult due to interference and environmental noise, which can impact intelligibility for those with hearing impairments and those with normal hearing threshold. Speech intelligibility is commonly assessed in audiology through speech audiometry in quiet environments. Nevertheless, this test may not effectively assess hearing challenges in noisy environments, as total silence is rare in daily activities. A recently patented method, known as the SRT50 FAST, has been developed for conducting speech audiometry in noise. This new method enables the acceleration and simplification of free field speech audiometry tests involving competition noise. This study aims to establish normative scores and standardize the SRT50 FAST method as a test for evaluating speech perception in noise in pediatric patients. METHODS: The study included 30 participants with normal hearing, consisting of 11 females and 19 males, ranging in age from 6 to 11 years. A series of speech audiometry tests were conducted to determine the speech reception threshold 50% (SRT50) in competing conditions. This included testing both the fast mode (SRT50 FAST) currently being studied and the traditional method (SRT50 CLASSIC). The SRT50, or Signal to Noise Ratio (SNR) at which 50% of speech recognition occurred, was investigated for both methods. RESULTS: The mean SRT50 FAST test score was -2.69 (SD = 3.15). The dataset exhibited a normal distribution with values ranging from 3.60 to -8.60. Since the scores are expressed in SRT, higher scores indicate poorer performance. We have established a threshold of 3.60 as the upper limit of the normal range, therefore, patients with scores above this threshold are considered to have abnormal results. CONCLUSIONS: This study aimed to establish normative data for the evaluation of free field speech in noise recognition using the SRT50 FAST method in the pediatric population. This method accurately investigates the necessary signal-to-noise ratio for achieving 50% recognition scores with bisyllabic words in a quick manner. The ultimate objective is to employ this test to identify the optimal configuration of hearing rehabilitation devices, particularly for pediatric patients with hearing aids and/or cochlear implants. Additionally, it can be used to assess pediatric patients with unilateral hearing loss.
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Ruído , Percepção da Fala , Humanos , Masculino , Feminino , Criança , Percepção da Fala/fisiologia , Valores de Referência , Teste do Limiar de Recepção da Fala , Limiar Auditivo/fisiologia , Audiometria da Fala/métodos , Razão Sinal-RuídoRESUMO
Pediatric ear, nose, and throat (ENT) surgery is very common, and its outcomes may improve with family education. In this regard, mobile health (mHealth) applications (apps), which are on the rise due to digital transformation, can be beneficial in healthcare. This study outlines the user-centered design and development of a mHealth app (version 5.15.0) to support family caregivers during the perioperative process of pediatric ENT surgery. Conducted over two years in an Italian maternal and child health hospital (January 2020-May 2022), the study employed a participatory design method based on the Information System Research (ISR) framework and guided by the principles of Slow Medicine. Utilizing the Relevance, Rigor, and Design cycles of the ISR framework, the mHealth app's content, functionalities, and technical features were defined and developed. A committee of fifteen experts guided the process with input from 25 family caregivers and 24 healthcare providers enrolled in the study. The mHealth app content was structured around five crucial educational moments characterizing the ENT perioperative period, providing evidence-based information on surgical procedures, strategies for preparing children for hospitalization and surgery, pain management, and post-discharge care. The mHealth app featured a function that sends customized notifications to guide caregivers at specific perioperative stages. The development of mHealth apps by implementing a rigorous, participatory, and Slow design process can foster accessible and family-centered information and care in the field of maternal and child health and beyond.
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Objective: Implantable hearing devices represent a modern and innovative solution for hearing restoration. Over the years, these high-tech devices have increasingly evolved but their use in clinical practice is not universally agreed in the scientific literature. Congresses, meetings, conferences, and consensus statements to achieve international agreement have been made. This work follows this line and aims to answer unsolved questions regarding examinations, selection criteria and surgery for implantable hearing devices. Materials and methods: A Consensus Working Group was established by the Italian Society of Otorhinolaryngology. A method group performed a systematic review for each single question to identify the current best evidence on the topic and to guide a multidisciplinary panel in developing the statements. Results: Twenty-nine consensus statements were approved by the Italian Society of Otorhinolaryngology. These were associated with 4 key area subtopics regarding pre-operative tests, otological, audiological and surgical indications. Conclusions: This consensus can be considered a further step forward to establish realistic guidelines on the debated topic of implantable hearing devices.
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Auxiliares de Audição , Humanos , Implantes Cocleares , Perda Auditiva/terapia , Perda Auditiva/cirurgia , ConsensoAssuntos
Meningite Pneumocócica/etiologia , Meningoencefalite/etiologia , Otite Média/complicações , Diagnóstico Tardio , Feminino , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Humanos , Lactente , Meningite Pneumocócica/diagnóstico , Meningoencefalite/diagnóstico , Otite Média/diagnósticoRESUMO
BACKGROUND: Language and communication outcomes in children with congenital sensorineural hearing loss (cSNHL) are highly variable, and some of this variance can be attributed to the quantity and quality of language input. In this paper, we build from the evidence that human language is inherently multimodal and positive scaffolding of children's linguistic, cognitive, and social-relational development can be supported by Parent Centered Early Interventions (PCEI), to suggest that the use of gestures in these interventions could be a beneficial approach, yet scarcely explored. AIMS AND METHODS: This systematic review aimed to examine the literature on PCEI focused on gestures (symbolic and deictic) used to enhance the caregiver-child relationship and infant's language development, in both typically and atypically developing populations. The systematic review was conducted following the PRISMA guidelines for systematic reviews and meta-analyses. From 246 identified studies, 8 met PICO inclusion criteria and were eligible for inclusion. Two reviewers screened papers before completing data extraction and risk of bias assessment using the RoB2 Cochrane scale. RESULTS: Included studies measured the effect of implementing symbolic or deictic gestures in daily communication on the relational aspects of mother/parent-child interaction or on language skills in infants. The studies indicate that gesture-oriented PCEI may benefit deprived populations such as atypically developing children, children from low-income families, and children who, for individual reasons, lag behind their peers in communication. CONCLUSIONS: Although gesture-oriented PCEI appear to be beneficial in the early intervention for atypically developing populations, this approach has been so far scarcely explored directly in the context of hearing loss. Yet, symbolic gestures being a natural part of early vocabulary acquisition that emerges spontaneously regardless of hearing status, this approach could represent a promising line of intervention in infants with cSNHL, especially those with a worse head start.
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Surdez , Gestos , Humanos , Lactente , Comunicação , Idioma , Desenvolvimento da Linguagem , Relações Pais-FilhoRESUMO
Objective: The study investigates what is the link between early verbal and non-vocal abilities, when does predominantly verbal communicative style occur after the intervention with cochlear implants (CI) or hearing aids (HA), and how predictive it is of later linguistic development in deaf and hard of hearing (DHH) infants and children. Methods: Cohort: children with moderate-to-profound hearing impairment (N = 49, 20 girls, mean age at HA or CI intervention = 15 months, range: 4-35 months). Measures: Receptive and productive vocabulary at 24 and 36 months and video analysis at 12 months post-intervention. Analysis: Predictive values of total and verbal responses to communicative turns for later vocabulary development were assessed, as well as the relative time course of the development of vocal/verbal communication in DHH children. Results: Vocabulary at 24 months is predicted by auditory responses at 12 months, as well as by overall responsiveness before intervention. Non-vocal responses decline and overall verbal responses increase significantly between 6 and 12 months after intervention. The trend is delayed in children with delayed (>12 months of age) treatment with CI or HA. Conclusions: Age of intervention affects the development of vocal/verbal communicative style. Language development, in particular, vocabulary growth, can be further stimulated by the enhancement of preverbal (both vocal and non-vocal) communicative skills.
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Ototoxic drugs can result in hearing loss and tinnitus. Early detection of the ototoxic process can help minimize or prevent these consequences. The American Speech-Language-Hearing Association has provided guidelines for monitoring ototoxicity, whereas Italy has not yet implemented a national monitoring protocol. This study aims to assess the current state of ototoxicity monitoring in patients receiving cisplatin therapy. A self-administered survey has been used to gather information from oncologists, audiologists, and ENT specialists. The research was conducted at Santa Maria della Misericordia hospital in Perugia. Two questionnaires were administered, one to ENT/audiology specialists and another to oncology specialists. Both questionnaires were used to collect information on awareness of chemotherapy-induced ototoxicity. A comprehensive understanding of cisplatin-induced ototoxicity has been widely established (100%). The most commonly reported audiological symptoms by patients were hearing loss (100%) and tinnitus (87.5%). The majority of ENT and audiologists (93.8%) and oncologists (92.9%) expressed the need for a specific ototoxic monitoring program. However, they noted the absence of a well-defined ototoxicity monitoring protocol. A well-established and efficient ototoxic monitoring system facilitates early detection of ototoxic hearing loss and subsequent rehabilitation of inevitable hearing impairment.
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Objective: To assess newborn hearing screening (NHS) impact on timing of cochlear implant (CI) surgery of patients with prelingual bilateral profound hearing impairment (BPHI), in order to evaluate whether the NHS ultimately serves the needs of the target population in Italy. Methods: An online questionnaire was created to survey subjects affected by prelingual BPHL born between 1990 and 2018. Questions focused on age at BPHI diagnosis, first and second CI surgery (if performed), and the region in which the surgery was performed. The survey was distributed to potential participants via social media communities used by hearing impaired people or their family members for sharing advice and offering support. Responses were analyzed using descriptive statistics. Results: Among the 318 respondents who completed the questionnaire, 276 (87%) reported having chosen CI surgery, 2/3 of them bilaterally. In the vast majority (97%) of cases the CI is used on a daily basis. Most of the people residing in the center (65%) and southern Italy (71%) had to move from their region of residence to perform the surgery. Late CI surgery was associated with failure to perform NHS (p = 0.007), birth before 2011 (p = 0.009), definitive diagnosis of BPHI after 6 months of life (p = 0.002), and progressive hearing impairment (p < 0.001). Conclusion: The worldwide scientific approval of the NHS as the current best opportunity for early diagnosis and CI treatment for prelingual BPHI is confirmed by what patients and families reported via the online questionnaire used for this study. In recent years, early bilateral cochlear implantation has become increasingly available in Italy, but late diagnosis, progressive hearing loss, failure to perform the NHS and lack of follow-up are still open questions. A large proportion of families had to move from the region of residence to have their child undergo CI surgery, revealing inequalities in terms of geographical disparities. Social media has proved to be a valuable, fast and inexpensive tool for gathering information on the effectiveness of health prevention programs, involving a large sample of individuals in a short amount of time.