Dupilumab improves sleep quality in chronic rhinosinusitis with nasal polyps.

PURPOSE: Chronic rhinosinusitis with nasal polyps (CRSwNP) often alters sleep quality. Dupilumab emerged as an innovative and effective therapy for refractory/recurrent severe CRSwNP. The aim of this observational retrospective study was to evaluate the sleep quality in patients with CRSwNP who underwent treatment with dupilumab. MATERIALS AND METHODS: Forty-five patients treated with dupilumab for CRSwNP were enrolled. Clinical parameters (age, sex, comorbidities, Nasal Polyp Score - NPS, Asthma Control Test - ACT), nasal cytology, quality of life (Sino Nasal Outcome Test 22 - SNOT-22), sleep quality (Pittsburgh Sleep Quality Index - PSQI, Epworth Sleepiness Scale - ESS), and risk of sleep apnea (STOP-BANG) were recorded before treatment (T0), and after 3 (T1), 6 (T2), and 12 months (T3). RESULTS: NPS, ACT and SNOT-22 total score improved during treatment (p < 0.05). Meanwhile, all sleep parameters evaluated with SNOT-22, ESS and PSQI improved over time (p < 0.001), expect for PSQI Use of sleeping medications. Indeed, sleep drugs are rarely used before and during the treatment. The global sleep quality was classified as poor in 88.9 % of cases at T0 and decreased to 5.7 % at T3. A high risk of sleep apnea was revealed by the STOP-BANG in 68.9 % of cases at T0 and 2.8 % of patient at T3 (p < 0.001). CONCLUSIONS: Dupilumab improves the sleep quality and reduce the risk of sleep apnea in patients with severe CRSwNP. Its favorable effect occurs within 3 months and is maintained during the treatment.

Ambulatory Phonation Monitoring in Prelingual and Postlingual Deaf Patients after Cochlear Implantation.

INTRODUCTION: Hearing loss is known to play a fundamental role in voice production due to a lack of auditory feedback. In this study, we evaluated both fundamental frequency (F0) and loudness of voice on adult deaf patients subjected to cochlear implantation, and we analyzed these results according to the prelingual or postlingual onset of the deafness. METHODS: The study population, balanced in terms of sex, consisted of 32 adults who had undergone cochlear implantation due to severe or profound bilateral hearing loss (16 with prelingual deafness and 16 with postlingual deafness) and their outcomes were compared with a control group of 32 normal hearing (NH) subjects. All subjects were asked to utter the sustained vowel /a/ for at least 5 s and then to read an Italian phonetically balanced text. Voice recordings were performed by means of an ambulatory phonation monitoring (APM 3200). Measurements were performed without cochlear implant (CI), then with CI switched on, both in quiet condition and with background noise. RESULTS: Compared to NH subjects, deaf individuals were overall characterized by higher F0 and loudness values, especially in the vowel task than the reading. In the sustained vowel task, no patients demonstrated significant voice changes after switching on the CI; contrarily, in the reading task, the use of the CI reduced both loudness and F0 up to values comparable to NH subjects, although only in males. There was no significant difference in speech parameters between prelingual and postlingual deafness, although overall lower values were evident in case of postlingual deafness. The use of the CI showed a significant reduction of F0 in males with postlingual deafness and of loudness, both for patients with prelingual and postlingual deafness. Finally, there was a positive correlation between postoperative hearing thresholds and overall speech loudness, highlighting how subjects with better hearing outcomes after CI positioning generally speak with a lower loudness and therefore a reduced vocal effort and load. DISCUSSION/CONCLUSION: We found similar speech performances between prelingual and postlingual deafness, both in the vowel /a/ phonation and in the reading, providing a further suggestion that prelingual adult patients may benefit from cochlear implantation in phonation as well, in addition to the known excellent hearing outcomes. Overall, these results highlight the ability of the CI to adjust in everyday speech certain phonatory aspects such as F0 and loudness by restoring the auditory feedback.

Binaural Hearing Using the ADHEAR Bone Conduction System in the Monaurally Occluded Ear.

INTRODUCTION: The study aimed to investigate binaural cues in the rehabilitation of unilateral occluded ears with a bone conduction hearing aid. METHODS: The study sample consisted of 40 adult volunteers with normal hearing. Unilateral pseudo-conductive hearing loss was induced by inserting an earplug into the external auditory canal (EAC) and silicone material in the concha for ear impression. The adaptive speech-in-noise test (Italian Matrix test) was performed in three spatial orientations to assess binaural cues (summation, squelch, and head shadow effects). All evaluations were performed in the normal condition, after EAC occlusion, and after application of an adhesive bone conduction hearing aid. Binaural contrast differences were calculated in the three conditions. RESULTS: In the EAC occlusion condition, there was a significant increase in the signal-to-noise ratio (SNR) in both the S0N0 (2.4 dB) and the S90N-90 (7.7 dB) settings, and a slight albeit significant increase in the S0N90 setting (1.35 dB). After fitting the BC hearing aid, there was a reduction of -1.8 dB SNR (p < 0.001) in the S0N0 setting and -2 dB (p = 0.003) in the S90N-90 setting. There was no improvement in the SNR (p = 0.405) in evaluation of the squelch effect (S0N90). These data were corroborated by a better binaural contrast due to a reduction in the summation effect in the monaural occlusion condition and a subsequent reduction in binaural contrast after fitting the hearing aid due to an increase in the summation effect (-2.5 dB vs. 0.3 dB; p < 0.001). CONCLUSIONS: Application of a bone conduction hearing aid in unilateral pseudo-conductive hearing loss strengthens speech recognition of noise by improving the summation effect and impeding the shadow effect of the head; however, there appears to be no improvement in speech perception in noise due to spatial release from masking.

Long-term evaluation of nasal polyposis recurrence: A focus on multiple relapses and nasal cytology.

PURPOSE: Recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP) is highly variable, reaching 55-60% of cases. Different results about clinical parameters as recurrence predictors has been reported. The aim of this retrospective study was to evaluate CRSwNP recurrence risk after a long-term follow-up (up to 20 years). Moreover, the role of nasal cytology was assessed. MATERIALS AND METHODS: Sixty-one patients who underwent functional endoscopic sinus surgery for CRSwNP were enrolled. Clinical parameters were recorded. Nasal cytology was performed at follow-up examinations. The Kaplan-Meier method was used to obtain the recurrence-free survival curves. The median number of recurrences per year was evaluated. RESULTS: Five- and 10-year recurrence rates were 30.29% and 66.06%, respectively. Median recurrence-free survival was 106 months. Asthma and Aspirin-Exacerbated Respiratory Disease represented predictors of multiple recurrences (p < 0.05). Intranasal steroids were the main treatment to prevent relapses (p < 0.05). Patients with normal cytology at follow-up evaluation had a lower probability to have first recurrence within 10 years (59% of cases), compared to neutrophil or eosinophil infiltrate (100% and 88% of cases, respectively) (p < 0.05). CONCLUSIONS: CRSwNP has a high recurrence risk, also more than 10 years after surgery. Nasal cytology may identify subjects with a higher risk of early recurrence.

Stapedial Reflex: A Possible Novel Biomarker of Early Bulbar Involvement in Amyotrophic Lateral Sclerosis Patients.

BACKGROUND AND AIM: Amyotrophic lateral sclerosis (ALS) is a neuromuscular progressive disorder, characterized by limb and bulbar muscle wasting and weakness. 30% of patients present a bulbar onset, while 70% a spinal outbreak, although most of them develop bulbar impairment later on. Due to the lack of an early biomarker of bulbar involvement, we chose to evaluate the role of stapedial reflex (SR) in order to predict preclinical bulbar impairment in ALS. MATERIALS AND METHODS: We enrolled 36 ALS patients. We assessed revised-ALS functional-rating-scale and SR for a total of 4 visits. We established the presence of SR, acoustic reflex latency test (ARLT), and SRs Decay. Patients who had not develop bulbar signs at fourth visit continued follow-up up to 15 months. Data were analyzed by using Mann-Whitney U test, Friedman test, and Cox regression analysis. RESULTS: We observed that SRs Decay at 500 and 1,000 Hz is the first parameter of SR to get altered in all ALS patients before the development of bulbar impairment. Twenty-eight patients developed bulbar impairment during the study. We highlighted a correlation between the progression rate of disease and both time of SRs Decay alteration and time of bulbar impairment from disease onset. Four patients who did not develop bulbar impairment had a progression rate lower than the other ones (p < 0.05). DISCUSSION AND CONCLUSIONS: This study shows that SR Decay test could be a sensitive measure for detecting pre-symptomatic bulbar involvement in ALS and could represent a simple, noninvasive, and useful biomarker of disease progression.

Cochlear Implant Outcomes in Prelingually Deafened Adults with and without Sound Deprivation: Are There Differences in Quality of Life?

BACKGROUND Indications for cochlear implantation (CI) are constantly being updated, and with them, the audiometric results achieved by patients. Patient satisfaction should always be considered, even in patients with lower audiological results. The aim of the present study was to compare quality of life (QoL), self-perceived hearing benefit, and audiometric results between prelingually and postlingually deafened patients, with and without sound deprivation, after CI. MATERIAL AND METHODS The sample included 46 patients with bilateral sensorineural hearing loss: 22 postlingually deafened and 24 prelingually deafened, further subdivided into sound-deprived (n=10) and non-sound-deprived (n=14). Auditory performance was evaluated with pure tone audiometry, speech recognition scores (SRS), and self-perceived hearing benefit, whereas QoL was evaluated with 2 self-reported questionnaires (Comprehensive Cochlear Implant Questionnaire and World Health Organization Quality of Life-BREF). RESULTS Audiometric results were worse in the prelingually deafened than in the postlingually deafened group, and worse in the prelingually deafened patients with sound deprivation. There was no marked difference in perceived CI benefit or QoL between the 2 groups or within the 2 prelingually deafened subgroups. No correlation was found between SRS and duration of CI use or between QoL and SRS in the prelingually and postlingually deafened groups. CONCLUSIONS Our findings demonstrate better auditory performance for the postlingually deafened group and no differences in perceived QoL or benefit of CI between the groups. The sound-deprived patients had equal scores on the perceived QoL questionnaire. These analyses suggest that sound-deprived, prelingually deafened patients may benefit from CI.

A new bone conduction hearing aid to predict hearing outcome with an active implanted device.

PURPOSE: We compared our historical medium-term data obtained with an active semi-implanted bone conduction device and the hearing results of a new passive bone conduction hearing device to determine its predictive value for the hearing results with the semi-implanted device. METHODS: The study sample was 15 patients with an active bone conduction implant (mean follow-up 26 months). Pure tone audiometry was performed with headphones, sound field speech audiometry was conducted unaided, and free-field speech audiometry was carried out with both the active bone conduction system and the passive device switched off. RESULTS: As compared with the unaided condition, speech reception was significantly improved with both devices. Comparison of speech reception threshold at 100% of word recognition showed no difference between the active and the passive device. At lower intensity the difference in speech perception was significant in the patients with monaural fitting (group A) and was non-statistically significant in those with binaural fitting (group B); the speech reception threshold at 50% of word recognition was 26.00 dB (± 10.22) with the active implant and 30.50 dB (± 7.98) with the passive device in group A (p = 0.047) and 24.00 dB (± 5.48) and 29.00 dB (± 2.24) in group B (p = 0.052), respectively. CONCLUSIONS: The hearing outcome after active bone conduction implant was comparable to published data. Compared with the unaided condition, speech recognition was significantly improved with the passive device. The device may also provide value to predict the hearing outcome with the implanted device, especially at higher intensities. LEVEL OF EVIDENCE: IV.

Acoustic reflex patterns in amyotrophic lateral sclerosis.

The aim of the study is to investigate acoustic reflex testing in amyotrophic lateral sclerosis patients. Amplitude, latency, and rise time of stapedial reflex were recorded for 500 and 1000 Hz contralateral stimulus. Statistical analysis was performed by the Wilcoxon test and the level of significance was set at 5 %. Fifty-one amyotrophic lateral sclerosis patients and ten sex- and age-matched control subjects were studied. Patients were further divided in two groups: amyotrophic lateral sclerosis-bulbar (38 cases, with bulbar signs at evaluation) and amyotrophic lateral sclerosis-spinal (13 cases, without bulbar signs at evaluation). Stapedial reflex was present in all patients. There was a statistically significant difference in the mean amplitude, latency, and rise time between the amyotrophic lateral sclerosis patients as compared with the controls. Amplitude was lower in both the amyotrophic lateral sclerosis-bulbar and the amyotrophic lateral sclerosis-spinal patients than in the controls (p < 0.05) and rise time was longer in both patient groups compared with the controls (p < 0.05). These results confirm the presence of abnormal acoustic reflex patterns in amyotrophic lateral sclerosis cases with bulbar signs and, moreover, suggesting a possible subclinical involvement of the stapedial motor neuron even in amyotrophic lateral sclerosis-spinal patients. Amplitude and rise time seem to be good sensitive parameters for investigating subclinical bulbar involvement.

Relationship between hearing threshold at the affected and unaffected ear in unilateral Meniere's disease.

Hearing loss in Menière's disease has been described to affect above all low frequencies (upward curve) with a tendency to become irreversible and non-fluctuating at the higher frequencies (peaked curve) over time. The aim of the study was to determine the effects of MD on hearing function on the basis of differences existing between the affected and the unaffected ear in a group of patients affected by definite unilateral MD and whose contralateral ear was not affected by any disease other than age-related hearing loss (ARHL). Following this procedure we have also evaluated the possible effects of age and disease duration on hearing loss in MD. The study group consisted of 86 subjects affected by definite unilateral MD. In our sample a peaked audiometric curve characterized the affected ears; however, the result after subtracting the normal ear hearing threshold was an upward sloping curve, which highlighted the greater suffering at the lower frequencies. On the basis of differences existing between affected and unaffected ear, our data suggest that threshold evolution is more related to disease duration rather than to age.

Cochlear Nerve Stimulation in the Internal Auditory Canal in Ossified Cochlea: A Case Study.

OBJECTIVE: To present the first reported case of intraneural direct cochlear nerve stimulation in a human being. STUDY DESIGN: This is a case report. RESULTS: A 23-year-old patient with bilateral progressive hearing loss associated with bilateral complete semicircular canal aplasia and ossified cochleas underwent cochlear implantation. During surgery, a patent cochlear lumen could not be found, and the array was positioned in the internal auditory canal adjacent to the cochlear nerve. Against our expectations, an assiduous rehabilitation and frequent fitting adjustments have led to a word recognition score, in open set speech with lip reading, of 18/25 and acceptable frequency discrimination. CONCLUSIONS: We are aware that this was an anomalous use of the cochlear implant, and it is not our aim to suggest a new indication for cochlear array positioning. However, this case shows that auditory perception, to some degree, can be obtained with intraneural direct cochlear nerve stimulation.

Oval and round window vibroplasty: a comparison of hearing results, risks and failures.

The aim of this study was to compare oval and round window vibroplasty. Eighteen (18) patients implanted with Vibrant Soundbridge (VSB) were enrolled. Two groups were formed depending on FMT placement: on round window in ten cases (RW group) and on oval window in eight (OW group). Pre and postoperative audiological tests were performed both under headphones and free-field settings, VSB on and off. One (1) RW patient experienced sudden hearing loss at the operated side after 4 months from surgery and was excluded from the analysis. Both groups showed good hearing results. Significant differences were measured at free-field pure-tone test with VSB on at 0.5 kHz (RW better than OW, p = 0.026) and 4 kHz (OW better than RW, p = 0.043). Both techniques share similar good results and are considered safe. However, we had one failure with deep and sudden hearing threshold worsening after some months of good results. From a surgical point of view OW vibroplasty is easier and safer to perform, when the stapes suprastructure is absent, as it does not require any drilling and should be preferred in such cases. More reports are needed to explain if RW vibroplasty is risky in a mid to long term.

Validation and reliability of the Italian version of the Self-reported Mini Olfactory Questionnaire (Self-MOQ).

Objective: Olfactory dysfunction (OD) represents a frequent complaint in general population and especially in patients with chronic sinonasal diseases. The aim of this study was the cross-cultural adaptation and validation of the Self-reported Mini Olfactory Questionnaire (Self-MOQ) into Italian. Methods: One hundred fifty patients affected by chronic sinonasal diseases and reporting hyposmia were enrolled. Other 150 normosmic subjects without inflammatory or neoplastic sinonasal disorders were used as a control group. The Short-form 36 (SF-36) questionnaire was used for clinical validity. Results: Cronbach's alpha coefficient was 0.825. The test-retest reliability was excellent. The good correlation between the Self-MOQ and the Visual Analogue Scale scores (p < 0.05) demonstrated the construct validity of the questionnaire. The Self-MOQ was able to distinguish between subjects with or without OD (p < 0.05). Higher Self-MOQ score was found in case of nasal obstruction and posterior rhinorrhoea (p < 0.05). Self-MOQ showed significant correlation with SF-36 general health, SF-36 role functioning/physical, and SF-36 pain (p < 0.05). Conclusions: The Italian version of the Self-MOQ showed good internal consistency, test-retest reliability, construct, and clinical validity.

Binaural hearing in monaural conductive or mixed hearing loss fitted with unilateral Bonebridge.

Objective: To determine the benefits of binaural hearing rehabilitation in patients with monaural conductive or mixed hearing loss treated with a unilateral bone conduction implant (BCI). Methods: This monocentric study includes 7 patients with monaural conductive or mixed hearing loss who underwent surgical implantation of a unilateral BCI (Bonebridge, Med-El). An ITA Matrix test was performed by each patient included in the study - without and with the BCI and in three different settings - to determine the summation effect, squelch effect and head shadow effect. Subjective hearing benefits were assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire. Results: The difference in signal to noise ratio of patients without and with BCI was 0.79 dB in the summation setting (p < 0.05), 4.62 dB in the head shadow setting (p < 0.05) and 1.53 dB (p = 0.063) in the squelch setting. The APHAB questionnaire revealed a subjective discomfort in the presence of unexpected sounds in patients using a unilateral BCI (aversiveness score) compared to the same environmental situations without BCI, with a mean discomfort score of 69.00% (SD ± 21.24%) with monaural BCI versus 25.67% (SD ± 16.70%) without BCI (difference: -43.33%, p < 0.05). In terms of global score, patients wearing a unilateral Bonebridge implant did not show any significant differences compared to those without hearing aid (difference: -4.00%, p = 0.310). Conclusions: Our study shows that the use of a unilateral BCI in patients affected by monaural conductive or mixed hearing loss can improve speech perception under noise conditions due to the summation effect and to the decrease of the head shadow effect. However, since monaural BCIs might lead to discomfort under noise conditions in some subjects, a pre-operative assessment of the possible individual benefit of a monaural BCI should be carried out in patients affected by unilateral conductive or mixed hearing loss in order to investigate the possible additional effect of the fitting of hearing aids.

Implantable hearing devices in clinical practice. Systematic review and consensus statements.

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.

Comparison of Active Bone Conduction Hearing Implant Systems in Unilateral and Bilateral Conductive or Mixed Hearing Loss.

BACKGROUND: To assess and compare binaural benefits and subjective satisfaction of active bone conduction implant (BCI) in patients with bilateral conductive or mixed hearing loss fitted with bilateral BCI and patients with monaural conductive hearing loss fitted with monaural BCI. METHODS: ITA Matrix test was performed both on patients affected by bilateral conductive or mixed hearing loss fitted with monaural bone conduction hearing implant (Bonebridge, Med-El) before and after implantation of contralateral bone conduction hearing implant and on patients with monaural conductive or mixed hearing loss before and after implantation of monaural BCI. The Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire was administered to both groups of subjects and the results were compared with each other. RESULTS: Patients of group 1 reported a difference of 4.66 dB in the summation setting compared to 0.79 dB of group 2 (p < 0.05). In the squelch setting, group 1 showed a difference of 2.42 dB compared to 1.53 dB of group 2 (p = 0.85). In the head shadow setting, patients of group 1 reported a difference of 7.5 dB, compared to 4.61 dB of group 2 (p = 0.34). As for the APHAB questionnaire, group 1 reported a mean global score difference of 11.10% while group 2 showed a difference of -4.00%. CONCLUSIONS: Bilateral BCI in patients affected by bilateral conductive or mixed hearing loss might show more advantages in terms of sound localisation, speech perception in noise and subjective satisfaction if compared to unilateral BCI fitting in patients affected by unilateral conductive hearing impairment. This may be explained by the different individual transcranial attenuation of each subject, which might lead to different outcomes in terms of binaural hearing achievement. On the other hand, patients with unilateral conductive or mixed hearing loss fitted with monaural BCI achieved good results in terms of binaural hearing and for this reason, there is no absolute contraindication to implantation in those patients.

Music in noise recognition: An EEG study of listening effort in cochlear implant users and normal hearing controls.

Despite the plethora of studies investigating listening effort and the amount of research concerning music perception by cochlear implant (CI) users, the investigation of the influence of background noise on music processing has never been performed. Given the typical speech in noise recognition task for the listening effort assessment, the aim of the present study was to investigate the listening effort during an emotional categorization task on musical pieces with different levels of background noise. The listening effort was investigated, in addition to participants' ratings and performances, using EEG features known to be involved in such phenomenon, that is alpha activity in parietal areas and in the left inferior frontal gyrus (IFG), that includes the Broca's area. Results showed that CI users performed worse than normal hearing (NH) controls in the recognition of the emotional content of the stimuli. Furthermore, when considering the alpha activity corresponding to the listening to signal to noise ratio (SNR) 5 and SNR10 conditions subtracted of the activity while listening to the Quiet condition-ideally removing the emotional content of the music and isolating the difficulty level due to the SNRs- CI users reported higher levels of activity in the parietal alpha and in the homologous of the left IFG in the right hemisphere (F8 EEG channel), in comparison to NH. Finally, a novel suggestion of a particular sensitivity of F8 for SNR-related listening effort in music was provided.

Current trends on subtotal petrosectomy with cochlear implantation in recalcitrant chronic middle ear disorders.

Objective: To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods: A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combination with subtotal petrosectomy. Patients' details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results: 55 patients were included with a mean follow-up time of 44 months. Cholesteatoma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions: Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients.

Orthostatic hypotension and psychiatric comorbidities in patients with dizziness.

PURPOSE: The present study was undertaken to investigate orthostatic hypotension and psychiatric comorbidity with anxiety and depression in dizzy patients. MATERIALS AND METHODS: Sixty-three patients with nonspecific dizziness and 27 volunteer subjects were evaluated with the head-up tilt test (HUTT) and the Standardized Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I. RESULTS: Orthostatic hypotension was induced by HUTT in 44% of patients and in 15% of volunteers (P = .0082); we found that the incidence of anxiety and depression was significantly higher (P < .05) in patients with nonspecific dizziness than in controls. Orthostatic hypotension was related to age but not to antihypertensive therapy and sex. Dizziness during the HUTT was reported by 49% of patients and 33% of volunteers (P = .2469). Among patients, dizziness was found to be related to sex (female) and anxiety. A correlation between dizziness and anxiety was also present in volunteers. Head-up tilt test induced vasovagal reactions in 2 volunteers. CONCLUSIONS: Orthostatic hypotension is present in a high percentage of patients with orthostatic dizziness, and anxiety and depression are an important factor in the onset of dizziness. A high percentage of abnormal responses in volunteer subjects seems to indicate that the HUTT is not indicated for routine use.

Relationship between pure tone audiometry and tone burst auditory brainstem response at low frequencies gated with Blackman window.

To assess the reliability of Blackman windowed tone burst auditory brainstem response (ABR) as a predictor of hearing threshold at low frequencies. Fifty-six subjects were divided in to three groups (normal hearing, conductive hearing loss, sensorineural hearing loss) after pure tone audiometry (PTA) testing. Then they underwent tone burst ABR using Blackman windowed stimuli at 0.5 kHz and 1 kHz. Results were compared with PTA threshold. Mean threshold differences between PTA and ABR ranged between 11 dB at 0.5 kHz and 14 dB at 1 kHz. ABR threshold was worse than PTA in each but 2 cases. Mean discrepancy between the two thresholds was about 20 dB in normal hearing, reducing in presence of hearing loss, without any differences in conductive and sensorineural cases. Tone burst ABR is a good predictor of hearing threshold at low frequencies, in case of suspected hearing loss. Further studies are recommended to evaluate an ipsilateral masking such as notched noise to ensure greater frequency specificity.

Control of Disabling Vertigo in Ménière's Disease Following Cochlear Implantation without Labyrinthectomy.

BACKGROUND: The placement of a cochlear implant (CI) can restore auditory function in the case of profound cochlear deafness, which may be due to Ménière's disease (MD) or be associated with symptoms related to endolymphatic hydrops. The usual treatment of disabling vertigo in MD is based on vestibular deafferentation by labyrinth ablation. The aim of the present study was to retrospectively evaluate the efficacy of the CI in the control of disabling vestibular manifestations in the case of MD unresponsive to medical treatments. METHODS: A case series of five MD patients with disabling vestibular manifestations associated with profound hearing loss was included. A complete audio-vestibular evaluation was performed after CI positioning. RESULTS: All patients reported clinical benefits after implant positioning: no vestibular crisis was reported after the surgery. The vHIT and the caloric test showed a normal function or a mild vestibular hypofunction. The auditory performances were comparable to those in the general implanted population. All patients reported subjective tinnitus reduction. CONCLUSIONS: To date, very few studies have reported vestibular outcomes in hydropic pathology on the implanted side; our results are encouraging. We can therefore confirm the efficacy and safety of the CI as a unique treatment for hearing loss, dizziness, and tinnitus in case of disabling cochlear hydrops, especially in those patients where the history of the disease requires preservation of the vestibular function.