Breakthrough Acute Necrotizing Invasive Fungal Rhinosinusitis by Alternariaalternata in a Patient with Acute Lymphoblastic Leukemia on Anidulafungin Therapy and Case-Based Literature Review.

Alternaria spp. have emerged as opportunistic pathogens particularly in immunosuppressed patients. A case of a breakthrough acute invasive fungal rhinosinusitis (AIFRS), caused by Alternaria alternata, is reported in a patient with acute lymphoblastic leukemia (ALL) on anidulafungin therapy, who was successfully treated with liposomal amphotericin B and surgical intervention. To date, 20 cases of AIFRS due to Alternaria spp. have been described, 19 in the USA and 1 in Chile, making this case report the first case of AIFRS due to Alternaria in Europe. The patients had median (range) age 25 (2-56) years (65% female), almost all of them (19/20) with hematological diseases and severe neutropenia (8-41 days pre-infection). Amphotericin B was the most frequently used antifungal agent, either alone or in combination. In all of the cases, systemic antifungal therapy was combined with surgery. Despite stabilization or improvement of the AIFRS, mortality was 38% (5 days to 8 months post-surgical debridement) due to their underlying disease or other infections without sign of AIFRS at autopsy.

The Effect of Antioxidant Supplementation in Patients with Tinnitus and Normal Hearing or Hearing Loss: A Randomized, Double-Blind, Placebo Controlled Trial.

Tinnitus is the perception of sound in the absence of any external stimulus. Oxidative stress is possibly involved in its pathogenesis and a variety of antioxidant compounds have been studied as potential treatment approaches. The objective of the present study was to assess the effects of antioxidant supplementation in tinnitus patients. This is a randomized, double-blind, placebo-controlled clinical trial. Patients (N = 70) were randomly allocated to antioxidant supplementation (N = 35) or to placebo (N = 35) for a total of 3 months. Demographic, anthropometric, clinical, and nutritional data were collected. Serum total antioxidant capacity (TAC), oxidized LDL (oxLDL), and superoxide dismutase (SOD), tinnitus loudness, frequency, and minimum masking level (MML), and scores in Tinnitus Handicap Inventory questionnaire (THI), Tinnitus Functional Index (TFI), and Visual Analogue Scale (VAS) were evaluated at baseline and follow-up. Tinnitus loudness and MML significantly decreased from baseline to post measure (p < 0.001) only in the antioxidant group, the overall change being significantly different between the two groups post-intervention (p < 0.001). THI and VAS decreased only in the antioxidant group. Differences in changes in serum TAC, SOD, and oxLDL post-intervention were insignificant. In conclusion, antioxidant therapy seems to reduce the subjective discomfort and tinnitus intensity in tinnitus patients.

Influence of cochlear implantation on the vestibular function.

The aim of the present study was to examine the influence of cochlear implantation on vestibular function. The function of the horizontal semicircular canal, the saccular function, and the incidence of vestibular symptoms were assessed before and after cochlear implantation. Twenty unilaterally cochlear implant patients were evaluated preoperatively, 1 and 6 months postoperatively, with caloric testing with electronystagmography (ENG) recordings and vestibular evoked myogenic potentials (VEMP) testing. A medical history was taken from every subject, noting the presence or absence of vertigo before and after the operation. A possible correlation between the appearance of postoperative vertigo and age, sex, implant side, preoperative caloric results and VEMP status, and postoperatively recorded changes in caloric and VEMP testing was also investigated. A statistically significant difference was found in the percentages of canal paresis (p = 0.01) and the percentages of VEMP waveform absence (p = 0.002) between the repeated measurements in the implanted side, whereas in the non-implanted side no difference was (p > 0.05) found. Four patients complained of postoperative vestibular symptoms. In three of them the symptoms lasted less than 6 months postoperatively, but the fourth patient was still dizzy 6 months after cochlear implantation. No correlation was found between the above-mentioned factors and the occurrence of postoperative vertigo. In conclusion, although changes of the peripheral vestibular function of the implanted side were recorded in our patients, permanent vertigo was rare. Predictive factors for the occurrence of postoperative vestibular symptoms could not be identified.

Screening protocols for the prevention of occupational noise-induced hearing loss: the role of conventional and extended high frequency audiometry may vary according to the years of employment.

BACKGROUND: Although occupational noise-induced hearing loss (NIHL) has become a major problem in industrialized societies, there is a notable lack of effective screening protocols to ensure its early diagnosis. The aim of this study was to detect a potential role of extended high frequency (EHF) audiometry in industrial hearing screening protocols. MATERIAL/METHODS: The population consisted of 151 persons, working for 8 hours daily in a noisy environment (90-110 dBA). The changes of hearing thresholds in industrial workers were analyzed, not only with respect to their age, as has been presented by previous studies, but also with respect to the duration of their previous employment. RESULTS: During the first 10 years of employment, the frequencies 12500, 14000 and 16000Hz were the only ones significantly affected. For the second decade of employment, thresholds were significantly elevated only at 2000 and 4000Hz. After exceeding 20 years of employment, the affected frequencies were 250, 500 and 1000Hz. The effects of age on hearing acuity were significant at all frequencies for the first 2 groups. CONCLUSIONS: EHF audiometry seems able to identify the first signs of NIHL, much earlier than conventional audiometry, and therefore may need to be implemented in the screening examinations especially of workers with less than 1 decade of employment. Hearing screening protocols could become more efficient by adjusting their frequency ranges according to the frequencies "at risk", which correspond to the duration of the workers' previous employment.