Effect of different concentrations of stem juice of Oxalis tuberosa Mol. and juice of the fruit of Gaultheria glomerata (Cav.) Sleumer on the antioxidant activity of the heat-treated functional beverage.

Functional beverages with added health benefits are popular among peoples and athletes because they help them recover faster from intense workouts and perform better overall. This research set out to determine how well heat-treated stem juice from Oxalis tuberosa Mol. "oca" and fruit juice from Gaultheria glomerata (Cav.) Sleumer "laqa-laqa" performed as an antioxidant in a functional drink. The "oca" stems and the "laqa-laqa" fruit were collected to obtain the juice. For this study, 30 semi-trained panellists used sensory evaluation to rate four treatments (Bo, B1, B2, and B3) with varying quantities of "oca" and "laqa-laqa" juice. The results concluded that the treatment B2, which included 300 ml of "oca" stem juice, 800 ml of "laqa-laqa" juice, 1000 ml of treated water, and 220 g of refined sugar, was given the highest score after a physicochemical evaluation of its colour, smell, taste, and overall appearance. Similarly, the results showed that the protein content increased by 1.38%, the fat content by 1.08%, the moisture percentage by 99.5%, the ash content by 1.82%, and the carbohydrate content by 6.22% after B2 treatment. Similarly, results revealed significant enhancement in antioxidant profiling such as total polyphenols: 1825 mg of gallic acid/100 g and antioxidant Activity: 89.56% µmol of trolox /100 g. In conclusion, due to its high energy content and antioxidant activity, it may be a viable nutritional option for athletes who engage in rigorous, frequent physical exertion.

Sub-Clinical Effects of Chronic Noise Exposure on Vestibular System.

AIM: to investigate the effect of chronic noise exposure on vestibular function of subjects without clinical evidence of vestibular disorders and with documented cochlear damage from noise. SUBJECTS AND METHODS: 25 patients with chronic noise-induced hearing loss (NIHL) and without vestibular complaints (group A) and 25 matched controls with sensorineural hearing loss without noise exposure (group B), underwent audiological and vestibular test including caloric and cervical vestibular-evoked myogenic potentials tests (cVEMPs). RESULTS: In subjects chronically exposed to noise, similarly to that of the auditory threshold, an increase in the evocation threshold of VEMPs has been documented, statistically significant (p<0,05) and independent of the performance of the auditory threshold. p1-n1 amplitude values showed a significant difference between group A and group B. No significant difference for p1-n1 latencies between the two groups was found. CONCLUSION: We have documented the possibility of vestibular lesion, along with cochlear damage, related to chronic acoustic trauma.

Pharmacological, Surgical and Diagnostic Innovations in Meniere's Disease: A Review.

PURPOSE: To investigate literature about pharmacological, surgical, and diagnostic innovations for Meniere's Disease (MD). SUMMARY: Meniere's disease is an inner ear disorder characterized by the presence of endolymphatic hydrops in the inner ear and symptomatology of recurrent and debilitating vertigo attacks, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. Although many therapeutic options for MD have been proposed during years, no consensus has been reached by the scientific community. In the last decade, many therapeutic options have been proposed, as intratympanic steroid, intratympanic gentamicin, and intravenous glycerol. Recently, the role of the antisecretory factor in the diet of MD patients have been investigated. Surgery is recommended for intractable MD; some authors proposed new approaches including transcanal endoscopic infracochlear vestibular neurectomy, new marsupiliazation technique in sac surgery, and tenotomy of the stapedius and tensor tympani muscles.

Drug-Induced Sleep Endoscopy (DISE) with Simulation Bite to Predict the Success of Oral Appliance Therapy in Treating Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS).

STUDY OBJECTIVES: Oral appliances have gained their place in the treatment of obstructive sleep apnea (OSA) where custom-made titratable mandibular advancement devices (MAD) have become the oral appliance of choice. This study aimed to asses the value of the drug-induced sleep endoscopy (DISE) using a MAD in the prediction of treatment outcome for OSAHS. METHODS: This is a prospective, single-center cohort study that enrolled sixty-six consecutive patients with diagnosed OSA (5 events/h < apnea-hypopnea index (AHI) < 50 events/h) to be treated with a custom-made titratable MAD. The patients were evaluated polysomnographically with the MAD in situ after the adaptation and titration period of 3 months. The associations between findings during DISE and treatment outcome were assessed. RESULTS: The subjects showed a wide range of severity of OSAHS pre-treatment: median AHI was 43.10 with a range from 20.13 to 66.07. The simulation bite was associated with a significant increase in cross-sectional area at level of the velopharynx, tongue base and epiglottis. MAD treatment response in the studied population was 91%, with a mean AHI improving from 43.10 to 12.93. CONCLUSIONS: Drug-induced sleep endoscopy with simulation bite is an acceptably reproducible technique for determining the sites of obstruction in OSAHS subjects; it thus offers possibilities as a prognostic indicator for treatment with MAD.

Chronic subjective dizziness: Analysis of underlying personality factors.

BACKGROUND: Chronic subjective dizziness (CSD) is characterized by persistent dizziness, unsteadiness, and hypersensitivity to one's own motion or exposure to complex visual stimuli. CSD may be triggered, in predisposed individuals with specific personality traits, by acute vestibular diseases. CSD is also thought to arise from failure to re-establish normal balance strategies after resolution of acute vestibular events which may be modulated by diathesis to develop anxiety and depression. OBJECTIVE: To confirm the role of personality traits linked to anxiety and depression (i.e., neuroticism, introversion, low openness) as predisposing factors for CSD and to evaluate how individual differences in these personality traits are associated with CSD severity. METHODS: We compared 19 CSD patients with 24 individuals who had suffered from periferal vestibular disorders (PVD) (i.e., Benign Paroxysmal Postural Vertigo or Vestibular Neuritis) but had not developed CSD as well as with 25 healthy controls (HC) in terms of personality traits, assessed via the NEO-PI-R questionnaire. RESULTS: CSD patients, relative to PVD patients and HCs, scored higher on the anxiety facet of neuroticism. Total neuroticism scores were also significantly associated with dizziness severity in CSD patients but not PVD patients. CONCLUSIONS: Pre-existing anxiety-related personality traits may promote and sustain the initial etiophatogenetic mechanisms linked with the development of CSD. Targeting anxiety-related mechanisms in CSD may be therefore a promising way to reduce the disability associated with CSD.

A proteomics-driven assay defines specific plasma protein signatures in different stages of Ménière's disease.

Ménière's disease (MD) is a common disorder of the inner ear whose hallmarks are vertigo, tinnitus, aural fullness, and progressive hearing loss. The degree of severity of the disease is quite heterogeneous, and so is its pathogenesis. A multifactorial inheritance of intrinsic and extrinsic factors has been described, but there is not a common agreement on the molecular basis of MD. In a recent article, we have demonstrated that patients suffering from MD share a common plasma proteomic signature, characterized by the presence of several up- and down-regulated proteins. In this study, we have further extended our analysis and show that the differential expression of plasma proteins can identify specific subsets of MD-affected individuals, depending on their stage. Our findings confirm our plasma proteomics-driven approach as a powerful tool for early diagnosis of MD and uncover a potentially starring role for some proteins in the development and fate of this frustrating disease, whose pathogenesis still remains unclear.

Bilateral transverse sinus stenosis in patients with tinnitus.

Tinnitus is a frequent complaint in patients affected by intracranial hypertension (IH). Recently, some studies have reported an association between idiopathic intracranial hypertension (IIH) and bilateral transverse sinus stenosis (BTSS). We investigated the relationship between BTSS and monosymptomatic tinnitus, regardless of its clinical characteristics, in subjects without clinical evidence of IH. We selected 78 subjects (all women, mean age 49.5 ± 10.36) affected by tinnitus, without clinical history of audiological and otological pathologies, enrolled among outpatients of the Institute of Audiology and Phoniatrics in Catanzaro, Italy, over a 2 year period. All subjects underwent psychometric evaluation, psychoacoustic assessment, neurological and ophthalmological examination, cerebral magnetic resonance venography (MRV) and brain magnetic resonance imaging (MRI). MRV identified BTSS in 17.9% (14 patients). In the BTSS group, tinnitus was bilateral/central in 21%, and monolateral in the remaining patients (50% left; 29% right ear). It was more frequently pulsating in the BTSS group, but 64.9% of BTSS subjects described their tinnitus as stable. No features of tinnitus showed statistical significance in association with BTSS. In BTSS subjects, we found values suggesting IH by lumbar puncture (LP) in 40% of cases. In these patients, LP gave immediate improvement of tinnitus. The association between BTSS and tinnitus, regardless of its features, must be considered when other causes of tinnitus are excluded.

Surgical treatment of recurring preauricular sinus: supra-auricular approach.

Congenital preauricular sinus is a malformation of the preauricular soft tissues with an incidence ranging between 0.1 and 0.9% in Europe and the United States. It presents a high risk of recurrence when treated by a standard surgical technique (simple sinectomy), the incidence of which is reported to be between 19% and 40%. The supra-auricular approach, proposed by Prasad et al. in 1990, is easier to perform and presents a lower recurrence risk. Personal experience is presented in the treatment of congenital preauricular sinus with the supra-auricular approach as first choice or in the case of recurrence following previous standard surgery. This report includes a short review of the literature in order not only to focus on the supra-auricular approach and check the efficacy as far as concerns reduction of recurrence risk but also to contribute to a more widespread use of this method.

Iatrogenic benign paroxysmal positional vertigo: review and personal experience in dental and maxillo-facial surgery.

The post-traumatic origin of benign paroxysmal positional vertigo remains the most likely, from a patho-physiologic point of view. Benign paroxysmal positional vertigo due to surgical "traumas" has been described in the medical literature. According to personal experience, these iatrogenic cases represent a rare possibility and may be the consequence of surgical interventions differing according to the anatomical district involved and surgical technique performed. The temporal relationship with the surgical action and clinical features may be involved in some of these cases, even if it is not possible to define any real cause-effect link. Herewith some cases of paroxysmal positional vertigo are described, strongly held to be of iatrogenic origin, focusing on dental and maxillo-facial surgery as risk factors for benign paroxysmal positional vertigo.

Functional analysis of R75Q mutation in the gene coding for Connexin 26 identified in a family with nonsyndromic hearing loss.

Mutations in the gene (GJB2) coding for Connexin 26 (Cx26) are responsible for genetic forms of sensorineural hearing loss. This article describes a family characterized by congenital profound hearing loss, inherited in an autosomal dominant fashion and associated to a R75Q substitution in Cx26. Cell transfection and fluorescence imaging, dye transfer experiments and dual patch clamp recording showed that the mutant completely prevents the formation of functional channels despite assembling into junctional plaques, in communication incompetent HeLa cells. The disease is not associated with palmar and plantar keratosis in any of the family members, suggesting that R75Q substitution is not sufficient for the development of the complete syndromic phenotype. The association of palmar and plantar keratosis with profound hearing loss may be dependent on genetic background, requiring a functional interaction between the mutated Cx26 and other epidermally expressed connexins.

Database of benign positional paroxysmal nystagmus.

Classification of various manifestations of benign positional paroxysmal nystagmus, due to canalolithiasis or to cupulolithiasis, as a reaction to movements and to the site of detritus, is now possible due to the integration of theoretical knowledge (relationships between the semicircular canals and/or ampullae and the vestibulo-ocular pathways) with the forms of nystagmus induced when the head is placed in various positions. A comparison is made of results in patients examined in three Departments, during the past 3 years, and data presented in the literature. Findings are presented in a database which enables the clinician to compare the standard diagnostic manoeuvres (Dix-Hallpike, Pagnini-McClure, Rose) with results obtained by placing the head in alternative positions. This approach offers all the information needed to identify the site of onset and hence to formulate a correct diagnosis, thus directly indicating the most appropriate liberating or repositioning manoeuvre or--in the case of a suspected central lesion--to suggest further tests. Moreover, it is suggested that this table could become a useful tool for teaching purposes.

Multidimensional Voice Program (MDVP) and amplitude variation parameters in euphonic adult subjects. Normative study.

The introduction, in the late 70s, of the first digital spectrograph (DSP Sonograph) by Kay Elemetrics has improved the possibilities of spectroacoustic voice analysis in the clinical field. Thanks to the marketing, in 1993, of the Multi Dimensional Voice Program (MDVP) advanced system, it is now possible to analyse 33 quantitative voice parameters which, in turn, allow evaluation of fundamental frequency, amplitude and spectral energy balance and the presence of any sonority gap and diplophony. Despite its potentials, the above-mentioned system is not widely used yet, partly on account of the lack of a standard procedure. Indeed, there are still only a few case reports in the literature taking into consideration prescriptive aspects related both to procedure and analysis. This study aims to provide the results of amplitude perturbation parameter analysis in euphonic adult patients. In our opinion, these are the most significant parameters in determining the severity of a phonation disorder. The study has been carried out on 35 patients (24 female, 11 male, mean age 31.6 years, range 19-59). The voice signal has been recorded using a 4300 B Kay Computer Speech Lab (CSL) supported by a personal computer including a SM48 Shure-Prolog microphone located at a distance of 15 cm and angled at 45 degrees. Input microphone saturation has been adjusted to 6/9 of the CH1 channel. The voice sample consisted in a held /a/ and the analysis has been carried out on the central 3 seconds of the recording. The analysis has been carried out using a 5105 MDVP software version 2.3 and the signal digitalised at a 50 kHz sample rate. In order for the sample to be as free from intensity or frequency changes as possible, each patient underwent a training session (including at least 3 phonation tests) before the recording. The study included only emissions between 55 and 65 dB and with spectrum stability. Environmental noise has constantly been monitored and maintained below 30 dB. Data from the 24 female patients showed: absolute Shimmer (ShdB) = 0.203 dB, relative shimmer (Shim %) = 2.226, amplitude perturbation quotient (APQ) = 1.758, smoothed amplitude perturbation quotient = 3.309, peak amplitude variation (vAm) = 7.042. Data from the 11 males showed: absolute Shimmer (ShdB) = 0.269 dB, relative shimmer (Shim %) = 2.892, amplitude perturbation quotient (APQ) = 2.611, smoothed amplitude perturbation quotient (SAPQ) = 3.433, peak amplitude variation (vAm) = 6.385. Statistical analysis (t test) showed no statistically significant difference between sexes, thus a single set of rules was used for both sexes.

Paroxysmal positional vertigo: short- and long-term clinical and methodological analyses of 794 patients.

Between 1995 and 2001, eight Italian clinical centres used the same diagnostic and therapeutic protocol in order to assess the clinical progress of paroxysmal positional vertigo and the benefits of an appropriate follow-up in prevention of relapse. The study population comprises 794 patients affected by paroxysmal positional vertigo. The study protocol comprised diagnostic staging including a complete otoneurological test, an anamnestic questionnaire aimed at identifying any possible risk factor, a blood test in basal conditions and monitoring of blood pressure. If necessary, more specific instrumental tests have been carried out. Appropriate rehabilitative manoeuvres were performed from 1 to 3 times within the same session. The patient was checked 3-5 days later: in the presence of a positive result, the treatment was repeated; if negative, patients were seen at clinical follow-up 7, 30, 180 and 365 days after recovery. Wherever possible, patients have been contacted 2 years after the first treatment and asked to answer a questionnaire and to attend for a clinical check-up. The incidence of paroxysmal positional vertigo appeared to be higher in females and in patients aged 50-70 years, being low in patients under 30. In 88.8% of cases posterior semicircular canals showed a significant involvement; in 6.8% of cases, only involvement of lateral semicircular canals; monolateral (2.7%) and bilateral (1.7%) multicanalar forms were rare. Paroxysmal positional vertigo forms involving posterior semicircular canals have been treated with Semont (simplified by Toupet), Epley, Parnes Price-Jones manoeuvres; those, involving lateral semicircular canals with Vannucchi-Vicini forced position and "barbecue" or Gufoni manoeuvre. Whilst all these manoeuvres were equally effective, longer recovery times have been observed in paroxysmal positional vertigo forms involving lateral semicircular canals when the Vannucchi-Vicini forced position was ineffective. Any relapses have been evaluated at least 15 days after a negative clinical pattern. Possible involvement of other semicircular canals (recurrence) some time after the first onset has been considered separately. Follow-up at 6 months showed recurrence in 12.4% of cases, while being chronic in 1.5% of cases. Only 9.3% of cases showed recurrence at 6 months, no statistically significant difference being observed between vertical (8.9%) and lateral canal (9.6%), forms. Relapses occurred in 3.1% of cases, in one third of which at least two risk factors were detected.

Development of communication and speech skills after cochlear implant in a sign language child.

In selecting patients to undergo cochlear implant, a pre-existing use of sign language gives rise to two problems that have been widely debated in the literature. First, the caution shown toward the candidacy of patients using this mode of communication, since it is considered a possible element of interference in the acquisition of speech. Secondly, refusal of the cochlear implant procedure, on the part of the deaf community, on the grounds both of cultural identity and of it being more "natural" for a deaf person to use an unimpaired visual channel rather than an impaired hearing channel. In order to establish whether knowledge of sign language does, indeed, affect speech production negatively and evaluate which mode of communication, oral or gestual, is preferred, the present investigation was carried out on a preverbal deaf child who had undergone cochlear implant at about 7 years of age and has always used both languages. His verbal skills were evaluated in the precochlear implant stage, then at 6 and 12 months after, together with the changes in his use of sign language and in the relationship between the two modes. Results, besides observing the presence of linguistic evolution at each level examined and already evident at 6 months, also documented a progressive reduction in the spontaneous use of sign language. In conclusion, the present experience revealed no temporal or qualitative differences in post-cochlear implant evolution of speech skills, in comparison with that observed in patients with an exclusively aural-oral approach. Furthermore, the increased use of the hearing pathway, made possible by cochlear implant, determined a spontaneous choice of verbal language as the most natural and economic mode of communication.

Changes in clinical and instrumental vestibular parameters following acute exposition to auditory stress.

Besides Tullio's phenomenon, resulting from anatomic changes in the labyrinth, a hypersensitivity to acoustic stimuli of the saccular structures appears to be the underlying cause of the vestibular responses detected in some patients. In order to evaluate the incidence of vestibular symptoms triggered by acute exposure to auditory stress (disco music), 40 subjects aged between 18 and 26 years, with no audiological and vestibular disorders, were submitted to otoneurologic tests. Subjects were exposed to disco music [intensity 128 dB (C)], for 3 hours. Tests have been carried out before and immediately after exposure. Canalar and macular functions have been evaluated using vestibular investigation techniques and vestibular evoked myogenic potentials. When compared to baseline data, post-exposure test results did not reveal any canalar damage. Pre- and post-exposure recordings of the vestibular-oculomotor reflex threshold have shown no significant changes. Conversely, post-stimulus recordings have shown a significant increase in the amplitude of the vestibular evoked myogenic potential response, thus indicating a possible irritative involvement of the macular receptor. This result suggests a direct action upon the receptor by acoustic stimulation which could, therefore, be the underlying cause of vestibular symptoms reported by patients following exposure to sufficiently intense acoustic stimuli. Prior to this study. a questionnaire concerning the relationship between habitual disco visiting and audio-vestibular symptoms has been completed by 310 students at the University of Catanzaro. This survey revealed a significant incidence of vestibular symptoms due to acoustic stress (Tullio's phenomenon) which led us to hypothesise that balance disorders due to auditory stress are much more frequent than commonly held, particularly since, in many cases, diagnoses is unknown or not easy due to the difficult procedures by which these conditions are diagnosed.

ABR and HIV-induced impairment of the central nervous system.

This in vivo study used Auditory Brainstem Responses (ABR) to evaluate nerve transmission integrity in the course of HIV infection. 48 normoacoustic HIV+ patients (40 men, 8 women) and 10 healthy age, sex and risk-factor matched controls underwent Brainstem Evoked Auditory potentials using a standard technique. Potentials were tested at cadences of 11 and 51 stimuli per second. ANOVA and Student's T test were used for inter Center for disease Control (CDC) classes and CDC classes vs control analysis of the values of the principal wave latencies (I, III, V) and interpeak intervals (I-III, III-V, I-V). Significant impairments in nerve transmission, shown best at the 51 pps cadence, were present from the earliest stages of HIV infection and worsened as the disease progressed. These results suggest that the upper part of the brainstem may be the main target of involvement in the tract being tested. Since electrophysiological tests allow detection of nervous dysfunction in subjects while still asymptomatic, these procedures could be usefully employed in order to better define the real onset of brain damage in HIV-1 seropositive patients and monitor the speed with which these lesions evolve.