Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users.

How is music perceived by cochlear implant (CI) users? This question arises as "the next step" given the impressive performance obtained by these patients in language perception. Furthermore, how can music perception be evaluated beyond self-report rating, in order to obtain measurable data? To address this question, estimation of the frontal electroencephalographic (EEG) alpha activity imbalance, acquired through a 19-channel EEG cap, appears to be a suitable instrument to measure the approach/withdrawal (AW index) reaction to external stimuli. Specifically, a greater value of AW indicates an increased propensity to stimulus approach, and vice versa a lower one a tendency to withdraw from the stimulus. Additionally, due to prelingually and postlingually deafened pathology acquisition, children and adults, respectively, would probably differ in music perception. The aim of the present study was to investigate children and adult CI users, in unilateral (UCI) and bilateral (BCI) implantation conditions, during three experimental situations of music exposure (normal, distorted and mute). Additionally, a study of functional connectivity patterns within cerebral networks was performed to investigate functioning patterns in different experimental populations. As a general result, congruency among patterns between BCI patients and control (CTRL) subjects was seen, characterised by lowest values for the distorted condition (vs. normal and mute conditions) in the AW index and in the connectivity analysis. Additionally, the normal and distorted conditions were significantly different in CI and CTRL adults, and in CTRL children, but not in CI children. These results suggest a higher capacity of discrimination and approach motivation towards normal music in CTRL and BCI subjects, but not for UCI patients. Therefore, for perception of music CTRL and BCI participants appear more similar than UCI subjects, as estimated by measurable and not self-reported parameters.

Emerging and re-emerging infectious disease in otorhinolaryngology.

SUMMARY: Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

First experience in Italy with a new transcutaneous bone conduction implant.

Since 2011, transcutaneous bone-anchored auditory implants have been an alternative to the classic percutaneous implant (Baha) for bilateral conductive/mixed hearing loss that cannot be corrected by surgery. Recently, a new transcutaneous device has been approved for clinical use. Its internal component is made of the classic titanium Baha fixture, coupled to a 27 mm diameter subcutaneous circular magnet. The external component includes a second circular magnet 29 mm in diameter and a digital sound processor. To date, there are no reports describing the results of the application of this device. The aim of the present study is to report on the anatomical and functional results of transcutaneous Baha implantation in three patients: two adults, one with syndromic aural atresia and one with bilateral conductive hearing loss due to bilateral tympanomastoidectomy, and an 8-year-old child with non-syndromic aural atresia. No major intraoperative or postoperative complications were observed. The three patients tolerated the external magnet, with no signs of skin irritation. Functional results were good: median unaided free-field PTA (0.5-3 kHz) was 50 dB HL (range = 41-66 dB HL); with the transcutaneous Baha median PTA (0.5-3 kHz) was 27 dB HL (range = 25-30 dB HL) and median gain was 25 dB HL (range = 11-39 dB HL). Preliminary results encourage use of the device as a valuable alternative to other implantable devices in these patients. To ensure the success of treatment, several precautions are suggested including gradually increasing use during the first post-operative months to favour skin adaptation to magnet pressure. In addition to skin reactions, in a paediatric age most concerns are related to the curvature of the skull, which may induce tenting of the skin over the internal magnet.

Two new cases of chronic tuberculous otomastoiditis in children.

This report focuses on tuberculous otomastoiditis treated at a third level Italian paediatric hospital. We reviewed the clinical charts of 4077 children who underwent middle ear surgery at the Audiology and Otology Unit of the Institution's ENT Department from January 1995 to December 2011. A tubercular aetiology was identified in 2 cases: a 4-year old boy who presented with primary ear involvement, i.e. with no other infected sites but the middle ear, and a 5-year old girl with secondary tuberculous otomastoidits, who was treated for pulmonary and mediastinal tuberculosis at the age of 7 months.

Alpha EEG Frontal Asymmetries during Audiovisual Perception in Cochlear Implant Users. A Study with Bilateral and Unilateral Young Users.

OBJECTIVES: The aim of the present study is to investigate the variations of the electroencephalographic (EEG) alpha rhythm in order to measure the appreciation of bilateral and unilateral young cochlear implant users during the observation of a musical cartoon. The cartoon has been modified for the generation of three experimental conditions: one with the original audio, another one with a distorted sound and, finally, a mute version. METHODS: The EEG data have been recorded during the observation of the cartoons in the three experimental conditions. The frontal alpha EEG imbalance has been calculated as a measure of motivation and pleasantness to be compared across experimental populations and conditions. RESULTS: The EEG frontal imbalance of the alpha rhythm showed significant variations during the perception of the different cartoons. In particular, the pattern of activation of normal-hearing children is very similar to the one elicited by the bilateral implanted patients. On the other hand, results related to the unilateral subjects do not present significant variations of the imbalance index across the three cartoons. CONCLUSION: The presented results suggest that the unilateral patients could not appreciate the difference in the audio format as well as bilaterally implanted and normal hearing subjects. The frontal alpha EEG imbalance is a useful tool to detect the differences in the appreciation of audiovisual stimuli in cochlear implant patients.

Role of bimodal stimulation for auditory-perceptual skills development in children with a unilateral cochlear implant.

This is a prospective randomised study that evaluated the differences arising from a bimodal stimulation compared to a monaural electrical stimulation in deaf children, particularly in terms of auditory-perceptual skills development. We enrolled 39 children aged 12 to 36 months, suffering from severe-to-profound bilateral sensorineural hearing loss with residual hearing on at least one side. All were unilaterally implanted: 21 wore only the cochlear implant (CI) (unilateral CI group), while the other 18 used the CI and a contralateral hearing aid at the same time (bimodal group). They were assessed with a test battery designed to appraise preverbal and verbal auditory-perceptual skills immediately before and 6 and 12 months after implantation. No statistically significant differences were observed between groups at time 0, while at 6 and 12 months children in the bimodal group had better scores in each test than peers in the unilateral CI group. Therefore, although unilateral deafness/hearing does not undermine hearing acuity in normal listening, the simultaneous use of a CI and a contralateral hearing aid (binaural hearing through a bimodal stimulation) provides an advantage in terms of acquisition of auditory-perceptual skills, allowing children to achieve the basic milestones of auditory perception faster and in greater number than children with only one CI. Thus, "keeping awake" the contralateral auditory pathway, albeit not crucial in determining auditory acuity, guarantees benefits compared with the use of the implant alone. These findings provide initial evidence to establish shared guidelines for better rehabilitation of patients undergoing unilateral cochlear implantation, and add more evidence regarding the correct indications for bilateral cochlear implantation.

Differences in the perceived music pleasantness between monolateral cochlear implanted and normal hearing children assessed by EEG.

The perception of the music in cochlear implanted (CI) patients is an important aspect of their quality of life. In fact, the pleasantness of the music perception by such CI patients can be analyzed through a particular analysis of EEG rhythms. Studies on healthy subjects show that exists a particular frontal asymmetry of the EEG alpha rhythm which can be correlated with pleasantness of the perceived stimuli (approach-withdrawal theory). In particular, here we describe differences between EEG activities estimated in the alpha frequency band for a monolateral CI group of children and a normal hearing one during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns related to the normal hearing group refers to a higher pleasantness perception when compared to the cerebral activity of the monolateral CI patients. In fact, the present results support the statement that a monolateral CI group could perceive the music in a less pleasant way when compared to normal hearing children.

ENT function in a 14-days guinness scuba dive.

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

EEG frontal asymmetry related to pleasantness of music perception in healthy children and cochlear implanted users.

Interestingly, the international debate about the quality of music fruition for cochlear implanted users does not take into account the hypothesis that bilateral users could perceive music in a more pleasant way with respect to monolateral users. In this scenario, the aim of the present study was to investigate if cerebral signs of pleasantness during music perception in healthy child are similar to those observed in monolateral and in bilateral cochlear implanted users. In fact, previous observations in literature on healthy subjects have indicated that variations of the frontal EEG alpha activity are correlated with the perceived pleasantness of the sensory stimulation received (approach-withdrawal theory). In particular, here we described differences between cortical activities estimated in the alpha frequency band for a healthy child and in patients having a monolateral or a bilateral cochlear implant during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns observed in a healthy child and that of a bilateral cochlear implanted patient are congruent with the approach-withdrawal theory. Conversely, the scalp topographic distribution of EEG power spectra in the alpha band resulting from the monolateral cochlear user presents a different EEG pattern from the normal and bilateral implanted patients. Such differences could be explained at the light of the approach-withdrawal theory. In fact, the present findings support the hypothesis that a monolateral cochlear implanted user could perceive the music in a less pleasant way when compared to a healthy subject or to a bilateral cochlear user.

Investigation on the pleasantness of music perception in monolateral and bilateral cochlear implant users by using neuroelectrical source imaging: a pilot study.

There is a debate in the specialized literature about the quality of fruition of music for patients that received a cochlear implant. Interestingly, very few studies have investigated the hypothesis that patients that use a bilateral cochlear implant could perceive the music in a more pleasant way as compared to unilaterally implanted patients. Previous observations in healthy subjects have indicated that variations of particular EEG rhythms correlated with the pleasantness of the perceived music. The aim of the present pilot study is then to apply the state of the art neuroelectrical imaging and the analysis of cortical representation of EEG rhythms to monitor the perceived pleasantness during the observation of a simple videoclip in one patient with a unilateral cochlear implant and in one receiving a bilateral cochlear implant. Results of this pilot study showed that on the base of such previously validated EEG rhythms, the fruition of music and video, in terms of pleasantness, is statistically higher in the bilaterally implanted patient when compared to the monolateral implanted patient.

Cochlear implant patients' speech understanding in background noise: effect of mismatch between electrode assigned frequencies and perceived pitch.

OBJECTIVE: To assess the electrode pitch function in a series of adults with postlingually implanted cochlear implants and with contralateral residual hearing, in order to investigate the correlation between the degree of frequency map mismatch and the subjects' speech understanding in quiet and noisy conditions. DESIGN: Case series. SUBJECTS: Seven postlingually deafened adults with cochlear implants, all with detectable contralateral residual hearing. Subjects' electrode pitch function was assessed by means of a pitch-matching test, in which they were asked to match an acoustic pitch (pure tones delivered to the non-implanted ear by an audiometer) to a perceived 'pitch' elicited by stimulation of the cochlear implant electrodes. A mismatch score was calculated for each subject. Speech recognition was tested using lists of sentences presented in quiet conditions and at +10, 0 and 5 dB HL signal-to-noise ratio levels (i.e. noise 10 dB HL lower than signal, noise as loud as signal and noise 5 dB HL higher than signal, respectively). Correlations were assessed using a linear regression model, with significance set at p < 0.05. RESULTS: All patients presented some degree of mismatch between the acoustic frequencies assigned to their implant electrodes and the pitch elicited by stimulation of the same electrode, with high between-individual variability. A significant correlation (p < 0.005) was found between mismatch and speech recognition scores at +10 and 0 dB HL signal-to-noise ratio levels (r2 = 0.91 and 0.89, respectively). CONCLUSION: The mismatch between frequencies allocated to electrodes and the pitch perceived on stimulation of the same electrodes could partially account for our subjects' difficulties with speech understanding in noisy conditions. We suggest that these subjects could benefit from mismatch correction, through a procedure allowing individualised reallocation of frequency bands to electrodes.

Predictive role of audiological and clinical features for functional results after stapedotomy.

OBJECTIVE: To analyze and compare the preoperative factors that potentially influence the outcome of stapedotomy in our study group. MATERIALS AND METHODS: 161 cases were enrolled. Clinical variables considered to influence functional results - air conduction (AC) and bone conduction (BC) pure-tone average (PTA), air-bone gaps (ABG), sensorineural hearing loss (SNHL), ABG gain and DeltaSNHL - were gender, age, case type (unilateral vs. bilateral), ear side (right vs. left), pregnancy, vascular disease and family history of otosclerosis. The audiometric variables were preoperative AC- and BC-PTA, SNHL and ABG. RESULTS: Univariate logistic regression analysis showed that the probability of obtaining a > or =10 dB gain is significantly affected by the following factors: age <50 years, AC-PTA > or =50 dB and preoperative ABG > or =30 dB. All the other factors included into the registration (gender, familiarity, side, bilateral vs. unilateral, pregnancy, vascular diseases and preoperative BC-PTA) were not found to significantly affect postoperative gain (p > 0.05). Nevertheless, multivariate logistic regression analysis maintained a statistically significant correlation only between gain > or =10 dB and both preoperative ABG > or =30 dB and age <50 years. CONCLUSIONS: The accurate knowledge of predictive factors is a valuable tool that permits the surgeon to plan surgery with a better case selection as well as assisting in counseling the patient with regard to the likelihood of success of the procedure.

Multiple viral genome search in endolabyrinthic fluids of profoundly deaf patients: possible cytomegalovirus intracochlear reactivation.

BACKGROUND: The cause of about 30% of bilateral sensorineural hearing loss (SNHL) is still unknown. A viral etiology is among the most frequently proposed ones and the supposed diagnosis is only based upon few clinical and laboratory data. The detection of viral presence within a damaged compartment may represent a way to supply interesting data for confirmation of viral etiology and to explain pathogenic mechanisms. OBJECTIVES: The aim of our study was to identify the possible presence of pathogenic viruses in the inner ear extracellular compartment in patients with bilateral severe sensorineural deafness of unknown etiology who underwent cochlear implant surgery. METHODS: 4 patients, aged from 2 to 7 years and affected by SNHL underwent cochlear implantation surgery and, at the same time, endolabyrinthine fluid sampling. The samples were subsequently sent for viral nucleic acid extraction and polymerase chain reaction (PCR) treatment: multiplex PCR and realtime-PCR were used. In each endolabyrinthine fluid sample, cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella-zoster virus (VZV), herpes simplex virus type 1 and 2 (HSV-1, HSV-2) and enterovirus genomes were searched for. RESULTS: One patient was positive for intracochlear CMV, as confirmed by another base-pair segment PCR. EBV, VZV, HSV and enterovirus were detected in none of the 4 patients. CONCLUSIONS: Our finding of CMV genome within the cochlea of a deaf patient without any evidence of acute and prenatal CMV infection suggests its possible role in postnatal inner ear injury through reactivation of latent virus within the cochlea. This hypothesis could also be considered valid for some patients with anti-CMV-IgG-positive serology and absence of endolabyrinthine viral genome since viruses can be in an inactive state at the time of fluid collection. PCR has proved to be a very useful tool in order to investigate infectious causes of deafness even for more than one virus type at a time and in a limited quantity of sample, such as the small volume of endolabyrinthine liquid collected from children during cochlear implant surgery.