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Studio dell’estensione del danno vestibolare nei pazienti affetti da ipoacusia improvvisa
No full textSi definisce ipoacusia improvvisa una perdita uditiva neurosensoriale ≥30 dB in tre frequenze adiacenti del campo uditivo tonale. Il meccanismo eziopatogenetico non è noto nella maggior parte dei casi. Studi precedenti hanno evidenziato, oltre ad alcuni indicatori prognostici (es. età del paziente, ritardo nel trattamento, grado di ipoacusia,...), anche l’importanza della valutazione della funzionalità vestibolare; ad esempio è stato dimostrato che la neuronite vestibolare e l’ipoacusia improvvisa associata a vertigine presentano esiti diversi al vHIT, suggerendo differenti eziologie.
Obiettivi dello studio sono: descrivere l’estensione del danno maculare e canalare nei pazienti con ipoacusia improvvisa, studiare l’associazione tra il danno vestibolare e la prognosi uditiva e descrivere pattern di danno vascolare.
Sono stati inclusi nello studio 86 pazienti con nuova diagnosi di ipoacusia improvvisa afferenti ad un centro di terzo livello. Criteri di inclusion: età >18 anni. Criteri di esclusione: follow up interrotto, pregresse patologie uditive omo- o contro-laterali, patologie dell’orecchio medio. I pazienti sono stati trattati secondo I protocolli ospedalieri e i dati clinici e strumentali relative a vHIT e VEMPs sono stati raccolti in modo prospettico. L’analisi statistica è stata svolta con il software SPSS 20.0 (IBB SPSS, IBM Corp., Armonk, NY). Le variabili continue sono state riportate come media ± DS o mediana e range. I test di Pearson (chi-squared) o il test di Fischer sono stati utilizzati per confrontare le variabili categoriche; i test ANOVA, Mann-Whitney U test o Kruskal-Wallis per le variabili continue. Una P<0.05 è stata considerata per la significatività statistica.
L'età media è stata di 55.7 anni (22-84). Il 73.3% (63/86) dei pazienti ha riferito vertigine. È stata trovata un’anormalità ai cVEMPs e ai oVEMPs rispettivamente nel 45.3% e 41.9% dei casi. La funzionalità canalare era alterata nel 16.3% dei casi per il canale laterale, 20.9% per il posteriore e 10.6% per l’anteriore. I pazienti sono stati suddivisi in 3 gruppi: pazienti con vertigine, pazienti senza vertigine e gruppo menierico. Alterazioni sacculari, del canale posteriore o di 3 o più recettori sono state riscontrate con maggiore frequenza nei pazienti del primo gruppo (p<0.05). UN deficit tricanalare si è verificato unicamente nei pazienti con vertigine. Sono stati identificati come fattori prognostici negative per la funzionalità uditiva le anormalità sacculari e l’elevato numero di alterazioni recettoriali (p<0.05). Inoltre, I pazienti con vertigine presentavano valori più elevati alla scala di Fazekas (p<0.05). I pazienti con pattern ischemico si presentavano con vertigine, perdite uditive più severe e prognosi peggiore (p<0.05).
In conclusione, uno studio complete dei recettori vestibolari e delle vie afferenti potrebbe migliorare la definizione dell’estensione del danno in questi pazienti, oltre che a fornire indicazioni prognostiche e permettere di identificare pattern a possibile patogenesi vascolare. La presenza di vertigine come sintomo associato, di un alto numero di alterazioni recettoriali e pattern lesionali ischemici sono associati ad un peggior recupero della funzione uditiva.Sudden sensorineural hearing loss (SSHL) is the loss ≥30 dB in three consecutive frequencies. The exact mechanism underlying SSHL remains elusive. Several prognostic indicators of favourable or unfavourable outcome in SSHL have been proposed (age, delay of treatment, the severity of hearing loss, etc.). The importance of the assessment of vestibular function was evidenced by previous studies. A recent study showed that vHIT results were different in vestibular neuritis and SSHL with vertigo, suggesting different causes of vestibular neuritis and SSHL.
The primary aim of the study is to describe the extension of macular and canal injury in patients affected by SSHL with or without vertigo. Secondary aims are to study the association between canal and macular function with hearing prognosis and to describe ischemic patterns of inner ear damage.
Consecutive patients with SSHL with or without vertigo who referred to Otolaryngology Unit of a tertiary hospital were consecutively recruited for one year. Inclusion criteria were: age ≥18 years, new diagnosis of SSHL. Exclusion criteria were: incomplete follow-up, previous ear disease, contralateral hearing loss. The usual therapeutic and diagnostic protocol was followed. Demographic, clinical and instrumental data were prospectively collected. o-/c-VEMPs and vHIT results were compared with hearing recovery and the presence of ischemic alterations at head MRI. Statistical analysis was performed using SPSS 20.0 (IBB SPSS, IBM Corp., Armonk, NY). Quantitative variables were checked for normal distribution using Kolmogorov-Smirnov and Shapiro-Wilk tests. Continuous variables were described by mean ± standard deviation or median and range. Comparisons between groups were performed by Pearson’s chi-squared test or Fischer’s exact test for categorical variables, one-way analysis of variance, Mann-Whitney U test or Kruskal-Wallis test for continuous variables. Differences between groups were considered significant at p<0.05.
147 patients had SSHL during the study period, 61 patients were excluded, 86 patients met the inclusion criteria and were included in the study. Median age was 55.7 years (22-84). Vertigo occurred in 73.3% (63/86) of cases. cVEMPs or oVEMPs abnormalities were found in 45.3% and 41.9%, respectively. Canal function was altered at the vHIT in lateral 16.3% for lateral, 20.9% for posterior and 10.6% for anterior canal. Three groups of patients were identified: patients without vertigo, patients with vertigo, patients with Meniere’s disease. Saccular dysfunction was more frequent in patients with vertigo (p<0.05). Posterior canal dysfunction was more frequent in patients with vertigo (p<0.05). Complete canals deficit was present only in patients with vertigo. Deficit of three or more receptors was more frequent in patients with vertigo (p<0.05). Impaired saccular function and high number of impaired receptors were associated with poor hearing outcome (p<0.05). Patients with vertigo had more severe Fazekas scale scores at head MRI (p<0.05). Patients with ischemic patterns had also vertigo (p<0.05), severe hearing loss and poor outcomes (p<0.05).
In conclusion, a complete assessment of vestibular receptors and afferents could help to better define the extension of the injury in SSHL and give information about the prognosis. Certain patterns of canal and macular injury could suggest ischemic cause. Vertigo, high number of injured receptors and certain patterns of canal or macular injuries are associated with poor outcome
Foreign Body in the Cervical Oesophagus: A Case Report
No full textBackground: Foreign bodies in the upper aerodigestive tract represent an uncommon cause of visits to emergency departments. In the majority of cases, foreign bodies do not go beyond the pharynx. They cause dyspnoea or pneumonia if they reach the tracheo-bronchial tree. If ingested, they will pass spontaneously through the gastrointestinal canal in the majority of cases. Nevertheless, especially in case of sharp-pointed or large objects, the foreign bodies can stop in the oesophagus. In case of dysphagia, stinging sensation and/or odynophagia occurring after eating a meal, a foreign body in the upper aerodigestive tract should be suspected. If not clinically visible, imaging is required. Case presentation: A 72-year-old woman presented to the Emergency Department with pharyngodynia, odynophagia, stinging, dysphagia, and sialorrhea for 12 hours. Her symptoms started after eating a meal with meat. The patient underwent a standard two-projection radiogram of the neck. The antero-posterior projection radiogram was unremarkable. The lateral projection radiogram showed 16 millimetres in maximum length radiopaque foreign body within the cervical oesophagus. The patient underwent transoral flexible oesophagoscopy under general anaesthesia, with successful removal of the foreign body (bony fragment). Her symptoms improved rapidly after the procedure, and the patient was discharged after 48 hours in good health. Conclusion: A foreign body in the cervical oesophagus may lead to visceral perforation. Once suspected, every effort should be made to identify and remove the foreign body to avoid potentially catastrophic consequences. In some cases, imaging could be necessary to detect the foreign body
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Spontaneous Upbeat Nystagmus and Selective Anterior Semicircular Canal Hypofunction on Video Head Impulse Test: A New Variant of Canalith Jam?
Get PDF: We describe a rare case of spontaneous upbeat nystagmus (UBN) attributable to a canalith jam involving the anterior semicircular canal (ASC) in a patient in whom comprehensive vestibular assessment was useful to identify the underlying pathomechanism. A 56-year-old woman with unsteadiness following repositioning procedures for left-sided benign paroxysmal positional vertigo (BPPV) presented with spontaneous UBN that showed slight right torsional components. A vestibular test battery detected isolated left ASC hypofunction on a video-head impulse test (Video-HIT). We postulated a persistent utriculopetal deflection of the left ASC cupula, which was attributable to entrapment of debris in a narrow canal tract, with consequent sustained inhibition of the ampullary afferents. Although spontaneous UBN receded after impulsive physical therapy, unsteadiness deteriorated into positional vertigo secondary to canalolithiasis involving the ipsilateral posterior canal. In our view, physical therapy possibly fragmented the canalith jam and released free-floating otoconia that eventually settled into the ipsilateral posterior canal. Video HIT revealed normalization of ASC hypofunction, and leftsided posterior canal canalolithiasis was successfully treated using appropriate repositioning procedures. We propose that a canalith jam involving the ASC should be considered in the differential diagnosis of spontaneous UBN, particularly in patients with a history of BPPV and isolated ASC hypofunction detected on video HIT
Features Associated With High Risk of Recurrence in Saccular Laryngeal Cysts: A Systematic Review and Qualitative Synthesis
No full textIntroduction: Saccular cysts are rare benign anomalies of the larynx (1.5% of laryngeal anomalies) determined by dilatation of the laryngeal saccule. They can be congenital or acquired. Clinical manifestation depends on the site of the cyst and the age of the patient. Children frequently have stridor and dyspnea, while adults usually complain of dysphonia.The therapeutic approach can be surgical or nonsurgical (needle aspiration or drainage).However, guidelines on the management of this disease are lacking in the literature.This systematic literature review was conducted through an interferential analysis with the aim of detecting the association between clinical, diagnostic, and operative factors and the recurrence of saccular cysts. Materials and methods: This systematic literature review was evolved following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist statement Papers published up to August 2023 containing relevant clinical data were searched in Embase/PubMed, Web of Science, Scopus, and Cochrane database. Full texts lacking information on the patient's data, clinical, radiological, and/or histological diagnosis of saccular cysts of the larynx were excluded. Articles with follow-up inferior to 6 months and not reporting any treatment of the cyst were excluded, too. Data concerning signs and symptoms, cyst characteristics, and the type of treatment were described, and the risk of recurrence was studied in association with these features. A qualitative synthesis of the results was performed. Results: Ninety-eight articles were screened. One hundred two patients were involved in the analysis. The articles with low or intermediate risk of bias were 22 (8 case reports and 14 case series) and they were included in the statistical analysis. Median age was 25 years (range 0-81). Saccular cysts were congenital (46/102, 45%) of cases acquired (56/102, 55%). Relying on the available data, all patients were symptomatic, with stridor as the main symptom (59%). Surgical approach was performed in 85% of cases, while drainage or needle aspiration of the cyst was the treatment of choice in the remaining 25% of cases. Twenty-four percent of patients had recurrence of the disease within 3 months. Median age at recurrence was 9 years. Cysts characteristics, preoperative management, and type of treatment were associated with an increased risk of disease recurrence (P < 0.05). Conclusions: Saccular cysts are rare congenital or acquired laryngeal diseases. Data regarding their management and factors associated with the risk of recurrence are still limited. Congenital cysts treated conservatively have a higher risk of recurrence than acquired cysts treated by open surgical techniques or by microlaryngoscopy. A better knowledge of factors associated with a higher risk of recurrence could help choose the best treatment
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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