19 research outputs found
Rehabilitation of severe-to-profound sensorineural hearing loss with an active middle ear implant
No full textBackground: Severe-to-profound sensorineural hearing loss (spSNHL) is mostly relying on the use of a cochlear implant (CI).
Aims: The present study reports on the auditory outcome from a group of subjects affected by
spSNHL who received an AMEI application.
Materials and methods: Nine out of 43 subjects who received a fully-implantable AMEI were initially candidated as off-label (primary off-label group or POLG). Twelve subjects showed over time a decrease in bone conduction threshold (BCT) in the operated ear (Secondary Off-Label Group or SOLG): SOLGa with no detectable BCT (9 subjects), SOLGb with residual low-frequency BCT (3 subjects). The auditory assessment included pure tone audiometry and speech audiometry in quiet and noise.
Results: A significant PTA5 difference was found at activation in SOLGb group and at the last fitting in SOLGa Group in respect to the label control group. No significant difference was found between POLG group and control group. Speech audiometry in noise revealed a significant lower gain in all three groups in comparison to the control group.
Conclusions: The adoption of an AMEI in unconventional indications could be beneficial also for subjects with spSNHL, although this solution can in some cases only be transient before performing CI surger
Early assessment of vestibular function after unilateral cochlear implant surgery
No full textIntroduction : Cochlear implantation (CI) has been reported to negatively effect on the vestibular function. The study of the vestibular function has variably been conducted by different types of diagnostic tools. The combined use of modern, rapidly performable diagnostic tools could reveal useful for standardizing the evaluation protocol.
Methods: In a group of 28 subjects undergoing CI, the video Head Impulse Test (vHIT), the cervical Vestibular Evoked Myogenic Potentials (cVEMPS) and the short-form of Dizziness Handicap Inventory (DHI) questionnaire were investigated pre-operatively and post-operatively (implant on and off) in both the implanted and the contralateral, non-implanted ear. All surgeries were performed with a round window approach (RWA), except for three otosclerosis cases were the extended RWA (eRWA) was used.
Results: The vHIT of the lateral semicircular canal showed a pre-operative vestibular involvement in nearly 50% of the cases, whilst the three canals were contemporarily affected in only 14% of them. In all the hypo-functional subjects, cVEMPs were absent. A low VOR gain in all the investigated SSCC was found in 4 subjects (14%). In those subjects, (21.7%) in whom cVEMPs were pre-operatively present and normal in the operated side, absence of response was post-operatives recorded.
Discussion/Conclusion: The vestibular protocol applied for the study showed to be appropriate for distinguishing between the CI operated and the non-operated ear. In this regard, cVEMPs showed to be more sensitive than vHIT for revealing a vestibular sufferance after CI, although without statistical significance. Finally, the use of the RWA surgery was apparently not avoiding signs of vestibular impairment to occur
On the role of depletive tests. a review analysis
No full textAn overview of the diagnostic role of depletion tests for staging Meniere’s disease, especially in the first phase of the disease, is reported. Pros and cons, as well reliability and specificity of this diagnostic procedure is thoroughly analysed
Mesenchymal stem cells for the treatment of psoriasis: a comprehensive review
No full textMesenchymal stem cells (MSCs) have recently been shown to have not only regenerative capabilities but also immunomodulating properties. For this reason, they are currently under investigation in clinical trials for the treatment of several autoimmune systemic disorders. Psoriasis is a systemic immune-mediated disease for which MSCs could have therapeutic potential. We analysed the existing literature with regard to MSC-based strategies for the treatment of psoriasis, using the MEDLINE, Embase, Scopus and Cochrane Library electronic databases from inception to the date of study. A number of studies confirm the involvement of MSCs in psoriasis pathogenesis and therefore designate MSCs as an important potential therapeutic tool in this setting. Preclinical data are mostly based on imiquimod-induced murine models of psoriasis, and confirm the anti-inflammatory and immunomodulatory action of MSCs in the setting of psoriasis. Six patients affected by psoriasis were described in four clinical studies. Despite significant differences in terms of therapeutic protocols and clinical outcomes, the MSC-based regimens were efficacious in 100% of the cases. Despite more data still being needed, MSCs could be a promising therapy for psoriasis
Traditional and adaptive speech audiometry in single-sided deaf (SSD) subjects rehabilitated by bone conductive implants (BCI), quality of life and long-term utilization
No full textBackground: Single-sided deafness (SSD) encompasses the presence of a profoundly deaf ear with a normal, contralateral one. Patients with SSD may have difficulty with speech intelligibility in noise and localizing sounds. Aims/Objectives: This retrospective study aims to evaluate the long-term effectiveness of bone conduction implant (BCI) in a group of patients with SSD. Material and Methods: Audiologic benefit was assessed through conventional speech audiometry and adaptive Matrix test. Impact on quality of life was evaluated with the Glasgow Benefit Inventory (GBI) questionnaire. BCI usage data were also obtained from each subject. Results: Thirty-two patients were included. No statistically significant improvements were found at standard audiometric tests using BCI, but at Matrix test the mean SRT is reached at S/N −1.16 dB without BCI and −2.07 with BCI with a statistically significant difference (p = 0.026). The mean GBI score was 25.12, ranging from −8.3 to 47.2. Ten subjects (31%) discontinued the BCI use overtime. Conclusions and Significance: Benefit assessment of BCI in SSD recipients can be difficult. Adaptive audiometric test could be useful. Quality of life measures seem to suggest potential ‘beyond-auditory’ benefits. SSD recipients can be inconsistent users of BCI
La presbiacusia. problematiche, diagnosi e opzioni riabilitative Presbycusis. problems, diagnosis and treatment
No full textPresbycusis is sensorineural bilateral symmetrical, progressive hearing loss, caused by the advance
of age. It involves mainly the higher frequencies and associated with tinnitus. Presbycusis the most
frequent form of sensorineural hearing loss of the adult, characterized by the progressive difficulty following
the conversation, especially in noisy environments. It is caused by reduction in the number of
Corti cells, induced by genetic and environmental factors. In the elderly communication disorders generate
isolation and depression, thereby causing a significant reduction of life quality. An observational
study at our hospital in 2010, using questionnaires on verbal-acoustic communication (Self Assessment
of Communication), found that older people have a poor perception of disability related to hearing
loss. For presbycusis to be diagnosed, tone audiometry and speech and sovraliminary tests have to be
carried out and must be integrated with the evaluation of extremely high frequencies (EHFs). In the
majority of cases, rehabilitation involves conventional hearing aids. The most commonly used are retroauricular
hearing aids, when these are contraindicated partially or totally implantable hearing device
scan be used. Careful follow up of the patient is also fundamental, using benefit questionnaires to find
the optimal fitting and therefore the best result
Video head impulse test in labyrinthine fistula due to middle ear cholesteatoma
No full textOBJECTIVES: To assess and monitor lateral semicircular canal (LSC) function over time in patients affected by chronic otitis media with cholestea- toma (CHO) complicated by fistula of LSC (LSC-F) before and after surgery using video Head Impulse Test (vHIT).
MATERIALS and METHODS: Eight patients aged 18-67 years affected by CHO with imaging-ascertained LSC-F were included in this preliminary prospective study. The following protocol has been applied: oto-microscopic diagnosis with patient’s history; computed tomography scan of the temporal bone; surgery with concomitant resurfacing of LSF-F; audiological and vestibular evaluation before surgery (T0) and at 30 days (T1), 6 months (T2), and 1 year after surgery (T3). vHIT was used to assess vestibulo-ocular reflex (VOR) in LSC.
RESULTS: None of the patients showed deterioration of bone conduction hearing levels during the different time of evaluation. Three patients showed a reduced VOR gain and catch-up saccades at T0, with VOR gain normalization at T2. This finding remained stable at the 1-year follow-up. The VOR gain in the nonaffected side generally experienced an increase, paralleled by the normalization on the affected side, with statistically significant correlation. The subjects with normal vHIT before surgery did not show any variation following surgery.
CONCLUSION: vHIT allows the assessment of LSC function in case of fistula. The adopted surgical fistula repair did not induce deterioration of the auditory or LSC function, but indeed, it could prevent worsening and help promoting recovery to the normal function.
KEYWORDS: Lateral semicircular canal, cholesteatoma, video Head Impulse Test, vestibulo-ocular reflex, labyrinthine fistul
Digital hearing aids for high-frequency sensorineural hearing loss: Preliminary experience with the RetroX (R) device
No full textAbstract: Conclusions. The RetroX(R) outer ear hearing aid seems to represent a means of overcoming problems with understanding speech in noise in patients with high-frequency sensorineural hearing loss (SNHL) without the need to wear conventional completely-in-the-canal (CIC) hearing aids, which are usually reported to annoy patients as a result of the occlusion effect. Objective. To present preliminary data from a study carried out to compare the efficacy, in the same individual, of a standard digital CIC hearing aid and a new implantable outer ear canal device, the RetroX. Material and methods. Three out of 15 adults affected by high-frequency SNHL who were candidates for auditory rehabilitation were evaluated by using speech audiometric tests in quiet and noise as well as a questionnaire shortly after use of a CIC hearing aid and the RetroX device, i.e. at 7 and 14 days. The efficacy of the RetroX was anticipated by testing all the subjects using a RetroX simulating system before starting the study protocol. Results. In all three implanted patients, the RetroX provided better audiological benefit for speech understanding in noise. These findings were corroborated by the results of the questionnaire, which showed greater satisfaction with the RetroX, especially regarding the absence of the occlusion effect
Intralabyrinthine Vestibular Schwannoma Responsive to Intratympanic Gentamicin Treatment
No full textIntralabyrinthine schwannoma (ILS) is a rare benign tumor that affects the ends of cochlear and vestibular nerves. In a majority of the cases, it occurs with unilateral progressive sensorineural hearing loss. Less frequent symptoms include tinnitus, imbalance, vertigo, or fullness. The advent of magnetic resonance imaging allows early diagnosis and enables an appropriate therapeutic protocol. This report describes a case of intravestibular schwannoma, with fluctuating hearing loss and intractable vertigo, treated with intratympanic gentamicin. The patient was a 28-year-old woman with intractable vertigo and fluctuating left-side hearing loss caused by left intravestibular schwannoma. Because surgery was temporarily rejected by the patient, a single dose of intratympanic gentamicin was administered. Following this, the patient showed a significant improvement in the symptoms. However, moderate to flat sensorineural hearing loss was also observed. Intratympanic gentamicin infiltration is a valid therapeutic option for patients with ILS, affected by intractable vertigo, when the patient refuses surgery
