Alberto Eibenstein

Olfactory screening test in mild cognitive impairment

AbstractMild cognitive impairment (MCI) is a transient status between physiologic ageing and dementia. Each year more than 12% of subjects with MCI develop Alzheimer’s disease. This study evaluated the presence of an olfactory deficit in amnesic MCI (aMCI) patients. Twenty–nine patients diagnosed with aMCI and a homogeneous control group of 29 subjects were enrolled in the study. Olfactory function was assessed by the Sniffin’ Sticks Screening Test (SSST) and the Mini Mental State Examination, the Clinical Dementia Rating, the Geriatric Depression Scale and the Mental Deterioration Battery were used to evaluate the neurocognitive status. aMCI patients showed a significant impairment of their olfactory identification compared to controls (SSST score: 8.3±2.1 vs. 10.8±0.9; p<0.001). These results suggest that olfactory tests should be part of the diagnostic armamentarium of pre–clinical dementia. A long–term follow up might confirm the olfactory identification function as an early and reliable marker in the diagnosis of pre–clinical dementia.

Modern psychophysical tests to assess olfactory function.

AbstractThe sense of smell significantly contributes to quality of life. In recent years much progress has been made in understanding the biochemistry, physiology and pathology of the human olfactory system. Olfactory disorders may arise not only from upper airway phlogosis but also from neurodegenerative disease. Hyposmia may precede motor signs in Parkinson’s disease and cognitive deficit in Alzheimer’s disease. These findings suggest the complementary role of olfactory tests in the diagnosis and management of neurodegenerative diseases. In this report we present a review of modern olfactory tests and their clinical applications. Although rarely employed in routine clinical practice, the olfactory test evaluates the ability of odour identification and is a useful diagnostic tool for olfaction evaluation. Olfactory screening tests are also available. In this work we strongly recommend the importance of an ENT evaluation before the test administration and dissuade from a self–administration of an olfactory test.

New Trends in Tinnitus Management

Tinnitus is a perception of sound in absence of sound stimulation. Tinnitus in many cases cannot be eliminated by conventional medical treatment with drugs or surgery. Some people who begin to notice tinnitus, whether spontaneous or induced by noise, trauma or other insult, will experience spontaneous resolution, but many patients will have persistent tinnitus. For some of them, tinnitus sensation will be joined by tinnitus suffering, with many adverse effects like anxiety, depression and sleep disorders. For these tinnitus sufferers the psychological and acoustic approach proposed by the Tinnitus Retraining Therapy and Acoustic Desensitization Protocol may be helpful. Periodically new treatments are suggested like low-frequency repetitive transcranial magnetic stimulation and sequential phase shift sound cancellation treatment based on the frequency and loudness matching of the tinnitus. The aim of this work is to review modern considerations for the treatment of tinnitus.

Myxoid Liposarcoma of the Oral Cavity: Case Report and Review of the Literature

Liposarcomas very rarely affect the oral cavity; in such cases the cheek is typically involved. Differential diagnosis between lipoma and other sarcomas is sometimes challenging because the macroscopic and histological features may be difficult to distinguish. Neoplasms with the morphology of lipoma should always receive a careful postoperative histopathologic evaluation. Complete surgical excision is the most effective treatment. We present a case of myxoid liposarcoma of the cheek, together with a literature review of intraoral liposarcomas reported during the last 60 years.Liposarcomas very rarely affect the oral cavity; in such cases the cheek is typically involved. Differential diagnosis between lipoma and other sarcomas is sometimes challenging because the macroscopic and histological features may be difficult to distinguish. Neoplasms with the morphology of lipoma should always receive a careful postoperative histopathologic evaluation. Complete surgical excision is the most effective treatment. We present a case of myxoid liposarcoma of the cheek, together with a literature review of intraoral liposarcomas reported during the last 60 years.

Isolated oropharyngeal Kaposi’s sarcoma in non AIDS patient: differences and similarities with spindle-cell haemangioendothelioma

Vascular tumours rarely affect the oropharynx and overall they can represent a diagnostic challenge since their clinico-histopathological patterns are not always clear. This case report, of an isolated pharyngeal vascular proliferation, allowed the authors to analyse the similarities and differences between Kaposis sarcoma and spindle-cell haemangioendothelioma. Moreover, it emphasizes the importance of diagnostic tools, such as the human herpesvirus 8 (HHV8) marker, that sometimes may represent the only reliable test for clearly establishing the diagnosis.

Suppression of Tinnitus in a Patient with Unilateral Sudden Hearing Loss: A Case Report

We describe a case of a 67-year-old woman with severe disabling right-sided tinnitus, mild hyperacusis, and headache. The tinnitus was associated with sudden right hearing loss and vertigo, which occurred about 18 months before. Magnetic resonance imaging (MRI) resulted in normal anatomical structures of the cochlea and of the cranial nerves showing a partial empty sella syndrome with suprasellar cistern hernia. Angio-MR revealed a bilateral contact between the anterior-inferior cerebellar artery (AICA) and the acoustic-facial nerve with a potential neurovascular conflict. Surgery was considered unnecessary after further evaluations. The right ear was successfully treated with a combination device (hearing aid plus sound generator). Shortly after a standard fitting procedure, the patient reported a reduction of tinnitus, hyperacusis, and headache which completely disappeared at the follow-up evaluation after 3, 6, and 12 months. This paper demonstrates that the combination device resulted in a complete tinnitus and hyperacusis suppression in a patient with unilateral sensorineural sudden hearing loss. Our paper further supports the restoration of peripheral sensory input for the treatment of tinnitus associated with hearing loss in selected patients.

Severe Hyperacusis, Photophobia, and Skin Hypersensitivity

We report a case of a patient with severe hyperacusis, photophobia, and skin hypersensitivity. The patient was initially treated with sound therapy and medical therapy for 4 months and successfully with a selective serotonin reuptake inhibitor (SSRI) and cognitive behavioral therapy which improved her mood and the tolerance for sounds and light.

A Device Supporting the Self Management of Tinnitus

Tinnitus is an annoying ringing in the ears, in varying shades and intensities. Tinnitus can affect a patient’s overall health and social well-being (e.g., sleep problems, trouble concentrating, anxiety, depression and inability to work). Usually, the diagnostic procedure of tinnitus passes through three steps, i.e., audiological examination, psychoacoustic measurement, and disability evaluation. All steps are performed by physicians, by using dedicated hardware/software and administering questionnaires. The paper reports on the results of a one-year running project whose aim is to directly support patients in such a diagnostic procedure by using a specific device and their smartphone.

Lipoma of Piriform Sinus: A Case Report and Review of the Literature

The lipomas of oropharynx, hypopharynx, and larynx are so rare that up to now approximately there have been 100 cases reported. The lipomas are slow-growing lesions that are capable of reaching considerable dimensions and are often detected at a late stage. The symptoms can vary both in dimension and in location, semiobstructing the aerodigestive tract or exerting compression on adjacent structure. In this case, the lesion, which originated from the piriform sinus, was removed endoscopically urgently due to obvious signs of tissue suffering caused by stretching of the pedicle as a result of displacement of the mass. The two aims of this case report are to expose an interesting and rare case study mainly for an Emergency Room Specialist and an ENT (Ear, Nose, and Throat) Specialist involved in solving the problem and to demonstrate that the choice of an endoscopic approach is useful in order to have an optimal visualization of the lesion and to perform a total eradication. The use of endoscopic devices also allows a rapid postoperative recovery, compared to external access and optimum locoregional control in the follow-up procedures to prevent possible relapses.

A rare case report of a typical variant ossifying fibromyxoid tumor (OFMT), located in the retroauricular perimastoid region

Highlights • Ossifying fibromyxoid tumor of soft parts (OFMT) has an uncertain histopathogenesis and is characterized by a peripheral bone shell embedded in a fibromyxoid matrix.• Folpe and Weiss proposed a classification with “typical”, “atypical” and “malignant” variants.• The exam revealed a right perimastoid mass formation (2.2 × 1.2 × 2 cm) with an oval morphology, extended right to the back of the external ear canal, characterized by the predominant calcific component.• The cytoplasm is described as a poorly eosinophilic, arranged to form solid nests and cords immersed in abundant collagenous and/or myxoid stroma, interposed in a mature irregularly shaped trabecular bone.• Considering that it is extremely rare, and the possibility of local metastasis especially for the malignant type, we believe that more studies are required for this “enigmatic” tumor.