Antonio Quaranta

The effect of unilateral multichannel cochlear implant on bilaterally perceived tinnitus.

Conclusions. Available multichannel cochlear implants (CIs) provide effective tinnitus suppression. More sophisticated speech strategies are more effective than analogue or slow strategies. The mechanisms by which tinnitus is suppressed by CIs are unclear; however, both acoustic masking and reorganization of the right auditory association cortex induced by the CI are possible mechanisms. CI significantly reduced the tinnitus-related handicap as assessed by the Tinnitus handicap Inventory (THI). Objective. The objective of the study was to evaluate the effects of a unilateral CI on bilaterally perceived tinnitus. Patients and methods. Forty-one profoundly deaf patients implanted with a multichannel CI reporting bilateral tinnitus were evaluated. All patients were asked to complete a questionnaire that evaluated the presence, location and intensity of tinnitus before and after cochlear implantation. Results. Seven patients (17%) reported the perception of a ‘new tinnitus’ after surgery. With the CI off tinnitus was abolished in 23 patients (56.1%) in the implanted ear and in 22 patients (53.6%) in the contralateral ear. With the CI on tinnitus was abolished in the ipsilateral ear in 27 patients (65.8%) and in the contralateral ear in 27 patients (65.8%). Statistical analysis showed a significant reduction of the total THI score and of each subscale score (p<0.001).

Air and bone conduction change after stapedotomy and partial stapedectomy for otosclerosis.

OBJECTIVE: The aim of this study was to analyze and compare the results obtained in otosclerosis patient undergoing stapedotomy and partial stapedectomy. STUDY DESIGN AND SETTINGS: Retrospective review of surgical series. The guidelines of the American Academy of Otolaryngology-Head and Neck Surgery for the evaluation of results of treatment of conductive hearing loss were used. RESULTS: Pure tone average (0.5 to 3 kHz) air-bone gap was 6.1 dB in the partial stapedectomy and 6 dB in the stapedotomy group. The air-bone gap (ABG) closure rate did not differ between the 2 groups, except at 4 kHz, where stapedotomy group showed greater closure (P 0.003). Mean postoperative ABG gain was significantly (P <0.05) higher in the stapedotomy group at 2, 3, and 4 kHz. Mean postoperative air-conduction gain did not differ significantly. Mean postoperative bone conduction (BC) change (1, 2, and 4 kHz) was 3.68 dB in partial stapedectomy and −0.02 dB in stapedotomy group, the difference being significant (P 0.007). Differences in BC change between the 2 groups were significant at each frequency. CONCLUSIONS: Similar good results can be obtained in experienced hands using either partial stapedectomy or stapedotomy technique. ABG closure rates were analogous in the 2 techniques as well as the complication rate. Although stapedotomy obtain better results at high frequencies, partial stapedectomy is associated with increased BC threshold at all frequencies.

Intratympanic therapy for Ménière's disease: effect of administration of low concentration of gentamicin.

We present results at 2 years follow-up of a group of 15 patients with Ménières disease treated with a low concentration of intratympanic gentamicin (IG group), compared with a group of 15 patients who refused any surgical treatment (NH group). IG was administered according to a predetermined and fixed schedule consisting of 2 doses of 0.5 ml gentamicin solution, pH 7.8, injected once a week, with a drug concentration of 20 mg/ml; the total dose of gentamicin was < or = 20 mg. Additional doses of IG were administered only in patients who had recurrence of vertigo. The results were evaluated following the American Academy of Otolaryngology Head and Neck Surgery 1995 criteria for reporting Ménières disease treatment results by means of interviews, audiologic and vestibular evaluations, and a questionnaire based on a six-point functional level scale. Seven of the 15 IG patients had recurrence of vertigo after the second injection and received a third dose of IG. Four patients had recurrence of vertigo after the third infiltration; three subjects received a fourth dose and one refused additional injection. At 2 years follow-up, 93% of the IG patients had complete (class A) or substantial (class B) control of vertigo. Only 47% of the NH patients had no vertigo or were substantially improved. Hearing deteriorated in 7% of the IG group and in 40% of the NH group. Tinnitus disappeared or improved in 20% of the IG patients and in 27% of the NH patients; 40% of the IG patients and 27% of the NH patients reported that their aural pressure was abolished. The present study demonstrates that, in patients with Ménières disease, 0.5 ml doses of gentamicin solution, with a concentration of 20 mg/ml, injected intratympanically once a week minimize the risk of hearing loss in the treated ear, permitting complete control of vertigo in more than half of cases after 2 doses and in almost all subjects (93%) after 4 doses.We present results at 2 years follow-up of a group of 15 patients with Méniè

Long-Term Outcome of Ménière’s Disease: Endolymphatic Mastoid Shunt versus Natural History

This retrospective study evaluates the outcome of 38 patients with intractable Ménière’s disease with a minimum of 7 years follow-up. Twenty underwent endolymphatic-mastoid shunt (EMS) and 18 were offered surgery but declined (natural history, NH, group). At the last control, 85% of the patients who were operated on (EMS group) and 74% of the NH patients had complete or substantial control of vertigo. The difference between the two groups was not significant. However, it was significant at 2 and 4 years follow-up. At 2 years, EMS patients had complete or substantial control of vertigo in 65% of the cases, at 4 and 6 years in 85% of the cases. Only 32% of the NH patients had complete or substantial control of vertigo at 2 years. This percentage rose to 50% at 4 years and to 74% at 6 years. Hearing results in the two groups were not significantly different. Tinnitus disappeared or decreased in 56% of the EMS patients and in 18% of the NH patients. Sixty-seven percent of the EMS patients and 29% of the NH patients reported that their aural fullness was abolished. In conclusion, over the years, approximately 8 out of 10 of our patients with Ménière’s disease achieved complete or substantial control of vertigo; however, this reduction was observed earlier in EMS patients than in those who declined surgery.

Cochlear implantation in otosclerosis.

Objective: The purpose of this study was to evaluate and compare the results obtained in a group of implanted otosclerotic patients with a group of cochlear implant (CI) patients not affected by otosclerosis. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Nine patients affected by profound sensorineural hearing loss caused by otosclerosis and nine patients affected by profound sensorineural hearing loss not caused by otosclerosis were evaluated. Intervention: Cochlear implantation. Main Outcome Measures: Preoperative imaging, intraoperative findings, postoperative facial nerve stimulation, and speech perception performance measures were performed and the data analyzed. Results: Otosclerosis patients showed signs of cochlear ossification both on high-resolution computed tomography scans and intraoperatively. The incidence of facial nerve stimulation was higher in the otosclerosis group, three out of nine, and was generally related to the use of electrical stimulation from the Nucleus 22 cochlear implant. Psychophysical and speech perception measures did not show significant differences between the two groups, despite some otosclerosis patients showing increased electrical thresholds and comfort levels and slightly poorer speech perception performance scores. Conclusions: Patients with otosclerosis who have progressed to profound hearing loss derive significant benefit from cochlear implants; however, an increased risk of cochlear ossification and facial nerve stimulation has to be taken in account during preoperative counseling. The advance in imaging techniques, CI technology and the possibility to stimulate precise regions of the cochlea with lower intensities make it possible for the surgeons and audiologists to readily and successfully manage these complications as they arise.

Masking Level Difference in Normal and Pathological Ears

The masking level difference (MLD) was studied in 9 normal subjects, in 15 patients with conductive hearing losses, in 9 subjects suffering from Menieres disease, and in 8 subjects with sensorineural hearing lossesResults showed that MLDs size not depend on the conductive impairement but it may be affected by the degree of the deafness both in Menieres disease and in sensorineural lesions

Surgical treatment of labyrinthine fistula in cholesteatoma surgery

Objective/Hypothesis: Evaluate the treatment of labyrinthine fistula in a large series of middle ear cholesteatomas. Study Design: Case series in a tertiary referral center. Methods: Between January 2001 and December 2007, 361 ears affected by mastoid and middle ear cholesteatoma were operated at our institution. The incidence of labyrinthine fistula, preoperative and postoperative hearing function, preoperative symptoms, type of surgery, and intraoperative findings were all analyzed. Results: The incidence of labyrinthine fistula was 12.7 percent. During surgery the matrix over the fistula was removed in all but one case. A labyrinthine fistula occurred in larger cholesteatomas as demonstrated by the higher number of cases with more than two sites involved (P < 0.001), facial nerve exposed (P < 0.001), and stapes superstructure eroded (P = 0.010). Postoperative change of bone conduction threshold and postoperative dead ears were not significantly different between fistula and nonfistula cases. Conclusions: The preservation of the bone conduction threshold is a common finding in small fistulas and can be obtained also in “large” fistulas when appropriate surgical technique is used. In fistulas involving the promontory the matrix should be left in situ when the endosteum is involved.

The effects of ‘supra-physiological’ vitamin B12 administration on temporary threshold shift

The aim of this study was to evaluate, in 20 young volunteer subjects, the effects of supra-physiological vitamin B12 administration on noise-induced temporary threshold shift (TTS). All subjects had hearing thresholds within 15dBHL and type A tympanograms. The subjects were randomly assigned to two different groups. Experimental group subjects received cyanocobalamin, 1 mg daily for 7 days, and 5 mg on the eighth day. Control group subjects received a placebo injection daily for 8 days. The vitamin B12 concentration, hearing thresholds and TTS2 (10 min of exposure, narrowband noise centred at 3 kHz, bandwidth of 775 Hz, 112 dB SPL) were measured before and 8 days after treatment. At the end of treatment, the serum vitamin B12 concentration was significantly increased in the experimental group. After 8 days of treatment, the control group showed the same hearing thresholds and TTS2 degrees. Statistical analysis showed that TTS2 decreased significantly at 3 and 4 kHz when cobalamin was used to increase the serum concentration of vitamin B12 to >2350 pg/ml. In addition, a protective effect at 3 kHz in the experimental group was evident when compared with the placebo group. These results suggest that elevated plasma cyanocobalamin levels may reduce the risk of hearing dysfunction resulting from noise exposure in healthy, young subjects. Sumario El propósito de este estudio fue evaluar, en 20 sujetos voluntarios jóvenes, los efectos de la administración supra-fisiológica de vitamina B12 sobre el cambio temporal de los umbrales auditivos inducido por ruido (TTS). Todos los sujetos tenían umbrales auditivos alrededor de 15 dB HL y timpanogramas tipo “A”, y fueron distribuidos al azar en dos grupos diferentes. Los sujetos del grupo experimental recibieron 1 mg diario de cianocobalamina por 7 días, y 5 mg en el octavo día. Los sujetos del grupo control recibieron una inyección diaria de placebo por 8 días. La concentración de vitamina B12, el umbral auditivo y el TTS2 (10 minutos de exposición, ruido de banda estrecha centrado en 3 kHz, ancho de banda de 775 Hz, 112 dB SPL) se midieron antes del tratamiento y 8 días después del mismo. Al final del tratamiento, la concentración sérica de vitamina B12 estaba significativamente elevada en el grupo experimental. Luego de 8 días de tratamiento, el grupo control mostró los mismos umbrales auditivos y grados de TTS2. El análisis estadístico mostró que el TTS2 disminuyó significativamente en 3 y 4 kHz, cuando se utilizó la cianocobalamina para aumentar las concentraciones séricas de vitamina B12 hasta>2350pg/ml. Además, fue evidente un efecto protector en 3 kHz en el grupo experimental cuando se comparó con el grupo placebo. Estos resultados sugieren que los niveles plasmáticos elevados de cianocobalamina pueden reducir el riesgo de disfunción auditiva como resultado de la exposición al ruido, en sujetos jóvenes sanos.

Cochlear implants: indications in groups of patients with borderline indications. A review.

Cochlear implants (CI) represent the current treatment for patients affected by profound sensorineural hearing loss (SNHL). Initially only deaf adult patients were considered to be candidates for a CI; however, the development of technology and matured experience have expanded the indications for cochlear implantation. Today, CIs are implanted in adults and children and broader indications are followed. There are, however, a number of patients who do not completely fulfill the current indications and who are potential candidates for CI. The duration of deafness and residual hearing represent prognostic indicators for CI performance; however, the candidacy of children with residual hearing and prelingually deafened adults are still under debate. Anatomical variants such as cochlear ossification, cochlear malformation and chronic otitis media represented and still represent for some surgeons a contraindication to CI. The otological experience of CI surgeons and the advent of auditory brainstem implants have changed the approach to these patients, who may still benefit from hearing rehabilitation. This paper briefly analyses and reviews the results obtained in these groups of patients, who were not, at least initially, considered to be candidates for cochlear implantation.

Effects of efferent acoustic reflex activation on psychoacoustical tuning curves in humans

Conclusions The results show that, in humans, activation of the contralateral EAR makes the PTC narrower at 1 kHz but wider at 4 kHz. These data are consistent with those reported previously in animals and demonstrate that, during medial efferent stimulation in humans, frequency resolution is improved at low frequencies but impaired at high frequencies. Objective To evaluate, in humans, the effect of activation of the contralateral efferent acoustic reflex (EAR) on the psychoacoustical tuning curves (PTCs) recorded for 1- and 4-kHz probe tones. Material and methods Ten young (20–30 years) volunteers served as subjects. They had normal hearing (thresholds<20 dB HL in the frequency range 0.25–8 kHz) and a functioning EAR (contralateral suppression of transient-evoked otoacoustic emissions≥0.8 dB). Frequency resolution was evaluated using PTCs. PTCs were recorded at 1 and 4 kHz using a simultaneous masking method. Q10 and Q20 were calculated as the ratio between the test frequency and the bandwidth of the PTC at 10 and 20 dB above the tip of the curve, respectively. The EAR was activated with a 40-dB SL contralateral narrow-band noise centered on the characteristic frequency of the PTC (1 or 4 kHz). Q10 and Q20 were measured in the presence and absence of the contralateral noise. Results Activation of the EAR led to a significant increase (p<0.001) in Q10 at 1 kHz and a significant decrease (p<0.001) at 4 kHz. Changes in the value of Q20 were not significant.