G. A. Bertoli

Electrocochleographic Findings: Meniere's Disease versus Sudden Sensorineural Hearing Loss

Electrocochleography was conducted in 185 patients with Menières disease and 117 with sudden deafness. Electrophysiological findings from the two groups were compared in order to identify pathogenic similarities between the two conditions. Parameters investigated were the summating potential (SP)/action potential (AP) ratio, audiometric profiles and audiometric changes after medical therapy. A high SP/AP ratio was found in the patients with sudden deafness, thus supporting a possible hydropic aetiology in this group. In conclusion, electrocochleography can be considered a useful technique as it permits identification of an hydropic condition in certain cases of sudden deafness.

Efficacy of Early Physical Therapy in Severe Bell’s Palsy A Randomized Controlled Trial

Background. Bell’s palsy (BP) is the most frequent form of peripheral palsy of the facial nerve. Prognosis for recovery is good for most patients; in the remaining cases, different grades of residual impairment persist. Physical therapy, in association with drug administration, aims to improve outcomes. Objective. To assess the efficacy of early physical therapy in association with standard drug administration versus pharmacological therapy only, in terms of time to maximum gains and grade of recovery of function, and to examine who will most benefit from rehabilitation. Methods. From June 2008 to May 2010, 232 individuals were evaluated. The 87 patients meeting the eligibility criteria were randomly assigned to the experimental group (prednisone and valacyclovir plus physical therapy, n = 39) or the control group (pharmacological therapy, n = 48) within 10 days of onset. Intention-to-treat analyses were done. Results. The physical therapy had a significant effect on grade (P = .038) and time (P = .044) to recovery only in patients presenting with severe facial palsy (House-Brackmann [HB] grade V/VI). No significant differences were found between the study and control groups for outcome of synkinesis. Conclusion. Physical therapy appears to be effective only in the more severe BP (baseline HB grade V/VI), whereas less severe BP (baseline HB grade IV) results in complete spontaneous recovery, regardless of physical therapy.

High-frequency audiometry above 8 kHz. Comparative results of normative thresholds obtained with a headphone system and a quasi-free-field system

Since a standard method for high-frequency audiometry does not yet exist, the authors, using 20 young subjects, compare the results obtained with a quasi-free-field system devised by Osterhammel et al. [Scand. Audiol. 6:91-95, 1977] and those obtained by a headphone system. The headphone system is considered to be better, because it offers many practical advantages.

New development in intraoperative video monitoring of facial nerve: A pilot study

Objective: The present study proposes an evolution of an intraoperative video-based facial nerve monitoring system for otologic and otoneurosurgical procedures in comparison with classical electromyographic (EMG) monitoring method. Study Design: Single-subject design study. Setting: Tertiary referral center, university clinic. Patients: Fifteen patients undergoing a translabyrinthine approach for removal of 2 cm or less acoustic neuroma. Intervention: Intraoperative monitoring during acoustic neuroma removal. Main Outcome Measures: Measurement of mouth angle displacement and EMG peak amplitude at different stimulation intensities were measured and compared to evaluate the validity and reliability of the proposed new system. Results: The electrophysiologic method has been shown to be slightly more sensitive, although it shows limitations especially in terms of electrical artifacts during cauterization, totally masking the EMG monitoring. Conclusion: The present version of video system can be considered as valid and reliable as EMG; its main advantages are the absence of electrical artifacts, less invasivity, and much less cost.

High-Frequency Audiometry in Children

On the grounds of recent literature and of their own previous studies, the authors have examined a group of 25 normal-hearing children, ranging from 7 to 10 years of age, with high-frequency audiometry. The results were compared with those obtained in a group of young adults. On the basis of these findings, average threshold values were derived for this age group; such data have not yet been published for this simple headset technique. Furthermore, the comparison between the two age groups enabled the authors to determine a deterioration of the high-frequency hearing threshold which takes place at a fairly early age. Reliability of the equipment, in which headphones were used as transducers, was checked and the reproducibility for this test was shown to be adequate, as seen from the low test-retest variability.

A Video-based System for Intraoperative Facial Nerve Monitoring: Comparison with EMG

Results Best results were achieved by performing intermittent offstimulus noise analysis including evaluation of the spectral behavior of each input channel; these results influence the choice of online processing algorithm (noise management). However, standard frequency analysis (e.g., FFT) is not useful in online evaluation due to extensive time consumption. Here, one has to fall back on more elementary techniques. Definitely, no method is capable of excluding the misjudgment of a spontaneously generated action potential as a stimulus-evoked nerve response in the rare cases that this AP meets all detection criteria including the time window. The occurrence of APs must cause a distinct acoustic or visual warning without detailed data. In a second step, additional information on amplitude and two-dimensional distribution can be assessed: a pre-interpretation, e.g., as color-coded projection on a virtual face, will present data in a manner that laymen can understand intuitively. The third level allows the assessment of the raw data of all 63 input channels.

The Medical Chantoplasty and the Platinum-weight Implant as to Prevent Ocular Complication Following Facial Palsy

Patients The criteria for eligibility in this study was dependent upon the length of follow up for each type of procedure and the availability of proper video/photographic documentation of each patient. Of the 133 patients reviewed, 117 patients met the inclusion criteria for this study. Of the 474 procedures performed, 389 met the inclusion criteria for this study. Sixty-eight percent of patients were female and 32% were male. The mean age of this population was 26 years with the majority of their facial paralysis resulting from neoplastic (39%) and developmental (33%) etiologies. The mean denervation time (duration of the paralysis prior to reinnervation) of each patient was slightly greater than 10 years. Nearly half (45%) of all patients underwent previous surgeries at other institutions.