Lucia Oriella Piccioni

Transmeatal Low-Level Laser Therapy for Chronic Tinnitus with Cochlear Dysfunction

Objectives: To establish the efficacy of low-level laser therapy for tinnitus. Methods: We performed a prospective, randomized double-blind study on 60 outpatients with tinnitus presenting sensorineural hearing loss in the affected ear. They were randomly divided into two groups, the first performing active laser therapy 20 min a day for 3 months with a 650-nm, 5-mW soft laser (group L), the second using a dummy device which duplicated all aspects of active laser therapy except for the activation of the laser beam (group C). One subject in both groups dropped out due to an increase in tinnitus loudness. Two more patients in each group ceased to comply with the protocol due to familiar problems. Results: The Tinnitus Handicap Inventory (THI) was considered the main outcome measure; no statistical difference was detected between the 2 groups in the THI total score (p = 0.97), and its functional (p = 0.89), emotional (p = 0.89) and catastrophic (p = 0.89) subscales. Moreover, a visual analog scale for self-perceived loudness of the tinnitus showed no difference between the groups (p = 0.69). Regarding psychoacoustic parameters, the minimum masking level showed no difference (p = 0.42), while loudness expressed in sensation level exhibited lower values in group L (p = 0.0127). Group L subjects also presented a decreased rate of hyperacusis (p = 0.02). No changes were detected in the audiometric threshold in both groups. Conclusions: Soft laser therapy demonstrated no efficacy as a therapeutic measure for tinnitus.

Ropivacaine peritonsillar infiltration for analgesia after adenotonsillectomy in children: A randomized, double-blind, placebo-controlled Study

Objectives: Our randomized, double-blind, placebo-controlled study evaluates the possible benefit of peritonsillar infiltration with 0.75% ropivacaine hydrochloride on the pain level after adenotonsillectomy in 3- to 7-year-old children. Methods: We randomly administered intraoperative peritonsillar infiltration with 0.2 mL/kg ropivacaine 0.75% (group R) or 0.2 mL/kg saline 0.9% (group F) to sixty 3- to 7-year-old children (ASA 1 or 2) who were undergoing adenotonsillectomy. Postoperative pain was assessed 6 and 24 hours after surgery by a 6-face Faces Pain Scale that allowed quantification of pain on a 100-mm horizontal line (0 = no pain). The number of rectal doses of acetaminophen-codeine required during the first postoperative day was recorded. Results: The pain scores did not differ between the groups, either 6 or 24 hours after surgery (group F, 43 ± 26, versus group R, 29 ± 23, and group F, 24 ± 23, versus group R, 30 ± 28, respectively). Acetaminophen-codeine doses were similarly required in the two groups. Conclusions: Peritonsillar infiltration with 0.75% ropivacaine does not provide any major postoperative analgesic effect in 3- to 7-year-old children after adenotonsillectomy. A possible clinically minor analgesia 6 hours after surgery is suggested.

Stiff-person syndrome with acute recurrent peripheral vertigo: possible evidence of gamma aminobutyric acid as a neurotransmitter in the vestibular periphery

OBJECTIVE We report a case of a 58-year-old man suffering from stiff-person syndrome and recurrent peripheral vertigo. METHOD A case report and a review of the recent literature on stiff-person syndrome are presented. RESULTS The patient presented with recurrent episodes of vertigo with a pure peripheral pattern and with concomitant episodes of burning muscle pain, muscle twitching, weight gain and fatigue, worsening with tension or stress that also occurred in periods without vertigo. Cochlear examinations only showed presbyacusis-like hearing loss. The diagnosis of stiff-person syndrome was made with electromyographic examination and from findings in the blood and cerebrospinal fluid of high titres of anti-glutamic acid decarboxylase (GAD67) autoantibodies. In a two-year follow-up period, therapy for stiff-person syndrome abolished episodes of both stiffness and vertigo. CONCLUSION As far as we know, no other clinical case of acute vestibular damage with a possible correlation with anti-glutamic acid decarboxylase antibodies has been described. Peripheral vertigo possibly related to a lack of gamma aminobutyric acid underlines a possible role of gamma aminobutyric acid as a neurotransmitter in the peripheral vestibular system.

The importance of clinical history in suspected otosclerosis: a case report

Abstract Isolated malleus handle fracture (IMHF) is a lesser-known pathology. Its subtle and non-pathognomonic clinical characteristics mean its diagnosis is often overlooked. We describe a case of conductive hearing loss brought to our attention with a suspected diagnosis of otosclerosis. We describe the diagnostic workup and management of the patient. We underline the importance of performing a thorough and appropriate clinical exam, the value of computer tomography (CT) reconstruction and above all, an accurate anamnesis regarding the onset of the symptomatology in order to consider isolated fracture of the malleus amongst the possible differential diagnoses.

Alpha and Theta EEG Variations as Indices of Listening Effort to Be Implemented in Neurofeedback Among Cochlear Implant Users

Theta and Alpha EEG rhythms appear useful for the listening effort estimation. In particular, Alpha would inhibit irrelevant stimuli, and Theta underlies working memory and processing. The balance between them seems essential for the word recognition, therefore evaluating the listening effort experienced by hearing impaired patients appears worthy, since noise/distortions in a speech signal increase listening effort. Aim of the study was the estimation of the effort during word in noise recognition under different noise conditions, and along the task. Results showed an increase in the frontal Theta and parietal Alpha for a difficult (but not the most difficult) noise condition, and for Theta in correspondence of the stimulus. Additionally, frontal Theta activity increased along the task for the same difficult noise condition during and after the stimulus.

fMRI Cerebral Activation during Speech in Laryngectomies

Objective: We focused our attention on the localization of the laryngeal phonatory area in a somatotopic context. This study investigates brain modification consequent to partial or complete removal of the larynx. Methods: From 2009 to 2011 we enrolled 18 patients, divided into 3 groups: 6 healthy volunteers, 6 subtotal laryngectomy patients, and 6 total laryngectomy patients. During fMRI recording, all subjects were trained to carry out 5 motor tasks. Results: Analyzing group 1, we obtained: bilateral activation in prefrontal gyrus and in cerebellar lobule VI during the phonation of the vowel E; activation of the same areas in addition to basal ganglia, cerebellar lobule VI and VIII, insular lobe, 42 Brodmann area and basal gyrus bilaterally, Rolandic operculum, and the supplementary motor area intonating vowel E. Glottal adduction during forced expiration and phonatory task activated the same areas. Phonatory tasks determined the same activation in all groups, with an extension of these areas proportional to surgical damage. In lip and tongue tasks we observed the same results in all groups. Conclusion: This study permitted the mapping of the human motor cortical areas that control intrinsic laryngeal muscles, differentiating them from those referable to the articulatory process. Studying subtotal and total laryngectomies, we identified an expansion of the laryngeal area activation, proportional to the degree of the laryngeal injury. We observed the functional recovery of brain regions considered evolutionarily ancient that are normally virtually quiescent.

Neurinoma of the Submandibular Space

Objective: Describe an uncommon lesion of the submandibular space. Method: We describe the surgical approach to a submandibular mass in a young boy. Results: The patient had a preoperative evaluation with a ultrasound examination that showed a well-defined, disomogeneous lesion of 50 × 36 × 36 mm of the left submandibular region. Magnetic resonance imaging showed a lesion of the submandibular space, extended to the left parapharyngeal space. This lesion had disomogeneous enhancement and a diameter of 6 cm. The patient underwent a fine needle aspiration cytology of the lesion that resulted compatible with a pleomorphic adenoma.The patient underwent the surgical excision of the lesion.The lesion occupied the left parapharyngeal space. The histological examination defined the lesion as a neurinoma of the parapharyngeal space. Conclusion: A neurinoma of the parapharyngeal space should be considered in the evaluation of the submandibular masses.

Rhytidectomy in Parotidectomy

Objective: 1) Describe our results in a different surgical approach to parotidectomy. 2) Establish the indications to this approach. 3) Establish the incidence of postoperative complications. Method: From February 2008 until June 2011 we analyzed 84 successive cases of parotidectomy performed with a rhytidectomy in our department. Results: In 73 cases a superficial parotidectomy was performed; in 9 cases a total parotidectomy, and in 2 cases the resection involved the skin overlying the lesion. The histology showed that most of the lesions were benign. The duration of surgery increased 20 minutes on average if compared to the usual Redon’s approach. We found 23 cases of salivary fistula, solved in 6 days on average. Only 1 patient had a postoperative hemorrhage and needed a surgical revision. Twelve patients developed a facial paralysis, but it resolved in all the cases 6 months later. Conclusion: Rhytidectomy can be considered a useful surgical approach in benignant parotid lesions. It allows a good exposition of anatomic structures and does not show an increase of surgical complications

Rhytidectomy Approach to the Excision of a Branchial Cyst

OBJECTIVE: Branchial cysts are congenital anomalies of the branchial apparatus related to the partial obliteration of a branchial sulcus. They are usually located anterior to the sternocleidomastoid muscle. The treatment is complete surgical excision. The traditional surgical approach is a horizontal incision in the neck. This technique is easy and radical but it produces a cervicotomy scar with aesthetic results sometimes unsatisfactory. In this work we present a novel application of the rhytidectomy approach to the excision of branchial cysts. METHOD: A 28-year-old man with a right laterocervical cyst. This lesion was surgically removed with a rhytidectomy approach. We evaluated the operating time and the aesthetic and functional results. The incision was conducted in the retroauricular sulcus and extended to the hairline. We preserved the great auricular nerve, the spinal accessory nerve, jugular vein, and carotid artery. RESULTS: Operating time was 90 minutes. The patient had no nerve deficits and 3 months after surgery, he was satisfied with the aesthetic result. CONCLUSION: The use of rhytidectomy in treatment of a branchial cyst improves aesthetic results with hidden scar, allowing no nerve or vasal injuries instead of a minimum additional operating time.