Luigi Volpini

Transcutaneous bone-conduction hearing device: audiological and surgical aspects in a first series of patients with mixed hearing loss

Abstract Conclusions: The Bonebridge® (BB) transcutaneous bone conductive implant (BCI) may overcome some of the issues related to a percutaneous BCI, such as management of the external screw, delayed activation or possible skin complications. Moreover, it has been shown to enable a functional outcome similar to percutaneous BCI in both conductive and mixed types of hearing loss. Objectives: To obtain clinical data from a preliminary series of patients implanted with a new transcutaneous BCI. Methods: Four subjects affected by conductive/mixed hearing loss underwent implantation of the BB by two approaches: the transmastoid, presigmoid approach and the retrosigmoid approach. Soundfield thresholds were assessed with warble tones in a soundproof audiometric booth, and word recognition scores (WRSs) as speech reception thresholds (SRTs) were used to compare the unaided versus the post-implantation condition. Results: The surgical procedure was completed in all cases, with only minor intraoperative divergence from the CT-based planning and no postoperative complications. The average improvement of the SRT in quiet with the BB in comparison to the unaided condition was 36.25 dB. All the implanted subjects reached SRT values below 65 dB, indicating a better understanding in quiet, with 100% word recognition.

Role of Kabat physical rehabilitation in Bell's palsy: A randomized trial

Conclusion: When applied at an early stage, Kabats rehabilitation was shown to provide a better and faster recovery rate in comparison with non-rehabilitated patients. Objective: To assess the validity of an early rehabilitative approach to Bells palsy patients. Patients and methods: A randomized study involved 20 consecutive patients (10 males, 10 females; aged 35–42 years) affected by Bells palsy, classified according to the House-Brackmann (HB) grading system and grouped on the basis of undergoing or not early physical rehabilitation according to Kabat, i.e. a proprioceptive neuromuscular rehabilitation. The evaluation was carried out by measuring the amplitude of the compound motor action potential (CMAP), as well as by observing the initial and final HB grade, at days 4, 7 and 15 after onset of facial palsy. Results: Patients belonging to the rehabilitation group clearly showed an overall improvement of clinical stage at the planned final observation, i.e. 15 days after onset of facial palsy, without presenting greater values of CMAP.

Combined protocol for treatment of secondary effects from facial nerve palsy

Abstract Conclusion: Rehabilitation was significantly efficient in both groups of patients with synkinesis, especially in those in whom treatment with botulinum toxin type A (BTX-A) preceded physical rehabilitation. Objective: To determine the influence of preventive treatment with BTX-A on synkinesis when physical rehabilitation is planned. Methods: Twenty patients, who recovered from facial palsy with final House-Brackmann (HB) grade II and III, were randomized to assess the efficacy of preventive BTX-A treatment on final synkinesis score after physical rehabilitation. Synkinesis was graded according to the four-point scale derived from the SunnyBrook Facial Grading System (FGS). Physical rehabilitation was carried out using NeuroMuscular Retraining Therapy (NMRT). In the randomized groups, NMRT was administered with (group a) or without pre-BTX-A treatment (group b). Results: Patients who were preliminarily treated with BTX-A in the affected area showed a 2.1 improvement of score on the SunnyBrook scale (p < 0.001), with significantly better results in comparison to the non-BTX-A group.

Delayed facial nerve palsy after surgery for the Esteem(®) fully implantable middle ear hearing device.

Abstract Conclusion: Delayed facial nerve (FN) impairment was shown to occur after Esteem® surgery, and taste disturbances were found in a limited number of subjects. Thus, when this type of active middle ear implant (AMEI) is to be implanted, these specific complications need to be shared with the candidate. Objectives: To report on FN involvement in Esteem® AMEI surgery. Methods: A total of 23 males and 11 females, who presented with sensorineural hearing loss of varying severity, underwent surgical implantation of the Esteem® AMEI. FN function was assessed according to the House-Brackmann (HB) grading system. A specific question regarding taste impairment was administered to each patient on the first day and 3 months after surgery. Results: None of the patients presented with a FN deficit in the first postoperative days. In three patients (8.8%), FN palsy developed after 7 days (two patients) and 10 days (one patient), and the severities were HB 4 (two cases) and HB 5 (one case). All patients fully recovered (HB 1) after 6–8 weeks. In 10 of the 34 implanted subjects (29.4%), taste disturbances were found on postoperative day 1, and these impairments remained in only 6 (17.6%) patients at the 3-month postoperative follow-up.

Delayed Effect of Active Pressure Treatment on Endolymphatic Hydrops

Objective: To identify eventual correlations between the effect of low-pressure treatment and endolymphatic hydrops in Ménière patients. Material and Methods: The study group consisted of subjects affected by definite Ménière disease (2015) and a severe degree of disability, who received a ventilation tube with or without a low-pressure treatment before undergoing a surgical procedure (vestibular neurectomy). After the placement of the ventilation tube, the subjects were either left alone with the tube or received 1 month of self-administered low-pressure therapy with a portable device. In all subjects, an electrocochleography (ECochG) was performed and specific questionnaires - Dizziness Handicap Inventory (DHI) and Functional Scale Level (FSL) - were completed before starting either arm of treatment, at the end of treatment, and then 3 and 6 months later. Results: All selected subjects presented with an ECochG pattern that was indicative of endolymphatic hydrops before starting either treatment. At the end of pressure treatment, 80% showed symptomatic improvement while maintaining the hydropic ECochG pattern. At the 3-month control stage, the hydropic pattern resulted normalized (<0.5) in all the improved subjects. Conclusions: Although 1 month of low-pressure treatment provided a positive symptomatological outcome, normalization of the hydropic ECochG parameters occurred only at a later time. Therefore, it is possible to assume that endolymphatic hydrops could be concurrent with a non-symptomatic stage of Ménière disease, and that the anti-hydropic effect of the low-pressure treatment, if any, would present with a certain delay after its completion.

Ten years of active middle ear implantation for sensorineural hearing loss

Abstract Objectives: To evaluate long-term benefits of a totally implantable active middle ear implant (AMEI) that has been used in a single implanting center for over 10 years. Methods: Forty-one subjects who underwent implantation with an Esteem® AMEI during a 10-years period were evaluated on the auditory benefits, as derived from pure tone and speech audiometry tests. The analysis included a comparison with a conventional hearing aid, the problematics related to the battery duration and surgical replacement and, finally, the complication rate. Results: Over 80% of the implanted subjects maintained over time a satisfactory auditory gain, ranging from 10 to over 30 dB in respect to the unaided situation, as mean at 0.5, 1, 2 and 4 kHz. In more than 60% of them, an improvement has also been found at 4 and 8 kHz. Battery duration varied according to the severity of the hearing loss and to the daily use of the device. No major post-operative complications were recorded, whilst explantation was necessary in five subjects, although none for device failure. Conclusions: The Esteem® can be considered a reliable device for rehabilitation of sensorineural hearing loss in alternative to conventional hearing aids.

A new semi-implantable middle ear implant for sensorineural hearing loss: three-years follow-up in a pilot patient’s group

Abstract Objective: The aim of this article is to report on the long-term follow-up of a new semi-implantable middle ear device utilized for restoration of moderate-to-severe sensorineural hearing loss in a first series of subjects. Methods: Three subjects, affected by sensorineural hearing loss, have undergone implantation of Maxum® middle ear implant, via a transcanal approach. They all underwent an auditory assessment, paying particular attention on the pre- versus post-operative hearing levels under the unaided, best-fitted hearing aided and implant-aided conditions. The audiometric evaluation has been repeated 3 years after implantation and implemented by questionnaires aiming at the evaluation of the quality of life. Results: The post-operative hearing threshold and discrimination in quiet appear to be similar or better than those provided by conventional hearing aids, with a concomitant improvement of the subjects’ quality of life. The application of the present device showed to be easy and reproducible, with no severe adverse effects recorded at the 3-years follow-up. Mild issues due to the external component were also observed, such as difficulty of keeping it continuously in place due to excess canal sweating in one subject, and a temporary loss of stability due to occurring irregularities of the external coating in another subject. Conclusions: Long-term, preliminary data reveal that the Maxum® device may provide equal or better functional gain and word recognition scores in quiet in patients with moderate-to-severe sensorineural hearing loss, in comparison to optimally fitted hearing aids, with a satisfactory improvement of their quality of life.

Simultaneous Contralateral Vestibular Schwannoma and Middle Ear Paraganglioma Tumor

To the best of our knowledge, only 2 cases of a simultaneous contralateral vestibular schwannoma (VS) and middle ear paraganglioma (MEP) have previously been reported in literature. We report the third case observed in a 43-year-old male, who presented with an 11-year history of right-sided hearing loss and a 1-year history of left-sided pulsatile tinnitus. A magnetic resonance imaging (MRI) showed a VS on the right side and computer tomography (CT) identified a Fisch type A1 paraganglioma on the left side. The VS was treated using a translabyrinthine approach and the MEP was kept under radiological observation for 1 year. Due to the growth of the MEP (Fisch type A2), it was treated with excision via a retroauricular approach. Our case was very challenging because there was a different and important pathology on each side, both carrying a risk of deafness as a consequence of the disease and/or the treatments.

Inner Ear Active Hearing Device in Non-Otosclerotic, Severe, Mixed Hearing Loss

Objective: To verify the efficacy of a powerful active hearing device in a patient different from far-advanced otosclerosis, specifically when the stapes footplate is mobile. Patient: A patient with severe-to-profound mixed hearing loss, who was not benefiting from the use of a conventional hearing aid, was selected for an inner ear active implant. This was justified by a bone conductive threshold above 60 dB, which had discouraged any other rehabilitative solutions such as a bone conductive implant, or an active middle ear implant (AMEI). Intervention: The hearing device was surgically applied using a combined transmastoid/transcanal approach. During surgery, a mobile stapes were found and was perforated for the insertion of a piston prosthesis, crimped on the new-incus of the device. Main Outcome Measure: The bone conduction threshold was assessed postoperatively to identify any possible surgery-related hearing deterioration. Pure tone audiometry was conducted in a sound field, and a speech reception threshold test was performed with the contralateral ear masked. The hearing outcome was assessed soon after the implant activation (6 weeks after surgery), and 6 months after surgery. Results: Upon activation of the device, a PTA4 of 45 dB was obtained (at 0.5, 1, 2 and 4 kHz). At 6 months after surgery, the speech discrimination score reached 90% at 80 dB SPL. Conclusion: The application of the Codacs device has shown to be compatible with a mobile stapes footplate, as demonstrated in this report. The footplate perforation did not cause any further hearing deterioration, and has allowed to achieve a favorable auditory outcome.

Middle Ear Implantation in Stapes Fixation

The role of implantable hearing devices to be applied in alternative to standard surgery or conventional hearing aids in case of stapes fixation is discussed. Apart from more rare cases of stapes fixation, otosclerosis represents the most frequent possible field of application, either in nonoperated cases or after postoperative functional sequels.