Pasquale Marsella

Cervical chordoma in childhood: clinical statistical contribution.

Parapharyngeal neoplasias are rarely noticed in childhood, since they have their peak incidence between the 2nd and 4th decade of life. The authors report a case of a 4-year-old patient presenting with a retrostyloid mass, accompanied by nasal obstruction and some difficulty in swallowing at 12 months of age. CT scanning well ascertained the delimitation of the tumor, but it was of no help in the differential diagnosis. In fact, after surgical excision, the histological examination of the specimen revealed a chordoma. This result was unexpected because of the region concerned and the lack of a CT demonstration of the cervical boney involvement. A cervical vertebral localization of a chordoma is rare in all age groups and it is of particular clinical and statistical interest in infancy.

Mental workload estimations in unilateral deafened children.

Despite of technological innovations, noisy environments still constitute a challenging and stressful situation for words recognition by hearing impaired subjects. The evaluation of the mental workload imposed by the noisy environments for the recognition of the words in prelingually deaf children is then of paramount importance since it could affect the speed of the learning process during scholar period.The aim of the present study was to investigate different electroencephalographic (EEG) power spectral density (PSD) components (in theta4-8 Hz - and alpha - 8-12 Hz - frequency bands) to estimate the mental workload index in different noise conditions during a word recognition task in prelingually deaf children, a population not yet investigated in relation to the workload index during auditory tasks. A pilot study involving a small group of prelingually deaf children was then subjected to EEG recordings during an auditory task composed by a listening and a successive recognition of words with different noise conditions. Results showed that in the pre-word listening phase frontal EEG PSD in theta band and the ratio of the frontal EEG PSD in theta band and the parietal EEG PSD in alpha band (workload index; IWL) reported highest values in the most demanding noise condition. In addition, in the phase preceding the word forced-choice task the highest parietal EEG PSD in alpha band and IWL values were reported at the presumably simplest condition (noise emitted in correspondence of the subjects deaf ear). These results could suggest the prominence of EEG PSD theta component activity in the pre-word listening phase. In addition, a more challenging noise situation in the pre-choice phase would be so “over-demanding” to fail to enhance both the alpha power and the IWL in comparison to the already demanding “simple” condition.

EEG frontal asymmetry related to pleasantness of music perception in healthy children and cochlear implanted users

Interestingly, the international debate about the quality of music fruition for cochlear implanted users does not take into account the hypothesis that bilateral users could perceive music in a more pleasant way with respect to monolateral users. In this scenario, the aim of the present study was to investigate if cerebral signs of pleasantness during music perception in healthy child are similar to those observed in monolateral and in bilateral cochlear implanted users. In fact, previous observations in literature on healthy subjects have indicated that variations of the frontal EEG alpha activity are correlated with the perceived pleasantness of the sensory stimulation received (approach-withdrawal theory). In particular, here we described differences between cortical activities estimated in the alpha frequency band for a healthy child and in patients having a monolateral or a bilateral cochlear implant during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns observed in a healthy child and that of a bilateral cochlear implanted patient are congruent with the approach-withdrawal theory. Conversely, the scalp topographic distribution of EEG power spectra in the alpha band resulting from the monolateral cochlear user presents a different EEG pattern from the normal and bilateral implanted patients. Such differences could be explained at the light of the approach-withdrawal theory. In fact, the present findings support the hypothesis that a monolateral cochlear implanted user could perceive the music in a less pleasant way when compared to a healthy subject or to a bilateral cochlear user.

Investigation on the pleasantness of music perception in monolateral and bilateral cochlear implant users by using neuroelectrical source imaging: A pilot study

There is a debate in the specialized literature about the quality of fruition of music for patients that received a cochlear implant. Interestingly, very few studies have investigated the hypothesis that patients that use a bilateral cochlear implant could perceive the music in a more pleasant way as compared to unilaterally implanted patients. Previous observations in healthy subjects have indicated that variations of particular EEG rhythms correlated with the pleasantness of the perceived music. The aim of the present pilot study is then to apply the state of the art neuroelectrical imaging and the analysis of cortical representation of EEG rhythms to monitor the perceived pleasantness during the observation of a simple videoclip in one patient with a unilateral cochlear implant and in one receiving a bilateral cochlear implant. Results of this pilot study showed that on the base of such previously validated EEG rhythms, the fruition of music and video, in terms of pleasantness, is statistically higher in the bilaterally implanted patient when compared to the monolateral implanted patient.

Dysontogenetic neoplasms of the thyroid gland in infancy: two case reports

Two rare cases of benign dysontogenetic neoplasms of the thyroid gland in pediatric age are presented, which were observed at the E.N.T. department of the Bambino Gesù Hospital of Rome, and successfully operated. The first case turned out to be a dysembryoma, classified as monodermic because of its origin from derivatives of only one germinal layer, the entoderm. The second case, a teratoma, presented a high seric concentration of AFP as the consequence of the synthetic activity of the share of embryonal epatic tissue present in the neoformation. Criteria to distinguish thyroid from cervical teratomata and to classify the different types of dysontogenetic neoplasms are discussed. The usual clinical and pathological manifestations of teratomas of the neck in infancy are mentioned. The necessity of a prompt surgical removal and of pre- and postoperative thyroid function studies is mentioned.

Safety and functional results of early cochlear implant switch-on in children

Objective To assess the safety and the possible advantages of early (1-wk) cochlear implant switch-on in children and to compare impedance and ECAP threshold changes between subjects undergoing early switch-on and those undergoing traditional, 1-month switch-on. Study Design Prospective cohort study. Setting Tertiary care referral pediatric center. Patients Seventeen children receiving a unilateral or bilateral Nucleus Freedom cochlear implant were included, for a total of 20 ears. Ten ears were assigned to the early (1-wk) switch-on group and 10 to the control group (switch-on after 4 wks). Interventions Common ground impedance values and electrically evoked compound action potential thresholds were measured from intraoperation until 9 months postoperatively. Speech perception improvements over time were also assessed. Main Outcome Measures Complication rate, impedance levels (k&OHgr;), and electrically evoked compound action potentials (current levels) Results Early switch-on was well tolerated by patients and did not cause complications. Impedances dropped significantly after switch-on in both groups. They also seemed to achieve an earlier stability in the early switch-on patients, although the difference between groups was not significant. ECAP thresholds showed a similar, nonsignificant decreasing trend over time in both groups. Speech perception improvements did not differ between groups. Conclusion This is the first study investigating the safety and the effects of an early cochlear implant switch-on in children. Results show that such a procedure is well tolerated by pediatric subjects and free from complications. Impedance measurements suggest that the earlier switched-on subjects benefit of lower and more stable impedances than subjects undergoing 1-month switch-on.

Bimodal Stimulation in Prelingually Deaf Children Lessons from a Cross-sectional Survey

Objective (1) To survey the use of bimodal stimulation by prelingually deaf children receiving unilateral cochlear implantation and (2) to investigate demographic and audiologic factors explaining the use of bimodal stimulation. Study Design Cross-sectional survey. Setting Tertiary care institution. Subjects and Methods The study included 44 unilaterally implanted prelingually deaf children from a single institution, with a minimum follow-up of 1 year. During routine follow-up visits, an examiner interviewed parents on their children’s use of bimodal stimulation. At the same time, residual hearing and hearing aid gain in the contralateral ear were assessed. Results Approximately half of patients (52%) used bimodal stimulation. On average, bimodal users showed better mean unaided and aided thresholds than nonbimodal users (P < .001). A mean 250- to 500-Hz unaided threshold ≤90 dB HL in the contralateral, nonimplanted ear was associated with a higher probability of bimodal use (P = .008). Parental satisfaction with the contralateral hearing aid was inversely correlated with mean 125- to 500-Hz and 1000- to 4000-Hz unaided thresholds (P < .001) and mean 250- to 500-Hz and 1000- to 4000-Hz aided thresholds (P < .001). Conclusions A mean 250- to 500-Hz unaided threshold ≤90 dB HL is associated with a higher probability of bimodal use by prelingually deaf children. Better residual hearing is associated with a higher degree of parental satisfaction with the contralateral hearing aid. This information could be useful to counsel parents of prelingually deaf children, when deciding between bimodal stimulation and simultaneous bilateral cochlear implantation.

Neuroelectrical imaging study of music perception by children with unilateral and bilateral cochlear implants

Abstract Objective To investigate by means of non-invasive neuroelectrical imaging the differences in the perceived pleasantness of music between children with cochlear implants (CI) and normal-hearing (NH) children. Methods 5 NH children and 5 children who received a sequential bilateral CI were assessed by means of High-Resolution EEG with Source Reconstruction as they watched a musical cartoon. Implanted children were tested before and after the second implant. For each subject the scalp Power Spectral Density was calculated in order to investigate the EEG alpha asymmetry. Results The scalp topographic distribution of the EEG power spectrum in the alpha band was different in children using one CI as compared to NH children (see figure). With two CIs the cortical activation pattern changed significantly, becoming more similar to the one observed in NH children. Conclusions The findings support the hypothesis that bilateral CI users have a closer-to-normal perception of the pleasantness of music than unilaterally implanted children.

Differences in the perceived music pleasantness between monolateral cochlear implanted and normal hearing children assessed by EEG

The perception of the music in cochlear implanted (CI) patients is an important aspect of their quality of life. In fact, the pleasantness of the music perception by such CI patients can be analyzed through a particular analysis of EEG rhythms. Studies on healthy subjects show that exists a particular frontal asymmetry of the EEG alpha rhythm which can be correlated with pleasantness of the perceived stimuli (approach-withdrawal theory). In particular, here we describe differences between EEG activities estimated in the alpha frequency band for a monolateral CI group of children and a normal hearing one during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns related to the normal hearing group refers to a higher pleasantness perception when compared to the cerebral activity of the monolateral CI patients. In fact, the present results support the statement that a monolateral CI group could perceive the music in a less pleasant way when compared to normal hearing children.