Ruggero Lapenna

Universal newborn hearing screening in Umbria region, Italy.

OBJECTIVE In Italy, universal newborn hearing screening (UNHS) was first introduced in some regions from 1997. Umbria Region has launched a UNHS program in all hospitals, which has been implemented throughout the region since July 2010. Before UNHS implementation in Umbria region, the average age of identification of congenital hearing loss was around 32 months of age with an average age of initial amplification treatment at least 2 months later. The coverage rate of newborn screening was only 34.4% in 2006. The aim of this study was to examine the results of this program and its evolution in the first 2.5 years since implementation in our region. METHODS Since July 2010, all 11 birth centers and hospitals in Umbria region have been involved in a UNHS program. The screening involves the automated otoacoustic emissions (AOAE) test and automatic auditory brain stem response (AABR) audiometry. The number of screening stages and tests used were different depending on whether the infants had audiological risk factors or not. RESULTS A total of 20,841 babies were born in the hospitals involved of whom 20,051 were well born babies (WB), while 790 babies (3.8%) presented identified audiological risk factors (BRF). The overall coverage rate in the study period was 93.8%. The prevalence of hearing loss was 2‰ for WB infants and 4.3% for BRF. Mean age at diagnosis was 5.31±3.95 and 11.28±7.73 months in the WB and BRF groups, respectively. CONCLUSIONS UNHS has allowed us to substantially increase the coverage rates and decrease the mean age at diagnosis and subsequent treatment. The identification of audiological risk factors is very important for adequate screening and follow-up. However the Joint Committee on Infant Hearing 2007 quality indicators and benchmarks for screening have not yet been fully achieved and there is still scope for some improvement. This could be achieved with a closer cooperation among institutions, parents, pediatricians, and ENT doctors.

Residual dizziness after successful repositioning maneuver for idiopathic benign paroxysmal positional vertigo: a review

The benign paroxysmal positional vertigo (BPPV) is a vestibular disorder cause of vertigo. The BPPV may be corrected mechanically by repositioning maneuvers but even after successful maneuvers, some patients report residual dizziness for a certain period afterward. Early recognition and treatment might decrease the incidence of residual dizziness in patients with BPPV, especially in those patients with psychiatric comorbidities and in the elderly, lowering the risk of falling. Many pathogenetic hypotheses for residual dizziness are under debate. The purpose of this review was to identify, evaluate and review recent researches about possible causal factors involved in residual dizziness and the implications on clinical practice. A literature search was performed using different databases such as Pubmed and Scopus. The following search terms were used: residual dizziness, otolithic membrane and BPPV. The search found a total of 1192 titles, which were reduced to 963 after a procedure of de-duplication of the found titles. The research was then restricted to an interval of time comprised between 2000 and 2016 for a total of 800 titles. Among these titles, only those including the terms benign paroxysmal positional vertigo were considered eligible for this review. Only publications in English language were taken into consideration and we excluded those with not available abstract. Finally, 90 abstracts were obtained and critically evaluated by two different Authors, and additional studies were identified by hand searching from the references of artiche of interest. Only 53 were included in this work.

The effect of speech rehabilitation therapy for muscle tension dysphonia on global postural strategy

Abstract Purpose: To examine postural control in muscle tension dysphonia (MTD) before and after a specific speech rehabilitation program. Methods: Twenty-six patients diagnosed with MTD underwent posturographic analysis before and after speech rehabilitation. Romberg test was performed with eyes open (EO), eyes closed (EC) and during the head retroflex (ECR) and the occlusal (ECO) tests to investigate the role of cervical and stomatognathic proprioception. The analyzed posturographic parameters were the Sway area (S), length (L) of the center of pressure (CP) oscillations, coordinates of the CP on frontal and sagittal plane, stomatognathic interference index (SSI) and cervical interference index (CSI). Considered parameters of microphone perturbation were the Jitter (JITT), Shimmer (SHIM) and noise to harmonic ratio (NHR). Results: Sixteen patients (61.5%) exhibited values above those expected for at least one of the posturographic parameters during one or more of the conditions with eyes closed. There were values outside the normal range in the Sway area under EC and ECR conditions, and in the coordinates of the center of pressure on the sagittal plane posteriorly under EC conditions. Highly destabilizing SSI was recorded in six of the patients (23%), while CSI was recorded in 18 (69.2%). After rehabilitation, seven patients continued to show posturographic alterations. There was a statistically significant improvement of all previous altered posturographic parameters. Eight patients whose S parameters had returned to the normal range after speech therapy, also showed significant improvement of all microphone signal parameters. Conclusion: This study shows that MTD might interfere with global postural strategy through the involvement of all cervical muscles proprioception. The strong correlation between the improvement of vocal and postural control, suggests that a posturographic study may be useful in the planning of the speech therapy, as well as in the evaluation of its effectiveness in terms of muscle relaxation.

Hemifacial spasm and neurovascular compression syndrome

A 49-year-old woman experienced left orbicularis oculi muscle spasms for 16 months. The first 5 months were characterised by rare involuntary spasms, became stronger at any physical or mental activity and later they even occurred while the patient was resting, causing contraction of all the muscles innervated by the left seventh cranial nerve. MR angiography revealed a neurovascular compression of the left facial nerve by the anterior inferior cerebellar artery (AICA) (figures 1 and 2). The patient was taken to surgery and a microvascular decompression through a retrosigmoid approach was performed. Facial nerve function monitoring was conducted intraoperatively. Figure 1 Preoperative 3T MRI: highly T2-weighted sequences for …

Disturbed auditory perceptions: An Update

The search for tinnitus mechanisms is a speculative endeavour; a broad number of mechanisms may cause the tinnitus symptom and numerous tinnitus models have been proposed in recent years.