Valentina Santomauro

Evaluation of an automated auditory brainstem response in a multi-stage infant hearing screening

An automated auditory brainstem response (AABR) method, the Maico MB-11 with BERAphone®, has been developed for hearing screening in newborns. The aim of this study was to test the validity of this automated ABR screening method in a multistage newborn hearing screening (NHS). We applied a “five level” protocol using transient evoked otoacoustic emission (TEOAE), AABR-MB-11 with BERAphone® and conventional auditory brainstem response (ABR). TEOAE, AABR, and conventional ABR testing were performed by ENT specialists experienced in neonatal screening techniques. Among the 8,671 newborns tested (males 3,889; females 4,782), only 42 newborns were lost to follow-up and the final false-positive rate was of 0.03%. Our experience highlights that for the neonatal period, conventional auditory brainstem response is the most reliable method for assessing the hearing level and minimizing the false-positive rate. Although AABR (performed by ENT specialists experienced in neonatal screening techniques) is easy to use, fast and with a good compliance, the device is unable to provide accurate and certain diagnosis on the degree of hearing loss to allow a proper treatment.

Water-soluble coenzyme Q10 formulation (Q-TER®) in the treatment of presbycusis

Abstract Conclusion: These preliminary data are encouraging for a larger clinical trial to collect additional evidence on the effect of Q-TER® in preventing the development of hearing loss in subjects with presbycusis. Objectives: The purpose of this study was to evaluate the efficiency and applicability of a water-soluble formulation of CoQ10 (Q-TER®) in subjects with presbycusis. Methods: A total of 60 patients with presbycusis were included and divided into three numerically equal groups. Group A underwent therapy with Q-TER®, 160 mg, once a day for 30 days; group B underwent therapy with vitamin E (50 mg), once a day for 30 days; group C received placebo, once a day for 30 days. Before and at the end of the treatment, all patients underwent pure tone audiometry, transient evoked otoacoustic emissions, otoacoustic products of distortion, auditory brainstem response, and speech audiometry. Results: Compared with group B, at the end of the treatment in group A the liminar tonal audiometry showed a significant improvement of the air and bone thresholds at the 1000 (14/20 vs 9/20), 2000 (14/20 vs 7/20), 4000 (15/20 vs 6/20), and 8000 Hz (13/20 vs 5/20). We found no significant differences in the other parameters and in group C.

Nasal tactile sensitivity in elderly

Abstract Conclusion: Although older people varied widely in tactile sensitivity, our results show that tactile thresholds increased with age. Objectives: The aim of this study was to evaluate the effects of aging on nasal tactile sensitivity. Methods: A total of 160 healthy patients aged between 50 and 90 years were included. According to their age, patients were divided into groups (A, B, C, D, E, F, G, and H). From the age of 50, each group included subjects with an age range of 5 years (i.e. group A, 50–55 years; group B, 56–60 years, etc.). Each patients outcome was assessed through the nasal monofilament test: a set of 20 Semmes-Weinstein monofilaments was used to detect nasal sensitivity for both nasal cavities. The sensitivity threshold was recorded as the minimum monofilament size from which patients could detect at least two of three stimuli. Results: In groups D (66–70 years), E (71–75 years), F (76–80 years), G (81–85 years), and H (86–90 years) a significantly (p < 0.05) higher stimulus (171.1 ± 0.34 mg vs 67.7 mg, 167.01 ± 0.31 mg 67.7 mg, 166.54 ± 0.28 mg 67.7 mg, 201.24 ± 0.43 mg 67.7 mg, 165,87 ± 0.27 mg 67.7 mg) was required to trigger a touch response in the monofilament test.

Water-soluble coenzyme Q10 formulation in presbycusis: Long-term effects

Abstract Conclusion: These findings provide the basis for understanding the duration of the effect after the last use of the drug and encourage a larger clinical trial to collect additional evidence on the effect of coenzyme Q10 (CoQ10) in preventing the development of hearing loss in subjects with presbycusis. Objectives: The aim of this study was to evaluate the long-term effects of a water-soluble formulation of CoQ10 (Q-TER) in subjects with presbycusis. Methods: Sixty patients with presbycusis were included and divided at random into three numerically equal groups. For 30 days, group A underwent therapy with Q-TER, group B underwent therapy with vitamin E, and group C received placebo. Before, at the end, and 6 months after the end of the treatment, all patients underwent evaluation of pure tone audiometry, transient evoked otoacoustic emissions and otoacoustic products of distortion, auditory brainstem response, and speech audiometry. Results: Compared with group B, at the end of the treatment in group A the pure tone audiometry showed a significant (p < 0.05) improvement of the audiometric thresholds at 1000, 2000, 4000, and 8000 Hz. This improvement was confirmed by the speech audiometry and last check. We found no significant differences in the other parameters and in group C.

Acoustic features of voice in patients with severe hearing loss

OBJECTIVE The aim of this study was to evaluate changes in the acoustic features of voice in patients with sensorineural hearing loss. DESIGN Thirty male patients, between 35 and 53 years of age with postlingual bilateral symmetric severe sensorineural hearing loss, were included (group A). As a control group (group B), 30 normal-hearing male adults, aged 38 to 51 years, were identified. SETTING ENT Department, University of Genoa (Italy). METHODS Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the Multidimensional Voice Program (Kay Elemetrics) in all subjects. MAIN OUTCOME MEASURES The parameters estimated were the average of fundamental frequency (F0), jitter percent (jitter), shimmer, noise to harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voicelessness (DUV), degree of voice breaks (DVB), and peak amplitude variation (vAm). RESULTS Compared to the control group, in group A, the following acoustic parameters presented a statistically significantly higher value (p < .05) of F0 (137.2 Hz vs 120.0 Hz), jitter (1.93% vs 0.67%), shimmer (6.67% vs 3.81%), NHR (0.19 vs 0.10), SPI (12.9 vs 8.76), DVB (2.12% vs 0.01%), DUV (9.53% vs 0.51%), and vAm (23.12 % vs 12.06%). In group A, F0 was also significantly higher in the balanced sentences (126 Hz vs 111 Hz). CONCLUSIONS This study demonstrates that hearing loss affects voice production by changing its parameters, especially in subjects with marked hearing loss.

Harmonic Scalpel in the Treatment of Snoring

Objective: The Ultracision Harmonic Scalpel (HS) is an ultrasonic cutting and coagulating surgical device. The mechanism of the HS is based on transforming electrical energy into mechanical movement of 55.5 kHz frequency. This work aims to report our 4 years’ experience with HS in the treatment of snoring (uvulopalatopharyngoplasty). Method: Specific handpieces shaped like hook and blade were preferred. After tonsillectomy, 2 incisions, were made on each side of the lateral margin of the uvula, with upward direction. Thereafter, an excision of the redundant mucosa of each posterior arch and subsequent creation of neouvula by a partial uvulectomy was done. Results: In all the patients treated, the HS allowed rapid intraoperative management with a precise and safe cut: the HS provided excellent control without side effects on the adjacent structures and postoperative complications. Compared with other techniques (laser, cold knife dissection, etc) HS’s group experienced shorter operation time, lesser blood loss, fewer days of hospitalization, lower postoperative pain, and improvement of voice quality. No complications with regard to hemostasis or other major complication (temporary velopharyngeal insufficiency, bleeding, globus sensation, etc) were noted in the HS group. Conclusion: Our experience highlights that the use of HS in uvulopalatopharyngoplasty confers some advantages over conventional methods: its use led to diminished bleeding, shorter operation time, lesser pain, better wound healing in the postoperative period, and reduction of snoring and improvement of voice quality.

Ribosomal therapy in patients with pharyngolaryngeal reflux

Abstract Conclusions: Our data confirm the induction of specific and nonspecific immune responses of the upper respiratory tract mucosa and the consequent improvement of its physiology, through an oral ribosomal therapy in patients with pharyngolaryngeal reflux disease (PLRD). Objectives: The aim of this study was to investigate the efficiency and applicability of oral ribosomal immunotherapy in adult patients with PLRD. Methods: One hundred adult patients with PLRD were enrolled. The patients were equally divided, at random, into two groups (A and B): group A patients underwent ribosomal prophylaxis with Immucytal® (one tablet daily, 8 days a month for 3 months), while group B received a placebo (same dosage for the same period). At the beginning, at the end, and 6 months after the beginning of the therapy, all patients underwent medical history, ENT examination, nasal-pharynx-laryngoscopy with optic fiber, plasma levels of immunoglobulins class E, A, G, M, subjective assessment of symptoms on a 10 cm visual analog scale (VAS), reflux symptoms index, and reflux finding score. Results: At the end and 6 months after the beginning of the treatment, all the patients in group A presented a significant (p < 0.05) improvement of almost all the different items analyzed.

Water-Soluble Coenzyme Q10 in Chronic Hearing Loss

Objective: Q-TER is a multicomposite water-soluble formulation of CoQ10; in particular, Q-TER consists of a mixture of maltodextrin, acting as a carrier, of CoQ10 molecules of sucrester, which serves as bioactivator. The purpose of this study was to evaluate the efficiency of Q-TER in subjects with chronic sensorineural hearing loss. Method: A total of 80 patients affected by chronic sensorineural hearing loss were included. The patients were divided, at random, into 2 numerically equal groups (A and B). Group A underwent therapy with Q-TER, 160 mg, once a day for 30 days; group B received placebo, once a day for 30 days. Results: Before, at the end, and 6 months after the end of the treatment, all patients underwent: pure tone audiometry, transient evoked otoacoustic emissions (TEAOE) and otoacoustic products of distortion (DPOAE), auditory brainstem response and speech audiometry. Compared with group B, at the end of the treatment in group A the pure tone audiometry showed a significant (P < .05) improvement of the audiometric thresholds at the 1.000, 2.000, 4.000, and 8.000 Hz. This improvement was confirmed by the data obtained with the speech audiometry and in the last check. We found no significant differences in the others parameters and in group B. Conclusion: It is quite early to be enthusiastic. There must be more studies with controlled results. However, this kind of therapy for chronic hearing loss seems to be interesting, especially to stop hearing decay. It is also remarkable that good results are found one month after the beginning of the treatment.

Acoustic Features of Voice in Patients with Snoring

Objective: Determine whether the acoustic characteristics of snoring sounds differed between 30 simple male adult snorers (group A) and 30 healthy adult male subject (group B) by using a multidimensional voice program (MDVP), which is a commonly used computer program that analyzes various aspects of voice. Method: Group A patients presented a Friedman tongue position grade I, tonsil size 2 to 3, a body mass index of 15. Phonetically balanced sentences and sustained vowels a, e, and i were digitally recorded with the MDVP; evaluation of voice handicap index (VHI) was done too. Results: Compared with control group, in group A: the acoustic parameters presented a statistically significantly higher value (P < .05) of fundamental frequency (158.2 Hz vs 120.2 Hz), jitter (2.03 % vs 0.66 %), shimmer (6.54 % vs 3.77 %), NHR (0.24 vs 0.11), SPI (13.7 vs 8.71), DVB (2.23 % vs 0.12 %), DUV (9.31 % vs 0.54 %) and vAm (22.09 % vs 11.13 %), according to the degree of hearing loss; VHI had a mean value of 66 (vs 37 of group B). Conclusion: The study indicates that snoring affects voice production by changing its acoustic parameters. A voice analysis program MDVP can be used for snoring sound analysis as a noninvasive procedure for examination of sleep-related breathing disorders.

Sulphurous Inhalation in Upper Respiratory Tract Infections

OBJECTIVE: The aim of this study was to evaluate the efficiency of sulfurous thermal water in the treatment of recurrent upper respiratory tract (RURT) infections. METHOD: 100 patients with RURT were included and randomly assigned into two groups. Patients underwent a 12-day course of warm vapor inhalations and nasal irrigations with sulfurous thermal water in group A, and a physiological solution in group B. At the beginning, at the end and 3 months after start, all patients underwent medical history, ENT examination, plasma levels of immunoglobulins class E, G, A, M (IgE, IgG, IgA, IgM), subjective assessment of symptoms (VAS), nasal mucociliary transport time (NMTT) determination, and evaluation of frequency, duration and severity of RURT episodes. RESULTS: Three months after the beginning of the treatment, compared with group B, in group A the results were as follows: serum concentration of IgE was significantly lower (p 0.05) (75.18 25.9 mg/dl vs. 98.31 41.3); IgA titers were not significantly higher (235.41 118.3 mg/dl vs. 214.49 111.7 mg/dl); serum concentrations of IgG and IgM unchanged; VAS scores were significantly (p 0.05) improved (1.9 0.20 vs. 7.2 0.52); NMTT was normal (11.36 1.57 min vs. 17.87 2.22 min); frequency, duration, severity of RURT episodes were significantly (p 0.05) lower. CONCLUSION: Our results indicate the efficiency and applicability of sulfurous thermal water in the treatment of RURT and show, in addition to their known effects, an immunomodulant activity that contributes to their therapeutic effects.