Working memory (WM) function can be reduced in patients suffering from unilateral hearing loss (UHL) and can affect their academic performance. We aimed to compare the WM abilities of three categories of children with UHL: patients implanted with hearing aids (HAs), patients receiving a bone-anchored hearing implant (BAHI), and subjects who did not receive hearing devices. A randomized clinical study, in which 45 children (mean age: 9.5 years) were evaluated by pure tone audiometry (to identify the side and the severity of the UHL), was conducted in a tertiary referral center. Patients were simply randomized into three groups: (1) children without HAs (No-HA group), (2) patients with a (digital) HA (HA group), and (3) children with a BAHI (BAHI group). Their working and short-term memories were studied in both noisy and silent conditions at the recruiting time (T0, baseline) and 6 months after (T1) the treatment. Statistical analyses were performed to analyze the variances between T0 and T1 within each group and between the three groups. The No-HA group improved its T1 WM scores in silence (p< 0.01), but not in noise. The HA and BAHI groups showed statistically significant variances of T1 WM in noise (p< 0.01 andp< 0.01, respectively). The HA and BAHI groups did not show statistically significant variances compared to T1. Our results suggest that hearing devices (HA and BAHI) in children with sensorineural UHL (SUHL) can improve WM capacity in noise. We speculate that bilateral hearing capacity might improve the quality of life of this population, especially during everyday activities where noise is present.

Flavonoids are widely used for the treatment of chronic venous insufficiency (CVI). In clinical trials, micronized purified flavonoid fraction (MPFF, 450 mg diosmin plus 50 mg hesperidin, Daflon 500 mg) has demonstrated its activity in CVI by improving venous tone and vein elasticity assessed by plethysmography. Randomized, double-blind, placebo-controlled clinical studies have shown an improvement in signs and symptoms related to CVI and a decrease in leg circumferences at the levels of the ankle and calf. The effect of MPFF on microcirculatory parameters suspected of participating in the pathophysiological process of venous ulceration has been investigated in patients. These include hemorheological parameters and transcutaneous oxygen tension measurements, which were shown to improve after treatment with MPFF. Finally, a randomized double-blind, placebo-controlled clinical study has shown that MPFF treatment for 2 months, in addition to standard compression therapy, accelerates leg ulcer healing in patients with ulcers ≤10 cm.

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.

Background: Supracricoid laryngectomies (SL) were introduced to radically treat laryngeal tumors while respecting laryngeal function. Despite SL with cricohyoidoepiglottopexy (CHEP) allows good functional results in terms of swallowing, breathing function and voice quality, older age has been traditionally considered a contraindication to SL. Aim of this study is to investigate the functional outcomes of SL with CHEP among elderly patients (age older than 70 years) and compare them with those obtained in younger subjects submitted to CHEP for laryngeal cancer. Materials and methods: Thirty-eight (36M, 2F; mean age: 61.9 years, age range: 51-79 years) patients were submitted to SL with CHEP for laryngeal carcinoma between January 2012 and December 2015. Preoperative endoscopic and imaging assessment was carried out. The surgical treatment performed was CHEP with preservation of both arytenoids (CHEP+AA) in 10 (68.4%) cases and with preservation of one arytenoid (CHEP+A) in 28 (31.6%) patients. Basing on their age, our patients were divided into 2 groups: age<70 years (group 1) and age >70 years (group 2). Among the 26 subjects of group 1, 6 were submitted to CHEP+AA, while 20 to CHEP+A; among the 12 patients of group 2, 4 were treated with CHEP+AA, while 8 with CHEP+A. Functional assessment was performed as follows: (a) Swallowing assessment was carried out considering the days required to resume an oral diet

Chronic rhinosinusitis (CRS) with nasal polyposis (NP) is a common chronic disease that often affects maxillary sinus. Endoscopic sinus surgery (ESS) is the most common procedure for treating the majority of maxillary sinus lesions by a middle meatal antrostomy (MMA) and the avvent of new microdebrider blades of 15, 40, 70, and 120° improved this approach. Nevertheless in some cases, angled microdebrider are not sufficient and canine fossa puncture (CFP) is performed as an alternative method to obtain a complete access to the maxillary antrum. The aim of this study is to review the literature regarding the indications of CFP in patients with severe maxillary sinus disease.

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.

Background The septal extension graft (SEG) is widely used in secondary rhinoplasty for correction of a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip secondary to an overresection of the caudal septum. Although SEG precise fixation can be relatively easy in the external approach, the difficulties of SEG placement in “closed” rhinoplasty can be discouraging. Objective To describe an easy surgical technique for SEG placement in endonasal revision rhinoplasty and to analyze the aesthetic results of the procedure. Methods Thirty-eight patients were submitted to an endonasal approach revision rhinoplasty with endonasal placement of SEG for the correction of a short nose with a hypoprojected and hyper-rotated nasal tip. Pre- and postoperative nasal length, tip projection, and tip rotation (nasolabial and lobulocolumellar angles) were measured for each patient. Results An increase (mean ± standard deviation) of nasal length by 15.02 ± 3.91% and an augmentation of tip projection by 11.34 ± 2.26% were noticed after surgery with respect to preoperative conditions. A significant (p < 0.001) decrease in the columellar-labial angle was recorded on postoperative (91.23 ± 3.85°) examination with respect to preoperative (99.81 ± 6.49°) conditions. A decrease (p < 0.001) in the columellar-lobular angle was noted on postoperative assessment (34.02 ± 5.28°) with respect to preoperative examination (50.02 ± 0.36°). No relevant postoperative complication was recorded. Conclusion The “endonasal” approach described for SEG placement was an easy and reliable procedure to treat a short nose with loss of tip support and projection, columellar retraction, and hyper-rotated tip, especially in revision surgery. The advantages of our technique over previously described approaches were reported.

Management of penetrating trauma to the paranasal sinuses with retained foreign bodies represents a challenge due to the proximity to vital neurovascular structures. The authors report the successful treatment of a patient with a work-related nail gun injury, carried out by means of a combined endoscopic endonasal external assisted procedure.A transnasal endoscopic approach was planned to minimize inadvertent movements of the nail during surgery and in case necessary to repair the orbit or skull base. No major bleeding or neurovascular complication was observed after surgery and a computed tomography scan was performed after surgery confirming the complete removal of the nail and with no damage of the orbit nor the skull base.

Here we report on two consecutive cases of tuberculosis in immunocompetent HIV-negative patients with lingual lesions. In both patients diagnosis was delayed. Disease progressed involving the lungs, lymph nodes and also the brain. Both patients are disease-free at 30 and 22 month follow-up respectively. Isolated Mycobacterium tuberculosis from these patients was multi-susceptible. Tuberculosis lesions of the oral cavity and brain are infrequently diagnosed in immunocompetent subjects from Western countries. Clinicians must take into greater consideration tuberculosis as a possible diagnosis when diagnosing chronic and/or recurrent lingual lesions even in the absence of pulmonary lesions.

OBJECTIVE:The study analyses the behavior of subjective visual vertical (SVV) in benign paroxysmal positional vertigo (BPPV) before and after treatment, and offers a clinical-pathogenic interpretation. METHODS:We studied 30 consecutive patients with BPPV of the posterior semicircular canal treated with the Epley repositioning maneuver. SVV was determined at three different stages: at the time of diagnosis (1st test), after the repositioning maneuver (2nd test), and then 7 days after the resolution of the clinical picture (3rd test). The main study parameter was represented by the mean of 6 consecutive measurements (SVV(0)) for each patient. SVV was also examined in 20 healthy subjects, who represented the control group. The comparison between mean values and standard deviations showed a statistical significance of p<0.05. RESULTS:During the first test, the degree of deviation of SVV was significantly higher in the patient group than in the control group. Tilting towards the affected side was observed in all cases. The 2nd test showed an inversion in the orientation of SVV in 16 patients, and as a result of the Epley maneuver there was a statistically significant variation in SVV(0) values in 20 patients with respect to the previous test (2nd test vs. 1st test). This involved 87% (23 patients) of those who then had a negative Dix-Hallpike test, and none of the ones in whom paroxysmal positional nystagmus persisted. Lastly, no differences emerged in the behavior of the patient group vs. the control group during the third test. CONCLUSIONS:SVV is often altered during active BPPV. The degree of otolithic dysfunction is never high and, in all cases, it is brief in duration. Tilting towards the dysfunctional side is essentially a constant in untreated BPPV. This could be due to a substantial loss of otoconia, with a decrease in the density and specific weight of the macula, and thus hypofunction of the receptor. The observation of a significant variation in SVV after therapeutic maneuvers has a favorable predictive value, as it probably reflects the migration of otoliths to the utricle, where saturation mechanisms can often have irritative effects leading to the inversion of SVV.

AIMS:Aural atresia is a congenital disease constituted by partial or complete lack of development of the external auditory canal, which is generally associated with malformations of the auricle and middle ear. Reconstruction of the auditory canal and correction of any deformities of the middle ear have yielded unpredictable results and variable functional outcomes, and there is a high rate of complications. Therefore, the use of bone-conduction hearing aids, such as the Baha, may represent a valid alternative for subjects who have conductive hearing loss with cochlear reserve that, as a rule, is fully conserved. The aim of this work is to reexamine our experience with the management of conductive and mixed hearing loss using the Baha system in children with bilateral aural atresia. METHODS:We examined 31 patients with bilateral congenital aural atresia in whom a Baha system had been implanted. The patients, 16 males and 15 females, were between 5 and 14 years of age (mean 8.7). The following parameters were assessed for each patient: mean preoperative air and bone conduction for frequencies between 0.5 and 4kHz; mean preoperative threshold with conventional bone-conduction hearing aids; mean postoperative threshold with the Baha system; improvement in quality of life evaluated with the Glasgow Children's Benefit Inventory; rate and type of surgical complications. RESULTS:The mean preoperative air- and bone-conduction thresholds were 51.2±12.5 and 14.1±6.3dB HL, respectively. The mean preoperative threshold with a conventional bone-conduction hearing aid was 29.3±7.2dB HL, and the mean postoperative threshold with the Baha system was 18.1±7.5dB HL. Quality of life improved for all operated patients. CONCLUSIONS:The results of our study of the Baha system to treat patients with bilateral aural atresia were extremely satisfactory compared both with those of surgical reconstruction of the auditory canal and those of traditional bone-conduction hearing aids. Furthermore, great improvement was noted in quality of life, while the rate of complications was very low. Therefore, we are convinced that the Baha system is the treatment of choice for hearing loss due to bilateral congenital aural atresia.

The aim of the study was to ascertain the validity of a personal protocol used for the diagnostic classification of a group of 20 patients suffering from migraine without aura and with recurrent vertigo and postural disorders. A series of ten factors (anamnestic and constitutional) considered predictive of migrainous vertigo and four types of response to sensory provocation made it possible to identify two types of patients: type A, simultaneous presence of at least 5 (≥50%) of the 10 factors considered and at least 2 (≥50%) of the four established responses; type B, presence of fewer than five factors (≤50%), or of more than five (≥50%) but fewer than two (≤50%) of the responses envisaged by the protocol. All patients underwent migraine prophylaxis for 4 months. Vertigo and postural status were evaluated using a questionnaire, i.e. the Dizziness Handicap Inventory (DHI), and a posturographic test before and after prophylaxis. The treatment was considered effective by 30% of the total group of 20 patients and by 75% of type A patients. No improvement was recorded in type B patients. Furthermore, the latter group did not show significant changes in the DHI or posturographic tests. Instead, type A patients demonstrated a statistically significant reduction in sway area and DHI score at the end of prophylaxis (P = 0.001). Research into a particular constitutional functional habitus, thus, proved useful for the diagnostic definition of migraine-associated vertigo.

We present the results of tinnitus retraining therapy (TRT) in a group of patients suffering from tinnitus and/or hyperacusia. Based on the scores from a specific questionnaire and the Tinnitus Handicap Inventory (THI), the patients were classified into five categories and began therapy according to Jastreboff's criteria. Depending on the individual case, therapy envisaged counselling sessions, ambient sound enrichment, sound generators and hearing aids. At the end of the 18-month period, therapeutic success was observed in 79% of the patients. The initial numerical values of the scale of the symptoms and the THI seem predictive of treatment outcome. The use of instruments (sound generators) increases the success rate, but the study also demonstrates the effectiveness of counselling and ambient sound enrichment. Failures mainly involved patients with hypacusia who refused to wear hearing aids, as this influenced the effectiveness of ambient sound enrichment and counselling. Paralleling the data in the literature, the results demonstrate the effectiveness of TRT, which cannot be attributed to a placebo effect given the extended duration of treatment.

OBJECTIVE: The study attempts to verify the effectiveness of mastoid oscillation as a physical measure in addition to repositioning manoeuvres for the treatment of the apogeotropic variant of paroxysmal positional vertigo of the lateral semicircular canal.MATERIALS AND METHODS: We evaluated 18 patients divided into two groups based on the physical procedures that were used: Group A (9 patients), in which the repositioning manoeuvre alone was used; Group B (9 patients), in which the manoeuvre was preceded by mastoid oscillation (frequency: 100 Hz; amplitude: 0.8 mm) for 60 seconds. The transformation of nystagmus into the geotropic form, expressing migration of the otoliths into the non-ampullary arm, was the main assessment parameter.RESULTS: Geotropic nystagmus was observed in 22% and 77% of cases, respectively in Group A and Group B, during the first repositioning session, and in 44% and 100%, respectively, after two sessions. The remaining patients from Group A required two more sessions in order to convert nystagmus in all cases. Overall, when compared to Group B (2.22 +/- 1.86), the patients from Group A presented a statistically significant increase (P=0.014) in the average number of manoeuvres (6.00 +/- 3.64) in order to convert nystagmus.CONCLUSIONS: Our experience demonstrates that the use of mastoid oscillation in addition to repositioning manoeuvres provides a substantial therapeutic advantage as it shortens the time required to resolve BPPV, thereby reducing the physical and mental stress that vertigo causes in these patients.

Chondrosarcoma of the larynx is a rare tumor of the upper respiratory tract that originates from cartilaginous tissue. The cricoid cartilage is the most frequent site of onset at the larynx. The diagnosis is not always easy, given the tumor's slow growth rate, the aspecificity of the symptoms, and the low degree of malignancy with which most cases present and which often causes it to be mistaken for a chondroma. A case is presented of a 61-year-old woman with a chondrosarcoma of the larynx, grade 2, originating from the cricoid cartilage and measuring about 3 cm in diameter. The patient underwent extirpation of the tumor together with the cricoid cartilage, with a successive thyrotracheal anastomosis because she refused a total laryngectomy, which would have been the indicated intervention on the basis of the extent and grade of the neoplasm. At 6 years from surgery, the patient is in a good state of health with good laryngeal function and without recurrence of the disease. This fact confirms that the surgical approach to chondrosarcoma of the larynx can in most cases be conservative, reserving demolitive surgery for the more aggressive forms, for tumors of greater extent, and for recurrences. In fact, good laryngeal function and therefore a good quality of life can be maintained even for long periods of time.

Objective: Comparative evaluation of two tests that, as a visual reference, respectively use a static light source (static testing) and a dynamic one (dynamic testing) to analyze subjective visual vertical in patients with unilateral vestibular dysfunction.Study Design: Prospective study.Setting: Otolaryngology and Cervicofacial Surgery Division, Department of Medical-Surgical Specialization, University of Perugia, Italy.Patients: Forty-two patients with unilateral vestibular dysfunction.Interventions: Determination of subjective visual vertical I to 2 days (first test) after the onset of vertigo. Repetition of 8 to 10 days (second test) and 90 days (third test) after onset.Main Outcome Measures: Test sensitivity and specificity.Results: The sensitivity of the static test was 85.7, 73.3, and 59.5% during the first, second, and third test, respectively. The dynamic test showed a sensitivity of 91.3, 86.8, and 78.1%, respectively. Specificity was 100% for the static test and 96.7% for the dynamic test.Conclusion: The dynamic test proved to be more useful in the weeks after the onset of dysfunction. Given the greater sensitivity of this test, the reduction in perception error time makes it more suitable for revealing false negatives that emerged when using the static test alone.