Biomedical subjects
Publications and source records attributed to A Pirodda.
A 53-year-old man presented with isolated bilateral progressive hearing loss from about 5 months. Fourteen months after onset of this isolated symptom a diagnosis of meningeal carcinomatosis (MC) was made. Isolated bilateral deafness is a rare first manifestation of MC.
AIM: Tympanosclerosis and atherosclerosis seem to have a similar inflammatory origin despite the different tissues involved. We have investigated the possible relationship between tympanosclerosis and atherosclerosis by evaluating the incidence of tympanic plaques in patients with significant carotid disease. METHODS: Between September 1(st) 2002 and April 30th 2003, we have evaluated all patients undergoing carotid surgery for significant carotid stenosis (group A). If at least 1/5 of the eardrum was occupied by plaques, then the case was considered positive. A control group of patients of similar age and no history of otological nor vascular pathologies was enrolled (group B). The 2 groups were compared statistically by Fisher's test and significance was set at p=0.05. RESULTS: Group A consisted of 84 patients. In this group 32 patients (38.1%) had tympanosclerosis; it was bilateral in 12 cases. Group B had 84 patients. In this group tympanosclerosis was present in 11 cases (13%). The difference between the 2 groups was statistically significant (p=0.005). CONCLUSION: More studies are needed before we can understand the cause of the association between these 2 pathologies. However early screening of atherosclerotic disease in patients with tympanosclerosis seems justifiable on the basis of the data of both the literature and the present study.
The term 'idiopathic' is used to design sudden sensorineural hearing loss when causative factors cannot be identified. In most cases a viral infection or a circulatory defect are considered to play a significant role when an alternative satisfactory explanation cannot be found. However some significant points remain unclear, since the great variability in age and general conditions of the affected people makes it difficult to find a reliable interpretation of the exact nature of this phenomenon which is reasonably considered to have a multifactorial origin. Under these conditions many different therapeutic strategies have been put forward, thus suggesting some degree of uncertainty not only about the pathogenetic mechanisms of the disease but also on the actual effectiveness of the disparate treatment approaches. In this paper the use of statins in sudden sensorineural hearing loss is firstly proposed on the basis of their metabolic and hemodynamic effects, and the possible clinical implications are outlined.
In spite of the well-consolidated technique that otosclerosis surgery has built up, there are several aspects that have yet to be satisfactorily explained. One of these is the greater long-term "vulnerability" that appears to characterize an ear that has been operated on compared to a healthy one. In searching for a feasible explanation of this phenomenon and its therapeutic implications, a retrospective analysis of 26 cases was carried out on patients who had been operated between 1966 and 1995 and had come to our attention between 1989 and 1999 due to a rapid, late deterioration in bone conduction. Short-term treatment was pharmacological and surgical in 19 cases and exclusively pharmacological in 7 cases. The analysis of the results of therapy was based on an evaluation criterion of PTA (250-4000 Hz) > 5 dB, calculated on the basis of the bone conduction threshold values. Possible prognostic factors were searched for by means of a multivariate analysis that took as its dependent variable the bone conduction hearing threshold following therapy and as independent variables the age, gender, monolaterality of the otosclerosis ascertained, a positive medical history for analogous phenomena and for previous surgical revision, concomitant vertigo, the time that had elapsed between initial treatment (operation) and deterioration, the technique adopted during the first operation, the extent of the rapid deterioration, the audiometric characteristics at the outset of treatment for the acute episode, the time that had elapsed between deterioration and treatment, the type of treatment, possible reopening of the oval window, and intraoperative findings of a perilymphatic fistula. In the 7 cases managed with pharmacological therapy alone, improvement was seen in 3 cases while the condition remained unvaried in 4 cases; surgical revision (which in 5 cases enabled the presence of a fistula to be ascertained) associated with pharmacological therapy brought improvement in 4 cases, worsening in 4 cases, and no variation of the condition in 11 cases. The only prognostic factor detected, of an unfavourable nature, was the presence of anacusis upon examination. The results obtained do not enable unambiguous conclusions to be drawn: it may in any case be inferred that, at least in certain particular cases, above all when a false cochlear deterioration or the presence of a fistula is suspected, an "aggressive" therapeutic approach may be justified.
BACKGROUND: Sudden sensorineural hearing loss (SSHL) is an acute disorder whose origin is often unclear. A vascular disorder may be a causative factor. OBJECTIVE: To determine whether hypotension influences the genesis of SSHL in healthy subjects. DESIGN: To investigate the role of a 24-hour blood pressure (BP) profile in a population of young subjects with SSHL from January 1, 1996, to December 31, 1999, by a nonrandomized controlled trial. SETTING: The Ear, Nose and Throat Section of the Department of Surgical and Anaesthesiological Sciences and the Department of Internal Medicine, S. Orsola Hospital, University of Bologna, Bologna, Italy. PATIENTS: The study population consisted of 23 untreated healthy patients diagnosed as having SSHL compared with 20 age- and sex-matched normotensive control subjects. Both groups underwent 24-hour BP monitoring, and their BP profiles were analyzed and compared with routine BP values. The data were analyzed with the Statistical Package for the Social Sciences, version 7.1, and the results are expressed as mean +/- SD. MAIN OUTCOME MEASURES: The mean BP values were expected to be lower in the study population. RESULTS: The average clinic and ambulatory BP values were significantly lower in patients with SSHL, for systolic (clinic, P =.004; ambulatory BP, P =.02) and diastolic (clinic, P =.03; ambulatory BP, P =.03) values. The occurrence of persistent hypotension (the presence of >2 consecutive recordings of systolic BP of < or =105 mm Hg and/or diastolic BP of < or =60 mm Hg) was increased in the population with SSHL. CONCLUSION: Systemic hypotension must be considered as the possible cause responsible for the development of SSHL in young healthy subjects.
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Benign paroxysmal positional vertigo (BPPV) is a labyrinthine disorder with a typical behavior: intense crises of rotational vertigo induced by postural changes of the head, with short duration and usually good responsiveness to rehabilitative maneuvers. This phenomenon is thought to be subsequent to the movement of floating particles in the labyrinthine fluids, which can provoke gravitational stimulations. In order to conduct a metabolic and autoimmune examination, 70 patients affected by BPPV were examined. In 34 cases (48.5%) autoimmune alterations were found: in 19 cases (27.1%) the level of anti-thyroid antibodies far exceeded the normal values with a significant incidence in comparison with a control group (P<0.01). No other 'risk factors' were present. It can be hypothesized that the diffusion of immune-complexes in the inner ear could change the composition of the endolymphatic fluid exerting a mechanical stimulation of the receptors and provoking the typical vertigo.
In a proportion of small acoustic neuroma patients, monitoring with magnetic resonance imaging shows no volumetric increase of tumour size over the years. The object of the study was to identify some indications for the clinical choice between immediate surgery (with the related risks) and watchful waiting. We performed a retrospective study of 47 non-surgically-treated patients affected by acoustic neuroma and monitored by gadolinium-enhanced MRI between January 1990 and February 1999. Six clinical variables (tumour size, sex, age, initial symptoms, ABR pattern and duration of the symptoms) were examined by univariate analysis. Chi-square test and variance analysis were performed to evaluate the statistical significance. In 30/47 (63.8%) cases, no growth was observed during the entire period of follow-up. In the remaining 17/47 (36.2%) patients, a volumetric increase was detected, most often within the first year of observation. The clinical factors examined did not significantly correlate with growth. Despite the relatively short period of observation, we believe that immediate surgery does not need to be considered mandatory for small acoustic neuromas, even in young patients. However the irregular behaviour of the tumour underlines the importance of monitoring with MRI at least once a year.
A possible role of hypotension in the genesis of sudden or slowly developing sensorineural hearing loss has been outlined. In order to confirm this hypothesis, and to exclude other vascular risk factors, a prospective study was carried out within the "Brisighella Study", a wide and homogeneous group of subjects thoroughly examined from a metabolic and cardiovascular point of view. Among them, 20 participants aged 50 years or less (18 women, 2 men) with diastolic blood pressure < or = 60 mmHg and/or systolic blood pressure < or = 105 mmHg were selected and underwent otological and audiometric examinations. Patients with previous audiological, vestibular and otological diseases were excluded. The control group was represented by 100 subjects (60 women, 40 men), aged 50 years or less, randomly chosen from within a sample of the normal population in the same region. A statistically significant incidence of sensorineural hearing loss was recorded in the study group (7/20 subjects, all affected by low-frequency hearing loss), while hearing impairment was observed in only 3/100 participants in the control group. The mean values of the main metabolic parameters were normal. An alteration of the vasomotor system associated with a hypotensive condition could be responsible as a possible factor in the origin of a cochlear damage and the consequent sensorineural hearing loss.
In the absence of a satisfactory interpretation, sudden sensorineural hearing loss is often attributed either to infective phenomena or to organic-type circulatory defects. This latter pathogenesis inevitably comes to mind in elderly patients or in the presence of signs of circulatory dysfunction. Nevertheless, the not-infrequent observation of sudden hearing loss in young persons lacking factors predictive of short-term vascular impairment makes us suppose the existence of etiopathogenetic mechanisms of a functional nature. A survey of our cases, matched with a control group, revealed the presence of lower mean blood pressure levels in the group of young patients with 'idiopathic' sudden hearing loss. This finding supports the hypothesis that a condition of haemodynamic imbalance linked to hypotension plays a role in the genesis of cochlear damage in young subjects. Such a mechanism would bear important therapeutic implications: should it be responsible for the damage in at least some cases, vasoactive drugs with a vasodilatative action could have adverse effects on the possibility of recovery.
Contralateral ear pathologies are frequently found in patients suffering from acquired cholesteatoma. A retrospective study was performed on 85 pediatric patients and 105 adults surgically treated for acquired middle ear cholesteatoma. All the patients were checked and the otomicroscopic picture photographed and compared in an attempt to gain insight into the pathogenesis and clinical indications by comparing two samplings from different age groups. In both groups the frequency of pathological contralateral ear manifestations was higher than found in the normal population. Similar results were obtained in the two groups and indicate that the same mechanisms come into play in both ears, starting at infancy. The finding of a particularly common association between cholesteatoma and contralateral retraction pockets with sinus cholesteatoma or pars tensa in the pediatric group appears to confirm that tubal dysfunction plays a pathogenic role in the genesis of cholesteatoma. From the practical point of view, systematic preventative measurement of the contralateral ear can lead to a reduction in major surgery and can affect the choice between open or closed tympanoplasty. Moreover, it may also condition the precision and length of the follow-up.
Malignant external otitis (MEO) is an infrequent but severe infective disorder, generally due to Pseudomonas aeruginosa, which most often affects elderly diabetics patients. The clinical features rarely permit exact diagnosis of MEO to be made promptly, and initially at least they are difficult to distinguish from those of external otitis. This explains the frequent delay in diagnosis with respect to the onset of symptoms. Physical examination almost always reveals the presence of aspecific granulation tissue in the external auditory canal, while the most common laboratory finding is raised erythrocyte sedimentation rate (ESR). Imaging has great diagnostic relevance: CT and MRI are very useful for spatial resolution, while radionuclide scanning and, in our experience, SPECT are superior for detecting early osteitis and monitoring response to therapy. We present an extensive review of the literature and our personal experience. In particular, we stress the relevance of immunological study of MEO patients: all our 4 patients had defective immune defences. As regards therapy, like other authors we underline the fundamental importance of long-term antibiotic treatment. The availability of quinolones and latest generation cephalosporins has greatly simplified the choice of antibiotic treatment, although clinicians should be aware of the possibility of drug-resistant bacterial strains.
The author reports a case of chronic otitis with cholesteatoma complicated by a fistula of the lateral semicircular canal and a stapedo-ovalar ankylosis, probably of otosclerotic origin, in which the decision to take advantage of the fistula to create conditions similar to those generally produced by labyrinthine fenestration allowed virtual functional recovery of the patient's hearing. The case illustrates how, with a ploy of this kind, certain intrinsically negative features may actually turn out to be a blessing in disguise.
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An aberrant internal carotid artery in a young woman complaining of pulsatile tinnitus and conductive hearing loss was diagnosed pre-operatively by CT scan and angiographic findings. An exploratory tympanotomy was performed in order to evaluate the cause of the severe conductive hearing loss. It was possible to detect a large persistent stapedial artery associated with a stapedial fixation of unknown cause. Despite these vascular anomalies a stapedotomy was performed successfully.
1. In addition to mossy and climbing fibers, the Purkinje (P)-cells of the cerebellar cortex receive noradrenergic (NA) afferents which originate mainly from the locus coeruleus. Since these fibers impinge also on the vermal cortex of the cerebellar anterior lobe, which receives a labyrinth input and projects to the lateral vestibular nucleus, experiments were performed in precollicular decerebrate cats to find out whether unilateral injection of alpha-adrenergic substances into the vermal cortex of the cerebellar anterior lobe exerted some influence on posture as well as on the dynamic characteristics of vestibulospinal (VS) reflexes evaluated by recording the multiunit EMG responses of the forelimb extensor triceps brachii of both sides to roll tilt of the animal at 0.15 Hz, +/- 10 degrees. 2. Unilateral injection into the vermal cortex of the culmen of the alpha 1-adrenergic agonist metoxamine or the alpha 2-adrenergic agonist clonidine (0.25 microliters at the concentration of 4 micrograms/microliters of saline) produced a postural asymmetry, characterized mainly by a slight decrease of the extensor tonus in the ipsilateral forelimb and an increased tonus in the contralateral forelimb. The same substances significantly increased the gain (imp./sec/deg) of the first harmonic component of the EMG responses of the ipsilateral and the contralateral triceps brachii to animal tilt. The crossed effects were more prominent for the alpha 2- than for the alpha 1-agonist. However, no significant changes in the phase angle of the responses were observed in both instances. The effects described above occurred within 5-10 min after the injection, reached the peak values after 15-20 min, and disappeared within 2 hours. 3. The postural and reflex changes described above were not due to irritative events following the injection, since they were not observed in control experiments after injection of 0.25 microliter of saline into the same corticocerebellar area prior to the administration of the alpha 1- or the alpha 2-adrenergic agonist. Moreover, the resulting effect were dose-dependent. 4. Both the ipsilateral as well as the contralateral effects induced by the alpha 1- or the alpha 2-adrenergic agonist metoxamine or clonidine were impaired by previous injection into the same corticocerebellar area of the corresponding alpha 1- or alpha 2-adrenergic antagonist prazosin or yohimbine, respectively (0.25 microliter at the concentration of 8-16 micrograms/microliters in both cases).(ABSTRACT TRUNCATED AT 400 WORDS)
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