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Biomedical subjects

Nicola Quaranta

Publications and source records attributed to Nicola Quaranta.

At least 19 recordsLinked to original sources
PubMed2006

Does a reduction of adhesion molecules by LDL-apheresis have a role in the treatment of sudden hearing loss?

Sudden hearing loss (SHL) is a highly disabling affliction that can severely affect the subject's social and relational life. Although the etiology of the complaint is still debated, it is thought that microcirculation disturbances conditioned by an endothelial dysfunction might be the main pathogenetic mechanism. Adhesion molecules favoring interaction between leukocytes and endothelial cells are early markers of endothelial damage. In the present report, we describe a case of SHL that derived evident benefit from a single session of LDL/fibrinogen apheresis, with complete hearing recovery. In this patient, in addition to reducing LDL cholesterol and fibrinogen, the circulating adhesion molecules (sE-selectin, sVCAM-1 and sICAM-1), previously present in higher than normal concentrations, were reduced by the treatment.

Blood Component Removal↗
PubMed2005

Air and bone conduction change after stapedotomy and partial stapedectomy for otosclerosis.

OBJECTIVE: The aim of this study was to analyze and compare the results obtained in otosclerosis patient undergoing stapedotomy and partial stapedectomy. STUDY DESIGN AND SETTINGS: Retrospective review of surgical series. The guidelines of the American Academy of Otolaryngology-Head and Neck Surgery for the evaluation of results of treatment of conductive hearing loss were used. RESULTS: Pure tone average (0.5 to 3 kHz) air-bone gap was 6.1 dB in the partial stapedectomy and 6 dB in the stapedotomy group. The air-bone gap (ABG) closure rate did not differ between the 2 groups, except at 4 kHz, where stapedotomy group showed greater closure (P 0.003). Mean postoperative ABG gain was significantly (P < 0.05) higher in the stapedotomy group at 2, 3, and 4 kHz. Mean postoperative air-conduction gain did not differ significantly. Mean postoperative bone conduction (BC) change (1, 2, and 4 kHz) was 3.68 dB in partial stapedectomy and -0.02 dB in stapedotomy group, the difference being significant (P 0.007). Differences in BC change between the 2 groups were significant at each frequency. CONCLUSIONS: Similar good results can be obtained in experienced hands using either partial stapedectomy or stapedotomy technique. ABG closure rates were analogous in the 2 techniques as well as the complication rate. Although stapedotomy obtain better results at high frequencies, partial stapedectomy is associated with increased BC threshold at all frequencies.

Audiometry, Pure-Tone↗
PubMed2005

Effects of efferent acoustic reflex activation on psychoacoustical tuning curves in humans.

CONCLUSIONS: The results show that, in humans, activation of the contralateral EAR makes the PTC narrower at 1 kHz but wider at 4 kHz. These data are consistent with those reported previously in animals and demonstrate that, during medial efferent stimulation in humans, frequency resolution is improved at low frequencies but impaired at high frequencies. OBJECTIVE: To evaluate, in humans, the effect of activation of the contralateral efferent acoustic reflex (EAR) on the psychoacoustical tuning curves (PTCs) recorded for 1- and 4-kHz probe tones. MATERIAL AND METHODS. Ten young (20-30 years) volunteers served as subjects. They had normal hearing (thresholds <20 dB HL in the frequency range 0.25-8 kHz) and a functioning EAR (contralateral suppression of transient-evoked otoacoustic emissions > or = 0.8 dB). Frequency resolution was evaluated using PTCs. PTCs were recorded at 1 and 4 kHz using a simultaneous masking method. Q10 and Q20 were calculated as the ratio between the test frequency and the bandwidth of the PTC at 10 and 20 dB above the tip of the curve, respectively. The EAR was activated with a 40-dB SL contralateral narrow-band noise centered on the characteristic frequency of the PTC (1 or 4 kHz). Q10 and Q20 were measured in the presence and absence of the contralateral noise. RESULTS: Activation of the EAR led to a significant increase (p < 0.001) in Q10 at 1 kHz and a significant decrease (p <0.001) at 4 kHz. Changes in the value of Q20 were not significant.

Acoustic Stimulation↗
PubMed2005

Cochlear implantation in otosclerosis.

OBJECTIVE: The purpose of this study was to evaluate and compare the results obtained in a group of implanted otosclerotic patients with a group of cochlear implant (CI) patients not affected by otosclerosis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Nine patients affected by profound sensorineural hearing loss caused by otosclerosis and nine patients affected by profound sensorineural hearing loss not caused by otosclerosis were evaluated. INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Preoperative imaging, intraoperative findings, postoperative facial nerve stimulation, and speech perception performance measures were performed and the data analyzed. RESULTS: Otosclerosis patients showed signs of cochlear ossification both on high-resolution computed tomography scans and intraoperatively. The incidence of facial nerve stimulation was higher in the otosclerosis group, three out of nine, and was generally related to the use of electrical stimulation from the Nucleus 22 cochlear implant. Psychophysical and speech perception measures did not show significant differences between the two groups, despite some otosclerosis patients showing increased electrical thresholds and comfort levels and slightly poorer speech perception performance scores. CONCLUSIONS: Patients with otosclerosis who have progressed to profound hearing loss derive significant benefit from cochlear implants; however, an increased risk of cochlear ossification and facial nerve stimulation has to be taken in account during preoperative counseling. The advance in imaging techniques, CI technology and the possibility to stimulate precise regions of the cochlea with lower intensities make it possible for the surgeons and audiologists to readily and successfully manage these complications as they arise.

Adolescent↗
PubMed2005

VEMPs and dynamic posturography after intratympanic gentamycin in Menière's disease.

In this study, we investigated whether vestibular evoked myogenic potentials (VEMPs) and dynamic posturography (DP) are useful in the evaluation of the vestibular function in patients affected by active monoaural Menière's disease (MD) treated with intratympanic gentamycin. Twelve subjects affected by monoaural MD were treated with weekly intratympanic injections of 0.5 ml of gentamycin at a concentration of 20 mg/ml. VEMPs were used to test saccular function, while postural control was analyzed by DP. The results obtained with these two techniques were compared with those obtained by using bithermal caloric test. The mean follow-up was 15.3 months (6--28 months). Therapy resulted in complete absence of the caloric response in six subjects (50) and in caloric test-induced asymmetry in the remaining individuals, ranging from 83 to 27. At follow-up, eleven patients (91.6%) were free of vertigo, while one patient had two vertigo spells 9 months after treatment. Before treatment, VEMPs were present in the affected ear of eleven patients. After treatment VEMPs were absent in all the patients. At the end of follow-up, reappearance of VEMPs was observed in two patients, with no changes in latency values and amplitude ratio. DP demonstrated a reduction of the Composite Score (CS) one week after therapy, with a prevalent reduction of the vestibular component. After 6 months, there was an improvement of the CS and, in particular, of the vestibular component. The present study demonstrates that bithermal caloric test and VEMPs allow for the functional evaluation of both the horizontal semicircular canal and the sacculus, suggesting that these techniques might be used together to monitor the efficacy of intratympanic gentamycin therapy. In addition, our data indicate that DP might provide important information on compensation phenomena and show that intratympanic gentamycin can improve postural control in MD patients.

Adult↗
PubMed2005

Sodium enoxaparin treatment of sensorineural hearing loss: an immune-mediated response?

The authors propose the existence of a new entity of autoimmune sensorineural hearing loss on the basis of diagnostic study and treatment experience with a series of 30 patients. Immunological mechanisms play an important role in the pathogenesis and natural course of various inner-ear diseases. Patients may present clinically with symptoms resembling Ménière's disease or even with sudden deafness. Currently, no widely used standard protocol for treatment of this autoimmune sensorineural hearing loss exists. Prompted by such observations, we implemented a protocol using a particular kind of heparin--sodium enoxaparin--with a low molecular weight. Patients were randomly assigned to two groups; to those in the first group, enoxaparin was administered subcutaneously at a dose of 2,000 IU twice daily for 10 days; the patients in the second group were treated with placebo. At the beginning and at the end of the therapy period, the patients were evaluated by instrumental examinations. Specifically excluded were patients with abnormal known coagulation. On discharge, all patients treated with enoxaparin presented both a subjective and objective decrease in symptoms. No patient experienced side effects from this treatment. The results indicate that administration of sodium enoxaparin abates sensorineural hearing loss in patients with autoimmune diseases. The clinical response to therapy can confirm diagnosis.

Adult↗
PubMed2004

The effects of 'supra-physiological' vitamin B12 administration on temporary threshold shift.

The aim of this study was to evaluate, in 20 young volunteer subjects, the effects of supra-physiological vitamin B12 administration on noise-induced temporary threshold shift (TTS). All subjects had hearing thresholds within 15 dBHL and type A tympanograms. The subjects were randomly assigned to two different groups. Experimental group subjects received cyanocobalamin, 1 mg daily for 7 days, and 5 mg on the eighth day. Control group subjects received a placebo injection daily for 8 days. The vitamin B12 concentration, hearing thresholds and TTS2 (10 min of exposure, narrowband noise centred at 3 kHz, bandwidth of 775 Hz, 112 dBSPL) were measured before and 8 days after treatment. At the end of treatment, the serum vitamin B12 concentration was significantly increased in the experimental group. After 8 days of treatment, the control group showed the same hearing thresholds and TTS2 degrees. Statistical analysis showed that TTS2 decreased significantly at 3 and 4kHz when cobalamin was used to increase the serum concentration of vitamin B12 to > 2350 pg/ml. In addition, a protective effect at 3 kHz in the experimental group was evident when compared with the placebo group. These results suggest that elevated plasma cyanocobalamin levels may reduce the risk of hearing dysfunction resulting from noise exposure in healthy, young subjects.

Adult↗
PubMed2004

Tinnitus and cochlear implantation.

Tinnitus is a common experience, but there is very marked heterogeneity of aetiology, perception and the extent of distress among individuals who experience tinnitus. In view of this, a modern approach to tinnitus should consider homogeneous groups of individuals. This review considers tinnitus experiences in patients undergoing cochlear implantation, this being of interest because the prevalence of tinnitus in this patient group prior to surgery may shed some light on the link between cochlear dysfunction and tinnitus Second, any change in tinnitus experience as a result of electrode placement surgery or cochlear implant activation has relevance for patient counselling and informed consent. Finally, in recent tinnitus retraining therapy literature there has been the suggestion that unilateral sound therapy for tinnitus patients may set up an unhelpful asymmetry of input to the auditory system, with possible exacerbation of contralateral tinnitus. Unilateral cochlear implant use represents the most dramatic asymmetry possible and hence is a test of that hypothesis. Relevant papers (n = 32) were identified from literature databases. The standard of reporting tinnitus results was inconsistent. Tinnitus is experienced by up to 86% of adult cochlear implant candidates, but is not universal and is only troublesome in a small proportion (reported as 27% in one study). Electrode insertion may induce tinnitus in a small (up to 4%) number of patients, but this is rare. Cochlear implant device use is associated with reduction of tinnitus intensity and awareness in up to 86% of patients, and rarely with exacerbation (up to 9%). There are some indications in the literature that the more complex the simulation strategy, the larger that effect. Specifically, unilateral cochlear implant use was generally associated with reduction of contralateral tinnitus (in up to 67% of individuals) rather than exacerbation, and so the assertion that unilateral sound therapy for tinnitus is contraindicated is not proven.

Cochlea↗
PubMed2004

The protective role of tiopronin in cisplatin ototoxicity in Wistar rats.

The purpose of this study was to evaluate cisplatin-induced ototoxicity and the protective effects of tiopronin. Twenty-four adult Wistar rats served as subjects and were divided into three groups. Eight rats receiving only saline (group A) were used as controls. Eight rats received cisplatin (2 mg/kg) injections (group B) and eight rats received cisplatin and tiopronin (300 mg/kg) (group C) for 8 consecutive days. Both ears of all animals were tested by DPOAE before treatment and on the 4th and 9th days. Seventy-two hours after the final recording session, all animals were killed, and the left cochleas were prepared for electron microscopy and analysed. DPOAE responses were significantly reduced in group B compared to controls (p<0.05). When tiopronin was added, DPOAE responses were significantly increased compared to those obtained with the administration of cisplatin alone (p<0.05). The cochleogram showed that tiopronin had a significant protective effect in the basal half and in the lower half of the middle turn. We conclude that tiopronin, a drug effective in protecting against cisplatin nephrotoxicity, is also effective in protecting against cisplatin ototoxicity.

Analysis of Variance↗
PubMed2004

Cochlear implants: indications in groups of patients with borderline indications. A review.

Cochlear implants (CI) represent the current treatment for patients affected by profound sensorineural hearing loss (SNHL). Initially only deaf adult patients were considered to be candidates for a CI; however, the development of technology and matured experience have expanded the indications for cochlear implantation. Today, CIs are implanted in adults and children and broader indications are followed. There are, however, a number of patients who do not completely fulfill the current indications and who are potential candidates for CI. The duration of deafness and residual hearing represent prognostic indicators for CI performance; however, the candidacy of children with residual hearing and prelingually deafened adults are still under debate. Anatomical variants such as cochlear ossification, cochlear malformation and chronic otitis media represented and still represent for some surgeons a contraindication to CI. The otological experience of CI surgeons and the advent of auditory brainstem implants have changed the approach to these patients, who may still benefit from hearing rehabilitation. This paper briefly analyses and reviews the results obtained in these groups of patients, who were not, at least initially, considered to be candidates for cochlear implantation.

Cochlea↗
PubMed2003

Effect of ipsilateral and contralateral low-frequency narrow-band noise on temporary threshold shift in humans.

OBJECTIVE: To evaluate the effect of ipsilateral and contralateral low-frequency (250 Hz) narrow-band noise (NBN) on the temporary threshold shift (TTS) induced by a 2 kHz tone in young normally hearing subjects with a functioning auditory efferent system. MATERIAL AND METHODS: Sixteen young volunteers served as subjects. All the subjects were young (20-30 years), disease-free and had a medical history negative for otological disease, noise exposure and use of ototoxic drugs. They had normal hearing [thresholds of 125-8,000 Hz below 20 dB hearing level (HL)], transient-evoked otoacoustic emissions and contralateral suppression. The subjects were randomly assigned to one of three different groups. Subjects in Group A (n = 5) were exposed to a 90 dB HL 2 kHz pure tone for 10 min. Subjects in Group B (n = 6) were exposed to a 90 dB HL 2 kHz pure tone and an ipsilateral 45 dB HL 250 Hz NBN for 10 min. Subjects in Group C (n = 5) were exposed to a 90 dB HL 2 kHz pure tone and a contralateral 45 dB HL 250 Hz NBN for 10 min. The right ear served as the test ear. The TTS 2 min after the end of the exposure (TTS2) was measured in all subjects at 2, 3 and 4 kHz. RESULTS: TTS, in Group A was significantly higher at 3 kHz (p = 0.011) and at 4 kHz (p = 0.003) than TTS2 in Group B. At 4 kHz, TTS2 in Group C was significantly higher (p = 0.013) than TTS2 in Group B. Although TTS2 in Group C was lower than TTS2 in Group A, this difference was not significant. The presence of an ipsilateral low-frequency NBN significantly reduced TTS2 induced by a 90 dB HL 2 kHz tone. A contralateral low-frequency NBN reduced TTS2 in this group of subjects; however, the reduction was not significant. CONCLUSION: The results of this study show that an ipsilateral low-intensity, low-frequency (250 Hz) NBN can give protection from a TTS induced by a 2 kHz tone. Contralateral low-frequency NBN did not induce any protective effect.

Acoustic Stimulation↗
PubMed2003

Audiologic presentation of cerebellopontine angle cholesteatoma.

OBJECTIVE: The aim of this study was to examine the audiologic presentation of patients with cerebellopontine angle (CPA) cholesteatoma. DESIGN: Retrospective case review. SETTING: Neuro-otologic tertiary referral centre. METHODS: The study population consisted of 11 patients with CPA cholesteatomas. The patients underwent a standard audiologic investigation in the preoperative setting, which consisted of pure-tone audiometry, speech audiometry, and auditory brainstem response (ABR). MAIN OUTCOME MEASURES: The audiologic parameters that were analyzed were the pure-tone threshold, pure-tone average (PTA), and speech discrimination scores (SDSs). The morphology and latency of the ABR were evaluated. In addition, the clinical and radiologic presentations of the lesions were reviewed. RESULTS: The mean PTA in the diseased ear was 22.6 dB HL (SD 18.2), whereas in the contralateral ear, it was 19.1 dB HL (SD 19.6). In 4 patients, the hearing loss was asymmetric, with the diseased ear being the worse ear. The mean SDS was 82.28% in the affected ear and 95.28% in the contralateral ear. ABR was abnormal in 9 of 10 cases (90%), with only the affected ear being abnormal in 4 cases. In the other 5 cases, the ABR was bilaterally abnormal. CONCLUSIONS: CPA cholesteatomas are very slow-growing lesions that involve the eighth cranial nerve. The paucity and insidious onset of symptoms mean that the diagnosis is often late, permitting the lesions to reach impressive dimensions at the time of diagnosis. Although magnetic resonance imaging represents the gold standard in the diagnosis of these lesions, ABR proved to be of value in the assessment of the auditory pathway, especially in those patients referred with a vague symptomatology and with normal hearing.

Adult↗
PubMed2003

Management of acoustic neuromas in the elderly: retrospective study.

The wide availability of gadolinium-enhanced magnetic resonance imaging (MRI-Gd) has led to the discovery of an increasing number of small and less symptomatic acoustic neuromas in elderly patients. We conducted a retrospective study in order to obtain data on outcomes and complications associated with different management strategies that would be useful in establishing a management guideline. We identified 44 patients aged 65 to 77 years with acoustic neuromas who had been managed with either surgery or simple observation with MRI-Gd imaging. Of the entire group, 36 patients had tumors larger than 1 cm, and they underwent surgery (most via the translabyrinthine approach). Complete removal of the tumor was achieved in 34 of these patients (94.4%). At the 1-year follow-up, grade VI facial nerve paralysis was evident in only two of 35 evaluable patients (5.7%). Postsurgical complications occurred in five patients (13.9%), including one death. The remaining eight patients had tumors 1 cm or smaller, and they were managed with periodic MRI-Gd scanning. At the 5-year follow-up, no tumor growth was seen in six of these patients. The other two patients exhibited a tumor growth rate of less than 2 mm per year. No patient in the observation group required surgical intervention.

Age Factors↗
PubMed2002

Management strategies in neurofibromatosis type 2.

The objective of this study was to review the experience of the Neurotology and Skull Base Surgery Unit of Addenbrooke's Hospital in Cambridge, England, in the management of patients with neurofibromatosis type 2 (NF2). This was a retrospective review of the institution's series conducted at a neurotological tertiary referral centre. Over a 17-year period (1984-2001), 35 patients with NF2 were managed. These patients presented with multiple cranio-spinal neoplasms, including 62 cerebellopontine angle tumours of which 59 were vestibular schwannomas (nine patients with unilateral tumours and 25 patients with bilateral tumours). Clinical presentation, diagnosis and patient management were reviewed. The outcome parameters measured were tumour progression, the incidence of complications (hearing deterioration and facial nerve palsy) and the need for secondary intervention. Five vestibular schwannomas were treated with stereotactic radiosurgery (gamma-knife), all of which showed evidence of progression in size and/or deterioration in hearing. Thirty-one VS were conservatively treated with annual surveillance. In nine cases, the tumours had a follow-up shorter than 6 months and were therefore excluded from the results. In 13 cases the VS did not progress in size, and the hearing remained stable, while in the remaining nine cases, tumour progression was evident. In fifteen cases, surgery was performed at the authors' institution. In 11 cases a translabyrinthine approach was adopted, and in the remaining four cases a retrosigmoid approach was preferred. In all these cases, tumour removal was total and facial nerve function was House-Brackmann grade I-III in 55%. Successful hearing preservation was elusive in those patients in whom a hearing preservation approach was attempted. NF2 remains an extremely challenging disorder for the neurotologist and the patient alike. Early diagnosis offers distinct advantages to the patients, their families and the community at large. Of the treatment modalities, surgery unequivocally offers the most superior tumour control. Hearing preservation remains a challenge in these patients, but is optimised by the early detection of tumours in the NF2 patient.

Adolescent↗
PubMed2002

Cochlear function in ears with immunomediated inner ear disorder.

The aim of the present study was to evaluate the performance of ears with inner ear disorder, responsive to immunosuppressive drugs, in advanced tests designed to assess primary cochlear functions (temporal integration, frequency selectivity, cochlear mechanics). The results of this study suggest that immunomediated inner ear disease results, in the acute clinical stage, in the development of endolymphatic hydrops, which increases the stiffness of the vibrating structures within the inner ear and causes dysfunctions of the outer hair cells. Our patients presented with upsloping or flat sensorineural hearing loss, absence of evoked otoacoustic emissions and distortion-product otoacoustic evoked emissions and abnormal temporal integration, frequency selectivity and cochlear mechanics. Following immunosuppressive treatment, hydrops recovered, hearing subsequently returned to normal, the audiometric curve became flat at low-to-middle frequencies and primary cochlear function tended to normalize. This study seems to support the usefulness of testing primary cochlear functions in order to monitor the clinical course of immunomediated inner ear disorders.

Acoustic Impedance Tests↗
PubMed2002

Cochlear implants in systemic autoimmune vasculitis syndromes.

The concept that autoimmunity may damage the inner ear was introduced by McCabe in 1979. Audiovestibular symptoms may occur in isolation or may be mediated by vasculitis in patients affected by systemic autoimmune disorders. Sensorineural hearing loss (SNHL) is typical in Cogan's syndrome but occurs less frequently in Beçhet's syndrome and in systemic necrotizing vasculitides. Patients affected by immune-mediated profound SNHL represent ideal candidates for cochlear implantation as these patients become deaf after years of hearing. The disease itself and the medication taken may, however, influence the prognosis of cochlear implantation in these patients. We retrospectively evaluated the pre- and intraoperative findings as well as the postoperative course and performance of a group of five patients affected by a systemic vasculitis syndrome who received a cochlear implant. Implantation was successful in all patients, no complications occurred and excellent postoperative speech perception was achieved. We conclude that cochlear implantation in patients affected by immune-mediated inner ear disorders is effective although the long-term results remain to be evaluated.

Adult↗