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Biomedical subjects

R Albera

Publications and source records attributed to R Albera.

At least 19 recordsLinked to original sources
PubMed2006

Age at diagnosis of deaf babies: a retrospective analysis highlighting the advantage of newborn hearing screening.

OBJECTIVE: Aim of the study was to assess the mean age at diagnosis of bilateral congenital hearing loss in the Audiology and Phoniatry Centre of the University of Turin, pointing out, by North-West Italy experience, the role of the newborn hearing screening in anticipating the age of diagnosis. METHODS: This was a retrospective study. Forty-six congenital deaf babies were reviewed and age at diagnosis was assessed for each, taking in consideration the role of hearing loss risk factors. Eighteen babies (39%) were sent by the centres that participate to the newborn hearing screening program while 28 (61%) came for parental or pediatrician suspicion of hearing loss and for general language delay. Sixteen babies (35%) presented risk factors for hearing loss. RESULTS: The mean age of identification of severe to profound hearing loss was 20.5 months (S.D.=15.3) in the whole group; considering the group of 28 babies not screened the mean age was 29.3 months (S.D.=13.4). This value decreased to 6.8 months (S.D.=3.6) in the group which underwent screening programme. This difference was statistically significant at Student's t-test (p<0.001). The average ages of diagnosis for healthy versus high risk children were significantly different only in the group of screened babies (p<0.05). CONCLUSIONS: Childhood hearing impairment is one of the most common of congenital disorders, and even though there is a general trend of early identification, in reality age of diagnosis is as yet still too late even in developed countries. Our results show that newborn hearing screening could reduce the age at which infants with hearing loss are diagnosed and treated; this would improve speech, language, auditory outcome and the quality of parents and infant life.

Age Distribution↗
PubMed2005

Retrosigmoid approach for vestibular neurectomy in Meniere's disease.

BACKGROUND: Vestibular nerve section is considered to be the most effective surgical procedure to control intractable symptoms secondary to Meniere's disease (MD). This study was developed to analyze the adequacy of retrosigmoid vestibular neurectomy in terms of vertigo control, hearing preservation and clinical complications of this procedure. METHODS: A retrospective review was carried out on 14 patients affected by definite unilateral MD who underwent vestibular neurectomy via the retrosigmoid approach. FINDINGS: One patient was lost from follow-up; another one had only a short postoperative observation. At follow-up performed on 12 cases, no patients reported any crisis of acute vertigo. Four patients were free from any vestibular symptoms, while 8 reported some slight gait disturbances. Hearing function was preserved in 10 patients and improved in 2. 1 year postoperative vestibular function was absent at the side operated on and unchanged on the other side in all the cases. CONCLUSIONS: Vestibular neurectomy via the retrosigmoid approach can be considered a safe and effective procedure in relieving medically refractory vertigo in Meniere's disease, while preserving hearing.

Adult↗
PubMed2005

Auditory-evoked potentials in general anesthesia monitoring: baseline study of availability in relation to hearing function in awake status.

BACKGROUND: It has been confirmed that middle latency auditory-evoked potentials are good indicators of the hypnotic level in patients undergoing general anesthesia. The focal point for the evocation of auditory-evoked potentials is the presence of a serviceable hearing function. The aim of the study was to evaluate the limit of hearing loss above which the test could not be applied. METHODS: To determine the limit of applicability of the technique, 100 subjects were studied. Twenty of them were normally hearing and 80 were affected by sensorineural hearing loss of various degrees. Each subject was submitted to pure tone audiometry, to determine hearing threshold, and then, in awake status, to auditory-evoked potentials recording using acoustic stimuli of 85 dB HL. RESULTS: All the 20 normally hearing subjects showed a reliable auditory-evoked potentials. Among the 80 subjects affected by hearing loss, only five had no potentials. These five subjects presented a pure tone audiometry threshold greater than 85 dB HL. CONCLUSION: The study demonstrated that middle latency auditory-evoked potentials recorded using an A-Line (software version 1.4) AEP monitor (Danmeter, Odense, Denmark) can be carried out even in presence of hearing loss if the pure tone threshold is less than 85 dB HL.

Acoustic Stimulation↗
PubMed2005

Intensity and fundamental frequency control in tracheoesophageal voice.

Tracheo-oesophageal voice prostheses are currently widely used following total laryngectomy. Data on maximum phonation time and spectrum have been studied by various Authors and are well known. On the contrary, intensity and fundamental frequency control have received little attention. Intensity and fundamental frequency play an important role in the prosodic aspects of speech. Fundamental frequency variations have been studied in tone language speakers, but the ability to voluntarily change intensity and fundamental frequency remain to be fully investigated. Aim of the present study was to analyse the ability of tracheo-oesophageal voice users to change intensity and fundamental frequency. A total of 12 male subjects who underwent total laryngectomy, in whom a tracheo-oesophageal prosthesis had been inserted, were considered. Maximum phonation time was calculated. Each subject was asked to utter an /a/ as loud as possible and an /a/ as soft as possible. Each subject was then asked to utter an /a/ at comfortable pitch and then at an interval of a fifth. Intensity as well as fundamental frequency variations were compared using Wilcoxon signed rank test. Correlation between maximum phonation time and variation in intensity and in fundamental frequency as well as between the two latter variables was calculated using Spearman's rank correlation coefficient. Mean maximum phonation time was 8 (+/- 3.8) sec. Mean energy was 50 (+/- 4.8) dB SPL for soft phonation and 68 (+/- 4.7) dB SPL for loud phonation. The difference observed was statistically significant (p < 0.02). Mean fundamental frequency values were 106 (+/- 14) Hz and 135 (+/- 34) Hz at the interval of a fifth. The difference observed was statistically significant (p < 0.02). Tracheo-oesophageal voice users were able to change intensity and fundamental frequency, but their control was rather poor. Variations in intensity, as well as fundamental frequency, did not show any correlation with maximum phonation time, and were not correlated with each other. In conclusion, the tracheo-oesophageal voice allows small fundamental frequency variations, but their control appears difficult. On the contrary, intensity variations appear larger and control somewhat easier.

Aged↗
PubMed2005

Informed consent in ENT. Patient's judgement about a specific consensus form.

The concept of informed consent was first used in the 60's. The meaning of this term is the need of a preliminary and valid consensus that places the doctor in an authorised condition whereby he is able to carry out his work. Notwithstanding the importance and delicacy of this topic and the potentially serious consequences, there is not, as yet, universal behaviour, on the part of doctors, regarding the mode of information and documentation on how the patient be informed. In a previous article, the authors outlined the best approach, on the part of the doctor in regard to the patient, in order to obtain valid informed consent. In particular, the specific information for each disease was proposed and this was not limited only to aspects related to type of treatment and possible risks, but thorough, with regard to adhering to the logical course (case history, objective tests, instrumental diagnosis carried out, etc.) that led the doctor to a certain diagnosis and a description of the proposed treatment possibilities as well as the treatment modalities excluded, with relative reasons. The study was designed in such a way as to define the degree of acceptance that this informative method has on the patients. This was achieved by means of a questionnaire filled in by 254 patients hospitalised in our department, about to undergo surgery. Judgement was substantially positive, in that, > 70% of patients agreed that the information was quite or very good, and 90% considered it sufficient or better. This demonstrates that even those subjects who received little information, were, in fact, satisfied with that given. The patient/doctor relationship was also judged positive. The patients felt that it was important to be kept informed about their condition, regardless of the form (written or spoken). In conclusion, the outcome of the questionnaire demonstrates the appreciation. on the part of the patients, regarding the procedure of information used in seeking consensus.

Adolescent↗
PubMed2004

Closure of tracheo-oesophageal fistula following removal of voice prosthesis; a new surgical technique.

The voice prosthesis is today the most widely used and accepted method of voice restoration following total laryngectomy. Fortunately, the cases in which it is necessary to temporarily or definitively close the fistula are rare (request of the patient, leakage from the fistula, aspiration pneumonia). Herein, an analysis is made of these cases and the surgical technique personally developed for the closure of tracheo-oesophageal fistula is described. This technique has been used in 8 patients with good results; moreover, it is a relatively low cost procedure and gives rise to few post-operative complications.

Device Removal↗
PubMed2003

Cochlear blood flow modifications induced by anaesthetic drugs in middle ear surgery: comparison between sevoflurane and propofol.

OBJECTIVE: Because it is necessary to maintain controlled hypotension during middle ear surgery in order to avoid bleeding and as it is known that cochlear blood flow (CBF) is related to blood pressure (BP), it is useful to evaluate CBF modifications induced by anaesthetics in order to prevent cochlear damage. The aim of this paper is to evaluate, using laser Doppler flowmetry, which anaesthetic drug, out of sevoflurane and propofol, has the smallest effect on CBF. MATERIAL AND METHODS: Twenty consenting adult patients scheduled for myringoplasty under general anaesthesia for simple tympanic membrane perforation were studied. Patients were divided into two groups: the first group was treated with sevoflurane and the second with propofol. For the first group, CBF measurement was carried out on three different occasions: (i) at a basal low drug dosage; (ii) having increased the drug dosage to a higher level; and (iii) having reduced the drug dosage to the basal low level again. For the second group, CBF measurement was carried out on three different occasions: (i) 10 min after injecting a bolus of propofol; (ii) immediately after a second propofol injection; and (iii) 10 min after a third injection of propofol. A probe was placed over the promontory in order to measure CBF levels. RESULTS: In the subjects treated with sevoflurane, after having increased the drug dosage, BP decreased significantly while CBF did not change significantly. In the subjects treated with propofol we recorded a significant reduction in BP, as well as a decrease in CBF. CONCLUSION: The results obtained show that sevoflurane has a hypotensive effect without modifying CBF, while propofol, although having a similar effect on BP to sevoflurane, has less of a protective effect on inner ear microcirculation.

Adult↗
PubMed2002

Differential expression and topography of adhesion molecules in laryngeal and oropharyngeal carcinomas.

This work describes the different patterns of expression of integrins and extracellular matrix proteins in normal and transformed mucosa in laryngeal and oropharyngeal carcinomas. Samples from each tumor group were sectioned and examined by immunohistochemistry using monoclonal antibodies raised against integrin chains (alpha2, alpha3, alpha6, beta1 and beta4) and their ligands (laminins 1 and 5, collagen type IV and two fibronectin isoforms: ED-A and ED-B). Controls were provided by samples of tumor-free laryngeal and oropharyngeal mucosa that had been removed during the surgical procedure. We found that the known distinct topographical pattern of integrins and the continuity of basement membrane components was altered in both groups but that the extent of changes was significantly more marked in oropharyngeal tumors, which are known to be more infiltrating and diffusive and to have a bad prognosis. These molecular patterns of expression can be used as an additional prognostic factor as they suggest a greater biological tumor aggressiveness of oropharyngeal tumors. We suggest that performing immunohistochemical analysis on biopsy samples may help in selecting the correct therapeutic strategy for these tumors and enable more accurate follow-up. The above-mentioned molecules may become part of the diagnostic toolbox of head and neck surgical pathologists.

Biomarkers↗
PubMed2002

[Balance disorders: a proposal of a new diagnostic methodology from the medico-legal standpoint].

Balance impairment is the object of requests for remuneration in 20-50% of the cases of cranial trauma. Most patients present slight disequilibrium following cranial traumas not involving concussion or cervical distraction. The various methods used in Italy to evaluate the biological damage score balance annoyances on a percentage basis ranging from 1% to 25% and base evaluation on vestibular testing results. The Authors feel that such evaluation approaches are limited. Indeed, since compensation mechanisms come into play, vestibular lesions are not always symptomatic. This means that the lesions detected solely through vestibular testing are not necessarily indicative of the extent to which the subject is affected. Furthermore, some extravestibular lesions can give rise to balance impairments which will go undetected by vestibular examination. Finally, an universally accepted diagnostic protocol still doesn't exist. In this work the Authors present a new method for balance impairments evaluation. While this technique still involves the normal evaluation range for vestibular damage (1-25%), it is based on the disturbance indicated by the patient rather than on the instrumentally detected damage. To objectively determine the real existence of the symptom, the Authors also propose a specific diagnostic strategy for each symptom, thus overcoming the problem of a diagnostic standard. The initial results, obtained on 56 subjects evaluated for post-traumatic balance impairment, show substantial agreement with previous methods. Our method allows to better recognize modest damage--for the most part extravestibular which go unrecognized with the conventional methods--and significantly modify the amount of more extensive damage, expression of vestibular damage which does not correspond to equally significant symptoms.

Craniocerebral Trauma↗
PubMed2001

Surgery of otosclerosis in the elderly.

Auditory results following stapes surgery in 26 patients with otosclerosis >60 years of age at the time of surgery were compared with those obtained in 140 patients <60 years undergoing stapes surgery during the same time period. Stapedotomy was performed in all cases. The mean follow-up period was 29 months. Hearing results as judged by postoperative air-bone gaps were as good in the older age group as in the younger patients. Moreover, complications of surgery, such as postoperative formation of perilymphatic fistula, did not occur more frequently in elderly vs younger patients. On the basis of the results obtained, it is concluded that stapes surgery should be offered to elderly patients with the same indications as younger patients with otosclerosis.

Adult↗
PubMed2001

Qualitative and quantitative evaluation of some vocal function parameters following fitting of a prosthesis.

The insertion of a prosthesis and restoration with pectoralis major myocutaneous flaps for patients subjected to total pharyngolaryngectomy is a technique now universally accepted; however the literature on the subject is lacking. Our study considers 10 patients subjected to total pharyngolaryngectomy and restoration with pectoralis major myocutaneous flaps who were fitted with vocal function prostheses and a control group of 50 subjects treated with a total laryngectomy without pectoralis major myocutaneous flaps and who were fitted with vocal function prostheses. Specific qualitative and quantitative parameters were compared. The quantitative measurement of the levels of voice intensity and the evaluation of the harmonics-to-noise ratio were not statistically significant (p > 0.05) between the two study groups at either high- or low-volume speech. On the contrary, statistically significant differences were found (p < 0.05) for the basic frequency of both the low and the high volume voice. For the qualitative analysis seven parameters were established for evaluation by trained and untrained listeners: on the basis of these parameters the control group had statistically better voices.

Carcinoma, Squamous Cell↗
PubMed2000

Current role of radiotherapy in the treatment of locally advanced laryngeal carcinomas.

BACKGROUND AND OBJECTIVES: During the past few years, radiotherapy (RT) has been increasingly used in combination with surgery in the treatment of locally advanced laryngeal carcinomas to improve survival rates in patients with more extensive tumors. METHODS: This is a retrospective study of a large series of stage III and IV laryngeal carcinomas, and postoperative RT was indicated for some of these cases. We retrospectively reviewed the medical records of 380 patients with stage III and IV tumors, of which 163 (43%) underwent surgery only and 217 (57%) received surgery and postoperative RT. RESULTS: The survival rates of patients who underwent surgery and RT were comparable to those of patients who underwent surgery only, but the former group was composed of subjects suffering from negative prognostic factors. CONCLUSIONS: The indications for combined treatment should be correlated with the prognostic factors to increase the survival rate of patients with stage III and IV laryngeal carcinoma.

Adult↗
PubMed2000

Adjuvant radiotherapy influences the survival of patients with squamous carcinoma of the head and neck who have poor prognoses.

The treatment of carcinoma of the head and neck in recent years has improved significantly, chiefly thanks to progress in surgery and radiotherapy. Despite these advances, the survival statistics reported in the literature show no appreciable evidence of radical improvement. The aims of this study were to evaluate the impact on survival achieved with the combination of surgical and postoperative radiotherapy in patients with advanced head and neck carcinomas and to identify the prognostic value of several host- and tumor-related factors that can influence the results of combined treatment. We retrospectively reviewed the medical records of 394 patients with stage III and IV carcinoma of the head and neck, of whom 170 (43%) underwent surgery alone and 224 (57%) received combined surgery and postoperative radiotherapy. The 394 patients were stratified for a set of variables including the patient's condition, the characteristics of the tumor, and the modality of treatment. Univariate analysis revealed that coexistent medical diseases, the size and site of the primary lesion, the stage of the tumor, and certain pathologic features had a negative impact on survival. Multivariate analysis showed that the removal of lymph nodes and postoperative radiotherapy can have a positive influence and can improve the prognosis. We compared the survival rates of the patients treated with surgery alone with those of the patients who underwent combined treatment, and we observed that the two survival curves were comparable, even if there was a bias because the combined treatment group consisted of patients with negative prognostic factors. The meaning of these results, compared with data from the literature, has been discussed.

Adult↗
PubMed2000

Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records.

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy.

Fistula↗
PubMed2000

[Functional results in the reconstruction of the ossicular chain in partial or total atrophy of the incus. Comparison between reconstruction using a moulded incus and hydroxyapatite PORP].

Ossicular chain defects modifying sound transmission through the middle ear can be treated with (re)implantation of remodeled autologous o homologous ossicles. In recent years, thanks to improved biocompatibility of the materials on the market, prostheses have been increasingly used in the partial or total ossicular chain reconstruction. The present study evaluates auditory ossicle reconstruction as a result of partial or total atrophy of the incus, comparing the use of the remodeled autologous incus with the use of partial hydroxyapatite prostheses (PORP). The study involved 79 patients of which 59 (74.7%) underwent ossicular chain reconstruction using a remodeled, inverted autologous incus while in the remaining 20 cases (25.3%) a hydroxyapatite prosthesis (PORP) was used. The effectiveness of the ossicular chain was evaluated by comparing pre- and postoperative audiometry and evaluating the average thresholds at frequencies of 0.5, 1, 2 and 3 KHz. The average preoperative audiometric gap (understood as the relationship between the air-bone gap) was 23 dB (Standard Deviation 11.2) while postoperatively it was 11 dB (SD 8.5) (p < 0.0001). Therefore the improvement in the air-bone gap was 12 dB (SD 11) for the overall population: 13 dB (SD 10) in those cases where reconstruction was performed using a remodeled incus and 8 dB (SD 11) when PORP was used. The postoperative cumulative gap between the air and bone pathways fell between 0 and 20 dB in 84% of the total population: 89% of those reconstructed with a remodeled incus and 73% of those using PORP. The middle ear ossicular chain reconstruction was performed using remodeled, inverted autologous incus in those cases where ossicular damage did not compromise its use while prostheses made of a biocompatible material (hydroxyapatite PORP) were reserved for those cases where the incus was absent or severely worn. The results obtained are satisfactory, remained stable in time and reflect the average values reported in the Literature.

Adolescent↗
PubMed1999

Carcinoma of the larynx in the elderly: analysis of potentially significant prognostic variables.

The incidence reported for carcinomas of the head and neck currently peaks between the sixth and seventh decades of life. In this retrospective study we were interested in learning whether age is a potentially significant prognostic factor for survival. We considered a set of variables in a series of 134 patients, divided into two groups; between 65 and 70 years of age, and older than 70. Stage I-II tumors were present in 44 patients, while locally advanced lesions (stages III-IV) were present in 90. Statistical analysis of survival was performed using the actuarial survival rates according to Kaplan-Meier; significance was evaluated using the log-rank test. Multivariate analysis was performed according to the Cox logistic regression model to determine the prognostic significance of any of the variables. Univariate analysis was performed on a series of variables regarding the patient, tumor and treatment. In the younger group, age appeared to be a favorable prognostic factor. Tumor size had a significant effect on disease-free survival, both globally and between the two groups (p < 0.05). Lymph node status substantially influenced the five-year survival rate (p = 0.001). Tumor invasion of the lymph nodes led to a difference between the two groups. Survival was lower in the younger than in the older group. There was a significant difference (p < 0.01) in survival between patients who had undergone surgery (75%) and those who received radiotherapy alone (33%). Multivariate analysis of these variables showed that disease stage, and treatment of lymph nodes were both significant (p = 0.0016 and p = 0.0002, respectively). Survival rates for the so-called "young elderly" (65-70 years) are generally higher than that for those aged 70 and over. Following accurate and comprehensive assessment by the anesthesiologist and the internist, and appropriate adjustment of the patient's nutritional and metabolic status, combined radical surgery and radiotherapy can and must be performed. Minimal palliative interventions, in the belief that tumor growth is biologically less aggressive in the elderly patient, should be avoided.

Aged↗
PubMed1999

[Maxillary ameloblastoma: a case report].

Ameloblastoma is a neoplasm of odontogenic origin. Although it is considered a benign lesion it presents some peculiarities including a high local recurrence rate, particularly after conservative surgery, and a high loco-regional invasiveness. The present work describes a case of ameloblastoma of the left maxillary sinus bordering on the homolateral nasal fossa. The male patient was admitted to the E.N.T. Dept II of the University of Turin in May 1998 and underwent left radical maxillectomy. The authors also review the literature on the topic.

Ameloblastoma↗