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Biomedical subjects

R Albera

Publications and source records attributed to R Albera.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Myringoplasty in children: a comparison with an adult population].

The indications for myringoplasty in children has always been a controversial subject since many authors feel the high frequency of the phlogistic auricular processes in children constitute an unfavorable prognostic factor to success of the procedure. The authors present the results obtained in 23 patients under 17 years of age who had undergone myringoplasty for simple perforation of the tympanum. In cases of posterior and inferior perforations, surgery was performed using the underlay technique and a transmeatal approach; in all other cases the overlay technique was used with a retroauricular approach. An average 30 month follow-up (range 12-55 months) revealed new perforations in only 2 cases (9%). From the functional point of view the average air/bone conduction gap was reduced to 10 dB. As a control, the results were compared to those obtained in 150 patients over 16 years of age, again affected by simple perforation of the tympanic membrane and treated by myringoplasty using the same methods. In the adults, 22 new perforations were found (15%) while the functional results were analogous to those obtained in the children group. In this light, it can be asserted that myringoplasty can be considered a safe procedure to be used in children and it does not appear essential to wait until they have finished growing before performing this procedure.

Adolescent↗
PubMed1997

[Annular wedge tympanoplasty: a variation of overlay myringoplasty].

Myringoplasty has been increasingly refined in recent years and today the most frequently employed are the "overlay", the "underlay" and the "interlay". Of these the overlay technique appears to best guarantee graft stability. However, with this technique there is the risk of blunting and neotympanum lateralization which can compromise functional recovery. To obviate these drawbacks, the authors propose a modification of the classical overlay technique. This modification consists of detachment of the anterior portion of the Gerlach annulus and the adjacent protympanum mucosa in order to insert the graft between the bony and fibrous portions of the annulus. This technique is defined as the "Annular Wedge Tympanoplasty" (AWT). From January 1993 to July 1994 a total of 74 tympanoplasties were performed using the AWT technique to reconstruct the tympanic membrane. In 71 (96%) of these, the opening closed completely. As regards incomplete healing, 2 cases showed signs of blunting, 3 showed posterior lateralization and 1 full lateralization with a reduction in the hearing level recovery. The work is not conclusive although it does present a technique which is easy to perform and which provides good functional recovery.

Adolescent↗
PubMed1997

[Evaluation of the cochlear aqueduct patency: comparison of 2 noninvasive techniques].

Variations in cephalo-rachidian fluid pressure can be transmitted to the middle ear through the cochlear aqueduct (CA). This gives us a non-invasive manner to evaluate any changes in fluid pressure by measuring middle ear impedance (impedancemetry). The present study compared two indirect methods for measuring intracranial pressure: a) impedancemetry during evoked jugulo-tympanic reflex (JTR) and b) study of the tympanic membrane (TM) fine motility using a MMS-10 analyzer. The latter is a new procedure involving the indirect evaluation of the fluid pressure. In fact, when the CA is open the labyrinthine fluid pressure is transmitted to the oval window, the stapes platina and, finally, to the tympanic membrane where it can be measured with an MMS-10 unit. This equipment can measure nanoliter shifts in the TM. In particular, comparison between the clinostatic and orthostatic tympanic motility measurements enable one to establish whether the CA is patent or not. In the present study 15 subjects were examined using both a) impedancemetry during jugular compression and b) analysis of the TM shift using an MMS-10 unit. In 14 of the 15 cases there was good correlation between the data obtained using both methods: in all but one case it proved possible to record a JTR-induced variation in impedance whenever the MMS-10 indicated that the CA was open. The results suggest that, in clinical practice, the two methods can be used in parallel for non-invasive monitoring of variations in intracranial pressure in patients with neurological involvement. On the other hand, in the E.N.T. field these techniques could be used to study inner ear pathologies causing dynamic alterations of the endolabyrinth fluids (endolymphatic hydrops, labyrinthine fistula).

Acoustic Impedance Tests↗
PubMed1995

[Autonomic nervous system disturbance as a possible cause of vertigo or dizziness].

In the present study possible interactions between dizziness, or vertigo, and eventual malfunctioning of the Autonomic Nervous System were evaluated. Two groups of ten patients each were patients each were tested. All the patients had vertigo or dizziness of uncertain etiology and ten had arterious hypotension. A careful anamnestic research was carried out in order to individualize symptoms or elements which could induce dysautonomia. A series of 6 tests aimed at evaluating cardiovascular responses was performed in all the patients. Alterations were present in 65% of the test responses. In particular, results were altered in patients with arterious hypotension. The Authors, underline the effectiveness of an adequate anamnesis in identifying patients with possible dysautonomia and affirm the validity of cardiovascular tests (non-invasive, specific and sensitive in obtaining information concerning the etiology of particular forms of dizziness.

Adolescent↗
PubMed1995

[The evaluation of isoflurane's effect on the cochlear blood flow by laser doppler flowmetry].

Laser-Doppler flowetry is actually the method of choice in cochlear blood flow measurement. The Authors analyze, by means of laser doppler flowmetry, the effect of isoflurane, an anesthetic drug with an hypotensive effect, on cochlear blood flow on 10 patients submitted to miringoplasty. A slight increase of cochlear blood flow was recorded in each subject nevertheless a significative reduction of systemic pressure. Since normally hypotension determines a reduction of cochlear blood flow, the Authors state that isoflurane has a protective effect on this microcircular district.

Administration, Inhalation↗
PubMed1994

Carcinoma of the external auditory meatus and middle ear. Results of the treatment of 28 cases.

AIMS: The authors report their experience on the treatment of 28 cases of middle ear (3) and external auditory meatus (EAM) cancers (25) with surgery and/or radiation therapy. According to histologic type, there were 23 squamous cell carcinomas, 4 basal cell carcinomas and 1 adenocystic carcinoma. METHODS: Surgery alone was performed in 2 cases, surgery combined with radiotherapy in 11 cases, and radiotherapy alone in 15 cases. Postoperative radiation therapy dose ranged between 4500 and 5500 cGy; the definitive dose was 6000-7000 cGy. The median follow-up was 61 months. RESULTS: Complete response rate 6 weeks after the end of the treatment, evaluated by CT scan, was 85.7% (24/28). Definitive local control was obtained in 20/28 cases for the primary site and in 26/28 cases for the neck. Nine of the 10 recurrences were retreated with low-dose radiotherapy combined with surgery, chemotherapy or hyperthermia. A new local control was obtained in 2 cases. Four patients were lost during the follow-up at 13, 14, 17 and 23 months after the end of the treatment. The survival rate was 54% (13/24); disease-free survival was 50% (11/22). CONCLUSIONS: Despite a not very aggressive treatment, our results are quite good.

Adult↗
PubMed1992

Retraction-convergence nystagmus: clinical and radiological study of 4 cases of vascular origin.

Retraction-convergence nystagmus is a classic finding in extensive and bilateral lesions of the dorsal midbrain, usually neoplastic and, as such, considered to signal a poor prognosis. We report 4 cases of retraction-convergence nystagmus associated with Parinaud syndrome arising from circumscribed lesions of vascular origin--3 hemorrhagic and 1 ischemic--with a completely benign course. The neuroimaging study enabled us to identify involvement of the pretectal areas and posterior commissure as well as of the dorsomedial thalamic nuclei in all cases. It thus seems that one or more of these areas must be involved in the genesis of this nystagmus.

Adult↗
PubMed1992

Vestibular apparatus disorders after external radiation therapy for head and neck cancers.

External irradiation of different head and neck cancers may involve parts of the ear. The vestibular function of 25 patients in which the inner ear was comprised in the irradiated volume was investigated by electronystagmography (ENG). Doses administered to the vestibular system ranged between 2800 and 5120 cGy. Five patients suffered subjective vertigo or dizziness. Eleven patients (three out of five with vertigo) showed vestibular abnormalities to ENG (44% of the total). Altered responses to specific tests were as follow: six patients to the bithermal caloric stimulation, two to the pendular-sinusoidal test and the other three to both of them. Patients were evaluated 3 and 6 months after the ending of the radiation therapy course. At the first evaluation, abnormalities to caloric test were noted in three patients (12%) and to sinusoidal rotatory test in one patient (4%). At the second evaluation, rates of abnormal response increased to 36% and 20%, respectively. Vestibular disorders seemed to be scantly related to the total radiation dose. Data of literature are discussed in order to identify possible implications on treatment planning.

Adult↗
PubMed1988

Hearing loss and desferrioxamine in homozygous beta-thalassemia.

The authors present the results obtained during an audiometric screening of 153 children aged 5-18 years, affected by beta-thalassemia and treated with regular blood transfusions and iron overload chelation by means of desferrioxamine. Thirty-eight percent of the patients showed a significant sensorineural hearing loss at high frequencies with recruitment. Younger patients had a greater hearing loss, indicating that cochlear damage was not due to the disease itself. Furthermore, hearing loss appeared to be correlated with the mean and peak desferrioxamine doses administered and was higher in subjects with lower iron load. Thus, the ototoxic effect seems to have been higher when a good iron chelation had been obtained. Among our patients, conductive hearing loss was not more frequent than in patients without beta thalassemia.

Adolescent↗
PubMed1987

Dynamic aspects of stapedial reflex in myasthenia gravis.

The modifications of stapedial reflex have been studied in 30 subjects affected by myasthenia gravis. The test was performed in basal conditions (i.e. at least 6 h after the last administration of an anticholinesterase drug), after the injection of Tensilon and again in basal conditions, 1 week after thymectomy. The reflex was elicited in 27 patients but in 1 case it appeared only after therapy. Among the various parameters analyzed, only rise velocity, decay velocity and amplitude have shown lower values in patients than in the normal group. These parameters increased significantly after the pharmacological test and 1 week after thymectomy in 60% of the cases. The data suggest that patients with more evident muscular damage are more likely to present a rise of stapedial strength after therapy. The efficiency of thymectomy has also been demonstrated.

Adolescent↗
PubMedDate not supplied

Impedance measurement as a noninvasive technique for the monitoring of intracranial pressure variations.

In previous reports it has been demonstrated that jugular compression causes a modification of middle ear acoustic impedance; this phenomenon has been named the jugulotympanic reflex (JTR). The aim of the present study was to contribute to the understanding of the origin of this reflex. We have analyzed the middle-ear impedance modifications induced by unilateral and bilateral jugular compression in 12 normal subjects, in 12 patients afflicted with otosclerosis, in 3 patients with Menière's disease and in 6 patients demonstrating intracranial hypertension. In the latter group, the cerebrospinal fluid (CSF) pressure was simultaneously recorded. The JTR was elicited in each normal subject and in each patient affected by Menière's disease and intracranial hypertension, while it was usually absent or modified in otosclerotic patients. The absence of the JTR in otosclerotic patients and, above all, the correspondence between CSF pressure and the middle-ear impedance modification induced by jugular compression suggest that it is due to the transmission of pressure changes from the CSF to the perilymph through the cochlear aqueduct.

Acoustic Impedance Tests↗
PubMedDate not supplied

Tympanic membrane displacement analyser tracing modifications induced by glycerol in Menière's disease.

The aim of the study was to detect inner ear fluid pressure changes induced by glycerol in Menière's disease (MD) by means of a tympanic membrane displacement analyser (TDA). The study group consisted of 25 MD patients. The Vi (maximum inward displacement of the tympanic membrane) and the Vm (mean displacement of the tympanic membrane) were measured at 10, 20 and 25 dB above the stapedial reflex threshold. Each patient received therapy based on glycerol. The control group consisted of 20 patients with non-hydropic sudden hearing loss. At 20 and 25 dB above stapedial threshold MD patients had lower Vi values before therapy. After glycerol, we observed a Vi increasing in the hydropic ears in 68-96 per cent of patients. Since a Vi improvement implies a reduction of perilymph pressure, our results confirm the effectiveness of Vi in detecting specific action of glycerol in MD.

Adolescent↗
PubMedDate not supplied

Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry.

The aim of this study was to evaluate the improvement of nasal flow and the fall of nasal resistance in 50 patients that underwent rhinoseptoplasty in our department and discuss the relative importance of valvular and septal deformities in nasal airway obstruction. Fifty consecutive patients underwent rhinoseptoplasty to improve nasal obstruction caused by severe septal deviation, external or internal valvular incompetence, or any combination of the three. We excluded patients with minor septal curvatures, septal perforations, or turbinate hypertrophy. Preoperative and postoperative rhinomanometry was performed on all 50 patients. In all 50 patients, septal and/or valvular surgery lowered nasal resistance in 90% of cases. Septoplasty alone with medial and basal osteotomies did not improve nasal flow (p < 0.4), whereas the correction of valvular obstruction alone increased nasal airflow in a statistically significant way (p < 0.0001). Moreover, patients with both valvular incompetence and septal deviation represented the group in which the greatest preoperative obstruction and the greatest postoperative improvement occurred. Nasal valvular function should be assessed with rhinomanometry in all preoperative rhinoplasty patients with airway obstruction. In many cases, valvular effects may surpass septal deviation as the primary cause of nasal airflow obstruction.

Female↗
PubMedDate not supplied

[Hearing disability in relation to audiometric threshold values: hypothesis on the determination of the onset of hearing loss].

BACKGROUND: The term auditory disability (AD) means the presence of auditory symptoms due to hearing loss. Until now the audiometric threshold cut-off between the presence or absence of AD was not clear. OBJECTIVES: In this study we attempted to define the value of audiometric threshold that could be considered as the limit between the presence or absence of weakness of auditory function, considered as the threshold as the 95th percentile of subjects that did not report AD. METHODS: The study group consisted of 1641 males, 891 normally hearing and 750 affected by noise-induced hearing loss (NIHL) Each subject was submitted to a questionnaire specifically created in order to determine the presence of AD. RESULTS: Statistical analysis confirmed the reliability of answers to items. AD was present in 577 subjects, not all affected by NIHL. Audiometric threshold and age correlated significatively with the degree of AD. CONCLUSIONS: The results obtained allowed the audiometric threshold values to be determined at the 95th percentile of subjects who did not report AD, in relation to the average of frequencies normally used in hearing loss evaluation.

Adolescent↗
PubMedDate not supplied

[Modification of vestibular function after radiation therapy for head and neck tumors].

The effect of radiation on the vestibular apparatus of animals and man have not been widely investigate. Referred symptoms are disequilibrium and spontaneous nystagmus in animals while histological features are intralabyrinthic haemorrhage, edema of the endolymphatic spaces and alterations of sensory hair cells. A group of 20 patients with head and neck cancer located in different sites (nasal cavity, oropharynx, oral cavity, parotid gland) underwent to vestibular investigations before and 3-6 months after radiation therapy. Ten patients (50%) showed an alteration of the vestibular function of peripheral origin after radiation treatment. Complications appeared from a few weeks up to several months following termination of radiotherapy. The slow development of the lesion permitted central compensation. Few patients had symptoms and vestibular symptomatology was always of secondary importance with respect to the initial pathology.

Adult↗