Mucocutaneous leishmaniasis: report of a case with massive involvement of nasal, pharyngeal and laryngeal mucosa.
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Aged↗
Biomedical subjects
S Bacciu
Publications and source records attributed to S Bacciu.
Effects of gastroesophageal reflux disease in laryngeal carcinoma.
Gastroesophageal reflux disease is associated with various otolaryngological disorders. The aim of this retrospective study was to determine the role of gastroesophageal reflux disease in the development of laryngeal squamous cell carcinoma (SCC) in non-smoking and non-drinking patients. The study population consisted of 36 consecutive non-smoking and non-drinking patients with histologically confirmed SCC of the larynx. As a control, a group of 125 lifetime non-smoking and non-drinking cancer-free subjects were selected. Patients with laryngeal cancer had a higher prevalence of gastroesophageal reflux disease than the control subjects (P < 0.0001). Our results confirm the fact that gastroesophageal reflux disease in itself is associated with an increased risk of laryngeal cancer.
Aged↗
Paget's disease and cochlear implantation.
Paget's disease of bone is a common disorder of unresolved etiology characterized by excessive bone resorption followed by excessive bone formation. If the skull is affected this may result in hearing loss and eventually develop into profound deafness. To date, no cases of cochlear implantation in patients with Paget's disease have been reported. The authors present a case of radiographically confirmed Paget's disease of the skull in a 77-year-old man with a 20-year history of progressive bilateral sensorineural hearing loss who underwent cochlear implantation. A successful insertion of the Nucleus 24 Contour electrode array was achieved without surgical and postoperative complications. At the 10 months' postoperative evaluation, the patient had gained useful open-set speech perception. In quiet conditions, his performance scores on the word and sentence recognition tests were 100 and 98 per cent, respectively. In the presence of noise (at +10 dB. signal-to-noise ratio), his performance scores on the word and sentence recognition tests were 96 and 94 per cent, respectively.
Aged↗
Speech recognition in elderly cochlear implant recipients.
The benefits of cochlear implantation in the adult and paediatric populations are well established. Cochlear implantation in the geriatric population still remains controversial because of the misconception that elderly patients might perform poorly. The purpose of this study was to report the speech performance of 16 patients over 65 years of age implanted with a Nucleus multichannel cochlear implant and to compare it with that of a control group of 14 adults aged between 41 and 59 years. At the 12 months postoperative evaluation, no significant differences were detected on speech performances between the elderly patients and the control group. The mean word recognition scores were 72.5% for the elderly group and 82% for the control group. The mean everyday sentence recognition scores were 72.5% for the elderly group and 85.7% for the control group. Overall, the results are encouraging and demonstrate that the elderly population with profound hearing loss obtain significant benefits from cochlear implantation despite the age-related auditory processing problems.
Adult↗
Gastroesophageal reflux as a possible co-promoting factor in the development of the squamous-cell carcinoma of the oral cavity, of the larynx and of the pharynx.
According to recent advances it is assumed that the gastroesophageal reflux (GER) is a possible co-promoting factor of the squamous-cell carcinoma development in the upper parts of the gastro-intestinal and respiratory systems, considering the higher frequency of lesions due to acid in the studied population interested by GER. The aim of this study is to investigate 274 patients with malignant neoplasm of the oral cavity, of the pharynx and of the larynx, by esophago-gastro-duodenoscopy (EGD) and to compare the incidence of GER in this group with a control group of healthy patients from their hospital. Acid exposure in the upper level of the esophagus often remains unknown using traditional pH-monitoring, especially if no pharyngeal probe is used. When necessary a good diagnostic test is EGD with mucosa biopsy; it allows to directly examine the lesion. We retrospectively studied the data of 274 patients suffering from a cancer of the upper aero-digestive tracts by EGD in order to diagnose lesions caused by GER. We compared non-smoking patients affected by GER and tumours a control group of healthy patients. Statistical analysis revealed a significant difference between the two groups using the z-Test (p = 0.0001). In our study, based on endoscopic data, we observed a high percentage of non-smoking patients affected by GER and squamous-cell carcinoma of the upper parts of the airways and the gastrointestinal system. For this reason we consider GER as a possible co-promoting factor of cancer in some patients.
Adult↗
[Multi-channel cochlear implant in cochlear ossification].
Cochlear ossification, considered until only a few years ago as a contraindication for cochlear implants (C.I.), may now be managed by means of a wide variety of surgical techniques. In cases with massive ossification, the drill-out circummodiolar technique described by Gantz et al. in 1988 and successively modified by Balkany et al. in 1997 may be adopted. The technique of electrode insertion in the scala vestibuli, perfected by Steenerson et al. in 1990, may be used when cochlear ossification has spread no further than the scala tympani. Other methods call for a groove to be drilled along the proximal tip of the basal turn of the cochlea (Cohen and Waltzman, 1993), the insertion of electrodes through the middle cranial fossa (Colletti et al., 2000), or the utilization of a double electrode array (Bredberg et al., 1997, Lenarz et al., 2001). This study reports the experience conducted at the Cochlear Implants Centre of the Otorhinolaryngoiatrics, Otological and Otoneurological Microsurgery Section of the University of Parma in a group of 15 patients who underwent C.I. in the presence of varying degrees of ossification. In 3 cases the ossification was limited to the region of the round window and a few millimetres of the scala tympani; cochleostomy was performed anteriorly and inferiorly to the anterior niche of the round window. In 11 cases (of which 3 of pediatric age), the ossification had spread to the horizontal portion of the scala tympani; in these cases, the electrodes were inserted in the scala vestibuli. The scala vestibuli was opened by drilling anteriorly to the round window and superiorly to the spiral ligament. In the only case of massively ossified cochlea, it was possible to partially insert the electrodes in a circum-modiolar tunnel. In the 12-month follow-up hearing test, the 3 patients with ossification of the round window region and the first millimetres of the scala tympani respectively averaged 61.6% in recognizing 2-syllable words and 59% in recognizing words embedded in phrases. The averages on the 12-month follow-up hearing test in the 8 adult patients who received the implant in the scala vestibuli were 80.6% in recognizing 2-syllable words and 89.1% in recognizing words in phrases. The 3 pediatric patients were classified on the Geers and Moog scale, which situated 2 of them in the 6th category of perception and 1 of them in the 4th category of perception. As regards the only case of massive cochlear ossification, the patient underwent surgery recently, and the sole follow-up available is the one conducted after only 3 months; the vowel identification average was 55%; the average on the VCV test was 31%; and the 2-syllable word recognition average was 20%.
Acoustic Stimulation↗
Congenital cholesteatoma of the tympanic membrane.
We present two cases of congenital cholesteatoma of the tympanic membrane. Congenital cholesteatoma within the tympanic membrane is a rare entity with only few cases documented. The aetiopathogenesis of this lesion is still unknown. An embryologic origin is hypothesized when cholesteatoma develops in patients without previous history of otitis as in the two cases we report. In cases with previous history of inflammatory process of the external or middle ear an acquired origin is suspected due to the proliferation of the basal cell layer of the tympanic membrane epithelium. Despite the rarity of the congenital tympanic membrane cholesteatoma, we think that its early diagnosis is of utmost importance to allow an easy removal and avoid middle ear involvement.
Biopsy, Needle↗
Cochlear effects of mesna application into the middle ear.
Mesna (sodium 2-mercapto-ethane sulphonate) belongs to a class of thiol compounds that produce mucolysis by disrupting the disulphide bonds of the mucus polypeptide chains. The registered indications of mesna include the treatment of pathologies of the respiratory tract and, in oncology, the prevention of toxic lesions of the urinary tract by antineoplastic agents. In the E.N.T. Clinic of the University of Parma, it has been found that mesna can be used to facilitate the dissection of the various tissue layers in any surgical procedure. One of these indications is surgical treatment of cholesteatoma, which is mainly composed by keratin, a protein rich is disulphide bonds that are easily disrupted by mesna. The aim of this study was to evaluate the toxicity of mesna application into the middle ear on the cochlear anatomy and physiology. Three groups of guinea pigs were used as subjects. Mesna solution (10 or 20%) was applied in one ear, while the opposite ear received a placebo (saline solution). Toxicity of mesna was assessed by means of transmission electron microscopy (TEM), scanning electron microscopy (SEM), and auditory brain-stem response (ABR). TEM and SEM did not show any toxic effect on cochlear morphology. There were no differences in ABR thresholds and wave III amplitude and latency between mesna-treated and control ears.
Animals↗
Scutumplasty: costal cartilage versus bone paté.
This study was carried out to evaluate the anatomical and hearing results of the reparation of attic defects in closed tympanoplasty. Reparation was carried out in 194 patients by using a costal cartilage allograft, and in 159 patients with a bone pate autograft. The follow-up was from 1 to 5 years. The study was not truly randomized owing to an occasional lack of allogenic costal cartilage. In the group 'costal cartilage' a partial resorption was observed in 5.7% and a complete resorption in 4.7% of the cases. In the group 'bone pate', partial resorption was observed in 5.5% and total resorption in 2.7% of the patients. Satisfactory hearing results were obtained in 86% of the patients of the group 'costal cartilage' and in 82% of the patients of the group 'bone paté'. Both graft materials may be recommended for repairing erosions caused by the cholesteatoma in the wall of the external auditory canal.
Adult↗
[Progressive sensorineural hearing loss: neoplastic causes].
Acoustic neuromas represent about 90% of all space-occupying lesions of the cerebellopontine angle and account for approximately 6% of all intracranial tumors. Progressive unilateral sensorineural hearing loss is the most frequent initial symptom occurring in over 90% of patients. A sudden onset of hearing loss occurs in 5%, while 5% of cases present with normal hearing. The incidence of hearing loss does not seem to be related to tumor size. Accuracy of the tumor detection by gadolinium-enhanced magnetic resonance imaging has been reported as 99-100% even for intracanalicular tumors. The ABR false negative rate for intracanalicular tumors has been reported to be as high as 9-11%. Rare lesions of the cerebellopontine angle include: meningiomas, epidermoids, arachnoid cysts, trigeminal nerve neuromas, facial nerve neuromas, neurinomas of lower cranial nerves, glomus tumors and metastases. Therefore, a high suspicion index and awareness of symptoms and an adequate audiologic and neuroradiologic work-up are the clues to early diagnosis and appropriate surgical treatment.
Cerebellar Neoplasms↗
[Cleft palate and dysfunction of the eustachian tube].
Secretory otitis media (SOM) is a frequent complication in infants with cleft palate. In cleft palate the muscles that open the Eustachian tube (tensor palatini and levator palatini) have abnormal connections thereby making the tube opening either difficult or impossible. This will lead to secretory otitis media in 95% of cases, since the middle ear will not be aerated. In this paper, 14 patients operated on for cleft palate during the first year of life were examined. SOM was treated only by medical therapy without the insertion of tympanostomy tubes. Post-operative follow-up ranged from 2 months to 5 years. In all patient SOM was still present at last follow-up with poor efficacy of medical therapy. Therefore, our therapeutic protocol includes myringotomy and insertion of tympanostomy tubes during the first general anesthesia for cleft palate treatment.
Adolescent↗
[Intraoperative tonal-threshold audiometry in the surgery of otosclerosis].
At the end of stapedioplasty, performed under local anesthesia, the surgeon usually tests the hearing function making questions to the patient turning his voice from a soft whisper to a loud tone. At the ENT Department, University of Parma Italy, a more precise method is employed in order to measure the air conduction threshold of the patient at the beginning and at the end of surgery. From April 1996 to October 1996, intraoperative pure-tone audiometry was performed in 36 patients who underwent stapedioplasty. A portable audiometer "Amplaid 161/C Amplifon" was used in the operating room. Air conduction thresholds were measured at 125-8000 Hz. Intraoperative pure-tone audiometry allows an instantaneous and a more accurate evaluation of the surgical functional results.
Adult↗
[Reconstruction of the tympanic membrane using Parmatymp bioprosthetic material. Summary of 20 years of experience].
Autogenous temporal fascia is the material most frequently used for the reconstruction of the tympanic membrane, in spite of certain drawbacks: 1) it is obtained by enlarging the incision or by a supplemental incision; 2) it may be insufficient or absent for reinterventions; 3) it tends to adhere to the middle ear, and 4) it retracts easily when the Eustachian tube is not functioning. This is the synthesis of 20 years of experience with Parmatymp (jugular bovine vein xenograft), a material that is easily available, resistant and suitable for all types of ear surgery.
Adolescent↗
[Electrocochleography by extra- and transtympanic methods: the results in a group of normal subjects].
Electrocochleography (ECoG) is an electrophysiologic approach to the study of hearing. In ECoG, electrical activity that originates within the cochlea or the auditory nerve is recorded. ECoG represents an evoked or stimulus dependent measure. The electrical potentials which can be analyzed in ECoG are: the cochlear microphonic potential (CM), the summating potential (SP) and the acoustic nerve potential (AP). Two major types of electrocochleography electrodes can be used, transtympanic and extratympanic. Transtympanic ECoG is performed by inserting a long needle electrode, placed through the tympanic membrane onto the promontory. Extratympanic ECoG is recorded by using electrodes placed within the external meatus near the tympanic membrane. At the ENT Department of the University of Parma, ECoG was performed in 10 normal hearing subjects (4 males and 6 females. Their ages ranged from 21 to 29 years (mean 26 years). All subjects underwent ECoG recording simultaneously with extratympanic and transtympanic technique.
Adult↗
[Brainstem auditory evoked potentials in neonatology: the method and results in a group of normal newborns].
Brainstem evoked responses audiometry was performed on 10 newborn infants. They ranged in postnatal age from 19 hours to 5 days and in estimated gestational age from 39 to 42 weeks. Clicks of 0.1 msec duration were presented at a rate of 11.4 per second. Measurements were made at 50, 80 and 100 dB. Wave V latencies were evaluated at 50, 80 and 100 dB HL in order to measure the auditory threshold. The latency of wave V is the datum of interest. Wave V responses were obtained bilaterally at 50 dB HL. Waves I and III latencies were measured at 100 dB HL.
Acoustic Stimulation↗
[The time parameters of the stapedius reflex. The normal results].
The evaluation of the temporal characteristics of the acoustic stapedius reflex is one the fundamental aspects of the impedance audiometry, since significant biological information to be used as sensitive indicators of distinctive pathologies can be obtained. At the Audiology Service of the E.N.T. Department of Parma four parameters of the acoustic stapedius reflex have been studied (onset latency, latency at 10% of the maximum amplitude, rise time, offset latency) in a group of people having normal ears without previous otological problems, with the aim to establishing some rules. The equipment used is the Madsen Impedenzometro ZO 174 which enables to obtain an average among a desired number of reflex responses. The report shows the value of the four parameters of the stapedius reflex obtained from the study of 10 normoacusic patients totalling 20 ears. The resulting guidelines can make up the basis for further research in pathological cases with cochlear, neural and central lesions.
Acoustic Impedance Tests↗
Technique and results in total reconstruction of the posterior canal wall using costal cartilage.
Middle ear reconstruction using the closed technique for the purpose of rehabilitating radical cavities includes all the surgical steps necessary to perform a combined approach tympanoplasty, both with respect to eradication of the disease and to reconstruction. The only point of difference is the total reconstruction of the posterior wall, which moreover constitutes the essential step. At present we perform posterior wall reconstruction by means of a coastal cartilage allograft, inserted into two grooves in the bone and firmly stabilized by fibrin glue. The operation, in 90% of cases, is performed in more than one stage.
Adolescent↗
Depressed urinary excretion of epidermal growth factor in psoriasis.
Epidermal growth factor (EGF) may have a modulatory role in renal growth and function. The aim of the present study was to evaluate whether urinary excretion of EGF is altered in psoriatic patients with or without arterial hypertension. The glomerular filtration rate was similar in psoriatics as compared with age- and sex-matched controls, whereas urinary EGF (microgram/g creatinine) was significantly reduced in psoriatics: normotensive subjects, 29.52 +/- 3.51 (psoriatics) versus 44.31 +/- 1.20 (controls, p less than 0.05); hypertensive subjects, 19.67 +/- 3.96 (psoriatics) versus 30.11 +/- 1.52 (controls, p less than 0.05). The urinary EGF excretion was lower in males than in females, save for hypertensive psoriatics. Urinary EGF correlated inversely with age and directly with urinary kallikrein excretion. Urinary kallikrein activity was reduced and microalbuminuria increased in hypertensive psoriatics. These alterations might suggest that initial deterioration of renal function is present in psoriasis.
Epidermal Growth Factor↗