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Biomedical subjects

A Quaranta

Publications and source records attributed to A Quaranta.

At least 19 recordsLinked to original sources
PubMed2001

Intratympanic therapy for Ménière's disease: effect of administration of low concentration of gentamicin.

We present results at 2 years follow-up of a group of 15 patients with Ménière's disease treated with a low concentration of intratympanic gentamicin (IG group), compared with a group of 15 patients who refused any surgical treatment (NH group). IG was administered according to a predetermined and fixed schedule consisting of 2 doses of 0.5 ml gentamicin solution, pH 7.8, injected once a week, with a drug concentration of 20 mg/ml; the total dose of gentamicin was < or = 20 mg. Additional doses of IG were administered only in patients who had recurrence of vertigo. The results were evaluated following the American Academy of Otolaryngology Head and Neck Surgery 1995 criteria for reporting Ménière's disease treatment results by means of interviews, audiologic and vestibular evaluations, and a questionnaire based on a six-point functional level scale. Seven of the 15 IG patients had recurrence of vertigo after the second injection and received a third dose of IG. Four patients had recurrence of vertigo after the third infiltration; three subjects received a fourth dose and one refused additional injection. At 2 years follow-up, 93% of the IG patients had complete (class A) or substantial (class B) control of vertigo. Only 47% of the NH patients had no vertigo or were substantially improved. Hearing deteriorated in 7% of the IG group and in 40% of the NH group. Tinnitus disappeared or improved in 20% of the IG patients and in 27% of the NH patients; 40% of the IG patients and 27% of the NH patients reported that their aural pressure was abolished. The present study demonstrates that, in patients with Ménière's disease, 0.5 ml doses of gentamicin solution, with a concentration of 20 mg/ml, injected intratympanically once a week minimize the risk of hearing loss in the treated ear, permitting complete control of vertigo in more than half of cases after 2 doses and in almost all subjects (93%) after 4 doses.

Adolescent↗
PubMed2001

Facial nerve paralysis in temporal bone fractures: outcomes after late decompression surgery.

The aim of this paper was to address some of the unanswered questions regarding management of facial nerve paralysis in temporal bone fractures (TBF), such as the outcomes after late facial nerve decompression surgery. The study design was a retrospective review of a consecutive clinical series. Thirteen patients who underwent late decompression surgery for facial nerve paralysis due to TBF involving the perigeniculate ganglion region were analyzed. Patients were operated on 27-90 days after trauma. A transmastoid extralabyrinthine approach was used in all cases. Facial nerve-sheath slitting was performed routinely. Normal or subnormal facial nerve function (HB 1 or HB 2) was achieved in 7/9 cases (78%) evaluated at > or = 1 year after surgery. Good functional results were also obtained in two patients operated on 3 months after trauma. Bases on the outcomes observed in the present series, in patients unable to be operated on early, presenting 1 to 3 months with >95% denervation on EnoG, facial nerve decompression may have a beneficial effect.

Decompression, Surgical↗
PubMed2001

[Long-term audition results in patients with chronic endolymphatic hydrops after selective vestibular neurotomy and endolymphatic sac surgery].

The purpose of the present study was to evaluate the long-term auditory results in the ears of patients suffering from unilateral Ménière's disease (Md) who had undergone retrolabyrinthine vestibular neurotomy (RVN) associated with endolymphatic sac (ES) surgery. Retrospective evaluation was performed on 45 patients with unilateral Md who had undergone RVN between 1982-1997. All patients had previously been treated with medical therapy for at least 6 months without showing any response. The forms of ES surgery performed were as follows: simple ES decompression (ESD) in 15 patients, chronic endolymphatic mastoid shunt (EMS) using a sylastic sheet in 15 ears and ES exclusion (ESE) of the proximal section in the remaining 15 patients. Evaluation of the results was performed using the parameters indicated by the "Committee on Hearing and Equilibrium"--AAO-HNS 1995. Comparison of the average post-operative and preoperative PTAs revealed a worsening of 9.2 dB (sd: +/- 17.1) in the ESE group. This variation was statistically significant (p < 0.05). When the individual patients were evaluated, the PTA remained unchanged in 10 cases (67%) in the ESD group, in 13 (87%) in the EMS group and in 10 (67%) in the ESE group. In no case did hearing improve. Statistical analysis did not reveal any significant difference between the three groups of patients. Tinnitus, present prior to surgery in all patients, disappeared or improved in 6 patients (40%) in the ESD group, in 6 (40%) of the EMS group and in 5 (33%) of the ESE group. The differences between groups were not significant. The sensation of plugged ears, present prior to surgery in 11 patients in the ESD and EMS groups and in 13 patients in the ESE group disappeared or improved respectively in 9 (82%), 10 (91) and 11 (85%) of the patients. The 10 remaining patients who did not have the sensation of plugged ears prior to surgery did not refer its appearance after surgery. Again for this symptom the difference between groups was not significant. The results of this research would appear to indicate that in patients with Md, evolution of the hearing symptoms observed after RVN can be improved by applying an EMS. This finding must be validated in a larger sampling.

Adult↗
PubMed2000

Paradoxical effects of contralateral white noise on evoked otoacoustic emissions in ears with acoustic neuroma.

A contralateral suppression effect on evoked otoacoustic emissions (EOAEs) is usually present in normally hearing subjects and in patients with sensorineural hearing loss, while it is absent or reduced in ears to which the vestibular nerve has been cut and in ears with acoustic neuroma (AN). To date, a paradoxical effect, that is an increase in EOAE amplitude during contralateral stimulation, has been described in one ear with sensorineural hearing loss of unknown aetiology and in three ears with AN (two in the present paper). Evidence has been provided that the contralateral suppression effect on EOAEs is accomplished largely, if not entirely, via the medial olivocochlear bundle (OCB). According to clinical data the absence or the reduced amount of contralateral suppression effect on EAOEs may be attributed to a totally, or partially, damaged or malfunctioning medial OCB. The way in which a contralateral noise may increase EOAE amplitude is more difficult to explain. One attractive hypothesis is that this paradoxical effect is a result of some pathological adaptive process in the medial OCB.

Acoustic Stimulation↗
PubMed2000

[Meniere's disease: diagnosis and new treatment perspectives].

Ménière's disease is characterized by attacks of vertigo and by sensorineural hearing loss, tinnitus, and ear fullness; these cochlear symptoms are unilateral in the majority of cases. Medical treatment tends to control vertigo and to cure the possible causes of endolymphatic hydrops (autoimmune disease, syphilis, metabolic and endocrine derangements, etc). In case of failure of medical treatment, surgery is considered. Endolymphatic mastoid shunt is indicated when hearing is normal or fluctuating. In all other cases, vestibular neurectomy or chemical vestibular labyrinthectomy, by means of intratympanic low concentration gentamicin (20 mg/mL), are indicated. Total or substantial regression of vertigo, at 2 years follow up, occurs in 65% of cases after endolymphatic-mastoid shunt, and in > 90% after vestibular neurectomy or chemical vestibular labyrinthectomy.

Diagnosis, Differential↗
PubMed1999

Intratympanic therapy for Ménière's disease. High-concentration gentamicin with round-window protection.

Many therapeutic options exist for the management of patients with Ménière's disease. In the last few years, the use of intratympanic gentamicin has been investigated as an alternative treatment to vestibular nerve section or labyrinthectomy. In humans, the concentration of gentamicin used for intratympanic treatment of vertigo ranges from 10 mg/mL to 40 mg/mL, and the number of doses from 2 to 14, with a total administered amount between 6 and 2.400 mg. Here lower doses of gentamicin were used, usually had the lowest incidence of hearing loss, but more injections were needed to ablate vestibular function. The purpose of this study was to evaluate the acute and chronic ototoxic effects of intratympanic high-concentration gentamicin after having obliterated the round-window niche with connective tissue in 11 subjects' ears with Ménière's disease. Intratympanic gentamicin was administered according to a predetermined and fixed schedule consisting of two doses of 0.5 mL gentamicin solution, injected once a week with a drug concentration of 80 mg/mL. The total dose of gentamicin was < or = 80 mg. The charts of the patients were surveyed in accordance with the 1995 AAO-HNS guidelines. Three patients had recurrence of vertigo between 3 and 6 months after the second injection and went on to one additional dose of gentamicin. At 2 years follow-up, 10 patients (91%) had complete and 1 (9%) substantial control of vertigo; 3 subjects (27%) had hearing decreased. Tinnitus disappeared or decreased in 3 patients (27%); eight subjects (73%) reported their aural pressure abolished or decreased. The present study demonstrates that in patients with Ménière's disease, 0.5 mL gentamicin solution, with a concentration of 80 mg/mL (total dose < or = 80 mg), injected intratympanically once a week after having obliterated the round-window niche, permits complete or substantial control of vertigo in two-thirds of cases after two doses and in all subjects after three doses. This vertigo control rate is compared to that observed after vestibular nerve section. Hearing results are not different from those with natural control, with endolymphatic sac surgery, and with vestibular nerve section.

Adult↗
PubMed1999

Vaccine storage in the community: a study in central Italy.

Maintaining the vaccine cold chain is an essential part of a successful immunization programme, but in developed countries faulty procedures may occur more commonly than is generally believed. A survey was conducted in a health district in central Italy to assess the methods of vaccine transportation and storage. Of 52 primary vaccination offices inspected, 39 (76.5%) had a refrigerator for vaccine storage but only 17 (33.3%) kept records of received and stored doses. None of the seven main offices selected for monitoring had a maximum and minimum thermometer and none monitored the internal temperature of the refrigerator. Moreover, other faulty procedures, such as the storage of food and laboratory specimens in vaccine refrigerators and the storage of vaccines on refrigerator door shelves, indicated that the knowledge and practice of vaccine storage and handling were often inadequate.

Documentation↗
PubMed1999

Malleus-handle fracture: historical review and three new cases.

OBJECTIVE: Isolated malleus-handle fracture is a clinical entity seldom reported in the medical literature but well known in the last century. The purpose of this paper was to review the literature over the last 150 years and describe three new cases. STUDY DESIGN: Extensive review of the literature and chart review of three patients with isolated malleus-handle fracture. SETTING: The study was performed partly at a private practice and partly in an academic tertiary referral center. PATIENTS: At least 43 malleus-handle fractures have been reported in the literature. Three new occurrences were studied. RESULTS: The review of the literature showed that head trauma with skull base fracture was the most frequent cause of malleus-handle fracture, followed by blows on the tympanic membrane and barotrauma, penetration of pen-holders or hair pins, penetration of twigs, and attempts to remove a foreign body pushed inside the ear. In the first patient reported here, the malleus-handle fracture was caused by a whirlpool bath, in the second, the cause was unknown, and, in the third, it was caused by a brisk decompression inside the ear canal. CONCLUSIONS: This lesion is not rare, and the diagnosis frequently is missed because the tympanic membrane appears intact. A careful otoscopic examination with pneumomassage, an abnormally high compliance at tympanometry, and a carefully recorded medical history may lead to the diagnosis of isolated malleus-handle fracture in a patient with a mild conductive hearing loss.

Acoustic Impedance Tests↗
PubMed1998

Temporary and permanent threshold shift: an overview.

Temporary threshold shift (TTS) as well as permanent threshold shift (PTS) represent the most common hearing effect of acute and chronic high level acoustic stimulation. TTS is typically related to the traumatizing stimulus spectrum and to the exposure level and duration. The stapedial acoustic reflex as well as the repetition rate of the exposure may influence TTS. PTS is related to a number of factors including exposure duration, subject's age, exposure to other ototoxic factors, presence of impulse noise components, etc. PTS is usually accompanied with alterations of several cochlear functions leading to altered speech discrimination mostly in presence of background noise. The main characteristics of both TTS and PTS are reviewed and discussed.

Acoustic Stimulation↗
PubMed1997

Cyclosporin A stimulates Na+ transport across the isolated skin of Rana esculenta.

Cyclosporin A (Cs A), added to the fluid bathing the internal surface of the isolated skin of Rana esculenta, increased short-circuit current (SCC) with a maximal effect at 5 microM. This effect was completely inhibited by amiloride (0.2 mM in the fluid bathing the external surface). By measuring both transepithelial fluxes of 22Na+ across symmetrical parts of the short circuited skin, Cs A was found to increase the net absorption of Na+. Naproxen (10 microM), a cyclooxygenase inhibitor, decreased the stimulation by Cs A of SCC, suggesting that in this stimulation prostaglandins are involved. The Cs A effect on Na+ transport could be caused by an inhibition of a Ca2+/calmodulin-dependent protein phosphatase, i.e. calcineurin, since: a) it is mimicked by another inhibitor of calcineurin, i.e. fenvalerate: b) the action of Cs A and fenvalerate on SCC are decreased by the calmodulin inhibitor W7.

Amiloride↗
PubMed1997

Remote masking in noise-exposed chinchillas.

Remote masking (RM), the phenomenon whereby an intense high-frequency masker elevates thresholds for low-frequency signals, has been shown to be sensitive to various types of hearing loss in humans and to temporary threshold shifts in chinchillas. In this experiment, RM was evaluated in chinchillas with permanent threshold shift (PTS). Thresholds for 0.5 and 1 kHz tones were measured in quiet and in the presence of an 88 dB SPL narrow band noise centered at 3 kHz in the animals exposed for 30 h to impact noise at 125 dB SPL as intensity. The results show that RM values are significantly lower in chinchillas with PTS than in normal hearing chinchillas.

Animals↗
PubMed1997

Comparison of long-term hearing results after vestibular neurectomy, endolymphatic mastoid shunt, and medical therapy.

OBJECTIVE: This study aimed to compare the hearing changes in the long term after vestibular neurectomy, endolymphatic mastoid shunt, and medical treatment in classic Meniere's disease. STUDY DESIGN: A retrospective case review was conducted based on audiologic follow-up between 5 and 21 years. SETTING: The study was performed at two centers in Bari University Hospital, one performing vestibular neurectomy as the first surgical procedure for Meinere's disease and the other, endolymphatic mastoid shunt. PATIENTS AND INTERVENTIONS: Of 68 patients with intractable idiopathic Meniere's disease, 29 underwent middle fossa vestibular neurectomy, and 17 had endolymphatic mastoid shunt; 22 were offered surgery but declined. MAIN OUTCOME MEASURES: Outcome measures were puretone average (PTA), speech reception threshold, and speech discrimination score before and after treatment. RESULTS: PTA declined by an average of 9.3 dB in neurectomy patients, 13.3 dB in patients undergoing endolymphatic mastoid shunt, and 18.1 dB in patients who were offered surgery but declined. Patients were subdivided into two cohorts based on their preoperative or initial PTA. In the patients who had PTA scores worse than 50 dB initially, the PTA declined an average of 4.3 dB in the vestibular neurectomy group, 11.5 dB in the endolymphatic sac group, and 4 dB in the nonsurgical group. In the patients with PTA > or = 50 dB initially, the PTA declined an average of of 25.3 dB in the vestibular neurectomy group, 16.1 in the endolymphatic sac group, and 26.2 dB in the nonsurgical group. Although shunt patients with good hearing initially deteriorated less than neurectomy patients and less than patients who declined surgery, the difference was not significant. CONCLUSIONS: These results indicate that patients with poor hearing stabilized, while patients with good hearing continued to deteriorate. The same conditions were observed in the patients who had surgery and those who were offered surgery but declined.

Adult↗
PubMed1996

The Bari Center: an audiology and otology pilot center for Mediterranean countries.

The Audiology and Otology Center for Mediterranean Countries began activities in 1990. Until today, the Bari Center has sponsored meetings, coordinated research projects and, above all, it has been host to 5 young colleagues coming from the Mediterranean Area, to take part in 2 or 3 month clinical stages: two from Egypt, one from Syria and one from Lybia. The Center is now verifying the possibilities of setting up an Audiology and Otology Center in Tirana (Albania).

Audiology↗
PubMed1996

Epidemiology of hearing problems among adults in Italy.

Estimates for the prevalence of self-reported hearing disability and measured hearing impairment as a function of age in the adult population of Italy are reported. The study was conducted in Bari, Florence, Milan, Padua, Palermo with questionnaire and audiological assessment; neither stage showed any gross bias arising from the particular cities chosen. The results have demonstrated that: 22% of subjects think their hearing abnormal, 24.4% report some difficulty understanding speech, 14.5% experienced prolonged spontaneous tinnitus and 17% have a > or = 25 dB HL bilateral hearing impairment; hearing problems increase progressively with age and show no significant differences between men and women; the occupational groups most at risk as far as hearing impairments are concerned are manual workers and workers exposed to occupational noise; the systemic disorders most significantly connected to hearing problems are dyslipidosis, diabetes, hypertension, cardiovascular diseases, liver diseases and cervical arthrosis; among every day habits, the consumption of alcohol seems the only element of risk, above all for tinnitus.

Adolescent↗
PubMed1992

Candida and stapedial otosclerosis: histopathological findings.

The stapes of 6 patients with stapedial otosclerosis was found to contain fungus hyphae (Candida) in the sectioned specimens. The footplate of all cases and the head of the stapes in 2 of the cases revealed single or multiple erosion cavities containing numerous thin branching PAS-positive fungus hyphae with swollen terminal endings and scanty blastospores. Osteoclasts were not observed; occasional osteoblasts, blue mantles and otosclerotic foci were seen. Four patients had been treated for several years with antibiotics and corticosteroids for recurrent serous otitis media and 1 patient had had frequent catheterization of the eustachian tube. It may be suggested that the Candida infection was a secondary event induced by a general and/or local immunodepressed condition.

Adolescent↗