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C Zini

Publications and source records attributed to C Zini.

At least 19 recordsLinked to original sources
PubMed2001

Closed tympanoplasty in cholesteatoma surgery: long-term (10 years) hearing results using cartilage ossiculoplasty.

The aim of this retrospective study was to evaluate the long-term hearing results of using costal cartilage prostheses in ossicular chain reconstruction procedures in subjects operated on for a middle ear cholesteatoma with an intact canal wall tympanoplasty. Thirty-six patients (four with bilateral disease) followed up for 10 years who underwent an ossiculoplasty with a cartilage prostheses between January 1987 and December 1989 constituted the population studied. All the subjects underwent a staged intact canal wall tympanoplasty with mastoidectomy. Ossiculoplasty with total or partial chondroprosthesis was performed during the second stage. The long-term outcome was evaluated in terms of hearing according to the guidelines of the Committee on Hearing and Equilibrium (1995), and in terms of complications (anatomical and functional). In 18 patients a partial cartilage ossicular replacement prosthesis (PORP) was used, while in 22 a total cartilage ossicular replacement prosthesis (TORP) was used. In the PORP group the mean preoperative air-bone gap (ABG) was 22.4 dB hearing level (HL); before the second stage the ABG was 37.9 dB HL, at 2 years it was 12.1 dB HL, at 5 years 15.3 dB HL and at 10 years 15.8 dB HL. In the TORP group the mean preoperative ABG was 31.6 dB HL; before the second stage the ABG was 41.1 dB HL, at 2 years it was 14.4 dB HL, at 5 years 17 dB HL and at 10 years 18.5 dB HL. In both groups the number of cases with a postoperative ABG of < 20 dB HL remained stable (P > 0.05) over time. The failure rate was 17.5%, but only in 5% of cases was a functional revision needed. No cases of extrusion of the prostheses were encountered. The use of a chondroprosthesis is associated with functional results similar to those obtained by other authors. The efficacy of the prostheses remains stable over time and is associated with a very low rate of complications and failures. In this series no extrusion occurred and in no case did an infectious disease develop after cartilage transplantation.

Adolescent↗
PubMed2000

Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy.

BACKGROUND: The aim of this study was to verify the efficacy of sodium-2-mercaptoethanesulfonate (mesna) in the chemical separation of tissues in abdominal myomectomies when used with the traditional mechanical separation techniques. STUDY DESIGN: In a prospective, randomized study, 58 women underwent abdominal myomectomy. In 29 of these, we used mesna for highlighting and separating tissues, and in the other 29 we used saline solution for the same purposes. The variables evaluated included the number of myomas removed, the volume of the biggest myoma, and the total volume of the myomas removed in every intervention. We also recorded operating time, the length of hospital stay, the degree of procedure difficulty, perioperative blood loss, operative complications, and cost. RESULTS: The operation was significantly shorter in the mesna group (p < 0.05) even though the volume and the number of myomas were larger. The degree of difficulty evaluated by the surgeon at the end of every operation was not significantly different in the two groups. The reduction in hemoglobin 24 hours after operation was significantly less in the patients treated with mesna (p = 0.006), but this difference was probably altered by the increase in hematocrit levels. CONCLUSIONS: Because of its ability as a chemical dissector, mesna may be a useful aid in this type of benign gynecologic operation. Larger studies to confirm this are needed.

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↗
PubMed1999

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↗
PubMed1998

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↗
PubMed1998

[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↗
PubMed1997

[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↗
PubMed1997

[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↗
PubMed1995

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↗
PubMed1993

[Transoral approaches to the skull base. An attempt of systematization].

This is a technical note concerning the classifications of the various operations possible via the buccal route towards the base of the skull and the first vertebrae. A part from the Hardy vestibulo-septal approach, mention must be made of the buccal and transpalatine approach, the direct buccal approach, the buccal approach widened downwards by transmandibular osteotomy, and finally the transmandibular and transcervical approach. These different technique enable the ablation of extradural and even intradural lesions at the level of the clivus, but are limited on the side by the pterygoid process and the large vessels.

Humans↗
PubMed1991

[Recurrent cholesteatoma after combined approach tympanoplasty: pathogenesis and prevention].

Over the last few years, we have increasingly reduced the use of open techniques in favour of combined approach tympanoplasty by adopting a strategy enabling the prevention of genuine recurrences of cholesteatoma. Recurrences due to the development of a residual cholesteatoma moving outwards towards the meatus can be considerably reduced by a careful eradication at the time of exeresis, and by early screening and exeresis of the residual cholesteatoma by a practically systematic second-look operation (two-stage tympanoplasty). To prevent further penetration of the skin into the new middle ear, an effective barrier has to be created between the skin and the mucosa (repair of the wall of the attic, reconstruction of the tympanum by a xenograft (Parmatymp), and proper drainage and airing the new cavity must be assured. To help with the proper regeneration of the mucosa and the maintenance of the drainage and airing pathways within the cavity, the use of silastic proved to be fundamental. This new strategy has enabled us to treat, with the combined approach, 84% of the 1,465 cases of cholesteatoma operated upon between 1975 and 1989.

Adult↗
PubMed1991

[Pathogenesis and prevention of recurrent cholesteatoma following closed tympanoplasty].

The use of the closed tympanoplasty in the treatment of cholesteatoma has been abandoned by many surgeons in the last years. In contrast, as well as other authors we have increasingly limited the use of open techniques. Our attitude towards the closed tympanoplasty is strictly connected with an accurate prevention strategy of recurrent cholesteatoma. The recurrent cholesteatoma takes origin from two following mechanism: 1--the residual cholesteatoma which exteriorizes towards the external auditory canal; 2--the new immigration of the skin into the middle ear through a new perforation or depending on a retraction pocket. The incidence of recurrent cholesteatoma due to the first cause may be considerably reduced by: a--complete eradication of disease during exeresis (complete removal of structures in contact with the cholesteatoma matrix); b--early detection and removal of residual cholesteatoma by an almost planned second look (staged tympanoplasty). In order to prevent new epithelial immigration into the middle ear it is necessary: a--to reconstruct a new barrier between skin and mucous lining [repair of the attic wall, reconstruction of the tympanic membrane by using xenografts (Parmatymp)]; b--to permit the drainage and aeration of the new tympanic cavity at the level of the bony Eustachian tube including the isthmus (performing, if necessary, the tubotomy and/or tuboplasty techniques). The same must be obtained at the level of the tympanic isthmus by enlargement of the epitympanic recesses in order to create a tunnel over the new ossicular chain and by a posterior tympanotomy in order to create a tunnel under the ossicular chain. The use of silastic sheeting is extremely important in order to allow a correct regeneration of the new mucous lining and an efficient drainage-aeration function into the new middle ear cavity (from the mastoid to the tubal isthmus).

Cell Movement↗
PubMed1990

MR cisternography of the cerebello-pontine angle and internal auditory canal in diagnosis of intracanalicular acoustic neuroma.

One hundred and fifteen patients, suffering from sensorineural hearing loss were tested with a 1.5 T superconducting magnet. The authors describe utility of both T1-weighted multiple slice and T2-weighted multiple echo images for the evaluation of cerebello-pontine angle, internal auditory canal and their neurovascular content. In seventy-three cases MR cisternography was normal. The remaining forty-two cases were subdivided into twenty extracanalicular masses, eleven small intra-extracanalicular and nine purely intracanalicular lesions. All the lesions were histologically proven acoustic neuromas, except one intracanalicular mass which was a meningioma. Examination was inconclusive only in two cases and decision was then made to follow the clinical course. Advantages of MR cisternography over CT and air CT cisternography, such as absence of ionizing radiation and contrast material, easy multiplanar evaluation of the region of interest and the possibility to delineate both the cisternal and canalar extremities of the tumor mass are pointed out.

Adult↗
PubMed1990

Primary intratemporal tumours of the facial nerve: diagnosis and treatment.

Benign primary tumours of the facial nerve are uncommon. A slowly progressive facial palsy should be considered the result of a nerve tumour until proven otherwise. Improvements in diagnostic imaging techniques of the temporal bone have increased the possibility of a correct pre-operative diagnosis but facial nerve tumours remain a frequently ignored or misdiagnosed entity as a consequence of their subtle and protean clinical manifestations. A series of 12 cases of primary facial nerve tumours is presented. The clinical features, diagnostic modalities and treatment are discussed in relation to a review of the literature.

Adult↗
PubMed1990

Inner ear cholesteatoma and the preservation of cochlear function.

Labyrinthine destruction by direct cholesteatoma invasion has always been considered a serious threat to the inner ear function. A number of reports in the literature have cited both patients who had preservation of hearing despite widespread erosion of the labyrinth by cholesteatoma and patients who had retained auditory function despite surgical removal of the matrix from the labyrinth. In most cases the vestibular portion of the inner ear was invaded but cases of cochlear involvement have been described as well. Twelve cases with pre-operative auditory function preservation despite extensive labyrinthine destruction treated at our Institution are reported. Seven cases retained cochlear function post-operatively. Possible explanations of this occurrence and implications of related with hearing preservation in the presence of widespread inner ear destruction by chronic inflammatory disease are discussed.

Adult↗
PubMed1988

Retrolabyrinthine versus middle fossa vestibular neurectomy.

The authors' experience in treating incapacitating peripheral vertigo using the middle cranial fossa (MCF) and the retrolabyrinthine (RL) approaches is presented. Among 94 operated cases, 56 have been treated using the MCF approach and 38 the RL approach. In 18 of the RL cases, a simple vestibular neurectomy has been associated with different adjunctive techniques (i.e., drainage of the endolymphatic sac, section of the Wrisberg intermediary nerve, and neurovascular decompression of the eight nerve) in an attempt to influence the disease from a pathogenetic viewpoint. The RL approach has demonstrated to be a valid alternative to the MCF approach, since it allows the same results to be obtained in the control of vertigo, with fewer risks to the facial nerve and hearing functions. Moreover, it allows the association, although still in an experimental way, of the simple vestibular neurectomy and the other "pathogenetic" methods mentioned above.

Adult↗
PubMed1988

Closed versus open technique in the management of labyrinthine fistulae.

A labyrinthine fistula is the most common complication of cholesteatomatous chronic ear disease. Its treatment remains a controversial subject. The present paper reports our approach to the management of this complication. Operations were performed on 1,226 cases of chronic otitis media with cholesteatoma between January 1971 and December 1985. A labyrinthine fistula was detected in 158 cases. We favor intact canal wall tympanoplasty even in the presence of medium or large fistulas: in the latter case, the matrix is not removed but is trimmed to cover only the bony defect and it is left in place. Open procedures with the preservation of the matrix over the fistula are done in an only-hearing ear with fistula, in ears with a wide defect of the posterior canal wall, and in ears with multiple labyrinthine fistulas. The management of the matrix over the fistula and the anatomic and functional results following each type of procedure are presented and discussed.

Cholesteatoma↗