Alessandro Scorpecci - Academia.edu (original) (raw)

Papers by Alessandro Scorpecci

2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2012

Interestingly, the international debate about the quality of music fruition for cochlear implante... more Interestingly, the international debate about the quality of music fruition for cochlear implanted users does not take into account the hypothesis that bilateral users could perceive music in a more pleasant way with respect to monolateral users. In this scenario, the aim of the present study was to investigate if cerebral signs of pleasantness during music perception in healthy child are similar to those observed in monolateral and in bilateral cochlear implanted users. In fact, previous observations in literature on healthy subjects have indicated that variations of the frontal EEG alpha activity are correlated with the perceived pleasantness of the sensory stimulation received (approach-withdrawal theory). In particular, here we described differences between cortical activities estimated in the alpha frequency band for a healthy child and in patients having a monolateral or a bilateral cochlear implant during the fruition of a musical cartoon.

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2013

The perception of the music in cochlear implanted (CI) patients is an important aspect of their q... more The perception of the music in cochlear implanted (CI) patients is an important aspect of their quality of life. In fact, the pleasantness of the music perception by such CI patients can be analyzed through a particular analysis of EEG rhythms. Studies on healthy subjects show that exists a particular frontal asymmetry of the EEG alpha rhythm which can be correlated with pleasantness of the perceived stimuli (approach-withdrawal theory). In particular, here we describe differences between EEG activities estimated in the alpha frequency band for a monolateral CI group of children and a normal hearing one during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns related to the normal hearing group refers to a higher pleasantness perception when compared to the cerebral activity of the monolateral CI patients. In fact, the present results support the statement that a monolateral CI group could perceive the music in a less pleasant way when compared to normal hearing children.

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2011

There is a debate in the specialized literature about the quality of fruition of music for patien... more There is a debate in the specialized literature about the quality of fruition of music for patients that received a cochlear implant. Interestingly, very few studies have investigated the hypothesis that patients that use a bilateral cochlear implant could perceive the music in a more pleasant way as compared to unilaterally implanted patients. Previous observations in healthy subjects have indicated that variations of particular EEG rhythms correlated with the pleasantness of the perceived music. The aim of the present pilot study is then to apply the state of the art neuroelectrical imaging and the analysis of cortical representation of EEG rhythms to monitor the perceived pleasantness during the observation of a simple videoclip in one patient with a unilateral cochlear implant and in one receiving a bilateral cochlear implant. Results of this pilot study showed that on the base of such previously validated EEG rhythms, the fruition of music and video, in terms of pleasantness, is statistically higher in the bilaterally implanted patient when compared to the monolateral implanted patient.

Annals of Otology, Rhinology & Laryngology, 2010

We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels ... more We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels of fatty acids, total cholesterol, low-density lipoproteins (LDLs), and the antioxidant coenzyme Q10. Forty-three patients with SSNHL and 43 healthy subjects were enrolled in the study. The main outcome measures were serum levels of fatty acids, coenzyme Q10, total cholesterol, and LDLs. On univariate logistic regression analysis, high levels of total cholesterol (p < 0.001), LDLs (p = 0.024), behenic acid (p < 0.001), docosahexaenoic acid (p < 0.001), linolenic acid (p = 0.017), and oleic acid (p < 0.001) and low levels of coenzyme Q10 (p < 0.001) and nervonic acid (p < 0.001) were associated with an elevated risk of SSNHL. On multivariate analysis, only hypercholesterolemia (p = 0.15) and low levels of coenzyme Q10 (p = 0.02) and nervonic acid (p = 0.005) were significantly associated with SSNHL. This is the first report of low serum levels of nervonic acid as an independent risk factor for SSNHL. Considering that hypercholesterolemia, high serum levels of LDL, and low serum levels of the antioxidant coenzyme Q10 were associated with SSNHL as well, we hypothesize that saturated fatty acids may play a role in determining the dysmetabolic state in a subset of SSNHL patients. Together, these findings suggest that not only total cholesterol and LDL levels, but also fatty acid determination, may help identify SSNHL patients with cardiovascular risk factors.

Otolaryngology - Head and Neck Surgery, 2006

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 8, 2014

Since 2011, a transcutaneous bone-anchored auditory implant (Sophono) has been available for pati... more Since 2011, a transcutaneous bone-anchored auditory implant (Sophono) has been available for patients affected by bilateral, conductive hearing loss that cannot be corrected by surgery. To date, very few cases of device application in the pediatric population have been described. The aim of the present study is to report on complications, functional outcome, and health-related quality of life of the first pediatric cases in Italy. Case series with planned data collection. Tertiary care pediatric center. Of 25 candidates with bilateral, conductive hearing loss screened between January 2012 and July 2013, 6 were included in the study (3 male and 3 female; median age, 9 years; age range, 5-17 years). Data concerning surgery, complications, functional outcome, and health-related quality of life were gathered prospectively. No major intraoperative complications occurred. Postoperative complications included 1 patient developing a skin ulceration below the external magnet and 1 patient reporting pain from using the device for more than 4 hours a day consecutively. Median free-field pure tone average (0.5-3 kHz) with the device was 32.5 dB HL, and median functional gain was 33 dB HL. Median Glasgow Children's Benefit Inventory score was +42. Sophono implants can be a valuable alternative to percutaneous implants in patients with bilateral, conductive hearing loss. To ensure the success of the treatment, several precautions should be taken, including a careful preoperative assessment of skull bone thickness and a close postoperative follow-up of the skin under the external processor, especially over the first months.

The international tinnitus journal, 2009

Tinnitus is a common symptom which often becomes disabling, affecting the emotional and psychosoc... more Tinnitus is a common symptom which often becomes disabling, affecting the emotional and psychosocial dimensions of life. There are many reports describing tinnitus suppression or attenuation through electrical stimulation of the ear, provided either by cochlear implants or by transtympanic stimulation. Our study project aims to assess the effects of electrical promontory stimulation (EPS) on persistent disabling tinnitus. We enrolled 11 patients affected by postlingual monoaural or binaural profound hearing loss and disabling tinnitus in the worse ear. EPS was performed with direct continuous positive current delivered by an active platinum-iridium needle electrode connected to a promontory stimulator device. The short-term effect on tinnitus was assessed during and immediately after the stimulation. Long-term effects were estimated after one month by comparing pre- and post-EPS Tinnitus Handicap Inventory (THI) scores. Immediately after EPS, five patients (45.4%) reported complete suppression and four (36.4%) reported attenuation of tinnitus. Two patients (18.2%) said it was unchanged. After one month, the THI score was reduced in five patients (45.4%) and remained unchanged in the other six patients (54.6%). The beneficial effects of EPS on tinnitus might be explained by interference with tinnitus generating circuits such as the dorsal cochlear nucleus and the inferior colliculus and by modification of cortical activity. EPS is to be considered a worthwhile attempt at tinnitus suppression, and could help select candidates for the positioning of an implantable electrical stimulator that might provide longer-term beneficial effect on tinnitus.

Objective: To compare the music perception skills of a group of Italian-speaking children with co... more Objective: To compare the music perception skills of a group of Italian-speaking children with cochlear implants to those of a group of normal hearing children; to analyze possible correlations between implanted children's musical skills and their demographics, clinical characteristics, phonological perception, and speech recognition and production abilities. Methods: 18 implanted children aged 5-12 years and a reference group of 23 normal-hearing subjects with typical language development were enrolled. Both groups received a melody identification test and a song (i.e. original version) identification test. The implanted children also received a test battery aimed at assessing speech recognition, speech production and phoneme discrimination. Results: The implanted children scored significantly worse than the normal hearing subjects in both musical tests. In the cochlear implant group, phoneme discrimination abilities were significantly correlated with both melody and song identification skills, and length of device use was significantly correlated with song identification skills. Conclusions: Experience with device use and phonological perception had a moderate-to-strong correlation to implanted children's music perception abilities. In the light of these findings, it is reasonable to assume that a rehabilitation program specifically aimed at improving phonological perception could help pediatric cochlear implant recipients better understand the basic elements of music; moreover, a training aimed at improving the comprehension of the spectral elements of music could enhance implanted children's phonological skills.

International Journal of Sports Medicine, 2011

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the st... more Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

Otology & Neurotology, 2012

To obtain objective data of bone conduction implant stability and osseointegration in children; t... more To obtain objective data of bone conduction implant stability and osseointegration in children; to compare in pediatric subjects the stability and osseointegration of the novel TiOblast-coated implant system (BI300) to the previous generation, as-machined model. Multicenter, controlled, nonrandomized, longitudinal, prospective study. Tertiary referral center. IIIb Ten subjects were enrolled, aged younger than 16 years and without comorbidities that negatively affect osseointegration. All patients were implanted "single stage": 5 received the previous generation, pure titanium fixture (control group), and 5 were implanted the BI300, TiOblast-coated fixture (test group). Measurement of implant stability and osseointegration. Implant stability and osseointegration as measured by means of resonance frequency analysis intraoperatively, at 1 week, 2 weeks, 1 month, and every month till processor loading 6 months after surgery. BI300 is, on average, more stable than the control fixture, both intraoperatively and over time till processor loading. Over the 6 months' follow-up, a stability increase was observed with both models, although it resulted statistically not significant. The BI300 implant system has a greater primary stability as compared with the previous generation model, but its faster osseointegration could not be definitely verified. It is reasonable to assume that the BI300 fixture will enable surgeons to perform single-stage surgery more safely and with a lower failure rate. The possibility of an earlier processor loading remains to be confirmed in a greater sample.

Cochlear Implants International, 2014

International Journal of Pediatric Otorhinolaryngology, 2014

International Journal of …, 2011

Otology & Neurotology, 2010

Auditory testing is not routinely performed within 4 to 6 weeks after stapedotomy because hearing... more Auditory testing is not routinely performed within 4 to 6 weeks after stapedotomy because hearing acuity is thought to be transiently depressed. The early postoperative effects of the 1-shot carbon dioxide (CO2) laser have never been reported. The purpose of this study is to present data for auditory thresholds measured within 2 days of laser stapedotomy and at the last follow-up. The study was prospective and unblinded. The study was conducted at the "A. Gemelli" University Hospital. From January to December 2008, 58 subjects underwent "1-shot" CO2 laser stapedotomies for otosclerosis. Pure-tonal audiometric test was performed preoperatively 2 days after surgery and at least 1 month after surgery during the follow-up. The closure of air-bone gap began in the early postoperative period and continued to improve through the late postoperative period. Bone-conduction hearing thresholds were stable even in the early postoperative follow-up and remained stable trough all the course of the study. Our data, supported by the literature, suggest that 1-shot CO2 laser stapedotomy is an effective and safe procedure for the treatment of otosclerosis.

Otology & Neurotology, 2014

To assess the safety and the possible advantages of early (1-wk) cochlear implant switch-on in ch... more To assess the safety and the possible advantages of early (1-wk) cochlear implant switch-on in children and to compare impedance and ECAP threshold changes between subjects undergoing early switch-on and those undergoing traditional, 1-month switch-on. Prospective cohort study. Tertiary care referral pediatric center. Seventeen children receiving a unilateral or bilateral Nucleus Freedom cochlear implant were included, for a total of 20 ears. Ten ears were assigned to the early (1-wk) switch-on group and 10 to the control group (switch-on after 4 wks). Common ground impedance values and electrically evoked compound action potential thresholds were measured from intraoperation until 9 months postoperatively. Speech perception improvements over time were also assessed. Complication rate, impedance levels (kΩ), and electrically evoked compound action potentials (current levels) Early switch-on was well tolerated by patients and did not cause complications. Impedances dropped significantly after switch-on in both groups. They also seemed to achieve an earlier stability in the early switch-on patients, although the difference between groups was not significant. ECAP thresholds showed a similar, nonsignificant decreasing trend over time in both groups. Speech perception improvements did not differ between groups. This is the first study investigating the safety and the effects of an early cochlear implant switch-on in children. Results show that such a procedure is well tolerated by pediatric subjects and free from complications. Impedance measurements suggest that the earlier switched-on subjects benefit of lower and more stable impedances than subjects undergoing 1-month switch-on.

The Journal of Laryngology & Otology, 2010

To assess the electrode pitch function in a series of adults with postlingually implanted cochlea... more To assess the electrode pitch function in a series of adults with postlingually implanted cochlear implants and with contralateral residual hearing, in order to investigate the correlation between the degree of frequency map mismatch and the subjects' speech understanding in quiet and noisy conditions. Case series. Seven postlingually deafened adults with cochlear implants, all with detectable contralateral residual hearing. Subjects' electrode pitch function was assessed by means of a pitch-matching test, in which they were asked to match an acoustic pitch (pure tones delivered to the non-implanted ear by an audiometer) to a perceived 'pitch' elicited by stimulation of the cochlear implant electrodes. A mismatch score was calculated for each subject. Speech recognition was tested using lists of sentences presented in quiet conditions and at +10, 0 and 5 dB HL signal-to-noise ratio levels (i.e. noise 10 dB HL lower than signal, noise as loud as signal and noise 5 dB HL higher than signal, respectively). Correlations were assessed using a linear regression model, with significance set at p < 0.05. All patients presented some degree of mismatch between the acoustic frequencies assigned to their implant electrodes and the pitch elicited by stimulation of the same electrode, with high between-individual variability. A significant correlation (p < 0.005) was found between mismatch and speech recognition scores at +10 and 0 dB HL signal-to-noise ratio levels (r2 = 0.91 and 0.89, respectively). The mismatch between frequencies allocated to electrodes and the pitch perceived on stimulation of the same electrodes could partially account for our subjects' difficulties with speech understanding in noisy conditions. We suggest that these subjects could benefit from mismatch correction, through a procedure allowing individualised reallocation of frequency bands to electrodes.

European Archives of Oto-Rhino-Laryngology, 2008

European Archives of Oto-Rhino-Laryngology, 2011

To assess and compare the functional results obtained by means of multiple-shot Erbium: yttriumal... more To assess and compare the functional results obtained by means of multiple-shot Erbium: yttriumaluminum-garnet (Er:YAG) laser to those obtained using "one-shot" CO 2 laser stapedotomy in patients aVected by otosclerosis. A retrospective case review was performed. Of the total number of 123 patients (114 ears) who underwent primary small-fenestra stapedotomy from January 2006 to September 2008, seven patients who received multiple-shot laser CO 2 stapedotomy were excluded from the study. The remaining 116 patients (104 ears) were sorted, and "one-shot" CO 2 laser stapedotomy (group A) was performed in 35/104 and Er:YAG laser stapedotomy (group B) in 69/104. After surgery, air conduction-pure tone average (AC-PTA) and air-bone gap (ABG) improved signiWcantly in both groups, whereas sensorineural hearing loss (SNHL) and bone conduction (BC)-PTA did not change in both the groups. In group A, the postoperative ABG was signiWcantly better (12.63 vs. 14.86 dB). Moreover, after "oneshot" stapedotomy, the AC-PTA signiWcantly improved in all tested frequencies. On the contrary, in group B the AC-PTA improved signiWcantly only in two frequencies (0.5 and 1 kHz). Consistent with previous reports, our Wndings conWrm that laser stapedotomy is a safe and eVective surgery, regardless of the technique. Based on our functional results, the "one-shot" CO 2 laser technique seems to be associated with a signiWcantly better postoperative ABG if compared to Er:YAG laser stapedotomy.

European Archives of Oto-Rhino-Laryngology, 2007

Preservation of residual hearing should be a desirable outcome of implant surgery. Prevention of ... more Preservation of residual hearing should be a desirable outcome of implant surgery. Prevention of neural degeneration due to loss of residual hair cells, together with the continuous progress in cochlear implant technology should be able to preserve cochlear integrity as well as possible. The degree of hearing preservation may vary depending on surgical approach, maximum insertion depth and other factors not uniformly considered to date. The aim of this retrospective case controlled study is to evaluate residual hearing after cochlear implant surgery. In particular, we analyzed data obtained with use of two different kinds of electrode arrays, with and without rigid introductor (stylet). We report the results on 37 patients with measurable preoperative hearing thresholds, mean age of 28 years (5-70 years), having the following implants: seven Advanced Bionics, four Med-El, 24 Cochlear, two MXM; 19 of them were performed using the stylet and the other 18 without it. A minimally invasive surgical approach was performed with a short retroauricular incision and a 1.2 mm cochleostomy. A complete electrode array insertion was obtained in all patients. Responses to pure-tone stimuli were measured for each ear in pre-implantation conditions and 3-12 months after surgery. After implantation 14 patients (38%) showed no hearing threshold variation, 29 (78%) maintained an appreciable hearing threshold level in the implanted ear, 8 (22%) had a total loss of residual hearing. Median increases of threshold levels were, in all 37 studied patients, 5, 10, 10 and 5 dB HL, respectively, for 125, 250, 500 and 1 kHz. For the 18 patients having implants without the stylet median increases of threshold levels were 0, 10, 5 and 7 dB HL; in the stylet group, they were 10, 5, 5 and 10 dB HL. On a comparison between the stylet and the non-stylet group, no significant differences in mean hearing threshold worsening were found. Data seem to suggest that cochlear function is less sensitive to mechanical trauma during implant surgery than was thought. Besides, electrode array stiffness seems not to influence preservation of cochlear residual functional integrity. Finally, the authors hypothesize a direct spiral ganglion activation under strong mechanical stimulation.

European Archives of Oto-Rhino-Laryngology, 2008

2012 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2012

Interestingly, the international debate about the quality of music fruition for cochlear implante... more Interestingly, the international debate about the quality of music fruition for cochlear implanted users does not take into account the hypothesis that bilateral users could perceive music in a more pleasant way with respect to monolateral users. In this scenario, the aim of the present study was to investigate if cerebral signs of pleasantness during music perception in healthy child are similar to those observed in monolateral and in bilateral cochlear implanted users. In fact, previous observations in literature on healthy subjects have indicated that variations of the frontal EEG alpha activity are correlated with the perceived pleasantness of the sensory stimulation received (approach-withdrawal theory). In particular, here we described differences between cortical activities estimated in the alpha frequency band for a healthy child and in patients having a monolateral or a bilateral cochlear implant during the fruition of a musical cartoon.

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2013

The perception of the music in cochlear implanted (CI) patients is an important aspect of their q... more The perception of the music in cochlear implanted (CI) patients is an important aspect of their quality of life. In fact, the pleasantness of the music perception by such CI patients can be analyzed through a particular analysis of EEG rhythms. Studies on healthy subjects show that exists a particular frontal asymmetry of the EEG alpha rhythm which can be correlated with pleasantness of the perceived stimuli (approach-withdrawal theory). In particular, here we describe differences between EEG activities estimated in the alpha frequency band for a monolateral CI group of children and a normal hearing one during the fruition of a musical cartoon. The results of the present analysis showed that the alpha EEG asymmetry patterns related to the normal hearing group refers to a higher pleasantness perception when compared to the cerebral activity of the monolateral CI patients. In fact, the present results support the statement that a monolateral CI group could perceive the music in a less pleasant way when compared to normal hearing children.

2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2011

There is a debate in the specialized literature about the quality of fruition of music for patien... more There is a debate in the specialized literature about the quality of fruition of music for patients that received a cochlear implant. Interestingly, very few studies have investigated the hypothesis that patients that use a bilateral cochlear implant could perceive the music in a more pleasant way as compared to unilaterally implanted patients. Previous observations in healthy subjects have indicated that variations of particular EEG rhythms correlated with the pleasantness of the perceived music. The aim of the present pilot study is then to apply the state of the art neuroelectrical imaging and the analysis of cortical representation of EEG rhythms to monitor the perceived pleasantness during the observation of a simple videoclip in one patient with a unilateral cochlear implant and in one receiving a bilateral cochlear implant. Results of this pilot study showed that on the base of such previously validated EEG rhythms, the fruition of music and video, in terms of pleasantness, is statistically higher in the bilaterally implanted patient when compared to the monolateral implanted patient.

Annals of Otology, Rhinology & Laryngology, 2010

We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels ... more We analyzed the relationships between sudden sensorineural hearing loss (SSNHL) and serum levels of fatty acids, total cholesterol, low-density lipoproteins (LDLs), and the antioxidant coenzyme Q10. Forty-three patients with SSNHL and 43 healthy subjects were enrolled in the study. The main outcome measures were serum levels of fatty acids, coenzyme Q10, total cholesterol, and LDLs. On univariate logistic regression analysis, high levels of total cholesterol (p < 0.001), LDLs (p = 0.024), behenic acid (p < 0.001), docosahexaenoic acid (p < 0.001), linolenic acid (p = 0.017), and oleic acid (p < 0.001) and low levels of coenzyme Q10 (p < 0.001) and nervonic acid (p < 0.001) were associated with an elevated risk of SSNHL. On multivariate analysis, only hypercholesterolemia (p = 0.15) and low levels of coenzyme Q10 (p = 0.02) and nervonic acid (p = 0.005) were significantly associated with SSNHL. This is the first report of low serum levels of nervonic acid as an independent risk factor for SSNHL. Considering that hypercholesterolemia, high serum levels of LDL, and low serum levels of the antioxidant coenzyme Q10 were associated with SSNHL as well, we hypothesize that saturated fatty acids may play a role in determining the dysmetabolic state in a subset of SSNHL patients. Together, these findings suggest that not only total cholesterol and LDL levels, but also fatty acid determination, may help identify SSNHL patients with cardiovascular risk factors.

Otolaryngology - Head and Neck Surgery, 2006

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, Jan 8, 2014

Since 2011, a transcutaneous bone-anchored auditory implant (Sophono) has been available for pati... more Since 2011, a transcutaneous bone-anchored auditory implant (Sophono) has been available for patients affected by bilateral, conductive hearing loss that cannot be corrected by surgery. To date, very few cases of device application in the pediatric population have been described. The aim of the present study is to report on complications, functional outcome, and health-related quality of life of the first pediatric cases in Italy. Case series with planned data collection. Tertiary care pediatric center. Of 25 candidates with bilateral, conductive hearing loss screened between January 2012 and July 2013, 6 were included in the study (3 male and 3 female; median age, 9 years; age range, 5-17 years). Data concerning surgery, complications, functional outcome, and health-related quality of life were gathered prospectively. No major intraoperative complications occurred. Postoperative complications included 1 patient developing a skin ulceration below the external magnet and 1 patient reporting pain from using the device for more than 4 hours a day consecutively. Median free-field pure tone average (0.5-3 kHz) with the device was 32.5 dB HL, and median functional gain was 33 dB HL. Median Glasgow Children's Benefit Inventory score was +42. Sophono implants can be a valuable alternative to percutaneous implants in patients with bilateral, conductive hearing loss. To ensure the success of the treatment, several precautions should be taken, including a careful preoperative assessment of skull bone thickness and a close postoperative follow-up of the skin under the external processor, especially over the first months.

The international tinnitus journal, 2009

Tinnitus is a common symptom which often becomes disabling, affecting the emotional and psychosoc... more Tinnitus is a common symptom which often becomes disabling, affecting the emotional and psychosocial dimensions of life. There are many reports describing tinnitus suppression or attenuation through electrical stimulation of the ear, provided either by cochlear implants or by transtympanic stimulation. Our study project aims to assess the effects of electrical promontory stimulation (EPS) on persistent disabling tinnitus. We enrolled 11 patients affected by postlingual monoaural or binaural profound hearing loss and disabling tinnitus in the worse ear. EPS was performed with direct continuous positive current delivered by an active platinum-iridium needle electrode connected to a promontory stimulator device. The short-term effect on tinnitus was assessed during and immediately after the stimulation. Long-term effects were estimated after one month by comparing pre- and post-EPS Tinnitus Handicap Inventory (THI) scores. Immediately after EPS, five patients (45.4%) reported complete suppression and four (36.4%) reported attenuation of tinnitus. Two patients (18.2%) said it was unchanged. After one month, the THI score was reduced in five patients (45.4%) and remained unchanged in the other six patients (54.6%). The beneficial effects of EPS on tinnitus might be explained by interference with tinnitus generating circuits such as the dorsal cochlear nucleus and the inferior colliculus and by modification of cortical activity. EPS is to be considered a worthwhile attempt at tinnitus suppression, and could help select candidates for the positioning of an implantable electrical stimulator that might provide longer-term beneficial effect on tinnitus.

Objective: To compare the music perception skills of a group of Italian-speaking children with co... more Objective: To compare the music perception skills of a group of Italian-speaking children with cochlear implants to those of a group of normal hearing children; to analyze possible correlations between implanted children's musical skills and their demographics, clinical characteristics, phonological perception, and speech recognition and production abilities. Methods: 18 implanted children aged 5-12 years and a reference group of 23 normal-hearing subjects with typical language development were enrolled. Both groups received a melody identification test and a song (i.e. original version) identification test. The implanted children also received a test battery aimed at assessing speech recognition, speech production and phoneme discrimination. Results: The implanted children scored significantly worse than the normal hearing subjects in both musical tests. In the cochlear implant group, phoneme discrimination abilities were significantly correlated with both melody and song identification skills, and length of device use was significantly correlated with song identification skills. Conclusions: Experience with device use and phonological perception had a moderate-to-strong correlation to implanted children's music perception abilities. In the light of these findings, it is reasonable to assume that a rehabilitation program specifically aimed at improving phonological perception could help pediatric cochlear implant recipients better understand the basic elements of music; moreover, a training aimed at improving the comprehension of the spectral elements of music could enhance implanted children's phonological skills.

International Journal of Sports Medicine, 2011

Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the st... more Scuba diving is known to affect the rhino-pharyngo-tubaric district (RPT unit). The aim of the study was to document function modifications of the RPT unit in 6 Italian divers (3 men and 3 women) who lived for 14 days consecutively at a depth of 8-10 m, breathing air (21% oxygen) at a pressure ranging between 1.8 and 2 ATA. RPT and inner ear assessment were carried out before the dive (TIME 0) and 24 h (TIME 1) after resurfacing, in order to investigate diving-related RPT and inner ear alterations. Physical examination after resurfacing revealed: fungal external otitis, otoscopic findings consistent with middle ear barotraumas and rhinosinusitis. Rhino-manometry showed a remarkable increase in inspiratory nasal flow and a substantial decrease in nasal resistance. No epithelial cell disruption was retrieved comparing pre and post resurfacing samples. Post-diving tubaric dysfunction was found. Pure tone audiometry revealed a bilateral 40 dB HL hearing loss at 4 kHz in 1 diver. Relevant PTA functions did not seem to be affected by the experiment, no remarkable changes were found at the Sensory Organisation Test and at the Motor Control Test. The 14-day underwater period had a positive effect on nasal flows and resistances.

Otology & Neurotology, 2012

To obtain objective data of bone conduction implant stability and osseointegration in children; t... more To obtain objective data of bone conduction implant stability and osseointegration in children; to compare in pediatric subjects the stability and osseointegration of the novel TiOblast-coated implant system (BI300) to the previous generation, as-machined model. Multicenter, controlled, nonrandomized, longitudinal, prospective study. Tertiary referral center. IIIb Ten subjects were enrolled, aged younger than 16 years and without comorbidities that negatively affect osseointegration. All patients were implanted "single stage": 5 received the previous generation, pure titanium fixture (control group), and 5 were implanted the BI300, TiOblast-coated fixture (test group). Measurement of implant stability and osseointegration. Implant stability and osseointegration as measured by means of resonance frequency analysis intraoperatively, at 1 week, 2 weeks, 1 month, and every month till processor loading 6 months after surgery. BI300 is, on average, more stable than the control fixture, both intraoperatively and over time till processor loading. Over the 6 months' follow-up, a stability increase was observed with both models, although it resulted statistically not significant. The BI300 implant system has a greater primary stability as compared with the previous generation model, but its faster osseointegration could not be definitely verified. It is reasonable to assume that the BI300 fixture will enable surgeons to perform single-stage surgery more safely and with a lower failure rate. The possibility of an earlier processor loading remains to be confirmed in a greater sample.

Cochlear Implants International, 2014

International Journal of Pediatric Otorhinolaryngology, 2014

International Journal of …, 2011

Otology & Neurotology, 2010

Auditory testing is not routinely performed within 4 to 6 weeks after stapedotomy because hearing... more Auditory testing is not routinely performed within 4 to 6 weeks after stapedotomy because hearing acuity is thought to be transiently depressed. The early postoperative effects of the 1-shot carbon dioxide (CO2) laser have never been reported. The purpose of this study is to present data for auditory thresholds measured within 2 days of laser stapedotomy and at the last follow-up. The study was prospective and unblinded. The study was conducted at the "A. Gemelli" University Hospital. From January to December 2008, 58 subjects underwent "1-shot" CO2 laser stapedotomies for otosclerosis. Pure-tonal audiometric test was performed preoperatively 2 days after surgery and at least 1 month after surgery during the follow-up. The closure of air-bone gap began in the early postoperative period and continued to improve through the late postoperative period. Bone-conduction hearing thresholds were stable even in the early postoperative follow-up and remained stable trough all the course of the study. Our data, supported by the literature, suggest that 1-shot CO2 laser stapedotomy is an effective and safe procedure for the treatment of otosclerosis.

Otology & Neurotology, 2014

To assess the safety and the possible advantages of early (1-wk) cochlear implant switch-on in ch... more To assess the safety and the possible advantages of early (1-wk) cochlear implant switch-on in children and to compare impedance and ECAP threshold changes between subjects undergoing early switch-on and those undergoing traditional, 1-month switch-on. Prospective cohort study. Tertiary care referral pediatric center. Seventeen children receiving a unilateral or bilateral Nucleus Freedom cochlear implant were included, for a total of 20 ears. Ten ears were assigned to the early (1-wk) switch-on group and 10 to the control group (switch-on after 4 wks). Common ground impedance values and electrically evoked compound action potential thresholds were measured from intraoperation until 9 months postoperatively. Speech perception improvements over time were also assessed. Complication rate, impedance levels (kΩ), and electrically evoked compound action potentials (current levels) Early switch-on was well tolerated by patients and did not cause complications. Impedances dropped significantly after switch-on in both groups. They also seemed to achieve an earlier stability in the early switch-on patients, although the difference between groups was not significant. ECAP thresholds showed a similar, nonsignificant decreasing trend over time in both groups. Speech perception improvements did not differ between groups. This is the first study investigating the safety and the effects of an early cochlear implant switch-on in children. Results show that such a procedure is well tolerated by pediatric subjects and free from complications. Impedance measurements suggest that the earlier switched-on subjects benefit of lower and more stable impedances than subjects undergoing 1-month switch-on.

The Journal of Laryngology & Otology, 2010

To assess the electrode pitch function in a series of adults with postlingually implanted cochlea... more To assess the electrode pitch function in a series of adults with postlingually implanted cochlear implants and with contralateral residual hearing, in order to investigate the correlation between the degree of frequency map mismatch and the subjects' speech understanding in quiet and noisy conditions. Case series. Seven postlingually deafened adults with cochlear implants, all with detectable contralateral residual hearing. Subjects' electrode pitch function was assessed by means of a pitch-matching test, in which they were asked to match an acoustic pitch (pure tones delivered to the non-implanted ear by an audiometer) to a perceived 'pitch' elicited by stimulation of the cochlear implant electrodes. A mismatch score was calculated for each subject. Speech recognition was tested using lists of sentences presented in quiet conditions and at +10, 0 and 5 dB HL signal-to-noise ratio levels (i.e. noise 10 dB HL lower than signal, noise as loud as signal and noise 5 dB HL higher than signal, respectively). Correlations were assessed using a linear regression model, with significance set at p < 0.05. All patients presented some degree of mismatch between the acoustic frequencies assigned to their implant electrodes and the pitch elicited by stimulation of the same electrode, with high between-individual variability. A significant correlation (p < 0.005) was found between mismatch and speech recognition scores at +10 and 0 dB HL signal-to-noise ratio levels (r2 = 0.91 and 0.89, respectively). The mismatch between frequencies allocated to electrodes and the pitch perceived on stimulation of the same electrodes could partially account for our subjects' difficulties with speech understanding in noisy conditions. We suggest that these subjects could benefit from mismatch correction, through a procedure allowing individualised reallocation of frequency bands to electrodes.

European Archives of Oto-Rhino-Laryngology, 2008

European Archives of Oto-Rhino-Laryngology, 2011

To assess and compare the functional results obtained by means of multiple-shot Erbium: yttriumal... more To assess and compare the functional results obtained by means of multiple-shot Erbium: yttriumaluminum-garnet (Er:YAG) laser to those obtained using "one-shot" CO 2 laser stapedotomy in patients aVected by otosclerosis. A retrospective case review was performed. Of the total number of 123 patients (114 ears) who underwent primary small-fenestra stapedotomy from January 2006 to September 2008, seven patients who received multiple-shot laser CO 2 stapedotomy were excluded from the study. The remaining 116 patients (104 ears) were sorted, and "one-shot" CO 2 laser stapedotomy (group A) was performed in 35/104 and Er:YAG laser stapedotomy (group B) in 69/104. After surgery, air conduction-pure tone average (AC-PTA) and air-bone gap (ABG) improved signiWcantly in both groups, whereas sensorineural hearing loss (SNHL) and bone conduction (BC)-PTA did not change in both the groups. In group A, the postoperative ABG was signiWcantly better (12.63 vs. 14.86 dB). Moreover, after "oneshot" stapedotomy, the AC-PTA signiWcantly improved in all tested frequencies. On the contrary, in group B the AC-PTA improved signiWcantly only in two frequencies (0.5 and 1 kHz). Consistent with previous reports, our Wndings conWrm that laser stapedotomy is a safe and eVective surgery, regardless of the technique. Based on our functional results, the "one-shot" CO 2 laser technique seems to be associated with a signiWcantly better postoperative ABG if compared to Er:YAG laser stapedotomy.

European Archives of Oto-Rhino-Laryngology, 2007

Preservation of residual hearing should be a desirable outcome of implant surgery. Prevention of ... more Preservation of residual hearing should be a desirable outcome of implant surgery. Prevention of neural degeneration due to loss of residual hair cells, together with the continuous progress in cochlear implant technology should be able to preserve cochlear integrity as well as possible. The degree of hearing preservation may vary depending on surgical approach, maximum insertion depth and other factors not uniformly considered to date. The aim of this retrospective case controlled study is to evaluate residual hearing after cochlear implant surgery. In particular, we analyzed data obtained with use of two different kinds of electrode arrays, with and without rigid introductor (stylet). We report the results on 37 patients with measurable preoperative hearing thresholds, mean age of 28 years (5-70 years), having the following implants: seven Advanced Bionics, four Med-El, 24 Cochlear, two MXM; 19 of them were performed using the stylet and the other 18 without it. A minimally invasive surgical approach was performed with a short retroauricular incision and a 1.2 mm cochleostomy. A complete electrode array insertion was obtained in all patients. Responses to pure-tone stimuli were measured for each ear in pre-implantation conditions and 3-12 months after surgery. After implantation 14 patients (38%) showed no hearing threshold variation, 29 (78%) maintained an appreciable hearing threshold level in the implanted ear, 8 (22%) had a total loss of residual hearing. Median increases of threshold levels were, in all 37 studied patients, 5, 10, 10 and 5 dB HL, respectively, for 125, 250, 500 and 1 kHz. For the 18 patients having implants without the stylet median increases of threshold levels were 0, 10, 5 and 7 dB HL; in the stylet group, they were 10, 5, 5 and 10 dB HL. On a comparison between the stylet and the non-stylet group, no significant differences in mean hearing threshold worsening were found. Data seem to suggest that cochlear function is less sensitive to mechanical trauma during implant surgery than was thought. Besides, electrode array stiffness seems not to influence preservation of cochlear residual functional integrity. Finally, the authors hypothesize a direct spiral ganglion activation under strong mechanical stimulation.

European Archives of Oto-Rhino-Laryngology, 2008