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Aim: Menière's disease (MD) diagnosis is based on the characteristics of vertigo and hearing loss. MD crisis do not present premonitory signs and often determine anxiety and modify significantly the way of life. Methods: The present study was carried out on 236 patients affected by unilateral definite MD according to AAO-HNS. Each patient has filled out a questionnaire based on 55 points that explore the characteristics of the disease and the quality of life. Results: In the majority of cases vertigo determines nausea, vomiting and unsteadiness. Tinnitus are often reported as very loud. The more frequent psychological aspects are sense of indecision, fear for the future, sadness and indifference. Conclusion: In conclusion, MD determines a relevant modification of the quality of life.

The purpose of this work was to create a rapid and simple instrument to evaluate the benefits of a hearing aid, that was at the same time reliable and complete. We created a new questionnaire by integration of other well consolidated psychometric tests to better investigate all the aspects that contribute in determining the hearing aid benefit, also considering as important some areas that are not usually considered (spatiality and quality of sound). We started from a 36-item questionnaire divided in six subscales (spatiality and quality of signal, intelligibility in silence, background noise intelligibility, averseness and reverberation), and submitted it to patients before hearing aid application and at 2-3 months after that. A statistically significant difference between results before and after hearing aid application was found. To obtain the final 30-item questionnaire, we analyzed the reliability of each subscale using Cronbach's alpha coefficient, and eliminated the item whose internal consistency was lower for every subscale. For these reasons, the CISQ questionnaire is a rapid and simple test that can be considered a reliable and complete instrument to evaluate the benefits of a hearing aid.Lo scopo di questo lavoro è stato quello di creare un questionario per valutare il beneficio protesico che fosse rapido e di facile utilizzazione, ma allo stesso tempo completo e attendibile. Partendo da altri test psicometrici ormai ben consolidati, abbiamo creato un nuovo questionario in grado di indagare i diversi aspetti che concorrono nel determinare il beneficio protesico del paziente, ovvero il grado di soddisfazione soggettiva che, insieme al guadagno protesico, porta alla definizione della cosiddetta resa protesica. Partendo dai test ad oggi maggiormente utilizzati abbiamo creato un primo questionario costituito da 36 domande, divise per sei sottoscale riguardanti i diversi ambiti che ci interessava indagare: comprensione in ambienti riverberanti, intelligibilità, intelligibilità nel rumore, percezione dei rumori forti, qualità del segnale e spazialità. Abbiamo poi somministrato il questionario a 40 pazienti ipoacusici prima della protesizzazione e tre mesi dopo l'applicazione della stessa, al termine cioè dell'adattamento protesico. Confrontando i due questionari mediante un'analisi statistica è stato possibile evidenziare una differenza statisticamente significativa tra le risposte date prima e dopo la protesizzazione. Affinché il questionario fosse attendibile abbiamo poi calcolato l'Alpha di Cronbach, coefficiente che serve a valutare la coerenza interna di raggruppamenti di items. Abbiamo quindi eliminato per ogni sottoscala la domanda dotata della minore coerenza interna, ottenendo così il questionario definitivo costituito da 30 domande. Il numero relativamente ridotto di items consente la rapida esecuzione del test rendendolo pertanto facilmente fruibile; allo stesso tempo però le sei sottoscale assicurano la completezza dell'indagine, comprendendo anche ambiti solitamente meno indagati (spazialità e qualità del suono). L'analisi statistica e il calcolo dell'Alpha di Cronbach assicurano altresì che le domande siano chiare, che portino a dare risposte nettamente differenti in una condizione di ipoacusia rispetto ad una di buona udibilità, e completamente attendibili. Per tutte queste caratteristiche il questionario CISQ può essere considerato un completo strumento di valutazione del beneficio protesico.

Tracheo-oesophageal voice prostheses are currently widely used following total laryngectomy. Data on maximum phonation time and spectrum have been studied by various Authors and are well known. On the contrary, intensity and fundamental frequency control have received little attention. Intensity and fundamental frequency play an important role in the prosodic aspects of speech. Fundamental frequency variations have been studied in tone language speakers, but the ability to voluntarily change intensity and fundamental frequency remain to be fully investigated. Aim of the present study was to analyse the ability of tracheo-oesophageal voice users to change intensity and fundamental frequency. A total of 12 male subjects who underwent total laryngectomy, in whom a tracheo-oesophageal prosthesis had been inserted, were considered. Maximum phonation time was calculated. Each subject was asked to utter an /a/ as loud as possible and an /a/ as soft as possible. Each subject was then asked to utter an /a/ at comfortable pitch and then at an interval of a fifth. Intensity as well as fundamental frequency variations were compared using Wilcoxon signed rank test. Correlation between maximum phonation time and variation in intensity and in fundamental frequency as well as between the two latter variables was calculated using Spearman's rank correlation coefficient. Mean maximum phonation time was 8 (+/- 3.8) sec. Mean energy was 50 (+/- 4.8) dB SPL for soft phonation and 68 (+/- 4.7) dB SPL for loud phonation. The difference observed was statistically significant (p0.02). Mean fundamental frequency values were 106 (+/- 14) Hz and 135 (+/- 34) Hz at the interval of a fifth. The difference observed was statistically significant (p0.02). Tracheo-oesophageal voice users were able to change intensity and fundamental frequency, but their control was rather poor. Variations in intensity, as well as fundamental frequency, did not show any correlation with maximum phonation time, and were not correlated with each other. In conclusion, the tracheo-oesophageal voice allows small fundamental frequency variations, but their control appears difficult. On the contrary, intensity variations appear larger and control somewhat easier.

Objective The aim of this work was to assess through a questionnaire the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a sample of 252 subjects with a diagnosis of definite vestibular migraine. Background Migraine is a common neurological disorder characterized by episodic headaches with specific features. About two-thirds of cases run in families, and patients may refer symptoms occurring in infancy and childhood, defined as episodic syndromes that may be associated with migraine. Migraine is associated with episodic vertigo, called vestibular migraine, whose diagnosis mainly relies on clinical history showing a temporary association of symptoms. Methods In this cross-sectional multicentric study, 252 subjects were recruited in different centers; a senior specialist through a structured questionnaire assessed features of vestibular symptoms and accompanying symptoms. Results The age of onset of migraine was 23 years, while onset of vertigo was at 38 years. One hundred and eighty-four subjects reported internal vertigo (73%), while 63 subjects (25%) reported external vertigo. The duration of vertigo attacks was less than 5 minutes in 58 subjects (23%), between 6 and 60 minutes in 55 (21.8%), between 1 and 4 hours in 29 (11.5%), 5 and 24 hours in 44 (17.5%), up to 3 days in 14 (5.5%), and more than 3 days in seven (2.8%); 14 subjects (5.5%) referred attacks lasting from less than 5 minutes and up to 1 hour, nine (3.6%) referred attacks lasting from less than 5 minutes and up to 1 to 4 hours, six (2.4%) referred attacks lasting from less than 5 minutes and up to 5 to 24 hours, and five (2%) cases referred attacks lasting from less than 5 minutes and up to days. Among accompanying symptoms, patients referred the following usually occurring, in order of frequency: nausea (59.9%), photophobia (44.4%), phonophobia (38.9%), vomiting (17.8%), palpitations (11.5%), tinnitus (10.7%), fullness of the ear (8.7%), and hearing loss (4%). In total, 177 subjects referred a positive family history of migraine (70.2%), while 167 (66.3%) reported a positive family history of vertigo. In the sample, 69% of patients referred at least one of the pediatric precursors, in particular, 42.8% of subjects referred motion sickness. The age of onset of the first headache was lower in the subsample with a familial history of migraine than in the total sample. Among the pediatric precursors, benign paroxysmal vertigo - BPV, benign paroxysmal torticollis, and motion sickness were predictive of a lower age of onset of vertigo in adulthood; cyclic vomiting was predictive for vomiting during vertigo attacks in adults. Conclusions Our results may indicate that vestibular symptoms in pediatric patients may act as a predisposing factor to develop vestibular migraine at an earlier age in adulthood.

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined "episodic symptoms which may be associated with migraine." The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.

Background: The model of explanation for the pathogenesis of Ménière's disease (MD) proposed by our group postulates a crucial role for the maintained activity of the labyrinthine gastric-type proton pump under ischaemic conditions. Thus, the administration of the common proton pump inhibitors (PPI) could exert a favourable influence on MD symptoms. Method: In order to help assess the validity of this hypothesis a questionnaire was administered to a selected population of sufferers from MD; the aim was to verify the percentage of PPI users and the incidence of MD symptoms among users and non-users. Results: These showed a higher prevalence of PPI users in the selected sample compared to an unselected large series in the literature; the difference was statistically significant in all cases. In contrast, no statistically significant differences between users and non-users were found regarding the incidence of symptoms in the previous six months, even though the group of PPI users had a slightly better performance. Conclusion: Despite these inconclusive findings and the consequent need for further studies to eventually propose PPI as a therapy for MD, some physiological and pharmacological aspects seem to support a possible positive influence of this category of drugs on the inner ear.

The incidence reported for carcinomas of the head and neck currently peaks between the sixth and seventh decades of life. In this retrospective study we were interested in learning whether age is a potentially significant prognostic factor for survival. We considered a set of variables in a series of 134 patients, divided into two groups; between 65 and 70 years of age, and older than 70. Stage I-II tumors were present in 44 patients, while locally advanced lesions (stages III-IV) were present in 90. Statistical analysis of survival was performed using the actuarial survival rates according to Kaplan-Meier; significance was evaluated using the log-rank test. Multivariate analysis was performed according to the Cox logistic regression model to determine the prognostic significance of any of the variables. Univariate analysis was performed on a series of variables regarding the patient, tumor and treatment. In the younger group, age appeared to be a favorable prognostic factor. Tumor size had a significant effect on disease-free survival, both globally and between the two groups (p0.05). Lymph node status substantially influenced the five-year survival rate (p = 0.001). Tumor invasion of the lymph nodes led to a difference between the two groups. Survival was lower in the younger than in the older group. There was a significant difference (p0.01) in survival between patients who had undergone surgery (75%) and those who received radiotherapy alone (33%). Multivariate analysis of these variables showed that disease stage, and treatment of lymph nodes were both significant (p = 0.0016 and p = 0.0002, respectively). Survival rates for the so-called "young elderly" (65-70 years) are generally higher than that for those aged 70 and over. Following accurate and comprehensive assessment by the anesthesiologist and the internist, and appropriate adjustment of the patient's nutritional and metabolic status, combined radical surgery and radiotherapy can and must be performed. Minimal palliative interventions, in the belief that tumor growth is biologically less aggressive in the elderly patient, should be avoided.

This work describes the different patterns of expression of integrins and extracellular matrix proteins in normal and transformed mucosa in laryngeal and oropharyngeal carcinomas. Samples from each tumor group were sectioned and examined by immunohistochemistry using monoclonal antibodies raised against integrin chains (alpha2, alpha3, alpha6, beta1 and beta4) and their ligands (laminins 1 and 5, collagen type IV and two fibronectin isoforms: ED-A and ED-B). Controls were provided by samples of tumor-free laryngeal and oropharyngeal mucosa that had been removed during the surgical procedure. We found that the known distinct topographical pattern of integrins and the continuity of basement membrane components was altered in both groups but that the extent of changes was significantly more marked in oropharyngeal tumors, which are known to be more infiltrating and diffusive and to have a bad prognosis. These molecular patterns of expression can be used as an additional prognostic factor as they suggest a greater biological tumor aggressiveness of oropharyngeal tumors. We suggest that performing immunohistochemical analysis on biopsy samples may help in selecting the correct therapeutic strategy for these tumors and enable more accurate follow-up. The above-mentioned molecules may become part of the diagnostic toolbox of head and neck surgical pathologists.

La vertigine nella sordità improvvisa

The treatment of carcinoma of the head and neck in recent years has improved significantly, chiefly thanks to progress in surgery and radiotherapy. Despite these advances, the survival statistics reported in the literature show no appreciable evidence of radical improvement. The aims of this study were to evaluate the impact on survival achieved with the combination of surgical and postoperative radiotherapy in patients with advanced head and neck carcinomas and to identify the prognostic value of several host- and tumor-related factors that can influence the results of combined treatment. We retrospectively reviewed the medical records of 394 patients with stage III and IV carcinoma of the head and neck, of whom 170 (43%) underwent surgery alone and 224 (57%) received combined surgery and postoperative radiotherapy. The 394 patients were stratified for a set of variables including the patient's condition, the characteristics of the tumor, and the modality of treatment. Univariate analysis revealed that coexistent medical diseases, the size and site of the primary lesion, the stage of the tumor, and certain pathologic features had a negative impact on survival. Multivariate analysis showed that the removal of lymph nodes and postoperative radiotherapy can have a positive influence and can improve the prognosis. We compared the survival rates of the patients treated with surgery alone with those of the patients who underwent combined treatment, and we observed that the two survival curves were comparable, even if there was a bias because the combined treatment group consisted of patients with negative prognostic factors. The meaning of these results, compared with data from the literature, has been discussed.

Pharyngocutaneous fistula is the most common complication of total laryngectomy. The management of this problem increases hospitalization time and delays initiation of postoperative radiotherapy, where indicated. To identify factors predisposing to the development of pharyngocutaneous fistula, we reviewed the postoperative courses of 293 patients who underwent total laryngectomy at our clinic. General factors taken into account were concurrent diseases such as diabetes, liver diseases, or chronic anemia; local factors included radiotherapy before and after surgery, preoperative tracheostomy, type of cervical lymph node removal, and method of pharyngeal closure. We then compared our data with those reported in the literature by other authors. Last, we applied the Fisher exact test to a correlation we found between the higher incidence of fistula in patients with diabetes, liver diseases, or anemia. The local factor that turned out to be statistically most significant for the development of fistula was preoperative radiotherapy.