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Acrylic hydrogels, like the polymer of 2-hydroxyethyl methacrylate, are biocompatible, mechanically stable, porous materials that can be coated with collagen or laminin acting as bioadhesive substrates. Poly-2-hydroxyethyl methacrylate sponges have been proposed for restoring the anatomical continuity of damaged neural structures. In the present work, the ability of poly-2-hydroxyethyl methacrylate sponges to provide the injured spinal cord neurons with a conductive substrate for their regenerating axons was investigated in 32 adult Wistar rats. Collagen impregnated poly-2-hydroxyethyl methacrylate sponges were implanted into suction cavities of the dorsal funiculus of the spinal cord. Two to four months after implantation, the spinal cord was removed and processed for histology, and S100 and GFAP immunohistochemistry. To study axonal regeneration into the sponge, the spinal cord or the sensorimotor cortex were injected with 0.05-0.1 microl of an 8% solution of lectin-conjugated horseradish peroxidase or 10% dextran tetramethylrhodamine. The fibroglial reaction, accumulation of mononuclear cells, and angiogenesis at the interface between the spinal cord and the sponge were minimal. Cystic cavitation in the spinal cord was virtually absent. Anterograde labeled axons were seen to penetrate and to elongate the full length of the sponge. These results demonstrate that poly-2-hydroxyethyl methacrylate sponges represent a safe supportive material for regenerating spinal cord axons.

SUMMARY Background Gastro-oesophageal reflux disease (GERD) may contribute to the onset of chronic cough (CC); however, the multichannel intraluminal impedance-pH (MII-pH) monitoring is often within the normal range and the response to proton pump inhibitors (PPIs) unsatisfactory. The measure of impedance baseline (IB) increases the sensitivity of MII-pH in patients with typical symptoms. Aim To evaluate the role of MII-pH variables, including IB, in predicting PPI response and to define the characteristics of the reflux pattern in CC patients. Methods Prospectively selected CC patients suspected GERD-related underwent MIIpH monitoring and, therefore, received a double dose of PPIs for at least 6 weeks. Patients filled symptom scores before MII-pH and after PPI therapy. MII-pH data were compared with those obtained in 60 non-erosive reflux disease patients with typical symptoms. Results A total of 156 CC patients entered the study: 68 (43.5%) responders and 88 (56.5%) nonresponders to PPIs. The number of reflux episodes was significantly higher in CC compared with that in typical symptoms patients. Nonresponder CC patients with a pathological acid exposure time (AET) and/or IB value were 43/88 (49%), while 15/88 (17%) presented only pathological AET (P < 0.001). CC patients with a pathological AET or IB, or with both a pathological AET and IB, showed a probability of PPI response twofold greater than patients with normal AET and IB. Conclusions The presence of a pathological AET or pathological IB in CC patients is associated with a greater probability of PPI response. IB is a promising variable in patients with CC, as it increases the diagnostic yield of MII-pH and allows confirmation of the GERD diagnosis in these patients.

BACKGROUND. The endoscopic endonasal transclival approach (EETCA) is a minimally-invasive technique allowing a direct route to the base of implant of clival lesions with reduced brain and neurovascular manipulation. On the other hand, it is associated with potentially severe complications related to the difficulties in reconstructing large skull base defects with a high risk of postoperative cerebrospinal fluid (CSF) leakage. The aim of this paper is to describe a precise layer by layer reconstruction in the EETCA including the suture of the mucosa as an additional reinforcing layer between cranial and nasal cavity in order to speed up the healing process and reduce the incidence of CSF leak. METHODS. This closure technique was applied to the last six cases of EETCA used for clival meningiomas (2), clival chordomas (2), clival metastasis (1), and craniopharyngioma with clival extension (1). RESULTS. After a mean follow-up of 6 months we had no one case of postoperative CSF leakage or infections. Seriated outpatient endoscopic endonasal controls showed a fast healing process of nasopharyngeal mucosa with less patient discomfort. CONCLUSIONS. Our preliminary experience confirms the importance of a precise reconstruction of all anatomical layers violated during the surgical approach, including the nasopharygeal mucosa.

Congenital agenesis of the parotid gland is a rare entity whose etiopathogenesis is still unclear. It is usually bilateral and is sometimes associated with other developmental anomalies of the head and neck region. A case is presented in which aplasia of the right parotid gland was associated with an omolateral angioma of the cheek. The radiological diagnostic approach and a review of the literature on agenesis of the salivary glands are presented.

Treatment of vestibular schwannomas presents many controversial aspects, from the indication to the selection of the best treatment option. In the era of stereotactic radiotherapy, microsurgery has to be competitive in terms of providing the best chances of functional preservation and complete tumor removal. The two most commonly used surgical approaches are the retrosigmoid suboccipital and the presigmoid translabyrinthine. We describe the endoscopy-assisted presigmoid retrolabyrinthine approach (EAPRA) aiming at combining the advantages of the retrosigmoid and translabyrinthine techniques. For 2 years (from May 2009 to June 2011), the EAPRA was used to remove medium to large sporadic vestibular schwannomas in ten patients. Complete tumor removal was obtained in eight patients, postoperative transient facial nerve function impairment or worsening was observed in two, and one had hearing deterioration postoperatively. No threatening complications occurred after surgery, and the length of hospitalization was usually less than 10 days. The EAPRA can provide direct access to the CPA along with labyrinthine complex conservation, allowing hearing function preservation and minimal cerebellar retraction. Endoscopic assistance is a crucial adjunct in the presigmoid retrolabyrinthine approach in order to address the limits imposed by labyrinthine complex preservation. It ensures complete visualization of the intracanalicular portion of the schwannoma, thus improving the rate of a radical tumor resection. The EAPRA could represent a valid surgical option in vestibular schwannoma surgery.

Fully implantable Cochlear Implants (CIs) would represent a tremendous advancement in terms of quality of life, comfort and cosmetics, for patients with profound sensorineural deafness. One of the main challenges involved in the development of such implants consists of finding a power supply means which does not require recharging. To this aim an inertial Energy Harvester (EH), exploiting the kinetic energy produced by vertical movements of the head during walking, has been investigated. Compared to existing devices, the EH needs to exploit very low frequency vibrations (

The transduction mechanism of the inner ear and the transmission of nerve impulses along the auditory way are highly dependent upon the cochlear oxygen supply. Several studies have considered the possibility that obstructive sleep apnea–hypopneas during sleep can interfere with these processes, and the results are not uniform. The aim of the study is to evaluate the auditory function in adult patients affected by severe obstructive sleep apnea syndrome (OSAS). Thirty-nine patients in this study were included and divided in OSAS group, with severe OSAS (Apnea–Hypopnea Index, AHI > 30), and control group with snoring without OSAS (AHI

Isolated malleus fracture is a rare clinical entity, and usually the handle of the malleus is involved. We report a video, to our knowledge the first in the literature, of a diagnostic otoscopy of a malleus fracture showing the movement of a left fractured malleus handle during a Valsalva maneuver (see the video online at www.laryngoscope.com).

Conclusion. Logon is superior to click to trigger larger and more consistent vestibular evoked myogenic potentials (VEMPs). Objectives. To record and compare the parameters of VEMPs evoked by bone- and air-conducted logon (l-VEMPs) and click (c-VEMPs). Subjects and methods. Air- and bone-conducted l-VEMPs and c-VEMPs were recorded in 28 normal ears with an Amplaid MK12 (Amplaid, Milan) equipment. Results. VEMPs response rate was 100% with both air-conducted logon and click, while l-VEMPs showed a higher response rate (79%) in comparison with c-VEMPs (21%) with bone-conducted stimuli. A significant (p

We report 44 cases of monomorphic adenoma (MA) of the major salivary glands observed during the years 1979–1989. All of these tumours were reviewed and classified on the basis of the World Health Organisation (WHO) criteria. Histological type, site, sex and age were considered. 34 cases of adenolymphoma were observed, all of them located in the parotid glands; 10 MA without lymphoid stroma were located in both parotid and submandibular glands. Distinctive histological and clinico-pathological features of the latter group of tumours are discussed, as well as the diagnostic criteria in distinguishing these tumours from pleomorphic adenoma and adenoid-cystic carcinoma.

Politzer manoeuvre causes retrograde inflation of the middle ear by forcing air through the Eustachian tube. It has been proposed as nonsurgical treatment of middle ear with effusion, Eustachian tube dysfunction and negative middle ear pressure from elevation changes. Even if Politzer manoeuvre can be considered a classical technique, it is generally performed without any feedback about its correctness neither about qualitative evidence about its efficacy. In this paper we describe an innovative device, named OtoFree, specifically designed to support medical doctors during Politzer manoeuvre. OtoFree provides information about the correctness of the manoeuvre and also useful hints about the treatments results.

Politzer maneuver causes retrograde inflation of the middle ear by forcing air through the eustachian tube, and it has been proposed by many authors as the main nonsurgical treatment of middle ear effusion. To our knowledge, this is the first case in the literature in which air entering into a middle ear with effusion through a Politzer maneuver has been captured on video (www.laryngoscope.com).

Primary low-grade fibromyxoid sarcoma (LGFMS) is an extremely rare tumour of the salivary glands and arises from undifferentiated pluripotential mesenchymal cells. We report a case of a huge (17 x ll x 10 cm) primary LGFMS of the parotid gland of a 57-year-old woman. Clinically, a 12x8 cm firm, non-tender, left parotid mass was observed, facial nerve function was not impaired and no enlarged lymph nodules were palpated on the neck. A contrast axial CT scan showed intense enhancement of the enlarged left parotid gland. The fine needle aspiration biopsy (FNAB) was compatible with sarcomatous tissue. The tumour was removed en bloc and the facial nerve was sacrificed; surgical margins were free from disease. Microscopically, the tumour consisted of fibrous and myxoid tissue with varying grades of cellularity and gradual transitions between the two. Post-operative radiotherapy was carried out on the left neck region and parotid tumour bed. Thirty-six months after surgery the patient presents good general conditions without any evidence of local or regional disease.The largest primary LGFMS of the parotid gland described in the literature is reported and a review of the literature on such neoplasms is also provided.

Rhinomanometry includes a set of methodologies to diagnose pathological alterations of the nostrils and nasal cavities. Some anatomic variations could cause partial or sub total obstruction of one or both nostrils, leading to insufficient nasal respiration. Rhinomanometry measures the airflow through one nostril at time, while a pad occludes the other. This method has some drawbacks, such as the alteration of airflow in the not-occluded nostril due to the presence of the pad, the low reproducibility, and a reduced patient comfort. In this paper we propose a new methodologies that, we call Video-Rhino- Hygrometer (VRH) and illustrate specific device to perform it. VRH may be considered as an automatized evolution of the classical Glatzel methods, because it infers information on clinical parameters analysing the image produced by the condense of the breath on a suitable surface. Specifically, VRH uses a web-cam to record these images and, after a suitable processing, it is able to compute a set of clinical features useful to perform diagnosis. Encouraging clinical tests show that the proposed approach provides results comparable with classical rhinomanometry tools without using the pad, obtaining reproducibility results, with an higher comfort for the patient and with a reduced examination time.

Congenital agenesis of major salivary glands is a rare entity with unclear etiopathogenesis, sometimes presenting in a bilateral form. This pathologic condition is often diagnosed with delay because of the poor clinical presentation. Only bilateral forms of parotid aplasia are responsible of such a severe lack of saliva causing dental caries, periodontal diseases, ascending sialadenitis and candidosis. In most cases, the aplasia involves more than a single major salivary gland and is occasionally associated with other developmental anomalies of the head-neck region. A case is presented in which an aplasia of the right parotid gland is associated with hypoplasia of the thyroid's right lobe and homolateral angioma of the homolateral cheek. We report the clinical and radiological findings in our patient and a review of the diagnostic imaging approach in such anomalies.

Objectives: To investigate the effect of nasal obstruction surgery on eustachian tube function and middle ear ventilation. Design: Prospective study. Setting: University Campus Bio-Medico of Rome. Participants: Forty consecutive patients who underwent nasal surgery were evaluated for middle ear ventilation and tubal function. Main outcome measures: Pre- and postoperative Valsalva and Toynbee tubal function tests, tympanometry and ear fullness sensation were evaluated for both ears of each patient. Results: Results of postoperative tubal function tests were significantly better than preoperative ones (90% versus 46%; P

The aim of the study was to evaluate hearing thresholds in 38 patients with rheumatoid arthritis, divided according to disease activity into active (group A, n = 20) and non-active (group B, n = 18) patients. Pure tone audiometry, tympanometry and complete rheumatological assessment were performed. All patients presented poorer auditory thresholds compared with controls. Patients of group A had both air and bone conduction thresholds poorer than group B (although not statistically significant), and most patients of both groups presented an air-bone (a-b) gap. No significant difference in middle ear pressure was noticed between patients and controls. No correlation between hearing impairment and duration of the disease or patients' age was found. The high prevalence of hearing loss in autoimmune diseases supports the importance of audiometric evaluation in such patients. The auditory recovery through middle ear surgery before cranial nerve involvement could be considered in selected patients. Further investigations are needed for a better knowledge of the middle and inner ear involvement in patients with rheumatoid arthritis.

Nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) are members of a family of structurally related secreted proteins, termed neurotrophins, which promote and regulate the survival of many kinds of neurons in the peripheral nervous system. Aim of the study is to dose the serum level of NGF and BDNF in 8 patients affected by sensorineural hearing loss (SNHL). The results show that in these patients the amount of circulating NGF, but not of BDNF, is significantly lower in comparison to that found in age-matched controls. The preliminary data of the present study suggest that NGF might have a crucial role in the auditory pathway, promoting the survival and preventing the degeneration of sensorineural cells.

Tinnitus and temporomandibular joint dysfunction (TMJD) are among the most common complaints encountered by physicians. Though the relationship between tinnitus and TMJD has attracted great interest during the past several years, theories attempting to explain this association are still few and inconsistent. Conceivably, TMJD could irritate auricolo-temporal nerve (ATN), triggering a somatosensory pathway-induced disinhibition of dorsal cochlear nucleus (DCN) activity in the auditory pathway. In genetically-predisposed TMJD patients, signals from cronically stimulated DCNs activating specific cortical neuronal networks, could yield plastic neural changes resulting in tinnitus. Based on current evidence of serotoninergic modulation of neural activity and plasticity in sensory pathways, reduced serotoninergic tone could promote plastic changes underlying tinnitus through diminished filtering of incoming signals. Therefore, the early establishment of specific treatments aimed at improving TMJD and/or boosting serotoninergic activity may be required to prevent the creation of 'tinnitus memory circuits'.

Otosclerosis is a primary osteodystrophy which affects a localized area within the human temporal bone. Hearing loss is the most functional deficit caused by otosclerosis. However, tinnitus and vestibular disorders are frequently reported by otosclerotic patients, especially in those patients with inner ear involvement. The best therapy in achieving a significant improvement is surgery (stapedoplasty). In most patients if the operation is not carried out for pure middle ear type, the hearing impairment can progress to high-degree hearing loss. Recently, guidelines for the treatment of otosclerosis reported the 20 dbHL threshold as the minimum air-bone gap in performing stapedoplasty. We believe that stapedoplasty is an effective procedure for selected patients affected by otosclerosis with an air-bone gap which is smaller than 20 dbHL. An operation in the earlier phases of the disease can arrest the progression of otosclerosis, preserve inner ear structures and provide a complete auditory recovery, with increased satisfaction of the patient.

Hearing impairment is the most prevalent sensory deficit in the human population. Otosclerosis and chronic otitis media are two of the most frequent causes of hearing loss of the Western world and both benefit from middle ear surgery. The success rate is high for both operations, in expert hands, but, in our clinic and in every ENT clinic, there remains a percentage of failure. Some of the most frequent post-operative complications can lead to tubal dysfunction. We believe that a correct and complete evaluation of the rhino-pharyngeal-tubal unit is very important before tympanoplasty and stapedioplasty in order to further reduce the incidence of some post-operative complications and to increase the success rate of middle ear surgery. What is well known in medicine, 'prevention is the best therapy', seems not oddly observed in ear surgery, where is usually operated the effect, while the evaluation and therapy of the causes seems to be underestimated.

Nerve growth factor (NGF) is the first and best characterised member of a family of neurotrophic factor. NGF is produced by numerous cells and it is present in physiologically relevant amounts in the bloodstream. It is known to promote the survival of peripheral sensory neurons and can be potentially useful as a therapeutic agent in neuronal system. On the both these observations we based our hypothesis that low circulating NGF might lead to sensorineural hearing loss (SNHL). To address this question we measured the levels of NGF in the bloodstream of patients affected by SNHL. The results showed that the amount of circulating NGF in these patients is significantly lower compared to levels found in patients not affected by this deficit. The results of the present study demonstrated that NGF might be a useful candidate for preventing the damage and promoting recovery or degeneration of the auditory pathways in humans.

The embryology of the ear and the different congenital anomalies depending on the arrest in development at a particular embryologic date are reviewed. The historical and the actual attitude towards surgical correction is discussed. The classification system, the evaluation and patients selection, the timing of auricular reconstruction and atresiaplasty, the preoperative evaluation, the patient and parents counselling, the surgical technique, the complications and alternative techniques are discussed.

We have studied the temporal bones of 4 deceased donors, individuals one with cochlear saccular degeneration, another with Mondini dysplasia, another with an ossification of the basal turn of the cochlea and the round window, post meningitis and the fourth who was implanted 10 years before. The indications and contraindications for cochlear implant placement are discussed.

The histopathological changes in the temporal bones of one donor individual deceased for complications of neurofibromatosis type 2 are studied. The different modalities of presentation of neurofibromatosis and the criteria for the differential diagnosis are presented. The possibilities of the auditory brainstem implants in this pathology are discussed.

The histopathological changes in the temporal bones of two deceased donors individuals with concomitant Ménierè's disease have been studied. In one temporal bone we have found a blockage of the endolymphatic duct by abnormal bone. The histopathological modifications and the different therapeutic options are discussed. Clinical guidelines are proposed.

The histopathological changes in the temporal bones of 3 deceased donors individuals with concomitant chronic cholesteatomatous otitis media have been studied. The different forms of cholesteatoma are analyzed: the primary congenital, the primary acquired and the secondary acquired. The different clinical relevance and the different therapeutic guidelines are discussed.

Otitis media (OM) is an infection localized in the middle ear: mastoid, middle ear cavity, Eustachian tube. The classification of OM includes otitis media with effusion, otitis media without effusion, and chronic otitis media. A rare complication of chronic otitis is cholesterol granuloma of the petrous apex. It may develop in any aerated portion of the temporal bone but most commonly develops when a pathologic process obstruct the air cell tracts to the petrous apex preventing normal aeration.

A classification of otitis media is proposed and the histopathological changes of otitis media with effusion are reviewed post mortem on two temporal bones. A case of adhesive otitis media is observed on temporal bone slides. The clinical and therapeutic aspect are examined and treatment guidelines are proposed.

Objective:To underline the importance of accurate clinical evaluation of major salivary gland obstructions, in order to choose the right surgical approach and to reduce the risk of complications.Case report:We report a case of an unusual, previously unreported upper airway obstruction caused by massive swelling of the tongue following a successful sialoendoscopy, performed for treatment of submandibular sialolithiasis under general anaesthesia.Conclusions:Sialoendoscopy has gained popularity and is an accepted method for diagnosis and treatment of most inflammatory conditions of the major salivary glands. It can be performed as an out-patient procedure under local anaesthesia, and is not usually associated with significant complications. However, in the presence of larger stones (>4 mm) of the submandibular gland, we suggest that interventional sialoendoscopy should be performed under general anaesthesia with optimal airway control, in order to manage the major risk of perforations and ductal lesions enabling spread of saline solution into the mouth tissues and causing life-threatening swelling of the floor of the mouth and tongue.

Sir, Although stapes surgery currently represents one of the most common surgical procedures in ENT practice, there is still an unsolved debate about the necessity of packing the external auditory canal (EAC) after surgery [1[e1]]. Some of the questions are: packing the EAC or not? In case of packing, what kind of packing is most convenient? Reabsorbable material or removable tampon? What about Wxing the tympanomeatal Xap with Fibrin Glue “Tissucol”? The Wrst author has performed more than 300 stapedotomies in the last 15 years, using mostly ear packing at the end of the surgical procedure, while the last author has operated more than 3,000 stapedotomies in the last 30 years, using mostly Wbrin glue in the last 10 years. The comparison of our diVerent experiences, together with those of the other authors who have assisted the two surgeons, leads to the following common considerations. Ear packing performed with reabsorbable tampon, like absorbable gelatin sponge (Gelfoam), assures an excellent hemostatic eVect and allows repositioned tympanomeatal Xap to heal in the correct position [2]. The following inconveniences have been observed: the mechanical interposition of gelatin between the skin edges may interfere with healing (http[K2]://www.pWzer.com/pWzer/main.jsp); gelatin may represent a nest for infection and has been reported to potentiate bacterial growth (http[K3]:// www.pWzer.com/pWzer/main.jsp); toxic shock syndrome has been reported in association with the use of Gelfoam in nasal surgery [3]; fever, failure of absorption, and hearing loss have been reported in association with the use of Gelfoam during tympanoplasty (http[K4]://www.pWzer. com/pWzer/main.jsp). However, it is not recommended that gelatine sponge is saturated with an antibiotic solution or dusted with antibiotic powder (http[K5]://www.pWzer.com/ pWzer/main.jsp). Ear packing with removable tampon, like non-absorbable sponge (Merocel tampon), assures an excellent absorption of post-operative excess Xuids and provides the expansion of the canal with an anatomically correct healing of tissues. It can also help to keep antibiotics in contact with the surgical site and its removal (3–7 days after surgery) is atraumatic. Conversely, like reabsorbable tampon, non-absorbable sponge tampon can give rise to local infection or formation of granulation tissue. Moreover, both packing strategies cause aural fullness, described by the patient as uncomfortable [1, 4]. Not packing does not allow a control of post-operative hemostasis and of tissue healing as precise as in the case of packing, especially in the stapes procedures without ear drilling canal and performing endoaural approach advocated by Fisch. In the case of signiWcant post-operative drainage, the tympanomeatal Xap can be displaced from its correct position and middle ear infection with sensorineural hearing loss can result [1]. Fibrin glue (Tissucol) used to Wx the repositioned tympanomeatal Xap encourages healing in its correct anatomical position. Moreover, since no packing is performed, the patient’s postoperative comfort is greatly enhanced and hearing improves directly after surgery [1]. The risk of infection is theoretically reduced by the absence of post-operative stagnation of Xuids. Without F. Salvinelli · M. Casale (&) · V. Rinaldi Department of Otolaryngology, Interdisciplinary Center for Biomedical Research (CIR), University “Campus Bio-Medico” School of Medicine, Via Longoni, 69/83, 00155 Rome, Italy e-mail: m.casale@unicampus.it