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OBJECTIVE: To test the osteo-regenerative potential of adipose tissue-derived stromal cells (ATSCs), an attractive human source for tissue engineering, in a rat model of mandibular defect. Human dermal fibroblasts (HDFs) were used as a differentiated cellular control in the study. DESIGN: The ATSCs and HDFs were isolated from human lipoaspirate and skin biopsy specimens, respectively. Cells were characterized in vitro and then adsorbed on an osteo-conductive scaffold to be transplanted in a mandibular defect of immunosuppressed rats. Naked unseeded scaffold was used as a negative control. MAIN OUTCOME MEASURES: Bone healing was studied by computerized tomography and histologic analysis after 4, 8, and 12 weeks. RESULTS: Computed tomography showed that undifferentiated ATSCs induced successful bone healing of the mandible defect when transplanted in animals, compared with HDFs and negative controls. Histologic analysis demonstrated that the newly formed tissue in the surgical defect retained the features of compact bone. CONCLUSION: Undifferentiated human ATSCs are suitable for cell-based treatment of mandibular defects, even in the absence of previous osteogenic induction in vitro.

The association between hearing impairment, the diagnosis of dementia, and the role of sensory therapy has been proposed for some time, but further research is needed. Current understanding of this association requires the commitment of those experts who can integrate experience and research from several fields to be able to understand the link from hearing to dementia. A workshop whose panelists included experts from many areas, ranging from ear, nose and throat (ENT) to dementia's specialists, was promoted and organized by the Giovanni Lorenzini Medical Science Foundation (Milan, Italy; Houston, TX, USA) to increase the awareness of the relationship between hearing loss and dementia, and included questions and comments following a presentation from the clinical researcher, Frank Lin, who has been evaluating the relationship between hearing loss and cognitive decline since 2009.

We reviewed our series of surgeries for paediatric cholesteatoma to assess outcomes and functional results considering the extension of disease and surgical techniques. Between January 2003 and December 2009, 36 patients (range 6-14 years) were operated on for cholesteatoma. We considered the sites involved by the cholesteatoma (mastoid, antrum, attic, middle ear, Eustachian tube), surgical techniques used (intact canal wall, canal wall down) and how our habits changed over the years; moreover, we evaluated ossicular chain conditions and how we managed the ossiculoplasty. As outcomes, we considered the percentage of residual and recurrent cholesteatoma for each technique and hearing function (air bone gap closure, high frequencies bone conduction hearing loss) at follow-up. Intact canal wall was performed in 20 patients and canal wall down in 13 patients, in 9 as first surgery. In both groups, we observed improvement of the air bone gap; in the intact canal wall group, a residual cholesteatoma was observed in 6 patients whereas, during follow-up, 2 patients who underwent a canal wall down showed a recurrent cholesteatoma that was treated in an outpatient setting. Eradication of cholesteatoma and restoration of hearing function in paediatric patients present unique surgical challenges. Our experience shows an increased choice of intact canal wall over the years. Therefore, it is important for the surgeon to counsel parents about the probable need for multiple surgeries, especially if an intact canal wall mastoidectomy is performed.Abbiamo analizzato i risultati nella nostra casistica riguardo al trattamento chirurgico del colesteatoma in età pediatrica considerando l'estensione della patologia e la tecnica chirurgica impiegata. Nel periodo compreso tra gennaio 2003 e dicembre 2009 abbiamo trattato 36 bambini e nell'analisi abbiamo valutato le sedi coinvolte dal colesteatoma (mastoide, antro, attico, cassa del timpano, tuba di Eustachio), la tecnica chirurgica impiegata (timpano plastica chiusa e aperta) e come il loro impiego si sia modificato nel corso degli anni; inoltre abbiamo valutato le condizioni della catena ossiculare e come abbiamo effettuato l'ossiculoplastica. Nell'analisi dei risultati abbiamo valutato il colesteatoma residuo e ricorrente per ciascuna tecnica e la funzionalità uditiva (riduzione dell'ipoacusia trasmissiva, ipoacusia neurosensoriale per le alte frequenze). La timpanoplastica chiusa è stata effettuata in 20 pazienti mentre quella aperta in 13 e per 9 di questi come primo intervento. Con entrambe le tecniche abbiamo ottenuto una riduzione dell'ipoacusia trasmissiva; un colesteatoma residuo è stato individuato in 6 pazienti trattati con timpanoplastica chiusa, mentre 2 patienti sottoposti a timpanoplastica aperta hanno presentetato durante il follow-up un coclesteatoma ricorrente. L'eradicazione del colesteatoma e il ripristino della funzionalità uditiva presentano maggiori problematiche nell'età pediatrica. La nostra esperienza fa emergere un maggior impiego della timpanoplastica chiusa nel corso degli anni. Perciò è importante che il chirurgo informi i genitori della possibilità di dover ricorrere a più interventi chirurgici durante la crescita del bambino, qualora si opti per una tecnica chiusa.

Aim of the present report is to discuss and underline the diagnostic algorithm and the surgical approach to giant parotid pleomorphic adenomas arising in the deep lobe and growing in the parapharyngeal space. Three cases are described and a review is made of the international literature concerning giant deep lobe parotid gland pleomorphic adenoma. Diagnosis was based on imaging, computed tomography scan and magnetic resonance imaging and upon cytology, by means of fine needle aspiration biopsy. The surgical approach varied according to the location of the tumour. All patients were discharged without complications and no cases of permanent facial nerve palsy were observed. An exhaustive pre-operative diagnostic algorithm is required before approaching this lesion. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.

Oxidative stress plays a significant role in noise-induced hearing loss (NIHL), as it largely participates in the mechanisms that underlie cell death after noise exposure and lead to sensorineural hearing loss. Many antioxidant drugs have been tested to prevent NIHL. We present three molecules with antioxidant properties (vitamin E, idebenone, N-L-acetylcysteine) that have been studied in our laboratory, and compare their protective effects. We induced acoustic trauma in treated guinea pigs, evaluated their hearing function via electrophysiological measurements at 1, 7 and 21 days, and performed morphological studies with scanning electron microscopy and TUNEL assay. All molecules had a certain effect in protecting hair cells from oxidative stress; vitamin E offered almost complete protection (8095%), N-L-acetylcysteine and idebenone also significantly reduced the threshold shift and hair cell loss. Our results support the effectiveness of antioxidant drugs in protecting against NIHL and provide a rationale for exploring therapeutic strategies in humans.

CONCLUSION: This study demonstrated an evident mismatch between frequencies assigned to electrodes and frequencies evoked by stimulation of those same electrodes in implanted patients. We propose that the mapping procedures should include, whenever possible, a comparison with homolateral residual hearing in order to obtain an appropriate frequency range assignation for each electrode. OBJECTIVES: The study aimed to investigate the correspondence between the frequencies assigned to each electrode and those actually perceived by the cochlear implant patient. PATIENTS AND METHODS: We studied five post-lingually deaf adults with detectable residual hearing in the implanted and in the contralateral ear, who had each received a Cochlear implant. An ACE standard setting was used for mapping. The patients were asked to match the electric pitch with the acoustic one following presentation of pure tones to both the implanted and the contralateral ear. RESULTS: In almost all patients the two most apical electrodes evoked higher frequencies than those assigned by the mapping software (E22 = 188-313, E21 = 313-438 Hz). Therefore, electric stimulation seems not to determine pitch sensations for frequencies

In the field of Industrial Hygiene, airborne particulate matter is traditionally defined as small particles made up of solid substances, little drops of liquid or microbiologic organisms. There is a strict correlation between the size of particles and their potentially harmful effects on health. Fine particles, i.e. less than 2.5 micrometers in diameter, have been particularly associated with premature mortality and other serious health effects. Animal studies on mice exposed to fine particles from an early age, have shown of secretory changes in the nasal cavity, with increased production of acidic muco-substances. In the course of further studies that are needed to define the effects of PM 2.5 particles on the nasal mucosa of humans, olfactometry could be used as a screening test to find first initial alterations caused by fine particles.

Cement is an hydraulic binding material, i.e. a product that when mixed with water can harden and set thanks to the presence of compounds such as silicates, aluminates and calcium ferrites. Since the cement production is a dusty industrial process, the health of workers in this sector has been monitored for many years. Contrasting results have been obtained from studies aimed at ascertaining the effects of cement on the respiratory tract. The aim of this brief review was to analyse the studies conducted to observe the inflammatory and neo-plastic pathologies of the upper-respiratory tract due to occupational exposure to cement. Studies currently available in the literature do not enable us to define the role of exposure to dust during cement manufacturing in the onset of disease of the upper respiratory tract. The Authors therefore believe it would be of scientific interest to set up a study protocol based on large populations working in this sector, so as to provide reliable data regarding the risk that this type of exposure might lead to the development of the aforementioned disease.

OBJECTIVE: To investigate the possible protective effects of alpha-tocopherol and tiopronin against cisplatin-induced cochlear damage. Cisplatin ototoxicity and nephrotoxicity seem to result from the inhibition of cochlear antioxidant defences, causing an increase in the amount of reactive oxygen species. Antioxidants, such as alpha-tocopherol and tiopronin, are able to suppress lipid peroxidation, thus attenuating tissue damage. MATERIAL AND METHODS: Hartley albino guinea pigs were used. The animals were treated for 7 consecutive days with either (I) cisplatin alone, (II) cisplatin+alpha-tocopherol acetate, (III) cisplatin+tiopronin, (IV) cisplatin+alpha-tocopherol acetate+tiopronin, (V) alpha-tocopherol acetate alone or (VI) tiopronin alone. Changes in cochlear function were characterized by means of compound action potential threshold shifts. After the functional testing, tympanic bullae were removed and processed for morphological examination of the sensorineural epithelium. Renal function was evaluated by measuring serum blood urea nitrogen and creatinine levels. RESULTS: Cisplatin induced progressive high-frequency hearing loss of 40-50 dB SPL. Alpha-tocopherol and tiopronin co-therapy significantly slowed the progression of hearing loss. Treatment with alpha-tocopherol acetate or tiopronin alone was less effective. Morphological observations showed an important loss of outer hair cells and degeneration of the organ of Corti in the basal and middle turns. Injection of both alpha-tocopherol and tiopronin reduced cochlear outer hair cell loss more than treatment with a single drug. Beneficial effects of alpha-tocopherol and tiopronin on cisplatin-induced nephrotoxicity were observed. CONCLUSION: This study supports the hypothesis that alpha-tocopherol and tiopronin interfere with cisplatin-induced damage, and suggests that concurrent treatment with the two drugs can be useful in protecting against hearing loss.

OBJECTIVE: Free radicals are involved in gentamicin ototoxicity and vestibular dysfunction and it has been demonstrated that free radical scavengers, such as alpha-tocopherol, are able to inactive free radicals, attenuating tissue damage This study was designed to investigate the possible protective effects of alpha-tocopherol against gentamicin-induced oto-vestibulo toxicity. MATERIAL AND METHODS: Adult albino guinea pigs were divided into four groups and were treated for 2 weeks as follows: Group A, controls; Group B, gentamicin plus corn oil; Group C, gentamicin only; and Group D, gentamicin plus alpha-tocopherol. To evaluate vestibular function, the animals underwent sinusoidal oscillations in the dark about their vertical and longitudinal axes to evoke horizontal and vertical vestibulo-ocular reflexes (VORs), respectively. Electrocochleographic recordings were performed using an implanted round window electrode. The compound action potentials (CAPs) at 2, 4, 8 and 16 kHz were measured every 5 days Morphological changes were analysed by means of scanning electron microscopy. RESULTS: Gentamicin induced a consistent reduction in VOR responses and a progressive high-frequency hearing loss of 50-60 dB sound pressure level. Alpha-Tocopherol co-therapy slowed the progression of hearing loss and significantly attenuated the final threshold shifts The impairment of vestibular function was reduced, as evidenced by an increased VOR gain. The massive loss of outer hair cells in the cochlear basal turn and of cristae ampullaris stereocilia in gentamicin-treated animals was not observed in the cochlea of animals protected with alpha-tocopherol. CONCLUSION: This study supports the hypothesis that alpha-tocopherol interferes with gentamicin-induced free radical formation, and suggests that this drug may be useful in preventing aminoglycoside oto-vestibulo toxicity.

Meningoencephalic herniation (MEH) in the middle ear and mastoid is a rare pathological entity with possible life-threatening complications. We treated 24 patients with a trans-mastoid approach, and the bony defect was closed by heterologous materials positioned in a multilayer fashion. The cause of the bony defect were chronic otitis media with cholesteatoma, iatrogenic, spontaneous and post-traumatic. The major presenting symptoms were meningitis, headache, conductive hearing loss, cerebrospinal fluid (CSF leak), neurologic deficit and pneumoencephalus, and stenosis of a canal wall down cavity. During follow-up, no patient developed complications due to surgery or related to the pathology, and imaging showed a stable occlusion of the bony defect. Different surgical treatments have been proposed to repair MEH, and the choice is based on the localization and size of the bony defect, preoperative auditory function and the presence of a coexisting pathology. We propose the use of collagenous membranes and bone substitutes for reconstruction of the floor of the middle fossa.Le ernie meningoencefaliche nell'orecchio medio e nella mastoide rappresentato una rara entità patologica con complicanze anche mortali. Abbiamo operato 24 pazienti con un approccio trans-mastoideo e abbiamo chiuso il difetto osseo utilizzando più strati di materiale eterologo. Nella nostra casistica il difetto osseo era stato causato nel 42% dei casi da un'otite cronica colesteatomatosa, nel 33% da causa iatrogena, nel 17% il difetto era spontaneo e infine nell'8% post-traumatico. I principali sintomi sono stati: meningite, cefalea, ipoacusia trasmissiva, fistola liquorale, deficit neurologici e pneumoencefalo, stenosi di cavità di timpanoplastica aperta. Durante il follow up nessun paziente ha presentato complicanze legate alla chirurgia o correlate alla patologia e le indagini radiologiche hanno evidenziato una stabile chiusura del difetto osseo. Numerose tecniche chirurgiche sono state proposte per la risoluzione di questa patologia e la scelta si basa sulla localizzazione e la grandezza del difetto osseo, la funzione uditiva e la presenza di patologie concomitanti. Riteniamo pertanto che la tecnica da noi proposta, che si basa sull'utilizzo di una membrana di collagene e di un sostituto osseo, possa essere adatta per la riparazione del pavimento della fossa cranica media e per la risoluzione di questa patologia.