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Objectives: This study aimed to compare the audiological benefits of a non-implantable wearable option for a bone conduction (BC) implant mounted on an arch (SoundArc) to those of traditional BC hearing aids (HAs) mounted on eyeglasses (BCHAs) in patients with moderate to severe conductive or mixed hearing loss., Methods: A preliminary cross-sectional observational prospective cohort study was conducted in the Tertiary Audiological Department, University Hospital. Fourteen adults with conductive or mixed hearing loss (PTA at 0.5-1-2-4 KHz = 67 ± 15 dB HL) who had been wearing conventional BCHAs mounted on eyeglasses for at least 3 years and had declined surgical implantation of a bone conduction hearing implant (BCHI) were included in the study. Unaided and aided pure-tone air conduction (AC) and bone conduction (BC) thresholds, as well as speech tests in quiet and noise, were recorded at baseline and in two different settings: with a BCHI mounted on SoundArc ® and with their own BCHAs mounted on eyeglasses using two couplers. Participants completed questionnaires in both conditions, including the International Inventory for Hearing Aids (IOI-HA), the Hearing Handicap Inventory for Adults/Elderly (HHIA/E), the Speech, Spatial, and Qualities of Hearing Scale (SSQ), a 10-point visual analog scale (VAS), and the Fatigue Impact Scale (FIS)., Results: A significant functional gain was observed in both settings ( p = 0.0001). Better speech perception in quiet and noise was observed with SoundArc compared to conventional BCHAs on eyeglasses (improvements in word repetition scores in noise: +19.3 at SNR +10 dB, p = 0.002; +12.1 at SNR 0 dB, p = 0.006; and +11.4 at SNR -10 dB, p = 0.002). No significant differences were found in IOI-HA, FIS, and HHIA/E scores. However, significantly better SSQ scores were reported for SoundArc in all domains ( p = 0.0038)., Conclusions: Although patients were accustomed to using BCHAs mounted on eyeglasses, the bone conduction wearable option of the BCHI (SoundArc) proved to be a viable alternative for adult patients with conductive or mixed hearing loss who are unable or unwilling to undergo BCHI surgery.

Background and Aim: Noonan syndrome (NS) is a congenital disorder characterized by a wide heterogeneity in clinical and genetic features. Hearing loss can frequently occur in NS, although not always mentioned in its diagnostic criteria. We are reporting on a child with an established NS who underwent bilateral cochlear implantation (CI) in the setting of cochlear nerve deficiency., Case Presentation: We present the case of a child-girl affected by NS. Newborn hearing screening and audiological evaluations reveled an asymmetric sensorineural hearing loss (SNHL), profound at left ear and severe at right ear. Hearing aids were fitted at the age of six months. Brain magnetic resonance imaging showed hypoplastic cochlear nerves. Due to progressive worsening of the hearing thresholds and inappropriate speech development, at the age of 2 years she underwent a left-sided cochlear implantation. Four years later, right ear was also implanted. Six years after the first surgery, a partial extrusion of the electrode array was noticed. Explantation and reimplantation of a new device was performed, adopting a subtotal petrosectomy approach. The patient reached a score of 95% in open-set speech perception tests., Conclusions: Hearing loss is a frequent finding in patients with NS; however, its nature and severity are very heterogenous. In consideration of the possible progression of SNHL, audiological follow-up in NS patients must be carefully and periodically performed so as to early detect worsening of hearing threshold. If indicated, cochlear implantation should be considered, taking account of audiological and systemic features of this syndrome.

Purpose: To report our experience in performing cochlear implantation under local anesthesia in a group of patients who were deemed unfit for general anesthesia., Methods: A retrospective chart review was performed to analyze undesirable events and any other discomfort complained by patients during cochlear implantation. Analysis of patient's satisfaction was performed by means of a survey instrument. We have also compared the duration of surgery and hospitalization time with a control group that was implanted under general anesthesia., Result: Twenty-one cochlear implantation in 20 patients were performed under local anesthesia. Age of patients ranged from 38 to 85 years. All interventions were successfully completed without any conversions to general anesthesia. Discomfort during surgery was reported in five cases: vertigo triggered by electrode insertion in two patients, pain during the round window approach in two patients and distress during the use of drill in one case; no patient experienced agitation. During the postoperative period, no complications or unpleasant experiences were reported. Only two patients stated that they would not perform cochlear implantation again under local anesthesia. Lower duration surgery and hospitalization time were found in the local anesthesia group., Conclusion: Local anesthesia with conscious sedation is a safe and effective alternative for cochlear implant candidates considered unfit for general anesthesia. Fundamental for a successful procedure are preoperative counselling, accurate selection of the patients and constant intraoperative assistance. Unfeasibility of facial nerve monitoring and minor detrimental effect on training are the principal disadvantages in performing cochlear implantation under local anesthesia., (© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To describe Otolaryngologists' perspective in managing COVID-19 patients with acute respiratory distress syndrome (ARDS) requiring tracheostomy in the ICUs during the pandemic peak in a dramatic scenario with limited resources., Setting: Tertiary referral university hospital, regional hub in northern Italy during SARS CoV 2 pandemic peak (March 9th to April 10th, 2020)., Methods: Technical description of open bedside tracheostomies performed in ICUs on COVID-19 patients during pandemic peak with particular focus on resource allocation and healthcare professionals coordination. A dedicated "airway team" was created in order to avoid transportation of critically ill patients and reduce facility contamination., Results: During the COVID-19 pandemic, bedside minimally invasive tracheostomy in the ICU was selected by the Authors over conventional surgical technique or percutaneous procedures for both technical and operational reasons. Otolaryngologists' experience derived from direct involvement in 24 tracheostomies is reported., Conclusions: Tracheostomies on COVID-19 patients should be performed in a safe and standardized setting. The limited resources available in the pandemic peak required meticulous organization and optimal allocation of the resources to grant safety of both patients and healthcare workers.

The current video presents the surgical management of a middle ear osteoma through a retroauricolar endocanalar approach, under local anesthesia. The video contains patient's medical history, pre-operative radiological evaluation, surgical approach to the lesion and clinical follow up., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The persistence of human bactericidal activity (hSBA) responses in adolescents was assessed 22 months after vaccination with one dose of Menveo® (MenACWY-CRM; Novartis) or Menactra® (MCV4) (sanofi pasteur). The proportion of subjects with hSBA titers ≥8 was significantly higher among recipients of MenACWY-CRM than MCV4 for serogroups A, W-135 and Y.

Aim: The radiographic method remains the main imaging technique for the physiological, anatomical and possibly pathological analysis of the spine thanks to its ease of use, precision and reliability. Despite this, the technique is inadequate for functional and dynamic studies. This paper aims to apply a dedicated noninvasive methodology based on optoelectronic techniques for the functional evaluation of the lumbar spine., Methods: A reference data set for typical movements (i.e. flexion/extension, lateral bending, axial rotation) of the lumbar spine has been developed. Twenty healthy subjects have been recruited (10 males and 10 females) to create the databases of healthy subjects; one subject who suffers from lumbar spine diseases has been analyzed and his mobility has been compared to healthy subjects., Results: Two databases have been created: in the former, the entire movement is normalized in time with respect to its duration; in the latter, all movements are classified in characteristic phases and each single phase is normalized to a defined duration. These databases include both the global movement of the lumbar tract of the spine and the movement of the single functional units (2 vertebrae, the intervertebral disk and the intervening surrounding soft tissues). Moreover, these databases are divided into male and female databases according to the natural differences in range of motion and pattern of movement. A clinical application for pathologic subjects is shown demonstrating the applicability and usability of this protocol., Conclusion: This method allows to assess both the quality and the quantity of lumbar spine movement (both global and metameric level) of the subject and to distinguish the patient from the healthy subject.

We used digital-CranioCorpoGraphy (dCCG) to document whiplash effects on head-on-trunk stabilization while subjects walked on the spot (Fukuda test). Twenty-five healthy subjects were compared with 33 whiplash patients. Whiplash patients were classified as chronic (more than 6 months after injury) and recent (less than 6 months after injury). Clear differences between healthy subjects and patients were seen and three different strategies were detected. Pattern A appeared similar to normals but quantitative analysis showed significant differences with paradoxical head over-stabilization (collar-effect); pattern B decreased head stability; pattern C decreased head stabilization with reduced displacements of the body. Due to the complexity of the data analyzed for each marker, a coefficient of performance (CP) was calculated to simplify the cut-off between normal and pathological tests. CP clearly identified an abnormal stepping pattern. Our findings indicate that firstly dCCG identified a specific vestibular task in whiplash patients, secondly whiplash did not always provoke vestibular involvement and thirdly dCCG could be a tool to discriminate patients with and without vestibular involvement after whiplash.

Aim: The assessment of spine mobility is an important parameter to define its functionality. In the last decades a lot of research has been carried out mainly through radiographic investigations; non invasive methods demonstrated not to be sufficiently accurate, not to allow free movement, not to provide metameric assessment and suitable for everyday clinical practice. The aim of this study is the development of a new experimental non invasive protocol, called Zoom on mobility of the spine (ZooMS) to assess the mobility of lumbar spine, from the 11th thoracic to the sacrum bone and the pelvis, with the possibility of identifying the metameric contribution of each rotation around all the axes correlated to the global movement., Methods: We developed a dedicated non invasive methodology based on optoelectronic techniques for 3D target recording to be applied to the functional evaluation of the mobility of the lumbar spine in young healthy males. Ten subjects participated in the method validation, performing free rotations (flexion/extension, lateral bending and axial rotation) from standing to the maximum excursion and back., Results: The comparison of the range of motion (RoM) with those presented in literature was satisfactory, although some differences were shown (above all in axial rotation, which however gives the minor contribution to the mobility of the lumbar spine). The validation of the protocol was successful in terms of intraoperator, interoperator and circadian remarking, the 3 factors eventually affecting its repeatability., Conclusion: The RoM of the whole lumbar spine and of each functional unit, together with the pattern of movement may so represent an innovative and important aspect in clinical applications.