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Pneumolabyrinth is a condition characterised by the presence of air within the inner ear and is a rare complication after cochlear implant surgery. One of the causes of pneumolabyrinth may be the increase in pressure in the middle ear. The use of continuous positive airway pressure (CPAP) is an effective treatment strategy for obstructive sleep apnoea. According to a recent study, the use of CPAP should be delayed by 1 or 2 weeks in subjects undergoing middle ear surgery; however, there is currently no indication to delay the CPAP in subjects undergoing cochlear implant surgery. We report the case of a patient on CPAP who underwent left cochlear implantation and, in the early postoperative period, reported severe vertigo and tinnitus. Cone-beam CT of the temporal bone revealed the presence of pneumolabyrynth. We believe that the use of CPAP should be delayed in subjects undergoing cochlear implantation to avoid the development of acute pneumolabyrinth.

Background and purpose: Clinical outcomes of multiple sclerosis (MS) patients affected by coronavirus disease 2019 (COVID-19) have been thoroughly investigated, but a further analysis on main signs and symptoms and their risk factors still needs attention. The objective of this study was to group together and describe based on similarity the most common signs and symptoms of COVID-19 in MS patients and identify all factors associated with their manifestation. Method: Logistic and linear regression models were run to recognize factors associated with each pooled group of symptoms and their total number. Results: From March 2020 to November 2021, data were collected from 1354 MS patients with confirmed infection of COVID-19. Ageusia and anosmia was less frequent in older people (odds ratio [OR] 0.98; p=0.005) and more in smoker patients (OR 1.39; p=0.049). Smoke was also associated with an incremental number of symptoms (OR 1.24; p=0.031), substance abuse (drugs or alcohol), conjunctivitis and rash (OR 5.20; p=0.042) and the presence of at least one comorbidity with shortness of breath, tachycardia or chest pain (OR 1.24; p=0.008). Some disease-modifying therapies were associated with greater frequencies of certain COVID-19 symptoms (association between anti-CD20 therapies and increment in the number of concomitant symptoms: OR 1.29; p=0.05). Differences in frequencies between the three waves were found for flu-like symptoms (G1, p=0.024), joint or muscle pain (G2, p=0.013) and ageusia and anosmia (G5, p < 0.001). All cases should be referred to variants up to Delta. Conclusion: Several factors along with the choice of specific therapeutic approaches might have a different impact on the occurrence of some COVID-19 symptoms.

Introduction: Noise-induced hearing loss (NIHL) is defined as the sensorineural hearing loss caused by acute acoustic trauma or chronic exposure to high-intensity noises. Exposure to noises can lead to irreversible damage to the inner ear and, consequently, to a permanent shift of the hearing threshold. Police officers are particularly at risk of acute or chronic hearing damages. The aim of this study is to evaluate the hearing loss of police officers in relation to the occupational risk factors and clinical-anamnestic characteristics by collecting and analyzing existing data and evidence available in public databases. Materials and Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses group (PRISMA). Studies were included if they met inclusion and exclusion criteria. Study selection, data extraction, and quality assessment were conducted independently by two researchers. Results: Our initial literature search yielded 29 peer-reviewed articles. Out of 29 papers, only 10 were included in the review, after inclusion and exclusion criteria were applied the. Conclusions: Hypertension, smoking and alcohol intake significantly affect hearing performance. In addition, a history of acoustic trauma, use of ototoxic drugs, exposure to noise in leisure-time activities and failure to use ear protectors are often found in a fair number of subjects. NIHL is also related to the age of the subjects as well as the extent and duration of noise exposure. Furthermore, NIHL is also influenced by shooting practice sessions police officers are required to undertake as well as by the chronic exposure to traffic noise, especially in motorcycle police officers.

A prospective observational study was conducted to evaluate the presence of swallowing, speech and orofacial muscle imbalance (OMI) disorders in patients with adenotonsillar hypertrophy and their regression after surgery. ENT, speech therapist and dentistry examination were conducted before and 12 months after surgery in 78 children between the ages of 2 and 12 with dysphagia, speech disorders and OMI adenotonsillar hypertrophy related with sleep-disordered breathing. Of the 78 patients enrolled, 62 underwent adenotonsillectomy, 9 adenoidectomy and 7 volume reduction of the palatine tonsils with a 12-month post-operative increase in SWAL-QOL score, weight gain, correction of ogival palate, dental crowding and tongue posture and consequent resolution of phono-articulatory disorders. All patients show an improvement in swallowing, phono-articulatory disorders’ symptoms and OMI correction at 12-month evaluation.

Introduction: Nasal packing is a common procedure used to ensure haemostasis after nasal surgery. Materials and Methods: A prospective, randomized, controlled and double-blinded study was conducted on 80 consecutive subjects to investigate whether using Nasal Dressing Sponge® (NDS) instead of simple Merocel® might improve patients' postoperative experience of nasal packing. Results: During the stay of the tampons no differences were noticed between the two groups as regards the postoperative pain. When it comes to pain during the packing removal, patients complained of worse symptoms in the side packed with Merocel. There was no bleeding after the removal of Merocel, whereas 5,6% patients were subject to some bleeding when NDS was removed. Conclusion: Merocel and NDS gave similar results regarding haemostatic activity. Nasal Dressing Sponge could decrease pain during the removal of the nasal pack, while it could be associated to a bigger incidence of mild bleeding after removing the pack.

The American Academy of Sleep Medicine and the American Academy of Otolaryngology–Head and Neck Surgery recommend surgery as an option for the treatment of OSAS, when noninvasive treatments such as CPAP or oral appliances have not been successful or are not tolerated. A gradual and logical approach must be taken into account when a patient seeks a surgical solution, and it is a fundamental requirement that the patient find a surgeon who understands both the pathophysiology of sleep apnea and anatomy of the upper airways (UA) to guarantee the best chances of success. The surgical options aim to solve the obstructive problem according to two ways, the first is the reduction of the content, and then acts through the volumetric reduction of soft tissues at the level of UA, most often at the level of palate, uvula, tonsils, adenoids and tongue. The second option aims at enlarging the container, and therefore on more complex interventions to adapt the bony structures of the skull. The soft palate in the snore-surgery is the anatomical site on which most of the attention has always been concentrated since it is responsible for most of the phenomena of snoring and most of the obstructive ones and has undergone the greatest innovations. The rationale for palatal surgery is to reduce volume and stiffen a structure that vibrating with the passage of air causes snoring and collapsing causes an obstruction of the UA. In general, interventions on the palate can be broadly divided into two groups, the first is represented by interventions that have the aim of reduce snoring, and in this case are less invasive surgeries, as the goal is that of stiffening the palate and reducing the excess mucosa that vibrating causes snoring. The second group consists of interventions that have the aim of reducing above the snoring especially the apnoic episodes, so they are interventions that have a greater invasiveness, since they must stiffen and reconstitute the functionality of a segment of the UA.

The Ewing's sarcoma Family of Tumors (EFT) includes classic Ewing's Sarcoma (ES) of bone, Extraskeletal Ewing's Sarcoma (EES) and malignant peripheral primitive Neuroectodermal Tumor (pNET) of bone and soft tissue. ES is an aggressive tumor with a high incidence of local recurrence and distant metastasis. The skeletal form is more common and typically occurs in the long bones of the extremities. The extra skeletal form occurs in the soft tissues of the lower extremities, paravertebral tissues, chest wall, retroperitoneum and rarely in the head and neck region in about 1-4% of cases. Involvement of the head and neck is usually identified in the nasal or oral cavities, sinuses or soft tissues of the neck.

The Ewing's sarcoma Family of Tumors (EFT) includes classic Ewing's Sarcoma (ES) of bone, Extraskeletal Ewing's Sarcoma (EES) and malignant peripheral primitive Neuroectodermal Tumor (pNET) of bone and soft tissue. ES is an aggressive tumor with a high incidence of local recurrence and distant metastasis. The skeletal form is more common and typically occurs in the long bones of the extremities. The extra skeletal form occurs in the soft tissues of the lower extremities, paravertebral tissues, chest wall, retroperitoneum and rarely in the head and neck region in about 1- 4% of cases. Involvement of the head and neck is usually identified in the nasal or oral cavities, sinuses or soft tissues of the neck. Primary Ewing's sarcoma of the base of tongue is exceedingly rare and here it is described its diagnosis and treatment.

Recurrent respiratory papillomatosis (RRP) is characterized by exophytic, benign, and papillary lesions infected by the virus in the epithelium of the upper aerodigestive tract. RRP is caused by persistent infection of the respiratory epithelium by human papillomavirus (HPV) HPV6 and-11. The clinical course of RRP is unpredictable, frequently relapsing, and may be lifelong. The aim of this study is to evaluate the efficacy and safety of the use of intralesional Cidofovir in the treatment of RRP.We have selected articles on the use of cidofovir as adjuvant therapy in laryngeal papillomatosis. We reviewed 20 reports that enrolled 185 patients with "adult onset recurrent respiratory papillomatosis" (AORRP) and 85 patients with "juvenile onset recurrent respiratory papillomatosis" (JORRP). We evaluated concentration of cidofovir, number of injections, injection interval, therapeutic response, side effects, and progression to dysplasia.The mean concentration of cidofovir was 7.5 mg/ml at injection. The mean number of injections per patient is 6 with 26 days between injections. The percentage of patients with dysplasia after use of cidofovir is 1.48%. The AORRP response to cidofovir is better with a 74% complete response rate, compared to 56.5% of the JORRP.Intralesion use of cidofovir has a good adjuvant action in RRP increasing the complete remission of the disease. The treatment does not increase the risk of laryngeal dysplasia.

Rehabilitation therapy can be used to treat balance disorders via exercises organized into anatomo-pathological protocols. In general, there is an indication for rehabilitation whenever compensation of a patient’s vestibular system fails to adequately resolve spontaneously. Although the therapeutical indications have expanded over time, it is especially useful to treat balance disorders in neurological patients and those with acute damage to the vestibular system. Specifically, it favors and accelerates spontaneous central compensation in a variety of neurological disorders such as Multiple Sclerosis, Parkinson's disease, cerebellar pathologies or in brain tumors like Vestibular Schwannoma (or Acoustic Neurinoma). The latter is a benign intracranial tumor that affects the acoustic nerve (or cranial nerve VIII), which is concerned with hearing, balance and head position. It represents about 6% of all intracranial tumors, with an incidence of approximately 1 per 100,000 person-years. Affected patients present with a range of symptoms including discomfort, reduced motor capacity and afflictions that lead to functional limitations in the activities of daily life and personal care, especially in performing tasks requiring some degree of postural balance. The aim is to treat them through a series of exercises to be repeated both with the aid of a specialized supervisor and unassisted at home; the treatment is based on proprioceptive and vestibular exercises that progressively improve their quality of life.

Sudden sensorineural hearing loss (SSNHL), identified by Dekleyn in 1944, is a important otological disorder. It is characterized by a hearing loss greater than 30 dB over three consecutive frequencies, in less than 72 hours, with no identifiable etiology. It is a real sensorineural emergency that can become a permanent handicap if not adequately treated. SSNHL has a prevalence of 5-20 in 100,000 inhabitants. Because of patients recovering rapidly or seeking no medical attention, the true figure might be higher. Sudden hearing loss occurs typically between 50 and 60 years of age and the lowest among 20-30. The prevalence of SSNHL is not significantly different between men and women. There are many potential causes of SSNHL, but despite extensive evaluations, the majority of cases elude definitive diagnosis and therefore, remain idiopathic. Reports estimate that the etiology of SSNHL is diagnosed in only 10% of cases. Therapy for SSNHL is a subject of controversy and the unknown etiology justifies heterogeneous therapeutic approaches, on one hand therapies’ aim is to correct the primary risk factors (smoke, diabetes, hypertension, previous viral or bacterial infection), on the other the purpose is to act on the main etiopathogenetic hypotheses (viral infection, immunologic, vascular compromise). Among the many treatments proposed, the glucocorticoids are the most adopted, but with different routes of administration: oral steroid, intratympanic steroid therapy and their combinations. Therefore, it is very important to establish a international therapeutic protocol correlated to subject’s performance status, risk factors, type and degree of hearing loss.

The pseudo-aneurysm is an encapsulated hematoma of post-traumatic origin which is in communication with the lumen of the artery of relevance. We present a rare case of pseudo-aneurysm occurring after superior thyroid trans-esophageal echocardiography (TEE) and external cardioversion. Singular occurrence in otolaryngology, if not recognized early a pseudo-aneurysm can result in dramatic events such cataclysmic bleeding or acute occlusion of the upper airway.

Leptin is a peptide produced by peptidergic cells or those able to process and secrete peptides. Originally, this function was considered proper and exclusive of certain neurons of the magnocellular and parvicellular hypothalamus. These cells originated from a common precursor, namely neural crest cells, which have the ability to produce hormonal neuropeptides. From this primitive neuroectodermal site, cells migrate to other organs: the gastro-entero-pancreatic system (GEP), the lung, heart, reproductive and urinary systems. Leptin is considered the typical neuropeptide with an anorexic function, and is also called the “satiety hormone” because it plays a key role in the control of energy expenditure and food intake. Leptin was identified for the first time in white and brown adipocytes. Although initially thought to be exclusively expressed and secreted by adipocytes, leptin has been identified in other tissues related with nutritional homeostasis, such as gastric and salivary glands. In addition, leptin or its receptors have been observed in gastric, colorectal and breast cancers. It is believed to have a role in stimulating cell proliferation, and is associated with a risk of developing cancer as well as progression and invasiveness. To date, the role of leptin in the development of the carcinoma of the larynx has been poorly investigated. The principal endpoint of this chapter was to evidence the peptidergic immunohistochemical expression of leptin in laryngeal SCCs, its possible role in cell proliferation and the prognostic factor and predictor of locoregional recurrences.

Neural tube defects (NTDs) are a group of congenital malformations of the central nervous system, which derive from an altered embryological development during neurulation. The different types of NTDs are closely related to their onset in the embryonic period; precocity is an index of greater severity of clinical manifestation. The myelomeningocele is one of the most common pathological conditions which is included into the spectrum of NTDs. It is characterized by the lack of fusion of the vertebral arches, resulting in eversion of the meninges and medullary content; it is the condition which clearly needs more assistance in the neonatal intensive care unit. The management of patients with NTDs is divided into different levels and particularly neonatologists have to monitor all the infants’ vital signs, to perform a careful neurological examination for the evaluation of motor and sphincterial functions and to recognize orthopedic abnormalities. Furthermore, concerning the open defects, which maintain a communication between the spinal cord and the outside, it is essential to prevent infections of the central nervous system through a broadspectrum antibiotic therapy. The diagnosis includes x-ray of the spine, which allows to locate the exact level of the vertebral defect and ultrasound scan of the region involved; also magnetic resonance imaging plays a very important diagnostic role. All this exams guarantees to every newborn affected by NTDs a comprehensive care approach, but also useful informations for diagnosis and prognosis.

Temporomandibular disorders (TMD) are musculoskeletal pain conditions characterized by pain in the temporomandibular joint (TMJ) and/or mastication muscles. Patients with TMD are frequently affected by otolaryngological symptoms like tinnitus, with a prevalence ranging from 2% to 59% of cases. There is still a debate in the scientific community about the relationship between tinnitus and TMD and actually the causal connection between them is not well understood. A possible explanation could be found in the ontogenetic development and in the mechanical and neuronal connections of the masticatory system and the middle ear. Additionally a potential role of TMD in tinnitus onset is suggested by the fact that TMD treatment can successfully alleviate or cure tinnitus symptoms.

Tinnitus is not a disease, but rather a symptom or condition characterized by a conscious perception of an unreal sound in the absence of external auditory stimulus. This ontological condition can modify everyday life in different ways: causing distress and annoyance, sleep disruption, anxiety and depression. The World Health Organization (WHO) describes tinnitus as a symptom of hearing disorder characterized by the sensation of buzzing, ringing, clicking, pulsations, grinding, hissing, roaring or other noises in the ear. Even if different treatments exist for “tinnitus-related abnormalities” such as cognitive behavioural therapy and/or sound therapy, no effective pharmacological approach is available, although much research is underway into the mechanism and possible treatments. Furthermore, no drugs are currently approved by the FDA for treatment of spontaneous idiopathic tinnitus, and few drugs reliably suppress or eliminated chronic tinnitus in the majority of patients. A large number of researches have been conducted to evaluate the efficacy of different classes of drugs in alleviating the symptoms of tinnitus. Tricyclic antidepressant, selective-serotonin-reuptake inhibitors, benzodiazepine, anticonvulsant agents, local anesthetics, diuretics, anticoagulants and vasodilators are just some of the drugs that have been taken into account to improve the quality of life and reduce awareness of-and reaction to-tinnitus. In this chapter, current evidence on emerging pharmacological approaches to tinnitus will be described and examined in terms of mechanism of action and effectiveness.

The effects of alcohol have been widely studied during the past century as alcohol abuse is a major health problem in Western society. In the last years, a growing body of evidence indicates that acetaldehyde, the first oxidation product of ethanol, is one of the mediators of peripheral and central effects of ethanol. Indeed, acetaldehyde has been recently taken into account as the mediator of the rewarding properties of alcohol. The role of acetaldehyde in ethanol-related properties has been proved by enzymatic manipulation studies in which the inactivation of acetaldehyde potentially synthesized in the brain produces the same results as blocking the formation of acetaldehyde by inhibiting brain catalase activity. Moreover, electrophysiological and pharmacological analyses showed that acetaldehyde is able to stimulate dopamine release in the nucleus accumbens through enhancement of firing rate, spikes/burst, and burst firing of ventral tegmental neurons. Thus, the aim of this review is to summarize latest results on the role of acetaldehyde as the mediator of ethanol-central effects.

Aim. The aim of this paper was to evaluate anatomical and functional outcomes 5 years after myringoplasty in children affected by perforated eardrum. To analyze the main differences in the frequency of postoperative complications between patients under and over 9 years of age. Methods. One hundred and thirty-two children, aged from 4 to 15 years, who underwent myringoplasty with or without mastoidectomy, were followed for a five-year period after surgery. The cohort was divided in two groups: children from 4 to 9 years old (G1) and patients older than 9 years (G2); all subjects underwent a pre- and post-operatively clinical exam and were evaluated through audiometry and impedenzometry. Adenoidectomy, if necessary, was performed three months before myringoplasty. Results. Of the total 132 children of our cohort, the 32.58% were from 4 to 9 years old (G1) and the 67.42% were older than 9 years (G2). Twenty-five (58.13%) G1 and 2 (2.24%) G2 patients underwent adenoidectomy before myringoplasty (P2 (good-excellent degree) in the 89.36% of G1 and 91% of G2 children (P>0.5). Conclusion. Nevertheless good audiologic outcomes in patients under and over 9 years of age, our study evidenced a different percentages of success after myringoplasty in G1 and G2 groups (P=0.0024). Thus, considering the higher percentage of postoperative complications in children with less than 9 years of age, myringoplasty should be considered cautiously due to the risk of reperforation and/or cholesteatoma.

RAZIONALE L’impianto cocleare è oramai il trattamento di scelta in tutti quei casi di sordità preverbale severa/profonda permettendo di ottenere a distanza di 12 mesi una soglia uditiva amplificata integralmente all’interno dello spettro acustico del parlato. Se ciò è dimostrato ampiamente dalla letteratura, è comunque vero che le aspettative familiari e le performances verbo/acustiche sono altamente variabili. Lo scopo del presente lavoro è quello di identificare tramite un accurato studio del profilo familiare ed individuale, tutte le possibili variabili in grado di influenzare i risultati. MATERIALI E METODI Le variabili oggetto del presente studio sono state suddivise in familiari ed individuali; tra le prime si è valutato: numero di familiari, titolo di studio, livello economico, attività lavorativa, aspettativa familiare; tra i fattori individuali: età al momento della diagnosi di sordità, lunghezza della sordità, patologie associate, utilizzo delle protesi acustiche, terapia riabilitativa (sanitaria/privata), età al momento dell’impianto, tipo di impianto, strategia utilizzata, uso quotidiano dell’impianto cocleare, stimolazione mono/bimodale. RISULTATI Le risposte ottenute dai tracciati audiometrici e dai questionari sulle capacità percettive verbali messe in relazione con il profilo familiare ed individuale hanno evidenziato una correlazione significativa tra alto livello economico, terapia riabilitativa privata, uso quotidiano dell’impianto cocleare e IT-MAIS, CAP e SIR (p>0.05). Di contro, a queste variabili familiari ed individuali sono corrisposte le aspettative familiari pre-impianto più elevate con il rischio pertanto di ‘false aspettative’. CONCLUSIONI Lo studio del profilo familiare e le caratteristiche individuali di un candidato all’impianto cocleare possono essere uno strumento in più da utilizzare come fattori predittivi per non creare delle false aspettative in termini di performance uditive e di intelligibilità nelle famiglie dei soggetti affetti da ipoacusia neurosensoriale bilaterale severa/profonda e candidati all’impianto cocleare.

RAZIONALE La chirurgia della staffa ha visto negli ultimi anni molte innovazioni nel trattamento chirurgico dell'otosclerosi. In particolare, la stapedectomia è stata sostituita sempre più dalla stapedotomia prima con metodo classico e successivamente con metodica invertita, in quanto si ritiene che tali varianti chirurgiche consentano una maggiore riduzione del gap tra via ossea e via aerea per le alte frequenze, una migliore discriminazione vocale oltre che minori complicanze intra e post operatorie. Lo scopo del presente studio è stato quello di confrontare i risultati della stapedotomia con la stapedectomia nei pazienti affetti da otosclerosi e in particolare il miglior recupero uditivo e l'insorgenza di complicanze intra e post-operatorie. MATERIALI E METODI Le variabili oggetto del nostro studio sono state: il sesso, l'età, la familiarità. I pazienti sono stati sottoposti a timpanometria e a audiometria tonale pre-operatoria e post-operatoria a distanza di 2 mesi dall'intervento. Le soglie uditive per la via aerea sono state ottenute per le frequenze 250-8000 Hz, mentre le soglie uditive per la via ossea sono state ottenute per le frequenze 250-4000 Hz. La soglia media (PTA) è stata calcolata per le frequenze 0.5, 1, 2, e 4 kHz ed è stato calcolato il gap tra la soglia media della via aerea e ossea. Infine si è valutata la presenza di acufeni e vertigini post-operatorie. Il confronto tra le due tecniche chirurgiche è stato eseguito tramite test χ2 a un livello di significatività P < 0.05 per ognuna di queste variabili. RISULTATI I pazienti trattati con stapedotomia dimostrano risultati in termini di valori audiometrici migliori per la frequenza 4 kHz per la via aerea ed una riduzione del gap tra la via aerea e la via ossea per la stessa frequenza (p < 0.05) . L' insorgenza di acufeni e vertigini post-operatorie è ridotta in seguito a intervento di stapedotomia, anche se i risultati ottenuti non sono statisticamente significativi, probabilmente perchè la presenza di queste due complicanze dipende anche dai materiali protesici utilizzati e dall'esperienza del chirurgo. CONCLUSIONI La stapedotomia, attualmente, sembra essere l'intervento di scelta rispetto alla stapedectomia, non solo per i migliori risultati audiometrici ottenuti per la frequenze acute ma anche per la minore incidenza di complicanze post-operatorie. Di contro la stapedectomia è un intervento imprescindibile qualora vi sia una totale compromissione della staffa o frattura della platina intraoperatoriamente.

The goal of this work was to study if patients suffering from tinnitus, that affects 14.5% of Italian people, are more susceptible to psychological distress than those who are not affected by tinnitus; to evaluate the prevalence of psychopathological disorders among the cohort, their relationship with the severity of tinnitus and eventual correlation between the distress caused by tinnitus and age of patients. 191 cases and 237 controls were enrolled between 2009-2011. Cases were 80 females and 111 males with mean age of 48.06. Controls were 106 females and 131 males with mean age of 47.09. Overall subjects completed Symptom CheckList-90 R (SCL 90-R) and some brief questionnaire about audiological history while Tinnitus Handicap Inventory (THI) was compiled by cases. Our study indicates that there is a significance correlation between tinnitus and psychopathological disorders, especially with anxiety (χ2=8.08; p=0.004) and sleep disturbance (χ2=38.85; p=0.0001) and there is a slight correlation between higher THI score and lower age subjects (r=0.76). Especially causing working impairment, the highest correlation resulted for ages 25-50 (r=0.96).

Seventy-eight consecutive subjects, 43 males and 35 females, ranging from 43 to 87 years of age suffering from dizziness and/or tinnitus due to vertebrobasilar insufficiency without other central nervous system diseases were treated with fixed combination of cinnarizine and dimenhydrinate two times a day and for two months. Data were collected considering the following parameters: age, sex, vestibular symptoms (unsteadiness, staggering, tendency to fall, swaying, vertigo due to change of position, bowing, walking, eye movements), headache, tinnitus, impaired hearing and aural fullness. Patients evaluated their vertigo symptoms and/or tinnitus intensities using a graded 3- point visual analog scale ranging from I (no symptoms) to 3 (strong symptoms) and their impact of life with classical tinnitus handicap inventory (THI) and dizziness handicap inventory (DHI) at first appointment, during the treatment and after therapy. The results of THI and DHI evidenced a statistical significant improvement either for tinnitus (t = 3.57; p

Upper respiratory tract infection (URTI) is a nonspecific term used to describe acute infections involving the nose, paranasal sinuses, pharynx and larynx and resulting from interplay between microbial load (viral and bacterial) and immune response. Infant and young children are prone to developing upper respiratory tract infections, which often result in bacterial complications especially acute otitis media because of the passage of bacteria (colonizing the nasopharynx) in the middle ear via Eustachian tube.

The minimally invasive sinus technique, (MIST) is different from minimally invasive sinus surgery. MIST implies a treatment philosophy and surgical model that is quite different from functional endoscopic sinus surgery (FESS). The goals of this article are to discuss the origins of functional sinus surgery as it relates to the evolution of FESS and MIST, define MIST as a philosophy and surgical model, discuss treatment of surgical sinus disease, and challenge the rationale for our departure from Messerklinger's "functional" concepts into what will be referred to as "contemporary FESS. " Many authors address the reduced revision rate (compared with FESS) following initial intervention with MIST, the potential to markedly reduce the rate of intranasal synechiae, and the reduction in immediate postoperative morbidity.

Postural control is a polisensory system based on the synergism of visual, proprioceptive (kinaesthetic), auditory and labyrinthic (both otolithic and canalar) inputs. Each individual, according to age, organizes different somatosensorial strategies in order to manage postural control. Therefore the prevalence of visual, auditory, proprioceptive and labyrinthic input management varies from subject to subject during growth. It is known that during the first year of age, before the achievement of an erect posture, this latter is mainly managed according to auditory and labyrinthic stimuli, whereas once the bipodalic stance is achieved, afferent proprioceptive information from the foot and from the paravertebral muscles become the main stimuli for static postural control and visual input for dynamic postural control. This shift depends on the development of anatomical and physiological systems. Because of the anatomical contiguity of the phonoreceptor and the vestibular organs, auditory inputs can influence postural control in the form of a wave of disturbances which affects the vestibular system and general postural control. In addition, afferent auditory pathways synapse to the inferior colliculus in the mesencephalon that through the anterior tectospinal tract together to the superior colliculus, that receive visual inputs, synapse to the superior olivary complex that through the olivocerebellar tract synapses in the cerebellum, that is the organ mainly responsible for postural control. Therefore, the aim of this work will be to elucidate the role of sounds in postural control.

Respiratory tract infections are the most common diseases in childhood. The respiratory tract, widely branched system of ducts, is particularly exposed to the action of microorganisms transmitted by air from here the high frequency of infections they face especially in the first years of life. It is usual distinguish: upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI). In particular, in infections of the upper airways, the inflammatory process, result of the interaction between microbes and the immune response, can be localized to the mucosa of the nose or sinuses (common cold and sinusitis), or the pharynx or larynx (pharyngotonsillitis and laryngitis) and it has predominantly a viral etiology although occasionally it may be followed by bacterial complications such as otitis media. The aim of the following article is the description of these different clinical pictures, highlighting the clinical and epidemiological features and current management guidelines.

Complex congenital malformations, associated in 30% of cases with mental retardation, recognize different etiologies: environmental causes, mendelian disease, chromosomal abnormalities, imprinted anomalies. Frequently complex congenital disorders are rare diseases. Rare diseases are infrequent pathological conditions (prevalence in the general population of less than 1/2.000 live births1), and often poorly understood. Because of their rarity these morbid conditions often either go undiagnosed or are diagnosed late with a negative impact for both the affected person and the family. The birth prevalence is high (2-4% of all births). The diagnosis is essential to program complex and integrated care interventions (follow-up programs aimed at early detection of any disease associated with different syndromes) and to carry out proper genetic family counseling (risk of recurrence, prenatal diagnosis, detection of heterozygotes etc).

Infants admitted to the neonatal intensive care unit (NICU), who represent the 4-8% of all births, present problems such as prematurity, low Apgar scores, infections, hyperbilirubinemia and hearing impairment. In particular significant hearing loss is the most common disorder at birth, occurring in 1 to 2 newborns per 1000 in the general population and 24% to 46% of newborns who are admitted to a NICU. This leads more difficulty to develope verbal skills (learning vocabulary, grammar, word order and idiomatic expressions), language, learning and speech. Hearing impairment influences also cognitive and affective development of infants making consequences in their interpersonal relationships. Joint Committee on Infants Hearing (JCIH) identified many risk factors in NICU infants like as prolonged mechanical ventilation, asphyxia, low birth weight and ototoxic medication and therefore the first step for early diagnosis of hearing loss is identify these factors. Second step is to plan a correct screening strategy. Screening procedures to detect hearing impairment may be divided into two categories: behavioral and electrophysiological. Behavioral techniques produce a high number of false-negative results due to the relative subjectivity of the assessment and difficulty in detecting mild or unilateral hearing loss. Electrophysiological procedures have greater sensitivity and specificity and include measuring the following: auditory brainstem responses (ABR), automated auditory brainstem responses (AABR), and evoked otoacoustic emissions (EOAE). In this chapter will analyze the prevalence of the risk factors in NICU infants most often associated with hearing loss and the screening methods to arrive as soon as possible an early diagnosis.

Newborn babies who need intensive medical care are often sheltered into a special area of the hospital called Neonatal Intensive Care Unit (NICU). In this structure, babies are regularly subject to conditions that would be considered harmful by older children and adults. In the last years, many clinical researches have paid particular attention to effectiveness of various pharmacological therapies, regularly used in neonatal intensive care that have sharply reduced mortality of newborn and preterm infants. Although there are many classes of drugs used for the treatment of different diseases (sepsis, pain, seizures, pulmonary hypertension and infection), the fledgling population is more difficult to handle because there are many physiological changes that happen in infants which do not occur at any other time of life. Furthermore, there are many drugs used during the first stage of life, able to induce various toxic effects on the principal organs and apparatus. For example, there are many relationships between amikacina serum levels and central conduction time in brainstem auditory evoked potentials within therapeutic range levels in newborns as index of drug toxicity in brainstem auditory centers in neonatally exposed infants. In this chapter, we will focus mainly on the principal pharmacological strategies used for dealing with neonatal diseases in the Neonatal Intensive Care Unit.