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Calistri V, Mancini P, Raz E, Nicastri M, Tinelli E, Russo FY, Fiorelli M, De Seta E, Carpentieri D, De Vincentiis M, Caramia F. fMRI in Bell's Palsy: Cortical Activation is Associated with Clinical Status in the Acute and Recovery Phases. J Neuroimaging 2020; 31:90-97. [PMID: 33146926 DOI: 10.1111/jon.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Using functional magnetic resonance imaging (fMRI), we explored cortical activation in patients with acute Bell's palsy (BP) and analyzed its correlates with clinical status in the acute phase, and with 6-month outcome. METHODS Twenty-four right-handed patients with acute BP within 15 days of onset and 24 healthy controls underwent fMRI during performance of unilateral active (hemi-smiling) and passive lip movement tasks with both the paretic and the normal lip. The degree of paresis was evaluated during the acute stage and at the 6-month follow up using the House-Brackmann (HB) grading scale. Complete recovery was defined as HB grade II or less at the end of the 6-month period. The difference in the HB grade (ΔHB) between the acute stage and the 6-month follow up was used to evaluate clinical improvement. RESULTS There were 24 patients with unilateral acute BP. HB grades ranged from III to VI. At 6 months, 11 patients (46%) had completely recovered and 12 (50%) were partially improved. Compared with healthy subjects, BP patients had a significantly greater activation of the frontal areas and the insula ipsilateral to the paretic side. In BP patients, there was an inverse correlation between the activation of the ipsilateral hemisphere when moving the paretic side and the degree of paresis at baseline. An association was also observed between activation and clinical outcome (both complete recovery and ΔHB). CONCLUSIONS In patients with BP, fMRI may represent a useful tool to predict long-term outcome, guide therapeutic approach, and monitor treatment response.
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Affiliation(s)
- Valentina Calistri
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | | | - Eytan Raz
- Department of Radiology, Neuroradiology Unit, New York University School of Medicine, New York, NY
| | - Maria Nicastri
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Emanuele Tinelli
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | | | - Marco Fiorelli
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | - Elio De Seta
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Daniele Carpentieri
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
| | | | - Francesca Caramia
- Department of Human Neurosciences, Neuroradiology Unit, Sapienza University, Rome, Italy
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Dincer D’Alessandro H, Ballantyne D, De Seta E, Musacchio A, Mancini P. Adaptation of the STARR test for adult Italian population: A speech test for a realistic estimate in real-life listening conditions. Int J Audiol 2016; 55:262-7. [DOI: 10.3109/14992027.2015.1124296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mancini P, Dincer D'Alessandro H, Guerzoni L, Cuda D, Ruoppolo G, Musacchio A, Di Mario A, De Seta E, Bosco E, Nicastri M. Adequate formal language performance in unilateral cochlear implanted children: is it indicative of complete recovery in all linguistic domains? Insights from referential communication. Int J Pediatr Otorhinolaryngol 2015; 79:598-604. [PMID: 25724630 DOI: 10.1016/j.ijporl.2015.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 01/11/2015] [Accepted: 02/03/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Referential communication (RC) is a key element in achieving a successful communication. This case series aimed to evaluate RC in children with unilateral cochlear implants (CIs) with formal language skills within the normal range. METHODS AND MATERIALS A total of 31 children with CIs, with language development within the normal range, were assessed using the Pragmatic Language Skills test (MEDEA). RESULTS Of the children with CIs, 83.9% reached performance levels appropriate for their chronological ages. The results confirmed a positive effect of cochlear implantation on RC development, although difficulties remained in some CI users. CONCLUSIONS The outcomes emphasize the need to pay greater attention to the pragmatic aspects of language, assessing them with adequate testing in the early phase after cochlear implantation. Clear knowledge of children's communicative competence is the key in optimizing their communicative environments in order to create the basis for future successful interpersonal exchanges and social integration.
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Affiliation(s)
- Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy.
| | - Hilal Dincer D'Alessandro
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
| | - Letizia Guerzoni
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital, Via Cantone del Cristo 40, 29121 Piacenza, Italy
| | - Domenico Cuda
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital, Via Cantone del Cristo 40, 29121 Piacenza, Italy
| | - Giovanni Ruoppolo
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
| | - Angela Musacchio
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
| | - Alessia Di Mario
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
| | - Elio De Seta
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
| | - Ersilia Bosco
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
| | - Maria Nicastri
- Department of Sense Organs, Sapienza University of Rome, Viale dell'Università 31, 00161 Rome, Italy
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Attanasio G, Leonardi A, Arangio P, Minni A, Covelli E, Pucci R, Russo FY, De Seta E, Di Paolo C, Cascone P. Tinnitus in patients with temporo-mandibular joint disorder: Proposal for a new treatment protocol. J Craniomaxillofac Surg 2015; 43:724-7. [PMID: 25868942 DOI: 10.1016/j.jcms.2015.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 11/13/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022] Open
Abstract
The present study was designed to verify the correlation between tinnitus and temporomandibular joint dysfunction.86 consecutive patients were enrolled in the study, all affected by subjective tinnitus without hearing impairment, from both genders, age between 18 and 60 years old. The final number of patients included in the study was 55. All patients received a temporo-mandibular joint examination. All the patients were asked to rate the severity of their symptoms before and after treatment using a VAS scale and the Tinnitus Handicap Inventory (THI) and they followed a standardized protocol for the investigation of tinnitus. All the subjects were monitored by the same researcher and they underwent the same splint treatment. The comparison between pre- and posttreatment phase scores showed in patients with predisposition of TMD and with TMD a statistically significant decrease of THI and VAS values. The characteristics of tinnitus and the degree of response to treatment confirmed the relationship between tinnitus and TMD. The authors believe that, when the most common causes of tinnitus, such as otologic disorders and neurological diseases are excluded, it is correct to evaluate the functionality of the temporo-mandibular joint and eventually treat its pathology to obtain tinnitus improvement or even resolution.
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Affiliation(s)
- Giuseppe Attanasio
- Dipartimento Organi di Senso, "Sapienza" Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Alessandra Leonardi
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, "Sapienza" Università di Roma, Via Caserta 6, 00161 Roma, Italy.
| | - Paolo Arangio
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, "Sapienza" Università di Roma, Via Caserta 6, 00161 Roma, Italy
| | - Antonio Minni
- Dipartimento Organi di Senso, "Sapienza" Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Edoardo Covelli
- Dipartimento Organi di Senso, "Sapienza" Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Resi Pucci
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, "Sapienza" Università di Roma, Via Caserta 6, 00161 Roma, Italy
| | - Francesca Yoshie Russo
- Dipartimento Organi di Senso, "Sapienza" Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Elio De Seta
- Dipartimento Organi di Senso, "Sapienza" Università di Roma, Viale del Policlinico 155, 00161 Roma, Italy
| | - Carlo Di Paolo
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, "Sapienza" Università di Roma, Via Caserta 6, 00161 Roma, Italy
| | - Piero Cascone
- Dipartimento di Scienze Odontostomatologiche e Maxillo-Facciali, "Sapienza" Università di Roma, Via Caserta 6, 00161 Roma, Italy
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Filipo R, Attanasio G, Russo FY, Cartocci G, Musacchio A, De Carlo A, Roukos R, De Seta E, Di Tillo G, Viccaro M, Sarnacchiaro P, Covelli E. Oral versus Short-Term Intratympanic Prednisolone Therapy for Idiopathic Sudden Hearing Loss. Audiol Neurootol 2014; 19:225-33. [DOI: 10.1159/000360069] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/23/2014] [Indexed: 11/19/2022] Open
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Filipo R, Attanasio G, De Seta E, Viccaro M. Post-operative Herpes simplex virus encephalitis after surgical resection of acoustic neuroma: a case report. J Laryngol Otol 2011; 119:558-60. [PMID: 16175983 DOI: 10.1258/0022215054352243] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Herpes simplex virus (HSV) encephalitis is a life-threatening consequence of HSV infection of the central nervous system. Although HSV encephalitis is rare, mortality rates reach 70 per cent in the absence of therapy and only a minority of individuals return to normal function. Antiviral therapy is most effective when started early, necessitating prompt diagnosis.A case of atypical HSV encephalitis is reported. The appearance of a strong headache followed by impairment of consciousness and hypertone of arms and legs complicated the post-operative course in a 33-year-old patient who underwent surgical removal of an acoustic neuroma. Several brain magnetic resonance imaging (MRI) and computed tomography scans performed in the first week after onset of symptoms of infection did not establish a proper diagnosis. Diffusion-weighted MRI detected brain abnormalities on the fourth day after onset of symptoms, and polymerase chain reaction identification of HSV 1 DNA confirmed the diagnosis. A positive prognosis was achieved due to the decision to start specific, high-dose antiviral therapy based on clinical suspicion, before a firm diagnosis was established.
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Affiliation(s)
- Roberto Filipo
- Department of Neurology and Otolaryngology, University La Sapienza, Rome, Italy.
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Filipo R, D'Elia C, Covelli E, Bertoli GA, De Seta E, Manganaro F, Mancini P. Haematoma after cochlear implantation: management of a minor complication. Acta Otolaryngol 2010; 130:108-13. [PMID: 19452335 DOI: 10.3109/00016480902939657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS The dimensions of the implant receiver and the material used have influenced the surgical approach leading to a reduction in complications. Ultrasonography of the haematoma is useful in the evaluation of dimensions, entity of fluid component and therapeutic options. OBJECTIVE Haematoma arising in the receiver area is considered a minor complication, nevertheless it can be complicated by infection and/or flap necrosis or fibrosis leading to difficulties in magnetic adherence of the receiver and rarely to explantation of the receiver. The objective of the study was to evaluate the clinical outcome of postoperative haematoma arising after cochlear implant surgery. PATIENTS AND METHODS This was a retrospective case series of 22 cochlear implant patients who developed post-implant haematoma over the receiver area. Haematoma extension and fluid collection were analysed via ultrasonography, implant type and predisposing factors such as trauma, coagulation disorders and type of skin incision. RESULTS Patients were divided into four groups on the basis of the main predisposing factor: coagulation disorders (n=7), trauma (n=3), revision surgery (n=6) and haematoma of unknown origin (n=6). The main factors correlated to haematoma onset were coagulation disorder, type of skin incision and flap revision. In all, 21 subjects had complete recovery and the speech perception performance was not compromised over time, while 1 subject (0.3%) with an extensive haematoma due to a pharmacologically induced coagulation disorder required explantation of the device.
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Affiliation(s)
- Roberto Filipo
- Dipartimento di Neurologia ed Otorinolaringoiatria, Università La Sapienza di Roma, Policlinico Umberto I, Rome, Italy.
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Bernardeschi D, Bertoli GA, Seta ED, Bava G, Minni A, Filipo R. A new integrated system for neural stimulation and bipolar coagulation: preliminary study. Acta Otolaryngol 2009; 129:214-6. [PMID: 18607982 DOI: 10.1080/00016480802078093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION The proposed device can be useful for promoting safety during bipolar coagulation in many surgical procedures and/or regions. OBJECTIVE A new system that integrates a neural stimulator and a bipolar coagulator is proposed, to improve neural (facial nerve) safety during ENT surgical procedures. This study aimed to evaluate the system. MATERIALS AND METHODS A home-made constant current neural stimulator (0.1-2 mA, pulsed, duration 200 micros), was connected via an automatic switch to a commercial bipolar microcoagulator (Medicon Instrumente mod. 101, Germany). Under general anesthesia, the extra-petrous portion of the facial nerve was identified in three rabbits. The adequate functioning of the device was tested via: 1) neural stimulation and EMG monitoring in basal conditions; 2) bipolar coagulation of connective tissue surrounding the facial nerve; 3) final assessment of the functional integrity of the nerve, via an intraoperative EMG and a postoperative evaluation. RESULTS Data obtained from all three rabbits provided adequate results in terms of neural stimulation, correct coagulation of juxta-nervous tissue, and functional integrity of the facial nerve, both intraoperatively and postoperatively.
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Filipo R, D'Elia C, Covelli E, Bertoli GA, De Seta E, Manganaro F, Mancini P. Haematoma after cochlear implantation: management of a minor complication. Acta Otolaryngol 2009. [DOI: 10.1080/00016480902939657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
OBJECTIVE To identify patients developing positional vertigo after cochlear implantation. STUDY DESIGN Prospective study on a cohort of patients undergoing cochlear implantation. SETTING Academic tertiary referral center. PATIENTS The study included 70 consecutive patients who underwent vestibular evaluation before and after cochlear implantation. INTERVENTION Medical record review. MAIN OUTCOME MEASURE Recorded vestibular symptoms after cochlear implantation. Patients with positional vertigo were considered case subjects, whereas those without vestibular symptoms were considered case controls. RESULTS Benign paroxysmal positional vertigo (BPPV) occurred in 8 patients (on the cochlear implant [CI] side in 7 patients, and in the other ear in 1). One patient had BPPV of the lateral semicircular canal on the implanted side, and 7 patients had BPPV of the posterior semicircular canal (on the same CI side in 6 patients, and on the opposite side in 1), which were detected and presented during the last examination. In 5 patients, the onset of symptoms varied from 7 to 130 days after implant activation; in 2 patients, the onset occurred before activation. CONCLUSION Three different mechanisms are proposed for the occurrence of BPPV in patients with CI. The first focuses on the fall of bone dust particles into the cochlea during cochleostomy. In the second, the vibration caused by drilling the cochlea would be sufficient to dislodge otoconia into the labyrinth. The third hypothesis suggests dislodging of an otolith because of the electric stimulation. In our patients, conservative approaches have been used with a minimal invasive cochleostomy and without perilymph suction. Thus, the vibratory trauma affecting the cochlea during cochleostomy seems to play a fundamental role in the development of paroxysmal vertigo in patients with implant.
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Affiliation(s)
- Marika Viccaro
- E.N.T. Department, The University La Sapienza, Rome, Italy.
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