The Validation of the Speech, Spatial and Qualities of Hearing Scale SSQ12 for Native Romanian Speakers with and without Hearing Impairment

BACKGROUND

The perceived impact of hearing loss varies considerably among those affected due to the heterogeneous types of hearing loss, their diverse etiologies, and the different rehabilitation possibilities. Therefore, assessing listening skills in a daily context using questionnaires is essential. This study aimed to investigate the validity and reliability of the adapted version of the Speech, Spatial and Qualities of Hearing Scale 12 (SSQ12) in the Romanian language.

MATERIALS AND METHODS

The SSQ12 is a 12-item self-reporting questionnaire that assesses a range of everyday listening situations. The internal consistency, test-retest reliability, and validity of the r-SSQ12 questionnaire resulting from the adaptation of the original scale were investigated.

RESULTS

The responses of 183 subjects aged between 11 and 79 years were evaluated. In total, 121 subjects had hearing loss (19 adolescents), and 62 subjects had normal hearing (11 adolescents). Significant differences were observed in the means of the overall score and for individual items between normal-hearing subjects and subjects with hearing loss. The SSQ12 had high internal consistency (Cronbach's alpha = 0.97), and the test-retest scores were highly correlated.

CONCLUSIONS

The SSQ12 scale can be used to investigate the self-reporting of hearing quality in both general populations to identify hearing disorders and populations with hearing loss.

Serous otitis media: Clinical and therapeutic considerations, including dexamethasone (C22H29FO5) intratympanic injection

Serous otitis media (SOM) occurs in children and constitutes one of the most significant causes of hearing loss in young age, posing as an important risk factor for long-term hearing loss. SOM is underdiagnosed, most frequently in infants, or the appointment to the ENT doctor is delayed due to non-acute symptomatology. The aim of the present study was to assess 285 patients with SOM diagnosed within a two-year span. The etiology and pathology of hearing loss in patients with different age groups were examined. The importance of a clinical examination and tympanometry was emphasized as absolutely necessary for a correct diagnosis. Treatment targeted Eustachian Tube permeabilization for satisfactory long-term middle ear aeration. Nasal drops with vasoconstrictor drugs (phenylephrine) and disinfectant (colloidal silver 1%) were commonly used, but some patients also benefitted from dexamethasone intratympanic injection. Patients were evaluated at the end of the treatment and follow-up occurred at one month, one year and three years later.

Characteristics of the intestinal microbiome in ankylosing spondylitis

The importance of intestinal microbiota in the development of various systemic diseases has been highlighted over time. Ankylosing spondylitis (AS) is a systemic disease with a complex pathogenesis involving a particular genetic marker and distinctive environmental triggers such as a specific gut dysbiosis. We conducted a prospective case-control study which included 60 subjects from Iasi Rehabilitation Hospital: 28 AS cases and 32 healthy controls. Intestinal microbiota analysis was performed by real-time polymerase chain reaction (qPCR) in stool samples. We performed the quantitative analysis of gut microbiome, focusing both on anti-inflammatory (Bifidobacterium, Lactobacillus, Faecalibacterium prausnitzii) and pro-inflammatory (Bacteroides, Escherichia coli) species. Overall, intestinal bacterial diversity in the AS group was decreased compared to that noted in the control. A significantly decreased level of Clostridium leptum was observed, associated with an increased level of Escherichia coli. We showed correlations between laboratory tests (liver and kidney functional tests, inflammatory syndrome), the presence of HLA-B27, smoker status, the forms of AS with peripheral arthritis vs. pure axial forms and bacterial structures. No significant correlations were shown for disease activity scores, radiological stage of sacroiliitis or for body mass index. Our findings support that the intestinal microbiome in AS patients has a special signature characterized by an inflammatory status. Numerous environmental, genetical, clinical and paraclinical factors can lead to changes in gut bacterial diversity in these cases.

Hearing rehabilitation after subtotal cochleoectomy using a new, perimodiolar malleable cochlear implant electrode array: a preliminary report

PURPOSE

We here report about the first surgical experience and audiological outcome using a new, perimodiolar malleable cochlear implant electrode array for hearing rehabilitation after subtotal cochleoectomy for intralabyrinthine schwannoma (ILS).

METHOD

Based on a cochlear implant with MRI compatibility of the magnet in the receiver coil up to 3 T, a cochlear implant electrode array was developed that is malleable and can be placed perimodiolar after tumor removal from the cochlea via subtotal cochleoectomy. Malleability was reached by incorporating a nitinol wire into the silicone of the electrode array lateral to the electrode contacts. The custom-made device was implanted in four patients with intracochlear, intravestibulocochlear or transmodiolar schwannomas. Outcome was assessed by evaluating the feasibility of the surgical procedure and by measuring sound field thresholds and word recognition scores.

RESULTS

After complete or partial tumor removal via subtotal cochleoectomy with or without labyrinthectomy, the new, perimodiolar malleable electrode array could successfully be implanted in all four patients. Six months after surgery, the averaged sound field thresholds to pulsed narrowband noise in the four patients were 36, 28, 41, and 35 dB HL, and the word recognitions scores for monosyllables at 65 dB SPL were 65, 80, 70, and 25% (one patient non-German speaking).

CONCLUSION

The surgical evaluation demonstrated the feasibility of cochlear implantation with the new, perimodiolar malleable electrode array after subtotal cochleoectomy. The audiological results were comparable to those achieved with another commercially available type of perimodiolar electrode array from a different manufacturer applied in patients with ILS.

Psychological Profile and Distinct Salivary Cortisol Awake Response (CAR) in Two Different Study Populations with Obstructive Sleep Apnea (OSA) and Central Serous Chorioretinopathy (CSC)

Obstructive sleep apnea (OSA) and central serous chorioretinopathy (CSC) are in terms of nosography different pathologies, however they share a stress-related physio-pathogenetic component, not yet explored in depth. Therefore, the aim of the present study was to ascertain whether OSA and CSC share a common profile, specifically in cortisol production focusing on the cortisol awake response (CAR), the area under curve (AUC_CAR) and the SLOPE_CAR compared with healthy matched controls. Furthermore, standardized self-administered questionnaires were used to identify mental health status related to depression, anxiety and subjective stress perception levels in the study populations. The results showed hypothalamus-pituitary-adrenal (HPA) axis activity anomalies, represented by a flattening CAR in the OSA group and a statistically significant increase in cortisol production in CSC patients at awakening. This disarrangement of the HPA axis activity associated with elevated distress and mental health scores, and its presence in both patients with OSA and patients with CSC, might represent the shared path explaining the stress-related component in these diseases. Further research is needed to investigate the psycho-neuro-endocrinological aspects of OSA and CSC to determine whether psychoeducation on effective stress coping strategies might be of value in improving the quality of life of OSA and CSC patients.

Characterization of Platinum-Based Thin Films Deposited by Thermionic Vacuum Arc (TVA) Method

The current work aimed to characterize the morphology, chemical, and mechanical properties of Pt and PtTi thin films deposited via thermionic vacuum arc (TVA) method on glass and silicon substrates. The deposited thin films were characterized by means of a scanning electron microscope technique (SEM). The quantitative elemental microanalysis was done using energy-dispersive X-ray spectroscopy (EDS). The tribological properties were studied by a ball-on-disc tribometer, and the mechanical properties were measured using nanoindentation tests. The roughness, as well as the micro and nanoscale features, were characterized using atomic force microscopy (AFM) and transmission electron microscopy (TEM). The wettability of the deposited Pt and PtTi thin films was investigated by the surface free energy evaluation (SFE) method. The purpose of our study was to prove the potential applications of Pt-based thin films in fields, such as nanoelectronics, fuel cells, medicine, and materials science.

Targeting Matrix Metalloproteinases in Atherosclerosis and Cardiovascular Dysfunction

Matrix metalloproteinases (MMPs) are the primary mediators of extracellular remodeling and their properties are useful in diagnostic evaluation and treatment. They are zinc-dependent proteases. MMPs have been involved in the mechanisms of atherosclerosis in various arterial areas, ischemic heart disease and myocardial infarction, atrial fibrillation and aortic aneurysms. Recently, MMP9 has been implicated in dyslipidemia and cholesterol synthesis by the liver. Increased MMP expression and activity has been associated with neointimal arterial lesions and migration of smooth muscle cells after arterial balloon dilation, while MMP inhibition decreases smooth muscle cell migration in vivo and in vitro.

Stress-induced Perioperative Depressive Symptoms

Sustained stress has been correlated with increases in cortisol levels and decreased levels of brain transmitters including serotonin or dopamine. As a result of better understanding of human pathophysiology and pain physiology, the fields of surgery and anesthesia have seen major advances in the last years.However, a high percentage of patients develop depressive symptoms following major surgery and pathogenic perspective is very complex and require an holistic approach.

Salivary a-amylase Activity-a Novel Non-Invasive Biomarker in Clinical Pathology

Salivary biomarkers have developed into biological clinical research because they are accessible and easily obtained. Salivary a-amylase was proposed as an associat marker of salivary cortisol in assessing stress and at the same time as a possible non-invasive indicator of autonomic nervous system activation. Studies conducted so far have tested a-amylase activity in psychiatric disorders, diabetic neuropathy, lung disease, and autonomic nervous system activation in hypertension or heart failure.

Uric Acid and NT-proBNP as Biomarkers of Cardiovascular Dysfunction in Hyperthyroidism and Hypothyroidism

The various thyroid axis dysfunctions have cardiovascular consequences both in hyperthyroidism and in hypothyroidism. This cross-sectional study included hyperthyroid and hypothyroid female patients in whom uric acid and NT-proBNP were determined in relation to changes in clinical findings and some echocardiographic parameters. The results of our study suggest that NT-proBNP is a better predictor than uric acid, correlating with left ventricular diastolic dysfunction and systolic blood pressure variations.

Methods for the Quantification of Salivary Cortisol and of a-amylase in Biosensors and Portable Devices

There is an increasing interest in the analysis of salivary biomarkers for medical practice. The objective of this article was to identify the specificity and sensitivity of quantification methods used in biosensors or portable devices for the determination of salivary cortisol and salivary a-amylase. There are no biosensors and portable devices for salivary amylase and cortisol that are used on a large scale in clinical studies. These devices would be useful in assessing more real-time psychological research in the future.

Distinct activation of the sympathetic adreno-medullar system and hypothalamus pituitary adrenal axis following the caloric vestibular test in healthy subjects

INTRODUCTION

The vestibular acute stress induces reversible alert-like reactions that involve the sympathetic adrenal-medullar system and hypothalamic-pituitary-adrenal axis responses. The present study aimed to evaluate salivary α-amylase and salivary cortisol production in relation with cardiovascular reactivity induced by acute stress in healthy subjects.

MATERIAL AND METHODS

Forty-eight young healthy male volunteers were examined under basal conditions and at various times after reaching the maximal nystagmic reaction following air caloric vestibular test. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at the same time as measurement of the salivary α-amylase and salivary cortisol. At the end of the caloric vestibular test session, perceived stress scale questionnaires were administered to measure the self-perceived stress impact induced by the task, and individual scores were compared with those measured on the enrollment day.

RESULTS

Following caloric vestibular test-evoked vertigo, salivary α-amylase and cortisol showed distinct trends in their production after acute stress: Student's t-test was used to compare the α-amylase vs cortisol slopes of the respective interpolated regression lines, and the difference was significant (t = -3.283; p<0.001); an increase in salivary cortisol production corresponded with a decrease in the salivary α-amylase concentration. In addition, salivary biomarker modifications were associated with consistent changes in the heart rate, systolic blood pressure and mean arterial pressure.

CONCLUSIONS

Using the air caloric vestibular test task as a stressor, the present study demonstrated a connection between the acute hormonal stress response to vestibular stimulation and cardiovascular output. However, further research is needed before we can define the potential importance of the consistent cardiovascular activity changes evoked by vestibular stimulation and the possible functional consequences for cardiovascular regulation and orthostatic tolerance in humans.

"Message from a turtle": otitis with Salmonella arizonae in children: Case report

RATIONALE

Salmonella enterica subsp arizonae is a common gut inhabitant of reptiles (snakes are the most common reservoir, but it also occurs in turtles). Alhough human cases owing to this organism are exceedingly rare, it may occasionally infect young infants and immunocompromised individuals with a history of intimate associations with reptiles. Our case is the 20th one among the infections with S arizonae in children, but the 2nd one of otitis and the first of mastoiditis. The other cases had different anatomical locations, such as gastroenteritis, osteomyelitis, meningitis, ankle infection, wound infection, and sinusitis.

PATIENT CONCERNS AND DIAGNOSIS

We report a rare case of otitis with Salmonella in a previously healthy adolescent, which was most likely acquired after bathing in a lake. The ear infection was complicated with mastoiditis. Audiometric testing showed a moderately conductive hearing loss (60 dB on pure-tone average).

INTERVENTION

Standard therapy for S arizonae was initiated. The surgery revealed a "hidden" cholesteatoma. Surgical management comprised of canal wall up mastoidectomy with attico-antrotomy and posterior tympanotomy followed by tympanoplasty.

OUTCOMES

Daily postoperative dressing care of the incision, along with antibiotic lavage of the external auditory canal packing, ensured a favorable evolution. The functional gain was important; the 1-month postsurgical pure tone audiogram indicated nearly normal hearing (a mean of 25 dB for air conduction thresholds).

LESSON

Salmonella enterica serotype arizonae is a rare cause of human infection, being a common organism in reptiles, like snakes and turtles. Young children are at a particular risk for acquiring such infections. Our study might encourage further epidemiologic investigations into these infections to generate a more effective strategy among public health agencies.

Salivary cortisol and α-amylase: subclinical indicators of stress as cardiometabolic risk

Currently, the potential for cardiovascular (CV) stress-induced risk is primarily based on the theoretical (obvious) side effects of stress on the CV system. Salivary cortisol and α-amylase, produced respectively by the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic-adrenomedullary (SAM) system during stress response, are still not included in the routine evaluation of CV risk and require additional and definitive validation. Therefore, this article overviews studies published between 2010 and 2015, in which salivary cortisol and α-amylase were measured as stress biomarkers to examine their associations with CV/CMR (cardiometabolic risk) clinical and subclinical indicators. A comprehensive search of PubMed, Web of Science and Scopus electronic databases was performed, and 54 key articles related to the use of salivary cortisol and α-amylase as subclinical indicators of stress and CV/CMR factors, including studies that emphasized methodological biases that could influence the accuracy of study outcomes, were ultimately identified. Overall, the biological impact of stress measured by salivary cortisol and α-amylase was associated with CV/CMR factors. Results supported the use of salivary cortisol and α-amylase as potential diagnostic tools for detecting stress-induced cardiac diseases and especially to describe the mechanisms by which stress potentially contributes to the pathogenesis and outcomes of CV diseases.

Homeopathic treatment for prolonged postoperative coma: a case report

Coma is the state of unrousable unconsciousness. There are variations in the degree of coma and the findings and signs found on the patient's clinical examination depend on the underlying cause of the disorder. The Glasgow Coma scale evaluates the best motor, verbal and eye answers of the patient. A patient is considered to be in a coma if his Glasgow Coma Scale is below 8 points. The progress that we have made throughout the years has also led to complications that can culminate in a major catastrophe like death, permanent brain damage, coma. A study performed reached the conclusion that prior comorbidity, older age, intraoperative hypotension, and cardiovascular surgery may predispose patients to postoperative coma. The article presents a case of postoperative coma treated successfully with homeopathy. Although a rare complication, postoperative coma is a severe, death-leading condition, causing immense suffering on both the patient and the patient's family. A multidisciplinary and thorough approach is necessary for these patients, but even after a well-conducted therapy, this condition leads to the death of the patient.

Imbalance in the diurnal salivary testosterone/cortisol ratio in men with severe obstructive sleep apnea: an observational study

INTRODUCTION

The complex relationship between sleep disorders and hormones could lead to alterations in the production of cortisol and testosterone in obstructive sleep apnea (OSA) patients.

OBJECTIVE

The purpose of this study was to determine the diurnal trajectories of salivary free-testosterone, free-cortisol and their ratio (T/C).

METHODS

Ten subjects newly diagnosed with OSA, based on nocturnal polysomnography evaluation and excessive daytime sleepiness, and seven matched controls were consecutively recruited. Cortisol and testosterone were measured in salivary samples collected upon awakening, at noon and in the evening. The psychometric evaluation of anxiety/depression and referred sexual function disturbances was performed to evaluate the presence of neuropsychological comorbidities.

RESULTS AND CONCLUSION

The main finding was that OSA subjects displayed hypocortisolism upon awakening and a significant reduction in testosterone concentration in the evening in comparison with the control group, which has maintained the physiological testosterone and cortisol diurnal fluctuation, with higher hormone concentrations in the morning and lower concentrations in the evening. The use of data from multiple diurnal measurements rather than a single point allowed the detection of T/C ratio changes of opposite signs at the beginning and end of the day: the OSA subjects had a higher T/C ratio than the controls in the morning, while their T/C ratio was significantly lower than that of the controls in the evening. The imbalances in the anabolic-catabolic diurnal equilibrium suggest that OSA is associated with a dysregulation of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes, potentially an underlying cause of some of the neuropsychological comorbidities observed in OSA patients.

No definitive evidence for a connection between autoimmune thyroid diseases and stress in women

The purpose of this literature review was to examine the available clinical studies performed during the last 15 years to identify if there is a causal relationship between the onset and course of autoimmune thyroid diseases (AITDs) and the hypothalamic-pituitary-adrenal (HPA) axis/sympathetic-adrenomedullary system (SAM) (dys)function in women. Using the PubMed, Web of Science and Scopus databases, a comprehensive search was performed, and 14 articles were finally identified. The majority of selected studies suggested a causal connection between Graves' Disease (GD) and stress, as well as between Hashimoto Thyroiditis (HT), with its variant postpartum thyroiditis, and stress. However, due to heterogeneity in the protocols, mainly based on the theoretical side effects of stress on the immune-neuroendocrine system, and the different modalities used to establish the impact of stress on individuals, no definitive conclusions could be reached to explain the mechanisms by which stress contributes to the onset of AITDs in women and to determine whether stress management could help in modifying the course of AITDs.

Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine

PURPOSE

The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD).

MATERIALS AND METHODS

Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method.

RESULTS

Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups.

CONCLUSIONS

Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.

Effects and tolerability of betahistine in patients with vestibular vertigo: results from the Romanian contingent of the OSVaLD study

Background and methods

An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD). Endpoints were changes in the Dizziness Handicap Index (primary endpoint), Medical Outcome Study Short-Form 36 (SF-36v2^®), and the Hospital Anxiety and Depression Scale.

Results

During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale). Statistically significant improvements of 12–14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001). Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001) and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001). Betahistine was well tolerated, with only one suspected adverse drug reaction recorded in the Romanian safety population (n=259).

Conclusion

Betahistine 48 mg/day was associated with improvements in multiple measures of health-related quality of life and had a good tolerability profile in these Romanian patients with recurrent peripheral vestibular vertigo.

Prevalence of mutations located at the dfnb1 locus in a population of cochlear implanted children in eastern Romania

OBJECTIVE

Hearing loss is one of the major public health problems, with a genetic etiology in more than 60% of cases. Connexin 26 and connexin 30 mutations are the most prevalent causes of deafness. The aim of this study is to characterize and to establish the prevalence of the GJB2 and GJB6 gene mutations in a population of cochlear implanted recipients from Eastern Romania, this being the first report of this type in our country.

METHODS

We present a retrospective study that enrolled 45 Caucasian cochlear implanted patients with non-syndromic sensorineural severe to profound, congenital or progressive with early-onset idiopathic hearing loss. We performed sequential analysis of exon 1 and the coding exon 2 of the GJB2 gene including also the splice sites and analysis of the deletions del(GJB6-D13S1830), del(GJB6-D13S1854) and del(chr13:19,837,343-19,968,698).

RESULTS

The genetic analysis of the GJB2 gene identified connexin 26 mutations in 22 patients out of 45 (12 homozygous for c.35delG, 6 compound heterozygous and 4 with mutations only on one allele). We found 6 different mutations, the most prevalent being c.35delG - found on 32 alleles, followed by p.W24* - found on 2 alleles. We did not identify the deletions del(GJB6-D13S1830), del(GJB6-D13S1854) and del(chr13:19,837,343-19,968,698).

CONCLUSIONS

Although the most prevalent mutation was c.35delG (80% from all types of mutations), unexpectedly we identified 5 more different mutations. The presence of 6 different mutations on the GJB2 gene has implications in hearing screening programs development in our region and in genetic counseling.

[Binaural cochlear implant--good choice in the treatment of deep sensorinural hearing loss]

Nowadays. cochelar implant is the only choice of treatment in deep bilateral deafness.

AIM

To evaluate the benefits of binaural implantation of a single receiver-stimulator device by using audiometric tests at 3 and 6 months intervals.

MATERIAL AND METHODS

The study included 3 patients with bilateral sensorineural deafness of cochlear origin. Following implantation they were assessed by pure tone audiometry (PTA), speech audiometry (SA), and sound localization tests (LT).

RESULTS

PTA showed a significant decrease in hearing thresholds level during the 6-month interval following implantation. As to the degree of speech discrimination in both quiet and noisy environment, SA showed evident progress at 6 months compared to the results at 3 month. The location tests revealed improved sound localization in both ears at 6 months compared to the results at 3 months.

CONCLUSIONS

Compared to unilateral implant, the binaural cochlear implant has the advantage of stereophonic hearing, facilitating the communication through a better understanding of speech in both quiet and noisy environment, and improving the quality of life by the location of sounds similar to natural hearing.

[Peripheral vestibular syndrome intricated pathogenic issues. A case report]

BACKGROUND

Ménière's syndrome appears to be the final common pathway of the mechanisms the inner ear responds to almost any injury. Although the autoimmune disease seems to play a major role, exposure to intense noise can also be a trigger in the appearance and/or aggravation of the disease.

MATERIAL AND METHODS

The case of 41 years old musician with a history of ankylosing spondylitis, diagnosed with Ménière's syndrome 5 years ago, is presented. Recently the symptoms became more polymorphic, revealing the association between benign paroxysmal positional vertigo (BPPV), Ménière's syndrome and high frequency hearing loss in an autoimmune background. Besides general, neurological and ENT examination, the diagnostic workup comprised of tonal audiogram, brain stem auditory evoked potentials, computerized dynamic posturography and videonistagmography.

RESULTS

The final diagnosis was acute noise trauma, Ménière's syndrome, left horizontal semicircular canal BPPV, bilateral sensorineural sudden aggravated hearing loss in high frequencies (above 9 kHz) and allegedly autoimmune inner ear disease. Treatment with an association of corticosteroids, vasodilators and vitamins combined with Vannucchi's maneuver were followed by a significant relief of the symptoms.

CONCLUSION

Although no causal relationship was found between acoustic trauma and increased endolymphatic pressure, both literature data and the case presented show that intense and prolonged noise exposure may aggravate peripheral vestibular syndrome.

[Spinal tuberculosis or bone metastases? Case report]

Tuberculosis remains one of the most important infectious disease worldwide and skeletal form has an incidence between 3% and 10%, depending on geographic area. The thoracolumbar junction is the most commonly involved in vertebral tuberculosis; some radiologic features are specifics, but other could be indistinguishable from that of lymphoma or metastases. We discuss the case of a 80-year-old man presented with a 2-month history of thoracolumbar pain, fatigability and fever. The vertebral radiography showed narrowing of the intervertebral disc space between T1 and T12, adjacent irregularity, erosion and lisis of vertebres, features visibles also on computed tomography. After the exclusion of the other causes of osteolisis, we started a standard regimen of tuberculostatic treatment and after one month of treatment the symptoms of patient improved noticeably. Other problems of diagnostic and treatment modalities of spinal tuberculosis are discussed.

[Seven years of cochlear implant at the ENT Clinic of "Recuperare" Hospital Iaşi]

This paper presents our Cochlear Implant Departments results from the beginning until present time. Our implant list contains 161 candidates. The enlisted was made based on the criteria's for implant candidates' selection and we have implanted already 17 of them (11 children and 6 adults). Surgical interventions were done according to standard procedure - the approach being through mastoidectomy and posterior tympanotomy. We discuss the results obtained with cochlear implantation in each case. The outline idea is that the cochlear implant was a good choice in all our implanted cases and the patients had achieved at least the performances predicted before implantation for every particular situation.

The pattern of auditory brainstem response wave V maturation in cochlear-implanted children

OBJECTIVE

Maturation of acoustically evoked brainstem responses (ABR) in hearing children is not complete at birth but rather continues over the first two years of life. In particular, it has been established that the decrease in ABR wave V latency can be modeled as the sum of two decaying exponential functions with respective time-constants of 4 and 50 weeks [Eggermont, J.J., Salamy, A., 1988a. Maturational time-course for the ABR in preterm and full term infants. Hear Res 33, 35-47; Eggermont, J.J., Salamy, A., 1988b. Development of ABR parameters in a preterm and a term born population. Ear Hear 9, 283-9]. Here, we investigated the maturation of electrically evoked auditory brainstem responses (EABR) in 55 deaf children who recovered hearing after cochlear implantation, and proposed a predictive model of EABR maturation depending on the onset of deafness. The pattern of EABR maturation over the first 2 years of cochlear implant use was compared with the normal pattern of ABR maturation in hearing children.

METHODS

Changes in EABR wave V latency over the 2 years following cochlear implant connection were analyzed in two groups of children. The first group (n=41) consisted of children with early-onset of deafness (mostly congenital), and the second (n=14) of children who had become profoundly deaf after 1 year of age. The modeling of changes in EABR wave V latency with time was based on the mean values from each of the two groups, allowing comparison of the rates of EABR maturation between groups. Differences between EABRs elicited at the basal and apical ends of the implant electrode array were also tested.

RESULTS

There was no influence of age at implantation on the rate of wave V latency change. The main factor for EABR changes was the time in sound. Indeed, significant maturation was observed over the first 2 years of implant use only in the group with early-onset deafness. In this group maturation of wave V progressed as in the ABR model of [Eggermont, J.J., Salamy, A., 1988a. Maturational time-course for the ABR in preterm and full term infants. Hear Res 33, 35-47; Eggermont, J.J., Salamy, A., 1988b. Development of ABR parameters in a preterm and a term born population. Ear Hear 9, 283-9] of normal hearing children: a sum of two decaying exponential functions, one showing an early rapid decrease in latency and the other a slower decrease. Remarkably, the time-constants fell well within the ranges described by Eggermont and Salamy (i.e., 3.9 and 68 weeks), consistent with the time-course of the neurophysiological mechanisms presumably involved in auditory pathway maturation during the first 2 years of life: i.e., myelination and increased synaptic efficacy. In contrast, relatively little change in wave V was evident in children with late-onset deafness. In agreement with the notion that EABR maturation follows an apex-to-base gradient as described for ABR, we observed that wave V latencies were longer for the basal than the apical end of the implant electrode array and remained so throughout the study period, whatever the time of onset of deafness.

CONCLUSIONS

The findings in the early-onset of deafness group support the theory that auditory pathways remain "frozen" during the period of sensory deprivation until cochlear implant rehabilitation restores the normal chronology of maturational processes. In children with late-onset deafness, however, some maturational processes may occur before the onset of deafness, and thus less additional maturation is required during the first two years of implant use resulting in no significant EABR latency changes being observed in this period. The results suggest that the rehabilitation-induced plasticity of the auditory pathways is, in case of late auditory deprivation, unlikely to result in neurophysiological outcomes similar to those observed in children with early auditory deprivation.

SIGNIFICANCE

Changes in EABR wave V latency over the first 2 years of cochlear implant use were found to be well fitted by the sum of two decaying exponential functions in children with early-onset deafness. This is in line with the maturation of ABR wave V latency in normal-hearing children over the first two years of life. Further studies are needed to assess whether the differences observed in terms of auditory pathways maturation are associated with consistent differences in terms of language development.