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Objective. To establish the safety and effectiveness of subtotal petrosectomy with cochlear implantation in patients affected by chronic middle ear disorders to refractory to previous surgical treatments. Methods. A multicentre, retrospective study was conducted on patients affected by recalcitrant chronic middle ear disorders who underwent cochlear implantation in combi-nation with subtotal petrosectomy. Patients’ details were collected from databases of 11 Italian tertiary referral centres. Additionally, a review of the most updated literature was carried out. Results. 55 patients were included with a mean follow-up time of 44 months. Cholestea-toma was the most common middle ear recurrent pathology and 50.9% of patients had an open cavity. 80% of patients underwent a single stage surgery. One case of explantation for device failure was reported among the 7 patients with post-operative complications. Conclusions. Subtotal petrosectomy with cochlear implantation is a benchmark for management of patients with recalcitrant chronic middle ear disorders. A single stage procedure is the most recommended strategy. Optimal follow-up is still debated. Further studies are required to investigate the role of this surgery in paediatric patients. © Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale.

The last decade has witnessed significant advances in imaging of the middle and inner ear and the auditory pathways. High resolution computerized tomography (CT) scanners and new magnetic resonance (MR) sequences have been implemented in clinical practice as valuable supportive tools for the Audiologist in the identification of the site of lesion and for the surgical planning by the Otologist. The purpose of this chapter is to review the current advanced methods of neuroradiological evaluation of patients with sensorineural hearing loss (SNHL), either congenital or acquired, especially focusing on the assessment of candidates to cochlear implantation (CI), with plenty of explicative images.

Objective: The aim of this study was to evaluate the effect of cochlear implantation (CI) in advanced Ménière’s disease (MD). Design: The initial search on PubMed, EMBASE, and Cochrane databases yielded 171 articles; no language restriction was applied. Study sample: A total of 11 articles met the inclusion criteria and were included in this systematic review. Six articles provided patient-level data on improvement in speech recognition testing after CI. Results: The methodological quality of included studies was assessed by examining the study design, level of evidence, method of measurement and adequacy of outcome reporting. A random-effect model was fitted for calculating weighted means. Post-operative improvement in word recognition score (WCS) was 50.8% (95% confidence interval: 34.6–67.1%); general improvement of vestibular symptoms after CI was found in 67% of the pooled patients; when reported in the studies, quality of life (QoL) and tinnitus were also generally improved after CI. Conclusions: CI in advanced MD is a valid option providing good outcomes in terms of speech performances, regardless of the disease duration, uni- or bilaterality, age at implantation, previous therapeutic procedures and stage of activity of MD.

Hearing impairment is common in patients with mucopolysaccharidoses (MPS) in the preschool age. Conductive or mixed hearing loss is the most frequent occurrence while the involvement of the inner ear or central auditory pathways may occur in more severe forms. A retrospective review of 82 children with MPS admitted at the Pediatric Department of the University of Milano Bicocca was performed to determine the incidence of otological symptoms. We focused particularly on audiological investigations in a subgroup of 47 children diagnosed before 6 years of age (MPS I, n = 11 patients; MPS II, n = 10; MPS III, n = 7; MPS IV, n = 14; MPS VI, n = 5). In 37 children, a magnetic resonance imaging (MRI) of the brain and cervical spine was also performed in order to correlate the audiological findings with the imaging of the middle and inner ear. A total of 40 out of 47 children (86%) showed some degree of hearing impairment: sensorineural or mixed hearing loss in 23 cases (48.93%) and retrocochlear in 4 (8.51%). MRI ascertained multiple CNS abnormalities in 13 (35.3%): dilated perivascular spaces in 5 (38.5%); dilated ventricular cavities in 5 (38.5%); demyelinated and gliotic areas in 3 (23.0%). Conversely, one-fourth of the children’s inner ears showed some morphological anomaly (24.3%).

Conselho Nacional de Desenvolvimento Científico e Tecnológico Para esta tese foram preparados quatro artigos científicos baseados em estudos de liberação de minerais de alimentos para ruminantes, absorção, metabolismo e equilíbrio de minerais para bovinos de corte, e ingestão de água de bovinos de corte. No primeiro artigo, o objetivo foi quantificar a digestibilidade da matéria seca (MS) e a disponibilidade de cinzas totais (CT) e liberação dos minerais de 12 alimentos concentrados e 12 volumosos comumente adotados em dietas para ruminantes, utilizando métodos in situ e in vitro. Os alimentos foram incubados no rúmen de machos não castrados por 8 deferentes tempos. Foram realizados dois ensaios, um para concentrados e outro para volumosos, com tempo máximo de incubação de 72 e 120 h, respectivamente. O resíduo das amostras incubadas durante 24 h foi tratado com pepsina e ácido clorídrico para simular a digestão no abomaso. As amostras iniciais e residuais após incubação in situ e in vitro foram avaliadas quanto aos teores de MS, CT e minerais. Um modelo assintótico foi adotado para estimar a liberação dos minerais, e as taxas de degradação da MS e CT. Foram avaliadas as correlações entre os teores nos alimentos e a liberação de cada mineral. “Clusteres” foram formados para agrupar os alimentos, em relação à liberação de CT. Observou-se grande variabilidade entre os alimentos concentrados e volumosos para todos os constituintes analisados. Grande variabilidade foi observada para a degradação ruminal efetiva da CT e para a liberação de cada mineral. Quando os alimentos foram agrupados de acordo com as estimativas α β e kd da liberação ruminal de CT, foram identificados 4 grupos. Do grupo "1" para o grupo "4", observou- se um crescimento na fração solúvel e uma redução na fração de liberação lenta e na taxa de liberação. O conteúdo de fibra de detergente neutro apresentou uma correlação negativa com a liberação de mineral no rúmen, enquanto o conteúdo de minerais apresentou correlação positiva. Esses resultados demonstram que a solubilização mineral no trato digestivo não é o fator limitante para a absorção mineral dos alimentos testados. Os objetivos do segundo e terceiro artigos foram medir os efeitos da suplementação mineral sobre ingestão de nutrientes e digestibilidade, desempenho, balanço e exigência de minerais, e concentrações de minerais no corpo de bovinos de corte Nelore alimentados com ou sem cálcio (Ca), fósforo (P ) e fontes suplementares de microminerais (MM) durante as fases de crescimento e terminação. Os animais (n = 51, Nelore, peso corporal inicial = 270,4 ± 36,6 kg, idade = 8 meses) foram atribuídos a um dos três grupos: referência (n = 5), mantença (n = 4) e desempenho (n = 42) . O grupo referência foi abatido no início do experimento para estimar a composição corporal dos demais animais. O grupo mantença foi utilizado para coletar valores de animais com baixos ganho corporal e ingestão de minerais. Os animais do grupo de desempenho foram designados para um dos seis tratamentos: cana-de-açúcar como volumoso e concentrado a base de farelo de soja e casca de soja com (SH100) e sem (SH0) suplementação de Ca, P e MM; Cana-de-açúcar como volumoso e concentrado a base de farelo de soja e milho moído com (SC100) e sem (SC0) suplementação de Ca, P e MM; e silagem de milho como volumoso e concentrado a base de farelo de soja e milho moído com (CS100) e sem (CS0) suplementação de Ca, P e MM. O experimento foi conduzido como um delineamento inteiramente casualizado com um arranjo fatorial 3 × 2, sendo 3 tipos de dietas e presença ou ausência de suplementação inorgânica de minerais. O consumo e digestibilidade de nutrientes, os parâmetros ósseos e séricos relacionados ao metabolismo de Ca e P e as concentrações hepáticas de minerais foram mensurados. Para avaliar a ingestão de cada mineral, a excreção fecal e urinária e a retenção aparente entre os tratamentos, contrastes ortogonais foram adotados. As exigências de mantença e os coeficientes de retenção verdadeiros foram calculados com o auxílio da regressão linear entre o consumo e a retenção de cada mineral. A composição mineral do corpo e as exigências para ganho de peso foram avaliados, utilizando modelos não lineares entre o conteúdo corporal e o consumo de cada mineral. Os consumos, digestibilidade e desempenho de nutrientes não foram afetados pelo fator mineral (P > 0,10). Os consumos de Ca, P, S, Cu, Zn, Mn, Co e Fe foram reduzidas na ausência de suplementação de Ca, P e MM (P < 0,05). A excreção fecal de Ca, Cu, Zn, Mn e Co também foi reduzida em tratamentos sem suplementação (P < 0,01). Em geral, os coeficientes de absorção e retenção aparentes foram reduzidos quando os minerais não foram fornecidos (P < 0,05). A resistência à ruptura dos ossos da costela e a densitometria óssea foram reduzidas (P < 0,04) na ausência de suplementação. Os parâmetros do metatarso não foram afetados (P > 0,10). O conteúdo de Cu no fígado foi reduzido (P < 0,01) em dietas sem suplementação. As exigências totais dos minerais foram menores para P, Cu e Zn e maiores para o Fe quando comparados às recomendações previamente publicadas. Portanto, a ausência de suplementação mineral não influencia o consumo e o desempenho de bovinos Nelore não castrados em confinamento. No entanto, esta ausência pode influenciar parâmetros séricos, hepáticos e ósseos de acordo com o tipo de dieta. Este estudo forneceu informações úteis sobre as exigências minerais e estratégias de fornecimento adequado de minerais para bovinos Nelore em condições tropicais. No quarto artigo, o objetivo foi validar seis equações já publicadas para predição da ingestão de água (IA) para bovinos de corte usando dados coletados em quatro experimentos realizados no Norte do Colorado (n = 1 experimento, novilhos de raça Angus) ou no Sudeste do Brasil (n = 3 experimentos, bovinos de corte Nelore). Características relacionadas ao desempenho animal, à composição da dieta e aos dados ambientais foram coletados em todos os experimentos. A predição de IA usando as equações publicadas atualmente foi testada através da regressão entre os valores previstos e mensurados. Todas as equações testadas diferiram dos dados observados. Vários fatores podem ajudar a explicar o porquê das equações publicadas não predizerem acuradamente a IA. Um dos fatores é que as equações testadas foram desenvolvidas em ambientes de clima temperado usando predominantemente animais Bos taurus taurus. A partir dos dados coletados no presente estudo, foram geradas novas equações baseadas no peso corporal metabólico, consumo de MS, umidade relativa e índice de temperatura e umidade para bovinos Nelore confinados no Sudeste brasileiro e baseadas no peso corporal metabólico, consumo de MS, temperatura máxima diária e nível de inclusão de concentrado na dieta para bovinos mestiços Angus no Norte do Colorado For the thesis composition were prepared four scientific manuscripts based on studies with mineral release, absorption, metabolism and balance, and water intake of beef cattle. In the first manuscript the objective was to quantify the dry matter (DM) digestibility and total ash (TA) and mineral release from 12 concentrate and 12 forage feedstuffs commonly fed to cattle using in situ and in vitro methods. The concentrate and forage feedstuffs were incubated in the rumen of ruminally cannulated beef bulls at 8 different time points. Two different trials were conducted for concentrates and forages, with maximum incubation time of 72 and 120 h, respectively. The residue from samples incubated for 24 h were treated with pepsin and HCl to simulate abomasum digestion. The initial and residual samples after in situ and in vitro incubations were measured. An asymptotic model was adopted for estimating solubility of minerals, degradation rate of DM, and TA. Correlations between feedstuff contents and mineral release were evaluated. Cluster analysis was performed to group feedstuffs, in relation to TA release. Large variability was observed between concentrate and forage feedstuffs for all analyzed constituents. Large variability was observed for the effective ruminal degradation of TA, and individual mineral release. When feedstuffs were clustered according with the α, β and kd estimates of TA ruminal release, 4 groups were identified. From group “1” to group “4” was observed an increase in the soluble fraction, and a reduction in both moderate releasable fraction and release rate. Neutral detergent fiber content has a negative correlation with mineral release in the rumen, while mineral content has positive correlation. These results demonstrate that mineral solubilization in digestive tract is not the limiting factor to mineral absorption from the feedstuffs tested. The objectives of the second and third manuscripts were to measure the effects of mineral supplementation on nutrient intake and digestibility, performance, mineral balance and requirements and mineral concentrations in the body of Nellore beef cattle fed with and without calcium (Ca), phosphorus (P) and micromineral (MM) supplemental sources during the growing and finishing phases. Nellore cattle (n = 51, initial body weight = 270.4 ± 36.6 kg, age = 8 months) were assigned to one of three vigroups: reference (n = 5), maintenance (n = 4), and performance (n = 42). Reference group was slaughtered at the beginning of the experiment to measure initial mineral status. The maintenance group was used to collect values of animals at low gain and reduced mineral intake. Animals of performance group were assigned to one of six treatments: sugarcane as a roughage source and a soybean meal and soybean hull-based concentrate with (SH100) and without (SH0) Ca, P and MM supplementation; sugarcane as the roughage source and a soybean meal and ground corn-based concentrate with (SC100) and without (SC0) Ca, P and MM supplementation; and corn silage as the roughage source with a soybean meal and corn-based concentrate with (CS100) and without (CS0) Ca, P and MM supplementation. The experiment was conducted as a completely randomized design with a 3 × 2 factorial arrangement of treatments. Nutrient intake and digestibility, bone and serum parameters related to Ca and P metabolism, and liver mineral concentrations were measured. Orthogonal contrasts were adopted to compare mineral intake, fecal and urinary excretion and apparent retention among treatments. Maintenance requirements and true retention coefficients were generated with the aid of linear regression between mineral intake and mineral retention. Mineral composition of the body and gain requirements were assessed using non-linear regression between body mineral content and mineral intake. Nutrient intake, digestibility and performance were not affected by mineral factor (P > 0.10). Intakes of Ca, P, S, Cu, Zn, Mn, Co, and Fe were reduced in the absence of Ca, P, and MM supplementation (P < 0.05). Fecal excretion of Ca, Cu, Zn, Mn, and Co were also reduced in treatments without supplementation (P < 0.01). Overall, excretion and apparent absorption and retention coefficients were reduced when minerals were not supplied (P < 0.05). Rib bone breaking strength and densitometry were reduced (P < 0.04) in absence of supplementation. Metatarsus parameters were not affected (P > 0.10). Liver Cu content was reduced (P < 0.01) in diets without supplementation. Dietary mineral requirements were lower for P, Cu, and Zn and greater for Fe when compared to previously published recommendations.Therefore, absence of mineral supplementation does not influence intake and performance of Nellore beef cattle. However, this absence may influence serum, liver and bone parameters according to dietary type. This study provides useful information about mineral requirements and mineral supplementation to obtain adequate dietary mineral supply of Nellore cattle in tropical conditions. In the fourth manuscript, the objective was to validate six current water intake (WI) equations for beef cattle using water intake data from four experiments conducted in North America (n = 1 experiment; crossbred Angus beef steers) and Brazil (n = 3 viiexperiments; Nellore beef cattle). Animal performance, diet composition, and environmental data were collected for all experiments. The prediction of WI using the current published WI equations was tested though the regression between predicted and measured WI values. All tested equations differed from the measured WI data from the four experiments. Several factors can help explain why the published equations did not predict the WI obtained from the three experiments, including that the tested equations were developed in temperate climates using predominantly Bos taurus taurus. From the current data, was generated new WI equations based on metabolic BW, DMI, humidity and temperature-humidity index for Nellore cattle in Brazil and metabolic BW, DMI, maximum daily temperature, and dietary concentrate level for Angus crossbred cattle in North America