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Objective: Middle and inner ear malformations cause technical difficulties in cochlear implantation (CI) with the most commonly traditional surgical procedure (posterior tympanotomy with mastoidectomy, using a microscope). The aim of the present study is to describe the endoscopic assisted CI approach in children with malformed ears. Material and Method: Twenty-five children (mean 3.6 years old; range: 2.8-9 years) with malformed middle and inner ear and bilateral profound hearing loss were operated on using a transattical/endoscopic assisted CI at our tertiary university referral center. The technique is described step-by-step and the outcomes are detailed. Results: All children were discharged from hospital within one day post-surgery. No immediate or late postoperative complications were noted. All children showed varying degrees of auditory benefit as measured by routine audiometry, speech perception tests and Categories of Auditory Performance (CAP) scores (average: 6). Conclusions: Endoscopic assisted approach permits to check directly the anatomical auditory distorted structures and even in the most complex conditions it assures a safe cochleostomy, followed by the correct insertion of the array in the scala tympany. [ABSTRACT FROM AUTHOR]

Background: Cochlear implantation (CI) in children with malformed ears can be challenging through the standard surgical technique. Several alternative approaches have been described. The endoscopic-assisted approach can be chosen as an effective and safe surgical technique, overcoming the drawbacks of the traditional approach., Material: We further describe a combined technique based on a limited mastoidectomy with no posterior tympanotomy and an endoscopic transmeatal approach to the round window (RW): the electrode is driven from the mastoid to the middle ear through the attic., Results: The concomitant endoscopic assistance allows for improved surgical vision, reducing the risk of major complications. The main advantages of this technique are related to better visualization of the RW for safe insertion of the electrode; avoidance of damage to the facial nerve (FN), due to direct visualization, and sparing the posterior tympanotomy; avoidance of subtotal petrosectomy, if not necessary., Conclusion: The purpose of this article, supported with a video file, is to describe step by step this endoscopic-assisted procedure in a patient with middle ear malformation., Competing Interests: Conflict of interest The authors have no conflict of interests, and the work was not supported or funded by any organization., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: To critically illustrate the personal experience with using the "Remote Check" application which remotely monitors the hearing rehabilitation level of cochlear implant users at home and further allows clinicians to schedule in-clinic sessions according to the patients' needs., Methods: 12-month prospective study. Eighty adult cochlear implant users (females n = 37, males n = 43; age range 20-77 years) with ≥ 36 months of cochlear implant experience and ≥ 12 months of stable auditory and speech recognition level volunteered for this 12-month long prospective study. For each patient, at the beginning of the study during the in-clinic session to assess the stable aided hearing thresholds and the cochlear implant integrity and patient's usage, the "Remote Check" assessment baseline values were obtained. "Remote Check" outcomes were collected at different times in the subsequent at-home sessions, to identify the patients that had to reach the Center. Chi-square test has been used for statistical analysis of the comparison of the "Remote Check" outcomes and in-clinic session results., Results: "Remote Check" application outcomes demonstrated minimal or no differences between all sessions. The at-home Remote Check application reached the same clinical outcomes as the in-clinic sessions in 79 out 80 of participants (99%) with high statistical significance (p < 0.05)., Conclusions: "Remote Check" application supported hearing monitoring in cochlear implant users that were not able to attend the in-clinic review during COVID-19 pandemic time. This study demonstrates that the application can be a useful routine tool also for clinical follow-up of cochlear implant users with stable aided hearing., (© 2023. The Author(s).)

Purpose: The aim of this study is to evaluate speech perception outcomes after a frequency reallocation performed through the creation of an anatomically based map obtained with Otoplan ® , a tablet-based software that allows the cochlear duct length to be calculated starting from CT images., Methods: Ten postlingually deafened patients who underwent cochlear implantation with MED-EL company devices from 2015 to 2019 in the Tertiary referral center University Hospital of Verona have been included in a retrospective study. The postoperative CT scans were evaluated with Otoplan ® ; the position of the intracochlear electrodes was obtained, an anatomical mapping was carried out and then it was submitted to the patients. All patients underwent pure tonal and speech audiometry before and after the reallocation and the audiological results were processed considering the Speech Recognition Threshold (SRT), the Speech Awareness Threshold (SAT) and the Pure Tone Average (PTA). The differences in the PTA, SAT and SRT values before and after the reallocation were determined. The results were statistically processed using the software Stata with a significance value of α < 0.05., Results: The mean values of SRT (61.25 dB versus 51.25 dB) and SAT (49 dB versus 41 dB) were significantly lower (p: 0.02 and p: 0.04, respectively) after the reallocation. No significant difference was found between PTA values (41.5 dB versus 39.25 dB; p: 0.18)., Conclusions: Our preliminary results demonstrate better speech discrimination and rapid adaptation in implanted postlingually deaf patients after anatomic mapping and subsequent frequency reallocation., (© 2022. The Author(s).)

Objective: The objective of this study is to describe what we consider to be the state-of-the-art procedure for the treatment of tympanic membrane perforations, and to present the results attained in our institution., Study Design: A retrospective cohort study, using data of Verona University Hospital, Italy. This medical record includes the data of 98 patients who underwent 100 transcanal endoscopic type I tympanoplasties from November 2014 to October 2017., Setting: Tertiary referral center University Hospital of Verona, Italy., Patients: Were enrolled 109 patients, that underwent endoscopic type I tympanoplasty in the period considered. Out of the selected patients, 11 (10.1%) were lost to long-term follow-up, and were therefore excluded from our study. Other exclusion criteria were surgical approaches that included other procedures. Patients whose follow-up was shorter than 6 months were excluded from this study., Intervention: The technique is based on an endoscopic placement of underlay graft of temporal fascia or tragal cartilage. We consider the data of four surgeons from Verona University ENT department., Main Outcome Measure: In the study we considered the reduction of the Air Bone Gap as functional outcome and the integrity of the reconstruction as anatomical outcome of success., Results: No major intraoperative complications were observed. The closure rate was 86%. The mean surgery time was 48.6 minutes. The air bone gap was improved within 20 DB HL in 89% of patient. Only 8% of patients needed revision surgery, and none needed a third surgical evaluation., Conclusion: Endoscopic ear surgery is by now a reality that has replaced in many cases exclusive microscopic ear surgery. Transcanal endoscopic type I tympanoplasty can be considered nowadays as an alternative technique for tympanic membrane perforations.

Objective: Complex middle and inner ear malformations are considered an important limitation for cochlear implant (CI) with traditional microscopic techniques. The aim of the present study is to describe the results of the endoscopic-assisted CI procedure in children with malformed ears., Study Design: Case series with chart review of consecutive patients., Setting: Two tertiary referral centers: University Hospital of Verona and University Hospital of Modena, Italy., Subjects and Methods: In total, 25 children underwent endoscopic-assisted cochlear implantation between January 2013 and January 2018. The audiologic and neuroradiologic assessment showed profound hearing loss and malformation of the middle and inner ear in all children. A complete review of anatomic features, surgical results, and audiologic outcomes was performed. The surgical technique is described step-by-step, and the outcomes are detailed., Results: All patients (mean age, 3.6 years; range, 2.8-9 years) underwent a transattical/endoscopic-assisted CI procedure. All children showed varying degrees of auditory benefit, as measured by routine audiometry, speech perception tests, and Categories of Auditory Performance scores (mean, 6). No immediate or late postoperative complications were noted., Conclusion: The endoscopic-assisted approach proved to be successful in cochlear implantation. The direct visualization and magnification allow (1) exploration of the tympanic cavity; (2) confirmation of all anatomic features, with strict control of the course of the facial nerve, round window area, and inner ear; and (3) performance of the cochleostomy with adequate insertion of the array.

Objective: Hearing restoration has always been a dream in vestibular schwannoma (VS) surgery. The aim of this study is to describe an endoscopic assisted transcanal retrocochlear approach to the internal auditory canal (IAC) with total removal of the VS; simultaneously we assessed the anatomical and functional aspects of hearing restoration with cochlear implant (CI)., Study Design: A retrospective case series., Setting: Tertiary referral center., Patients: Six patients affected by VS involving the fundus of the IAC (Koos stage I-II) were included in this study. The patients already demonstrated symptoms of IAC involvement by the neuroma, with severe to profound hearing loss., Interventions: Transcanal microscopic, endoscopic assisted, approach was chosen for total tumor removal. Preoperative and intraoperative electrophysiological monitoring was performed using electrically evoked auditory brainstem responses (EABR) to evaluate preservation of cochlear function., Main Outcome and Measures: A retrospective evaluation of electrophysiological data collected during surgeries has been conducted; clinical outcomes, surgical complications, and postoperative radiological evaluations were also considered., Results: Total tumor removal was achieved in all patients with no major complications. One patient showed temporary facial palsy (HB stage II). We were able to preserve cochlear function in five out of six patients. In those patients intraoperative monitoring with EABR was performed after tumor removal with good responses., Conclusions: Transcanal retrocochlear approach for VS removal allows preservation of cochlea and cochlear nerve function. This is the first step towards developing an effective surgical technique for VS removal and hearing rehabilitation with CI.

This study investigated the effects of introducing hydroxyapatite nanoparticles into a matrix metalloproteinase (MMP) sensitive poly(ethylene glycol) (PEG) hydrogel containing cell adhesion peptides of RGD for bone tissue engineering. MC3T3-E1 pre-osteoblasts were encapsulated in the biomimetic PEG hydrogel, which was formed from the photoclick thiol-norbornene reaction system, cultured for up to 28 d in growth medium or osteogenic differentiation medium, and evaluated by cellular morphology and differentiation by alkaline phosphatase (ALP) activity and bone-like extracellular matrix deposition for mineral and collagen. Hydroxyapatite nanoparticles were incorporated during hydrogel formation and cell encapsulation at 0%, 0.1% or 1% (w/w). Incorporation of hydroxyapatite nanoparticles did not affect the hydrogel properties as measured by compressive modulus and equilibrium swelling. In growth medium, encapsulated MC3T3-E1 cells remained largely round regardless of hydroxyapatite concentration. ALP activity increased by 25% at day 14 and total collagen content increased by 55% at day 28 with increasing hydroxyapatite concentration from 0% to 1%. In differentiation medium, cell spreading was evident regardless of hydroxyapatite indicating that the MC3T3-E1 cells were able to degrade the hydrogel. For the 1% hydroxyapatite condition, ALP activity was 27% higher at day 14 and total collagen content was 22% higher at day 28 in differentiation medium when compared to growth medium. Mineral deposits were more abundant and spatial elaboration of collagen type I was more evident in the 1% (w/w) hydroxyapatite condition with differentiation medium when compared to all other conditions. Overall, osteogenesis was observed in the hydrogels with hydroxyapatite nanoparticles in growth medium but was enhanced in differentiation medium. In summary, a biomimetic hydrogel comprised of MMP-sensitive crosslinks, RGD cell adhesion peptides, and 1% (w/w) hydroxyapatite nanoparticles is promising for bone tissue engineering.

Poly(ethylene glycol) PEG-based hydrogels are promising for cell encapsulation and tissue engineering, but are known to elicit a foreign body response (FBR) in vivo. The goal of this study was to investigate the impact of the FBR, and specifically the presence of inflammatory macrophages, on encapsulated cells and their ability to synthesize new extracellular matrix. This study employed an in vitro co-culture system with murine macrophages and MC3T3-E1 pre-osteoblasts encapsulated in a bone-mimetic hydrogel, which were cultured in transwell inserts, and exposed to an inflammatory stimulant, lipopolysaccharide (LPS). The co-culture was compared to mono-cultures of the cell-laden hydrogels alone and with LPS over 28 days. Two macrophage cell sources, RAW 264.7 and primary derived, were investigated. The presence of LPS-stimulated primary macrophages led to significant changes in the cell-laden hydrogel by a 5.3-fold increase in percent apoptotic osteoblasts at day 28, 4.2-fold decrease in alkaline phosphatase activity at day 10, and 7-fold decrease in collagen deposition. The presence of LPS-stimulated RAW macrophages led to significant changes in the cell-laden hydrogel by 5-fold decrease in alkaline phosphatase activity at day 10 and 4-fold decrease in collagen deposition. Mineralization, as measured by von Kossa stain or quantified by calcium content, was not sensitive to macrophages or LPS. Elevated interleukin-6 and tumor necrosis factor-α secretion were detected in mono-cultures with LPS and co-cultures. Overall, primary macrophages had a more severe inhibitory effect on osteoblast differentiation than the macrophage cell line, with greater apoptosis and collagen I reduction. In summary, this study highlights the detrimental effects of macrophages on encapsulated cells for bone tissue engineering., Statement of Significance: Poly(ethylene glycol) (PEG)-based hydrogels are promising for cell encapsulation and tissue engineering, but are known to elicit a foreign body response (FBR) in vivo. The impact of the FBR on encapsulated cells and their ability to synthesize tissue has not been well studied. This study utilizes thiol-ene click chemistry to create a biomimetic, enzymatically degradable hydrogel system with which to encapsulate MC3T3-E1 pre-osteoblasts. The osteogenic capabilities and differentiation of these cellswerestudied in co-culture with macrophages, known drivers of the FBR.This study demonstrates that macrophages reduce osteogenic capabilities of encapsulated cellsin vitroand suggestthat the FBR should be considered for in vivo tissue engineering., (Copyright © 2018. Published by Elsevier Ltd.)

Objective Vestibular schwannoma (VS) is a benign tumor of the lateral skull base. Different microscopic surgical techniques are described in literature: the retrosigmoid and translabyrinthine approaches are used to treat big tumors located in the cerebellopontine angle, and the middle cranial fossa approach is utilized for small tumors with good hearing preservation. The expanded transcanal transpromontorial (ExpTT) approach is a combined microscopic-endoscopic technique previously indicated for Koos stage I and II VS and now proposed for larger VS, up to 3 cm in diameter, with linear progression into the cerebellopontine angle and touching the brainstem. Study Design The study was a retrospective case series of patients who underwent ExpTT surgery for VS in our ear, nose, and throat department. Setting We reviewed the surgical videos and electrophysiologic data recorded during the surgical operations. Subjects and Methods From January 2015 to January 2017, 20 patients affected by Koos stage II and III VS underwent surgery in our department with the ExpTT approach. This novel technique is described step by step, with a focus on the surgical procedure and anatomic landmarks; outcomes are detailed in terms of early and late complications. The mean follow-up was 15 months. Results The ExpTT approach permitted, in all patients, gross total resection of the tumor without any complication and with preservation of facial nerve function. All patients had a good postoperative recovery. Conclusion The ExpTT technique is a new approach that combines the advantages of a microscopic technique with the ones offered by the endoscope in removal of VS.

Surgical approaches to vestibular schwannomas (VS) are widely known and extensively recorded. For the first time, an exclusive endoscopic approach to the internal acoustic canal (IAC) was described and used to safely remove a cochlear schwannoma involving IAC in March 2012. The aim of this article was to summarize indications and technique to treat intracanalicular VS by transcanal/transpromontorial endoscopic approach. Because management of intracanalicular VSs is complex and strongly debated, this kind of therapeutic option in the appropriate and selected cases could modify classic concepts of the management of this pathology., (Copyright © 2016 Elsevier Inc. All rights reserved.)

When we walk in place with our eyes closed after a few minutes of walking on a treadmill, we experience an unintentional forward body displacement (drift), called the sensory-motor aftereffect. Initially, this effect was thought to be due to the mismatch experienced during treadmill walking between the visual (absence of optic flow signaling body steadiness) and proprioceptive (muscle spindles firing signaling body displacement) information. Recently, the persistence of this effect has been shown even in the absence of vision, suggesting that other information, such as the sound of steps, could play a role. To test this hypothesis, six cochlear-implanted individuals were recruited and their forward drift was measured before (Control phase) and after (Post Exercise phase) walking on a treadmill while having their cochlear system turned on and turned off. The relevance in testing cochlear-implanted individuals was that when their system is turned off, they perceive total silence, even eliminating the sounds normally obtained from bone conduction. Results showed the absence of the aftereffect when the system was turned off, underlining the fundamental role played by sounds in the control of action and breaking new ground in the use of interactive sound feedback in motor learning and motor development.

Pneumolabyrinth due to late complications of stapes surgery is a rare entity. Symptoms may include various degrees of hearing loss, tinnitus and dizziness. We report the case of a 67-year-old patient who developed a unique pneumolabyrinth variant affecting the vestibule, cochlea and semicircular canals 28 years after stapedectomy. The patient presented with intractable paroxysmal positional vertigo of the lateral semicircular canal. The pneumolabyrinth was visualized by means of high resolution computed tomography. Exploratory tympanotomy findings were consistent with a perilymphatic fistula. One year after surgical treatment the subject was free of vertigo spells. Pathogenetic mechanisms are discussed., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

To verify whether injection of substances into the endolymphatic sac (ES) diffuses into the endolymphatic compartments of the human inner ear and in particular to the endolymphatic space of the scala media (ESp-SM), as demonstrated in animals, an exploratory investigation with magnetic resonance imaging (MRI) and intraoperative electrocochleographic recordings (ECoG) was conducted in patients with Ménière's disease (MD) treated with ES decompression. A mixture of dexamethasone and gadolinium (GD) in solution was injected into the ES of 4 patients. The results of the ES injection procedure were compared with administration of the same solution intratympanically (IT, 1 patient) and via a platinotomy in 2 patients. The study was conducted retrospectively at a tertiary referral center. Main outcomes measures were pre- and postintervention complete audiological and neuro-otological evaluation; intraoperative ECoG investigation with evaluation of the morphology of acoustically elicited compound action potentials (CAPs) and 1.5 T MRI evaluations at different follow-up times. Distribution of GD from the ES injection procedure was observed first in the ES, after 24 h in the vestibule and semicircular canals, and after 24-48 h in the ESp-SM in all patients. High signal was detected within the inner ear for 1 week or more (mean: 10 days; range: 7-16 days). Changes in morphology and latency of CAPs were observed within 30 min of the dilatory injection into the ES in all patients. Administration of GD into the vestibule and the IT approach did not distribute the contrast in the ES and GD was observed in the perilymphatic space of the vestibule, cochlea and semicircular canals. No side effects relating to administration of GD into the ES, IT or into the vestibule were observed. To the best of our knowledge this is the first demonstration in humans that drugs injected into the endolymphatic structure of the ES diffuse to the cochlea, presumably into the ESp-SM. The possibility of injecting substances into the endolymphatic space might open up new prospects in the treatment of inner ear disorders. Further studies will be needed to define the limitations of this approach., (Copyright © 2010 S. Karger AG, Basel.)

Conclusions: Round window implant (RWI) with a floating mass transducer (FMT) may be suggested as the first choice in hearing rehabilitation for patients with chronic otitis media (COM) and extensive destruction of the ossicular chain., Objective: To investigate the pros and cons of the total ossicular replacement prosthesis (TORP) vs the RWI in restoration of hearing in patients with COM., Patients and Methods: Thirty-eight patients with bilateral moderate to severe mixed or conductive hearing loss from COM without cholesteatoma and bilateral ossicular chain erosion (footplate residual) were alternately assigned to a titanium-TORP (T-TORP) and to RWI with the FMT of the Medel Vibrant Soundbridge (MVBS) located onto the RW niche. The therapeutic efficiency, preoperative vs postoperative air-conduction gain and speech recognition were investigated for the two groups and statistically analyzed at 36 months postoperatively. The following postoperative anatomic conditions were also evaluated for the two groups: 1) recurrence of infection, 2) retraction pocket, 3) extrusion rate, and 4) displacement of the prosthesis., Results: Good functional results and stability at 36 months were obtained with both procedures. The extrusion rates for T-TORP were low. So far no extrusion has been observed for RWI. Hearing results were statistically much better for RWI vs T-TORP for all investigated parameters.