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Two of the most used objective measures are electrically evoked action potentials (ECAPs) and electrically evoked stapedius reflex thresholds (ESRTs). Although stimuli used for these measures differ considerably, both measures are influenced by subjective loudness percept. We focus on the subjective maximum acceptable loudness (MAL) to investigate if loudness sensitivity varied along the electrode array during ECAP recordings. In addition, we explored how the MAL reached during an ECAP recording related to the postoperative ESRT.Uni- and bilaterally implanted young CI users (Loudness tolerance during ECAP recordings was lowest at the two apical-most electrode contacts (number 1 and 2). There was a moderate correlation between the MAL achieved during ECAP recordings and ESR maximum stimulation amplitudes. (r: 0.44344).ECAP recordings should commence at basal or medial contacts to increase the users' comfort and loudness tolerance, especially in young CI users. A higher maximum stimulation appears to increase the chance of the automatic determination of ECAP thresholds for all electrode contacts.

The relationship between SARS-CoV-2 infection and dizziness is still unclear. The aim of this study is to assess the prevalence and characteristics of dizziness and vertigo among patients with mild-to-moderate COVID-19. Patients discharged from the emergency rooms with a confirmed SARS-CoV-2 diagnosis were assisted by daily telephone calls until nasopharyngeal swab negativization, and specific symptoms concerning balance disorders were investigated through targeted questions posed by experienced physicians. The study included 1512 subjects (765 females, 747 males), with a median age of 51 ± 18.4 years. New-onset dizziness was reported by 251 (16.6%) patients, among whom 110 (43.8%) complained of lightheadedness, 70 (27.9%) of disequilibrium, 41 (16.3%) of presyncope, and 30 (12%) of vertigo. This study analyzed in detail the prevalence and pathophysiological mechanisms of the different types of balance disorders in a large sample, and the results suggest that dizziness should be included among the main symptoms of COVID-19 because one-sixth of patients reported this symptom, with females being significantly more affected than males (20.3 vs 12.9%, P

Neuropatia uditiva è un termine appropriato? Revisione sistematica della letteratura sulla sua ezio patogenesi.Per chiarire la ezio-patogenesi della Neuropatia Uditiva (NU), sono stati identificati 845 articoli divisi in quattro categorie: Revisioni, Audiologia, Trattamenti, Eziologia. Gli articoli sull’eziologia riguardavano: genetica, istopatologia, patologie mediche, diagnostica per immagini. La NU isolata è stata descritta nelle deficienze da otoferlina, peivachina e DIAPH3. Tra le sindromi emergono Charcot Marie Tooth, Friedreich Ataxia, i disordini mitocondriali e le neuropatie visive. Per quanto riguarda l’istopatologia chiarificanti sono stati gli articoli sui prematuri. Sia la patologia periferica che quella intracranica sono state descritte nella diagnostica per immagini. La patologia medica più frequente è risultata la bilirubinopatia, seguita dal diabete. In conclusione, la cosiddetta neuropatia uditiva non è riferibile ad una condizione patologica definita, poiché si tratta di un dato strumentale presente in una ampia serie di condizioni patologiche in cui il nervo acustico è spesso paradossalmente indenne. La revisione della letteratura porta a suggerire di abbandonare il termine di Neuropatia Uditiva perché fuorviante in molti casi.To clarify the aetio-pathogenesis of Auditory Neuropathy Spectrum Disorder (ANSD), a total of 845 papers were divided into four categories: Review, Audiology, Treatment and Aetiology. Aetiology was the topic analysed categorising papers as: Genetics, Histopathology, Imaging and Medical diseases. Isolated ANs were in relation to Otoferlin, Pejvakin and DIAPH3 deficiency, and the syndromes were mainly Charcot Marie Tooth, Friedreich Ataxia, mitochondrial disorders and those associated with optic neuropathies. In histopathology papers, important information was available from analyses on human premature newborns and on some syndromic neuropathies. From cochlear dysmorphism to cerebral tumours associated with ANs, these are described in what is identified as the Imaging area. Finally, the prevalent clinical pathology was bilirubinopathy, followed by diabetes. In conclusion, AN/ANSDs do not refer to a clear pathological condition, but to an instrumental pattern without any evidence of auditory nerve involvement, except in a few conditions. The terms AN/ANSD are misleading and should be avoided, including terms such as “synaptopathy” or “dis-synchrony”.

In Italy, the antibiotic prescription rate for children is very high. The aim of this study is to evaluate the change in the monthly rate of antibiotic prescriptions for respiratory and ear infections among children during the COVID-19 pandemic.This retrospective study included all children aged14 years who referred to a pediatric primary care clinic in Milan (Italy) between January 1, 2019, and April 30, 2022. We examined the trends in the antibiotic prescription rate, comparing the pre-lockdown (2019), total lockdown (March-April 2020), partial lockdown (November-December 2020) and post-lockdown (November-December 2021 and March-April 2022) periods.A total of 12 569 visits (mean age of patients: 6.3±3.8 years), with 3228 antibiotic prescriptions, were included in the study. The overall antibiotic prescription rate was 25.7%, with a nadir (5.8%) in May 2020. Compared to 2019, the highest reduction in antibiotic prescription rate was found in February 2021 (-30.3% [95% CI, -36.2%, -24.4%]). A significant increase in the antibiotic prescription rate was observed in November-December 2021 and in March-April 2022 compared to the corresponding periods of the previous year (P0.001).This study showed a drastic decrease in the antibiotic prescription rate for respiratory and ear infections during the COVID-19 pandemic, with a nadir immediately after the total lockdown. Day care center and school attendance did not reverse this positive trend during the partial lockdown, unlike what happened with the relaxation of restrictive measures and the resumption of social activities after the lockdown.

Background: Parkinsonian features have been described in patients harboring variants in nuclear genes encoding for proteins involved in mitochondrial DNA maintenance, such as TWNK. Objectives: The aim was to screen for TWNK variants in an Italian cohort of Parkinson's disease (PD) patients and to assess the occurrence of parkinsonism in patients presenting with TWNK-related autosomal dominant progressive external ophthalmoplegia (TWNK-adPEO). Methods: Genomic DNA of 263 consecutively collected PD patients who underwent diagnostic genetic testing was analyzed with a targeted custom gene panel including TWNK, as well as genes causative of monogenic PD. Genetic and clinical data of 18 TWNK-adPEO patients with parkinsonism were retrospectively analyzed. Results: Six of 263 PD patients (2%), presenting either with isolated PD (n=4) or in combination with bilateral ptosis (n=2), carried TWNK likely pathogenic variants. Among 18 TWNK-adPEO patients, 5 (28%) had parkinsonism. Conclusions: We show candidate TWNK variants occurring in PD without PEO. This finding will require further confirmatory studies. © 2022 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.

To assess the role of flat panel computed tomography (FPCT) in the evaluation of cochlear implant (CI) electrode position and its relation to speech perception. From March 2015 to March 2019, we retrospectively enrolled deaf subjects ≥ 18 years who underwent unilateral CI by one surgeon, imaged with FPCT and assessed with disyllabic words score before CI and at 6 months of follow-up. We calculated the disyllabic score difference before CI and after CI (ΔSDS) and divided the subjects in favorable and unfavorable outcome groups using the median ΔSDS as a cutoff. We compared the demographic, clinical, electrode characteristics, and the CI positioning variables scalar position, surgical insertion depth (SID), linear insertion depth (LID), angular insertion depth (AID) and wrapping factor (WF). We studied 50 subjects (F/M = 27/23; median age = 60.5 years, IQR: 50–70 years). The median ΔSDS was 80% (interquartile range [IQR]: 60–100%) in quiet and 80% (IQR: 47.5–100%) in noise. Of the subjects 23 demonstrated a favorable outcome and had earlier age at CI (median 52 years; IQR 45–67 years versus median 62 years; IQR: 56–71 years p = 0.032) and a significantly higher SID (median: 4.02 mm IQR: 3.00–5.35 mm versus median: 2.94 mm IQR: 2.06–3.90 mm; p = 0.029). No difference was found for LID (p = 0.977), AID (p = 0.302), and WF (p = 0.224). A logistic regression model built with the age at CI, number of CI electrodes, and the SID was significant χ2 ((df = 3, N = 50) = 14.517, p = 0.002). The model explained 33.7% (Nagelkerke R2) of ΔSDS variance and correctly classified 76% of the cases. The SID measured by FPCT predicts the ΔSDS at 6 months follow-up, alongside with age at implantation and number of CI electrodes.

Introduction: Sudden sensorineural hearing loss (SSHL) is a relatively frequent disease, but a sensitive marker or a reliable test to identify the underlying cause is still unavailable. Neuroradiology appears to offer the most promising tools, especially magnetic resonance imaging (MRI). In a recent study from our group, we explored the ability of MRI to detect subtle changes in the inner ear compartments by means of a 3D-fluid-attenuated inversion recovery sequence, aiming at identifying 3 distinct MRI patterns (haemorrhagic, inflammatory, brain-labyrinth barrier breakdown). In the present study, we contrasted the MRI patterns at onset with relevant prognostic factors, with the audiological features of each patient’s SSHL and with treatment outcomes. Methods: In this retrospective study, we enrolled 50 adult subjects (54.61 ± 18.26 years) with SSHL. They underwent an MRI within 72 h from admission, and 5 audiological evaluations: at admission, on the 5th day after the start of medical therapy, at the end of the first cycle of hyperbaric oxygen therapy, then 1 and 6 months later. Results: Abnormalities of the MRI signal and/or post-contrast enhancement asymmetry of the cochlea (“pattern+ MRI”) correlated with worse audiological outcomes at 1 month, but the different MRI patterns were not correlated with any specific prognostic model, despite rigid protocol settings. However, a significant difference was found for low-tone SSHL, which were always “pattern” negative at MRI (p = 0.01), and for profound SSHL which demonstrated a pattern+ MRI in 80% (p = 0.04). At the onset of SSHL, a pattern+ MRI was found in 29/50 cases (58.0%) and was related with lesser degree of recovery of pure-tone average at 1 month and lesser chance to retain the hearing threshold benefit in the long term. Given the limited numbers of patients enrolled so far, the relative impact of comorbidities on each MRI pattern remains uncertain. At 6 months, we observed a trend of greater and more stable recovery (p = 0.023) and less frequent recurrence of SSHL in patients with a normal MRI. Conclusions: The 3 observed MRI patterns did not correlate consistently with specific audio-vestibular features or any peculiar aspect of the patient’s clinical history. Larger series of patients with SSHL are needed, possibly from multicentric studies.

Objective To evaluate the role of social isolation during the lockdown due to the SARS-CoV-2 outbreak (severe acute respiratory syndrome coronavirus 2) in modifying the prevalence of otitis media with effusion (OME) and the natural history of chronic OME. Study Design Retrospective study. Setting Tertiary level referral audiologic center. Methods We assessed the prevalence of OME among children aged 6 months to 12 years who attended the outpatient clinic for hearing or vestibular disorders during 2 periods before the lockdown, May-June 2019 (n = 350) and January-February 2020 (n = 366), and the period immediately after the lockdown, May-June 2020 (n = 216). We also compared the disease resolution rates between a subgroup of children with chronic OME (n = 30) who were diagnosed in summer 2019 and reevaluated in May-June 2020 and a similar subgroup (n = 29) assessed in 2018-2019. Results The prevalence of OME in this clinic population was 40.6% in May-June 2019, 52.2% in January-February 2020, and 2.3% in May-June 2020. Children with chronic OME had a higher rate of disease resolution in May-June 2020 (93.3%) than those examined in May-June 2019 (20.7%, P < .001). Conclusion Closure of schools and the physical distancing rules were correlated with a reduction in the prevalence of OME and favored the resolution of its chronic forms among children who attended the outpatient clinic. These data could suggest that in the presence of chronic OME, keeping young children out of group care settings for a period might be beneficial to allow for OME resolution.

The purpose of the study was to examine the subjective and objective potential advantage for speech understanding in noise achieved by cochlear implant (CI) recipients when using the autosensitivity control (ASC) input signal processing in combination with the adaptive dynamic range optimization (ADRO). Eighteen subjects (8 females, 10 males, mean age 17.7 &plusmn, 6.7) were enrolled in a prospective open blinded comparative study between the ASC + ADRO condition vs. the ADRO alone, 16 were sequential binaural and 2 were monoaural CI recipients. All patients had been wearing their CI for at least 3 years, had no additional disabilities, had an age-appropriate receptive and expressive language. Word recognition performances in noise (at signal-to-noise ratio +5 dB HL) were significantly better in the ADRO-alone condition than in the ADRO + ASC condition. (p = 0.03) These objective outcomes were in agreement with the subjective reports. No significant difference was found in quiet. Our results, apparently in contrast with other reports in the literature, suggest that the decision of adding the slow-acting automatic reduction in microphone sensitivity provided by ASC should be limited to selected CI recipients.

Introduction: Recently, Interacoustics presented a new otoacoustic emission protocol where the probe pressurizes the ear cavity, thus eliminates the risk of non-assessment (REFER outcome) due to a negative middle ear pressure. This study evaluated the characteristics and the performance of this new protocol on a newborn well-baby population. Methods: One hundred sixty-three newborns (age 2.7 ± 1.1 days) for a total of 294 ears were assessed randomly. Transiently evoked otoacoustic responses were acquired by the Titan device (Interacoustics), using the default and a pressurized TEOAE protocol. The data were analyzed in terms of signal to noise ratios (S/Ns) at 5 frequencies, namely, 0.87, 1.94, 2.96, 3.97, and 4.97 kHz. To assess any possible gestational age (GE) effects on the TEOAE variables, the responses were subdivided in 4 different age subgroups. Results: There were no significant differences between the left and right ear TEOAE responses, for age (in days), GE (in weeks), weight (in grams), and S/N at all 5 frequencies. Considering the pooled 294 ears, paired t tests between the default and the pressurized TEOAE data showed significant differences across all 5 frequencies (p < 0.01). The pressurized protocol generated TEOAE responses presenting larger S/Ns, and a positive additive effect of approximately 2.31 dB was observed at all tested frequencies. There were no significant GE effects on the pressurized TEOAE responses. In terms of performance, both protocols performed equally (same number of PASSes). Conclusion: The pressurized TEOAE protocol generates responses with higher S/Ns which might be useful in borderline cases where the middle ear status might cause a REFER screening outcome.

The purpose of this study was to assess vestibular findings and clinical history in a large cohort of patients affected by Ménière's disease.We retrospectively analysed 511 adult patients fulfilling criteria for definite unilateral Ménière's disease according to Barany Society. Thorough clinical history, audiometric exam, central nervous system MRI, quantification of serum autoantibodies and complete vestibular function test were performed.Mean age at clinical record was 55.4 years, while age at onset of the first vertigo attack was 47.4 ± 14.3 years. Ménière's disease overlapped with migraine in 43.4% of patients. In 31.7% of cases, positivity was found for at least one autoantibody. Forty-nine patients (9.6%) had family history for Ménière's disease. Bedside examination resulted in 14.7% positivity for video head impulse test, 58.9% for skull vibration-induced nystagmus, 38.7% for the positional test and 23.1% for the post head shaking test. Complete negative examination was reported in 115 cases.Ménière's disease was seen to present a characteristic phenotypic pattern in our cohort, confirming the crucial role of thorough anamnesis and bedside examination in diagnosis.Sindrome di Ménière: valutazione dell’esame vestibolare e della storia clinica in un’ampia popolazione.Analizzare un’ampia casistica di pazienti affetti da sindrome di Ménière con particolare attenzione al dato anamnestico ed ai test di funzione vestibolare.Sono stati raccolti retrospettivamente i dati di 511 pazienti affetti da sindrome di Ménière monolaterale definita, che soddisfacevano i criteri della Barany Society. Ogni paziente è stato sottoposto a raccolta anamnestica, esame audiometrico tonale, RM encefalo, test di autoimmunità ed esame otovestibolare.L’età media alla presentazione clinica è stata di 55,4 anni mentre l’età del primo episodio di vertigine è risultata essere 47,4 ± 14,3. Il 43,4% della popolazione soffre contestualmente di emicrania. Nel 31,7% dei casi è stata quantificata una positività di almeno un autoanticorpo. Quarantanove pazienti hanno riferito un familiare affetto da possibile sindrome di Ménière. La video head impulse è risultata positiva nel 14,7%, il test vibratorio nel 58,9%, 38,6% il test posizionale nel 38,7% e la HST nel 23,1%; una completa negatività ai test vestibolari è stata rilevata in 115 casi.La sindrome di Ménière è spesso associata ad un fenotipo clinico e strumentale suggestivo che conferma il ruolo cruciale di una attentata raccolta anamnestica e dell’esame vestibolare nella diagnosi.

Objective: The aim of this study was to evaluate the effect of cochlear implantation (CI) in advanced Meniere'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.

Older adults with hearing loss have difficulties during conversation with others because an elevated auditory threshold reduces speech intelligibility, especially in noisy environments. Listening and comprehension often become exhausting tasks for hearing-impaired elders, resulting in social isolation and depression. The aim of the present study was to investigate the advantages of hearing aid use in relation to relief from listening-related fatigue, which is still controversial. Participants included a sample of 49 hearing-impaired elders affected by presbycusis for whom hearing aids were prescribed. The Modified Fatigue Impact Scale was used to assess cognitive, physical and psychosocial fatigue. The vitality subscale of the Short Form Health Survey 36 and a single item of the multi-dimensional Speech, Spatial and Quality Hearing Scale (“Do you have to put a lot of effort to hear what is being said in conversation with others?”) were also used. The Cognitive Failures Questionnaire was used to investigate daily errors related to lack of memory and reduced mindedness. Hearing aids rehabilitation resulted in improved speech intelligibility in competing noise, and a significant reduction in cognitive and psychosocial fatigue and listening effort in conversation. Vitality was also improved and a significant reduction in the Cognitive Failures Questionnaire scores was observed. Findings from the study indicate that the use of hearing aids in older impaired-listeners provide them not only with an increased auditory function but also with a reduction in listening-related fatigue and mindedness.

Meniere disease (MD) is defined by a clinical syndrome of recurrent attacks of spontaneous vertigo associated with tinnitus, aural fullness, and sensorineural hearing loss (SNHL). Most patients have unilateral SNHL, but some of them will develop contralateral SNHL during the course of the disease. Several studies have reported a frequency of 2 to 73% SNHL in the second ear, according to the duration of disease and the period of follow-up. We hypothesize that unilateral and bilateral MD are different conditions, the first would initially involve the apical turn of the cochlea, while bilateral MD would affect the entire length of the cochlea. The aim of the study is to search for clinical predictors of bilateral SNHL in MD to build a predictive model of bilateral involvement.A retrospective, longitudinal study including two cohorts with a total of 400 patients with definite MD was carried out. The inception cohort consisted of 150 patients with MD and the validation cohort included 250 cases. All of the cases were diagnosed of unilateral MD according to their hearing loss thresholds. The following variables were assessed as predictors of bilateral SNHL for the two cohorts: sex, age of onset, familiar history of MD, migraine and high-frequency hearing loss (HFHL, defined if hearing threshold20 dB in two or more consecutive frequencies from 2 to 8 KHz). A descriptive analysis was carried out according to the presence of HFHL in the first audiogram for the main variables. By using multiple logistic regression, we built-up several predictive models for the inception cohort and validated it with the replication cohort and merged dataset.Twenty-three (19.3%) and 78 (41%) of patients with HFHL developed contralateral SNHL during the follow-up, in the inception and validation cohorts, respectively. In the inception cohort, the best predictive model included HFHL in the first audiogram (OR = 6.985, p = 0.063) and the absence of migraine (OR = 0.215, p = 0.144) as clinical predictors for bilateral SNHL [area under the curve (AUC) = 0.641, p = 0.002]. The model was validated in the second cohort (AUC = 0.621, p0.001). Finally, we merged both datasets to improve the precision of the model including HFHL in the first audiogram (OR = 3.168, p = 0.001), migraine (OR = 0.482, p = 0.036) and age of onset35 years old (OR = 2.422, p = 0.006) as clinical predictors (AUC = 0.639, p0.001).A predictive model including the age of onset, HFHL in the first audiogram and migraine can help to assess the risk of bilateral SNHL in MD. This model may have significant implications for clinical management of patients with MD.

Congenital cytomegalovirus (cCMV) is the leading nongenetic cause of sensorineural hearing loss (HL). However, there are no universally accepted approaches to diagnosis, follow-up and treatment. The aim of this study was to evaluate the main characteristics of cCMV-infected children, focusing on their management and long-term hearing outcomes.This retrospective study included all children with cCMV infection who were referred to a third-level referral audiologic center for a 6-year hearing follow-up. The main information collected from the medical records included gestational age, birth weight, trimester of maternal seroconversion, hearing status at birth and after 6 years, hearing fluctuations, treatment with oral valganciclovir (within the first month of life and for 6 months), use of hearing devices, presence of speech-language delay, motor delay, cognitive delay and balance disorders, awareness of cCMV among parents, and parents' engagement in behaviors that could increase the risk of CMV infection during pregnancy.A total of 141 children with cCMV infection (72 males and 69 females; mean gestational age: 37This study confirmed the importance of performing a long audiological follow-up in children diagnosed with cCMV infection due to the possible late-onset, progressive and fluctuating nature of HL. Moreover, the study highlighted many current controversies in preventive (poor prenatal education), diagnostic (routine maternal serological screening) and therapeutic (valganciclovir administered to asymptomatic children) approaches to cCMV infection. More efforts should be made to improve prevention strategies and raise awareness of cCMV infection risks among the population.

Objective The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment. Study design Prospective observational study. Setting Tertiary referral university center. Patients Forty-seven patients (22 M, 25 F; age: 54.4 ± 17.5 yr) consecutively referred to the Department of Emergency for ISSHL. Interventions All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy). Main outcome measure(s) MR patterns, clinical, and laboratory findings. Results MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood-labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2-40.8)] and the latter was the only variable associated with an unfavorable outcome [(B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9-56.7)]. Conclusion Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.

L’audiometria con risposte motorie nello screening uditivo di soggetti adulti.Lo scopo dello studio è di testare l’efficacia di un nuovo test di audiometria vocale a risposte motorie (VTMR) nel rumore da utilizzare per determinare l’handicap uditivo in programmi di screening per soggetti adulti. La VTMR consiste nell’esecuzione manuale di 5 comandi verbali ricevuti dal paziente a diverse intensità di segnale e fornisce un punteggio relativo alla comprensione nel rumore. In questo studio osservazionale prospettico 916 su 1.300 volontari (605 maschi, 695 femmine, età media 56 ± 17 anni), sono stati sottoposti a uno screening uditivo con audiometria tonale liminare e VTMR ad un rapporto segnale/rumore (S/N) di 0 e –10 dB HL. Risultati: la differenza tra soggetti normo- e ipoacusici, in funzione di tutte le variabili considerate, è risultata statisticamente significativa per la combinazione di audiometria tonale e VTMR. Il test VTMR con S/N di –10 dB è risultato essere uno strumento rapido, pratico ed efficiente nel differenziare tra soggetti normo- e ipoacusici con un cut-off di 4 su 5 comandi verbali eseguiti correttamente. Nel sottogruppo dei pazienti con riferita limitazione della partecipazione sociale, la sensibilità e la specificità del test VTMR sono rispettivamente del 90% e del 62%. La VTMR può essere utilizzata singolarmente nello screening di soggetti adulti per testare sia l’impairment uditivo che la limitazione sociale che ne consegue.The aim of this study was to test the efficacy of Verbal Tasks and Motor Responses (VTMR) speech audiometry in providing a rapid and true-to-life assessment of hearing-related problems as a single test in adult hearing screening programmes. The VTMR consists in manual execution of 5 verbal commands received by patients at different signal intensity levels and fixed masking noise; it provides a score of speech comprehension in noise. This was a prospective observational study in 916 individuals out of 1,300 volunteers (605 males, 695 females, aged 56 ± 17 years) who completed adult hearing screening. VTMR speech audiometry was performed at signal to noise (S/N) ratios of 0 dB and –10 dB. The difference between normal and hearing impaired subjects in terms of all the considered variables was statistically significant for pure-tone audiometry and VTMR testing. VTMR testing at a S/N ratio of –10 dB with a cut-off of four correctly executed tasks and was a rapid, feasible and efficient means of differentiating between normal and hearing impaired subjects. When used to screen hearing impaired subjects with participation restrictions, the sensitivity and specificity of the VTMR test rose to 90% and 62%, respectively. The VTMR test in noise could be used as a stand-alone tool when screening for impairment and self-perceived participation restriction together.

Premature infants are at high risk for hearing loss (HL). The aim of the present study is to assess the frequency of preterm infants affected by HL who experience hearing improvement over months and evaluate possible factors associated with hearing changes.This retrospective study was conducted in a third-level referral audiologic center. Preterm infants with a confirmed diagnosis of sensorineural HL within the first 3 months of life were reassessed at 18 months corrected age using the click-evoked auditory brainstem response between January 1, 2012, and June 30, 2020. The frequency of hearing improvement and associations between possible risk factors and hearing changes were evaluated.A total of 138 preterm infants (71 male and 67 female; mean gestational age: 30This study confirms the importance of performing a long audiological follow-up and postponing the indication for cochlear implantation in children with a history of preterm birth. Because of the expression of mesenchymal stem cells and high total antioxidant capacity, breast milk might play a protective role in the auditory system of preterm infants. These findings could have important implications for clinical practice, positively impacting the long-term hearing outcomes of preterm infants.

Background Sudden sensorineural hearing loss (SSNHL) is rare in children, and its etiology remains largely unknown, although viral infections seem to play an important role. The aim of this study is to report 5 children who experienced permanent SSNHL and had dual positivity of serum anti-Epstein-Barr virus (EBV) IgM and anti-Cytomegalovirus (CMV) IgM antibodies. Methods The study was conducted in a third-level referral audiological center. The medical charts of children under age 14 who experienced SSNHL without hearing recovery between September 1, 2017 and August 31, 2020, were reviewed. These children had undergone diagnostic evaluations, including brain magnetic resonance imaging, serological testing, thrombophilia and autoimmunity screening, to find possible causes of SSNHL. Results In all 5 patients identified, anti-EBV IgM, anti-CMV IgM and anti-CMV IgG antibodies were detected by chemiluminescent immunoassay (CLIA) immediately after the diagnosis of SSNHL, which occurred from 2 to 4 weeks after the onset of symptoms attributable to primary EBV infection. No abnormalities were demonstrated by coagulation and immunologic tests. Brain magnetic resonance imaging showed normal findings. Conclusions This study suggests that primary EBV infection should be considered one of the most likely causes of SSNHL without any hearing recovery in children. Therefore, a routine audiological examination should be recommended for children with virologically confirmed primary EBV infection at approximately 3-4 weeks after onset of symptoms and then repeated with periodic follow-up. Further studies on a wider number of children affected by SSNHL might clarify the possible pathogenetic role of this dual serological positivity.

Two tiny muscles are attached to the ossicles of the middle ear: the stapedius, whose role as a protector of the inner ear against loud noise has been widely accepted, and the tensor tympani, which remains a mystery since no valid method of detecting its contraction has yet been developed. However, tonic contraction of the tensor tympani has been associated with a number of otological conditions including fullness, tinnitus, slight hearing loss, and Meniere-like findings. Our hypothesis is that an easily recognizable sign in the acoustic immittance testing that is part of almost every basic audiological evaluation indicates the contraction of the tensor tympani. During acoustic reflex assessment, a loud stimulus causes a bilateral contraction of the stapedial muscles and an increase in impedance which appears as a deflection in the tracing of the immittance test results. In the case of a contracted tensor tympani, when an intense sound is sent to provoke the acoustic reflex, the stapedius must overcome its resistance which would otherwise have the opposite effect on the footplate. This effort can be seen as a small peak or "preshoot" preceding the greater negative deflection of the impedance. We report the cases of ten patients with unilateral aural symptoms such as tinnitus, impaired noise tolerance, fullness, ear pressure and/or ear discomfort during chewing; the preshoot was present only in the symptomatic ear. If further studies confirm our hypothesis, this could give rise to new therapeutical strategies aimed at reducing contraction of the tensor tympani and balancing its function.

Introduction Dysphonia has been described in patients affected by coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the prevalence of dysphonia, and its severity and extent, of voice fatigue and of dysphagia in non hospitalized patients affected by COVID-19 in Lombardy, the Italian region most hit by the first explosive outbreak of COVID-19 in Europe. Methods Demographic and clinical data of 160 consecutive patients, with COVID-19 diagnosis confirmed by nasal swabs processed by reverse transcription polymerase chain reaction, were gathered by means of telephone interviews performed by physicians in charge of daily follow-up. General and specific symptoms concerning voice and swallowing impairment were investigated. Dysphonia grade and duration were graded on 4-point scales, while voice fatigue was graded on a 5-point scale. Results Dysphonia was reported by 70 (43.7%) patients and was positively associated with voice fatigue (P < 0.001), cough (P = 0.005), rhinitis (P = 0.01), and dyspnea (P = 0.06); it was mild and/or moderate in 69 patients, but its duration was > 2 weeks in 33/70 (47.1%) patients and >1 month in 11/70 (15.7%). Grade and duration of dysphonia were positively associated with cough and rhinitis (all P values < 0.01). Voice fatigue was reported by 43/160 patients (26.8%) and its severity was correlated with dysphonia (P < 0.0001), cough (P = 0.02), rhinitis (P = 0.02), dyspnea (P < 0.001), and loss of appetite (P = 0.01). Dysphagia was encountered in 27/160 patients (16.9%) and was associated with dysgeusia, cough, arthralgia, myalgia and loss of appetite but not with dysphonia. Conclusions Dysphonia was a highly prevalent and long-lasting symptom in this series; it has been underestimated to date. Further studies might shed light on the pathophysiology of voice disorders in COVID-19 patients.