Management of tinnitus: oral treatment with melatonin and sulodexide 12 November 2009
Posted by Giulio Filograna Pignatelli M.D. in miscellaneus, Otology & Neurotology, Uncategorized.add a comment
Neri G, Baffa C, De Stefano A, Poliandri A, Kulamarva G, Di Giovanni P, Petrucci AG, Castriotta A, Citraro L, Cerrone D, D’ Orazio F, Croce A.
Basic and Applied Medical Sciences Department, G. d Annunzio University of Chieti-Pescara, Chieti, Italy.
The main problem arising from tinnitus is the disturbance it causes in day-to-day life and disturbance in sleep leading to fatigue and general discomfort. We attempted to study the effect of melatonin in conjunction with Sulodexide as a treatment method for tinnitus and evaluate its effectiveness. We studied 102 patients suffering from tinnitus with a Prospective Randomised Controlled Study conducted in a tertiary care ENT department. After randomisation, 34 patients were treated with melatonin and Sulodexide, another 34 were treated with melatonin alone, and the remaining 34 (control group) were managed without therapy in order to evaluate spontaneous variations in quality of tinnitus. Patients were assessed prospectively with Tinnitus Handicap Inventory and Acufenometry both pre-treatment and post-treatment. Among the patients we studied, we found better results with both Tinnitus Handicap Inventory and Acufenometry in the group who received melatonin and Sulodexide as against melatonin alone. Any improvement was noted in the control group. In conclusion, our opinion is that melatonin in combination with Sulodexide is a viable treatment option for patients suffering from central or sensorineural tinnitus.
Characterization of bilateral superior canal dehiscence 11 November 2009
Posted by Giulio Filograna Pignatelli M.D. in Otology & Neurotology.add a comment
Boleas Aguirre MS, Migliaccio A, Carey J.
Clínica Universitaria de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Navarra, España. msboleas@unav.es
In the superior canal dehiscence syndrome, patients can have sound- or pressure-induced vertigo and oscillopsia.
They may also present conductive hearing loss or higher than normal bone conduction thresholds. Clinical manifestations are due to the effect of a third mobile window in the inner ear created by the dehiscence. Diagnosis is based on clinical manifestations, vertical and rotatory nystagmus induced by sound and pressure reflecting SSC stimulation, reduced threshold and increased amplitude of vestibular evoked myogenic potentials (VEMP) and temporal bone CT scan images showing the SSC dehiscence. Characteristic eye movements can be recorded with the scleral search coil technique.
Corticosteroid response and supporting cell antibody in autoimmune hearing loss 29 September 2009
Posted by aledestefano in Otology & Neurotology, Uncategorized.add a comment
Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor 48109-0506, USA.
OBJECTIVE: To determine whether antibodies to supporting cells are associated with response to corticosteroids in patients with autoimmune sensorineural hearing loss. DESIGN: Prospective analysis of antibody to inner-ear antigens. SETTING: Collaborating otology practices in Pennsylvania, Michigan, and Indiana. PATIENTS: Sixty-three patients with rapidly progressive unilateral or bilateral sensorineural hearing loss of unknown cause suggestive of autoimmune sensorineural hearing loss. INTERVENTIONS: Pretreatment audiometry, serum analysis by Western blot (WB) and immunofluorescence (IF) tests, corticosteroid therapy, and follow-up audiometry. MAIN OUTCOME MEASURES: Antibody reactivity and audiogram changes were analyzed for association with response to treatment. RESULTS: More than half of the patients (37/63) had antibodies to both a 68- to 72-kDa protein and to inner-ear supporting cells, 16 patients had positive results on one assay only, and 10 had negative results on both. Twenty-eight patients improved and 35 did not. The WB findings did not correlate with response. Of the WB-positive patients, 49% (21/43) improved, as did 35% (7/20) of the WB-negative patients (P = .30). In contrast, 53% (25/47) of IF-positive patients improved, compared with only 19% (3/16) in the IF-negative group (P = .02). Of those who improved, 89% (25/28) were IF positive. CONCLUSIONS: Antibody to an inner-ear supporting cell antigen was significantly associated with hearing improvement after corticosteroid therapy (relative rate, 2.8). Patients with IF-positive serum are nearly 3 times more likely to experience improved hearing with corticosteroid treatment than those who are IF negative. Antibodies to inner-ear supporting cell antigen may have value in diagnosis and treatment of patients with autoimmune sensorineural hearing loss.
link: http://archotol.ama-assn.org/cgi/content/full/131/8/665
Classification and hearing evolution of patients with sudden sensorineural hearing loss 28 September 2009
Posted by aledestefano in Otology & Neurotology.add a comment
Penido NO, Cruz OL, Zanoni A, Inoue DP.
Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil. nopenido@terra.com.br
The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference in thresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.
A new classification of lip zones to customize injectable lip augmentation 24 September 2009
Posted by Giulio Filograna Pignatelli M.D. in Cosmetic surgery, miscellaneus, Uncategorized.add a comment
Jacono AA
OBJECTIVES: To present a new classification of 15 anatomical lip zones used to direct placement of injectable fillers during lip augmentation and to evaluate the new classification’s ability to customize lip contour and size. METHODS: Study participants were consecutive patients presenting to a facial plastic and reconstructive surgery practice for injectable lip augmentation with a nonanimal-sourced stabilized hyaluronic acid (Restylane; Medicis Aesthetic Inc, Scottsdale, Arizona). A nonrandomized, prospective case series. RESULTS: A total of 137 treatments were performed on lips of 66 patients. The mean (SD) satisfaction score was 4.5 (0.6) on an integral scale of 1 (dissatisfied) to 5 (most satisfied). The mean (SD) persistence until lips returned to preoperative appearance based on patient subjective evaluation was 4.9 (1.5) months. Patients were free of adverse effects. CONCLUSIONS: Using a new classification of lip anatomical zones to direct the injection of a nonanimal-sourced stabilized hyaluronic acid has increased my ability to better control lip shape and size in lip augmentation. This technique was met with high patient satisfaction and no adverse effects. Persistence of injected nonanimal-sourced stabilized hyaluronic acid was similar to that seen in other studies.
