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ABSTRACT: Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients.
International Journal of Otolaryngology 01/2011; 2011:709469.
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ABSTRACT: To evaluate the correlation between caloric and vestibular evoked myogenic potential test results, initial audiogram data, and early hearing recovery, in patients with idiopathic sudden hearing loss.
One hundred and four patients with unilateral idiopathic sudden hearing loss underwent complete neurotological evaluation. Results for vestibular evoked myogenic potential and caloric testing were compared with patients' initial and final audiograms.
Overall, abnormal vestibular evoked myogenic potential responses occurred in 28.8 per cent of patients, whereas abnormal caloric test results occurred in 50 per cent. A statistically significant relationship was found between the type of inner ear lesion and the incidence of profound hearing loss. Moreover, a negative correlation was found between the extent of the inner ear lesion and the likelihood of early recovery.
In patients with idiopathic sudden hearing loss, the extent of the inner ear lesion tends to correlate with the severity of cochlear damage. Vestibular assessment may be valuable in predicting the final outcome.
The Journal of Laryngology & Otology 11/2010; 125(3):251-7. · 0.60 Impact Factor
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ABSTRACT: Adult laryngeal rhabdomyosarcomas are rare tumours commonly treated by laryngectomy.
We present a case of subglottic laryngeal rhabdomyosarcoma in an elderly woman, treated by endoscopic resection.
Despite the fact that this tumour is traditionally treated aggressively, this approach is not supported by the literature. Due to the varying biological behaviour of this tumour in adults, we believe that conservative surgical procedures or combination therapies should be preferred, rather than total laryngectomy.
The Journal of Laryngology & Otology 10/2009; 123(11):e21. · 0.60 Impact Factor
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ABSTRACT: To evaluate the results of vestibular evoked myogenic potential testing in patients with idiopathic sudden hearing loss, and to correlate these results with the findings of caloric testing, the clinical appearance of vertigo and the influence of age.
Eighty-six patients with unilateral idiopathic sudden hearing loss and 35 healthy controls underwent a standard protocol of neurotological evaluation. Vestibular evoked myogenic potential responses were measured and compared with caloric responses.
On the affected side, 30.2 per cent of patients showed abnormal vestibular evoked myogenic potential responses, while 52.3 per cent had abnormal caloric responses. A statistically significant relationship was found between the results of these two tests. A statistically significant relationship was also found between the type of vestibular lesion and the occurrence of vertigo. Advancing age correlated statistically with more extensive labyrinthic lesions.
A combination of vestibular evoked myogenic potential and electronystagmography testing indicated the existence of vestibular involvement in many patients with idiopathic sudden hearing loss. Both tests are necessary in order to obtain a more thorough and in-depth knowledge of the pathophysiology of idiopathic sudden hearing loss.
The Journal of Laryngology & Otology 09/2009; 123(12):1325-30. · 0.60 Impact Factor
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ABSTRACT: The aim of this study was to investigate the contribution of electronystagmography and magnetic resonance imaging to the aetiological diagnosis of vertigo and unsteadiness, in a population in which the history and clinical examination provide no conclusive diagnosis of the origin of the dysfunction (i.e. peripheral or central).
This retrospective study included 102 patients, who underwent full ENT clinical evaluation, history and neurotological assessment (including pure tone audiography, auditory brainstem response testing, electronystagmography and magnetic resonance imaging).
Electronystagmography contributed to establishment of a diagnosis in 53/102 patients (52 per cent), whereas magnetic resonance imaging did the same in four of 102 patients (3.9 per cent).
Electronystagmography remains the most useful examination for aetiological diagnosis of patients with vertigo and unsteadiness, since the actual number of patients with vertigo and unsteadiness of central origin is small (3.9 per cent), even in a population in which history and clinical examination may indicate an increased probability of central nervous system dysfunction.
The Journal of Laryngology & Otology 03/2009; 123(8):851-6. · 0.60 Impact Factor
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ABSTRACT: To evaluate the ability of VEMP to disclose spatial dissemination of Multiple Sclerosis.
Forty-six MS patients with auditory and/or vestibular symptoms were studied. Patients were divided in two groups. Group 1 included 24 patients with brainstem MRI findings, and Group 2 included 22 patients without MRI findings. VEMP and BAEP have been recorded and assessed.
Abnormal p13n23 wave was observed in 50%, while unilateral absence or bilateral delay of the n34p44 in 43% of the patients. The overall diagnostic value considering abnormal cases suggested by both first and second VEMP waves was increased to 71%. Statistically significant differences revealed between patients and controls for p13 latency (p=0.018). The p13n23 was abnormal in 7 patients, although MRI scanning did not reveal brainstem lesions. In 9 out of 18 MS patients suffering from unilateral hearing loss, n34p44 was present in the unaffected ears and absent in the affected side, although p13n23 was normal.
Abnormal VEMP imply the presence of lesions undetected by MRI neuroimaging, which verifies the diagnostic value of the method. Unilateral absence of n34p44 complex was related with sensorineural hearing loss, supporting the hypothesis that n34p44 is of cochlear origin.
Journal of Vestibular Research 01/2009; 19(1-2):59-66. · 1.35 Impact Factor
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ABSTRACT: To assess the outcomes of neonatal hearing screening with regard to the final diagnosis in a very large number of newborns and investigate related strengths and weaknesses of the program.
In this study, 76,560 newborns were assessed.
All neonates were assessed using transient evoked otoacoustic emissions (TEOAEs).
From the 76,560 neonates screened, 1,564 (2%) failed the test. According to the screening protocol, all parents of failed neonates were asked to bring their children 1 month following discharge to repeat the test. Of the 541 (34.6%) newborns who repeated the test, 303 (56%) were found normal and 238 (44%) again failed TEOAE. The latter children were referred to two special public centers for full audiology evaluation. In addition, 124 neonates were also referred due to other reasons revealed in the screening process (family history, high levels of bilirubin, etc.). Of the 362 children who were referred to the two special audiology centers, 113 (31.2%) were evaluated by these two centers. In addition, 42 children who had failed initial screening and did not show up for a follow-up appointment to repeat TEOAE were also assessed in the same centers. Of the 155 children who had a special audiologic evaluation, 56 (36.1%) were found to have hearing loss (HL) and 99 (63.9%) normal hearing. In detail, 28 had bilateral sensorineural HL greater than 40 dB, 10 had unilateral sensorineural HL greater than 40 dB, and 18 had otitis media with effusion or other conductive HL.
Derived from the present study: 1) repeated testing of "failed" newborns in the maternity hospital and before discharge leads to an acceptable referral rate of 2%; 2) the 1-month follow-up of "failed" newborns further limits the false positive results but leads to high rate of newborns lost to follow-up; 3) a dedicated secretariat system should be implemented to follow-up each "failed" newborn and remind parents about their follow-up appointments; and 4) additional measures such as detailed educational material and parental friendly approach should also be implemented.
The Laryngoscope 08/2008; 118(7):1253-6. · 1.75 Impact Factor
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ABSTRACT: Anterior semicircular canal (ASC) lithiasis is uncommon and usually self-treated. In the rare cases when such patients seek medical advice, diagnosis requires careful consideration of the patient's symptoms and the clinical characteristics of the nystagmus triggered by the Dix-Hallpike (D-H) examination. In this study, two atypical cases of ASC benign paroxysmal positional vertigo (BPPV) are presented and the relevant literature is reviewed. Regardless of their unique symptoms, both participants in this study were diagnosed with lithiasis of the left ASC. The clinical manifestations of ASC BPPV may differ significantly from typical symptoms seen in the more common posterior semicircular canal BPPV. The possible mechanisms responsible for this intriguing variance, as well as guidelines for diagnosing the affected side, are discussed.
International journal of audiology 06/2008; 47(5):276-82. · 1.34 Impact Factor
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ABSTRACT: Acute tonsillitis or pharyngitis may lead to suppurative thrombophlebitis of the internal jugular vein. This complication, also known as Lemierre's syndrome, remains, even nowadays, life threatening, due to dissemination of septic thromboemboli to various organs. Respiratory deficiency and renal impairment are often reported in patients suffering from Lemierre's syndrome.
The unusual clinical manifestation of this case involves severe acute renal and respiratory deficiency in addition to microangiopathic consumption coagulopathy in a young patient treated with macrolides five days after the onset of acute tonsillitis.
The usual causative pathogen, namely Fusobacterium necrophorum, shows a varying sensitivity to macrolides. As a result, the syndrome may present itself in a variety of clinical forms even in patients under treatment with macrolides. A high index of suspicion is therefore crucial for in time prevention of potentially life threatening complications.
The Journal of Laryngology & Otology 06/2008; 122(5):527-30. · 0.60 Impact Factor
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ABSTRACT: Vestibular Evoked Myogenic Potentials (VEMPs) are saccular responses to acoustic stimuli. They can be recorded from the sternocleidomastoid muscle ipsilaterally to the stimulated ear. Their reflex arc includes the ipsilateral vestibular nuclei.
To determine the usefulness of VEMPs in localising brainstem lesions.
We used VEMPs, Blink Reflex (BR) and Brainstem Auditory Evoked Responses (BAERs) to evaluate six patients presenting with acute ischaemic or haemorrhagic brainstem lesions, or basilar dolichoectasia.
MRI in patient one revealed a dorsolateral medullary infarct on the right. VEMP amplitude was reduced ipsilaterally. The R2 BR component was delayed bilaterally upon stimulation of the affected side. Patients two and three had suffered a left lateral lower pontine infarct and a right lateral lower pontine haemorrhage. In patients four and five, MRA revealed dolichoectasia of the basilar artery exerting pressure on the lower lateral pons. VEMP amplitude was reduced ipsilaterally. Patient six had an ischaemic lesion in the right upper lateral pons. The R1, R2i and R2c BR components were delayed ipsilaterally. BAERs waves IV and V were absent on the right. VEMPs were normal.
VEMPs are affected by lesions of the lateral lower pons and upper medulla. Our results suggest that they may be a useful addition in the localisation of such lesions.
B-ENT 02/2008; 4(4):215-9.
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ABSTRACT: The treatment of acute lymphoblastic leukemia (ALL) often combines a neurotoxic chemotherapeutic protocol such as Berlin-Frankfurt-Munster-95 (BFM-95) with gentamicin, an antibiotic known to have an early and quickly reversed impact on olivocochlear reflex in animal studies. This study investigates whether this combination has any long-term side effects on the medial olivocochlear bundle (MOCB).
In all 47 children of the study suppression of distortion product otoacoustic emissions (DPOAEs) by contralateral application of white noise (WN) was used to assess the function of the MOCB. The population was divided into three groups depending on the time interval between the end of therapy and examination. The group examined shortly after chemotherapy included 12 children who had received low gentamicin doses (less than 13 days). The group evaluated 2 years after therapy involved another 12 children who had required medium gentamicin doses (more than 13, less than 23 days). The group examined 3 years after therapy included a subgroup of 12 children to whom low gentamicin doses were infused and another 11 children with high gentamicin doses (more than 23 days).
Three years after therapy the olivocochlear reflex was efficiently produced in both subgroups of low and high gentamicin doses. Two years after therapy, contralateral WN induced increase of DPOAEs at 4 of the 12 examined frequencies. Shortly after therapy, WN increased, instead of suppressing, DPOAEs at five frequencies.
This abnormal result of contralateral noise application perceived as impaired cochlear efferent innervation may indicate that ALL-BFM-95 exerts a toxic effect on the MOCB, which is slowly reversed within the first 3 years after chemotherapy and does not seem to be affected in the long term by different cumulative doses of gentamicin.
International Journal of Pediatric Otorhinolaryngology 12/2007; 71(11):1767-73. · 1.17 Impact Factor
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ABSTRACT: Aim of this study was to investigate the clinical characteristics, management and prognosis of non-Hodgkin lymphomas of the nasal cavity and paranasal sinuses. Overall 12 patients with non-Hodgkin malignant lymphoma, at our Institute, were studied over an eight-year period from 1997 to 2005. Patients' data collected were age, sex, presenting signs and symptoms, histology, treatment, complications, and outcome. Also available were computerised tomography findings, and paraffin-embedded tissue bocks. Mean age was 62 years (range: 42-81), with a male dominance (male to female ratio: 7:5). Most patients had not presented any specific symptoms, such as nasal obstruction, headaches, epistaxis and facial swelling. Using immunocytochemistry on paraffin-embedded tissue sections, the predominance of large B-cell subtype was detected. Treatment administered: only radiotherapy (stage IEA) or in combination with chemotherapy (IIE-IVE). Of these patients, 5 died from the disease, 4 survived without disease, 2 survived with the disease, and one died of non-related causes. Non-Hodgkin's lymphomas are relatively rare. Early diagnosis, based mainly on tissue biopsy and computerised tomography, is essential in the management of non-Hodgkin lymphoma.
Acta otorhinolaryngologica Italica: organo ufficiale della Società italiana di otorinolaringologia e chirurgia cervico-facciale 03/2007; 27(1):6-9. · 0.86 Impact Factor
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ABSTRACT: The case of a hydatid cyst located in the duct of Wharton of a 56-year-old farmer is reported not only because of the unusual location of the disease, but also because the clinical manifestations and surgical findings of the hydatid cyst strongly resembled those of a salivary calculus in the duct of Wharton. The patient presented with a non-painful swelling of the right submandibular region. The mass, which appeared 5 years before seeking medical advice, augmented progressively during the first year after its onset and remained stable during the next 4 years. The subsequent surgical excision of the mass was uneventful and a round mass, which was palpated intraoperatively in the duct of Wharton was assumed to be a sialolith. The diagnosis for a hydatid cyst of the duct of Wharton was made by histological examination. Although salivary calculus is the most common finding in cases of obliteration of the duct of Wharton, histological examination of the surgically excised submandibular gland may reveal benign tumours. In extremely rare cases where hydatid cysts are located in the cervicofacial area, a detailed further diagnostic procedure is required in order to diagnose possible involvement of other organs.
International Journal of Oral and Maxillofacial Surgery 03/2007; 36(2):177-9. · 1.51 Impact Factor
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ABSTRACT: Auricle reconstruction is a surgical procedure described in the medical literature as early as 600 BC. The aim of the present paper is to review these attempts and their results.
Literature search and medical history books were used as scientific sources.
More than 40 different cartilagenous, osseous or other alloplastic frame materials (autogenous tibial bone, iliac bone, mastoid bone, maternal auricular cartilage, autogenous nasoseptal cartilage, allogenous meniscus, autogenous meniscus and many more) have been used since 1891. From approximately 40 reconstruction procedures that had been proposed, only eight were still in use in the 1980s. The reason for abandoning the majority of these surgical techniques was the unacceptable aesthetic result. However, at the end of the 20th Century two new techniques were introduced. These techniques were designed by Satoru Nagata and Burt Brent. Both techniques provide cosmetic and functional results that are acceptable both to the patient and to the surgeon.
Although the outcome of surgical auricle reconstruction was in general disappointing through the centuries, at the end of the 20th Century new surgical methods were established and at the present time auricle reconstruction can be attempted with acceptable results.
Journal of Plastic Reconstructive & Aesthetic Surgery 02/2007; 60(6):659-62. · 1.49 Impact Factor
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ABSTRACT: Vincristine is a well known neurotoxic chemotherapeutic agent. Dose dependent and cumulative peripheral neuropathy is the main dose limiting side effect of chemotherapy with vincristine. The mechanisms responsible for the neurotoxic effects of vincristine have not yet been fully understood. This prospective study was directed at determining whether vincristine treatment interferes with the function of the medial olivocochlear bundle.
Fifteen children suffering from leukemia were subjected to tympanogram, stapedial muscle reflex, pure tone audiometry and transient evoked otoacoustic emissions (TEOAEs) in the absence and presence of contralateral white noise on day 1 and on day 22 of treatment with vincristine. The function of the medial olivocochlear bundle was assessed by the phenomenon of suppression of otoacoustic emissions by contralateral application of white noise.
The study revealed a statistically significant decrease of contralateral suppression amplitudes in all cases after three sessions of chemotherapy with vincristine. On the contrary no alterations were observed in pure tone audiometry thresholds. A non-significant decrease of the mean TEOAEs' amplitudes was also noted. When analyzed by frequency, however, this decrease reached the level of statistical significance at two frequencies.
Vincristine treatment seems to exert a neurotoxic effect on the efferent olivocochlear system, which takes place early in the course of chemotherapy. This is a new aspect to be added to the possible mechanisms underlying the toxicity of vincristine in the auditory periphery. Whether changes in efferent function might contribute to understanding the mechanisms of neurotoxicity caused by vincristine, or find any clinical application as a predictor or early detector of neurological side effects of vincristine still remains to be seen.
International Journal of Pediatric Otorhinolaryngology 02/2007; 71(1):63-9. · 1.17 Impact Factor
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ABSTRACT: A discharging ear is a very common condition for the general practitioner and the ENT surgeon. Oral and intravenous antibiotics have potential complications, are costly, and exhibit increasing resistance. This study explores the advantages and disadvantages of all common otic preparations and compares effectiveness, safety, cost and complication rates. In chronic otitis media (chronic discharging ears), topical antibiotics seem to be the treatment of choice by comparison with oral or intravenous antibiotics. Cultures and antibiograms do not correspond directly to clinical efficacy, as laboratory determination of resistance does not take into account the high concentration of antibiotics in local preparations. It is safer to use quinolone drops as a first-line treatment, but it is still possible to use short courses of other drops if quinolones are either unavailable or contraindicated (e.g. allergy), or when bacteria are resistant to them. However, in such a situation, a round window membrane involved in an established inflammatory process and therefore less permeable to the passage of topical preparations is the preferred setting, as ototoxicity is a potential complication, especially in the case of gentamicin, in which case patients should be warned accordingly.
International Journal of Clinical Practice 10/2006; 60(9):1115-9. · 2.41 Impact Factor
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ABSTRACT: To evaluate the prognostic factors in benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning procedures (CRPs).
Retrospective study of consecutive BPPV cases diagnosed over three years. All patients underwent a complete otolaryngologic, audiologic and neurotologic evaluation. The appropriate CRP was performed, depending on the type of BPPV. Prognostic factors studied included age, sex, aetiology, duration of disease, abnormal electronystagmographic findings, canal involvement, improper performance of manoeuvres, response on first or repeat treatment, and presence of recurrences.
One hundred and fifty-five patients were studied, 66 men and 89 women, with mean ages of 58.7 and 60.4 years, respectively. Age and the involvement of two canals or bilateral disease had an effect on initial treatment outcome and were correlated to increased recurrences but not to repeat treatment outcome. Secondary BPPV, abnormal electronystagmographic findings and improper performance of manoeuvres had a significant effect both on initial and repeat treatment, but not on recurrences. Sex and duration of symptoms had no effect.
Canalith repositioning procedures provide fast and long-lasting treatment of BPPV in most patients. However, in a small subgroup of patients, failures may be noticed that may be attributed to various prognostic factors.
The Journal of Laryngology & Otology 08/2006; 120(7):528-33. · 0.60 Impact Factor
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ABSTRACT: Vincristine chemotherapy is mainly associated with neurotoxic effects. The ototoxicity of vincristine has been related to high dosage, while low and moderate doses do not seem to induce significant hearing impairment when measured by pure tone or speech audiometry. Otoacoustic emissions have been reported to be more sensitive in early detection of ototoxicity than conventional pure tone audiometry. The present study was directed at determining whether vincristine treatment interferes with outer hair cell function in the absence of measurable changes in pure tone audiometry.
We studied prospectively a cohort of ten children suffering from leukemia. All children were subjected to tympanogram, stapedial muscle reflex, pure tone audiometry, transient evoked (TEOAEs) and distortion product (DPOAEs) otoacoustic emissions on day 1 and on day 22 of treatment with vincristine. TEOAEs were analyzed in terms of emission level and reproducibility as a function of frequency. DPOAEs were obtained as DP-grams and were analyzed in terms of amplitude.
The analyzed parameters of TEOAEs and DPOAEs revealed a declining tendency, although changes did not reach statistical significance. Pure tone audiometry and stapedial reflex thresholds were not altered.
For the population of this study, vincristine did not seem to cause significant alterations of otoacoustic emissions' recordings and consequently significant outer hair cell damage.
International Journal of Pediatric Otorhinolaryngology 07/2006; 70(6):1003-8. · 1.17 Impact Factor
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ABSTRACT: The remnants of the acoustic ossicles have been used in ossicular reconstruction during mastoid surgery for many decades. The present study assessed the status of the acoustic ossicles in 114 patients (57 with cholesteatoma and 57 without) during surgery for chronic otitis media using the operating microscope. In 52 cases, the ossicles (malleus and/or incus) were assessed using both the surgical and scanning electron microscope in order to reveal any erosions and compare the findings. From the 57 operated ears with cholesteatoma, 45 (79%) had ossicular erosion whereas 12 (21%) did not. In the group of 57 operated ears with chronic otitis media without cholesteatoma, 33 (58%) had ossicular erosion whereas 24 (42%) did not. This difference was statistically significant (p = 0.02). With regard to the 52 operated cases who were studied with both microscopes, in the cholesteatoma patients the surgical microscope was not able to reveal any ossicular erosions in 39% of the cases, whereas the scanning electron microscope revealed moderate or severe erosions in the same ears. This suggests that the operating microscope is not reliable enough to determine if ossicular remnants can be used in ossicular reconstruction following cholesteatoma surgery. There is a considerable risk that epithelia or other cholesteatoma particles remain in the areas of erosions that cannot be seen with the operating microscope. The use of such ossicular remnants may lead to cholesteatoma recurrence and failures in mastoid surgery. Therefore, autoclaving or alternative prosthesis may be considered in such cases.
ORL 02/2006; 68(4):243-6. · 0.91 Impact Factor
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ABSTRACT: In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available, and many countries implement elective screening in high-risk newborns.
To assess the failure rates of neonates in hearing screening and the relative importance of risk factors for hearing impairment, both in neonatal intensive care units and in well-baby nursery neonates. The impact on cost-effectiveness is also evaluated.
In the current study, 25,288 newborns were assessed; 23,574 were full-term newborns in the well-baby nursery and 1,714 neonates were in neonatal intensive care units.
All neonates had a general examination (including assessment for congenital anomalies and related history) and were assessed using transient evoked otoacoustic emissions. All newborns were older than 36 weeks at examination and thus had reliable transient evoked otoacoustic emissions.
From the 23,574 full-term neonates in the well-baby nursery, 23,123 (98.1%) passed the test and 451 failed (1.9%). Fifty-three of the 23,574 neonates (0.2%) had a risk factor for hearing impairment; 44 (83%) passed the test and 9 failed (17%). Family history of congenital hearing loss and congenital anomalies were the most frequent risk factors for hearing loss. From the 1,714 neonates in neonatal intensive care units, 1,590 (93%) passed the test and 124 failed (7%). Two hundred thirty-two of the 1,714 neonates (14%) had a risk factor for hearing impairment; 205 (88%) passed the test and 27 failed (12%). In neonatal intensive care unit neonates, toxic levels of ototoxic drugs, mechanical ventilation for more than 24 hours, prematurity, and low birth weight were the most frequent risk factors for hearing loss. Congenital anomalies/syndromes were the most important risk factors for failing screening in both the neonatal intensive care unit and the well-baby nursery, as they showed the highest risk of failing hearing screening. The second most important factor in neonatal intensive care unit newborns was low birth weight, and the third was prematurity in relation to the possibility of failing hearing screening.
The present study found 575 neonates failing hearing screening of 25,288 tested newborns (2.3%). The fact that 78% of newborns who failed hearing screening were in the well-baby nurseries further supports the necessity of universal hearing screening instead of selective screening in neonatal intensive care units, even with the obvious impact on cost-effectiveness. Even if limited funding lead to selective screening in neonatal intensive care units, this should not be applied to high-risk newborns but to all neonatal intensive care unit neonates. Continuous assessment of risk factors and the related possibility of failing hearing screening are of paramount importance in designing hearing screening programs and refining the respective criteria.
Ontology & Neurotology 12/2005; 26(6):1186-90. · 1.90 Impact Factor
