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Pure Tone Audiometry showing a moderate bilateral symmetric hearing loss with a descending curve on high frequencies.
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Modulation of tinnitus characteristics such as pitch and loudness has been extensively described following movements of the head, neck and limbs, vertical or horizontal eye gaze, pressure on myofascial trigger points, cutaneous stimulation of the hands, electrical stimulation of the median nerve, and transcranial direct current stimulation. Modulat...
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Citations
... Tinnitus, the perception of a sound when no external stimulation is present 23 , is commonly found in patients with hearing loss following presbycusis 24,25 , noise exposure 26,27 or other auditory conditions 28,29 ; however, it can also be found in patients with a clinically normal hearing, following synaptopathy 30,31 , somatic disorders [32][33][34][35][36][37] and psychological dysfunctions 38 . binaural perception and in the integration of sounds, can be compromised in MS patient 43 . ...
Many symptoms of multiple sclerosis may affect the ear, nose and throat. The most common otolaryngologic symptoms of multiple sclerosis are speech disorders, followed by sleep disorders, vertigo and disequilibrium, dysphagia, smell alterations, and hearing loss. Less common symptoms include sialorrhea, facial palsy, taste alterations, trigeminal neuralgia and tinnitus. The origin of otolaryngologic symptoms in MS is mainly central, although increasing evidence also suggests a peripheral involvement.
Otolaryngologic symptoms in multiple sclerosis may have different clinical presentations; they can appear in different stages of the pathology, in some cases they can be the presenting symptoms and their worsening may be correlated with the reactivation of multiple sclerosis. Many of these symptoms significantly affect the quality of life or patients and lead to increased morbidity and mortality.
Otolaryngologic symptoms are common in multiple sclerosis; however, they are often overlooked. In many cases, they follow the relapsing-remitting phases of the disease, and may spontaneously disappear, leading to a delay in Multiple Sclerosis (MS) diagnosis. Clinicians should be aware of otolaryngologic symptoms of multiple sclerosis, especially when they are associated to neurologic symptoms, as they may be early signs of a still undiagnosed multiple sclerosis or could help monitor disease progression in already diagnosed patients.
... performed to evaluate the presence somatic tinnitus [18][19][20][21][22] ; all maneuvers on the temporomandibular joint and head and neck did not induce a modulation of tinnitus pitch or loudness, thus excluding a somatosensory origin of tinnitus. ...
Multiple Sclerosis (MS) is a chronic inflammatory and neurodegenerative disease of the central nervous system characterized by the destruction of myelin sheaths and axonal loss. Presenting symptoms of multiple sclerosis may vary and if not promptly identified may lead to a delayed diagnosis of Multiple sclerosis. In this paper, we present a rare case of a patient with ageusia as presenting symptom of Multiple sclerosis; the symptom spontaneously resolved after two weeks and was followed by hyposmia, dizziness, tinnitus and facial paraesthesia that eventually led to a clinical diagnosis of Multiple sclerosis. The presence of gustatory, olfactory and audio-vestibular symptoms has been associated with disease activity and progression of several inflammatory and neurodegenerative diseases of the central nervous system including Multiple sclerosis. Gustatory alterations may be due to the presence of demyelinating lesion in the brain area of taste; the progression of the disease may explain the additional olfactory and audio-vestibular symptoms described in this patient. Even if taste alteration is an extremely rare presenting symptom of Multiple sclerosis, its presence in young women should always be carefully investigated as it could be an early sign of Multiple sclerosis.
... However, not all individuals with clinical hearing loss develop hypersensitivity to sound; recent literature has proposed a role for "hidden hearing loss" in subjects with apparent normal hearing thresholds and a reduced neural output from the cochlea [32][33][34][35] . Hyperacusis may involve and be modulated by areas outside the classical auditory pathways following multisensory integration, as also described in tinnitus [36][37][38] . ...
There is a growing awareness that children may experience hyperacusis, a condition that is often associated with behavioral and developmental disorders. This preliminary study was aimed to investigate the effects of hyperacusis alone on various components of speech and language in children without developmental disorders. This study was conducted on 109 children aged between 4 and 7 years attending kindergarten and primary school. Hyperacusis was assessed through behavioral observation of children and questionnaires for parents. Different components of speech and language were assessed through specific tests. Hyperacusis was diagnosed in fifteen children (13.8%); ten (66.7%) were attending primary school and five (33.3%) kindergarten. A significant difference between children with and without hyperacusis was found for tests evaluating the average number of words in a sentence and phonemic fluency; older children appeared to have more difficulties. Several differences in education profiles were found: parents of children with hyperacusis spent less time with their children compared to parents of children without hyperacusis. Our preliminary results suggest some difficulties in lexical access and the use of shorter sentences by children with hypersensitivity to sound; however, the small size of our sample and the largely unknown interactions between hyperacusis and developmental disorders suggest caution when interpreting these results. Further studies on larger samples are necessary to gain additional knowledge on the effects of hyperacusis on speech and language in children without developmental disorders.
... Tinnitus is defined as the perception of a sound in the absence of a matching external acoustic stimulus and is often described by patients as buzzing, hissing, roaring, or screeching. 1 It is estimated that 95% of the world population experiences tinnitus at least once in life. 1 Several conditions can produce tinnitus, including psychiatric disorders, 2 posttraumatic head injury, 3 systemic diseases such as multiple sclerosis, 4 autoimmune diseases, 5 and, as recently reported by Ralli et al., 6 somatic modulation. More rarely, tinnitus can be caused by a vascular compression of the VIII cranial nerve (cochlear nerve) by a vessel with an anomalous course (e.g., anterior inferior cerebellar artery [AICA]). ...
Background:
The use of surgical cochlear nerve decompression is controversial. This study aimed at investigating the safety and validity of microsurgical decompression via an endoscope-assisted retrosigmoid approach to treat tinnitus in patients with neurovascular compression of the cochlear nerve.
Case description:
Three patients with disabling tinnitus due to a loop in the Internal Auditory Canal (IAC) were evaluated with Magnetic Resonance Images (MRI), and tests of Pure Tone Auditory (PTA), Tinnitus, and Auditory Brain Response (ABR) to identify the features of the cochlear nerve involvement. We observed a loop with a caliber greater than 0.8mm in all patients. Patients were treated via an endoscope-assisted retrosigmoid microsurgical decompression. None of the patients reported short-term or long-term post-surgery complications. After the surgery, tinnitus resolved immediately in two patients , while in the other patient symptoms persisted although they improved; in all patients, hearing was preserved and ABR improved.
Conclusion:
Microsurgical decompression via endoscope-assisted retrosigmoid approach is a promising, safe, and valid procedure for treating tinnitus caused by cochlear nerve compression. This procedure should be considered in patients with disabling tinnitus who present altered ABR and a loop that has a caliber greater than 0.8mm and is in contact with the cochlear nerve.
Tympanic membrane perforation is a common condition in clinical otolaryngology. Although some eardrum patients can self-heal, a long period of non-healing perforation leads to persistent otitis media, conductive deafness, and poor quality of life. Tympanic membrane repair with autologous materials requires a second incision, and the sampling site may get infected. It is challenging to repair tympanic membranes while maintaining high functionality, safety, affordability, and aesthetics. 3D bioprinting can be used to fabricate tissue patches with materials, factors, and cells in a design manner. This paper reviews 3D printing technology that is being used widely in recent years to construct eardrum stents and the utilized applied materials for tympanic membrane repair. The paper begins with an introduction of the physiological structure of the tympanic membrane, briefly reviews the current clinical method thereafter, highlights the recent 3D printing-related strategies in tympanic membrane repair, describes the materials and cells that might play an important role in 3D printing, and finally provides a perspective of this field.
Background:
Tympanic membrane perforations (TMPs) are a common complication of trauma and infection. Persisting perforations result from the unique location of the tympanic membrane. The wound is surrounded by air of the middle ear and the external auditory canal. The inadequate wound bed, growth factor, and blood supply lead to circular epithelialization of the perforation's edge and premature interruption of defect closure. Orthotopic animal models use mechanical or chemical tympanic membrane laceration to identify bioactive wound dressings and overcome premature epithelialization. However, all orthotopic models essentially lack repetitive visualization of the biomaterial-wound interface. Therefore, recent progress in 3D printing of customized wound dressings has not yet been transferred to the unique wound setup of the TMP. Here, we present a novel application for the mice dorsal skinfold chamber (DSC) with an epithelialized full-thickness defect as TMP model.
Methods:
A circular 2-mm defect was cut into the extended dorsal skinfold using a biopsy punch. The skinfold was either perforated through both skin layers without prior preparation or perforated on 1 side, following resection of the opposing skin layer. In both groups, the wound was sealed with a coverslip or left unclosed (n = 4). All animals were examined for epithelialization of the edge (histology), size of the perforation (planimetry), neovascularization (repetitive intravital fluorescence microscopy), and inflammation (immunohistology).
Results:
The edge of the perforation was overgrown by the cornified squamous epithelium in all pre-parations. Reduction in the perforation's size was enhanced by application of a coverslip. Microsurgical preparation before biopsy punch perforation and sealing with a coverslip enabled repetitive high-quality intravital fluorescence microscopy. However, spontaneous reduction of the perforation occurred frequently. Therefore, the direct biopsy punch perforation without microsurgical preparation was favorable: spontaneous reduction did not occur throughout 21 days. Moreover, the visualization of the neovascularization was sufficient in intravital microscopy.
Conclusions:
The DSC full-thickness defect is a valuable supplement to orthotopic TMP models. Repetitive intravital microscopy of the epithelialized edge enables investigation of the underlying pathophysiology during the transition from the inflammation to the proliferation phase of wound healing. Using established analysis procedures, the present model provides an effective platform for the screening of bioactive materials and transferring progress in tissue engineering to the special conditions of tympanic membrane wound healing.
The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMP) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anaesthetic risks and high failure of graft patency. The tissue engineering strategy, which includes the applications of a 3D scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, the overview the in vitro and preclinical studies of emerging products over the past five years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.
Platelets play a crucial role in hemostasis, tissue regeneration and host defense. Based on these settings, platelet-rich plasma (PRP) and its derivatives are therapeutically used to promote wound healing in several scenarios. This review summarizes the biological mechanisms underlying the most traditional as well as innovative applications of PRP in wound healing. These mechanisms involve the combined action of platelet-derived growth factors and cytokines, together with the role of plasma-derived fibrillar, antioxidant and homeostatic factors. In addition, regenerative treatments with PRP consist of personalized and non-standardized methods. Thus, the quality of PRP varies depending on endogenous factors (e.g., age; gender; concomitant medication; disease-associated systemic factors; nutrition) and exogenous factors (anticoagulants and cellular composition). This review also analyses whether these factors affect the biological mechanisms of PRP in wound healing applications.
Objective
We aimed to evaluate the effect of autologous platelet-rich plasma gel (PRPG) on fat graft myringoplasty (FGM) in tympanic membrane perforations caused by chronic otitis media.
Methods
This retrospective study involved 63 patients who underwent operations between 2015 and 2018. Fat graft myringoplasty was performed with the transcanal approach with and without the use of PRPG in the surgical field. The patients were classified into 2 groups: group A, which included 32 patients who underwent FGM with the use of autologous PRPG, and group B, which included 31 patients who underwent FGM alone. Tympanic membrane perforations were divided into 2 groups: small perforations (1-2 mm) in a single quadrant and large perforations (2-4 mm) in at least 2 quadrants.
Results
Both groups were statistically matched regarding age and sex. The mean postoperative follow-up was 11.6 and 12.1 months for groups A and B, respectively. Four months postoperatively, the success rate of the graft in group A (100%) was significantly higher than that in group B (83.8%; P = .03). The preoperative and postoperative median air–bone gaps of the groups were similar ( P = .653 and P = .198, respectively). No worsening of the air–bone gap was noted postoperatively in either group.
Conclusions
This study demonstrated that autologous PRPG application during FGM allows for a higher success rate than FGM alone. Furthermore, the use of PRPG with FGM for large perforations increases the success rate. Further studies are needed to investigate the PRPG healing effect on other tympanic membrane perforation closure techniques.
The effectiveness of a hearing aid (HA) is commonly assessed by a questionnaire that provide information on the benefits/disadvantages of the use of the HA in real life situations. This work wants to analyze if acoustic benefit and satisfaction levels depend by an HA equipped with different technologies (Basic technology HA, Medium technology HA, Premium technology HA trough the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire administered to 60 patients and the Hearing Handicap Inventory (HHI) questionnaire administered to 14 patients. The results show that regardless of technology, persistent problems remain such as perception in noisy environments. A further effort is required by the technicians in the evaluation of the patient as a whole, from the identification of the HA that ergonomically better suits the needs of each patient until the adaptation in complex environments, for the minimization of the perception of disability.
