Voice quality after transoral CO2 laser microsurgery (TOLMS): systematic review of literature.

PURPOSE: Transoral laser microsurgery (TOLMS) with carbon dioxide is a safe approach for laryngeal carcinoma. In literature there are three main methods for evaluating speech outcomes: acoustic and aerodynamics analysis, perceptual evaluation and patient-reported outcomes (PROs). The aim of this study was to systematically review the literature about the voice quality outcomes of TOLMS according to type of cordectomy. METHODS: A systematic literature review was performed and all the results until December 2021 were extrapolated. We evaluated the acoustic and aerodynamics parameters (fundamental frequency, harmonics to noise ratio, jitter, shimmer and maximum phonation time), perceptual data (GRBAS scale) and patient-related outcomes (VHI scale). RESULTS: 24 studies met the inclusion criteria for a total number of 1207 patients enrolled. The number for each type of cordectomy are: 287 type I (23.78%), 311 type II (25.78%), 328 type III (27.14%), 129 type 4 (10.69%) and 152 type V (12.60%). Patients are grouped according to the type of cordectomy in: limited cordectomy (type I and II) and extended cordectomy (types III-IV-V). The difference between two groups is statistically significative in terms of acoustic analysis, perceptual data and patient-related outcomes (p < 0.05). CONCLUSIONS: Patients who underwent type I or II cordectomy have significantly better quality of voice in terms of VHI, perceptual voice quality evaluations and acoustic parameters compared to type III, IV and V cordectomies. The effect of TOLMS on the voice should depend from the extent of the resection and in particular from the scar of the vocal muscle.

Maxillary fungus ball in a diabetic patient. An odontogenic origin.

INTRODUCTION: Fungus ball (FB) represents a granulomatous mass due to a fungal colonization which may disseminate and potentially lead to a systemic infection. Maxillary fungus ball is considered to be a complication of dental treatment and, according to relevant literature, it often stems from improper endodontic therapies. MATERIAL AND METHODS: The authors report the case of a 69-year-old caucasian woman with nasal respiratory distress and frequent sinusitis symptoms. According to clinical and radiological evidence, FESS surgery was planned, thus validating FB diagnostic hypothesis. CONCLUSIONS: Fungal infection should always be considered in patients with sinusitis and previous root canal theraphy. Misdiagnosis can lead to severe complications. Surgical removal seems to be effective and resolutive. KEY WORDS: Endoscopic surgery, Fungus Ball, Maxillary sinusitiss.

Minimally invasive flap compared to a trapezoidal flap in lateral approach maxillary sinus elevation procedures: Four-month post-loading results from a split-mouth randomised controlled trial.

PURPOSE: To test a minimally invasive flap in the lateral approach for maxillary sinus floor elevation when compared to a trapezoidal flap. MATERIALS AND METHODS: Each patient received a bilateral sinus elevation procedure based on two different randomly allocated surgical approaches according to a split-mouth design: in the test side, a horizontal incision at mucogingival line was realised; in the control side, a trapezoidal flap was elevated to prepare the lateral window. Each sinus was filled using deproteinised bovine bone and the window covered with a collagen membrane. Implants were inserted according to a two-stage technique 6 months after sinus elevation procedures, submerged and then loaded after 6 months with definitive screw-retained metal-ceramic prostheses. Patients were followed up to 4 months post-loading. Outcome measures included: implant and prosthesis failures, complications, peri-implant marginal bone level changes, residual bone height and width, recorded before sinus augmentation and 180 days post-intervention by computed tomography (CT) scans, surgical times and patient discomfort data, assessed using a visual analogue scale (VAS) diagram for each treated side at 1, 7, 14 and 30 days of follow-up. RESULTS: Seventeen patients were enrolled in this trial and none dropped out. Five completely edentulous patients were treated with full-arch prosthetic restorations (Toronto dental prosthesis) and 12 patients with partial metal-ceramic screw-retained prostheses. In total 72 implants were inserted, 37 in the test group and 35 in the control group. No prosthesis or implant failures occurred. A total of seven patients showed complications: five of them had complications in both test and control sides. Eight complications were detected in each group. During maxillary sinus elevation procedures, nine interventions (four from the test group and five from the control group) were affected by intrasurgical complications (six membrane perforations and three severe bleedings); post-surgical complications occurred to three patients (one submucosal emphysema in a patient from the test group, one wound dehiscence and a graft infection both recorded in the control group); a total of four implants in two patients in the test group, versus three implants from one patient in the control group showed peri-implant mucositis. There were no statistically significant differences in complications between the two groups (P = 1.00; 95% confidence interval [CI]: 0.15-3.11). Patients from the control group, at 4 months after loading, lost on average 0.53 mm (standard deviation [SD] 0.27; 95% CI: 0.40-0.65), and patients from the test group lost on average 0.66 mm (SD 0.27; 95% CI: 0.53-0.78); the difference was not statistically significant (mean difference: 0.07 mm; SD 0.34; 95% CI: -0.03-0.17; P = 0.102). Significant values for bone augmentation in height, 9.26 mm (SD 1.46; 95% CI: 8.56-9.95) in the test group and 9.38 mm (SD 1.95; 95% CI: 8.45-10.30) in the control group, and width, 1.68 mm (SD 1.04; 95% CI: 1.18-2.20) in the test group and 1.60 mm (SD 1.27; 95% CI: 0.99-2.20) in the control group, were found from the 180-day CT scans. No statistically significant differences were detected between the two groups, either for the bone augmentation data (difference: 0.27 mm; 95% CI: 0.15-0.38; P = 0.60) or for the bone width values (difference: 0.02 mm; 95% CI: 0.07-0.11; P = 0.67). A significant reduction in the total surgical time was found in the test group (mean difference: 6.64 minutes; SD 4.32; 95% CI: 4.58-8.69), with the difference being statistically significant (P = 0.009). Evaluation of patients' postoperative discomfort showed a significant preference for the test procedure: at 1 day the VAS value was 4 (interquartile range [IQR] 2 to 5) in the test group; in the control group the VAS score was 5 (IQR 4 to 8). The intergroup difference was statistically significant (P = 0.002). At the 7-day follow-up, the VAS value was 1 in the test group (IQR 0 to 3) and 3 in the control group (IQR 0 to 7), this difference was statistically significant (P = 0.003). No differences were detected at 14 and 30 days (P > 0.05). CONCLUSIONS: A minimally invasive approach to access the sinus cavity can be as successful as a conventional trapezoidal flap in maxillary sinus floor elevations.

Peri-implant Soft Tissue Stability After Single Implant Restorations Using Either Guided Bone Regeneration or a Connective Tissue Graft: A Randomized Clinical Trial.

The purpose of the present study was to compare two different surgical procedures, connective tissue graft and guided bone regeneration, when applied in conjunction with implant placement. Probing pocket depth and the recession depth were recorded at the implant site after crown placement (T1) and at the 1-year follow-up (T2), while the keratinized tissue height and the buccal mucosa thickness were recorded at three different time points: at the time of implant surgery (T0), after crown placement, and at the 1-year follow-up. No statistically significant differences in peri-implant mucosa thickness, recession, or other periodontal parameters were recorded at adjacent teeth.

Lateral approach for sinus floor elevation: large versus small bone window - a split-mouth randomized clinical trial.

OBJECTIVES: To test whether a reduction of bone window dimension, in a split-mouth randomized study design, focused on lateral sinus floor elevations, can achieve better results than a wider window in terms of augmented bone height and a reduction of patient discomfort and surgical complications. MATERIALS AND METHODS: Of the sixteen subjects enrolled in the study, each underwent a bilateral sinus lift procedure based on two different access flaps to maxillary sinus. Test side: small access window (6 × 6 mm) + bone filling using a special device. Control side: large access window (10 × 8 mm) + manual bone filling. Alveolar bone height and width were measured at pre-op and 6-month post-op CT scans; repeatable measurements were obtained using radiographic stents. Surgical intervention duration was also recorded. Patients' evaluation of surgical discomfort was assessed using a VAS diagram at 7-day, 14-day and 30-day follow-up. RESULTS: A significant bone augmentation in height and width of alveolar crest was obtained in both test (8.71 ± 1.11 mm, 4.70 ± 0.58 mm) and control (8.5 ± 2.02 mm, 4.68 ± 0.70 mm) sides, although no significant differences were found between the two groups. Neither any significant differences emerge in data concerning the duration of the intervention (Test 42.62 ± 6.67 min, Control 41.68 ± 8.34 min). Patients' opinion relating to surgical discomfort showed a preference for test procedure at 7-day, 14-day and 30-day follow-up. CONCLUSIONS: A reduction of window dimensions did not affect the safety of the surgical procedure. The two testing techniques showed no statistically significant differences in surgical intervention duration. Patients' opinion at 7-day and 14-day post-op showed a preference for test procedure.

Esthetic Outcomes of Single-Tooth Implant-Supported Restorations Using Metal-Ceramic Restorations with Zirconia or Titanium Abutments: A Randomized Controlled Clinical Study.

The aim of this study was to test whether zirconia abutments exhibit the same clinical and esthetic outcomes as titanium abutments in single-tooth implant restorations in the esthetic area. The 24 treated patients were randomly assigned to a test (zirconia abutment) or control (titanium abutment) group. Objective evaluations were carried out using the Implant Crown Aesthetic Index (ICAI) and the Papilla Index (PI) at the 1-month and 12-month follow-up examinations after crown cementation. No significant differences, either in ICAI or in other periodontal or radiographic measurements, were observed. At 1 year, zirconia and titanium abutments exhibited the same esthetic outcomes.

Psychometric validation of the Italian version of the I-QoL questionnaire: clinical and urodynamic findings.

INTRODUCTION AND HYPOTHESIS: The aim was to validate the Italian version of the Incontinence-Quality of Life questionnaire (I-QoL) in women with clinical and urodynamic urinary incontinence (UI). A secondary end point was to compare the results of women with reported UI, but negative urodynamic findings. METHODS: The Italian translation of the I-QoL was administered to 267 Italian women with pelvic organ prolapse < stage III, and who had undergone previous surgical or medical therapy for UI. Cronbach's alpha was calculated to assess internal consistency of the I-QoL items. Reproducibility was assessed using the intraclass correlation coefficient (ICC). Convergent validity involved comparison of I-QoL scores and the Short Form-36 Health questionnaire. RESULTS: One hundred and sixty-seven patients were considered for the primary end point: 47 had a negative history of UI and a normal urodynamic test, 120 complained of UI confirmed by a urodynamic test, 59 had a positive history for UI and a urodynamic test negative for UI, and 35 patients not reporting UI had a positive urodynamic test. The I-QoL score revealed that the QoL was lower in patients with reported UI, irrespective of urodynamic findings. The overall I-QoL summary score and subscales showed high internal consistency (alpha ranges from 0.88 to 0.96). ICC ranged from 0.98 to 0.99, demonstrating the stability of the scores. The physical domain of the I-QoL showed a 0.27 correlation with the physical functioning subscale of the SF-36. No significant difference in I-QoL scores was found among various types of UI. CONCLUSION: The Italian translated version of the I-QoL is reliable, consistent and a valid instrument for assessing impact on quality of life in Italian speaking women with UI.

Delayed retroauricular cerebrospinal fluid (CSF) collection in cochlear implantation.

In the literature, this is the first description of a delayed retroauricular cerebrospinal fluid (CSF) collection in a child after 18 months of cochlear implantation. During surgical revision, anomalous thinning of the dura and leakage of CSF was found beneath the receiver, requiring local sealing and repositioning. Exposure of the dura is a procedure usually performed during housing of the receiver to avoid excessive protrusion of the implant in subjects with insufficient bone thickness. In most cases, this has proved to be a safe procedure. However, in some cases, as in children, exposure of the dura should be undertaken with care.

Haematoma after cochlear implantation: management of a minor complication.

CONCLUSIONS: The dimensions of the implant receiver and the material used have influenced the surgical approach leading to a reduction in complications. Ultrasonography of the haematoma is useful in the evaluation of dimensions, entity of fluid component and therapeutic options. OBJECTIVE: Haematoma arising in the receiver area is considered a minor complication, nevertheless it can be complicated by infection and/or flap necrosis or fibrosis leading to difficulties in magnetic adherence of the receiver and rarely to explantation of the receiver. The objective of the study was to evaluate the clinical outcome of postoperative haematoma arising after cochlear implant surgery. PATIENTS AND METHODS: This was a retrospective case series of 22 cochlear implant patients who developed post-implant haematoma over the receiver area. Haematoma extension and fluid collection were analysed via ultrasonography, implant type and predisposing factors such as trauma, coagulation disorders and type of skin incision. RESULTS: Patients were divided into four groups on the basis of the main predisposing factor: coagulation disorders (n=7), trauma (n=3), revision surgery (n=6) and haematoma of unknown origin (n=6). The main factors correlated to haematoma onset were coagulation disorder, type of skin incision and flap revision. In all, 21 subjects had complete recovery and the speech perception performance was not compromised over time, while 1 subject (0.3%) with an extensive haematoma due to a pharmacologically induced coagulation disorder required explantation of the device.

Follow-up of cochlear implant use in patients who developed bacterial meningitis following cochlear implantation.

OBJECTIVES/HYPOTHESIS: The present study is a long-term follow-up of speech perception outcomes and cochlear implant use in three cases of meningitis that occurred after cochlear implantation. STUDY DESIGN: Case series study. METHODS: Study was performed on three children implanted with different models of Clarion devices, two of them with positioner. Recognition and comprehension were assessed via the Italian adaptation of GASP (TAP) test, and phonetically balanced bi-syllabic words in open-set. High resolution computed tomography scan acquisition was performed to obtain axial coronal and oblique multiplanar reconstructions of the cochlea. RESULTS: Two patients were affected by enlarged cochlear acqueduct and Mondini malformation the first carrying positioner. One patient had a normal cochlea, and the positioner could have been the main cause of bacterial spread. As a consequence of meningitis the child with normal cochlea and the other with enlarged vestibular acqueduct developed cochlear ossification, increased M-level and worsening of hearing outcomes. The child with Mondini malformation developed facial nerve stimulation. Contralateral implantation was performed in the first two patients. CONCLUSION: Bacterial meningitis occurring after cochlear implantation may induce cochlear ossification, facial nerve stimulation, and permanent or temporary loss of implant use. Planned follow-up with high resolution computed tomography and evaluation of M-levels could be useful prognostic tools in the management of these patients.

Music perception in cochlear implant recipients: comparison of findings between HiRes90 and HiRes120.

CONCLUSIONS: Increased spectral resolution via implementation of perceptual channels with HiRes120 (PSP) would seem to provide better perception of music than with standard HiRes, mainly from the point of view of music appreciation as recorded via the questionnaire. More specific tests are required for appreciation of timbre, preferably by application of protocols based on perceptual attributes using rating scales, which would not be biased by knowledge of music. OBJECTIVE: The objective of this study was to verify the hypothesis whereby the implementation of perceptual channels in HiRes120 may lead to an improvement in the perception of music, owing to an increase in spectral resolution. SUBJECTS AND METHODS: Music perception was studied in 12 adult subjects, making a comparison between performance with HiRes90 and HiRes120 with perceptual channels. Quality of perception, loudness and rhythm were all assessed via a questionnaire. Further tests included timbre recognition trials and pitch ranking. RESULTS: Whereas there was a significant improvement in appreciation of music as seen by the questionnaire, timbre and pitch trials seemed to be biased by various subjective factors and require further study using different criteria.

The effect of unilateral multichannel cochlear implant on bilaterally perceived tinnitus.

CONCLUSIONS: Available multichannel cochlear implants (CIs) provide effective tinnitus suppression. More sophisticated speech strategies are more effective than analogue or slow strategies. The mechanisms by which tinnitus is suppressed by CIs are unclear; however, both acoustic masking and reorganization of the right auditory association cortex induced by the CI are possible mechanisms. CI significantly reduced the tinnitus-related Handicap as assessed by the Tinnitus handicap Inventory (THI). OBJECTIVE: The objective of the study was to evaluate the effects of a unilateral CI on bilaterally perceived tinnitus. PATIENTS AND METHODS: Forty-one profoundly deaf patients implanted with a multichannel CI reporting bilateral tinnitus were evaluated. All patients were asked to complete a questionnaire that evaluated the presence, location and intensity of tinnitus before and after cochlear implantation. RESULTS: Seven patients (17%) reported the perception of a 'new tinnitus' after surgery. With the CI off tinnitus was abolished in 23 patients (56.1%) in the implanted ear and in 22 patients (53.6%) in the contralateral ear. With the CI on tinnitus was abolished in the ipsilateral ear in 27 patients (65.8%) and in the contralateral ear in 27 patients (65.8%). Statistical analysis showed a significant reduction of the total THI score and of each subscale score (p < 0.001).

Vestibular impairment and cochlear implantation.

CONCLUSION: Cochlear implantation (CI) may induce vestibular impairment soon after surgery as well as after implant activation. This impairment seems to be independent from the cause of deafness and can be considered a possible complication from the intra-operative trauma and, to minor degree, from the ongoing electric stimulation. It would also seem that vestibular damage occurs independently from the likelihood of post-operative hearing deterioration. In unilateral selected CI cases, vestibular examination can be proposed as additional pre-operative exam for selection of the ear to be implanted. OBJECTIVES: This study has been planned in order to get evidence of eventual impairment of the vestibular apparatus after cochlear implantation as well as to verify whether the impairment could be related to different variables, such as cause of deafness, concomitant hearing deterioration, surgical trauma and duration of electrical stimulation. METHOD: Charts from two different populations of implantees have been reviewed, 21 from a prospective, 72 from a retrospective study, respectively. All the patients were implanted with Clarion(R) devices of different generation. Vestibular testing was based on rotatory, caloric (when possible) and stabilometric measurements, which were carried out pre-operatively and at the following different times: 5 weeks after CI surgery, and 30, 60 and 90 days after CI activation. Hearing thresholds were also assessed in those patients who showed signs of vestibular impairment as well as in a group of patients without vestibular disorders (control). Patients belonging to the retrospective group were all asked to fill a questionnaire regarding their balance condition. Results. In 14.3% of the prospective study group, a grade I and II spontaneous nystagmus was evidenced pre-operatively and remained unchanged during the whole assessment period. A grade II spontaneous nystagmus was present in 3 patients (21.4%) of the same group after surgery. In the immediate post-operative period, vestibular impairment was displayed as true rotational vertigo in 21.4% and unsteadiness in 42.8% of the study group. Severe unsteadiness was present during the first 2 days after activation in 14.3% of the subjects. In 21.4% of the patients a VPPB episode occured. In the retrospective study group, 26.4% of the subjects referred pre-operative dizziness and 25 patients (34.7%) referred immediate post-operative vertigo episodes, which remained in a milder form after CI activation in 12% of them. The hearing threshold showed to deteriorate in both vestibular-impaired and control CI population without significant difference.