Tinnitus can be defined as a phantom sensation in the absence of an external sound. In our study, we evaluated the effect of cochlear implant on tinnitus evolution. Among adult, postlingually deaf patients who underwent cochlear implantation at our clinic, we selected 20 subjects with pre-implantation tinnitus (group A) and 10 subjects without pre-implantation tinnitus (group B). Pre- and post-surgery tinnitus was assessed through two questionnaires: the first one dealing with tinnitus characteristics and psychosocial impact, and the second one represented by THI, an internationally validated score of evaluation of the effects of tinnitus on patient's emotions and activities of daily living. None of the patients belonging to group B developed tinnitus after surgery. As for group A, 40% of patients declared suppression of tinnitus, 30% attenuation of tinnitus after surgery, 25% reported tinnitus was unchanged and 5% reported worsening of tinnitus. In the nine patients with bilateral tinnitus (45%), after implantation tinnitus disappeared from both sides in four patients and attenuated bilaterally in four patients. A comparison between pre- and post-implantation THI scores showed decreased score in 65% of cases, unchanged score in 30% and increased score in 5%. The beneficial effect of cochlear implant on tinnitus, reported by a majority of patients, could be due to acoustic masking, to direct electrical stimulation of the acoustic nerve, and above all to a possible cochlear implantation dependent reorganization of the central auditory pathways and associative cerebral areas. In the light of these results, the authors propose (1) to include tinnitus in the selection criteria of which ear to implant; (2) to consider implantation eligibility for patients with bilateral severe hearing loss associated with severe tinnitus; and (3) to inform patients about the small risk of post-operative tinnitus worsening.

Preservation of residual hearing should be a desirable outcome of implant surgery. Prevention of neural degeneration due to loss of residual hair cells, together with the continuous progress in cochlear implant technology should be able to preserve cochlear integrity as well as possible. The degree of hearing preservation may vary depending on surgical approach, maximum insertion depth and other factors not uniformly considered to date. The aim of this retrospective case controlled study is to evaluate residual hearing after cochlear implant surgery. In particular, we analyzed data obtained with use of two different kinds of electrode arrays, with and without rigid introductor (stylet). We report the results on 37 patients with measurable preoperative hearing thresholds, mean age of 28 years (5-70 years), having the following implants: seven Advanced Bionics, four Med-El, 24 Cochlear, two MXM; 19 of them were performed using the stylet and the other 18 without it. A minimally invasive surgical approach was performed with a short retroauricular incision and a 1.2 mm cochleostomy. A complete electrode array insertion was obtained in all patients. Responses to pure-tone stimuli were measured for each ear in pre-implantation conditions and 3-12 months after surgery. After implantation 14 patients (38%) showed no hearing threshold variation, 29 (78%) maintained an appreciable hearing threshold level in the implanted ear, 8 (22%) had a total loss of residual hearing. Median increases of threshold levels were, in all 37 studied patients, 5, 10, 10 and 5 dB HL, respectively, for 125, 250, 500 and 1 kHz. For the 18 patients having implants without the stylet median increases of threshold levels were 0, 10, 5 and 7 dB HL; in the stylet group, they were 10, 5, 5 and 10 dB HL. On a comparison between the stylet and the non-stylet group, no significant differences in mean hearing threshold worsening were found. Data seem to suggest that cochlear function is less sensitive to mechanical trauma during implant surgery than was thought. Besides, electrode array stiffness seems not to influence preservation of cochlear residual functional integrity. Finally, the authors hypothesize a direct spiral ganglion activation under strong mechanical stimulation.

Currently, there are no studies assessing everyday use of cochlear implant (CI) processors by recipients by means of objective tools. The Nucleus 6 sound processor features a data logging system capable of real-time recording of CI use in different acoustic environments and under various categories of loudness levels. In this study, we report data logged for the different scenes and different loudness levels of 1,366 CI patients, as recorded by SCAN. Monitoring device use in cochlear implant recipients of all ages provides important information about the listening conditions encountered in recipients' daily lives that may support counseling and assist in the further management of their device settings. The findings for this large cohort of active CI users confirm differences between age groups concerning device use and exposure to various noise environments, especially between the youngest and oldest age groups, while similar levels of loudness were observed.

No abstract

Convalescent plasma from COVID 19 patients enhances intensive care unit survival rate. A preliminary reportCoronavirus pandemic disease (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). At the time of this paper writing, over 2,5 million cases of COVID-19 have been reported, with more than 280,000 deaths all over the world. Italy is one of the first countries involved, with more than 200,000 reported infected people and 30,000 deaths. In the Basilicata south Italy region live 560,000 people, with 372 reported infected cases, 34 recovered in intensive care units (ICU) and 15 deaths [1]. There are no specific treatments for COVID-19 and the vaccine is still far away. Scientific community is trying to better define best shared therapeutic protocols in early and advanced clinical stages. Still, critical cases are about 6%, with serious illness rate of 14%, with involvement of sepsis, acute respiratory distress syndrome (ARDS), multiple organ failure, and vascular and thromboembolic findings [2,3]. Mortality rate is 2-3%, with higher values, more than double, for > 65 years old patients [4]. Among ICU patients, almost 1 patient on 3 dies, with higher rates for older patients [5].A systematic review and exploratory meta-analysis performed in 2014 identified 32 studies of SARS coronavirus infection and severe influenza [6]. These studies involved 699 treated patients and 568 untreated "controls". The review revealed evidence for a consistent reduction in mortality upon plasma therapy. Furthermore, exploratory post hoc meta-analysis showed a significant reduction in the pooled odds of mortality following treatment, compared with placebo or no therapy [7]. As for SARS-CoV-2, many clinical trials are in course, FDA approved the procedure [8] and there are recent Chinese encouraging reports [9][10][11][12].In order to preliminarly evaluate the importance of convalescent plasma transfusions in intensive care units, authors compared mortality rates between two groups: patients untreated (group 1) and those treated with convalescent plasma (group 2). Group 1 includes all 34 Basilicata region patients recovered in COVID dedicated intensive care units (ICU), with mean age of 63 years old and comorbidity rate > 70%. All patients were treated by means of invasive and not invasive O2 ventilation, tracheostomy when needed, antiretroviral agents, hydrossycloroquine (Plaquenil, Sanofi, Italy), steroids and not steroid antinflammatory agents, heparin, azithromycin and other wide spectrum antibiotics, tocilizumab (Roactemra, Roche, Italy). Group 2 is composed of all actually reported COVID-19 ICU patients in literature, included in three recently published papers [10][11][12], with a total number of 19 cases, mean age of 54 years old, with mean comorbidity rate similar to group 1, underwent to pharmaceutical and supporting treatments with these differences: no heparin, hydrossycloroquine and tocilizumab, but in addiction submitted to arbidol (Umifenovir, Pharmstandard, China) in 10 cases, and in all c...