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.

The aim of the present study is to construct a reference model with the indication for the attitude, the requirements and the resources needed in order to be able to deal with deafness in the presence of disabilities or associated problems. The study group consisted of 13 adults and 18 children affected by profound deafness, with associated problems and disabilities, who were implanted with Clarion® and Med-El® devices. Selection criteria for candidacy to cochlear implantation and counselling, hospitalization, fitting and speech therapy/rehabilitation are described. Findings were assessed evaluating: (i) use of acoustic feedback, on the ground of Erber's model; (ii) self-sufficiency: assessed by a questionnaire; and (iii) social and family relationships: qualitative judgment based on direct observation, analysis of drawings and structured interviews with family teachers and therapists. The whole group showed benefit from cochlear implantation, with particular satisfaction for post-lingual deaf-blind adults, as well as for subjects with associated psychopathologies and mental retardation. In conclusion, cochlear implants can improve life quality in profoundly deaf subjects with associated disabilities, increasing both listening and communication skills as well as self-sufficiency while family and social relationships tend to remain stable.

Many reports suppose that the development of aural exostosis depends on the action of an irritative stimulus like frequent and repeated cold water contact. This survey studies the incidence of this lesion in a group of 433 athletes practicing aquatic sports on a highly competitive level. Among these, water activities like sailing and deep-sea diving, which up to now were never considered, were also studied. 32 exostoses were found to affect 12 subjects monolaterally and 20 subjects bilaterally. Not one of a control group of 476 athletes was found to be affected by aural exostosis. For each athlete in this study the following parameters are considered: age and sex, type of sport, total amount of hours spent in water contact, aural pathology history and otoscopic findings. The authors suggest the existence of facilitating factors other than total water contact time, as shown by the absence of a precise correlation between this parameter and the presence of the aural hyperostotic lesion.

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Two unusual cases of cochlear implant (CI) surgery complication are reported: introduction of the electrode array into the superior semicircular canal with normal morphology and a growing amplitude of neural potential (neural response imaging, NRI) during intra-operative monitoring control. In the first case, a two-year-old patient affected by congenital sensorineural profound deafness was bilaterally implanted with two Clarion 90 k devices and intra-operative electrophysiological and radiological controls were performed. After introduction of the array in the right side NRI was performed and a neural potential was found only on two apical electrodes. Radiological intra-operative control with antero-posterior trans-orbital plain films was performed to assess the position of the electrodes inside the cochlea. Radiography showed the electrode array in the superior semicircular canal in the right ear. The electrode array was removed and reinserted correctly. In the second case, a 72-year-old man underwent left cochlear implantation for sensorineural profound deafness of unknown origin. Intra-operative electrophysiological testing (NRI) showed the presence of neural potential on three tested channels. In this case, as routinely employed since 2006, an intra-operative static fluoroscopy control was performed, this showed the electrode array in the superior semicircular canal. The electrode array was removed and reinserted correctly. In conclusion, intra-operative monitoring tests during CI surgery play different roles: measurement of impedances and NRI can evaluate the integrity of implant electrodes and the status of the electrode cochlea interface, but they cannot be the only way to confirm correct positioning of the array. In our opinion the intra-operative radiological check is helpful during CI surgery, especially when there is any doubt about correct electrode insertion.

Clarion-implanted children using the Hi-Resolution strategy can develop better speech perception skills at 12 months post-implantation compared to children fitted with the SAS or CIS strategy. SAS or CIS users implanted before the age of 5 years tend to achieve better results at 1 year follow-up than children implanted later. In contrast, in Hi-Resolution users, a trend towards better results for recognition and comprehension tasks was observed in children implanted after 5 years of age.

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.

The HiRes and HiRes 120 switch-over groups showed quite similar results for speech perception in quiet. However, the HiRes 120 switch-over group achieved these results within a shorter time after conversion. Switch-on children showed improvement in all speech perception categories, reaching approximately 60% recognition and 30% comprehension in quiet. Results for A section signE discrimination scores in quiet and noise showed a clear improvement for both HiRes 120 switch-on and switch-over groups compared with the HiRes group.