Papers by Susanna Fortunato
A retrospective chart review was used for 31 patients with sudden, progressive or fluctuating sen... more A retrospective chart review was used for 31 patients with sudden, progressive or fluctuating sensorineural hearing loss (Shl) in the only hearing ear who had been consecutively evaluated at the EnT, Audiology and Phoniatrics Unit of the University of Pisa. The group of patients was evaluated with a complete history review, clinical evaluation, imaging exam (Mri, CT), audiologic tests (tone and speech au-diometry, tympanometry, study of stapedial reflexes, ABr and otoacoustic emission) evaluation. in order to exclude genetic causes, patients were screened for CX 26 and CX30 mutations and for mitochondrial dnA mutation A1555g. Patients with sudden or rapidly progressive Shl in the only hearing ear were treated with osmotic diuretics and corticosteroids. in patients who did not respond to intravenous therapy we performed intratympanic injections of corticosteroid. hearing aids were fitted when indicated and patients who developed severe to profound Shl were scheduled for cochlear impl...
Acta Otorhinolaryngologica Italica, 2016
SUMMARY A retrospective chart review was used for 31 patients with sudden, progressive or fluctua... more SUMMARY A retrospective chart review was used for 31 patients with sudden, progressive or fluctuating sensorineural hearing loss (SHL) in the only hearing ear who had been consecutively evaluated at the ENT, Audiology and Phoniatrics Unit of the University of Pisa. The group of patients was evaluated with a complete history review, clinical evaluation, imaging exam (MRI, CT), audiologic tests (tone and speech audiometry, tympanometry, study of stapedial reflexes, ABR and otoacoustic emission) evaluation. In order to exclude genetic causes, patients were screened for CX 26 and CX30 mutations and for mitochondrial DNA mutation A1555G. Patients with sudden or rapidly progressive SHL in the only hearing ear were treated with osmotic diuretics and corticosteroids. In patients who did not respond to intravenous therapy we performed intratympanic injections of corticosteroid. Hearing aids were fitted when indicated and patients who developed severe to profound SHL were scheduled for cochle...
The Journal of Laryngology & Otology, 2018
BackgroundEosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis show... more BackgroundEosinophilic granulomatosis with polyangiitis and granulomatosis with polyangiitis show variable otorhinolaryngological involvement. Up to 14 per cent of granulomatosis with polyangiitis patients have subglottis involvement; little is known about the laryngeal involvement in eosinophilic granulomatosis with polyangiitis.MethodA literature review was conducted, together with a prospective cross-sectional analysis of 43 eosinophilic granulomatosis with polyangiitis patients. All patients underwent fibre-optic laryngoscopy with narrow-band imaging, and completed health-related questionnaires.ResultsThe literature review showed only two cases of laryngeal involvement in eosinophilic granulomatosis with polyangiitis; in our cohort, no cases of subglottis stenosis were found, but local signs of laryngeal inflammation were present in 72 per cent of cases. Of the patients, 16.2 per cent had a pathological Reflux Finding Score (of 7 or higher).ConclusionLaryngeal inflammation in eo...
American Journal of Audiology, 2019
Objective Recent literature has shown a growing interest in the relationship between presbycusis ... more Objective Recent literature has shown a growing interest in the relationship between presbycusis and cognitive decline, but significant evidence about the long-term benefit of rehabilitation on cognitive functions has not been reported yet. The aim of the study was to analyze audiological and neuropsychological performances in patients with cochlear implant (CI) or hearing aids (HAs) over time. Materials and Method Forty-four bilaterally deaf patients aged more than 60 years (25 with CI candidacy and 19 with HA candidacy) were enrolled. Patients were subjected to audiological evaluation, to a battery of neuropsychological tests (Mini-Mental State Examination [MMSE], Rey Auditory Verbal Learning Task [RAVLT], Rey–Osterreith Complex Figure Test, Digit/Corsi Span Forward and Backward, Multiple Features Target Cancellation, Trail-Making Test, Stroop Test, and Phonological and Semantic Word Fluency), and to a quality of life assessment (Short Form 36, Glasgow Benefit Inventory, Glasgow H...
Audiology and Neurotology, 2019
Objectives: The aim of this study was to evaluate the results after cochlear implant (CI) in elde... more Objectives: The aim of this study was to evaluate the results after cochlear implant (CI) in elderly patients and to compare them to those obtained in younger adult patients. A possible correlation between the results in older CI recipients and some variables of the patients was also investigated. Methods: The sample consisted of 107 patients over 40 years of age at surgery divided into 3 subgroups according to age at implantation. Results in terms of speech perception in silence and with background noise were compared between the 3 groups. The patients also completed the Glasgow Benefits Inventory (GBI) questionnaire. Results: Older patients achieved significant benefits after CI with regard to speech perception in silence and with background noise. We also recorded benefits for the GBI. Discussion: In line with the literature, our data confirm that CI is an effective procedure also in elderly patients, conferring benefits in speech perception and quality of life.
European Archives of Oto-Rhino-Laryngology, 2017
Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and n... more Fungus ball (FB) is an non-invasive form of mycosis, that generally affects immunocompetent and non-atopic subjects. Involvement of the frontal sinus is extremely rare. We report two cases with frontal sinus fungus ball that underwent endoscopic endonasal frontal Draf type IIb or III sinusotomy with complete removal of the cheesy clay-like material. There were no intra-operative or postoperative complications, and no recurrence of disease was evident during the follow-up of 51 and 26 months, respectively. The Draf type IIb or type III frontal sinusotomy seems to be highly effective for the treatment of frontal sinus FB and can represent a valid alternative to the traditional external approaches.
The Laryngoscope, 2016
Objectives/Hypothesis: To evaluate the clinical features of audiologic impairment and its relatio... more Objectives/Hypothesis: To evaluate the clinical features of audiologic impairment and its relationship with the nasal, vestibular, and rheumatologic profile in a cohort of patients with eosinophilic granulomatosis with polyangiitis (EGPA), formerly named Churg-Strauss syndrome. Study Design: Prospective cross-sectional study. Methods: Thirty-nine patients with EGPA, considered controlled according to the Birmingham Vasculitis Activity Score and the Vasculitis Damage Index, underwent a complete audiologic evalutaion with otomicroscopy, impedance audiometry, speech audiometry, and auditory brainstem responses; rhinologic evaluation was made by means of fiberoptic endoscopy and nasal cytology; the clinical evaluation was completed with analysis of the facial function and, in patients with referred vertigo, with videonystagmography (VNG). Data were compared to the rheumatologic profile (eosinophil count, antineutrophil cytoplasmic antibodies status). Results: Thirty-four of 39 patients fulfilled the inclusion criteria. Of those, 18 (52, 8%) were affected by variable degrees of hearing loss (sensorineural hearing loss [SNHL]) in four cases (11, 8%), mixed sensorineural and conductive hearing loss in two (5, 9%), presbycusis in six (17, 6%), and otitis media with effusion (OME) in six (17, 6%). Vestibular impairment was represented by benign paroxysmal positional vertigo and unspecific dizziness in three (8, 8%) and four cases (11, 8%), respectively, all with normal VNG. Ear involvement was statistically related to the EGPA vasculitic pattern and independent from the nasal impairment, cytology, and duration of nasal symptoms. No facial palsy was registered. Conclusion: In our experience, the largest in the existing literature, the otological involvement in EGPA is common and may occur variably as SNHL or OME. Otological involvement occurs early in the course of the disease process, but is nonspecific in making the diagnosis of EGPA. Its recognition is therefore fundamental.
La Presse Médicale, 2013
disease was 4 (range 0-18) and median BVAS/WG score was 2 (range 0-4). Within individual patients... more disease was 4 (range 0-18) and median BVAS/WG score was 2 (range 0-4). Within individual patients TARC/CCL17, eotaxin-3, IgG4, ESR, CRP, IgE and eosinophil count could not discriminate between times of remission vs. active disease. Eotaxin-3 levels and eosinophil counts were, however, significantly higher in patients not using glucocorticoids during the 28 days before study visit, regardless of disease activity. Serum eotaxin-3, but not the other biomarkers, was significantly elevated during active disease in patients not using glucocorticoids but not elevated in active disease when the patient was taking glucocorticoids. Discussion.-All tested biomarkers failed to clearly differentiate active and inactive disease. Eotaxin-3 may be useful in relapsing EGPA patients not receiving glucocorticoids before serum sampling. Conclusion.-Defining biomarkers of relapses in patients with EGPA remain a challenge especially during times of glucocorticoid use.
The Neuroradiology Journal, 2010
Hearing loss greater than 30 dB over three contiguous pure-tone frequencies occurring within a th... more Hearing loss greater than 30 dB over three contiguous pure-tone frequencies occurring within a three day period is defined as sudden hearing loss. It is usually sensorineural (SSNHL), unilateral and appears as an otologic emergency. SSNHL has many possibile etiologies such as: labyrinthine viral infection, ischemic or hemorrhagic illness, trauma, immuno-mediated inner ear disease, tumor, inner ear malformation, and an imbalance between perilymphatic and endolymphatic fluid pressure. Nevertheless in almost 80% of cases SSNHL belongs to the idiopathic category because the etiology is unknown. The aim of this study was to test the diagnostic impact of two MR devices. Fifteen cases of SSNHL studied with a 1.5 T unit in our hospital between January 2006 and December 2008 within two weeks of the onset were retrospectively evaluated. Since January 2009 three more patients affected by SSNHL have been scanned with a 3T MR unit. We discuss the diagnostic sensitivity, clinical usefulness and t...
The Journal of laryngology and otology, 2014
To evaluate the long-term stability of intratympanic steroids and investigate the 'real' ... more To evaluate the long-term stability of intratympanic steroids and investigate the 'real' impact of sudden sensorineural hearing loss on patients. A total of 14 patients treated with intratympanic steroids were evaluated by audiometric and vestibular examinations. The modified Glasgow Benefit Inventory was used to evaluate quality of life changes after intratympanic steroid treatment. There was no significant difference between pure tone average post-intratympanic steroids and at follow up. The general Glasgow Benefit Inventory score was not significantly associated with the presence of tinnitus or dizziness, or with patient age. The change in pure tone average after intratympanic steroid treatment did not correlate with social or physical scores, but correlated strongly with the general Glasgow Benefit Inventory score (p = 0.0023). Intratympanic steroid administration led to a stable improvement in hearing. Quality of life assessment showed that patients can feel satisfactio...
Case Reports in Otolaryngology, 2013
Salivary gland tumors are rare. The majority of these tumors are benign and about 70% are pleomor... more Salivary gland tumors are rare. The majority of these tumors are benign and about 70% are pleomorphic adenomas (PA). Nasopharynx is an unusual site for the PA tumor. Only six cases are presented in the literature from 1990 to 2011. The diagnosis of this disease is linked to the sum of imaging tests, clinical and histological study of the mass of the above. The radiologic features of noninvasion of surrounding structures give the first clue to the benign lesion. From the review of the literature and our experience is identified as the gold standard in surgical treatment for this condition. Thanks to the endoscopic surgery, we can perform a complete resection of the lesion without damaging adjacent structures. We presented a case of pleomorphic adenoma of nasopharynx with literature review.
JAMA Otolaryngology–Head & Neck Surgery, 2013
The unpredictability of idiopathic sudden sensorineural hearing loss (ISSNHL) presents a challeng... more The unpredictability of idiopathic sudden sensorineural hearing loss (ISSNHL) presents a challenge to preventive care. Our study confirms the potentially important role of the 3-T magnetic resonance imaging (MRI), and in particular of the 3-dimensional fluid-attenuated inversion-recovery (3D-FLAIR) sequence, in the diagnosis and prognosis of ISSNHL to guide medical treatment. Objective: To confirm the diagnostic, clinical, and prognostic role of 3D-FLAIR MRI in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Design, Setting, and Patients: Retrospective study in a tertiary referral center with a consecutive sample of 23 patients diagnosed as having unilateral ISSNHL from January 2010 to March 2011. Exposures: Patients underwent 3D-FLAIR MRI at 3 T to evaluate ISSNHL, and the MRI images were compared with those belonging to a random group of 20 agematched healthy patients. Main Outcomes and Measures: Precontrast and postcontrast high-intensity 3D-FLAIR MRI findings in patients with ISSNHL and the correlation with clinical findings. Results: Thirteen patients showed high-intensity signals in the affected inner ear on precontrast and postcontrast 3D-FLAIR MRI (57%). From the analysis of different MRI sequences, we posited 3 radiologic patterns likely correlated with mild hemorrhage, acute inflammation, and presence or absence of blood-labyrinth or nerve barrier (BLB) breakdown. Hypersignal on 3D-FLAIR MRI was positively associated with pretreatment hearing loss (P=.04) and presence of vertigo (P=.04). A strict correlation also existed between distribution of the signal (vestibule, semicircular canals) and clinical features (vertigo) (P =.04). Conclusions and Relevance: Use of 3D-FLAIR MRI at 3 T may contribute to the elucidation of pathologic conditions in the inner ears of patients with ISSNHL and provide new radiologic indicators (mild hemorrhage, acute inflammation, presence or absence of BLB breakdown) that might assume the role of prognostic factors.
Case reports in otolaryngology, 2013
Lymphomas represent the second most frequent malignant tumor (incidence 2.5%) in the head and nec... more Lymphomas represent the second most frequent malignant tumor (incidence 2.5%) in the head and neck region. Non-Hodgkin lymphomas (NHLs) present with cervical lymph node involvement, but in 40% extranodal site could be primary involved: nasopharynx, the lacrimal sac, the temporal bone, or the others areas. NHLs of the ear are rarely reported. In this report, we described a patient with primary NHL of the external ear canal who was successfully treated with surgical excision and chemotherapy.
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Papers by Susanna Fortunato