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Bilateral Middle Fossa Floor Meningiomas Invading the Middle Ear

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International Journal of Otolaryngology and Head & Neck Surgery 2024年第5期13卷 373-377页

作者： Nuwan T. Meegalla Malini Suresh Nair michele Marie gandolfi Department of Otolaryngology Atrium Health Wake Forest Baptist Winston-Salem NC USA Department of Otolaryngology Wake Forest University School of Medicine Winston-Salem NC USA

This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.

关键词： Conductive Hearing Loss Multifocal Meningioma Middle Ear Meningioma

A Rare Case of Tarceva Resulting in Tympanic Membrane Necrosis

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International Journal of Otolaryngology and Head & Neck Surgery 2013年第4期2卷 135-137页

作者： michele M. gandolfi Ana H. Kim Department of Otolaryngology New York Eye and Ear Infirmary New York USA

Objective: To report a novel case of Tarceva? treatment for small cell lung carcinoma resulting in tympanic membrane necrosis. Patient: A 49-year-old male with tympanic membrane necrosis and presumed resistant acute otitis externa and chronic inflammation of the left ear. Patient is status post chemotherapy and radiation diagnosed with non-small cell lung cancer in December 2008 with on-going therapy with Tarceva? for residual disease. Intervention: Tympanoplasty of left ear. Results: Improvement of symptoms of irritation and improvement of hearing and speech reception thresholds. All acid fast bacilli, fungal and bacterial cultures of the intra-op specimen were negative. Conclusions: The possibility that long term Tarceva? therapy could have caused the tympanic membrane necrosis and acute otitis media like symptoms is feasible since Tarceva? is an inhibitor of epidermal growth factor receptor (EGFR) tyrosine kinase. Upon activation of EGFRs it undergoes a transition from inactive monomeric form to active homodimer or hertodimer with another member of the ErbB receptor family. This then initiates several signal transduction cascades, leading to DNA synthesis and cell proliferation. Activation of the receptor is important in the innate immune response in human skin. Some of the common side effects include an aceiform skin rash but this is the first reported link between tympanic membrane necrosis and Tarceva?.

关键词： Tympanic Membrane Necrosis Tympanoplasty Tarceva©

Audiogram Bone-Conduction Testing Induced Seizure in Patient with Traumatic Brain Injury

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第5期12卷 326-330页

作者： Lauren G. Himes Nelson H. May michele M. gandolfi Department of Otolaryngology Head & Neck Surgery Wake Forest University School of Medicine Winston Salem NC USA

In this case report, we discuss a patient who presented with Tullio’s phenomenon, who also experienced bone-conduction induced seizures on two occasions. Tullio’s phenomenon refers to sound induced vestibular symptoms, including disequilibrium oscillopsia, and vertical nystagmus. We were ultimately able to rule out some of the more common pathologies associated with Tullio’s phenomenon for this patient based on imaging findings. However, given the specific nature of her chronic symptoms, as well as her seizure like activity in clinic, we performed a literature search to investigate other less common pathologies associated with Tullio’s phenomenon. Given her past medical history of mixed psychogenic non-epileptic seizures (PNES), there is likely a somatic component to her presentation. However, given the specific and unexpected nature of these events, we propose that her symptoms may also be related to a unique inner ear pathology. Specifically, we feel that she may have exhibited symptoms of vestibular atelectasis, a relatively new otologic diagnosis characterizing the pathologic collapse of the ampulla and utricle, such that the membranous labyrinth contacts the stapes. In this way, loud sounds or changes in pressure may induce vestibular symptoms. Dizzy patients can be a difficult demographic to diagnose and manage, especially when their presentation is complicated by other functional neurologic disorders. Ultimately, we believe that this case report offers helpful insights into a new disease process associated with Tullio’s phenomenon.

关键词： Seizure Audiogram Traumatic Brain Injury

The Impact of Age on Cochlear Implant Performance

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International Journal of Otolaryngology and Head & Neck Surgery 2015年第5期4卷 329-337页

作者： Brian Schwab michele gandolfi Erica Lai Erin Reilly Lorie Singer Ana H. Kim Department of Otolaryngology New York Eye and Ear Infirmary of Mount Sinai New York USA

Objective: Cochlear implantation is the emerging treatment of choice for severe and profound sensorineural hearing loss, yet there are conflicting data on outcomes in adults. There is significant variability in the literature concerning the exact effect of age on cochlear implant outcomes. We sought to evaluate the outcomes of cochlear implant performance stratified by age. Study Design: Retrospective review. Methods: Audiologic preoperative and postoperative evaluation consisted of word recognition scores (Consonant-Nucleus-Consonant). Complications were retrospectively collected after each cochlear implantation. A sub-analysis was performed comparing patients implanted at a younger (21 - 64 years) and older (65 and above) age. Results: A total of 240 patients were evaluated. Patients experienced a significant improvement in audiologic performance as seen with word recognition scores (p < 0.00001). The mean post-implant score was 44.6% (at 3 months) and 53.5% (at 24 months) at 50 dB compared to average pre-implantation aided score of 6%. There was no significant difference between postoperative performances in younger versus older patient groups. Multiple regressions showed no correlation with duration of deafness at time of implantation or age and performance. There was no significant difference in performance based on side of implantation. Conclusion: This is one of the largest series to date on hearing outcomes in adults who receive a cochlear implant. No statistical differences were noted between the younger and older groups or based on side of implantation. The audiologic benefit in the adult population is clearly demonstrated.

关键词： Cochlear Implantation Age Duration of Deafness

Predicted and measured soil retention curve parameters in Lombardy region north of Italy

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International Soil and Water Conservation Research 2016年第3期4卷 207-214页

作者： Fatma Wassar Claudio gandolfi michele Rienzner Enrico Antonio Chiaradia Ettore Bernardoni IBIMET-CNR via Madonna del Piano 1050019 Sesto F.noFIItaly Dipartimento di Scienze Agrarie e Ambientali(DISAA) Universitàdegli Studi di Milano(UNIMI)Via Celoria 220133 MilanoItaly ISSTEG Institut Supérieur des Sciences et Techniques des EauxcitéAmal 46072 GabèsTunisia

Water retention characteristics are fundamental input parameters in any modeling study on water flow and solute *** properties are difficult to measure and for that reason,we usually need to use direct and indirect methods to determine *** extensive comparison between measured and estimated results is needed to determine their applicability for a range of different *** this study attempts to make a contribution specifically in this *** properties were determined in two representative sites located in Landriano field,in Lombardy region,northern *** the laboratory we used the pressure plate apparatus and the tensiometric *** soil water retention was determined including measurements of soil water content with SENTEK probes and matric potential with *** soil waer retention curves(SWRC)were also settled on with some recently developed pedo-transfert functions(PTFs).Field retention curves were compared against those obtained from PTFs estimations and laboratory *** comparison showed that laboratory measurements were the most *** had the highest ranking for the validation indices(RMSE ranging between 2.4%and 7.7%and bias between 0.1%and 6.4%).The second best technique was the PTF Rosetta(Schaap et al.2001).They perform only slightly poorer than the laboratory measurements(RMSE ranging between 2.7%and 10%and bias between 0.3%and 7.7%).The lowest prediction accuracy is observed for the Rawls and Brakensiek(1985)PTF(RMSE ranging between 6.3%and 17%and bias between 5%and 10%)which is in contradiction with previous finding(Calzolari et al.,2001),showing that this function is well representing the retention characteristics of the *** to time and cost investments of laboratory and field measurements,we conclude that the Rosetta PTF developed by Schaap et al.(2001)appears to be the best to predict the soil moisture retention curve from easily available soil properties in the Lombardy area a

关键词： Comparison Laboratory water retention Field measurements Curve measurements Pedo-transfert functions