Papers by Federica Di Berardino
American Journal of Neuroradiology, 2018
BACKGROUND AND PURPOSE: No reliable MR imaging marker for the diagnosis of Menière disease has be... more BACKGROUND AND PURPOSE: No reliable MR imaging marker for the diagnosis of Menière disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease. MATERIALS AND METHODS: We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Menière disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window. RESULTS: We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen ϭ 0.87; 95% CI, 0.69-1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity ϭ 81%, specificity ϭ 96%, positive predictive value ϭ 88%, and negative predictive value ϭ 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity ϭ 81%, specificity ϭ 96%, positive predictive value ϭ 96%, negative predictive value ϭ 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears. CONCLUSIONS: The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Menière disease ears from other ears, thus resulting in a valid tool for ruling in Menière disease in patients with mimicking symptoms. ABBREVIATIONS: AAO-HNS ϭ American Academy of Otolaryngology-Head and Neck Surgery; BLB ϭ blood-labyrinthine barrier; CH ϭ cochlear hydrops; HC ϭ healthy control; MD ϭ Menière disease; nMD ϭ normal in a patient with MD; NPV ϭ negative predictive value; PPV ϭ positive predictive value; SSHL ϭ sudden sensorineural hearing loss; VEH ϭ vestibular endolymphatic hydrops; VES ϭ vestibular endolymphatic space; VESCO ϭ vestibular endolymphatic space contacting the oval window
PubMed, 2007
Ménière's disease (MD) is an idiopathic inner-ear disorder characterized by fluctuating hearing l... more Ménière's disease (MD) is an idiopathic inner-ear disorder characterized by fluctuating hearing loss, episodic vertigo, and tinnitus. Though MD's etiology is unknown, growing evidence suggests that autoimmunity may be involved in its development. The aim of this prospective study was to investigate the presence of anti-heat shock protein 70 (anti-HSP70) antibodies during the acute phase of MD and to relate its presence to the antibody pattern. We examined the sera of 13 patients by Western blot immunoassays for reactivity to bovine inner-ear antigen (anti-HSP70) antibodies. The presence of viral antibodies and autoantibodies (herpes simplex, types 1, 2; herpes zoster; cytomegalovirus; Epstein-Barr; IgM; IgG; cardiolipin; thyroglobulin and thyroperoxidase; and antinuclear, antimitochondrial, and anti-smooth-cell antibodies) were also tested. We found reactivity to HSP70 in only 1 of the 13 MD patients (7.7%), and it occurred during herpes zoster reactivation. We found no relationship between the presence of antibodies to HSP70 and immunological or viral testing.
Minerva pediatrics, Oct 31, 2023
Frontiers in Surgery, Aug 23, 2021
The diagnosis of "definite" Méniére's disease (MD) relies upon its clinical manifestations. MD ha... more The diagnosis of "definite" Méniére's disease (MD) relies upon its clinical manifestations. MD has been related with Endolymphatic Hydrops (EH), an enlargement of the endolymphatic spaces (ES) (cochlear duct, posterior labyrinth, or both). Recent advances in Magnetic Resonance (MR) imaging justify its increasing role in the diagnostic workup: EH can be consistently recognized in living human subjects by means of 3-dimensional Fluid-Attenuated Inversion-Recovery sequences (3D-FLAIR) acquired 4 h post-injection of intravenous (i.v.) Gadolinium-based contrast medium, or 24 h after an intratympanic (i.t.) injection. Different criteria to assess EH include: the comparison of the area of the vestibular ES with the whole vestibule on an axial section; the saccule-to-utricle ratio ("SURI"); and the bulging of the vestibular organs toward the inferior 1/3 of the vestibule, in contact with the stapedial platina ("VESCO"). An absolute link between MD and EH has been questioned, since not all patients with hydrops manifest MD symptoms. In this literature review, we report the technical refinements of the imaging methods proposed with either i.t. or i.v. delivery routes, and we browse the outcomes of MR imaging of the ES in both MD and non-MD patients. Finally, we summarize the following imaging findings observed by different researchers: blood-labyrinthine-barrier (BLB) breakdown, the extent and grading of EH, its correlation with clinical symptoms, otoneurological tests, and stage and progression of the disease.
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Sep 1, 2022
Acta Otorhinolaryngologica Italica, Mar 25, 2019
BMC Research Notes, Dec 1, 2019
Objective: The purpose of the research is to test the measurement of the total urinary volume, in... more Objective: The purpose of the research is to test the measurement of the total urinary volume, induced by the diuretic osmotic action of mannitol, in a group of symptomatic MD patients and in healthy controls. Results: An altered excretory urinary volume after mannitol challenge was observed in symptomatic MD (874.3 ± 302.1) compared to healthy volunteers (361.7 ± 181.6) (p = 0.0001). This easy and self-administered method might be proposed to replace the analysis of the urinary sugars' concentration in symptomatic MD patients.
European Annals of Otorhinolaryngology, Head and Neck Diseases, Aug 1, 2022
Springer eBooks, 2014
In all medical fields a good case history evaluation is the key of a correct diagnostic pathway. ... more In all medical fields a good case history evaluation is the key of a correct diagnostic pathway. Patients’ complaints have to be documented as completely as possible just from the beginning of the disease. Sometimes the examiner uses technical terms to question the patient, and this can lead to confusion and misunderstandings. The first diagnostic task is to differentiate between vertigo and dizziness or disequilibrium, ruling out the many varieties of indistinct dizziness such as faintness. Vertigo is linked with a spinning sensation around the head and frequently a vestibular disorder. Vertigo is the awareness of some dysfunction in the balance mechanisms, that is, a dysfunction in the balance mechanisms becomes a conscious experience. The sensation is characterized by feelings of “spatial disorientation”, whereof the illusion of false movement is the most characteristic. “Rotatory sensation” is the most typical sensation, but it is not the sole feeling generated by balance dysfunction. The basic impression has to be the sensation of loss of stable subjective relationship with the environment. In this way less typical sensations must be included and are called “atypical” vertigo. On the other hand, syncopes, blackout, drop attacks, odd sensations in the head, etc., have to be denied as primary “vertigo” sensations, but they can accompany true vertigo. Dizziness or a turning sensation inside the head may result from disturbances of integrating structures within the central nervous system. Atypical dizziness is usually confused with disequilibrium. The term “dizziness” is used popularly. It includes a multitude of symptoms related to the vestibular system or other aspects of the nervous system. Dizziness is applied to physical, emotional or intellectual disturbances, whose common denominator seems to be a loss of stability, a disruption of the pattern in which the individual is aware of his surroundings and their relation to him, whether these refer to his physical orientation in space, his emotional equilibrium or his intellectual clarity. It is important that the patient describes symptoms with his/her own words in the simplest way. In this sense Grateu [1] proposed a simplified chart to investigate vertigo and dizziness during common or less common daily activities (Fig. 15.1) every time the examiner has to lead the patient in order to identify the main elements of patient history.
Laryngoscope, Jan 17, 2012
Objectives/Hypothesis: Wheat is one of the most common food allergens found in patients with Meni... more Objectives/Hypothesis: Wheat is one of the most common food allergens found in patients with Meniere's disease (MD). Gluten from wheat has been identified to have a etiopathogenetic role in celiac disease, IgE hypersensitivity to wheat disease, and recently to gluten sensitivity. The aim of this study was to verify the incidence of gliadin prick test response in patients affected by MD. Study Design: Prospective individual case-control study. Methods: There were 58 adult patients with definite MD, 25 healthy volunteers, and 25 patients with grass pollen rhinoconjunctivitis tested with skin prick test to gliadin. Results: A total of 33 MD patients (56.9%) proved to be sensitive to gliadin, eight of whom were positive to prick test after 20 minutes, 13 after 6 hours, 11 after 12 hours, and one after 24 hours. Conclusions: This is the first report of gliadin skin test response in MD. Further studies are needed to define the relationship between immune response to wheat proteins and MD symptoms.
Clinical Case Reports, Sep 1, 2022
This case report describes a peculiar and innovative fixing procedure with a Poly‐D,L‐lactic acid... more This case report describes a peculiar and innovative fixing procedure with a Poly‐D,L‐lactic acid (PDLLA) polymer in the unusual case of magnet dislodgment and rupture of the cochlear implant (CI) silicone sheath holding the magnet.
International Archives of Allergy and Immunology, 2005
Background: Recent but limited evidence suggests that nasal lavage with hypertonic saline may be ... more Background: Recent but limited evidence suggests that nasal lavage with hypertonic saline may be useful as an adjunctive treatment modality in the management of pediatric allergic rhinitis. The aim of this study was to clarify whether nasal irrigation with hypertonic solution should be routinely recommended to children with seasonal grass pollen rhinoconjunctivitis. Methods: Fourty-four children with seasonal grass pollen rhinoconjunctivitis were recruited. Twenty-two patients were random ized to receive three-times daily nasal rinsing with hypertonic saline during the pollen season, which lasted 7 weeks. Twenty-two patients were allocated to receive no nasal irrigation and were used as controls. Twenty patients per group completed the study. A mean daily rhinoconjunctivitis score based on the presence of nasal discharge and obstruction as well as ocular symptoms as reddening and itching were calculated for each week of the pollen season. Patients were allowed to use oral antihistamines when required and the mean number of drugs taken per week was also calculated. Results: The mean weekly rhinoconjunctivitis score in the active group was reduced during the whole pollen period. This difference was statistically significant in week 6 and 7 of therapy. A markedly reduced intake of oral antihistamines was also observed in patients allocated to nasal rinsing, being statistically significant in 5 of the 7 weeks. No adverse effect was reported in the active group. Conclusions: This study supports the use of nasal rinsing with hypertonic saline in the pediatric patient with seasonal allergic rhinoconjunctivitis. This treatment proved to be tolerable, inexpensive and effective.
The Journal of Allergy and Clinical Immunology, Sep 1, 2009
American Journal of Rhinology & Allergy, 2017
Background: Nasal rinsing with an atomizer spray was found to be effective in the treatment of al... more Background: Nasal rinsing with an atomizer spray was found to be effective in the treatment of allergic rhinitis. Two parameters express the nasal functions: (1) mucociliary clearance (MCC), and (2) the pH and its stability. MCC is the main factor that defines the time of pollen transition on the nasal mucosa and, therefore, the amount of the allergen glycoprotein elution. Objective: We hypothesized that the nasal wash efficacy could be due to the reduction of contact time of the grass pollen on the nasal mucosa (improving MCC). Methods: Forty patients with seasonal grass pollen oculorhinitis were randomized in two groups: 20 received three times daily nasal rinsing with hypertonic solution buffered to pH 6.1, before and during the peak pollen season in 2015 (active group), and another 20 patients were allocated to the control group and received no nasal treatment. The daily symptoms score and the use of oral antihistamines when required were evaluated during the grass pollen peak season. All the patients completed the study. Results: In comparison with the control group, in the active group, a significant decrease of both nasal symptoms (p ϭ 0.01) and consumption of antihistamines (p ϭ 0.035) was found. Furthermore, the MCC was significantly worse (p ϭ 0.011) only in the control group. Conclusion: The nasal treatment maintained the efficiency of the MCC in the patients in the active group, who showed a significant reduction of symptoms and medication score. The MCC decreased the transit time of the pollen on the nasal mucosa, which favored an elution of the allergenic proteins.
Background: Meniere's disease (MD) has been recently linked to gluten assumption. Approximately 7... more Background: Meniere's disease (MD) has been recently linked to gluten assumption. Approximately 75% of MD patients show positive skin test to food and about 50% of the positive responses are specific to the gliadin acid extract fraction. Aim of this study was to investigate the humoral immune responses to wheat antigens and related autoantigens in MD patients. Methods. We assessed the reactivity of sera from 28 patients with definite MD and 100 healthy controls against a repertoire of 51 antigens usually associated with immune reaction to gluten. Results. MD patients showed an increase of anti-wheat IgA, anti-cerebellar peptide IgA and anti-glutamic acid decarboxylase (GAD) 65 IgM compared to healthy controls. In particular, the increase of antiwheat IgA and GAD 65 IgM has been confirmed in a subgroup of MD patients symptomatically responding to a gluten free diet (GFD). Conclusion. In MD patients, an increase of the antibody production against gluten biomarkers was observed; in particular, anti-wheat IgA seems to be associated to clinical response to GFD.
Biomedical journal, Apr 1, 2016
Background: Several studies have demonstrated that the prevalence of temporomandibular disorders ... more Background: Several studies have demonstrated that the prevalence of temporomandibular disorders (TMDs) in tinnitus patients ranges from 7% to 95%, and it is reported in literature that idiopathic tinnitus patients should be referred to a dentist to define whether or not the tinnitus is associated with TMD. However, the possible pathophysiological relation between TMDs and tinnitus is not generally investigated in clinical practice. Methods: The patterns and forces of occlusal contacts have been studied by means of Tscan III in 47 tinnitus patients (23 suffering from idiopathic tinnitus and 24 affected by M eni ere disease [MD]) and 13 healthy subjects. Results: The center of force target was offset in the opposite direction in 15/23 idiopathic tinnitus and in 7/24 MD patients (p ¼ 0.026). No significant variation was found in the occlusal force. Conclusions: Our data suggest that a diagnostic screening method for occlusal stability in the intercuspidal position might be clinically useful in idiopathic tinnitus patients.
Research Square (Research Square), Sep 25, 2019
Objective. The purpose of the research is to test the measurement of the total urinary volume, in... more Objective. The purpose of the research is to test the measurement of the total urinary volume, induced by the diuretic osmotic action of mannitol, in a group of symptomatic MD patients and in healthy controls. Results. An altered excretory urinary volume after mannitol challenge was observed in symptomatic MD (874.3 ± 302.1) compared to healthy volunteers (361.7 ± 181.6). (p = 0.0001) This easy and selfadministered method might be proposed to replace the analysis of the urinary sugars' concentration in symptomatic MD patients.
Veins and Lymphatics, May 10, 2017
Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by demye... more Multiple sclerosis (MS) is a chronic disease of the central nervous system characterized by demyelinating lesions with acute phases and progressive loss of sensorimotor functions. Mèniére disease (MD) is a disorder of the inner ear characterized by acute spells of vertigo and hearing loss and progressive loss of cochleo-vestibular function. Both the diseases have a multifactorial pathogenesis and quite the same chronic cerebro-spinal insufficiency (CCSVI) frequency. However, as far as Author's knowledge concerns, no patients affected with both diseases are described so far. The aim of this paper is to investigate whether MS and MD present different CCSVI patterns. Three groups of patients were enrolled: 60 definite MS-27 definite unilateral MD (MEN)-41 with other no-Mèniére, audiovestibular disorders (OVD). All subjects underwent magnetic resonance venography (MRV) and venous Duplex (ECD) and only patients that satisfied both MRV and ECD CCSVI diagnostic criteria were considered. J1 was normal in 57% of MS, 88% of MEN and 95% of OVD. Stenosis (ST) were detected, respectively, in 30% of MS and 2% in MEN and OVD. J2 was normal in 78% of MS, 64% of MEN and 95% of OVD. At this level alterations of the trunk (AT) were detected in 17% in MS and 26% in MEN; J3 was normal in 74% of MS, 64% of MEN and 86% of OVD. AT were found in 15% of MS, 26% of MEN and 8% of OVD. Hyperplasia of the Vertebral Veins was observed in 35% of MS, 40% of MEN and in 15% of OVD. Other compensatory collaterals were detected in 25% in MS and only in 5% in MEN and OVD. Our results indicate that the MS pattern is characterized by J1 stenosis, J2 trunk alterations, a prevalence of J1-J2 medial-distal alterations, compensatory collaterals besides vertebral venous system. MD pattern is characterized by trunk alteration in J3, a prevalence of J3-J2 medial-proximal alterations and vertebral veins hyperplasia without other detectable collaterals. Although the group of patients with venous alterations is very small, OVD patients show a CCSVI pattern that is more similar to MD than MS pattern. The difference between MS and MD patterns indicates that CCSVI is not a unique entity and it could be an explanation of the fact that subjects affected with both the diseases are not reported.
Minerva pediatrics, Jun 1, 2021
BACKGROUND Sudden sensorineural hearing loss (SSNHL) is rare in children, and its etiology remain... more BACKGROUND Sudden sensorineural hearing loss (SSNHL) is rare in children, and its etiology remains largely unknown, although viral infections seem to play an important role. The aim of this study is to report 5 children who experienced permanent SSNHL and had dual positivity of serum anti-Epstein-Barr virus (EBV) IgM and anti-Cytomegalovirus (CMV) IgM antibodies. METHODS The study was conducted in a third-level referral audiological center. The medical charts of children under age 14 who experienced SSNHL without hearing recovery between September 1, 2017 and August 31, 2020, were reviewed. These children had undergone diagnostic evaluations, including brain magnetic resonance imaging, serological testing, thrombophilia and autoimmunity screening, to find possible causes of SSNHL. RESULTS In all 5 patients identified, anti-EBV IgM, anti-CMV IgM and anti-CMV IgG antibodies were detected by chemiluminescent immunoassay (CLIA) immediately after the diagnosis of SSNHL, which occurred from 2 to 4 weeks after the onset of symptoms attributable to primary EBV infection. No abnormalities were demonstrated by coagulation and immunologic tests. Brain magnetic resonance imaging showed normal findings. CONCLUSIONS This study suggests that primary EBV infection should be considered one of the most likely causes of SSNHL without any hearing recovery in children. Therefore, a routine audiological examination should be recommended for children with virologically confirmed primary EBV infection at approximately 3-4 weeks after onset of symptoms and then repeated with periodic follow-up. Further studies on a wider number of children affected by SSNHL might clarify the possible pathogenetic role of this dual serological positivity.
Journal of International Advanced Otology, Aug 16, 2018
INTRODUCTION Delayed facial palsy (DFP) is an uncommon complication after middle ear surgery; it ... more INTRODUCTION Delayed facial palsy (DFP) is an uncommon complication after middle ear surgery; it occurs after >72 hours of an uneventful ear surgery [1]. Shea described this phenomenon as "five and a half day syndrome, " meaning that all his personal observations shared the same time lag from surgery. [2] DFP after stapedectomy is a very rare event (0.22%) [3]. Its incidence in the literature ranges between 0.07% and 1.4%. [4-6] While immediate facial palsy is easily explained by the use of local anesthetics (if transient) or by intraoperative severe surgical trauma (if permanent), many hypotheses have been proposed about the late facial nerve dysfunctions, including reactivation of a quiescent virus colonizing the nerve ganglion. According to Shea et al. [4] the most probable etio-pathogenetic mechanism for DFP is the activation of a latent herpesvirus in the geniculate ganglion, induced by mechanical stimulation or reactive inflammation of the facial nerve during middle ear surgery. This hypothesis has been supported by many other observations after otological surgical procedures [7-18] and preventive antiviral therapy has been proposed in patients with positive history to varicella zoster virus and herpes simplex virus 1 and 2. However, serological search of a viral etiology is often inconclusive, not always identifying which virus (HSV type 1, 2, or VZV) is involved; the proposed use of preventive therapy with antivirals in all stapedectomy patients is still debated and often not applied in clinical practice [4-7]. The purpose of this work is to review the relevant literature on DFP after stapedectomy, aiming at properly assessing the viral etiology and at identifying factors that might influence the prognosis or the recovery time or the choice of therapies, and describe a very unusual case of DFP characterized by VZV reactivation showed by the eruption of typical RH lesions. MATERIALS and METHODS A PubMed search encompassing all publications over the last 40 years was initially performed searching for "facial palsy OR paralysis OR paresis" AND "stapedectomy OR stapedotomy OR stapes surgery" using Boolean combinations; Further, the terms "delayed OR late" were added to the search. The date of last search was 18 th March 2018. After screening all the articles abstracts, full-text works pertinent
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Papers by Federica Di Berardino