Objectives: The primary end point of this study was to evaluate the impact of bile acids on severity of laryngo-pharyngeal reflux (LPR) and the possible correlation with esophagitis and upper airway malignancies. The second end point was to evaluate if salivary bile acids and molecules other than pepsin might serve as diagnostic biomarkers of LPR. Design: Observational prospective comparative study. Setting: Otorhinolaryngology unit of a tertiary hospital. Participants: Sixty-two consecutive adult outpatients suspected of LPR. Main outcome measures: Bile acids, bilirubin and pepsinogen I-II were measured in saliva. Patients underwent pH metry and based on the results of bile acids were subdivided as acid, mixed and alkaline LPR. Results: Significantly higher Reflux Findings Score (RFS) and Reflux Symptoms Index (RSI) were seen in patients with alkaline and mixed LPR compared to acid LPR. Salivary bile acids >1 µmol/L seem to be a reliable indicator of the severity of LPR. Compared to those without, patients with esophagitis or a history of upper airway malignancy have high concentrations of bile acids in saliva. Among the molecules studied, bile acids were the most suitable for diagnosis of LPR, with a sensitivity of 86% and a positive predictive value of 80.7%. Conclusions: Our data suggest that high concentrations of bile acids are associated with higher values of RSI and RFS in LPR as well as a higher risk of esophagitis and history of upper airway malignancies. We finally observed that bile acids provided the best biometric parameters for diagnosis of LPR among the molecules tested.

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In all three implanted patients, the RetroX provided better audiological benefit for speech understanding in noise. These findings were corroborated by the results of the questionnaire, which showed greater satisfaction with the RetroX, especially regarding the absence of the occlusion effect.

Thyroglossal duct (TGD) remnants in the form of cysts or fistulas usually present as midline neck masses and they are removed along with the central body of the hyoid bone (Sistrunk’s procedure). For other pathologies associated with the TGD tract, the latter operation might be not necessary. In the present report, a case of a TGD lipoma is presented and a systematic review of the pertinent literature was performed. We present the case of a 57-year-old woman with a pathologically confirmed TGD lipoma who underwent transcervical excision without resecting the hyoid bone. Recurrence was not observed after six months of follow-up. The literature search revealed only one other case of TGD lipoma and controversies are addressed. TGD lipoma is an exceedingly rare entity whose management might avoid hyoid bone excision.

Objective: Total deafness may be among the consequences of a skull encephalic trauma with bilateral fracture of the temporal bone. The recovery of hearing function can occur with the application of a cochlear implant. The functional results will depend on the presence of neurological or neuropsychological alterations both morphological at cochlear level. Method: We present four cases of postverbal total deafness subsequent to single and/or bilateral fracture of the temporal bone who underwent cochlear implantation from 2000 to 2009. Two patients had monolateral anacusia with onset in childhood contralateral to the fracture, and 2 patients had injuries with bilateral fracture of the petrosal bone. Results: In all cases correct positioning of the electrode array was possible without complications after surgery, and at the activation all electrodes were working. Because of the greater encephalic damage and the reduced capacity of cortical integration, in 2 patients the spectral type of stimulation strategies was chosen with low rates of stimulation. One year after the activation of the perceptual-verbal ability all patients reached the recognition level in open set, and 3 patients were able to have telephone conversations with familiar voices. The patients with greater neurological complications also obtained significant benefits on the cognitive side. Conclusion: In these cases different variables affect the recovery of hearing function with the cochlear implant. CNS damage may be associated with fibrosis or ossification of the cochlea and limits to the proper insertion of the electrodes array. The neuropsychological and neurological complications, in our opinion, are not factors of exclusion.