Giulio Badin

Background/Objectives: As precision medicine advances, attention to sex and gender determinants across epidemiological and clinical domains has intensified. However, in the audio-vestibular field, knowledge on sex- and gender-related aspects remains relatively limited. The main aim of this review has been to analyze the available gender medicine-based evidence in vestibular disorders. In particular, our investigation considered the following: (i) pathophysiology and clinical presentation, including differences in predominant signs and symptoms, diagnostic modalities and findings, underlying biological mechanisms associated with vestibular disorders across sex-specific groups; (ii) prognostic variables, including response to treatment, recovery rates, and long-term functional outcomes; (iii) the potential role of sex- and gender-specific diagnostic and therapeutic approaches in the management of vestibular disorders. Methods: Our protocol was registered on PROSPERO (CRD42025641292). A literature search was conducted screening PubMed, Scopus and Web of Science databases. After removal of duplicates and implementation of our inclusion/exclusion criteria, 67 included studies were identified and analyzed. Results: Several studies reported a higher incidence of vestibular dysfunctions among females, with proposed associations involving hormonal fluctuations, calcium metabolism and vitamin D. Estrogen receptors within the inner ear and their regulatory effects on calcium homeostasis have been proposed as potential mechanisms underlying these sex-specific differences. Furthermore, lifestyle factors, comorbidities and differential health-seeking behaviors between males and females may also modulate disease expression and clinical course. Conclusions: Gender-specific variables could not be independently analyzed because none of the included studies systematically reported gender-related data, representing a limitation of the available evidence. Current evidence suggests the presence of sex-related differences in the epidemiology and clinical expression of vestibular disorders, but substantial gaps remain regarding mechanisms, outcomes, and clinical implications. Future research should prioritize prospective, adequately powered studies specifically designed to assess sex and gender influences, integrating biological, psychosocial, and patient-reported outcomes, and adopting standardized sex- and gender-sensitive reporting frameworks.

During pregnancy, women experience substantial anthropometric, cardiovascular, hormonal and psychological changes that affect several organs involving the circulatory, respiratory, gastrointestinal, musculoskeletal, dermatological and sensory systems. The main aim of this review was to analyse the available literature on postural strategies throughout pregnancy in both static and dynamic conditions. The secondary aim was to assess and discuss the current knowledge regarding vestibular disorders during pregnancy. Pregnant women with vestibular disorders need appropriate and safe treatments to resolve or reduce symptoms without risks for mother and foetus. Our protocol was registered on PROSPERO (CRD42024622122). A literature search was conducted screening PubMed, Scopus and Web of Science databases. After duplicates removal and exclusion of records due to coherence with the inclusion/exclusion criteria, 41 articles relevant to the topic were examined. Although some studies claimed no changes in postural behaviour during pregnancy, most of the available evidence seems to demonstrate significant modifications in posture and balance metrics, with multiple mechanisms. Physiological changes that occur in the mother's body during pregnancy have been considered as a possible substrate for developing vestibular disorders. Dizziness and vertigo were reported in pregnancy in small, low-quality studies. Benign paroxysmal positional vertigo, vestibular neuritis, Ménière disease, vestibular migraine and vestibular schwannoma have all been documented in pregnant women. To overcome reported limitations, prospective studies, preferably multicentre and involving third-level audio-vestibular centres are mandatory in order to define rational diagnostic and treatment approaches for vestibular disorders to protect the safety of the mother and foetus.

Background and Objective: Arytenoid dislocation (AD) and subluxation (AS) impact vocal fold mobility, potentially affecting the quality of life. Their management, including the timing and modality of treatment, remains a subject of research. Our primary objective was to assess and compare the available treatment strategies for AS and AD. Material and methods: the protocol was registered on PROSPERO (CRD42023407521). Manuscripts retrieved from a previously published systematic review were evaluated. To comprehensively cover the last 25 years, an updated literature search was conducted, screening PubMed, Scopus, and Cochrane databases. Review Methods: We included studies that reported treatment modalities and the time to treatment (TT) for AS/AD, with outcomes objectively evaluated. Data on treatment success were pooled, and the impact of TT on recovery outcomes was analyzed. Results: Thirteen studies involving 361 patients were included. The majority of cases were attributed to iatrogenic trauma following intubation. Closed reduction (CR) was the primary treatment, with high success rates for both general (success rate: 77%, CI: 62–87%) and local anesthesia (success rate: 89%, CI: 70–97%). The standardized mean difference for the TT effect on treatment outcome was −1.24 (CI: −2.20 to −0.29). Conclusions: The absence of randomized controlled trials and the overall moderate-to-low quality of the studies highlighted the importance of the finding’s careful interpretation. This meta-analysis underscores the effectiveness of CR in managing AS/AD, with both general and local anesthesia yielding high success rates. The findings highlight the importance of TT, suggesting that early intervention is paramount. Future clinical research is needed to further refine these findings and optimize treatment protocols.

Research on Cochlear implant (CI) outcomes has been mainly focused on verbal communication, whereas music perception has been less extensively explored. This study evaluated a music rehabilitation program, based on the mobile phone app Meludia (Meludia, France) to improve quality of life (QoL) and verbal perception in CI patients. In this non-randomised clinical trial, the experimental group underwent 16 Meludia sessions, while controls did not receive any music-specific rehabilitation. Patient-reported outcome (PRO) measures, including the MUSQUAV questionnaire and NCIQ domains, were utilised alongside Matrix speech perception tests (which measure speech understanding in noise). Forty patients with CI were considered: experimental group (21 patients) and control group (19 patients). Significant improvements (p = 0.017, and p < 0.001) in music-related PRO (MUSQUAV), and general CI PRO measures (NCIQ), respectively, were found in the experimental group. No significant differences were found in Matrix speech perception tests post-rehabilitation. Overall, 57% of participants in the experimental group reported subjective improvements in music perception. This study showed the potential of home-based music rehabilitation in enhancing QoL for CI patients, supporting the possibility of implementing specific musical training programs in audiological care. Larger, randomised, controlled trials are necessary for further characterisation of this topic.

Introduction: Cochlear implants (CI) have been developed to enable satisfying verbal communication, while music perception has remained in the background in both the research and technological development, thus making CI users dissatisfied by the experience of listening to music. Indications for clinicians to test and train music abilities are at a preliminary stage compared to the existing and well-established hearing and speech rehabilitation programs. The main aim of the present study was to test the utility of the application of two different patient reporting outcome (PRO) measures in a group of CI users. A secondary objective was to identify items capable of driving the indication and design specific music rehabilitation programs for CI patients. Materials and Methods: A consecutive series of 73 CI patients referred to the Audiology Unit, University of Padova, was enrolled from November 2021 to May 2022 and evaluated with the audiological battery test and PRO measures: Musica e Qualità della Vita (MUSQUAV) and Nijmegen Cochlear Implant Questionnaire (NCIQ) Italian version. Results: The reliability analysis showed good consistency between the different PRO measures (Cronbach’s alpha = 0.873). After accounting for the epidemiological and clinical variables, the PRO measures showed a correlation with audiological outcomes in only one case (rho = −0.304; adj. p = 0.039) for NCIQ-T with the CI-pure tone average. A willingness for musical rehabilitation was present in 63% of patients (Rehab Factor, mean value of 0.791 ± 0.675). Conclusions: We support the role of the application of MUSQUAV and NCIQ to improve the clinical and audiological evaluation of CI patients. Moreover, we proposed a derivative item, called the rehab factor, which could be used in clinical practice and future studies to clarify the indication and priority of specific music rehabilitation programs.