Luigi Falchetta

Cochlear implantation (CI) is the treatment of choice for patients with severe or profound sensorineural deafness, providing substantial improvements in hearing perception and quality of life.Howev...

BACKGROUND: To evaluate the clinical efficacy and safety of hyperbaric oxygen therapy (HBOT) combined with systemic corticosteroids in patients with idiopathic sudden sensorineural hearing loss (ISSNHL), with particular focus on treatment timing, predictors of hearing recovery, and the impact of comorbidities. METHODS: This retrospective observational cohort study was conducted at a tertiary referral center (AOU “San Giovanni di Dio e Ruggi d’Aragona,”Salerno, Italy). A total of 332 adult patients with ISSNHL treated between 2014 and 2024 were included. All patients received combined therapy with systemic corticosteroids (oral prednisone 1 mg/kg/day, tapered over 10-15 days) and HBOT (2.4 atmospheres absolute, 90 minutes per session; median of 10 sessions). Audiometric outcomes were assessed using pure-tone average (PTA). Treatment response was defined as a ≥30% improvement in PTA compared with baseline. Multivariate logistic regression was performed to identify independent predictors of hearing improvement. Safety outcomes were also recorded. RESULTS: Mean baseline PTA was 61.3 Å} 21.5 dB HL, improving to 44.6 Å} 22.7 dB HL after treatment, with a mean hearing gain of 16.7 Å} 14.2 dB HL (P < .001). Overall, 151 patients (43.5%) met the response criteria. Responders presented with significantly higher baseline PTA compared with nonresponders (67.6 vs. 56.8 dB HL, P < .001) and more frequently reported tinnitus (64.2% vs. 51.5%, P = .014). Median time to treatment initiation was 15 days (interquartile range: 7-30). Multivariate analysis identified shorter time to treatment (odds ratio [OR]: 0.95, 95% CI: 0.92-0.98), presence of tinnitus (OR: 1.79, 95% CI: 1.15-2.80), and higher baseline PTA (OR: 1.03, 95% CI: 1.01-1.05) as independent predictors of hearing improvement. Common comorbidities, including hypertension, diabetes, and cardiovascular disease, were not significantly associated with treatment response. No serious adverse events related to HBOT were observed. CONCLUSION: Hyperbaric oxygen therapy combined with systemic corticosteroids was associated with improved audiometric outcomes in patients with ISSNHL, particularly when initiated early. Shorter time to treatment, greater baseline hearing loss, and the presence of tinnitus emerged as independent predictors of hearing recovery. Overall, these findings suggest an association between early HBOT use and improved audiometric outcomes and support its consideration as an adjunctive component of multimodal treatment strategies for ISSNHL.

Background: Hearing loss is highly prevalent among older adults and represents a growing public health burden. Increasing attention has been given to the associations between hearing loss, cognitive decline, and dementia risk. Cochlear implantation is an established intervention for adults with severe-to-profound sensorineural hearing loss who obtain limited benefit from conventional amplification, but its potential cognitive effects remain debated. Objective: This narrative review summarizes current evidence on cognitive outcomes after cochlear implantation in adults and older adults, with particular attention to cognitive domains, long-term trajectories, methodological limitations, and clinical implications. Main findings: Available evidence suggests that cochlear implantation may be associated with improvement or stabilization of selected cognitive domains, particularly attention, executive function, working memory, and memory. However, findings are heterogeneous across studies, cognitive tools, and follow-up durations. Prospective longitudinal studies using hearing-adapted or visually presented cognitive batteries support the possibility of postoperative cognitive benefit, but the magnitude and durability of this effect vary between individuals and domains. Long-term studies suggest that cognitive improvement may be strongest during the first postoperative years and may later stabilize or attenuate, whereas auditory and quality-of-life benefits appear more consistently sustained. Conclusions: Cochlear implantation should be regarded as an established hearing rehabilitation strategy with robust benefits for auditory performance and quality of life, and as a potentially cognition-supportive intervention in selected older adults with severe-to-profound hearing loss. Current evidence does not yet prove that cochlear implantation prevents dementia. Future studies should use standardized hearing-adapted cognitive protocols, longer follow-up, adequate comparison groups, and clinically meaningful cognitive endpoints.

A pyolaryngocele is a rare, potentially life‐threatening complication of laryngocele, resulting from secondary infection and obstruction of the saccular neck. Clinical severity ranges from mild dysphonia to acute airway compromise. We report a 51‐year‐old man with a sore throat, dysphagia, and dyspnea. Flexible laryngoscopy and contrast‐enhanced CT revealed an internal pyolaryngocele. After emergency tracheostomy and intravenous antibiotics, the patient underwent CO ₂ laser microlaryngoscopic excision and marsupialization. Postoperative recovery was uneventful, with complete healing and no recurrence at follow‐up. This case underscores the importance of early diagnosis and highlights CO ₂ laser surgery as an effective, minimally invasive option. Internal pyolaryngocele is a rare airway emergency that requires prompt management. CO ₂ laser excision appears to be a safe and effective first‐line approach in selected internal cases.