Daniele De Seta

Objectives: This study aimed to analyze in a comprehensive systematic review the hearing rehabilitation strategies for single-sided deafness (SSD) and asymmetric hearing loss (AHL) in children. Current rehabilitative options include contralateral routing of signal (CROS) devices, bone conduction devices, and cochlear implantation (CI). Methods: A systematic review of PubMed/MEDLINE was performed to identify studies on pediatric SSD and AHL rehabilitation published up to 7 July 2025. Reviews, meta-analyses, case reports, and animal studies were excluded. Eligible studies included pediatric populations treated with rehabilitative devices, with outcomes focused on speech perception, auditory performance, binaural hearing, quality of life, and questionnaire-based measures. Study selection followed PRISMA principles. Results: A total of 1527 records were identified by three authors through PubMed/MEDLINE (2003–July 2025) after duplicate removal. Title screening retained 581 studies, and abstract screening retained 267 studies. Fifty-eight full-text papers were assessed for eligibility; 10 were excluded due to overlapping patient cohorts, leaving 48 papers for the qualitative synthesis. Overall, 1622 children were analyzed; 43 studies focused on SSD and five on AHL. Conclusions: Available evidence supports rehabilitation in pediatric SSD and AHL. CROS systems offer a non-surgical and reversible option with benefits in selected listening situations but limited effects on localization. Bone conduction devices may improve hearing in noise and some functional outcomes, especially in conductive indications. CI appears to provide the greatest opportunity to restore bilateral auditory input, particularly when performed early in congenital SSD.

Objectives: To analyze the impact of robotic-assisted electrode array insertion on vestibular function after cochlear implantation (CI) in children. Methods: This single-center retrospective study included 80 ears from pediatric patients who underwent CI: 42 in the robotic-assisted group (2021-2024) and 38 in the manual group (2015-2020). All surgeries were performed by the same surgeon. Vestibular function was assessed preoperatively and postoperatively using objective tests, including cervical vestibular evoked myogenic potentials (cVEMP) and video head impulse test (vHIT). Subpopulations were defined based on the availability of complete vestibular data: 68 ears were included in the cVEMP analysis and 74 in the vHIT analysis. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test. Results: Overall mean age at CI was 56±51 months and post-CI vestibular assessment was performed at a mean delay of 18±13 months. In the robotic group, 100% of the sample (n=36) preserved saccular function (cVEMP), compared with 85% (n=27/32) in the manual group ( P =0.02). vHIT analysis revealed no statistically significant differences between groups in canal function preservation; 92% (n=36/39) of the robotic group and 100% (n=35/35) of the manual group maintained normal canal responses postoperatively. Per-canal delta-gain analysis for vHIT showed no significant changes for any canal (anterior: P =0.75; lateral: P =0.06; posterior: P =0.92). Conclusions: Robotic-assisted electrode array insertion had significantly higher post-CI cVEMP preservation compared with manual techniques after pediatric cochlear implantation. This may suggest that robotic slow electrode array insertion is less traumatic for the vestibule and helps preserve saccular function.

Background: Vestibular granuloma is a rare complication of a common surgical procedure, such as stapedotomy; it can significantly impact the outcome of surgery, leading to severe impairment and deterioration in the patient’s quality of life. Case report: A 59-year-old male underwent stapedotomy with a titanium prosthesis. Initially, hearing function improved but, within days, the patient developed vertigo and worsened hearing loss. HR CT of temporal bone revealed soft tissue in the tympanic cavity, prompting revision surgery. Granulomatous tissue surrounding the prosthesis was removed, leading to symptom relief. However, the patient later developed Persistent Postural-Perceptual Dizziness (PPPD), requiring SSRI therapy. Discussion: The sudden onset of persistent vertigo and hearing loss, that rapidly worsens in post-operative setting, represents a crucial red flag for the surgical team. Hearing assessments and imaging play a key role in quickly diagnosing the cause of these complications, which may be attributed to an inflammatory response at the surgical site, possibly due to granuloma formation. This enables the surgical équipe to swiftly implement appropriate care strategies for the patient, even in the presence of additional and subsequent complications like PPPD, which requires a comprehensive, multimodal approach to treatment. Conclusion: This case highlights the risk of a series of complications after surgery and even after reoperation, ultimately requiring conservative multimodal treatment and follow-up. Early recognition and coordinated care are essential for optimal long-term management of patients, even in the presence of unfavorable outcomes and complications.