Cochlear implant surgery in far-advanced otosclerosis can be challenging due to the degenerative process that affects the cochlea. We used OTOPLAN® to plan and define the details of surgery in a patient with such severe alteration of the cochlea that cochlear implant could be contraindicated. A 73-year-old man affected by bilateral far-advanced otosclerosis, previously treated by bilateral stapedotomy, presented 0% of speech discrimination using bilateral hearing aids. A unilateral cochlear implant was planned. The patient underwent radiologic investigation pre-surgery with temporal bone computer tomography, magnetic resonance imaging, and OTOPLAN. Radiology confirmed bilaterally advanced signs of fenestral and cochlear otosclerosis with large osteolytic cavities along the whole cochlea leading to the mixture of endolymph and perilymph. The OTOPLAN identified the alteration of the cochlea in detail. Based on the results of the software, we used a perimodiolar implant on the left ear. No intraoperative or post-operative surgical complications were observed. The patient was checked 6 months after surgery, he did not refer any problems and obtained 75% of speech discrimination at 65 dB. Our case suggests that OTOPLAN is a useful tool in far-advanced otosclerosis because careful planning of the surgery can positively affect the results. Despite the complexity of the anatomy, the software exactly described the real intrasurgical finding. We think that the use of OTOPLAN might improve the surgical indication. Cite this article as: Ricci G, Lapenna R, Gambacorta V, della Volpe A, Faralli M, Di Stadio A. OTOPLAN, cochlear implant, and far-advanced otosclerosis: Could the use of software improve the surgical final indication? J Int Adv Otol. 2022;18(1):74-78.

Background: Acute otomastoiditis (AOM) may occasionally progress to severe intracranial complications in children. While immunological and microbiological factors have been studied, the role of temporal bone anatomical variants remains less well-defined. The aim of this study is to investigate the prevalence of anatomical variants in pediatric patients with acute complicated otomastoiditis (ACOM) compared to those with uncomplicated ones (AUOM) and healthy controls (HC) and assess their potential association with intracranial complication patterns. Methods: This retrospective, single-center study reviewed clinical and neuroradiological data of patients aged 0–16 years admitted for AOM between 2018 and 2025. ACOM patients were compared to AUOM and HC groups (the latter undergoing neuroimaging for minor head trauma). Two experienced neuroradiologists evaluated imaging to identify anatomical variants involving the following: (1) sigmoid sinus and emissary veins; (2) tegmen tympani; and (3) mastoid pneumatization. Statistical analyses assessed prevalence differences across groups. Results: Among 282 AOM patients, 58 had intracranial complications. Anatomical variants were significantly more frequent in ACOM patients versus both AUOM and HC (p < 0.01). In this subgroup, vascular anatomical variants were notably associated with vascular or combined (vascular and infectious) complications; tegmen tympani and mastoid pneumatization variants showed no significant subgroup associations. Conclusion: Anatomical variants, particularly vascular anomalies of the sigmoid sinus and emissary veins, appear to increase pediatric AOM patients’ susceptibility to intracranial complications. Recognition of these configurations through early neuroimaging could aid risk stratification and improve diagnostic and therapeutic strategies.

Purpose: Inflammations of the upper respiratory tract (URT) are common both in adults and children and they are generally treated using aerosol therapy with mucolytic medications and steroids. When these inflammations affect children, the treatment must be rapid and resolutive to prevent complications. Steroids present some contraindications, i.e. alteration of smell, that must be considered especially in children. Therefore, alternative treatments that have similar efficacy but limited adverse effects should be considered. This study aims at evaluating the efficacy of Adelmidrol to treat inflammation of the URT in children. Methods: Case-Control study. Control group used standard treatment for URT inflammation (mucolytics and steroids); treatment groups were treated by Adelmidrol spray. Sixty children (age range 2.5–4.5 years) were randomly assigned to (i) control group, (ii) treatment group 1 (TG1)- Adelmidrol nasal spray only and (iii) treatment group 2 (TG2), in which Adelmidrol was administered in both nasal and oral spray solution. The URT and the tympanic membrane were evaluated at T0, T1 (30 days) and T2 (90 days). The treatments were performed for 90 consecutive days. Results: At the end of the treatment, TG2 (combination of nasal and oral sprays) had the best outcomes both on URT findings (χ²: p = 0.0004) and tympanic membrane conditions (χ²: p = 0.03). TG1 showed similar outcome of CG. Conclusions: These preliminary results in our group of 60 children showed that Adelmidrol had the same efficacy of standard treatment when used as nasal spray only and was better than the standard treatment when used combining nasal and oral sprays. The molecule seems to offer the same benefit of standard treatment without side effects. If confirmed on a larger sample, the use of Adelmidrol could be suggested as an alternative to traditional treatment for the inflammation of URT in children.

Background: Acute mastoiditis is the most frequent suppurative complication of acute otitis media in children. AM can lead to both extracranial complications and intracranial complications. Recent studies suggest an increase in cases after the COVID-19 pandemic. Objective: To compare the epidemiological and clinical characteristics of pediatric patients diagnosed with acute mastoiditis admitted to Santobono-Pausilipon Children’s Hospital before and after COVID-19. Methods: We conducted a retrospective study including all patients aged 0–16 years with AM admitted to our hospital between January 2017 and December 2024. Patients were stratified into three groups: pre-COVID-19: 1 January 2017–28 February 2020; COVID-19: 1 March 2020–31 December 2021; and post-COVID-19: 1 January 2022–31 December 2024. Demographic data, clinical presentations, complications, laboratory findings, and treatment modalities were analyzed and compared between groups. Results: A total of 276 children (153 males and 123 females; median age: 49 months, age range: 1–177 months) were included. Hospital admissions for AM increased in the post-COVID-19 period, reaching more than a threefold increase in 2024 compared with the pre-COVID-19 years. Similar to the overall number of AM cases, the absolute number of complications, especially IC, such as thrombosis and empyema, increased. The rate of surgical procedures increased during the post-COVID-19 period, with an overall increase of 88.5%. Both the duration of antibiotic therapy and hospital stay were significantly longer in the post-COVID-19 period. Conclusions: The COVID-19 pandemic has been associated with epidemiological and clinical changes in pediatric AM patients. These findings highlight the need for effective preventive strategies, including enhanced vaccination coverage and the promotion of early diagnosis. Additionally, implementing standardized clinical protocols could support more efficient and consistent management, reducing hospital stays and recurrence rates.

I programmi di identificazione precoce delle ipoacusie infantili permette di intraprendere rapidamente l’iter riabilitativo e protesico appropriato; nonostante ciò appare ancora elevato il numero di pazienti che non aderiscono al programma terapeutico. L’obiettivo di questo articolo è presentare i risultati di un’analisi strategica che prende in considerazione i punti di forza, i punti di debolezza, le opportunità e i rischi del processo di follow up audiologico/protesico/linguistico di bambini affetti da ipoacusia bilaterale permanente. Il follow up in questione, coinvolgendo bambini piccoli, implica il coinvolgimento di professionisti specializzati e inseriti in un team multidisciplinare e una gestione plurisettoriale complessa e prolungata. Nell’ambito del progetto finanziato dal Ministero della Salute Italiano CCM 2013 denominato “Programma regionale di identificazione, intervento e presa in carico precoci per la prevenzione dei disturbi comunicativi nei bambini con deficit uditivo” lo scopo di quest’analisi è stata quella di offrire delle raccomandazioni per armonizzare i criteri di valutazione dei risultati terapeutici e trarre spunto da questi per successivamente fornire delle linee guida riguardanti le metodiche più adeguate nella valutazione del bambino con ipoacusia permanente.