E Ferrary

Unité Inserm U1077, Caen, Lower Normandy, France

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Publications (137)252.64 Total impact

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    ABSTRACT: Loading otoprotective drug into cochlear implant might change its mechanical properties, thus compromising atraumatic insertion. This study evaluated the effect of incorporation of dexamethasone (DXM) in the silicone of cochlear implant arrays on insertion forces.
    08/2014;
  • ARO 2014; 01/2014
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    ABSTRACT: Otological microsurgery is delicate and requires high dexterity in bad ergonomic conditions. To assist surgeons in these indications, a teleoperated system, called RobOtol, is developed. This robot enhances gesture accuracy and handiness and allows exploration of new procedures for middle ear surgery. To plan new procedures that exploit the capacities given by the robot, a surgical simulator is developed. The simulation reproduces with high fidelity the behavior of the anatomical structures and can also be used as a training tool for an easier control of the robot for surgeons. In the paper, we introduce the middle ear surgical simulation and then we perform virtually two challenging procedures with the robot. We show how interactive simulation can assist in analyzing the benefits of robotics in the case of complex manipulations or ergonomics studies and allow the development of innovative surgical procedures. New robot-based microsurgical procedures are investigated. The improvement offered by RobOtol is also evaluated and discussed.
    BioMed Research International 01/2014; 2014:891742. · 2.88 Impact Factor
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    ABSTRACT: Introduction. In order to achieve a minimal trauma to the inner ear structures during array insertion, it would be suitable to control insertion forces. The aim of this work was to compare the insertion forces of an array insertion into anatomical specimens with three different insertion techniques: with forceps, with a commercial tool, and with a motorized tool. Materials and Methods. Temporal bones have been mounted on a 6-axis force sensor to record insertion forces. Each temporal bone has been inserted, with a lateral wall electrode array, in random order, with each of the 3 techniques. Results. Forceps manual and commercial tool insertions generated multiple jerks during whole length insertion related to fits and starts. On the contrary, insertion force with the motorized tool only rose at the end of the insertion. Overall force momentum was 1.16 ± 0.505 N (mean ± SD, n = 10), 1.337 ± 0.408 N (n = 8), and 1.573 ± 0.764 N (n = 8) for manual insertion with forceps and commercial and motorized tools, respectively. Conclusion. Considering force momentum, no difference between the three techniques was observed. Nevertheless, a more predictable force profile could be observed with the motorized tool with a smoother rise of insertion forces.
    BioMed Research International 01/2014; 2014:532570. · 2.88 Impact Factor
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    ABSTRACT: Ossicular surgery requires a high dexterity for the manipulation of the fragile and small middle ear components. Currently, the only efficient technique for training residents in otological surgery is through the use of temporal bone specimens, where any existing surgical simulator does not provide useful feedback. The objective of this study was to develop a finite-element model of the human ossicular chain dedicated to surgical simulation and to propose a method to evaluate its behavior. A model was developed based on human middle ear micromagnetic resonance imaging. The mechanical parameters were determined according to published data. To assess its performance, the middle ear transfer function was analyzed. The robustness of our model and the influence of different middle ear components were also evaluated at low frequency by static force pressure simulations. The mechanical behavior of our model in nominal and pathological conditions was in good agreement with published human temporal bone measurements. We showed that the cochlea influences the transfer function only at high frequency and could be omitted from a surgical simulator. In addition, surgeons were able to manipulate the validated middle ear model with a real-time haptic feedback. The computational efficiency of our approach allowed real-time interactions, making it suitable for use in a training simulator. © 2013 S. Karger AG, Basel.
    Audiology and Neurotology 12/2013; 19(2):73-84. · 2.32 Impact Factor
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    ABSTRACT: Most cochlear implantations are unilateral. To explore the benefits of a binaural cochlear implant, we used water-labelled oxygen-15 positron emission tomography. Relative cerebral blood flow was measured in a binaural implant group (n = 11), while the subjects were passively listening to human voice sounds, environmental sounds non-voice or silence. Binaural auditory stimulation in the cochlear implant group bilaterally activated the temporal voice areas, whereas monaural cochlear implant stimulation only activated the left temporal voice area. Direct comparison of the binaural and the monaural cochlear implant stimulation condition revealed an additional right temporal activation during voice processing in the binaural condition and the activation of a right fronto-parietal cortical network during sound processing that has been implicated in attention. These findings provide evidence that a bilateral cochlear implant stimulation enhanced the spectral cues associated with sound perception and improved brain processing of voice stimuli in the right temporal region when compared to a monaural cochlear implant stimulation. Moreover, the recruitment of sensory attention resources in a right fronto-parietal network allowed patients with bilateral cochlear implant stimulation to enhance their sound discrimination, whereas the same patients with only one cochlear implant stimulation had more auditory perception difficulties.
    Archives of Oto-Rhino-Laryngology 11/2013; · 1.29 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate electrode array position in relation to cochlear anatomy and its influence on hearing performance in cochlear implantees. Twenty-two patients (25 ears) with Med-El cochlear implants were included in this retrospective study. A negative correlation was observed between electrode-modiolus distance (EMD) at the cochlear base and monosyllabic word discrimination 6 months after implantation. We found no correlation between EMD and hearing outcome at 12 months. The insertion depth/cochlear perimeter ratio appeared to negatively influence the EMD at the base. Indeed, deep insertions in small cochleae appeared to yield smaller EMD and better hearing performance. This observation supports the idea of preplanning the surgery by adapting the electrode array to the length of the available scala tympani. © 2013 S. Karger AG, Basel.
    Audiology and Neurotology 10/2013; 18(6):406-413. · 2.32 Impact Factor
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    ABSTRACT: Abstract Conclusion: The use of the bone anchoring device associated with a fiducial marker, both fixed close to the operating field, improves the reproducibility and effectiveness of the computer-assisted navigation in lateral skull base surgery. Objectives: Computer-assisted navigation in lateral skull base surgery using the electromagnetic system Digipointeur® needs an external fiducial marker (titanium screw) close to the operating field to increase position accuracy (PA) to about 1 mm. Displacement of the emitter placed in the mouth (Buccostat®) induces a drift of the system, leading to at least 20% of unsuccessful procedures. The aim of this study was to evaluate the PA, stability, and reproducibility of computer-assisted navigation in lateral skull base surgery using a bone anchoring device to provide a fixed registration system near the operating field. Methods: Forty patients undergoing a lateral skull base procedure with the Digipointeur® system performed with both the titanium screw and bone anchoring device were included in this prospective study. They were divided in two groups. In the first one (n = 9), the PA was measured before and after screw registration for five intratemporal landmarks, during a translabyrinthine approach. In the second group (n = 31), all lateral skull base procedures were included and the PA was evaluated visually by the surgeon on different landmarks of the approaches as well as the stability of the system. Results: In the first group, the PA was 7.08 ± 0.59 mm and 0.77 ± 0.17 mm (mean ± SEM, p < 0.0001) before and after screw registration, respectively. In the second group, the PA was considered as accurate by the surgeon in all cases and no drift of the system was observed. Computer-assisted surgery was never abandoned due to increased stability of the bone-anchored emitter.
    Acta oto-laryngologica 08/2013; · 0.98 Impact Factor
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    ABSTRACT: The objective of this study is to evaluate the anatomical and functional results of rehabilitation of canal wall down (CWD) mastoidectomy using granules of biphasic ceramic. This is a study design retrospective in a tertiary referral centre Fifty-seven patients (59 ears) operated on between 2006 and 2010 of mastoid obliteration with granules of biphasic ceramic (TricOs(®), Maurepas, France) have been included (55 revisions and 4 first surgeries). Forty-six patients presented already a CWD mastoidectomy. The mean pre-operative bone conduction (BC) was 29 ± 3.4 dB (mean ± SEM) and mean air conduction (AC) was 57 ± 3.2 dB. Cholesteatoma was found in 33 cases. All but seven cases had post-operative otoscopy examination at 1, 3, 6 months, and 1 year postoperative with a CT scan and pure tone audiometry. Mean follow-up was 14 ± 1.8 months (3-35). At one-year follow-up (n = 52), 47 cases (90 %) presented well-healed external auditory canal. Five cases (10 %) of uncovered granules without sign of infection of external auditory canal skin were observed. Mean post-operative threshold was 25 ± 1.8 and 46 ± 1.9 dB for BC and AC , respectively (n = 47). CT scan (n = 42) showed no opacity suggesting residual disease within or behind obliteration. Mastoid obliteration with granules of biphasic ceramic is a safe and effective procedure that allows restoration of a near normal external auditory canal.
    Archives of Oto-Rhino-Laryngology 02/2013; · 1.29 Impact Factor
  • Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 01/2013; 130(4):A9.
  • Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 01/2013; 130(4):A76.
  • Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 01/2013; 130(4):A76.
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    ABSTRACT: Otosclerosis is a complex disease characterized by an abnormal bone turnover of the otic capsule resulting in conductive hearing loss. Recent findings have shown that Angiotensin II (Ang II), a major effector peptide of the renin-angiotensin system, plays important role in pathophysiology of otosclerosis, most likely by its pro-inflammatory effects on the bone cells. Since reactive oxygen species play a role both in inflammation and in cellular signalling pathway of Ang II, the appearance of the "second messenger of free radicals" the aldehyde 4-hydroxynonenal (HNE) protein adducts in otosclerotic bone has been analysed. Immunohistochemical analysis of HNE-modified proteins on tissue samples of the stapedial bones performed on 15 otosclerotic patients and 6 controls, revealed regular HNE-protein adducts presence in the subperiosteal parts of control bone specimens, while irregular areas of the pronounced HNE-protein adducts presence were found within stapedial bone in case of otosclerosis. To study possible interference of HNE and Ang II in human bone cell proliferation, differentiation and induction of apoptosis we used an in vitro model of osteoblast-like cells. HNE interacted with Ang II in a dose-dependent manner, both by forming HNE-Ang II adducts, as revealed by immunoblotting, and by modification of effects on cultured cells. Namely, treatment with 0.1nM Ang II and 2.5μM HNE stimulated proliferation, while treatment with 10μM HNE or in combination with Ang II (0.1, 0.5 and 1nM) decreased cell proliferation. Moreover, 10μM HNE alone and with Ang II (except if 1nM Ang II was used) increased cellular differentiation and apoptosis. HNE 5μM did not affect differentiation or significantly changed apoptosis. On the other hand, when cells were treated with lower concentrations of HNE and Ang II we have observed decrease in cellular differentiation (combination of 1.0 or 2.5μM HNE with 0.1nM Ang II) and decrease in apoptosis (0.1 and 0.5nM Ang II). Cellular necrosis was increased with 5 and 10μM HNE if given alone or combined with Ang II, while 0.5nM Ang II and combination of 1μM HNE with Ang II (0.1 and 0.5nM) reduced necrosis. These results indicate that HNE and Ang II might act mutually dependent in regulation of the bone cell growth and in pathophysiology of otosclerosis.
    Free Radical Biology & Medicine 12/2012; · 5.27 Impact Factor
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    ABSTRACT: Abstract Conclusion: Residual hearing could be preserved with various arrays ranging from 16 to 18 mm in insertion length and 0.25 to 0.5 mm tip diameter. Whether array insertion is performed through a cochleostomy or a round window, tip diameter is an essential criterion for the array design to improve hearing preservation results. Objectives: The goal of this study was to report the outcome of patients implanted with electric acoustic cochlear implants with various surgical techniques and array designs. Methods: Thirty-two implanted ears (30 patients) were included in this retrospective study. Three array models were inserted: Contour Advance implant (n = 16), Nucleus Hybrid-L (n = 12), and Med-El Flex EAS (n = 4). Postoperative pure tone audiometry was performed at 3 and 12 months after implantation. Results: Three months postoperatively, hearing preservation within 30 dB was achieved in 50%, 50%, and 84% cases of patients implanted with a Contour Advance, Flex-EAS, and Hybrid-L, respectively. Two patients (Hybrid-L group) had a delayed sudden hearing loss (> 30 dB) 3 months postoperatively and three patients (Contour Advance group) had total hearing loss at 1 year. Best results were achieved using arrays with small tip diameters. Cochleostomy or round window insertion did not affect hearing preservation results.
    Acta oto-laryngologica 12/2012; · 0.98 Impact Factor
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    ABSTRACT: The aim of this study was to investigate hearing preservation in adults receiving cochlear implants with Flex arrays. Fifteen adults (19 ears) implanted with Flex EAS® (n = 4) or Flex Soft® (n = 15; MedEL, Innsbruck, Austria) were included in this retrospective study. The mean array insertion length was 25 ± 0.9 mm (n = 19), and the mean cochlear coverage was 435 ± 14.5° (n = 19), with no difference between EAS and Soft arrays. Residual low-frequency hearing was preserved in all implanted ears but deteriorated [pure-tone average (125-1000 Hz) 55.1 ± 2.90 dB before vs. 81.0 ± 3.02 dB after surgery (n = 19, p < 0.01)]. Both Flex arrays allow deep insertion with reproducible hearing preservation.
    Audiology and Neurotology 07/2012; 17(5):331-7. · 2.32 Impact Factor
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    ABSTRACT: The aim of the study was to evaluate force profiles during array insertion in human cochlea specimens and to evaluate a mechatronic inserter using a 1-axis force sensor. Today, the surgical challenge in cochlear implantation is the preservation of the anatomic structures and the residual hearing. In routine practice, the electrode array is inserted manually with a limited sensitive feedback. Hifocus 1J electrode arrays were studied. The bench test comprised a mechatronic inserter combined to a 1-axis force sensor between the inserter and the base of the array and a 6-axis force sensor beneath the cochlea model. Influence of insertion tube material, speed (0.15, 0.5, and 1.5 mm/s) and lubricant on frictions forces were studied (no-load). Different models were subsequently evaluated: epoxy scala tympani model and temporal bones. Frictions forces were lower in the plastic tube compared with those in the metal tube (0.09 ± 0.028 versus 0.14 ± 0.034 at 0.5 mm/s, p < 0.001) and with the use of hyaluronic acid gel. Speed did not influence frictions forces in our study. Insertion force profiles provided by the 1- and 6-axis force sensors were similar when friction forces inside the insertion tool (no-load measurements) were subtracted from the 1-axis sensor data in the epoxy and temporal bone models (mean error, 0.01 ± 0.001 N). Using a sensor included in the inserter, we were able to measure array insertion forces. This tool can be potentially used to provide real-time information to the surgeon during the procedure.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 07/2012; 33(6):1092-100. · 1.44 Impact Factor
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    ABSTRACT: Cochlear implant array insertion forces are potentially related to cochlear trauma. We compared these forces between a standard (Digisonic SP; Neurelec, Vallauris, France) and an array prototype (Neurelec) with a smaller diameter. The arrays were inserted by a mechatronic tool in 23 dissected human cochlea specimens exposing the basilar membrane. The array progression under the basilar membrane was filmed together with dynamic force measurements. Insertion force profiles and depth of insertion were compared. The recordings showed lower insertion forces beyond 270° of insertion and deeper insertions with the thin prototype array. This will potentially allow larger cochlear coverage with less trauma.
    Audiology and Neurotology 05/2012; 17(5):290-8. · 2.32 Impact Factor
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    ABSTRACT: Objectifs Stimuler électriquement le nerf récurrent au cours de la chirurgie thyroïdienne ou parathyroïdienne et enregistrer les réponses musculaires ; en déduire, si possible, un pronostic fonctionnel de la mobilité vocale postopératoire. Patients et méthodes Le monitoring peropératoire du nerf récurrent a été effectué au moyen d’une sonde d’intubation endotrachéale équipée de deux paires d’électrodes de surface (NIM Medtronic Xomed, Jacksonville, Flo, États-Unis) et positionnée en regard des cordes vocales. Deux cent quinze nerfs récurrents ont été monitorés de manière prospective chez 141 patients ayant subi une thyroïdectomie totale (n = 74), une hémithyroïdectomie (n = 63) ou une parathyroïdectomie (n = 4). Dans tous les cas, la réponse musculaire a été recueillie après stimulation directe du nerf récurrent par une sonde monopolaire. Résultats Le seuil minimal de stimulation avant (prédissection) et après la dissection (postdissection) du nerf récurrent, entraînant une réponse musculaire supérieure ou égale à 100 μV, variait de 0,1 à 0,85 mA (moyenne à 0,4 mA). L’intensité de stimulation supramaximale a été définie à 1 mA. L’amplitude de la réponse musculaire était très variable d’un individu à l’autre, mais la similitude des réponses à une stimulation supramaximale de 1 mA, entre pré- et postdissection, d’une part, et entre postdissection aux extrémités proximale et distale du nerf exposé, d’autre part, était corrélée à une mobilité laryngée postopératoire normale. À l’inverse, l’altération de la réponse musculaire a témoigné d’un risque substantiel de paralysie récurrentielle, sans pouvoir prédire si celle-ci sera définitive ou non. Conclusions Cette méthode de monitoring est simple, non invasive et aussi sensible que celles utilisant des électrodes de recueil intramusculaires. Le monitoring est une aide précieuse au repérage du nerf et permet, en cours et en fin d’intervention, de s’assurer de son intégrité fonctionnelle et ainsi d’adapter la stratégie chirurgicale.
    Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 04/2012; 129(2):90–97.
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    ABSTRACT: Cochlear implant in adults is a procedure, dedicated to rehabilitate severe to profound hearing loss. Because of technological progresses and their applications for signal strategies, new devices can improve hearing, even in noise conditions. Binaural stimulation, cochlear implant and hearing aid or bilateral cochlear implants are the best opportunities to access to better level of comprehension in all conditions and space localisation. By now minimally invasive surgery is possible to preserve residual hearing and use a double stimulation modality for the same ear: electrical for high frequencies and acoustic for low frequencies. In several conditions, cochlear implant is not possible due to cochlear nerve tumour or major malformations of the inner ear. In these cases, a brainstem implantation can be considered. Clinical data demonstrate that improvement in daily communication, for both cochlear and brainstem implants, is correlated with cerebral activation of auditory cortex.
    La Revue de Médecine Interne. 03/2012; 33(3):143–149.
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    ABSTRACT: The aim of this study was to assess the expression and production of inflammation mediators in basal condition and after angiotensin II (AngII) in otosclerosis. Human stapedial cell cultures (6 otosclerosis and 6 controls) were incubated with AngII (10(-7)M, 24 h) or vehicle. Cytokines and their mRNA expression were assessed by antibody and cDNA arrays. In basal conditions, otosclerotic cultures produced higher amounts of interleukin (IL)-1β and interferon-inducible protein 10, and smaller amounts of tissue inhibitor of metalloproteinase 2. AngII promoted inflammation by increasing interferon γ and IL-10, and by decreasing macrophage inflammatory protein 1α and soluble tumor necrosis factor receptor II. Otosclerotic cultures produced higher proinflammatory cytokines in basal condition. AngII appeared to promote inflammation via these mediators in otosclerosis.
    Audiology and Neurotology 01/2012; 17(3):169-78. · 2.32 Impact Factor

Publication Stats

722 Citations
252.64 Total Impact Points

Institutions

  • 2004–2014
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2013
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 2009–2013
    • Hôpital Beaujon – Hôpitaux Universitaires Paris Nord Val de Seine
      Clicy, Île-de-France, France
  • 2006–2012
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • The University of Tokyo
      • Faculty & Graduate School of Medicine
      Tokyo, Tokyo-to, Japan
  • 2003–2012
    • Paris Diderot University
      • Faculté de Médecine Xavier Bichat
      Lutetia Parisorum, Île-de-France, France
  • 2005–2009
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 1989–2008
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2007
    • Institut National de la Transfusion Sanguine, Paris
      Lutetia Parisorum, Île-de-France, France
  • 2002
    • Karolinska University Hospital
      Tukholma, Stockholm, Sweden
  • 2000
    • Karolinska Institutet
      • Institutionen för fysiologi och farmakologi
      Solna, Stockholm, Sweden
  • 1999
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France
  • 1998
    • University of Bordeaux
      Burdeos, Aquitaine, France
  • 1996–1998
    • Universita degli studi di Ferrara
      • Department of Audiology
      Ferrara, Emilia-Romagna, Italy
  • 1992
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 1987
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France