-
[show abstract]
[hide abstract]
ABSTRACT: Postoperative imaging plays a growing role in clinical studies concerning prognostic factors in cochlear implantation. Indeed, intracochlear position of the cochlear implant has recently been identified as a contributor in functional outcomes and radiological tools must be accurate enough to determine the final placement of the electrode array. The aim of our study was to validate cone beam computed tomography as a reliable technique for scalar localization of the electrode array. We performed therefore a temporal bone study on ten specimens that were implanted with a perimodiolar implant prototype. Cone beam reconstructions were performed and images were analyzed by two physicians both experienced in cochlear implant imaging, who determined the scalar localization of the implant. Temporal bones then underwent histological control to document this scalar localization and hypothetical intracochlear lesions. In four cases, a dislocation from scala tympani to scala vestibuli was suspected on cone beam reconstructions of the ascending part of the basal turn. In three of these four specimens, dislocation in pars ascendens was confirmed histologically. In the remaining temporal bone, histological analysis revealed an elevation with rupture of the basilar membrane. Histological assessment revealed spiral ligament tearing in another bone. We conclude that cone beam is a reliable tool to assess scalar localization of the selectrode array and may be used in future clinical studies.
Archives of Oto-Rhino-Laryngology 03/2013; · 1.29 Impact Factor
-
Peter Blamey,
Françoise Artieres,
Deniz Başkent,
François Bergeron,
Andy Beynon,
Elaine Burke,
Norbert Dillier,
Richard Dowell, Bernard Fraysse,
Stéphane Gallégo, [......],
Karen Schauwers,
Henryk Skarzynski,
Piotr H Skarzynski,
Olivier Sterkers,
Assia Terranti,
Eric Truy,
Paul Van de Heyning,
Fréderic Venail,
Christophe Vincent,
Diane S Lazard
[show abstract]
[hide abstract]
ABSTRACT: Objective: To update a 15-year-old study of 800 postlinguistically deaf adult patients showing how duration of severe to profound hearing loss, age at cochlear implantation (CI), age at onset of severe to profound hearing loss, etiology and CI experience affected CI outcome. Study Design: Retrospective multicenter study. Methods: Data from 2251 adult patients implanted since 2003 in 15 international centers were collected and speech scores in quiet were converted to percentile ranks to remove differences between centers. Results: The negative effect of long duration of severe to profound hearing loss was less important in the new data than in 1996; the effects of age at CI and age at onset of severe to profound hearing loss were delayed until older ages; etiology had a smaller effect, and the effect of CI experience was greater with a steeper learning curve. Patients with longer durations of severe to profound hearing loss were less likely to improve with CI experience than patients with shorter duration of severe to profound hearing loss. Conclusions: The factors that were relevant in 1996 were still relevant in 2011, although their relative importance had changed. Relaxed patient selection criteria, improved clinical management of hearing loss, modifications of surgical practice, and improved devices may explain the differences.
Audiology and Neurotology 10/2012; 18(1):36-47. · 2.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To describe the clinical and radiologic features of associated spontaneous tegmen defects (STDs) with semicircular canal dehiscences (SCCDs) and to postulate a novel etiopathogenic hypothesis of these pathologic conditions.
Medical records of all patients with surgically confirmed STD between 2001 and May 2010 were reviewed. We excluded all secondary tegmen defects. Clinical, audiological, and radiologic data were analyzed.
Twenty-three patients matched the inclusion criteria. Semicircular canal dehiscence was associated to STD in 13 patients. Of these patients, 12 (95%) had protruding superior semicircular canals in the middle cranial fossa versus only 3 (30%) of 10 patients for the nondehiscent cases. Twenty-two patients complained of hearing loss. Cerebrospinal fluid leak was found in 13 patients. Four patients had history of meningitis. Vestibular symptoms were present in 8 patients.
This is the largest series of reported coexistence of STD and SCCD in the literature. Protrusion of the superior semicircular canal in the middle cranial fossa is probably an additional factor underlying STD and SCCD etiopathogeny. Semicircular canal dehiscence should always be looked for when STD is present.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 03/2012; 33(4):591-5. · 1.44 Impact Factor
-
Diane S Lazard,
Christophe Vincent,
Frédéric Venail,
Paul Van de Heyning,
Eric Truy,
Olivier Sterkers,
Piotr H Skarzynski,
Henryk Skarzynski,
Karen Schauwers,
Stephen O'Leary, [......],
Paul J Govaerts, Bernard Fraysse,
Richard Dowell,
Norbert Dillier,
Elaine Burke,
Andy Beynon,
François Bergeron,
Deniz Başkent,
Françoise Artières,
Peter J Blamey
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: To test the influence of multiple factors on cochlear implant (CI) speech performance in quiet and in noise for postlinguistically deaf adults, and to design a model of predicted auditory performance with a CI as a function of the significant factors. STUDY DESIGN: Retrospective multi-centre study. METHODS: Data from 2251 patients implanted since 2003 in 15 international centres were collected. Speech scores in quiet and in noise were converted into percentile ranks to remove differences between centres. The influence of 15 pre-, per- and postoperative factors, such as the duration of moderate hearing loss (mHL), the surgical approach (cochleostomy or round window approach), the angle of insertion, the percentage of active electrodes, and the brand of device were tested. The usual factors, duration of profound HL (pHL), age, etiology, duration of CI experience, that are already known to have an influence, were included in the statistical analyses. RESULTS: THE SIGNIFICANT FACTORS WERE: the pure tone average threshold of the better ear, the brand of device, the percentage of active electrodes, the use of hearing aids (HAs) during the period of pHL, and the duration of mHL. CONCLUSIONS: A new model was designed showing a decrease of performance that started during the period of mHL, and became faster during the period of pHL. The use of bilateral HAs slowed down the related central reorganization that is the likely cause of the decreased performance.
PLoS ONE 01/2012; 7(11):e48739. · 4.09 Impact Factor
-
Sofie Jansen,
Heleen Luts,
Kirsten Carola Wagener,
Birger Kollmeier,
Matthieu Del Rio,
René Dauman,
Chris James, Bernard Fraysse,
Emilie Vormès,
Bruno Frachet,
Jan Wouters,
Astrid van Wieringen
[show abstract]
[hide abstract]
ABSTRACT: To compare results on the everyday sentence test 'FIST', the new closed-set sentence test 'FrMatrix', and the digit triplet screening test 'FrDigit3'.
First, the FrMatrix was developed and normative values were obtained. Subsequently, speech reception thresholds (SRTs) for the three types of tests were gathered at four study centers representing different geographic regions in Belgium and France.
Fifty-seven normal-hearing listeners took part in the normative study of the FrMatrix, and 118 subjects, with a wide range of hearing thresholds, participated in the comparative study.
Homogenizing the individual words of the FrMatrix with regard to their intelligibility resulted in a reference SRT of -6.0 (±0.6) dB SNR and slope at the SRT of 14.0 %/dB. The within-subject variability was only 0.4 dB. Comparison of the three tests showed high correlations between the SRTs mutually (>0.81). The FrMatrix had the highest discriminative power, both in stationary and in fluctuating noise. For all three tests, differences across the participating study centers were small and not significant.
The FIST, the FrMatrix, and the FrDigit3 provide similar results and reliably evaluate speech recognition performance in noise both in normal-hearing and hearing-impaired listeners.
International journal of audiology 11/2011; 51(3):164-73. · 1.34 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Bilateral stimulation through cochlear implants induces a brain activity pattern closer to the normal one than unilateral stimulation.
Although it has been shown that speech comprehension through bilateral cochlear implants leads to better performances than after unilateral implantation, the existence of neural underpinnings of this improvement remains to be studied.
We performed an H2O positron emission tomographic study of word recognition in 5 patients with bilateral cochlear implants and 5 normal-hearing controls. Subjects had to distinguish words from nonwords in binaural and monaural conditions.
There was no overactivation in patients for binaural stimulation, with a hypoactivation in the right temporal cortex. For monaural stimulation, patients demonstrated more activation contralaterally to the stimulation side in the posterior temporal cortex and in the cerebellum.
Binaural stimulation through cochlear implants is advantageous compared with the monaural at the neurofunctional level because the pattern of brain activity is closer to the normal one.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2011; 32(8):1210-7. · 1.44 Impact Factor
-
Robert J S Briggs,
Michael Tykocinski,
Roland Lazsig,
Antje Aschendorff,
Thomas Lenarz,
Timo Stöver, Bernard Fraysse,
Mathieu Marx,
J Thomas Roland,
Peter S Roland,
Charles G Wright,
Bruce J Gantz,
James F Patrick,
Frank Risi
[show abstract]
[hide abstract]
ABSTRACT: Multi-centre collaborative study to develop and refine the design of a prototype thin perimodiolar cochlear implant electrode array and to assess feasibility for use in human subjects.
Multi-centre temporal bone insertion studies.
The modiolar research array (MRA) is a thin pre-curved electrode that is held straight for initial insertion with an external sheath rather than an internal stylet. Between November 2006 and February 2009, six iterations of electrode design were studied in 21 separate insertion studies in which 140 electrode insertions were performed in 85 human temporal bones by 12 surgeons. These studies aimed at addressing four fundamental questions related to the electrode concept, being: (1) Could a sheath result in additional intra-cochlear trauma? (2) Could a sheath accommodate variations in cochlea size and anatomies? (3) Could a sheath be inserted via the round window? and (4) Could a sheath be safely removed once the electrode had been inserted? These questions were investigated within these studies using a number of evaluation techniques, including X-ray and microfluoroscopy, acrylic fixation and temporal bone histologic sectioning, temporal bone microdissection of cochlear structures with electrode visualization, rotational tomography, and insertion force analysis.
Frequent examples of electrode rotation and tip fold-over were demonstrated with the initial designs. This was typically caused by excessive curvature of the electrode tip, and also difficulty in handling of the electrode and sheath. The degree of tip curvature was progressively relaxed in subsequent versions with a corresponding reduction in the frequency of tip fold-over. Modifications to the sheath facilitated electrode insertion and sheath removal. Insertion studies with the final MRA design demonstrated minimal trauma, excellent perimodiolar placement, and very small electrode dimensions within scala tympani. Force measurements in temporal bones demonstrated negligible force on cochlear structures with angular insertion depths of between 390 and 450°.
The MRA is a novel, very thin perimodiolar prototype electrode array that has been developed using a systematic collaborative approach. The different evaluation techniques employed by the investigators contributed to the early identification of issues and generation of solutions. Regarding the four fundamental questions related to the electrode concept, the studies demonstrated that (1) the sheath did not result in additional intra-cochlear trauma; (2) the sheath could accommodate variations in cochlea size and anatomies; (3) the sheath was more successfully inserted via a cochleostomy than via the round window; and (4) the sheath could be safely removed once the electrode had been inserted.
Cochlear implants international 08/2011; 12(3):129-39.
-
[show abstract]
[hide abstract]
ABSTRACT: Psychophysical and neuroimaging studies in both animal and human subjects have clearly demonstrated that cortical plasticity following sensory deprivation leads to a brain functional reorganization that favors the spared modalities. In postlingually deaf patients, the use of a cochlear implant (CI) allows a recovery of the auditory function, which will probably counteract the cortical crossmodal reorganization induced by hearing loss. To study the dynamics of such reversed crossmodal plasticity, we designed a longitudinal neuroimaging study involving the follow-up of 10 postlingually deaf adult CI users engaged in a visual speechreading task. While speechreading activates Broca's area in normally hearing subjects (NHS), the activity level elicited in this region in CI patients is abnormally low and increases progressively with post-implantation time. Furthermore, speechreading in CI patients induces abnormal crossmodal activations in right anterior regions of the superior temporal cortex normally devoted to processing human voice stimuli (temporal voice-sensitive areas-TVA). These abnormal activity levels diminish with post-implantation time and tend towards the levels observed in NHS. First, our study revealed that the neuroplasticity after cochlear implantation involves not only auditory but also visual and audiovisual speech processing networks. Second, our results suggest that during deafness, the functional links between cortical regions specialized in face and voice processing are reallocated to support speech-related visual processing through cross-modal reorganization. Such reorganization allows a more efficient audiovisual integration of speech after cochlear implantation. These compensatory sensory strategies are later completed by the progressive restoration of the visuo-audio-motor speech processing loop, including Broca's area.
Human Brain Mapping 05/2011; 33(8):1929-40. · 5.88 Impact Factor
-
Cochlear implants international 05/2011; 12 Suppl 1:S130-2.
-
[show abstract]
[hide abstract]
ABSTRACT: High-resolution computed tomography (CT) scan may reveal an isolated fenestral form of otosclerosis, and an extensive form, which involves multiple foci around the otic capsule. Pre- and postoperative hearing thresholds are poorer in patients with extensive otosclerosis and their chance of overclosure is reduced by 90%.
To evaluate the relationship between CT scan extension of otosclerotic foci and hearing thresholds in the operated ear, before and after stapedotomy.
A preoperative CT scan was performed in 200 patients suspected of having otosclerosis. CT scan findings were categorized as negative, isolated fenestral otosclerosis, and extensive otosclerosis. Preoperative and 2 months postoperative air-conduction (AC) and bone-conduction (BC) thresholds were collected.
In the operated ear, 150 CT scans (75%) revealed an isolated fenestral otosclerosis; 35 (17.5%) were classified as extensive otosclerosis. Mean preoperative BC was significantly poorer in extensive otosclerosis (30.3 dB) than in isolated fenestral otosclerosis (24.6 dB). Mean postoperative BC remained lower in extensive otosclerosis (30.3 dB) than in isolated fenestral otosclerosis (21.2 dB). An overclosure greater than 10 dB was found in 20% of isolated fenestral otoscleroses and in 2.85% of extensive otoscleroses (chi-square: 5.5; p = 0.02).
Acta oto-laryngologica 02/2011; 131(4):351-7. · 0.98 Impact Factor
-
Isabelle Mosnier,
Alain Stepanian,
Gabriel Baron,
Camille Bodenez,
Alain Robier,
Bernard Meyer, Bernard Fraysse,
Pierre Bertholon,
Fannie Defay,
Nejma Ameziane,
Evelyne Ferrary,
Olivier Sterkers,
Dominique de Prost
[show abstract]
[hide abstract]
ABSTRACT: The pathogenesis of idiopathic sudden sensorineural hearing loss (ISSHL) remains unknown, but vascular involvement is one of the main hypotheses. The main objective of this study was to investigate the association between ISSHL and cardiovascular and thromboembolic risk factors.
Multicentric case-control study.
Ninety-six Caucasian patients with ISSHL and 179 sex- and age-matched controls were included. Patients were evaluated on the day of the inclusion and 1 week, 3 weeks and 3 months later. Clinical information concerning personal and familial cardiovascular and thromboembolic risk factors and concerning the ISSHL was collected. Blood samples were collected for genetic analysis of factor V Leiden and G20210A polymorphism in the factor II gene. The severity of the hearing loss was classified as mild (21-40 dB), moderate (41-70 dB), severe (71-90 dB) and profound or total (>90 dB). Hearing improvement was calculated as a relative improvement of hearing thresholds using the contralateral ear as baseline.
Systolic blood pressure was higher in patients (130 ± 1.7 mm Hg) than in controls (124 ± 1.1 mm Hg, p = 0.003). The personal/familial history of cardiovascular events was also more prevalent in patients (p = 0.023 and p = 0.014, respectively), whereas no difference was found in the prevalence of personal cardiovascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, smoking habits). There was no correlation between the audiogram type, the hearing outcome and the presence of cardiovascular risk factors. No significant difference was observed in the personal/familial history or in the presence of thromboembolic risk factors. The prothrombin and factor V mutations were uncommon in both patients and controls. The final hearing threshold was only correlated with the severity of the initial hearing loss (p < 0.001), but not influenced by the presence of vertigo, audiogram type, time elapsed from onset of ISSHL to hospitalization or failure of a previous oral therapy. Hearing stabilization was obtained at 21 days in 92% of patients.
These results support the theory of vascular involvement as the etiology of some cases of ISSHL. The sole predictive factor of poor final hearing is the severity of the initial hearing loss.
Audiology and Neurotology 01/2011; 16(1):55-66. · 2.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The need for revision stapes surgery has many causes, and among these, we describe a particular displacement of the piston: the "lateralized piston syndrome". The goal of this study is to define criteria and surgical management of this syndrome.
Retrospective study over 13 years.
Tertiary reference center.
A review of 1,289 consecutive stapes operations revealed 119 revisions (9%) from which 22 cases (18.5%) could be classified under the lateralized piston syndrome.
Revision stapedotomy.
Medical files, preoperative and postoperative audiograms, computed tomographic scans, and operative reports.
The 22 cases presented as a delayed conductive hearing loss in 95.5% of cases. Preoperative computed tomographic scans showed a lateralized piston out of the stapedotomy in 81% of cases and touching the tympanic membrane in 54.5% of cases. Revisions revealed a lateral displacement of the piston out of the entire oval window in 86% of cases, with closure of the stapedotomy in all cases and incus necrosis in 77% of cases. Conventional pistons were fitted in 12 cases. In case of a significantly eroded incus, total prostheses (TORPs) in 6 cases and offset pistons in 4 cases were placed. Air-bone gap (ABG) was closed to within 20 dB in 82% of cases. Air-conduction puretone audiometry improvement was 17.2 dB (standard deviation [SD], 19.2), with a mean postoperative ABG of 16.2 dB (SD, 12.7). Only 1 ear, operated with TORP, had a sensorineural deterioration of 20 dB. With offset pistons, ABG was closed to within 20 dB in 100% of cases with a mean postoperative ABG of 8.8 dB (SD, 7.2).
The lateralized piston syndrome was found in 18.5% of stapes surgery revisions. Surgical management was effective in correcting the conductive hearing loss. In the event of significant eroded incus, we observed better results with offset pistons than with TORPs.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 12/2009; 30(8):1138-44. · 1.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the reliability of high-resolution computed tomographic scan (HRCT scan) for the diagnosis of otosclerosis and to determine its usefulness to predict hearing deterioration and surgical difficulties.
Prospective study.
Tertiary reference center.
Two hundred nine ears (200 patients) presenting progressive conductive hearing loss with normal tympanic membrane, abnormal stapedial reflex, and scheduled for stapes surgery. The mean age was 47.3 years.
All patients underwent HRCT scan before surgery (slice thickness of 0.6 to 1 mm). Stapedotomy was performed in 99% of cases.
High-resolution computed tomographic scan results were categorized as positive, doubtful, or negative. We classified a CT scan as positive for otosclerosis when a hypodense focus was seen around the otic capsule. Preoperative and postoperative air- and bone-conduction thresholds were collected.
Of 209 HRCT scans, 84.2% were classified positive, 8.6% doubtful, and 7.2% negative. In all patients with positive CT scan, otosclerosis was confirmed in surgery. Among 15 negative cases, we found 4 minor malformations and 1 fracture of the stapes. Footplate incidents (mobilized, floating, or fractured footplate; 5.3%) occurred significantly more frequently when an HRCT scan was negative or doubtful (p = 0.05). Mean preoperative air-bone gap was 27.7 dB (standard deviation, 10). Mean postoperative air-bone gap was within 10 dB in 65% and within 20 dB in 92% of cases. Greater than 10 dB deterioration of bone-conduction thresholds occurred in 2% of cases. Mean preoperative and postoperative bone-conduction thresholds were significantly lower in cases of round window obliteration, pericochlear, or internal auditory canal hypodensities (p < 0.005 and p < 0.0001, respectively).
In our series, the sensitivity of HRCT scan to otosclerosis was 95.1%. Hypodense otosclerotic foci were mostly localized at the anterior part of footplate. Negative or doubtful cases were associated with the highest incidence of stapes footplate complications. Foci involving otic capsule, internal auditory canal, or round window led to a significantly higher risk of sensorineural hearing loss.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2009; 30(8):1152-9. · 1.44 Impact Factor
-
Bernard Fraysse
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2009; · 1.44 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study assessed the direct medical cost of cochlear implantation in children and adults in France. A prospective multicentre study involving 19 French University Hospitals included 268 children and 201 adults who were severely to profoundly hearing-impaired. Medical resources utilisation included diagnostic tests, in-patient care, device implants, adverse events and follow-up visits for rehabilitation in the 1st year. The mean costs were 34,686 per child and 31,946 per adult. The cost of device implant represents 64.4% and 68.8% of the total cost for children and adults, respectively. The current reform of financing of the healthcare system requires detailed knowledge of the costs of interventions, hence the costs of cochlear implantation should be factored into resource allocation decisions. Differences in our results compared to other studies can be explained mostly by methodological differences in cost analyses.
The European Journal of Health Economics 08/2009; 10(3):347-55. · 1.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cette étude avait pour but de comparer l'efficacité et la tolérance du dichlorhydrate de bétahistine et de la flunarizine. C'était une étude multicentrique, en double aveugle, randomisée, sur un type de vertige bien précis : le vertige paroxystique itératif ou récurrent avec ou sans syndrome cochléaire typique de Ménière. Cinquante-cinq patients ont été traités pendant 2 mois (28 dans le groupe bétahistine, 27 dans le groupe flunarizine). L'analyse de l'évolutivité des symptômes à l'intérieur d'un groupe a montré une meilleure efficacité de la bétahistine. En effet, l'amélioration des critères : durée, intensité des vertiges et présence de signes neurovégétatifs, était statistiquement significative dans le groupe bétahistine après le premier et le deuxième mois de traitement; cette amélioration significative n'a été observée dans le groupe flunarizine qu'a la fin du premier mois de traitement. De plus, dans le groupe bétahistine, d'autres critères importants avaient également une amélioration statistiquement significative : nombre de vertiges, présence de signes vestibulaires et de symptômes cochléaires. Les effets indésirables observés étaient conformes à ceux déjà publiés dans la littérature pour chacun des 2 produits : gastralgies pour la bétahistine, et somnolence, asthénie, syndrome dépressif pour la flunarizine.
07/2009; 111(s490):1-10.
-
[show abstract]
[hide abstract]
ABSTRACT: To compare performance on a song recognition task of bilaterally combined electric and acoustic hearing (bimodal stimulation) with electric or acoustic hearing alone.
Subjects were 14 adults with cochlear implants (CI) who continued to use a hearing aid (HA) in one/both ears. Subjects were asked to identify excerpts from 15 popular songs, which were familiar to them, presented in a random order via a single loudspeaker. Presentation conditions were fixed in order: bimodal, CI alone and then HA alone. Musical excerpts were presented in each condition with and then without lyrics.
In a subgroup of subjects (n = 8) with better low-frequency residual hearing (thresholds <85 dB hearing level (HL)), mean scores for bimodal stimulation were significantly greater than for CI alone. In addition, mean 'no lyrics' scores for HA alone (59.7%) were significantly greater than for CI alone (38.8%). All of these subjects considered bimodal stimulation to be the most enjoyable way to listen to music. For the remaining subjects (n = 6) there was no benefit from using bimodal stimulation over CI alone, and the majority of these preferred to listen to music using CI alone.
Bimodal stimulation provides better perception of popular music, particularly melody recognition, compared to CI alone when low-frequency residual hearing is better than 85 dB HL.
Audiology and Neurotology 01/2009; 14 Suppl 1:14-21. · 2.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cochlear implant surgeons should have a good knowledge of how to diagnose device failures and how to deal with medical complications related to cochlear implantation. Electrode array misplacement may be due to unidentified inner ear malformation. Use of peroperative telemetry and radiographic examination should help to avoid such complications.
To review our experience of cochlear implant revision surgery and to compare our series to the literature. To report two cases of electrode array misplacement into the vestibular system and to discuss how to prevent this complication.
This was a retrospective review of cochlear implant revision surgery in a tertiary reference center.
Of 487 cochlear implantations, 3.8% of adults and 4.5% of children underwent a revision surgery. The mean time to device failure was 7.6 years in children and 1.5 year in adults. Causes of revision were seven hard failures, four soft failures, and nine medical reasons. Among the medical reasons, four patients had skin flap infection associated with an extended endaural approach. Audiologic performances were stable or improved following reimplantation in 90% of cases. We had two cases of electrode array misplaced into the vestibular system.
Acta oto-laryngologica 12/2008; 129(4):380-4. · 0.98 Impact Factor
-
Isabelle Mosnier,
Olivier Sterkers,
Jean-Pierre Bebear,
Benoit Godey,
Alain Robier,
Olivier Deguine, Bernard Fraysse,
Philippe Bordure,
Michel Mondain,
Didier Bouccara,
Alexis Bozorg-Grayeli,
Stéphanie Borel,
Emmanuèle Ambert-Dahan,
Evelyne Ferrary
[show abstract]
[hide abstract]
ABSTRACT: To evaluate speech performance, in quiet and noise, and localization ability in adult patients who had undergone bilateral and simultaneous implantation.
Prospective multi-center study.
Twenty-seven adult patients with profound or total hearing loss were bilaterally implanted in a single-stage procedure, and simultaneously activated (Med-El, Combi 40/40+). Subjects were assessed before implantation and at 3, 6 and 12 months after switch-on. Speech perception tests in monaural and binaural conditions were performed in quiet and in noise using disyllabic words, with speech coming from the front and a cocktail party background noise coming from 5 loudspeakers. Sound localization measurements were also performed in background noise coming from 5 loudspeakers positioned from -90 degrees to +90 degrees azimuth in the horizontal plane, and using a speech stimulus.
There was a bilateral advantage at 12 months in quiet (77 +/- 5.0% in bilateral condition, 67 +/- 5.3% for the better ear, p < 0.005) and in noise (signal-to-noise ratio +15 dB: 63 +/- 5.9% in bilateral condition, 55 +/- 6.9% for the better ear, p < 0.05). Considering unilateral speech scores recorded in quiet at 12 months, subjects were categorized as 'good performers' (speech comprehension score > or =60% for the better ear, n = 19) and 'poor performers' (n = 8). Subjects were also categorized as 'asymmetrical' (difference between their 2 unilateral speech scores > or =20%, n = 11) or 'symmetrical' (n = 16). The largest advantage (bilateral compared to the better ear) was obtained in poor performers: +19% compared to +7% in good performers (p < 0.05). In the group of good performers, there was a bilateral advantage only in cases of symmetrical results between the 2 ears (n = 10). In the group of poor performers, the bilateral advantage was shown in both patients with symmetrical (n = 6) and asymmetrical results (n = 2). In bilateral conditions, the sound localization ability in noise was improved compared to monaural conditions in patients with symmetrical and asymmetrical performance between the 2 ears. No preoperative factor (age, duration of deafness, use of hearing aids, etiology, etc.) could predict the asymmetrical performance, nor which ear would be the best.
This study demonstrates a bilateral advantage (at 12 months after the implantation) in speech intelligibility and sound localization in a complex noisy environment. In quiet, this bilateral advantage is shown in cases of poor performance of both ears, and in cases of good performance with symmetrical results between the 2 ears. No preoperative factor can predict the best candidates for a simultaneous bilateral implantation.
Audiology and Neurotology 10/2008; 14(2):106-14. · 2.46 Impact Factor
-
Isabelle Mosnier,
Olivier Sterkers,
Didier Bouccara,
Samia Labassi,
Jean-Pierre Bebear,
Philippe Bordure,
Christian Dubreuil,
Thibaud Dumon,
Bruno Frachet, Bernard Fraysse, [......],
Michel Mondain,
Didier Portmann,
Alain Robier,
Sébastien Schmerber,
Jean-Marc Thomassin,
Eric Truy,
Alain Uziel,
François-Michel Vanecloo,
Christophe Vincent,
Evelyne Ferrary
[show abstract]
[hide abstract]
ABSTRACT: To assess audiological performance, satisfaction rate, and side effects of 100 patients who have been using the middle ear implant Vibrant Soundbridge (VSB) for 5 to 8 yr when compared with data collected from 3 to 18 mo postsurgery.
Audiological testing and subjective evaluation using self-assessment scales were performed in 77 out of the 100 patients using the VSB for 5 to 8 years. The results were compared to data collected 3 months (audiological testing) and 18 months (self-assessment scales) after surgery. Twenty-three patients have not been evaluated for different reported reasons.
Pure-tone hearing thresholds decreased similarly in both implanted and contralateral ears. The satisfaction ratings and the functional gain provided by the VSB remained stable. Speech comprehension in quiet conditions without the VSB decreased from 56 to 37% in 5 to 8 yr, but an 81% score was achieved with the VSB.
This study demonstrates that the performance of the VSB does not deteriorate for more than 5 yr, without adverse effect. These results confirm the safety and the effectiveness of the VSB with a long-term follow-up.
Ear and Hearing 05/2008; 29(2):281-4. · 2.58 Impact Factor
