Isabelle Mosnier

Hôpital Beaujon – Hôpitaux Universitaires Paris Nord Val de Seine, Clicy, Île-de-France, France

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Publications (59)50.74 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To compare the fitting time requirements and the efficiency in achieving improvements in speech perception during the first 6 months after initial stimulation of computer-assisted fitting with the Fitting to Outcome eXpert' (FOX™) and a standard clinical fitting procedure. Method Twenty-seven post-lingually deafened adults, newly implanted recipients of the Advanced Bionics HiRes 90K™ cochlear implant from Germany, the UK, and France took part in a controlled, randomized, clinical study. Speech perception was measured for all participants and fitting times were compared across groups programmed using FOX and conventional programming methods. Results The fitting time for FOX was significantly reduced at 14 days (P < 0.001) but equivalent over the 6-month period. The groups were not well matched for duration of deafness; therefore, speech perception could not be compared across groups. Discussion Despite including more objective measures of performance than a standard fitting approach and the adjustment of a greater range of parameters during initial fitting, FOX did not add to the overall fitting time when compared to the conventional approach. FOX significantly reduced the fitting time in the first 2 weeks and by providing a standard fitting protocol, reduced variability across centres. Conclusions FOX computer-assisted fitting can be successfully used at switch on, in different clinical environments, reducing fitting time in the first 2 weeks and is efficient at providing a usable program.
    Cochlear implants international. 08/2014;
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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 objective of this study was to measure performance benefits obtained by upgrading recipients of the Cochlear™ Nucleus(®) CI24 cochlear implant to the new CP810™ sound processor. Speech recognition in quiet and in spatially separated noise was measured in established users of the Cochlear ESPrit 3G™ (n = 22) and Freedom™ (n = 13) sound processors, using the "Everyday" listening program. Subjects were then upgraded to the CP810 processor and were re-assessed after a 3-month period, using both the "Everyday" program and the new "Noise" program, which incorporates several pre-processing features including a new directional microphone algorithm ("Zoom™"). Subjective perceptions were also recorded using the abbreviated profile of hearing aid benefit (APHAB) questionnaire. Mean scores for monosyllables in quiet, presented at 50 and 60 dB SPL, increased by 11 % (p < 0.0001) and 8 % (p < 0.001), respectively, after upgrade, for all subjects combined. Significant increases were also recorded for both processor groups. In noise, the mean scores were 60.0 and 67.4 % for the original and CP810 Everyday programs, respectively (difference not significant). With the CP810 Noise programs the mean score increased to 82.5 % (p < 0.01), with significant increases in both processor groups. There was evidence of slightly greater upgrade benefit in users of the ESPrit 3G processor and in relatively poor performers. The APHAB questionnaire also indicated significant reduction in perceived difficulty in the background noise and reverberation sub-scales after upgrade. The findings of the study appear to support the expectation of increased benefit from the new CP810 sound processor.
    Archives of Oto-Rhino-Laryngology 02/2013; · 1.29 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
  • D. Dulon, I. Mosnier, D. Bouccara
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    ABSTRACT: Varios fármacos tienen una toxicidad potencial para el oído interno que se traduce por síntomas auditivos: acúfenos, hipoacusia perceptiva que afecta a las frecuencias agudas y trastornos del equilibrio. La afectación suele ser irreversible y bilateral, pero se han descrito casos unilaterales. Los principales fármacos son los antibióticos aminoglucósidos y macrólidos, la aspirina y los salicilatos, los diuréticos de asa y algunos antimitóticos (sales de platino). Estos cuadros suelen ser latentes al principio, por lo que deben detectarse en caso de exposición a un fármaco potencialmente ototóxico, sobre todo cuando existan factores agravantes potenciales, en especial una insuficiencia renal. En este artículo se detallarán los mecanismos fisiopatológicos causantes para los antibióticos aminoglucósidos, incluidos los factores genéticos implicados. Varios trabajos recientes se centran en el desarrollo de tratamientos destinados a proteger el oído interno.
    EMC - Otorrinolaringología. 02/2013; 42(1):1–13.
  • Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale. 01/2013; 130(4):A9.
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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: 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. · 2.32 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 objective of the study was to compare the performance of cochlear implantation between post-meningitic and non-meningitic patients, and to evaluate the impact on hearing outcome of technical advances in cochlear implant technology. Retrospective chart review was used as the study design. Twenty adults with post-meningitic profound hearing loss receiving unilateral or bilateral cochlear implants between 1990 and 2008 were tested. Results were compared to a control group of 46 adults implanted for a non-meningitic hearing loss, with the same pre-operative speech scores. Speech scores were poorer in post-meningitic patients compared to those of control group, whatever the duration after implantation (p < 0.0001). Speech scores of subjects implanted and fitted before 2001 were compared to those of subjects implanted after 2001, with the same duration of hearing loss. Performance improved with implants and processors available after 2001, with a magnitude of improvement higher in post-meningitic patients (p < 0.0001 and p < 0.05 in post-meningitic and control groups, respectively, two-way ANOVA). Consequently, speech scores of post-meningitic patients implanted after 2001 achieved those of control subjects (two-way ANOVA). Advances in cochlear implant technology and coding strategy improve hearing outcome in post-meningitic adult patients, who now achieve similar performance as those of non-meningitic patients.
    Archives of Oto-Rhino-Laryngology 01/2012; · 1.29 Impact Factor
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    ABSTRACT: The aim of this study was to stimulate the recurrent laryngeal nerve during thyroidectomy or parathyroidectomy and to record the muscle responses in an attempt to predict postoperative vocal fold mobility. Intraoperative recurrent laryngeal nerve monitoring during general anaesthesia was performed by using an electrode-bearing endotracheal tube (nerve integrity monitor EMG endotracheal tube [Medtronic Xomed, Jacksonville, Flo, USA]). Two hundred and fifteen recurrent laryngeal nerves from 141 patients undergoing total thyroidectomy (n=74), hemithyroidectomy (n=63), or parathyroidectomy (n=4) were prospectively monitored. In each case, the muscle potential was recorded after stimulation of the recurrent laryngeal nerve by a monopolar probe. The nerve stimulation threshold before and after dissection that induced a muscle response of at least 100 μV ranged from 0.1 to 0.85 mA (mean 0.4 mA). The supramaximal stimulation intensity was defined as 1 mA. The amplitude of muscle response varied considerably from one patient to another, but the similarity of the muscle response at supramaximal intensity between pre- and postdissection and between postdissection at the proximal and distal exposed portions of the nerve was correlated with normal postoperative vocal fold function. Inversely, alteration of the muscle response indicated a considerable risk of recurrent laryngeal nerve palsy, but was not predictive of whether or not this lesion would be permanent. Recurrent laryngeal nerve monitoring with a system using surface electrodes is a simple, non-invasive technique that is just as sensitive as monitoring by intramuscular electrodes. Monitoring is helpful for initial nerve identification and is useful to determine nerve function during and after surgery, and to adapt the surgical strategy accordingly.
    European Annals of Otorhinolaryngology, Head and Neck Diseases 01/2012; 129(2):69-76.
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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 01/2012; 33(3):143-9. · 0.90 Impact Factor
  • 01/2012;
  • Cochlear implants international 05/2011; 12 Suppl 1:S124-6.
  • International Journal of Pediatric Otorhinolaryngology - INT J PED OTORHINOLARYNGOL. 01/2011; 75:92-92.
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    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. · 2.32 Impact Factor
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    ABSTRACT: We describe and evaluate the process of fixation of the Digisonic SP cochlear implant with two titanium screws. The characteristics of this implant allow cochlear implantation using a minimal incision, a subperiosteal pocket, and fixation with two titanium screws, without drilling a custom-fitted seat or creating suture-retaining holes in the skull. The fixation system relies on two tailfins for use of osseo-integratable screws, incorporated into the cochlear implant housing. The first version of this fixation system was modified after a case of device migration: the size of the titanium insert inside the silicone tailfin was increased. Data on 156 patients (8 months to 86 years of age) from a 4-year period in 6 cochlear implantation centers were retrospectively evaluated. Ten patients have undergone bilateral implantation. Of 166 implantations, 4 postoperative infections and 1 device failure after head trauma were reported. No cerebrospinal fluid leaks or epidural hematomas were reported. One device migration was observed in the first series; no device migrations occurred in the second series. The fixation system with screws embedded in the Digisonic SP involves a fast and simple surgical technique that seems to efficiently prevent implant migration.
    The Annals of otology, rhinology, and laryngology 08/2010; 119(8):501-5. · 1.21 Impact Factor
  • Didier Bouccara, Arach Madjlessi, Isabelle Mosnier
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    ABSTRACT: Attributable to the ageing of the hearing system, presbycusis presents a wide variability in the general population. Early detection is necessary in order to be able to provide the patient with a suitable hearing aid. Collaboration between otolaryngologists and geriatricians proves to be advantageous as a consultation for a memory complaint may be the opportunity to detect presbycusis and vice versa.
    Soins. Gérontologie 01/2010;
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    ABSTRACT: The superior temporal sulcus (STS) is specifically involved in processing the human voice. Profound acquired deafness by post-meningitis ossified cochlea and by bilateral vestibular schwannoma in neurofibromatosis type 2 patients are two indications for auditory brainstem implantation (ABI). In order to objectively measure the cortical voice processing of a group of ABI patients, we studied the activation of the human temporal voice areas (TVA) by PET H(2)(15)O, performed in a group of implanted deaf adults (n=7) with more than two years of auditory brainstem implant experience, with an intelligibility score average of 17%+/-17 [mean+/-SD]. Relative cerebral blood flow (rCBF) was measured in the three following conditions: during silence, while passive listening to human voice, and to non-voice stimuli. Compared to silence, the activations induced by voice and non-voice stimuli were bilaterally located in the superior temporal regions. However, compared to non-voice stimuli, the voice stimuli did not induce specific supplementary activation of the TVA along the STS. The comparison of ABI group with a normal-hearing controls group (n=7) showed that TVA activations were significantly enhanced among controls group. ABI allowed the transmission of sound stimuli to temporal brain regions but lacked transmitting the specific cues of the human voice to the TVA. Moreover, among groups, during silent condition, brain visual regions showed higher rCBF in ABI group, although temporal brain regions had higher rCBF in the controls group. ABI patients had consequently developed enhanced visual strategies to keep interacting with their environment.
    NeuroImage 06/2009; 47(4):1792-6. · 6.25 Impact Factor

Publication Stats

223 Citations
50.74 Total Impact Points

Institutions

  • 2012–2013
    • Hôpital Beaujon – Hôpitaux Universitaires Paris Nord Val de Seine
      Clicy, Île-de-France, France
  • 2005–2013
    • Paris Diderot University
      • Faculté de Médecine Xavier Bichat
      Lutetia Parisorum, Île-de-France, France
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 2008–2012
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
  • 2011
    • Hôpital Louis-Mourier – Hôpitaux Universitaires Paris Nord Val de Seine
      Colombes, Île-de-France, France
  • 2010
    • Centre Hospitalier de Courbevoie - Neuilly – Puteaux
      Neuilly, Île-de-France, France