To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L... more To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. Prospective, with sequential enrolment and within-subject comparisons. Post-operative performance using a Freedom Hybrid sound processor was compared with that of pre-operative hearing aids. Sixty-six adult hearing-impaired subjects with bilateral severe-to-profound high frequency hearing loss. Group median increase in air-conduction thresholds in the implanted ear for test frequencies 125-1000 Hz was < 15 dB across the population; both immediately and one year post-operatively. Eighty-eight percent of subjects used the Hybrid processor at one year post-op. Sixty-five percent of subjects had significant gain in speech recognition in quiet, and 73% in noise (≥ 20 percentage points/2 dB SNR). Mean SSQ subscale scores were significantly improved (+ 1.2, + 1.3, + 1.8 points, p < 0.001), as was mean HUI3 score (+ 0.117, p < 0.01). Combining residual hearing with CI gave 22-26 %age points mean benefit in speech recognition scores over CI alone (p < 0.01). Useful residual hearing was conserved in 88% of subjects. Speech perception was significantly improved over preoperative hearing aids, as was sound quality and quality of life.
To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L... more To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. Prospective, with sequential enrolment and within-subject comparisons. Post-operative performance using a Freedom Hybrid sound processor was compared with that of pre-operative hearing aids. Sixty-six adult hearing-impaired subjects with bilateral severe-to-profound high frequency hearing loss. Group median increase in air-conduction thresholds in the implanted ear for test frequencies 125-1000 Hz was < 15 dB across the population; both immediately and one year post-operatively. Eighty-eight percent of subjects used the Hybrid processor at one year post-op. Sixty-five percent of subjects had significant gain in speech recognition in quiet, and 73% in noise (≥ 20 percentage points/2 dB SNR). Mean SSQ subscale scores were significantly improved (+ 1.2, + 1.3, + 1.8 points, p < 0.001), as was mean HUI3 score (+ 0.117, p < 0.01). Combining residual hearing with CI gave 22-26 %age points mean benefit in speech recognition scores over CI alone (p < 0.01). Useful residual hearing was conserved in 88% of subjects. Speech perception was significantly improved over preoperative hearing aids, as was sound quality and quality of life.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
While multichannel implants can produce far better results than single-channel implants, the resu... more While multichannel implants can produce far better results than single-channel implants, the results of a multichannel implantation are impossible to predict accurately preoperatively. Single-channel implants, which produce average and constant results, still have a major merit in that their cost is much lower. Since extracochlear implantation with transcutaneous approach is innocuous, we have been promoting this type of implantation as a temporary procedure until much more effective systems are found in the future, or as a definitive implantation.
The association between hearing impairment and cognitive decline has been established; however, t... more The association between hearing impairment and cognitive decline has been established; however, the effect of cochlear implantation on cognition in profoundly deaf elderly patients is not known. To analyze the relationship between cognitive function and hearing restoration with a cochlear implant in elderly patients. Prospective longitudinal study performed in 10 tertiary referral centers between September 1, 2006, and June 30, 2009. The participants included 94 patients aged 65 to 85 years with profound, postlingual hearing loss who were evaluated before, 6 months after, and 12 months after cochlear implantation. Cochlear implantation and aural rehabilitation program. Speech perception was measured using disyllabic word recognition tests in quiet and in noise settings. Cognitive function was assessed using a battery of 6 tests evaluating attention, memory, orientation, executive function, mental flexibility, and fluency (Mini-Mental State Examination, 5-word test, clock-drawing test, verbal fluency test, d2 test of attention, and Trail Making test parts A and B). Quality of life and depression were evaluated using the Nijmegen Cochlear Implant Questionnaire and the Geriatric Depression Scale-4. Cochlear implantation led to improvements in speech perception in quiet and in noise (at 6 months: in quiet, 42% score increase [95% CI, 35%-49%; P < .001]; in noise, at signal to noise ratio [SNR] +15 dB, 44% [95% CI, 36%-52%, P < .001], at SNR +10 dB, 37% [95% CI 30%-44%; P < .001], and at SNR +5 dB, 27% [95% CI, 20%-33%; P < .001]), quality of life, and Geriatric Depression Scale-4 scores (76% of patients gave responses indicating no depression at 12 months after implantation vs 59% before implantation; P = .02). Before cochlear implantation, 44% of the patients (40 of 91) had abnormal scores on 2 or 3 of 6 cognition tests. One year after implant, 81% of the subgroup (30 of 37) showed improved global cognitive function (no or 1 abnormal test score). Improved mean scores in all cognitive domains were observed as early as 6 months after cochlear implantation. Cognitive performance remained stable in the remaining 19% of the participants (7 of 37). Among patients with the best cognitive performance before implantation (ie, no or 1 abnormal cognitive test score), 24% (12 of 50) displayed a slight decline in cognitive performance. Multivariate analysis to examine the association between cognitive abilities before implantation and the variability in cochlear implant outcomes demonstrated a significant effect only between long-term memory and speech perception in noise at 12 months (SNR +15 dB, P = .01; SNR +10 dB, P < .001; and SNR +5 dB, P = .02). Rehabilitation of hearing communication through cochlear implantation in elderly patients results in improvements in speech perception and cognitive abilities and positively influences their social activity and quality of life. Further research is needed to assess the long-term effect of cochlear implantation on cognitive decline.
Annales d'Otolaryngologie et de Chirurgie Cervico-faciale, 2009
An observation of a difficult-to-diagnose complication of the cochlear implant: recurring cutaneo... more An observation of a difficult-to-diagnose complication of the cochlear implant: recurring cutaneous extrusion of a cochlear implant is reported. The history of an adult patient with total deafness is reported. She received an implant in her right ear in 1988, which was then explanted because of absence of hearing results. She received a second implant in her left ear in 2002, which was then explanted in 2007 because of cutaneous extrusion. In 2008, a second implant of a different brand was placed in her left ear, with the central part placed away from the first site, but extrusion recurred. A new attempt to encapsulate the central part with a hydroxyapatite box also ended in extrusion and was explanted in 2008. Various diagnoses to explain these cutaneous problems were suggested during this clinical progression: infection, allergy, and a reaction to a foreign body. No hypothesis could be clearly ruled out. Cutaneous complications after cochlear implant are exceptional. As soon as cutaneous disorders appear, a rigorous diagnostic process must be followed so that the patient can be recommended a long-lasting solution to restore quality hearing.
Proceedings of the 2005 workshops on Genetic and evolutionary computation - GECCO '05, 2005
Cochlear implants are electronic devices that stimulate directly the auditory nerve to allow tota... more Cochlear implants are electronic devices that stimulate directly the auditory nerve to allow totally deaf patients to hear again. This paper presents an interactive evolutionary algorithm (IEA) designed to help finding the best parameters of a cochlear implant for a specific patient.
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 1990
The experience with cochlear implantation at Avicenne hospital prompted us to carry out a retrosp... more The experience with cochlear implantation at Avicenne hospital prompted us to carry out a retrospective study on tinnitus in a population of operated patients. Improvement or disappearance of the symptoms was noted in all cases. These results, which partly match those found in the literature, are probably produced by rehabilitation inhibiting the "deafferentation" mechanisms in analogy with pain phenomena. In some precise cases, which are described, they led us to proposing implantation even though the main, if not sole, complaint of the patient was tinnitus.
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 1990
Like any modality of perception, the processes of hearing can be divided up into two levels: modu... more Like any modality of perception, the processes of hearing can be divided up into two levels: modular or primary, and symbolic or central. Multiple-canal implantation is rather applied to the former mechanism, single-canal implantation to the latter. A bank of electrical signals recognizable from each other is being built up. It may be utilized in single-canal systems using this vocabulary to form sentences. The proper phonetic feature to be matched will then have to be selected.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
The cochleovestibular tract is seldom involved by sarcoidosis (about 50 cases have been described... more The cochleovestibular tract is seldom involved by sarcoidosis (about 50 cases have been described since 1948). As a clinical expression of sarcoidosis, deafness is fluctuant in 50% of all cases, bilateral, and most often associated with facial palsy and uveitis, the vestibular reflexes being reduced. The histological studies demonstrate lesions at all levels from the cochlea to be brain stem, but the main mechanism is an infiltration of the arachnoid vessels. The prognosis of sarcoidosis deafness is usually poor in spite of corticosteroid therapy. This paper is illustrated by 3 cases observed in Avicenne Hospital.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
There is theoretically no major surgical problem for implantation. The basic techniques all inclu... more There is theoretically no major surgical problem for implantation. The basic techniques all include on an approach through the windows. The authors describe a solution (which has already been used previously) for cophotic hollowing-out cavities, with a suprapetrosal way and an approach on the hidden aspect of the cochlea. The transcutaneous passage can be displaced from the ear lobe to a depression of the auricle.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
The insertion of reliable extracochlear single-canal cochlear implants in cophotic and subcophoti... more The insertion of reliable extracochlear single-canal cochlear implants in cophotic and subcophotic patients allows the electrical stimulation of the acoustic nerve for rehabilitation, as well as audiovestibular explorations that are no longer possible in the acoustic mode. The authors therefore aim at replacing all these examinations with their Electrical equivalent: --early evoked potentials (E-BERA), --medium-latency evoked potentials (E-MLR), --Event-related evoked potentials (E-P300), for which, to our knowledge, theses are the first recordings, --electrical stapedial reflex, --vestibular stimulations. The method, results and clinical and physiological applications of each method are given, as well as its prospects.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
Pathophysiology of the obstructive sleep apnea syndrome shows three components: intra and peripha... more Pathophysiology of the obstructive sleep apnea syndrome shows three components: intra and peripharyngeal obstacles, excessive pharyngeal wall compliance and upper airway dilator muscle dysfunction. The intent of this paper is to provide an overview of the anatomy, histology, physiology and pathophysiology of the upper airway dilator muscles based on previously published articles. The upper airway dilator muscles can be separated in three different systems, main and accessory dilators, local and regional. They act in synergy. Their contraction occurs at the beginning of inspiration, thus maintaining opened the pharyngeal lumen through inspiration. Their action is modulated by several chemo or physical stimuli. In some apneic patients, these muscles demonstrate a dysfunction: hyperactivity during wakefulness, electromyogram wave amplitude reduced, delayed contraction during sleep and abnormal response to stimuli. This dysfunction might be due to neuromuscular histological abnormalitie...
The Vibrant Soundbridge is an active semi-implantable middle ear implant for the rehabilitation o... more The Vibrant Soundbridge is an active semi-implantable middle ear implant for the rehabilitation of patients with a sensorineural hearing loss who are not able to derive adequate benefit from conventional hearing aids. A retrospective study was performed to assess the overall level of satisfaction of implanted patients and to investigate the potential determinants of postoperative success. A retrospective survey of audiological data from repeated measures and subjective data from self-assessment scales administered postoperatively was conducted to determine the degree of benefit and satisfaction for Vibrant Soundbridge implantees. Twenty-one tertiary referral and teaching hospitals. The first 125 VSB implantees implanted in France between August 1997 and May 2001 were included in the study. No clinically significant change was observed for residual hearing postoperatively. Most patients (83%) reported they were either satisfied or very satisfied with the Vibrant Soundbridge. Analysis of correlation revealed a moderate correlation (Pearson coefficient r = 0.59) between the degree of benefit reported via the patient survey and the degree of benefit reported via the Glasgow Benefit Inventory. A moderate correlation (Pearson coefficient r = 0.66) was observed between speech comprehension scores in quiet for the preoperative unaided condition and the postoperative aided Vibrant Soundbridge condition. No correlation was observed between subjective reports of satisfaction postoperatively and performance on preoperative objective tests or patient characteristics. The results indicate a high level of satisfaction with the VSB as a treatment of sensorineural hearing impairment in patients with a wide range of characteristics. Preoperative scores for unaided speech comprehension tests in quiet may be a potential indicator of success on aided Vibrant Soundbridge speech comprehension tests postoperatively but do not reflect patient satisfaction with the device reported on self-assessment scales.
The Journal of the Acoustical Society of America, 2008
ABSTRACT Current sound processors in cochlear implants show poor frequency resolution compared to... more ABSTRACT Current sound processors in cochlear implants show poor frequency resolution compared to normal auditory processes. They smooth spectral gaps within background maskers, thereby preventing implant users from experiencing release from masking (i.e., improved speech identification in maskers showing spectral gaps compared to maskers with continuous spectra). The Advanced Bionics' HiRes120 coding scheme aims to increase the transmission of fine-grain spectral information using a strategy based upon current steering. If HiRes120 improves the precision of spectral coding compared to the standard HiRes strategy, listeners should show improved release from masking for the slowest spectral modulations in a noise masker. This hypothesis is tested in newly implanted adults who alternately use HiRes and HiRes120 sound processing for a period of 10 months. Every two or three months, consonant identification is measured in each implantee in the presence of a stationary speech-shaped noise (SSN) masker at a fixed signal-to-noise ratio yielding 30-40% correct identification with unmodulated noise. The SSN masker is either unmodulated or spectrally modulated to produce periodic, three ERB-wide "spectral gaps" in the noise masker. Masking release scores defined as the change in consonant identification performance in modulated versus unmodulated noise will be presented and discussed.
To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L... more To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. Prospective, with sequential enrolment and within-subject comparisons. Post-operative performance using a Freedom Hybrid sound processor was compared with that of pre-operative hearing aids. Sixty-six adult hearing-impaired subjects with bilateral severe-to-profound high frequency hearing loss. Group median increase in air-conduction thresholds in the implanted ear for test frequencies 125-1000 Hz was < 15 dB across the population; both immediately and one year post-operatively. Eighty-eight percent of subjects used the Hybrid processor at one year post-op. Sixty-five percent of subjects had significant gain in speech recognition in quiet, and 73% in noise (≥ 20 percentage points/2 dB SNR). Mean SSQ subscale scores were significantly improved (+ 1.2, + 1.3, + 1.8 points, p < 0.001), as was mean HUI3 score (+ 0.117, p < 0.01). Combining residual hearing with CI gave 22-26 %age points mean benefit in speech recognition scores over CI alone (p < 0.01). Useful residual hearing was conserved in 88% of subjects. Speech perception was significantly improved over preoperative hearing aids, as was sound quality and quality of life.
To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L... more To investigate the preservation of residual hearing in subjects who received the Nucleus Hybrid L24 cochlear implant. To investigate the performance benefits up to one year post-implantation in terms of speech recognition, sound quality, and quality of life. Prospective, with sequential enrolment and within-subject comparisons. Post-operative performance using a Freedom Hybrid sound processor was compared with that of pre-operative hearing aids. Sixty-six adult hearing-impaired subjects with bilateral severe-to-profound high frequency hearing loss. Group median increase in air-conduction thresholds in the implanted ear for test frequencies 125-1000 Hz was < 15 dB across the population; both immediately and one year post-operatively. Eighty-eight percent of subjects used the Hybrid processor at one year post-op. Sixty-five percent of subjects had significant gain in speech recognition in quiet, and 73% in noise (≥ 20 percentage points/2 dB SNR). Mean SSQ subscale scores were significantly improved (+ 1.2, + 1.3, + 1.8 points, p < 0.001), as was mean HUI3 score (+ 0.117, p < 0.01). Combining residual hearing with CI gave 22-26 %age points mean benefit in speech recognition scores over CI alone (p < 0.01). Useful residual hearing was conserved in 88% of subjects. Speech perception was significantly improved over preoperative hearing aids, as was sound quality and quality of life.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
While multichannel implants can produce far better results than single-channel implants, the resu... more While multichannel implants can produce far better results than single-channel implants, the results of a multichannel implantation are impossible to predict accurately preoperatively. Single-channel implants, which produce average and constant results, still have a major merit in that their cost is much lower. Since extracochlear implantation with transcutaneous approach is innocuous, we have been promoting this type of implantation as a temporary procedure until much more effective systems are found in the future, or as a definitive implantation.
The association between hearing impairment and cognitive decline has been established; however, t... more The association between hearing impairment and cognitive decline has been established; however, the effect of cochlear implantation on cognition in profoundly deaf elderly patients is not known. To analyze the relationship between cognitive function and hearing restoration with a cochlear implant in elderly patients. Prospective longitudinal study performed in 10 tertiary referral centers between September 1, 2006, and June 30, 2009. The participants included 94 patients aged 65 to 85 years with profound, postlingual hearing loss who were evaluated before, 6 months after, and 12 months after cochlear implantation. Cochlear implantation and aural rehabilitation program. Speech perception was measured using disyllabic word recognition tests in quiet and in noise settings. Cognitive function was assessed using a battery of 6 tests evaluating attention, memory, orientation, executive function, mental flexibility, and fluency (Mini-Mental State Examination, 5-word test, clock-drawing test, verbal fluency test, d2 test of attention, and Trail Making test parts A and B). Quality of life and depression were evaluated using the Nijmegen Cochlear Implant Questionnaire and the Geriatric Depression Scale-4. Cochlear implantation led to improvements in speech perception in quiet and in noise (at 6 months: in quiet, 42% score increase [95% CI, 35%-49%; P < .001]; in noise, at signal to noise ratio [SNR] +15 dB, 44% [95% CI, 36%-52%, P < .001], at SNR +10 dB, 37% [95% CI 30%-44%; P < .001], and at SNR +5 dB, 27% [95% CI, 20%-33%; P < .001]), quality of life, and Geriatric Depression Scale-4 scores (76% of patients gave responses indicating no depression at 12 months after implantation vs 59% before implantation; P = .02). Before cochlear implantation, 44% of the patients (40 of 91) had abnormal scores on 2 or 3 of 6 cognition tests. One year after implant, 81% of the subgroup (30 of 37) showed improved global cognitive function (no or 1 abnormal test score). Improved mean scores in all cognitive domains were observed as early as 6 months after cochlear implantation. Cognitive performance remained stable in the remaining 19% of the participants (7 of 37). Among patients with the best cognitive performance before implantation (ie, no or 1 abnormal cognitive test score), 24% (12 of 50) displayed a slight decline in cognitive performance. Multivariate analysis to examine the association between cognitive abilities before implantation and the variability in cochlear implant outcomes demonstrated a significant effect only between long-term memory and speech perception in noise at 12 months (SNR +15 dB, P = .01; SNR +10 dB, P < .001; and SNR +5 dB, P = .02). Rehabilitation of hearing communication through cochlear implantation in elderly patients results in improvements in speech perception and cognitive abilities and positively influences their social activity and quality of life. Further research is needed to assess the long-term effect of cochlear implantation on cognitive decline.
Annales d'Otolaryngologie et de Chirurgie Cervico-faciale, 2009
An observation of a difficult-to-diagnose complication of the cochlear implant: recurring cutaneo... more An observation of a difficult-to-diagnose complication of the cochlear implant: recurring cutaneous extrusion of a cochlear implant is reported. The history of an adult patient with total deafness is reported. She received an implant in her right ear in 1988, which was then explanted because of absence of hearing results. She received a second implant in her left ear in 2002, which was then explanted in 2007 because of cutaneous extrusion. In 2008, a second implant of a different brand was placed in her left ear, with the central part placed away from the first site, but extrusion recurred. A new attempt to encapsulate the central part with a hydroxyapatite box also ended in extrusion and was explanted in 2008. Various diagnoses to explain these cutaneous problems were suggested during this clinical progression: infection, allergy, and a reaction to a foreign body. No hypothesis could be clearly ruled out. Cutaneous complications after cochlear implant are exceptional. As soon as cutaneous disorders appear, a rigorous diagnostic process must be followed so that the patient can be recommended a long-lasting solution to restore quality hearing.
Proceedings of the 2005 workshops on Genetic and evolutionary computation - GECCO '05, 2005
Cochlear implants are electronic devices that stimulate directly the auditory nerve to allow tota... more Cochlear implants are electronic devices that stimulate directly the auditory nerve to allow totally deaf patients to hear again. This paper presents an interactive evolutionary algorithm (IEA) designed to help finding the best parameters of a cochlear implant for a specific patient.
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 1990
The experience with cochlear implantation at Avicenne hospital prompted us to carry out a retrosp... more The experience with cochlear implantation at Avicenne hospital prompted us to carry out a retrospective study on tinnitus in a population of operated patients. Improvement or disappearance of the symptoms was noted in all cases. These results, which partly match those found in the literature, are probably produced by rehabilitation inhibiting the "deafferentation" mechanisms in analogy with pain phenomena. In some precise cases, which are described, they led us to proposing implantation even though the main, if not sole, complaint of the patient was tinnitus.
Annales d'oto-laryngologie et de chirurgie cervico faciale : bulletin de la Société d'oto-laryngologie des hôpitaux de Paris, 1990
Like any modality of perception, the processes of hearing can be divided up into two levels: modu... more Like any modality of perception, the processes of hearing can be divided up into two levels: modular or primary, and symbolic or central. Multiple-canal implantation is rather applied to the former mechanism, single-canal implantation to the latter. A bank of electrical signals recognizable from each other is being built up. It may be utilized in single-canal systems using this vocabulary to form sentences. The proper phonetic feature to be matched will then have to be selected.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
The cochleovestibular tract is seldom involved by sarcoidosis (about 50 cases have been described... more The cochleovestibular tract is seldom involved by sarcoidosis (about 50 cases have been described since 1948). As a clinical expression of sarcoidosis, deafness is fluctuant in 50% of all cases, bilateral, and most often associated with facial palsy and uveitis, the vestibular reflexes being reduced. The histological studies demonstrate lesions at all levels from the cochlea to be brain stem, but the main mechanism is an infiltration of the arachnoid vessels. The prognosis of sarcoidosis deafness is usually poor in spite of corticosteroid therapy. This paper is illustrated by 3 cases observed in Avicenne Hospital.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
There is theoretically no major surgical problem for implantation. The basic techniques all inclu... more There is theoretically no major surgical problem for implantation. The basic techniques all include on an approach through the windows. The authors describe a solution (which has already been used previously) for cophotic hollowing-out cavities, with a suprapetrosal way and an approach on the hidden aspect of the cochlea. The transcutaneous passage can be displaced from the ear lobe to a depression of the auricle.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
The insertion of reliable extracochlear single-canal cochlear implants in cophotic and subcophoti... more The insertion of reliable extracochlear single-canal cochlear implants in cophotic and subcophotic patients allows the electrical stimulation of the acoustic nerve for rehabilitation, as well as audiovestibular explorations that are no longer possible in the acoustic mode. The authors therefore aim at replacing all these examinations with their Electrical equivalent: --early evoked potentials (E-BERA), --medium-latency evoked potentials (E-MLR), --Event-related evoked potentials (E-P300), for which, to our knowledge, theses are the first recordings, --electrical stapedial reflex, --vestibular stimulations. The method, results and clinical and physiological applications of each method are given, as well as its prospects.
Annales d Otolaryngologie et de Chirurgie Cervico-Faciale
Pathophysiology of the obstructive sleep apnea syndrome shows three components: intra and peripha... more Pathophysiology of the obstructive sleep apnea syndrome shows three components: intra and peripharyngeal obstacles, excessive pharyngeal wall compliance and upper airway dilator muscle dysfunction. The intent of this paper is to provide an overview of the anatomy, histology, physiology and pathophysiology of the upper airway dilator muscles based on previously published articles. The upper airway dilator muscles can be separated in three different systems, main and accessory dilators, local and regional. They act in synergy. Their contraction occurs at the beginning of inspiration, thus maintaining opened the pharyngeal lumen through inspiration. Their action is modulated by several chemo or physical stimuli. In some apneic patients, these muscles demonstrate a dysfunction: hyperactivity during wakefulness, electromyogram wave amplitude reduced, delayed contraction during sleep and abnormal response to stimuli. This dysfunction might be due to neuromuscular histological abnormalitie...
The Vibrant Soundbridge is an active semi-implantable middle ear implant for the rehabilitation o... more The Vibrant Soundbridge is an active semi-implantable middle ear implant for the rehabilitation of patients with a sensorineural hearing loss who are not able to derive adequate benefit from conventional hearing aids. A retrospective study was performed to assess the overall level of satisfaction of implanted patients and to investigate the potential determinants of postoperative success. A retrospective survey of audiological data from repeated measures and subjective data from self-assessment scales administered postoperatively was conducted to determine the degree of benefit and satisfaction for Vibrant Soundbridge implantees. Twenty-one tertiary referral and teaching hospitals. The first 125 VSB implantees implanted in France between August 1997 and May 2001 were included in the study. No clinically significant change was observed for residual hearing postoperatively. Most patients (83%) reported they were either satisfied or very satisfied with the Vibrant Soundbridge. Analysis of correlation revealed a moderate correlation (Pearson coefficient r = 0.59) between the degree of benefit reported via the patient survey and the degree of benefit reported via the Glasgow Benefit Inventory. A moderate correlation (Pearson coefficient r = 0.66) was observed between speech comprehension scores in quiet for the preoperative unaided condition and the postoperative aided Vibrant Soundbridge condition. No correlation was observed between subjective reports of satisfaction postoperatively and performance on preoperative objective tests or patient characteristics. The results indicate a high level of satisfaction with the VSB as a treatment of sensorineural hearing impairment in patients with a wide range of characteristics. Preoperative scores for unaided speech comprehension tests in quiet may be a potential indicator of success on aided Vibrant Soundbridge speech comprehension tests postoperatively but do not reflect patient satisfaction with the device reported on self-assessment scales.
The Journal of the Acoustical Society of America, 2008
ABSTRACT Current sound processors in cochlear implants show poor frequency resolution compared to... more ABSTRACT Current sound processors in cochlear implants show poor frequency resolution compared to normal auditory processes. They smooth spectral gaps within background maskers, thereby preventing implant users from experiencing release from masking (i.e., improved speech identification in maskers showing spectral gaps compared to maskers with continuous spectra). The Advanced Bionics' HiRes120 coding scheme aims to increase the transmission of fine-grain spectral information using a strategy based upon current steering. If HiRes120 improves the precision of spectral coding compared to the standard HiRes strategy, listeners should show improved release from masking for the slowest spectral modulations in a noise masker. This hypothesis is tested in newly implanted adults who alternately use HiRes and HiRes120 sound processing for a period of 10 months. Every two or three months, consonant identification is measured in each implantee in the presence of a stationary speech-shaped noise (SSN) masker at a fixed signal-to-noise ratio yielding 30-40% correct identification with unmodulated noise. The SSN masker is either unmodulated or spectrally modulated to produce periodic, three ERB-wide "spectral gaps" in the noise masker. Masking release scores defined as the change in consonant identification performance in modulated versus unmodulated noise will be presented and discussed.
Uploads
Papers by Bruno Frachet