Adriaan F. van Olphen

A functional anatomic study of the relationship of the nasal cartilages and muscles to the nasal valve area

The functioning of the nasal valve area is largely determined by the stability and the mobility of the lateral nasal wall. To gain insight into the kinematics of the lateral nasal wall, we studied the functional anatomy of the nasal muscles and the intercartilaginous and osseous‐cartilaginous junctions. We performed gross and microscopic nasal dissection and serial sectioning in 15 human cadaveric noses. In addition, two noses were used for three‐dimensional reconstruction of the nasal cartilages. We conclude that the lateral nasal wall can be seen as made up of three parts. At the level of the osseous‐cartilaginous chain of bone, lateral nasal cartilage, and lateral crus, the lateral nasal wall is relatively stable, limited mobility being allowed by translation and rotation in the intercartilaginous joint and a coupled distortion of the cartilages. At the level of the hinge area the lateral nasal wall is supported by one or more accessory cartilages, embedded in soft tissue, and therefore much more compliant. The alar part of the nasalis muscle, which originates from the maxilla and inserts on these cartilages, may dilate the valve area by drawing this hinge area laterally. The third and most compliant part of the lateral nasal wall is the part that is not supported by cartilage, the ala. The dilatator naris muscle largely occupies the ala and is attached to the lateral crus; it opens the vestibule and nostril. The third nasal muscle that influences the lateral nasal wall is the transverse part of the nasalis muscle. It overlies the nose but is not attached to it. This muscle stabilizes the lateral nasal wall, in particular, the lateral nasal cartilage, the intercartilaginous junction, and the hinge area, by moving the nasal skin.

MRI versus CT in assessment of cochlear patency in cochlear implant candidates

Objective To investigate how cochlear patency as seen on preoperative CT and MRI scans correlates with findings at surgery in cochlear implant patients. Material and Methods CT and MRI scans of 25 patients were reviewed by 3 independent observers. The reviewers classified the cochlear patency and recorded the location of any suspected decrease in patency. Their results were compared with the findings noted during surgery. Results Decreased cochlear patency was found in six patients at surgery. The mean sensitivity/specificity of CT and MRI assessment was 33%/88% and 41%/91%, respectively. Conclusion Our study suggests that CT, using axial and semi-longitudinal planes, is equivalent to MRI in predicting cochlear patency.

Audiological performance after cochlear implantation: a 2-year follow-up in children with inner ear malformations

Conclusions: Open-set speech perception in children with an inner ear malformation is equal to that of other congenitally deaf children after an average of 2 years follow-up. Objective: To analyze audiological performance after cochlear implantation in a sample of children with radiographically detectable malformations of the inner ear compared to performance in prelingually deafened children at large. Materials and methods: Nine children with osseous inner ear malformations were compared to 22 congenitally deaf children, all of whom underwent cochlear implantation. All subjects were tested on their electrical evoked compound action potential. Speech perception tests were performed using the monosyllabic trochee polysyllabic test without visual support and the open-set monosyllabic wordlist. Results: In all, 20% of the congenitally deaf children in our center study have inner ear abnormalities. Inner ear malformations were limited to incomplete partition of the cochlea; none of the subjects had common cavity malformations. Electrical compound action potentials were successfully recorded in both groups intraoperatively. Speech perception tests on open-set speech yielded an average of 48.8% (SD 21.2%) in the group of children with inner ear malformations vs 54.5% (SD 21.1%) in congenitally deaf children. In four of nine cases with an inner ear malformation we encountered a minor CSF leak.

Intracochlear assessment of electrode position after cochlear implant surgery by means of multislice computer tomography

The development of electrode arrays, the past years, has focused on modiolus-hugging cochlear implant electrodes. Besides, atraumatic implantation of electrodes is of importance for the use in hearing preservation, in cases of combined electric and acoustic stimulation. Intracochlear positioning of the individual electrodes by means of multislice computer tomography (CT) has not yet been shown. In this study we formulated and tested a CT imaging protocol for postoperative scanning of the temporal bone in cochlear implant subjects. Both a fresh human temporal bone and a fresh human cadaver head were implanted with a cochlear implant. Multislice CT was performed for adequate depiction of the cochlear implant. All scans were analyzed on a viewing workstation. After mid-modiolar reconstruction we were able to identify the intracochlear electrode position relative to the scala tympani and scala vestibuli. This was possible in both the implanted isolated temporal bone and the fresh human cadaver head. The feasibility of imaging the electrode position of the cochlear implant within the intracochlear spaces is shown with multislice CT. An imaging protocol is suggested.

Intra- and postoperative electrode impedance of the straight and Contour arrays of the Nucleus 24 cochlear implant: Relation to T and C levels

The objective of this study was to investigate electrode impedance in cochlear implant recipients in relation to electrically evoked stapedius reflex measurements during surgery, and to electrode design, stimulation mode, and T and C levels over a nine month period after surgery. Seventy-five implant recipients, implanted with a Nucleus straight electrode array or a Contour array, were included. The results show that: (1) during surgery electrode impedance decreases markedly after electrically evoked stapedius reflex measurements, (2) after surgery, during the period without stimulation until speech processor switch-on, impedance increases, (3) after processor switch-on impedance decreases. The lower impedance values after a period of stimulation are found at the higher T and C levels. Impedances of the straight array electrodes are lower than those of the Contour array. The difference corresponds mainly to their respective surface areas. In addition, the straight array shows a larger increase of impedance in the apical direction than the Contour array, probably because of the larger fluid environment around the basal electrodes of the straight array. Sumario El objetivo de este estudio fue investigar la impedancia de los electrodos en implantados cocleares en relación con medidas de reflejo estapedial evocado eléctricamente durante la cirugía, con el diseño del electrodo, el modo de estimulación, y los niveles T y C durante los 9 meses siguientes a la cirugía. Se incluyeron setenta y cinco sujetos implantados con un electrodo Nucleus recto o con uno Contour. Los resultados muestran que, 1) la impedancia de los electrodos disminuye marcadamente después de las mediciones del reflejo estapedial evocado eléctricamente, durante la cirugía, 2) la impedancia aumenta después de la cirugía, durante el período sin estimulación y hasta la activación de procesador de lenguaje, 3) después de la activación del procesador la impedancia disminuye. Se encontró que los menores valores de impedancia después de un periodo de estimulación se encuentran en los niveles T y C más altos. Las impedancias de los electrodos rectos son más bajas que aquellas del Contour. La diferencia corresponde a sus respectivas áreas de superficie. Además, los electrodos rectos muestran un incremento mayor de la impendacia en la dirección apical que los electrodos Contour, probablemente debida al ambiente con más líquido alrededor de los electrodos basales de los electrodos rectos.

Effect of cochlear implantation on voice fundamental frequency in post-lingually deafened adults

The present study addresses the effect of cochlear implantation on the voice fundamental frequency at which 20 post-lingually deafened Dutch subjects utter speech materials. All subjects received the Nucleus 22 cochlear implant (3 WSP and 17 MSP processors). Speech recordings were made pre-implantation and three and twelve months post-implantation with the implant switched on and off. The fundamental frequency (f0) was sampled while reading a text. The pre-implantation results show that in some subjects, f0 was too high compared with the range in f0 of normally-hearing subjects. Post-implantation, with the implant switched on, we found that the abnormally high f0 values pre-implantation changed toward the normative values. In addition, post-implantation we found that the range over which f0 varied within a subject while reading the text, the f0 sway, decreased for most subjects who, pre-implantation, had their f0 sway outside the normative ranges, the normative range being defined as the interval between the mean plus/minus one standard deviation of the f0 sway found for normally-hearing subjects. Voice fundamental frequency of post-lingually deafened adults is characterized by large interindividual variability in the pre-implantation f0 values. This large interindividual variability is found also in the effect of cochlear implantation on f0.

Changes in Vowel Quality in Post-lingually Deafened Cochlear Implant Users

The present study addresses the effect of cochlear implantation on vowel production of 20 post-lingually deafened Dutch subjects. All subjects received the Nucleus 22 implant (3 WSP and 17 MSP processors). Speech recordings were made pre-implantation and three and twelve months post-implantation with the implant switched on and off. The first and second formant frequencies were measured for eleven Dutch vowels (monophthongs only) in an h-vowel-t context. Twelve months post-implantation, the results showed an increase in the ranges of the first and second formant frequency covered by the respective vowels when the implant was switched on. The increase in the formant frequency range was most marked for some subjects with a relatively small formant range pre-implantation. Also, at 12 months post-implantation with the implant switched on we found a significant shift of the first and second formant frequency towards the normative values. Moreover, at this time the results showed significantly increased clustering of the respective vowels, suggesting an improvement in the ability to produce phonological contrasts between vowels. Clustering is defined as the ratio of the between-vowel variance of the first and second formant frequency and the within-vowel variance of three tokens of the same vowel.

Cochlear Orientation and Dimensions of the Facial Recess in Cochlear Implantation

Objective: To study the dimensions of the facial recess and the spatial relationship between the facial recess and the cochlea, using CT scanning in cochlear implantees. Method: In 29 cochlear implantees, preoperative CT scans of the temporal bone were compared with findings done at surgery. The dimensions of the facial recess and the relationship between the facial recess and the cochlea were both measured on a viewing station and classified on printed films by 3 blinded and independent reviewers. Results: No significant relations could be found between either intuitive classification of facial recess width or electrode array insertion feasibility and the measurements with the viewing station. The 3 reviewers had large interobserver variability. In 5 cases, neither intuitive review of the CT scans nor viewing station measurements could predict any of the problems encountered during surgery. Conclusion: Our findings show that intuitive review was not reliable in classifying facial recess width. Viewing station measurements, in classifying the spatial relation between the facial recess and the cochlear basal turn, need a more detailed review in terms of the relationship with the operation direction and the orientation of the basal turn of the cochlea. Advanced imaging techniques, specifically multislice CT, might improve the diagnostic capabilities.

Electrode insertion depth in cochlear implantees estimated during surgery, on plain film radiographs and with electrode function testing

Three methods of determining electrode insertion depth in cochlear implantees are studied: intraoperative counting of inserted electrodes, plain film radiography using Stenvers projection and postoperative electrode function testing. In 16 cases the number of electrodes inserted in the cochlea were counted both by the surgeon at surgery and by two independent observers on plain film radiographs using Stenvers projections. The electrode function was tested postoperatively. The differences between the three methods in estimation of the number of intracochlear electrodes were analyzed with t -tests, and 95% confidence intervals (95% CI) of the mean differences were calculated. The mean difference between the radiograph observers was 0.25 electrode (95% CI, –0.69 to 1.19 electrodes.) The mean difference between radiography observations and the surgical counts was 0.60 electrode (95% CI, –0.71 to 1.91 electrodes.) The mean difference between surgical counting and electrode function testing was 0.40 electrode (95% CI, –0.66 to 1.46 electrodes.) The mean difference between radiograph observations and electrode function testing was 0.50 electrode (95% CI, –0.51 to 1.51 electrodes.) No significant differences existed between the three methods. Our findings showed similar results in estimating electrode array insertion depth with the three methods. Plain film radiography using Stenvers projection is satisfactory if imaging is indicated for determining the number of inserted electrodes.

Phoneme Recognition by Deaf Individuals Using the Multichannel Nucleus Cochlear Implant

Experiments have been carried out to determine which cues are used in phoneme identification by deaf individuals using a cochlear implant. Five deaf individuals with a Nucleus 22-channel cochlear implant were tested with open set speech audiometry in free field without lipreading. Speech material consisted of lists of Dutch words of the Consonant-Vowel-Consonant type (CVC-words). Word scores ranged from 0 to 22%, phoneme scores from 11 to 54%. For each subject the responses to the initial consonant, the vowel and the final consonant were entered into separate confusion matrices. Kruskal analysis, which provided a geometric representation of these confusions, showed that in the recognition of consonants the feature of voicing is all important. Vowels were identified on the basis of the frequencies of the first and second formants. In one subject the electrode array could only partially be inserted into the cochlea, leaving roughly half the second formant area of the electrode array outside the cochlea. For this subject vowel identification was based upon the first formant and vowel duration; there was no contribution of second formant information to vowel identification. Compressing the first and second formant frequency to the limited intracochlear array did not enhance transmission of second formant information and did not improve performance. The basic findings for consonant and vowel recognition could be explained by the speech coding strategy of the Nucleus speech processor in which voicing determines stimulus periodicity and formant frequencies determine channel selection. Kruskal analysis of phoneme confusions may aid in programming and evaluating the performance of the Nucleus cochlear implant.