Alexis Bozorg-Grayeli

Speech Performance and Sound Localization in a Complex Noisy Environment in Bilaterally Implanted Adult Patients

Objective: To evaluate speech performance, in quiet and noise, and localization ability in adult patients who had undergone bilateral and simultaneous implantation. Study Design: Prospective multi-center study. Methods: 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° to +90° azimuth in the horizontal plane, and using a speech stimulus. Results: 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 ≥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 ≥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. Conclusion: 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.

Cochlear implants in elderly people: Preliminary results

The objective of this study was to evaluate the benefit of cochlear implantation in adults aged 60 years and over. Twenty-eight patients, older than 60 years and with profound bilateral sensorineural hearing loss, received a cochlear implant between 1991 and 2001. The mean age was 66 years and the median follow-up was 22.5 months. Speech perception scores before and after implantation were analyzed retrospectively in order to evaluate the benefit of cochlear implantation. There was a significant improvement of the disyllabic words and sentences scores after implantation. The patients who were over 70 years performed as well as those who were younger. The surgical procedure was well tolerated in all patients. One patient developed a postoperative vertigo due to a perilymphatic fistula. In conclusion, cochlear implantation offers improvement in speech perception to the elderly population, as in the younger population. A careful assessment of the physical status of these patients remains essential in order to evaluate the risk–benefit of this procedure.

Performances et complications de l’implant cochléaire chez 134 patients adultes implantés depuis 1990

Objectifs Le but de cette etude etait d’analyser de facon retrospective les performances, les facteurs predictifs et les complications de l’implant cochleaire dans une population de sujets adultes presentant une surdite post-linguale. Methodes Entre 1990 et 2003, 134 patients adultes ont ete implantes, de facon unilaterale chez 129 d’entre eux et bilaterale chez 5 d’entre eux. Le benefice auditif a 6, 12, 24 et 36 mois a ete analyse ainsi que les performances a 12 mois en fonction de l’etiologie, de l’âge, de la lecture labiale et de la strategie de codage. Resultats L’implant cochleaire apporte un benefice auditif important des 6 mois postoperatoire par comparaison aux performances avant l’implantation (p Conclusion L’implant cochleaire apporte un benefice important et rapide, avec une morbidite tres faible, quels que soient l’âge des sujets, l’etiologie et la qualite de la lecture labiale.

Bénéfice de l’implant cochléaire chez le sujet âgé

Objectif Evaluation de l’efficacite de l’implant cochleaire chez le sujet âge de 60 ans et plus. Materiel et methodes Les dossiers de 56 patients âges de 60 ans et plus, presentant une surdite profonde et totale bilaterale, ont ete analyses de facon retrospective. Au terme du bilan, 28 patients ont ete implantes. L’âge moyen dans ce groupe etait de 66 ans et le recul moyen etait de 22,5 mois. Les bilans orthophoniques pre et post-operatoires ont ete analyses dans le but d’evaluer le benefice apporte par l’implant cochleaire. Le bilan orthophonique pre-operatoire a ete compare a celui des patients non implantes. Resultats Le bilan orthophonique post-implantation retrouve une amelioration significative de la comprehension des mots dissyllabiques et des phrases sans contexte. Les patients âges de 60 a 70 ans et de plus de 70 ans ont des performances similaires. Les suites ont ete marquees par 1 cas de vertige secondaire a une fistule perilymphatique. Aucun retard de cicatrisation n’est survenu. Dans le groupe de patients non implantes (âge moyen : 68 ans), l’implant a ete refuse principalement en raison d’un benefice audio-prothetique juge suffisant par le patient (18 cas), mais egalement par crainte de l’intervention (5 cas). L’âge moyen, la cause et duree de la surdite ainsi que les resultats du bilan orthophonique initial etaient similaires au groupe de patients implantes. Conclusion Cette etude met en evidence le benefice apporte par l’implant cochleaire chez le sujet âge. Les resultats laissent presager qu’un benefice comparable aurait pu etre obtenu dans le groupe de patients qui a refuse l’implantation. Une implantation la plus precoce possible pourrait raccourcir la duree de la surdite et conserver une perception auditive binaurale dans le but d’optimiser les performances chez le sujet âge.

The Voice Track multiband single-channel modified Wiener-filter noise reduction system for cochlear implants: patients' outcomes and subjective appraisal

Abstract Objective: The aim of this study was to evaluate the potential improvements of speech perception and sound quality provided by a multiband single channel noise-reduction algorithm based on the modified Wiener-filter adapted to cochlear implant sound processing. Design: This study was a longitudinal trial with a repeated-measures design. Outcome measures were performed on the first day when the noise reduction feature was provided and after a one month habituation period. Objective measures included pure-tone thresholds and vocal audiometry assessments. Speech perception was measured in quiet and in the presence of two types of noise: a stationary speech shaped noise and a two-talker cocktail noise. Subjective sound quality was assessed using a ten item questionnaire. Study Sample: Thirteen post-lingual deaf adults, experienced users of a cochlear implant system, took part in this study. Results: The noise-reduction algorithm provided a benefit for the perception of speech presented in a stationary speech shaped noise and an overall improvement in subjective sound quality ratings. Conclusions: It was shown that a single channel noise reduction system based on a modified Wiener-filter approach can improve speech in noise perception performance and subjective sound quality in cochlear implant patients.

A neuro-imaging approach to evidencing bilateral cochlear implant advantages in auditory perception.

CEA-Inserm U1000 Neuroimaging and Psychiatry, Service Hospitalier Frederic Joliot, Orsay, France, CEA, DRM, DSV, Service Hospitalier Frederic-Joliot, Orsay, France, Laboratoire de Correction Auditive, Eric Bizaguet, Paris, France, Inserm, UMR-S 867, Paris, France, AP-HP, Hopital Beaujon, Service d’ORL et de Chirurgie cervico-faciale, Clichy, France, Universite Paris 7 Denis Diderot, Paris, France, AP-HP, Hopital Louis Mourier, Service d’ORL et de Chirurgie cervico-faciale, Colombes, France, AP-HP, Hopital Pitie-Salpetriere, Service Urgences cerebro-vasculaires, Paris, France, Universite Paris 6 Pierre et Marie Curie, Paris, France

H+, K+-ATPase is not Involved in Endolymph pH Homeostasis

In endolymph, the calculated electrochemical gradients suggest the presence of active transport of H+ and K+. The presence of H+,K+-ATPase, an active transporter that mediates the exchange of intracellular H+ for extracellular K+, was investigated using reverse transcription-polymerase chain reaction on rat microdissected inner ear tissues. Distal colon and kidney were used as positive controls. The two H+,K+-ATPase colonic or gastric isoforms were not detected in the rat cochlea and endolymphatic sac. This result suggests that H+,K+-ATPase is not involved in H+ and K+ endolymph homeostasis.In endolymph, the calculated electrochemical gradients suggest the presence of active transport of H+ and K+. The presence of H+, K+-ATPase, an active transporter that mediates the exchange of intracellular H+ for extracellular K+, was investigated using reverse transcription-polymerase chain reaction on rat microdissected inner ear tissues. Distal colon and kidney were used as positive controls. The two H+, K+-ATPase colonic or gastric isoforms were not detected in the rat cochlea and endolymphatic sac. This result suggests that H+, K+-ATPase is not involved in H+ and K+ endolymph homeostasis.

Association of the Duration of Antibiotic Therapy With Major Surgical Site Infection in Cochlear Implantation

Importance Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy. Objective To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis. Design, Setting, and Participants Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included. Interventions Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis. Main Outcomes and Measures Major infection and explantation. Results Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290). Conclusions and Relevance After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.