Christoph Arnoldner

Speech and music perception with the new fine structure speech coding strategy: preliminary results

Conclusions. Taking into account the excellent results with significant improvements in the speech tests and the very high satisfaction of the patients using the new strategy, this first implementation of a fine structure strategy could offer a new quality of hearing with cochlear implants (CIs). Objective. This study consisted of an intra-individual comparison of speech recognition, music perception and patient preference when subjects used two different speech coding strategies with a MedEl Pulsar CI: continuous interleaved sampling (CIS) and the new fine structure processing (FSP) strategy. In contrast to envelope-based strategies, the FSP strategy also delivers subtle pitch and timing differences of sound to the user and is thereby supposed to enhance speech perception in noise and increase the quality of music perception. Patients and methods. This was a prospective study assessing performance with two different speech coding strategies. The setting was a CI programme at an academic tertiary referral centre. Fourteen post-lingually deaf patients using a MedEl Pulsar CI with a mean CI experience of 0.98 years were supplied with the new FSP speech coding strategy. Subjects consecutively used the two different speech coding strategies. Speech and music tests were performed with the previously fitted CIS strategy, immediately after fitting with the new FSP strategy and 4, 8 and 12 weeks later. The main outcome measures were individual performance and subjective assessment of two different speech processors. Results. Speech and music test scores improved statistically significantly after conversion from CIS to FSP strategy. Twelve of 14 patients preferred the new FSP speech processing strategy over the CIS strategy.

Surgical considerations in cochlear implantation in children and adults: a review of 342 cases in Vienna.

: A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide.Conclusions Our data represent the experience of the largest cochlear implant program in Austria. In conclusion, cochlear implantation is a safe procedure, associated with a low rate of intra- and postoperative complications. Nevertheless, patients should be informed about possible problems and especially about the risk of a reoperation due to device failure. Objectives To evaluate the cause of deafness, the intraoperative findings and the complication rate for all cochlear implant operations performed consecutively between 1994 and 2003 at Vienna General Hospital. Material and methods Including all surgeries for bilateral implantation and revision, a series of 342 operations performed on 164 adults (age range 14.5–81 years; mean age 50.79 years) and 128 children (age range 0.75–14 years; mean age 5.00 years) was retrospectively analyzed. Results The etiology of deafness was predominantly congenital or progressive (66.89%). The routine mastoidectomy approach was chosen in 300 patients (87.72%) and the suprameatal approach in 42 (12.28%). Intraoperatively, 4 children (2.53%) had a cerebrospinal fluid fistula and 35 patients (10.23%) showed cochlear ossification. Three adults (1.63%) and two children (1.27%) had facial nerves with an aberrant course. The overall complication rate was 12.2%, the rate of major complications was 4.97% and the rate of minor complications was 4.09%. There were no cases of either postoperative meningitis or facial nerve palsy. Both flap necrosis and electrode dislocation occurred in one adult patient (0.54%), but in none of the children. Formation of cholesteatoma was found in one adult (0.54%) and one child (0.63%). The rate of device failure was 7.07% for adults and 13.92% for children.: Isolated fracture of the malleus seems to be an extremely rare ossicular injury. All previously reported cases involved the handle of the malleus. This is the first reported case of fracture of the neck of the malleus. The diagnosis can easily be missed because the tympanic membrane remains intact. Furthermore, the history may not be suggestive. Surgical repair is particularly difficult.

Effect of deep insertion of the cochlear implant electrode array on pitch estimation and speech perception

Conclusion. Deeply inserted electrodes offer the possibility that apical stimulation may improve speech performances. Therefore, deep insertion is reasonable and should be performed in patients with profound or total hearing loss. Objectives. To evaluate the importance of insertion depth beyond 25 mm in a group of cochlear implant patients with deeply inserted electrodes up to 32 mm. Patients and methods. In the first part of the study patients were asked to perform a pitch estimation for channels across the whole length of the electrode array. We evaluated whether pitch discrimination was possible along the whole cochlea and especially in its apical part. Then, the audiological performances of 10 patients were tested in 5 conditions, in which we artificially varied the insertion depth in each patient by activating and deactivating channels. The patients were tested immediately in the new condition to avoid adaptation. Results. The results showed that activating the electrodes in the uppermost region of the cochlea improves speech perception significantly. Furthermore it could be demonstrated that the pitch perceived in the cochlea with electrical stimulation decreases with increasing insertion depth along the whole length of deeply inserted electrode arrays.

Indication criteria and outcomes with the Bonebridge transcutaneous bone-conduction implant

The aim of this study was to evaluate functional hearing gain, speech understanding, and preoperative bone‐conduction thresholds with the bone‐conduction implant Bonebridge.

1-year results using the Opus speech processor with the fine structure speech coding strategy

Conclusion: In contrast to the Tempo+ the new Opus speech processor stimulates with the new fine structure programming (FSP) speech coding strategy and offers an extended frequency spectrum. A significant improvement in speech perception for sentences at 10 dB SNR (signal to noise ratio) was observable. Objectives: The aim of this study was to investigate the long-term effects on speech perception in quiet and in noise with the Opus speech processor using FSP. Subjects and methods: Eight post-lingually deaf patients implanted with Pulsar cochlear implants and fitted with Tempo+ speech processors (both MED-EL) for a minimum of 1 year were tested at baseline with Tempo+ using continuous interleaved sampling (CIS), and at 1 year follow-up with the Opus speech processor using FSP. Monosyllables and sentence tests were performed in quiet, and sentence tests (HSM) in noise with 15, 10 and 5 dB SNR. Results: Mean speech perception scores showed a trend towards improvement for all tests. A statistically significant (p<0.05) improvement was only observed for the sentence test in noise at 10 dB SNR.

Intranasal submucosal bevacizumab for epistaxis in hereditary hemorrhagic telangiectasia: a double-blind, randomized, placebo-controlled trial.

The purpose of this study was to investigate the efficacy of bevacizumab (“Avastin”) for the treatment of epistaxis in hereditary hemorrhagic telangiectasia (HHT).

A new fine structure speech coding strategy: speech perception at a reduced number of channels.

Objective One of the most commonly used speech coding strategies for cochlear implants is continuous interleaved sampling (CIS), which codes the envelope information of an acoustic signal. Based on this strategy, MED-EL has recently developed the new fine structure processing (FSP) speech coding strategy, which also transmits subtle pitch and temporal cues. The aim of this study was to investigate the number of active channels necessary for good speech perception with FSP and whether there is an advantage for FSP compared with CIS at a reduced number of channels. Methods Ten postlingually deafened patients using MED-EL Pulsar cochlear implants participated in this study. Patients were tested with all 12, 8, 5, 3, and 2 channels with CIS and FSP strategy, resulting in a total of 10 conditions. Performance was tested with numbers, monosyllables, and sentence tests. Results Our results showed an improvement in speech perception, with up to 5 channels for numbers and for monosyllables and sentence tests. Statistically significant increases in performance were noted from 3 to 8 channels for numbers, from 3 to 5 channels for monosyllables, and from 5 to 8 channels for sentence tests. No statistical significance was observed whether FSP or CIS was used. Conclusion Based on these findings, the number of channels necessary for speech perception with FSP is similar to published results using CIS. There seems to be no advantage for FSP compared with CIS in the conditions of the present experiment.

Surgical revision of hemorrhage in 8388 patients after cold-steel adenotonsillectomies

ZusammenfassungZIEL DER STUDIE: Tonsillektomie und Adenoidektomie sind die häufigsten Operationen in der Hals-, Nasen-, Ohrenheilkunde. Die schwerwiegendste Komplikation ist die postoperative Blutung, die in 2% bis 4% Prozent der Fälle auftritt. Das Ziel dieser Studie war es, die Inzidenz und mögliche prediktive Faktoren von postoperativen Blutungen, die eine operative Sanierung benötigten, bei Patienten nach Tonsillektomie/Adenoidektomie zu bestimmen. STUDIENDESIGN: An einer einzigen Institution wurden retrospektiv 8388 Patienten nach Tonsillektomie/Adenoidektomie im Zeitraum 1994 bis 2006 untersucht. Die Tonsillektomie wurde mit Hilfe von Kaltinstrumenten und bipolarer Diathermie für die Hämostasis durchgeführt. RESULTATE: Eine postoperative Blutung, die eine chirurgische Versorgung in Intubationsnarkose notwendig machte, trat bei 114 Patienten nach Tonsillektomie (1,78%) und bei 7 Patienten (0,35%) nach Adenoidektomie auf. Nach Tonsillektomie traten 85,09% der Blutungen später als 24 Stunden nach Operation (zwischen dem ersten Tag nach der Operation und dem 15. postoperativen Tag) auf. Nach Adenoidektomie traten hingegen in 85,71% die Blutungen unmittelbar nach der Operation (innerhalb der ersten 24 Stunden) auf. Zwei Patienten (0,03%) benötigten eine Bluttransfusion, weder wurde eine Ligatur der A. carotis externa durchgeführt noch traten Todesfälle ein. Die höchste Inzidenz war bei Patienten älter als 16 Jahre (2,19%) zu beobachten. In den wärmeren Jahreszeiten war die Inzidenz höher (1,98%) als in den kälteren (1,63%). Assistenzärzte hatten eine geringere Blutungsinzidenz (1,75%) als Fachärzte (1,84%). SCHLUSSFOLGERUNGEN: Adenoidektomie ist ein sicherer Eingriff, der tagesstationär durchgeführt werden kann. Unsere Daten zeigen aber, dass Patienten nach Tonsillektomie eine Hospitalisierung bis zum 15. postoperativen Tag benötigen würden. Dennoch besteht kein Zweifel, dass sowohl ökonomische, soziale als auch organisatorische Faktoren gegen diese Forderung sprechen. Daher bleibt die sorgfältige Aufklärung des Patienten und/oder der Eltern eines der wichtigsten Parameter, um die Sicherheit der Tonsillektomie zu erhöhen.SummaryPURPOSE OF THE INVESTIGATION: Tonsillectomy and adenoidectomy are the most common surgical procedures in otorhinolaryngology. The most serious complication is postoperative hemorrhage, with a 2–4% risk of substantial bleeding. The aim of this study was to evaluate the incidence of and possible predictive factors for postoperative hemorrhage requiring surgical revision in patients undergoing cold dissection tonsillectomy/adenoidectomy. BASIC PROCEDURES: We performed a single-institution retrospective study of 8388 patients who underwent tonsillectomy and/or adenoidectomy between 1994 and 2006. Tonsillectomy was performed using only cold-steel dissection with bipolar diathermy for hemostasis. MAIN FINDINGS: Hemorrhage occurred in 114 patients (1.78%) after tonsillectomy and in seven patients (0.35%) after adenoidectomy. After tonsillectomy 85.09% of the hemorrhages were secondary, occurring between the postoperative days 1 and 15, whereas in the adenoidectomy group 85.71% of the bleeding episodes were primary. Two patients (0.03%) required blood transfusions, none of the patients required an external carotid artery ligation, and there were no cases of death in our series. On the basis of logistic regression analysis, patient age was found to be a statistically significant risk factor (P = 0.007): the highest incidence was found in patients over 16 years of age (2.19%). At warmer times of year the incidence was higher (1.98%) than at colder times (1.63%). The resident surgeons caused a hemorrhage incidence of 1.75% and the consultant surgeons one of 1.84%. The incidence was significantly higher in male patients (2.2%) than in female patients (1.4%; P = 0.016). PRINCIPAL CONCLUSIONS: Our data show that whereas adenoidectomy can be safely performed as a one-day procedure, tonsillectomy complications due to postoperative hemorrhages might be avoided only if patients were to stay in hospital until postoperative day 15, which would clearly be impractical for economic, organizational and social reasons. A crucial factor for increasing the safety of this procedure is the provision of meticulous education and information for the patient and/or parents.

FS4, FS4-p, and FSP: a 4-month crossover study of 3 fine structure sound-coding strategies.

Objectives: The aim of the present study was to compare two novel fine structure strategies “FS4” and “FS4-p” with the established fine structure processing (FSP) strategy. FS4 provides fine structure information on the apical four-electrode channels. With FS4-p, these electrodes may be stimulated in a parallel manner. The authors evaluated speech perception, sound quality, and subjective preference. Design: A longitudinal crossover study was done on postlingually deafened adults (N = 33) who were using FSP as their default strategy. Each participant was fitted with FS4, FS4-p, and FSP, for 4 months in a randomized and blinded order. After each run, an Adaptive Sentence test in noise (Oldenburger Sentence Test [OLSA]) and a Monosyllable test in quiet (Freiburger Monosyllables) were performed, and subjective sound quality was determined with a Visual Analogue Scale. At the end of the study the preferred strategy was noted. Results: Scores of the OLSA did not reveal any significant differences among the three strategies, but the Freiburger test showed a statistically significant effect (p = 0.03) with slightly worse scores for FS4 (49.7%) compared with FSP (54.3%). Performance of FS4-p (51.8%) was comparable with the other strategies. Both audiometric tests depicted a high variability among subjects. The number of best-performing strategies for each participant individually was as follows: (a) for the OLSA: FSP, N = 10.5; FS4, N = 10.5; and FS4-p, N = 12; and (b) for the Freiburger test: FSP, N = 14; FS4, N = 9; and FS4-p, N = 10. A moderate agreement was found in the best-performing strategies of the Speech tests within the participants. For sound quality, speech in quiet, classical, and pop music were assessed. No significant effects of strategy were found for speech in quiet and classical music, but auditory impression of pop music was rated as more natural in FSP compared with FS4 (p = 0.04). It is interesting that at the end of the study, a majority of the participants favored the new coding strategies over their previous default FSP (FSP, N = 13; FS4, N = 13; FS4-p, N = 7). Conclusions: In summary, FS4 and FS4-p offer new and further options in audio processor fitting, with similar levels of speech understanding in noise as FSP. This is an interesting result, given that the strategies’ presentation of temporal fine structure differs from FSP. At the end of the study, 20 of 33 subjects chose either FS4 or FS4-p over their previous default strategy FSP.

Preclinical evaluation of thermoreversible triamcinolone acetonide hydrogels for drug delivery to the inner ear

Graphical abstract