Emmanuèle Ambert-Dahan

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.

Auditory brainstem implant in neurofibromatosis type 2 and non-neurofibromatosis type 2 patients.

Objective: To evaluate the auditory brainstem implant (ABI) performances in neurofibromatosis type 2 (NF2) and non-NF2 patients. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Between 1996 and 2006, 31 adult patients (mean age, 41 yr; range, 17-65 yr) were implanted with a 21-electrode Nucleus device (Cochlear Inc., Lane Cove, Australia). The population comprised 23 NF2, 3 postmeningitis bilateral ossified cochleas, 3 solitary vestibular schwannomas on the only hearing ear, 1 inner ear malformation, and 1 bilateral cochlear destruction by otosclerosis. Intervention: Auditory brainstem implant was placed through a translabyrinthine or a retrosigmoid approach. Main Outcome Measures: Auditory brainstem implant was evaluated by open-set words and sentences in sound, vision, and sound-plus-vision modes. Results: In NF2 patients, 16 (70%) were daily users of their implants. In these patients, the open-set dissyllabic word recognition was 36 ± 6.0 % for vision-only mode, 33 ± 6.5 % for sound-only mode, and 65 ± 8.0 % in vision-plus-sound mode with a high interindividual variation. Negative prognostic factors were long duration of total hearing loss (>10 yr), low number of active electrodes (<10), and local complications (meningitis, hematoma). Six non-NF2 patients (75%) were daily ABI users. The performances of patients with ossified cochleas were similar to best NF2 cases. Conclusion: A clear benefit of ABI could be evidenced in NF2 patients, especially in case of small tumor and short duration of hearing loss. Auditory brainstem implant may also be indicated in patients with bilateral profound hearing loss and a predictable failure of cochlear implantation.

Cochlear Implant Benefits in Deafness Rehabilitation: PET Study of Temporal Voice Activations

Cochlear implants may improve the medical and social prognosis of profound deafness. Nevertheless, some patients have experienced poor results without any clear explanations. One correlate may be an alteration in cortical voice processing. To test this hypothesis, we studied the activation of human temporal voice areas (TVA) using a well-standardized PET paradigm adapted from previous functional MRI (fMRI) studies. Methods: A PET H215O activation study was performed on 3 groups of adult volunteers: normal-hearing control subjects (n = 6) and cochlear-implanted postlingually deaf patients with >2 y of cochlear implant experience, with intelligibility scores in the “Lafon monosyllabic task” >80% (GOOD group; n = 6) or <20% (POOR group; n = 6). Relative cerebral blood flow was measured in 3 conditions: rest, passive listening to human voice, and nonvoice stimuli. Results: Compared with silence, the activations induced by nonvoice stimuli were bilaterally located in the superior temporal regions in all groups. However these activations were significantly and similarly reduced in both cochlear implant groups, whereas control subjects showed supplementary activations. Compared with nonvoice, the voice stimuli induced bilateral activation of the TVA along the superior temporal sulcus (STS) in both the control and the GOOD groups. In contrast, these activations were not detected in the POOR group, which showed only left unilateral middle STS activation. Conclusion: These results suggest that PET is an adequate method to explore cochlear implant benefits and that this benefit could be linked to the activation of the TVA.

Is Electrode-Modiolus Distance a Prognostic Factor for Hearing Performances after Cochlear Implant Surgery?

The aim of this study was to evaluate electrode array position in relation to cochlear anatomy and its influence on hearing performance in cochlear implantees. Twenty-two patients (25 ears) with Med-El cochlear implants were included in this retrospective study. A negative correlation was observed between electrode-modiolus distance (EMD) at the cochlear base and monosyllabic word discrimination 6 months after implantation. We found no correlation between EMD and hearing outcome at 12 months. The insertion depth/cochlear perimeter ratio appeared to negatively influence the EMD at the base. Indeed, deep insertions in small cochleae appeared to yield smaller EMD and better hearing performance. This observation supports the idea of preplanning the surgery by adapting the electrode array to the length of the available scala tympani.

Processing of voices in deafness rehabilitation by auditory brainstem implant.

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.

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.

Cognitive Evaluation of Cochlear Implanted Adults Using CODEX and MoCA Screening Tests

OBJECTIVE The relationship between hearing loss and cognitive function has already been established. The objective of our study was to determine whether the two short cognitive tests, COgnitive Disorders EXamination (CODEX) and Montreal Cognitive Assessment (MoCA), could be used in daily clinical practice to detect cognitive impairment, and its changes after cochlear implantation. PATIENTS Eighteen patients with severe to profound postlingual progressive hearing loss (mean age ± SEM: 64 ± 3.5 yr; range, 23-83 yr) were tested before, and 12 months after cochlear implantation, with adapted visual presentation of CODEX and MoCA tests. Auditory performance was tested under best-aided conditions in quiet and noise. RESULTS Twelve months after cochlear implantation, hearing performance had clearly improved (paired t tests, p < 0.05). In addition, among the eight patients who had an abnormal cognitive score before implantation, four improved their cognitive performance, and were thus considered to be normal. No major alteration of cognitive performance was observed in the 10 patients who had normal cognitive performance before implantation. CONCLUSION CODEX and MoCA are rapid tests that could be considered to be relevant cognitive performance screening tests. They could be used in daily clinical practice to improve the multidisciplinary sensory-cognitive monitoring of the elderly population.

Emotional recognition of dynamic facial expressions before and after cochlear implantation in adults with progressive deafness

ABSTRACT Visual processing has been extensively explored in deaf subjects in the context of verbal communication, through the assessment of speech reading and sign language abilities. However, little is known about visual emotional processing in adult progressive deafness, and after cochlear implantation. The goal of our study was thus to assess the influence of acquired post‐lingual progressive deafness on the recognition of dynamic facial emotions that were selected to express canonical fear, happiness, sadness, and anger. A total of 23 adults with post‐lingual deafness separated into two groups; those assessed either before (n = 10) and those assessed after (n = 13) cochlear implantation (CI); and 13 normal hearing (NH) individuals participated in the current study. Participants were asked to rate the expression of the four cardinal emotions, and to evaluate both their emotional valence (unpleasant‐pleasant) and arousal potential (relaxing‐stimulating). We found that patients with deafness were impaired in the recognition of sad faces, and that patients equipped with a CI were additionally impaired in the recognition of happiness and fear (but not anger). Relative to controls, all patients with deafness showed a deficit in perceiving arousal expressed in faces, while valence ratings remained unaffected. The current results show for the first time that acquired and progressive deafness is associated with a reduction of emotional sensitivity to visual stimuli. This negative impact of progressive deafness on the perception of dynamic facial cues for emotion recognition contrasts with the proficiency of deaf subjects with and without CIs in processing visual speech cues (Rouger et al., 2007; Strelnikov et al., 2009; Lazard and Giraud, 2017). Altogether these results suggest there to be a trade‐off between the processing of linguistic and non‐linguistic visual stimuli. HIGHLIGHTSJudgments of dynamic facial emotions are examined in adults with progressive deafness.Pre and Post‐CI subjects are not uniformly impaired in judging emotions in faces.Findings suggest a negative impact of hearing loss on facial emotions perception.CI users might focus more on verbal cues and pay less attention to non‐verbal cues.This compensatory strategy could contribute to an emotional sensitivity degradation.

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