Jafar-Sasan Hamzavi

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.

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.

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.

Envelope versus fine structure speech coding strategy: a crossover study.

Objective: The transmission of fine structure information to cochlear implant users is an expanding area of research. Previous studies comparing the fine structure processing (FSP) speech coding strategy to the envelope-based continuous interleaved sampling (CIS) strategy indicated improved speech perception when using the fine structure strategy. Those investigations were performed with an extended frequency spectrum in the low frequencies together with the fine structure strategy. The current study addresses the question whether these improvements are due to the presentation of fine structure per se or rather the extended frequency spectrum. Hence, this cross over study compares the two strategies using an identical frequency spectrum. Study Design: Randomized crossover study. Patients: 31 patients were randomly assigned to two groups. Interventions: One group was fitted with a CIS map for 4 weeks, tested and subsequently fitted with a FSP map for 4 weeks. The other group followed the same pattern in reverse. Main Outcome Measures: Test material consisted of sentence tests in noise, monosyllables in quiet and melody recognition. Results: No statistical significance was noted between the different speech coding strategies at an identical frequency spectrum. Conclusion: This study shows that there is no difference in speech perception with FSP compared to CIS at an extended frequency spectrum. Therefore, the extended frequency spectrum in the low frequencies might explain a benefit of FSP observed in previous studies.

Tenotomy of the middle ear muscles causes a dramatic reduction in vertigo attacks and improves audiological function in definite Meniere's disease

Abstract Conclusions: Because the presented data reveal an immediate and persistent reduction of vertigo and a clear improvement in hearing function and functional scales, we conclude tenotomy to be effective in unilateral, definite Menieres disease – laying the foundation for future prospective, randomized controlled trials. Objectives: This study compares the unique long-term results of tenotomy of the stapedius and tensor tympani muscles in definite Menieres disease refractory to medical treatment and presents a hypothesis on why tenotomy seems effective. Methods: This was an interventional cohort study. The study sample comprised 30 patients (15 males, 15 females; average age 57 ± 13.1 years) with definite Menieres disease (AAO-HNS criteria, 1995). Patients were evaluated pre- and postoperatively using pure tone audiometry, AAO-HNS questionnaires regarding vertigo attacks, functional level scores, and tinnitus, and were followed up for 2–9 years. Postoperative values were calculated for the patient collective as a whole and consequently divided into three equal postoperative terms of 3 years each. Results: A statistically significant improvement of inner ear hearing levels postoperatively (p = 0.041) and a major reduction in vertigo attacks in all groups (p < 0.001) with complete absence of attacks in 26/30 patients was noted. Results remained constant up to 9 years postoperatively. Although tinnitus persisted, the intensity was lower overall (p = 0.013).

Electric acoustic stimulation in patients with postlingual severe high-frequency hearing loss: clinical experience.

BACKGROUND/AIMS The aim of this study was to describe audiological outcomes and surgical considerations in electric acoustic stimulation for patients with severe to profound high-frequency hearing loss. METHODS In this latest series of patients in our center, all patients were supplied with the new (atraumatic) Flex EAS MED-EL electrode. Eleven patients (age 7.62-71.32 years) with profound high-frequency hearing loss were implanted with this electrode, which was designed to preserve residual hearing despite the intracochlear insertion of an electrode array. All patients were operated on by the same surgeon (W.G.). RESULTS The rate of complete or partial hearing preservation was 100% after a mean follow-up period of 7.85 months (range 0.95-15.65 months). CONCLUSION This study proves that both refined surgical techniques and atraumatic electrodes are mandatory to preserve residual hearing after cochlear implantation. Flexible, thin, and free-fitting straight electrodes, such as the MED-EL Flex EAS electrode used in this study, seem to most accurately meet the requirements for hearing preservation in electric acoustic stimulation.

Cochlear Implant Channel Separation and Its Influence on Speech Perception – Implications for a New Electrode Design

There are a variety of factors which can influence cochlear implantation outcome. Channel interaction is one of the variables responsible for audiological performance deterioration in multichannel implants. Electrode design is – among others – one way to decrease the incidence of channel interaction. At present, electrodes differ in overall length, diameter, contact design and distribution, but none of the electrodes available have a distinct variability in the amount of space between contacts across the length of the electrode. The aim of this study was to investigate whether a new electrode design featuring larger contact spacing in the apical part of deeply inserted electrodes would lead to an increase in speech perception. Eighteen postlingually deafened patients fitted with MedEl Combi 40+ or MedEl Pulsar cochlear implants using the MedEl implementation of continuous interleaved sampling participated in this study. Patients were tested in 6 conditions, in which the channel spacing and distribution of electrode contacts in each patient were artificially varied by activating or deactivating different channels. Performance was tested immediately after each change in setup with a monosyllable and sentence test (Hochmaier, Schultz and Moser). Our results showed that the condition with the highest distance between contacts in the apical part (up to 6.4 mm instead of 2.4 mm) is the most effective for the matched map condition: the results improved statistically significantly for the sentence test from 72% in the standard 12-channel condition to 83.2% and from 40.8 to 50% for the monosyllable test. Based on these findings, we present a new electrode design which can help achieve further increases in speech perception with cochlear implants.