Otoacoustic emissions and medial olivocochlear suppression during auditory recovery from acoustic trauma in humans.

It is well known that the large inter-individual susceptibility to noise exposure makes it impossible to predict the degree of hearing loss which will develop after any given intense noise exposure. The acoustic trauma which sometimes occurs affects cochlear mechanisms, the damage being most probably due to deactivation of the active processes of the outer hair cells (OHCs), which receive direct efferent innervation. The present report is of a follow-up study involving young military personnel recovering auditively from impulse noise exposure, and seeks to assess changes in cochlear status by means of otoacoustic emissions (OAEs) and their modulation by the medial olivocochlear (MOC) system. The study investigated the relationship between recovery of cochlear function and variables that could serve as predictors of vulnerability to noise-induced hearing loss (NIHL). Thirty-six subjects with unilateral NHIL above 4 kHz were included. Normal and affected ears were compared with respect to click-evoked and spontaneous OAEs (CEOAEs and SOAEs, respectively) and for contralateral CEOAE suppression. Measurements were obtained: (i) just after the traumatic exposure (D0); (ii) 3 days after this first measurement (D3); and (iii) 30 days after (D30). Significant improvement in the 4, 6 and 8 kHz thresholds was observed for the affected ear, with large inter-subject variability. No significant change was observed in CEOAE amplitude or MOC suppression, whereas incidence of SOAE was found to increase in the affected ear, leading to higher SOAE prevalence on this side I month after the intense noise exposure. There was no significant correlation between NIHL at 4, 6 and 8 kHz and MOC functioning on D0, but significant correlations were obtained between audiometric threshold improvement by D3 and contralateral CEOAE suppression, with better recovery in subjects with greater MOC suppressive action. The MOC system could be an underlying mechanism in post-traumatic auditory threshold recovery.

Loudness growth functions and EABR characteristics in Digisonic cochlear implantees.

Electrically evoked auditory brainstem responses (EABRs) and loudness functions were measured in 14 subjects equipped with an MXM Digisonic cochlear implant. EABRs were evoked by 75-Hz pulse trains presented on the apical electrode. Loudness functions at the same rate and at a rate more conventional for psychoacoustic measurements (300 Hz) were measured using a categorical loudness-scaling procedure. The results revealed a significant difference in the loudness functions measured at 75 and 300 Hz, loudness increasing more steeply with stimulus intensity for the latter rate. Significant correlations between EABR wave V thresholds and perceptual thresholds measured at both 75 and 300 Hz were observed. Furthermore, in 8 out of the 14 patients, EABR wave V saturated at a stimulus level corresponding precisely to the loudest bearable, i.e. "Too loud" level for the 300-Hz stimulation rate; this same level corresponded to the "Comfortable" loudness level for the 75-Hz stimulation rate. On average, an almost linear relationship was observed over the first half of the loudness range between the stimulus intensity, expressed as a pulse duration in log units, and wave V amplitude in dB. Although further investigation is required before maximum comfort levels can be predicted reliably from EABR measures in individual subjects, these results indicate new directions regarding the estimation of perceptual dynamic range limits on the basis of EABR measures in cochlear implantees.

Evaluation of cochlear implanted children's voices.

Cochlear implant (CI) is a good means in developing communication in deaf children. Nevertheless, compared to children with the same age, CI patients' voices are far from being similar. In this work, the voice of CI children has been compared with the voice of corresponding normal children (same age, same sex) included in the main stream. Six girls and two boys participated to the experiment. The phonetic material was a paragraph of the French standard text La bise et le soleil (The North Wind and the Sun). An objective and a subjective analysis of the voice were done and parameters were compared between both groups of people (implantees and control). Studied parameters were voice pitch, intensity, fluency, pauses, articulation and pleasantness in the objective analysis, and voice pitch, formants, and duration for the objective study. It appeared that intensity variations were different between control and implanted subjects. Also voice formants were not situated in the same region regarding the normal ranges, but differences were difficult to assess. Globally, the main change was in the speaking duration. This method is open for further studies and points out some relevant items for an efficient use in rehabilitation sessions.

[Language comprehension by children with profound congenital deafness after cochlear implant]. / Compréhension du langage par les enfants sourds profonds congénitaux au moyen de l'implant cochléaire.

The consequences of profound deafness on oral language development in children are drastic and well-known. Modern multichannel cochlear implant (CI) has been proven to enhance speech production skills in prelingually deaf children. Speech production skills, however, are known not to be a reliable reflection of oral language competence as a whole. Language is an acquired common code in a specific group, enabling exchange of ideas, feelings and knowledge. In humans, speech is one of the channels conveying language. Assessing language development in CI children is more difficult than simply assessing speech production skills. Many factors may contribute to a poor or an excellent outcome, making it difficult to compare groups of children wearing or not wearing CI. The present study compared receptive language levels in paired matched children from CI and non-CI groups. The main conclusion of this study is that language comprehension scores grow significantly higher over time post-surgery in CI than in paired-matched non-CI children, despite better initial pure tone audiometric thresholds of the latter.

Comprehension of language in congenitally deaf children with and without cochlear implants.

The consequences of profound early deafness on oral language in children are drastic. The modern cochlear implant (CI) has been shown to enhance speech production skills in prelingually deaf children. Many factors may contribute to a poor or an excellent outcome, making it difficult to compare groups of children wearing or not wearing cochlear implants. The present study compared receptive language levels in matched pairs of children from CI group and non-CI groups. The pre-op receptive language development curve suggest a possible growth over time with the maturation and the speech therapy. Comparison showed that the slope for post-op CI children to be greater than for non-CI children, and that this difference is statistically significant, and that the slope for CI children to be greater post- than pre-operatively. The main conclusion is that receptive language scores grow significantly higher over time after surgery in CI than in pair-matched non-CI children, despite better initial pure tone audiometric thresholds of the latter.

Cochlear implants for adults obtaining marginal benefit from acoustic amplification: a European study.

OBJECTIVE: This study aimed to examine the application of a speech recognition score of 30% on open-set word materials as the upper limit for preoperative performance in determining cochlear implant (CI) candidacy for European non-English-speaking hearing-impaired persons. This study also aimed to determine the effect of implantation on residual pure-tone hearing thresholds and to determine the incidence and benefit of a contralateral hearing aid postimplant. STUDY DESIGN: The single-subject design study, involving 20 postlinguistically deafened subjects, compares preoperative performance with hearing aids to postoperative performance with a CI at 6 months after surgery. Subjects were implanted with either the Nucleus Mini 22 or the Nucleus 24 CI systems implementing the MPEAK and SPEAK coding strategies. Fourteen subjects meeting the selection criteria were accrued consecutively specifically for inclusion in the study, whereas the remaining 6 retrospectively implanted subjects were identified for inclusion via patient records. PATIENTS: The investigation included 8 clinics over 3 countries (France, Germany, and Spain) and involved 20 postlinguistically deafened subjects who obtained marginal benefit from acoustic amplification before surgery. Nineteen subjects were older than 18 years of age with 1 subject being 14 years old included in the data report as well. MAIN OUTCOME MEASURES: Open-set speech recognition was evaluated before and after surgery using recorded word lists and sentence lists in the subject's native language to determine benefit from the treatment. Baseline audiograms were obtained before surgery for frequencies of 0.25-8.0 kHz for both ears and compared to pure-tone hearing thresholds measured at 1 month after surgery to determine the effect of the implantation on residual hearing. Additionally, a questionnaire was administered to determine the incidence and benefit of continued hearing aid use in the contralateral ear postimplant. RESULTS: Nineteen of the 20 study subjects displayed a significant benefit after surgery at 6 months after switch-on for open-set speech recognition. The remaining subject displayed no significant change in performance on objective testing. The implantation resulted in a significant downward shift in hearing thresholds for the implant ear in the majority of subjects. However, 50% of subjects displayed conservation of some residual hearing. For the majority of subjects, hearing aid use in the contralateral ear was discontinued because of lack of perceived benefit after surgery. CONCLUSIONS: The Nucleus Multichannel CI provides a significant benefit for postlinguistically deafened adults who display marginal benefit from acoustic amplification. Therefore, in French-, German-, and Spanish-speaking clinics, a speech recognition score of 30% on open-set word materials is considered an appropriate upper limit for preoperative performance in determining CI candidacy. In view of a significant downward shift in pure-tone thresholds in the implant ear for the majority of subjects, in cases of asymmetry, it is recommended that the poorer ear be implanted. After surgery, the majority of subjects did not perceive an added benefit from continued use of their contralateral hearing aid.

Correlation between electrical auditory brainstem response and perceptual thresholds in Digisonic cochlear implant users.

OBJECTIVES: To examine the relationships between psychophysical perceptions and the electrically evoked auditory brainstem responses (EABRs) in multichannel cochlear implant (CI) users and to determine the effectiveness of EABRs in electrode failure. DESIGN: A descriptive study reported the EABR characteristics while the different electrodes were activated. Characteristics of the EABR and of the perceptual measures served as compared variables in a correlational study. SETTING: The study was carried out in the audiology clinic of an otolaryngology department at a university hospital. PATIENTS: The subjects consisted of nine consecutively selected habitual Digisonic DX1OR multichannel CI users. Seven patients were postlinguistically deafened adult patients; two were congenitally deaf children. MAIN OUTCOME MEASURES: Ipsilateral recordings were performed using a previously published method. Morphology, latency, and amplitude measures of the EABR recordings were described, computed, and compared with the literature data for EABRs obtained while activating other types of CI and for acoustically evoked ABRs. Correlations between EABRs and behavioral perception thresholds were analyzed using the parametric Pearson's correlation test. RESULTS: EABRs allowed the authors to detect failure of no. 10 electrode integrity in one child. Perceptual threshold measures were found to be highly significantly related to the EABR threshold across subjects and electrode position (n = 31, r = 0.98; P < 0.001; linear regression equation: perceptual threshold = 1.06 EABR threshold + 0.76). The latencies and amplitudes were found to be similar to those described in the literature. CONCLUSIONS: EABRs may be used to estimate settings for the Digisonic DX10 CI even in a pediatric population, although they cannot entirely replace behavioral measurements, especially in children. The EABR can be employed for electrode dysfunction diagnosis. Further studies are needed to determine whether recordings of EABR quality could contribute to the evaluation of functional prognosis during the rehabilitation.

Auditory cortex activation in deaf subjects during cochlear electrical stimulation. Evaluation by functional magnetic resonance imaging.

RATIONALE AND OBJECTIVES: The authors detect activation in the auditory cortex during cochlear electrical stimulation in deaf patients using functional magnetic resonance (MR) imaging. METHODS: Stimulating electrode was inserted gently under local anesthesia close to the round window membrane of the cochlea in seven cochlear implant candidates. These patients suffered from postlingual-acquired deafness. Four patients were stimulated above the electrical perception threshold and three below the electrical discomfort threshold. Functional scans (fast low-angle shot 91 mseconds/60 mseconds) were acquired in an oblique axial plane running parallel to the sylvian fissure. Four consecutive series of six images were obtained in 6 minutes. The acquisition time of each image was 15 seconds. RESULTS: During electrical cochlear stimulation below the discomfort threshold, the three patients described "auditory" sensations with activation of the superior temporal regions. In two patients with electrical stimulation of the left ear, the maximum signal intensity increased by 8.42% in the right auditory cortex and 5.69% in the left. In one patient with a right electrical stimulation only the left cortex was activated. Electrical cochlear stimulation above the perception threshold induces no significant activation in the auditory cortex. CONCLUSION: Functioning MR imaging can detect activation in the auditory cortex during cochlear electrical stimulation in deaf patients using a conventional 1.5-tesla system in a routine hospital environment. Further studies are needed to investigate its usefulness in clinical practice.

Minimal endoscopic approach to subperiosteal orbital abscess.

OBJECTIVE: To limit endoscopic abscess drainage to the opening of the ethmoid cells involved, adjacent to the subperiosteal orbital abscess. DESIGN: Prospective study. PATIENTS: Twenty children with subperiosteal orbital abscess complicating acute sinusitis. INTERVENTION: Endoscopic opening of the medial wall of the bulla ethmoidalis and of the lamina papyracea. RESULTS: The limited endoscopic approach allowed subperiosteal orbital abscess drainage in all patients with positive clinical outcomes. Extensive ethmoidectomy was not necessary to achieve drainage. CONCLUSIONS: Endoscopic subperiosteal orbital abscess drainage does not require complete ethmoidectomy as was previously performed and can be limited to the opening of the bulla ethmoidalis and the lamina papyracea through the bulla ethmoidalis.

EABRs and surface potentials with a transcutaneous multielectrode cochlear implant.

In a previous study, the authors described a technique for recording ipsilateral EABRs using the DIGISONIC MXM cochlear implant (Gallégo et al, Acta Otolaryngol (Stockh) 1996; 116: 228-33) and showed that the EABR input/output functions were very similar across electrodes. In the present study a test of electrode functioning based on the recording of surface potentials is presented. Then, for each electrode the relationship between EABR thresholds and hearing thresholds was determined. Lastly, the relationship between EABR parameters and patients' performances was studied. The results show that the functioning of each implanted electrode can be assessed quickly, accurately and objectively. Furthermore it is demonstrated that a strong correlation between EABR and hearing threshold can be obtained using an automatic EABR wave detection technique. Finally it is shown that EABR inter-peak intervals are related to patient performance. These results are of the utmost importance for cochlear implant setting in children as they indicate a method of objective assessment of the functioning of each electrode and of the corresponding hearing threshold.

Evidence of peripheral hearing asymmetry in humans: clinical implications.

Auditory system hemispheric asymmetry in language processing is well-established, and there are many indications of lateralization as of the peripheral auditory system i.e., as of the cochlea. The left ear is more susceptible to noise damage; tinnitus is more predominant there, while spontaneous otoacoustic emissions (SOAEs) are more often found in the right ear. The present study addressed the following two questions: Does this right-ear SOAE prevalence exist as early as preterm birth? Is there any functional asymmetry in the medial olivo-cochlear (MOC) efferent system, known to modulate outer hair cell contractions? The study involved 483 preterm neonates (gestional age: 24-37 weeks) and 70 right-handed adults (age: 18-31 years). In each ear, SOAEs and evoked otoacoustic emissions (EOAEs) were recorded and analysed, and, for the adults, functional MOC system assessment was made. Results showed SOAEs and EOAE amplitude to be right-predominant and in adults a right MOC functional predominance. These results indicate peripheral auditory system lateralisation, and an early origin thereof. The MOC system being thought to play a protective role, its physiological lateralisation may be relevant to the left prevalence of tinnitus and of auditory fatigue.

Discoordinate pharyngolaryngomalacia.

In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective solution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe those cases of laryngomalacia in which endoscopic treatment did not reverse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalacia with complete supraglottic collapse during inspiration, without shortened AEFs or redundant mucosa, and with associated pharyngomalacia. Twenty-seven of 82 children with severe laryngomalacia presented a DPLM. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these patients. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aortopexy). Tracheostomy was necessary in 13 children. Bi-level positive airway pressure (BiPAP) was used successfully in 2 children and tracheotomy was avoided. Treatment still needs to be better defined.

Effectiveness of ribosomal fractions of Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and the membrane fraction of Kp (Ribomunyl) in the prevention of clinical recurrences of infectious rhinitis. Results of a multicenter double-blind placebo-controlled study.

A multicenter, double-blind, placebo-controlled study was conducted to investigate the efficacy of an immunostimulant, Ribomunyl, in the prevention of recurrences of infectious rhinitis in adults. This trial involved 327 patients (168 Ribomunyl treated and 159 placebo cases) with an average of 4.3 +/- 1.8 rhinitis episodes per patient recorded during the year preceding the study. The main criterion of efficacy was the cumulative number of recurrences of infectious rhinitis during a 6-month follow-up period, as analyzed by standard tests. An additional analysis of relative risk of recurrences used multivariate failure for time data. Ribomunyl was effective throughout the study period, starting from the first month of treatment: a mean of 1.0 +/- 1.1 recurrences was recorded in the Ribomunyl group as compared to 1.5 +/- 1.4 recurrences in the placebo group; this indicated one-third fewer infections (P = 0.001). The protective effect of Ribomunyl on the relative risk for recurrences was estimated to be 0.58 by multivariate analysis (95% CI: 0.43-0.78, P = 0.0001). Analysis of secondary criteria also favored Ribomunyl: 38.5% less antibiotic courses per patient (0.8 +/- 1.3 vs 1.3 +/- 1.6; P = 0.002) and the number of days with antibiotics (5.6 +/- 9.3 vs 9.1 +/- 12.1; P = 0.002).

[Value of auditory evoked potentials of the brain stem in patients with a Digisonic cochlear implant]. / Intérêt des potentiels évoqués auditifs électriques du tronc cérébral chez les patients porteurs d'un implant cochléaire Digisonic.

We report our techniques of electrically elicited Auditory Brainstem Responses (eABR) in Digisonic DX 10 cochlear implanted patients and summarize the theoretical interests of objectives measures in pre-, per- and post-operative periods of the cochlear implantation process. This report demonstrates the major interest of eABR during rehabilitation with a cochlear implant. EABR allowed us to detect the lack of device integrity in one electrode in one patient. The quality of electrically elicited responses can contribute to appreciate the electrophysiological responses during electrical stimulation. We found a very strong correlation between the objective thresholds (obtained by means of eABR) and subjective ones (obtained by means of behavioral methods); this is of major interest in the pediatric populations.

Contrasting strategic approaches to the management of subglottic hemangiomas.

The standards of treatment of subglottic hemangiomas are steroids and laser vaporization. If these methods do not provide a sufficient airway, a tracheotomy may be required. Analysis of the data available in the literature shows that there is a place for other therapeutic solutions. Open surgical excision could be one of them but is controversial. So far, it represented a 'last' resort procedure before tracheotomy. Our approach to open surgical excision is different. A prospective decision is taken in the initial therapeutic approach. Infants are considered candidates for excision in cases of large hemangiomas that extend beyond the limits of laser. Laser is, then, avoided in order not to damage the overlying mucosa. Interferon is not utilized because a rapid effect is not expected on the respiratory distress. Open surgical excision without tracheotomy is performed. A cricoid enlargement is associated at the end of the procedure. Risk for post-operative subglottic stenosis is limited. When conceived this way, open surgical excision seems effective to manage large life-threatening hemangiomas.

Is perilymphatic pressure altered in tinnitus?

Tinnitus is characterized by the continuous or intermittent auditory perception of various sounds (buzzing, whistling, etc.) in the absence of any external stimulus. Perilymphatic hyperpressure is one of the numerous mechanisms which could hypothetically be involved in tinnitus generation. In the present experiment, perilymphatic pressure was measured indirectly using the tympanic membrane displacement technique. Twenty-five tinnitus patients were investigated at 10, 15 and 20 dB above the acoustic reflex threshold with ipsilateral stimulation. The variables Vi (inward tympanic displacement), Vm (mean tympanic displacement) and their variations according to stimulus level were compared between tinnitus sufferers and age-matched or hearing-matched controls. Tympanic displacement was measured in sitting and supine positions so as to evaluate cochlear aqueduct patency. No systemic changes in response occurred in tinnitus patients, except at a high stimulation level, perhaps due to hearing impairment.

Ipsilateral ABR with cochlear implant.

Ipsilateral ABR recording technique was developed with the MXM DIGISONIC DX10 cochlear implant, involving, firstly, setting of recording variables with regard to implant and ABR constraints, and, secondly, enhancement of recording quality by signal processing. The resulting recording quality then enabled us to characterize ABR latency, amplitude and wave reproductibility according to stimulus intensity and stimulation site (electrode stimulated). The findings agree with those of the literature on contralateral human and ipsilateral animal studies. Waves III and V amplitude increased with stimulus intensity. Waves III and V latency was insensitive to stimulus intensity or site. ABR quality diminished basally.

One-stage tracheal reconstruction of congenital tracheal stenosis.

Congenital tracheal stenosis (CTS) is a condition difficult to manage and associated with a high mortality rate. The principles of one-stage laryngotracheoplasty have been adapted to the surgical management of CTS. Three children underwent a one-stage anterior tracheoplasty with costal cartilage grafting and without cardiopulmonary bypass. Extubation was performed within 13 days. One child developed granulation tissue one month postoperatively, and this was removed endoscopically. The three children were free of respiratory obstruction signs during follow-up ranging from 8 months to 3 years. Postoperative endoscopies have shown growth of the grafted trachea.

[Submental myocutaneous island flaps: anatomical study and prospective use]. / Le lambeau musculo-cutané sous mental en îlot: étude anatomique et perspectives d'utilisation.

The authors describe a myocutaneous cervical island flap based on the submental vessels. The anatomy based on 12 fresh cadaver dissection is outlined the submental arteries were injected with methylene blue, and the flap design and technique were studied. The flap has a long, reliable pedicle and cutaneous dimension measured 10 x 5 cm. The flap has an excellent skin color match and wide are of rotation and can extend to the whole homolateral face, the whole oral cavity, the whole homolateral oropharyngeal. The donor site scare dissimulated under the mandible is perfectly acceptable.

Spontaneous and evoked otoacoustic emissions in pre-term and full-term neonates: is there a clinical application?

In neonates and infants, hearing impairment leads to impaired language and cognitive development. For that reason, early detection of this sensory deficit is of outstanding importance, particularly in pre-term neonates, who constitute a high risk population in regard to very early acquired hearing loss. Evoked (EOAE) and spontaneous otoacoustic emission (SOAE) recording in 93 pre-term and full-term neonates revealed that this technique is potentially useful for auditory screening in neonatology units. EOAEs and SOAEs can be recorded successfully from 30 weeks of conceptional age. SOAEs were found to be prevalent in females and presented higher peak numbers in right than in left ears. Furthermore, SOAE incidence in pre-term and full-term neonates was found to be high in EOAE positive ears, associated with strong and robust EOAEs.