The French MBAA2 sentence recognition in noise test for cochlear implant users.

OBJECTIVE: The "Marginal benefit from acoustic amplification" version 2 (MBAA2) sentence test has been used in France in the routine evaluation of cochlear implant (CI) users for 20 years. Here we present four studies that characterise and validate the test, and compare it with the French matrix sentence test. DESIGN AND SAMPLE: An analytic method was developed to obtain speech recognition threshold in noise (SNR50) from testing at a fixed signal to noise ratios (SNRs). Speech recognition was measured at several fixed SNRs in 18 normal-hearing listeners and 15 CI listeners. Then, the test-retest reliability of the MBAA2 was measured in an additional 15 CI listeners. Finally, list equivalence was evaluated in eight CI listeners. RESULTS: The MBAA2 test produced lower SNR50s and SNR50s were obtained in more CI listeners than with the French matrix test. For the MBAA2, the standard deviation of test-retest differences in CI listeners was around 1 dB SNR. Three lists had deviant difficulty and nine low item-to-total correlations. CONCLUSIONS: We propose to reduce the number of MBAA2 test lists to reduce variability. The MBAA2 test has high test-retest reliability for percent correct and SNR50, and is suitable for the assessment of cochlear implant patients.

Increased audiovisual integration in cochlear-implanted deaf patients: independent components analysis of longitudinal positron emission tomography data.

It has been demonstrated in earlier studies that patients with a cochlear implant have increased abilities for audio-visual integration because the crude information transmitted by the cochlear implant requires the persistent use of the complementary speech information from the visual channel. The brain network for these abilities needs to be clarified. We used an independent components analysis (ICA) of the activation (H2(15)O) positron emission tomography data to explore occipito-temporal brain activity in post-lingually deaf patients with unilaterally implanted cochlear implants at several months post-implantation (T1), shortly after implantation (T0) and in normal hearing controls. In between-group analysis, patients at T1 had greater blood flow in the left middle temporal cortex as compared with T0 and normal hearing controls. In within-group analysis, patients at T0 had a task-related ICA component in the visual cortex, and patients at T1 had one task-related ICA component in the left middle temporal cortex and the other in the visual cortex. The time courses of temporal and visual activities during the positron emission tomography examination at T1 were highly correlated, meaning that synchronized integrative activity occurred. The greater involvement of the visual cortex and its close coupling with the temporal cortex at T1 confirm the importance of audio-visual integration in more experienced cochlear implant subjects at the cortical level.

Does brain activity at rest reflect adaptive strategies? Evidence from speech processing after cochlear implantation.

In functional neuroimaging studies, task-related activity refers to the signal difference between the stimulation and rest conditions. We asked whether long-term changes in the sensory environment may affect brain activity at rest. To answer this question, we compared regional cerebral blood flow between a group of normally hearing controls and a group of cochlear-implanted (CI) deaf patients. Here we present evidence that long-term alteration of auditory experience, such as profound deafness followed by partial auditory recuperation through cochlear implantation, leads to functional cortical reorganizations at rest. Without any visual or auditory stimulation, CI subjects showed changes of cerebral blood flow in the visual, auditory cortex, Broca area, and in the posterior temporal cortex with an increment of activity in these areas from the time of activation of the implant to less than a year after the implantation.

[Cochlear implants in elderly: performance outcomes in the long term]. / L'implant cochléaire chez le sujet âgé: évolution des performances à long terme.

OBJECTIVES: To study and compare the evolving capacities of speech discrimination with cochlear implants in older patients compared to patients implanted at a younger age. METHODOLOGY: A retrospective study comparing a group of 52 patients aged over 65 with a control group of 58 patients aged between 30 and 50 years, followed for 5 years after implantation. We analyzed and compared the evolution of speech discrimination in silence (disyllabic words, sentences) and noise (sentences, S/N ratio: +10 dB) after implantation. RESULTS: In the group of elderly patients, the speech discrimination in silence remains stable over time (for disyllabic words, score at 6 months: 72.8 +/- 20.2%; score at 5 years: 73.7% +/- 19.7). Discrimination in noise tends to improve (mean score at 6 months: 70.5% +/- 21.5; score at 5 years: 76.9% +/- 16.9). The results obtained are in silence are comparable to the results of the group of patients aged between 30 and 50. In noise, their performance remains lower than the control group (mean differences between scores: -10.8; confidence interval at 95%: -17.9, -5.3). CONCLUSION: The cochlear implant is effective over the long term in elderly patients, for speech discrimination in quiet and in noise. In silence, their performance is comparable to younger patients with implants.

The humanitarian and outreach ethics charter in ENT. Ethics at the heart of missions.

Humanitarian action, in the broad sense, including global outreach missions by ENT physicians, has been effective for many years. These volunteer missions have not had any specific regulatory framework, be it medical, social or above all ethical. The testimony of ENT physicians in certain "recipient" countries, in particular during the 2017 Paris Congress of the International Federation of Otorhinolaryngological Societies (IFOS), revealed the importance of adequate coordination between "provider" and "recipient" teams. Several ethical reports have been made, but few specifically focused on ENT outreach. The present review is based on feedback from several missions given to the French Society of OtoRhinoLaryngology and Head and Neck Surgery (SFORL) and IFOS, and on a review of the literature. A specific charter of global outreach and humanitarian missions in ENT has been drawn up. This review is essential for optimizing the sharing of knowledge and training in otorhinolaryngology across the world while respecting mandatory sociocultural and ethical rules.

Vestibular disorders: clinician ENT perspective on the need for research and innovation.

OBJECTIVE: Vertigo and dizziness are a frequent reason for medical consultation. However, diagnostic and therapeutic management is sometimes limited, and clinicians are faced with many unmet needs. The purpose of this study was to identify and prioritize these needs. METHODS: A questionnaire methodology was used to determine the need for innovation in vestibular disorder management. The questionnaire was sent to 19 teams in French-speaking ENT centers. We measured the concordance of the panel of experts on 56 questions related to the different vestibular pathologies encountered and the desired modalities of innovations. RESULTS: Thirteen questions were identified as priorities. The needs expressed by the experts had better knowledge of the pathophysiological mechanisms of the main diseases encountered and the development of new treatment modalities. Particular attention was paid to inner ear imaging techniques and the development of specific electrophysiology techniques. DISCUSSION: Some of the anticipated innovations are already under development, such as new inner ear fluid imaging techniques (hydrops visualization using MRI) or in situ treatments (transtympanic dexamethasone or gentamicin injections). Others, such as new electrophysiological techniques, are still not fully developed CONCLUSION: This study provides a snapshot of the needs of the medical profession in vestibular disorder management. It highlights a real concern of the attending personnel, as well as a critical need to optimize the means of diagnosing and treating patients with vestibular disorders.

MRI evaluation of the endolymphatic space in otosclerosis and correlation with clinical findings.

PURPOSE: The purpose of this study was to investigate the clinical features of ears with otosclerosis and their correlation with endolymphatic hydrops and blood-labyrinth barrier (BLB) impairment on 3T magnetic resonance imaging (MRI). MATERIALS AND METHODS: This was a single-center retrospective imaging study. Thirty-nine ears from 29 patients (17 men, 12 women; mean age 52±12 [SD] years; range 27-74 years) with non-operated otosclerosis were included. All patients underwent three-dimensional fluid attenuated inversion recovery (FLAIR) MRI sequences performed 4hours after the intravenous administration of a single dose of gadolinium-based contrast material. MRI examinations were analyzed by two radiologists for the presence of saccular hydrops (SH) and BLB impairment. Results of MRI examinations were compared with clinical findings, hearing levels and extent of otosclerotic lesions based on high-resolution computed tomography findings. BLB impairment was evaluated using the signal intensity ratio, ratio of intensities between the basal turn of the cochlea and the medulla. RESULTS: SH was observed in 1/39 (3%) otosclerotic ears and BLB impairment in 8/39 (21%) while 8/29 patients with otosclerosis (28%) had vertigo. No significant associations were found between SH or BLB impairment on MRI, and the presence of vertigo or the degree of sensorineural hearing loss. CONCLUSION: Clinical manifestations of otosclerosis (sensorineural hearing loss and rotatory vertigo) were not significantly associated with MRI findings such as BLB impairment and endolymphatic hydrops. SH was only observed in one patient with obstruction of the vestibular aqueduct by an otosclerotic focus.

Improvement in speech-reading ability by auditory training: Evidence from gender differences in normally hearing, deaf and cochlear implanted subjects.

Several neuropsychological and neuroimaging studies on gender differences in speech processing lead to the suggestion that women use the neural network of predictive and integrative analysis of speech to a larger extent than men. During speech-reading there is indeed a lack of reliable clues for word recognition which should emphasize predictive and integrative strategies of the brain. Our study aimed to explore gender differences in deaf and cochlear implanted (CI) patients at different levels during speech-reading, for words or phonemes, that we consider, correspond to increased involvement of predictive and integrative analysis. We collected speech-reading scores in a control group of normally hearing subjects (n=42) and in a group of deaf patients - who are good speech-readers - tested before, early after and late after cochlear implantation (n=97). Patient groups were almost equally distributed between follow-up and new patients. In normally hearing controls, women speech-read words better than men. This difference was also observed in all patients but not in experienced cochlear implant users. We did not observe a gender difference during speech-reading of isolated phonemes neither for controls nor for patients. We conclude that the better speech-reading ability of women for words but not for phonemes is in line with their greater use of predictive and integrative strategies for speech processing. Furthermore, we observed a progressive cross-modal compensation in male CI users after cochlear implantation which suggests a synergetic perceptual facilitation involving the visual and the recovering auditory modalities. This could lead to an improved performance in both auditory and visual modalities, the latter being constantly recruited to complement the crude information provided by the implant. Altogether, our data provide insights into cross-modal compensation in the adult brain following sensory privation.

Prevention of progression to dementia in the elderly: rationale and proposal for a health-promoting memory consultation (an IANA Task Force).

Alzheimer's disease (AD) is the most frequent form of dementia and according to the most recent estimation it affects nearly 27 million people in the world. The onset of the disease is generally insidious. It is becoming increasingly evident that the underlying pathophysiological mechanisms are active long before the appearance of the clinical symptoms of the disease. In the current context, it is important to develop strategies to delay the onset of cognitive decline. Delaying the onset by 5 years would reduce the prevalence by half at term, and a delay of 10 years would reduce it by three-quarters. The effectiveness of currently suggested preventive approaches remains to be confirmed, but certain strategies could be applied straight away to at-risk subjects. We propose that a health-promoting memory consultation should be set up for elderly persons who have attended a specialized memory consultation and in whom the diagnosis of dementia and of AD in particular, has not been established by standardized tools. Through this consultation, they would be offered full multidimensional investigation of all aspects of their health status, follow-up could be organized, general practitioners in private practice could be made more conscious of this population and the elderly could be made more aware of the risk factors to which they are exposed. The development of an information policy for the elderly would meet a present need. In our reflection, we must take into account the question of how to give this preventive consultation its due place in the healthcare pathway of the elderly person in order to ensure coordinated follow-up with all the other health professionals involved. The principle of the health-promoting memory consultation is undergoing validation in a large French multicentre preventive trial in 1200 frail elderly persons aged 70 years followed for three years, the Multidomain Alzheimer Preventive Trial (MAPT).

Categorization of common sounds by cochlear implanted and normal hearing adults.

Auditory categorization involves grouping of acoustic events along one or more shared perceptual dimensions which can relate to both semantic and physical attributes. This process involves both high level cognitive processes (categorization) and low-level perceptual encoding of the acoustic signal, both of which are affected by the use of a cochlear implant (CI) device. The goal of this study was twofold: I) compare the categorization strategies of CI users and normal hearing listeners (NHL) II) investigate if any characteristics of the raw acoustic signal could explain the results. 16 experienced CI users and 20 NHL were tested using a Free-Sorting Task of 16 common sounds divided into 3 predefined categories of environmental, musical and vocal sounds. Multiple Correspondence Analysis (MCA) and Hierarchical Clustering based on Principal Components (HCPC) show that CI users followed a similar categorization strategy to that of NHL and were able to discriminate between the three different types of sounds. However results for CI users were more varied and showed less inter-participant agreement. Acoustic analysis also highlighted the average pitch salience and average autocorrelation peak as being important for the perception and categorization of the sounds. The results therefore show that on a broad level of categorization CI users may not have as many difficulties as previously thought in discriminating certain kinds of sound; however the perception of individual sounds remains challenging.

[Vestibular dysfunction after cochlear implantation: a national multicenter clinical study]. / Vertiges et troubles de l'equilibre après implantation cochléaire. Analyse préliminaire des données du PHRC national: "Diffusion de la technique des implants cochléaires: etude d'impact des conséquences médicales, sociales et economiques".

Vertigo and dizziness are the most common complications of cochlear implantation. Data of a multicentric study about clinical aspects and cost utility were collected for vertigo and dizziness: incidence, clinical and treatment were analyzed among 469 adults and children. Results demonstrated that 16% of adults and 3% of children experienced dizziness postoperatively. In a few cases a specific mechanism as perilymphatic fistula was identified. In other cases the mechanism underlying delayed vertigo remains speculative and endolymphatic hydrops was suggested.

PET-imaging of brain plasticity after cochlear implantation.

In this article, we review the PET neuroimaging literature, which indicates peculiarities of brain networks involved in speech restoration after cochlear implantation. We consider data on implanted patients during stimulation as well as during resting state, which indicates basic long-term reorganisation of brain functional architecture. On the basis of our analysis of neuroimaging literature and considering our own studies, we indicate that auditory recovery in deaf patients after cochlear implantation partly relies on visual cues. The brain develops mechanisms of audio-visual integration as a strategy to achieve high levels of speech recognition. It turns out that this neuroimaging evidence is in line with behavioural findings of better audiovisual integration in these patients. Thus, strong visually and audio-visually based rehabilitation during the first months after cochlear implantation would significantly improve and fasten the functional recovery of speech intelligibility and other auditory functions in these patients. We provide perspectives for further neuroimaging studies in cochlear implanted patients, which would help understand brain organisation to restore auditory cognitive processing in the implanted patients and would potentially suggest novel approaches for their rehabilitation. This article is part of a Special Issue entitled .

Menière's disease: pathophysiology and treatment.

Menière's disease is defined by the association of 4 symptoms: vertigo attacks, fluctuating hearing loss, tinnitus and an auricular plenitude sensation. The pathophysiology is commonly explained by a distension of membranous labyrinth by the endolymph, equally called endolymphatic hydrops. Recent studies also tend to relate the disease to immune mechanisms. The treatment is medical in the majority of patients but there is no international consensus on the management of the different stages of Menière's disease. Regarding the lack of clinical studies clearly demonstrating the effectiveness of a certain therapy or another. the recommendations are usually based on the empirical experience of practitioners and on the observation of a marked amelioration at 2 years of treatment in the majority of patients. The treatment of the acute phase of Menière's disease is basically symptomatic. Vestibular suppressant drugs have a well-established record in controlling acute attacks of vertigo. Most have variable anticholinergic, anti-emetic and vestibular sedative effects. If necessary, the administration of benzodiazepines will help to alleviate anxiety. Long term management of Menière's disease includes a low salt diet, the use of diuretics in the post-crisis phase, and the very common use in Europe of histaminergic agents. Corticosteroids are used in bilateral forms of Menière's disease, particularly if an autoimmune basis is suspected. All authors insist on the interest and the importance of regular follow-up, especially with regard to the psychological status and responsiveness to treatment of the patient. Surgical indications are rare and the least invasive procedures are used first. The choice of the procedure should take into consideration the need to preserve the auditory function of the patient.

Ciliary neurotrophic factor prevents unweighting-induced functional changes in rat soleus muscle.

The purpose of the present work was to see whether changes in rat soleus characteristics due to 3 wk of hindlimb suspension could be modified by ciliary neurotrophic factor (CNTF) treatment. Throughout the tail suspension period, the cytokine was delivered by means of an osmotic pump (flow rate 16 microg. kg(-1). h(-1)) implanted under the hindlimb skin. In contrast to extensor digitorum longus, CNTF treatment was able to reduce unweighting-induced atrophy in the soleus. Twitch and 146 mM potassium (K) tensions, measured in small bundles of unloaded soleus, decreased by 48 and 40%, respectively. Moreover, the time to peak tension and the time constant of relaxation of the twitch were 48 and 54% faster, respectively, in unloaded soleus than in normal muscle. On the contrary, twitch and 146 mM K contracture generated in CNTF-treated unloaded and normal soleus were not different. CNTF receptor-alpha mRNA expression increased in extensor digitorum longus and soleus unloaded nontreated muscles but was similar in CNTF-treated unloaded muscles. The present results demonstrate that exogenously provided CNTF could prevent functional changes occurring in soleus innervated muscle subject to unweighting.