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Vallauris, France

Lazard D.S.,French Institute of Health and Medical Research | Giraud A.-L.,French Institute of Health and Medical Research | Gnansia D.,MXM Neurelec | Meyer B.,Service dORL et de chirurgie cervico faciale | And 3 more authors.
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2012

The cochlear implant (CI), by enabling oral communication in severely to profoundly deaf subjects, is one of the major medical advances over the last fifty years. Despite the globally very satisfactory results, individual outcomes vary considerably. The objective of this review is to describe the various factors influencing the results of CI rehabilitation with particular emphasis on the better understanding of neurocognitive mechanisms provided by functional brain imaging. The following aspects will be discussed: 1. Peripheral predictors such as the degree of preservation of nerve structures and the positioning of the electrode array. 2. The duration of auditory deprivation whose influence on brain reorganization is now becoming more clearly understood. 3. The age of initiation of hearing rehabilitation in subjects with pre-lingual deafness influencing the possibility of physiological maturation of nerve structures. 4. The concepts of sensitive period, decoupling and cross-modality. 5. In post-lingually deaf adults, brain plasticity can allow adaptation to the disability induced by deafness, subsequently potentiating CI rehabilitation, particularly as a result of audiovisual interactions. 6. Several studies provide concordant evidence that implanted patients present different phonological analysis and primary linguistic capacities. The results of CI rehabilitation are dependent on factors situated between the cochlea and cortical associative areas. The importance of higher cognitive influences on the functional results of cochlear implantation justify adaptation of coding strategies, as well as global cognitive management of deaf patients by utilising brain plasticity capacities. © 2011 Elsevier Masson SAS. Source


Study of some aspects of the tinnitus treatment for unilateral deaf with an extracochlear electrical stimulation device. In France, there are about 6000 cases of sudden hearing loss, all of them bring with tinnitus. At present, the treatment of chronic tinnitus is based on the natural development or the facilitation of habituation. For the tinnitus, which resist to the habituation, the principle of the treatments consists in facilitating the habituation process. In a sound therapy the use of a sound generator, with a hearing aid if necessary, is proposed in order to facilitate habituation. But, in case of unilateral deafness acoustical habituation is not possible and tinnitus may cause a depression. Electrical stimulation offers a new therapeutic perspective, which overcomes the main problems to habituation. This approach is very promising that's why it seems essential to study some aspects. The project tries to answer to four questions: How do we have to stimulate electrically for a maximal efficiency? how can we fit the electric stimulation for maximal efficiency? When is it necessary to set up the stimulation? Can we intend to apply this technique to subjects having hearing residues? Recent experimental studies have proposed Tinnelec® stimulator of the MXM Company as a therapeutic solution for the difficult tinnitus treatment in-patient with unilateral deafness. Many points will be examined through a clinical study and an animal study. © 2010 Elsevier Masson SAS. All rights reserved. Source


Lazard D.S.,APHP | Lazard D.S.,French Institute of Health and Medical Research | Bordure P.,Hopital Hotel Dieu | Lina-Granade G.,de Chirurgie Cervico Maxillo | And 10 more authors.
Acta Oto-Laryngologica | Year: 2010

Conclusion: Patients implanted with the Digisonic® SP device showed better identification scores than those implanted with the Convex device, with skills continuing to improve over a longer time period. Technological improvements were beneficial in terms of speech perception in quiet. Objective: To compare speech perception skills for post-lingually deaf patients implanted with a previous Neurelec device, the Digisonic ® Convex, with those implanted with a more recent one, the Digisonic® SP, which provides more electrodes and a faster stimulation rate. Methods: This was a retrospective study of 100 implanted patients, 45 with the Digisonic® Convex implant and 55 with the Digisonic® SP. Speech perception (dissyllabic words and sentences, in open set) was evaluated until 1 year after implantation. Results: Patients fitted with the Digisonic® SP implant showed significantly better scores after 3, 6, and 12 months (mean scores: 53%, 62%, and 68% for words; 58%, 69%, and 75% for sentences) than those fitted with the Convex implant (34%, 42%, and 43% for words; 38%, 59%, and 51% for sentences). The improvement in speech perception after implantation for SP patients continued throughout the 12 months for words and 6 months for sentences, versus 6 months for words and 3 months for sentences for Convex patients. © 2010 Informa Healthcare. Source


Verhaert N.,Hospital Edouard Herriot | Verhaert N.,University Hospitals Leuven | Lazard D.S.,Service dORL et chirurgie cervico faciale | Gnansia D.,MXM Neurelec | And 8 more authors.
Audiology and Neurotology | Year: 2012

In this prospective study the outcome of the Digisonic® SP Binaural cochlear implant (CI), a device enabling electric stimulation of both cochleae by a single receiver, was evaluated in 14 postlingually deafened adults after 12 months of use. Speech perception was tested using French disyllabic words in quiet and in speech-shaped noise at +10 dB signal-to-noise ratio. Horizontal sound localization in quiet was tested using pink noise coming from 5 loudspeakers, from -90 to +90° along the azimuth. Speech scores in quiet were 76% (±19.5 SD) in the bilateral condition, 62% (±24 SD) for the better ear alone and 43.5% (±27 SD) for the poorer ear alone. Speech scores in noise were 60% (±27.5 SD), 46% (±28 SD) and 28% (±25 SD), respectively, in the same conditions. Statistical analysis showed a significant advantage of the bilateral use in quiet and in noise (p < 0.05 compared to the better ear). Significant spatial perception benefits such as summation effect (p < 0.05), head shadow effect (p < 0.0001) and squelch effect (p < 0.0005) were noted. Sound localization accuracy improved significantly when using the device in the bilateral condition with an average root mean square of 35°. Compared with published outcomes of usual bilateral cochlear implantation, this device could be a valuable alternative to two CIs. Prospective controlled trials, comparing the Digisonic SP Binaural CI with a standard bilateral cochlear implantation are mandatory to evaluate their respective advantages and cost-effectiveness. © 2012 S. Karger AG, Basel. Source


Vaerenberg B.,The Eargroup | Vaerenberg B.,University of Antwerp | Pean V.,MXM Neurelec | Lesbros G.,MXM Neurelec | And 5 more authors.
Cochlear Implants International | Year: 2013

Objective: To assess the auditory performance of Digisonic® cochlear implant users with electric stimulation (ES) and electro-acoustic stimulation (EAS) with special attention to the processing of low-frequency temporal fine structure. Method: Six patients implanted with a Digisonic® SP implant and showing low-frequency residual hearing were fitted with the Zebra® speech processor providing both electric and acoustic stimulation. Assessment consisted of monosyllabic speech identification tests in quiet and in noise at different presentation levels, and a pitch discrimination task using harmonic and disharmonic intonating complex sounds (Vaerenberg et al., 2011). These tests investigate place and time coding through pitch discrimination. All tasks were performed with ES only and with EAS. Results: Speech results in noise showed significant improvement with EAS when compared to ES. Whereas EAS did not yield better results in the harmonic intonation test, the improvements in the disharmonic intonation test were remarkable, suggesting better coding of pitch cues requiring phase locking. Discussion: These results suggest that patients with residual hearing in the low-frequency range still have good phase-locking capacities, allowing them to process fine temporal information. ES relies mainly on place coding but provides poor low-frequency temporal coding, whereas EAS also provides temporal coding in the low-frequency range. Patients with residual phase-locking capacities can make use of these cues. © W. S. Maney & Son Ltd 2013. Source

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