OBJECTIVE:This study aimed to investigate if robot-assisted image-guided cochlear implant surgery can be used efficiently and safely in our center. STUDY DESIGN:Clinical prospective interventional monocentric study. SETTING:The study was conducted in subjects over the age of 18 years who underwent unilateral cochlear implantation using a robotic system between September 2021 and December 2022. PATIENTS:Subjects were included if the anatomy allowed for a safe trajectory for direct cochlear access to be planned. INTERVENTION:Subjects underwent surgery using the robotic procedure. MAIN OUTCOME MEASURES:The ratio of successful electrode array insertions through the robotically drilled tunnel. RESULTS:Ten subjects were included. The robot-assisted procedure was successful in nine cases (one bur failure). No case of facial palsy was observed. The mean drilling accuracy was 0.13 ± 0.08 mm (range, 0.03-0.26 mm) at the facial nerve, 0.14 ± 0.09 mm (range, 0.07-0.38 mm) at the chorda tympani, and 0.2 ± 0.12 mm (range, 0.03-0.26 mm) at the round window. In all robotically drilled cases, it was possible to insert the electrode array through the tunnel. One case required a second-turn cochleostomy due to an unexpected fibrosis of the basal turn. One case of partial electrode array insertion required conversion to standard procedure, which showed no improvement. For the remaining seven cases, the mean insertion depth was 520 ± 104 degrees (range, 378-712 degrees). The surgical time was 247 ± 37 minutes (range, 177-299 minutes). CONCLUSION:This study demonstrated the safety and efficiency of the direct tunnel approach.

PURPOSE:Hearing loss is a common deficit that remains underdiagnosed. To address this issue, automatic self-hearing tests have been developed. These tools are based on pure-tone detection and speech-in-noise evaluation. The present study evaluated the acceptability and the feasibility of hearing screening for patients consulting in private family practice medicine. METHODS:Data were collected in 3 French medical care centers from May through November 2022. Fast pure-tone (SoTone) and speech-in-noise (SoNoise) tests were available on the SONUP application. Three parameters were measured: (1) duration of the protocol; (2) pertinence of performing both pure-tone and speech-in-noise tests; and (3) number of hearing-impaired patients detected and their follow-up (ie, consultation with an ear, nose, and throat [ENT] specialist, and hearing aid fitting). RESULTS:Of the 516 eligible patients, 219 (42%) were able to perform both tests. Among the screened patients, 161 (74%) had negative test results, while 59 (27%) had positive results indicating hearing loss. Although patients were encouraged to consult an ENT specialist, only 14 did so, and 8 agreed to be fitted with hearing aids. The average duration of the tests, including the explanation (1 minute 43 seconds), was 6 minutes 8 seconds. Interestingly, the SoTone (1 minute 10 seconds), appears to be sufficient for detecting hearing loss. CONCLUSIONS:This study supports integration of app-based hearing screenings into family medical care, as it is compatible with routine consultations. The use of tablet-based applications may assist general practitioners by enhancing the diagnosis of hearing disorders.

El 16% de la población adulta y un 50% de las personas mayores de 75 años presentan trastornos auditivos (sorderas, acúfenos). Debido al aumento de la esperanza de vida y a la exposición al ruido, que aceleran el envejecimiento, muchas personas mejorarían su audición con una adaptación audioprotésica. En la actualidad, casi todas las audioprótesis son digitales y con conexión inalámbrica. Estos dispositivos pueden ser retroauriculares, que se colocan sobre el pabellón, o intraauriculares, disimulados más o menos en el conducto auditivo externo. El fundamento de estos aparatos es amplificar la información pertinente (en particular el habla) para dirigirla hacia el tímpano. En este artículo, se describe el funcionamiento y las estrategias de tratamiento de la señal para adaptarse a las diversas situaciones auditivas de los pacientes. Sin duda, la adaptación protésica se basa en un proceso científico, especialmente porque se apoya en un estudio audiológico completo y en programas informáticos de tratamiento de la señal sofisticados. Sin embargo, el éxito de la adaptación audioprotésica requiere también una rehabilitación del paciente, así como un acompañamiento personalizado y frecuente para lograr un ajuste adaptado a la sordera, al entorno, a la vida y a las expectativas de la persona con sordera.

Objectives: Real-time monitoring of cochlear function to predict the loss of residual hearing after cochlear implantation is now possible. Current approaches monitor the cochlear microphonic (CM) during implantation from the electrode at the tip of the implant. A drop in CM response of >30% is associated with poorer hearing outcomes. However, there is prior evidence that CM amplitude can fluctuate in a manner unrelated to hearing trauma, leading to false positives. By monitoring another cochlear response, the auditory nerve neurophonic (ANN), a differentiation between CM drops that result in reduced cochlear output from false positives may be possible. The hypothesis tested in the present work was that ANN/CM ratios measured during a CM drop will increase during drops not associated with postoperative hearing loss. Design: Twenty-eight adult participants with known CM drops during implantation were taken from a larger data set. This contains adult cochlear implant candidates scheduled to receive a Cochlear Nucleus cochlear implant with either the slim-straight or slim-modiolar electrode array with preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted. Patients were recruited from eight international implant sites. Pure-tone audiometry was measured postoperatively and 4 to 6 weeks after implantation. Electrocochleography was measured during and immediately after the implantation of the array in response to a 500-Hz, 6-msec pure-tone pip at 110 dB HL. Results: The ANN/CM ratio rose during CM drops in 19 of these patients and decreased in 9. At the follow-up timepoint, patients with a decreasing ANN/CM ratio had a median hearing loss of 29.0 dB, significantly worse than the group with increasing ratio at 13.3 dB (p = 0.004). Considering only the change in ANN amplitude during a CM drop led to smaller groups (ANN drop during CM drop N = 17, ANN increasing during CM drop N = 6) due to 5 patients having undetectable ANN during the CM drop. Using the ANN alone also led to as poorer prediction of hearing preservation, with median hearing preservation in the ANN increasing group of 12.9 dB, significantly better than the ANN decreasing group of 25 dB (p = 0.02). The group with a decreasing ANN/CM ratio had maximum CM amplitude immediately after insertion lower than the maximum amplitude reached during insertion (mean maximum postinsertion amplitude of 98% of during-insertion amplitude). In comparison, the ANN/CM ratio increasing group tended to have a larger CM amplitude immediately after insertion (mean maximum CM amplitude postinsertion of 164% of the maximum during-insertion amplitude). Conclusions: These data show that the ANN/CM ratio is a measure that can differentiate between patients with CM drops that lead to a loss of residual hearing and those that do not. The ANN/CM ratio is easily measured and responds rapidly during a CM drop, showing clinical promise for improving current and developing approaches to intraoperative monitoring.

INTRODUCTION:Cochlear implantation is a recent approach proposed to treat single-sided deafness (SSD) and asymmetric hearing loss (AHL). Several cohort studies showed its effectiveness on tinnitus and variable results on binaural hearing. The main objective of this study is to assess the outcomes of cochlear implantation and other treatment options in SSD/AHL on quality of life.METHODS:This prospective multicenter study was conducted in 7 tertiary university hospitals and included an observational cohort study of SSD/AHL adult patients treated using contralateral routing of the signal (CROS) hearing aids or bone-anchored hearing systems (BAHSs) or who declined all treatments, and a randomized controlled trial in subjects treated by cochlear implantation, after failure of CROS and BAHS trials. In total, 155 subjects with SSD or AHL, with or without associated tinnitus, were enrolled. After 2 consecutive trials with CROS hearing aids and BAHSs on headband, all subjects chose any of the 4 treatment options (abstention, CROS, BAHS, or cochlear implant [CI]). The subjects who opted for a CI were randomized between 2 arms (CI vs. initial observation). Six months after the treatment choice, quality of life was assessed using both generic (EuroQoL-5D, EQ-5D) and auditory-specific quality-of-life indices (Nijmegen Cochlear implant Questionnaire [NCIQ] and Visual Analogue Scale [VAS] for tinnitus severity). Performances for speech-in-noise recognition and localization were measured as secondary outcomes.RESULTS:CROS was chosen by 75 subjects, while 51 opted for cochlear implantation, 18 for BAHSs, and 11 for abstention. Six months after treatment, both EQ-5D VAS and auditory-specific quality-of-life indices were significantly better in the "CI" arm versus "observation" arm. The mean effect of the CI was particularly significant in subjects with associated severe tinnitus (mean improvement of 20.7 points ± 19.7 on EQ-5D VAS, 20.4 ± 12.4 on NCIQ, and 51.4 ± 35.4 on tinnitus). No significant effect of the CI was found on binaural hearing results. Before/after comparisons showed that the CROS and BAHS also improved significantly NCIQ scores (for CROS: +7.7, 95% confidence interval [95% CI] = [4.5; 10.8]; for the BAHS: +14.3, 95% CI = [7.9; 20.7]).CONCLUSION:Cochlear implantation leads to significant improvements in quality of life in SSD and AHL patients, particularly in subjects with associated severe tinnitus, who are thereby the best candidates to an extension of CI indications.

OBJECTIVE:This study evaluated the diagnostic performances of a tablet-based hearing screening test by assisted-test and self-test modes. DESIGN/METHOD:Measurements were performed with the SoTone tests in normal hearing and hearing-impaired adult participants using an Android tablet and calibrated Bluetooth headphones. The duration of assisted- and self-test modes were compared. Receiver operating characteristic (ROC) curves were plotted after calculations of sensitivity and specificity at 20, 30, and 35 dB HL cut-off values. STUDY SAMPLE:217 participants performed the tests. The effect of test mode (assisted versus self) was compared in a sample of 103 participants. RESULTS:Self-test duration (89 s) was significantly longer than the assisted-test duration (75 s) (p = 0.003, Wilcoxon test). For the 20, 30, and 35 dB HL cut-off values, sensitivity was between 92% and 96%, and specificity was between 79 and 90%. Concordance of results between assisted-test and self-test modes was excellent (Cohen's kappa = 0.81, p < 0.001). CONCLUSIONS:The SoTone hearing screening test is accurate for identifying the presence of a suspected hearing loss at 20 dB HL or more in adults. It can be used either in assisted-test or self-test modes.

BackgroundSpeech-in-noise (SIN) audiometry is a valuable part of audiological diagnostics and clinical measurements, providing information on an individual's ability to understand in noise. To date, such tests have been developed with natural voice presented monaurally or binaurally (via diotic and dichotic presentation). The time required to develop such tests is often long. The use of synthetic voice would simplify the test creation process and self-testing would improve accessibility.DesignMeasurements were performed using an Android tablet (Samsung Galaxy Tab A7) and calibrated Bluetooth headphones (Tilde Pro C, Orosound). Normative values were first defined using natural or synthetic voice on 69 normal-hearing participants. A total of 463 participants then undertook the SIN test comprising synthetic voice and dichotic antiphasic presentation. Of these, 399 also performed the SIN test with diotic presentation.ResultsNo significant differences in the speech reception threshold (SRT) were found between natural and synthetic voices for diotic presentations (p = 0.824, paired Student t-test) with normative values of −10.7 dB SNR (SD = 1.5 dB) and −10.4 dB SNR (SD = 1.4 dB), respectively. For the SoNoise test with synthetic voice and dichotic antiphasic presentation, the results showed a normative value of −17.5 dB SNR (SD = 1.5 dB), and a strong correlation (r = 0.797, p < 0.001) with the four-frequency pure-tone average (4f-PTA). Receiver operating curves (ROC) were then calculated: for a 4f-PTA of 20 dB hearing level (HL), the SRT was −14.5 dB SNR with a sensitivity of 84% and specificity of 89%. For a 4f-PTA of 30 dB HL, the SRT was −13.7 dB SNR with a sensitivity of 89% and specificity of 91%. For a 4f-PTA of 35 dB HL, the SRT was −13.0 dB SNR with a sensitivity of 88% and specificity of 93%. The normative binaural intelligibility level difference (BILD) value was 8.6 dB (SD = 2.0 dB) with normal-hearing participants. The learning effect due to the task and interface was 1.7 dB (1st to 7th test) and test duration was 3 min.ConclusionThe SoNoise test in its synthetic dichotic antiphasic presentation is a fast and reliable tool to diagnose hearing impairment at 20, 30, and 35 dB HL cut-offs.

INTRODUCTION Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. MATERIAL AND METHODS The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its management in face-to-face or even distance learning. CONCLUSION In case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. It is recommended to perform free-field speech audiometry in noise to measure intelligibility in an environment as close as possible to reality. Questionnaires can be used in addition to audiometry to best assess the patient's disability. It is recommended that hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time elapsed since the fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, integrating different training domains in addition to face-to-face sessions.

To investigate the functional state of the auditory nerve fibers (ANFs), the electrophysiological tests routinely used in clinics (electrocochleography and evoked potentials of the auditory nerve and brainstem) only capture the first action potentials firing in synchrony at the onset of the acoustic stimulation. Unfortunately, no information concerning spontaneous rate and adaptation time constants can be obtained from such far-field potentials. By combining neuronal activity measurements at the round window and signal-processing algorithms, we constructed a peri-stimulus time response (PSTR), with a waveform similar to the peri-stimulus time histograms (PSTHs) derived from single-fiber recordings in young adult female gerbils. The predictive model derived from gerbils was then validated in mice and finally applied to humans This study offers a promising diagnostic tool to map the human auditory nerve, thus opening new avenues to better understanding auditory neuropathies, tinnitus, and hyperacusis. (c) 2023 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.

Auditory neuropathy spectrum disorder (ANSD) refers to a range of hearing impairments characterized by an impaired transmission of sound from the cochlea to the brain. This defect can be due to a lesion or defect in the inner hair cell (IHC), IHC ribbon synapse (e.g., pre-synaptic release of glutamate), postsynaptic terminals of the spiral ganglion neurons, or demyelination and axonal loss within the auditory nerve. To date, the only clinical treatment options for ANSD are hearing aids and cochlear implantation. However, despite the advances in hearing-aid and cochlear-implant technologies, the quality of perceived sound still cannot match that of the normal ear. Recent advanced genetic diagnostics and clinical audiology made it possible to identify the precise site of a lesion and to characterize the specific disease mechanisms of ANSD, thus bringing renewed hope to the treatment or prevention of auditory neurodegeneration. Moreover, genetic routes involving the replacement or corrective editing of mutant sequences or defected genes to repair damaged cells for the future restoration of hearing in deaf people are showing promise. In this review, we provide an update on recent discoveries in the molecular pathophysiology of genetic lesions, auditory synaptopathy and neuropathy, and gene-therapy research towards hearing restoration in rodent models and in clinical trials.

OBJECTIVE:In this paper, we focus on the carrying out and validation of minimally invasive three-dimensional (3D) ultrasound (US) imaging of the auditory system, which is based on a new miniaturized endoscopic 2D US transducer.METHODS:This unique probe consists of a 18 MHz 24 elements curved array transducer with a distal diameter of 4 mm so it can be inserted into the external auditory canal. Typical acquisition is achieved by rotating such a transducer around its own axis using a robotic platform. Reconstruction of a US volume from the set of acquired B-scans during the rotation is then performed using scan-conversion. The accuracy of the reconstruction procedure is evaluated using a dedicated phantom that includes a set of wires as reference geometry.RESULTS:Twelve acquisitions obtained from different probe poses are compared to a micro-computed tomographic model of the phantom, leading to a maximum error of 0.20 mm. Additionally, acquisitions with a cadaveric head highlight the clinical applicability of this set up. Structures of the auditory system such as the ossicles and the round window can be identified from the obtained 3D volumes.CONCLUSION:These results confirm that our technique enables the accurate imaging of the middle and inner ears without having to deteriorate the surrounding bone.SIGNIFICANCE:Since US is a real-time, wide available and non-ionizing imaging modality, our acquisition setup could facilitate the minimally invasive diagnosis and surgical navigation for otology in a fast, cost-effective and safe way.

Les tests électrophysiologiques couramment utilisés en clinique (électrocochléographie et potentiels évoqués du nerf auditif et du tronc cérébral) pour évaluer la fonction auditive capturent uniquement le premier potentiel d’action généré de manière synchrone par les fibres du nerf auditif en début de la stimulation acoustique. Malheureusement, aucune information sur l’activité spontanée et les constantes temporelles (adaptation rapide et lente) des fibres du nerf auditif ne peut être obtenue à partir de ces potentiels en champ lointain. En combinant des enregistrements à la fenêtre ronde chez la gerbille et des algorithmes de traitement du signal, nous avons pu enregistrer des potentiels présentant les mêmes caractéristiques temporelles que les fibres du nerf auditif. Le modèle prédictif dérivé des gerbilles a ensuite été validé chez des souris et finalement chez l’homme. Cette étude offre un outil de diagnostic prometteur pour cartographier le nerf auditif humain, ouvrant ainsi de nouvelles voies pour mieux comprendre les neuropathies auditives, les acouphènes et l’hyperacousie.

Objectives: Electrocochleography (ECochG) is emerging as a tool for monitoring cochlear function during cochlear implant (CI) surgery. ECochG may be recorded directly from electrodes on the implant array intraoperatively. For low-frequency stimulation, its amplitude tends to rise or may plateau as the electrode is inserted. The aim of this study was to explore whether compromise of the ECochG signal, defined as a fall in its amplitude of 30% or more during insertion, whether transient or permanent, is associated with poorer postoperative acoustic hearing, and to examine how preoperative hearing levels may influence the ability to record ECochG. The specific hypotheses tested were threefold: (a) deterioration in the pure-tone average of low-frequency hearing at the first postoperative follow-up interval (follow-up visit 1 [FUV1], 4 to 6 weeks) will be associated with compromise of the cochlear microphonic (CM) amplitude during electrode insertion (primary hypothesis); (b) an association is observed at the second postoperative follow-up interval (FUV2, 3 months) (secondary hypothesis 1); and (c) the CM response will be recorded earlier during electrode array insertion when the preoperative high-frequency hearing is better (secondary hypothesis 2). Design: International, multi-site prospective, observational, between groups design, targeting 41 adult participants in each of two groups, (compromised CM versus preserved CM). Adult CI candidates who were scheduled to receive a Cochlear Nucleus CI with a Slim Straight or a Slim Modiolar electrode array and had a preoperative audiometric low-frequency average thresholds of ≤80 dB HL at 500, 750, and 1000 Hz in the ear to be implanted, were recruited from eight international implant sites. Pure tone audiometry was measured preoperatively and at postoperative visits (FUV1 and follow-up visit 2 [FUV2]). ECochG was measured during and immediately after the implantation of the array. Results: From a total of 78 enrolled individuals (80 ears), 77 participants (79 ears) underwent surgery. Due to protocol deviations, 18 ears (23%) were excluded. Of the 61 ears with ECochG responses, amplitudes were <1 µV throughout implantation for 18 ears (23%) and deemed “unclear” for classification. EcochG responses >1 µV in 43 ears (55%) were stable throughout implantation for 8 ears and compromised in 35 ears. For the primary endpoint at FUV1, 7/41 ears (17%) with preserved CM had a median hearing loss of 12.6 dB versus 34/41 ears (83%) with compromised CM and a median hearing loss of 26.9 dB (p < 0.014). In assessing the practicalities of measuring intraoperative ECochG, the presence of a measurable CM (>1 µV) during implantation was dependent on preoperative, low-frequency thresholds, particularly at the stimulus frequency (0.5 kHz). High-frequency, preoperative thresholds were also associated with a measurable CM > 1 µV during surgery. Conclusions: Our data shows that CM drops occurring during electrode insertion were correlated with significantly poorer hearing preservation postoperatively compared to CMs that remained stable throughout the electrode insertion. The practicality of measuring ECochG in a large cohort is discussed, regarding the suggested optimal preoperative low-frequency hearing levels (<80 dB HL) considered necessary to obtain a CM signal >1 µV.

L’apprentissage de la chirurgie au bloc opératoire est de plus en plus difficile. Dans ce contexte, l’apport de la simulation devient primordial, et prend une place exponentielle dans la formation au fraisage de l’os temporal. L’objectif de cette revue de la littérature est de décrire les différents types de simulateurs disponibles pour le fraisage de l’os temporal après avoir exposé les contraintes actuelles auxquelles doit faire face l’enseignement traditionnel. Afin de répondre à cet objectif, la revue de la littérature a été réalisée sur la base de données Medline disponible via Pubmed. Les résultats de cette recherche peuvent être retrouvés en effectuant les deux recherches suivantes : « temporal bone » and training and surgery; « temporal bone » and training and drilling. Sur 467 articles identifiés, 71 ont été retenus pour référencer cette revue. Pour s’affranchir des nombreuses contraintes éthiques, financières, culturelles ou de temps de travail inhérentes à la pratique du fraisage de l’os temporal, de nombreux simulateurs ont été développés. Ces simulateurs peuvent être classés en différentes familles : modèle cadavérique, modèle animal, maquette synthétique, modèle virtuel. Les avantages principaux des simulateurs physiques et virtuels sont leur facilité d’accès, la possibilité de répéter les gestes sur un modèle standardisé, et l’absence de problèmes éthiques. Un processus de validation des différents simulateurs est un prérequis indispensable avant de pouvoir les inclure dans la formation des apprenants, afin de s’assurer de leur efficacité et ainsi renforcer la sécurité du patient au bloc opératoire.

Middle ear muscle (MEM) abnormalities have been proposed to be involved in the development of ear-related symptoms such as tinnitus, hyperacusis, ear fullness, dizziness and/or otalgia. This cluster of symptoms have been called the Tonic Tensor Tympani Syndrome (TTTS) because of the supposed involvement of the tensor tympani muscle (TTM). However, the putative link between MEM dysfunction and the symptoms has not been proven yet and the detailed mechanisms (the causal chain) of TTTS are still elusive. It has been speculated that sudden loud sound (acoustic shock) may impair the functioning of the MEM, specifically the TTM, after an excessive contraction. This would result in inflammatory processes, activation of the trigeminal nerve and a change of the MEMs state into a hypersensitive one, that may be associated to the cluster of symptoms listed above. The goal of this study is to provide further insights into the mechanisms of TTTS. The middle ear function of 11 patients who reported TTTS symptoms has been investigated using either admittancemetry and/or measurement of air pressure in the sealed external auditory canal. While the former method measured the middle ear stiffness the latter provides an estimate of the tympanic membrane displacement. Most patients displayed results consistent with phasic contractions of the TTM (n = 9) and/or Eustachian Tube (ET) dysfunction (n = 6). The MEM contraction or ET dysfunction could be evoked by acoustic stimulation (n = 3), somatic maneuvers (n = 3), or pressure changes in the ear canal (n = 3). Spontaneous TTM contraction (n = 1) or ET opening (n = 1) could also be observed. Finally, voluntary contraction of MEM was also reported (n = 5). On the other hand, tonic contraction of the TTM could not be observed in any patient. The implications of these results for the mechanisms of TTTS are discussed.

Objectives: This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs. Material and methods: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. Results: Eight tests of speech audiometry in noise can be used in France. Conclusion: To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other). (c) 2021 Elsevier Masson SAS. All rights reserved.

Balloon dilatation of the Eustachian tube (BDET) is an option for treating chronic obstructive Eustachian tube dysfunction (COETD). In this prospective multicentric study, the main objective was to evaluate the results of BDET in unilateral COETD refractory to medical treatment. Adults with unilateral COETD whose Eustachian Tube Score (ETS) was less than 5 despite medical pressure therapy were included. The primary endpoint was the change in ETS measured at 2, 6, and 12 months after BDET. Secondary objectives were the evolution of clinical symptoms assessed by the Eustachian Tube Questionnaire (ETDQ-7), audiometry, tympanometry, and otoscopy changes after BDET. Twenty-eight patients were included between May 2014 and December 2017 and were treated with BDET without adverse effects in three different referral centers. Population’s median age was 52 (Q25; Q75: 24, 82) years. The median follow-up time was 381 (Q25; Q75: 364; 418) days. The median ETS was 2 (Q25; Q75: 1; 4) before BDET. There was a significant improvement in ETS at 2 and 6 months and 1 year after BDET (score at 1 year: 6 (Q25; Q75: 2; 8) (p < 0.0001)). There was a significant, sustained improvement in the ETDQ-7 with a score of 4.21 (Q25; Q75–3.50; 4.79) before BDET and 3.43 (Q25; Q75–2.43; 4.14) (p = 0.0012) at 1 year. There was a suggestive improvement in tympanometry results at 1 year (p = 0.025). BDET provides an improvement in symptoms and objective measures assessed at 1 year in patients with COETD who have failed medical treatment. Trial Registration: NCT02123277 (April 25, 2014).

Cochlear implants are the most common and successful sensory neuroprosthetic devices. However, reimplantation can be required for medical reasons, device failure, or technological upgrading. Resolving the problem driving the intervention and offering stable or better audiological results are the main challenges. We aimed to analyze the success rate of this intervention and to identify factors influencing speech perception recovery after reimplantation in the pediatric population. We retrospectively collected the causes and the outcomes of 67 consecutive reimplantations in one cochlear implant center over 30 years. Reimplantation resolved the cause without recurrence for 94% of patients. The etiology of deafness, time since implantation, indication of reimplantation, sex, and age did not influence word discrimination test scores in silence, 3 years after surgery. However, adherence to a speech rehabilitation program was statistically associated with gain in perception scores: +8.9% [−2.2; +31.0%] versus −19.0% [−47.5; −7.6%] if no or suboptimal rehabilitation was followed (p = 0.0037). Cochlear reimplantation in children is efficient and is associated with predictable improvement in speech perception, 3 years after intervention. However, good adherence to speech rehabilitation program is necessary and should be discussed with the patient and parents, especially for the indication of reimplantation for technological upgrading.

Sound-level coding in the auditory nerve is achieved through the progressive recruitment of auditory nerve fibers (ANFs) that differ in threshold of activation and in the stimulus level at which the spike rate saturates. To investigate the functional state of the ANFs, the electrophysiological tests routinely used in clinics only capture the first action potentials firing in synchrony at the onset of the acoustic stimulation. Assessment of other properties (e.g., spontaneous rate and adaptation time constants) requires single-fiber recordings directly from the nerve, which for ethical reasons is not allowed in humans. By combining neuronal activity measurements at the round window and signal-processing algorithms, we constructed a peristimulus time response (PSTR), with a waveform similar to the peristimulus time histograms (PSTHs) derived from single-fiber recordings in young adult female gerbils. Simultaneous recordings of round-window PSTR and single-fiber PSTH provided models to predict the adaptation kinetics and spontaneous rate of the ANFs tuned at the PSTR probe frequency. The predictive model derived from gerbils was then validated in female mice and finally applied to humans by recording PSTRs from the auditory nerve in normal-hearing patients who underwent cerebellopontine angle surgeries. A rapid adaptation time constant of ∼3 ms and a mean spontaneous rate of ∼22 spikes/s in the 4 kHz frequency range were found. This study offers a promising diagnostic tool to map the human auditory nerve, thus opening new avenues to better understanding auditory neuropathies, tinnitus, and hyperacusis.SIGNIFICANCE STATEMENT Neural adaptation in auditory nerve fibers corresponds to the reduction in the neuronal activity to prolonged or repeated sound stimulation. For obvious ethical reasons, single-fiber recordings from the auditory nerve are not feasible in humans, creating a critical gap in extending data obtained using animal models to humans. Using electrocochleography in rodents, we inferred adaptation kinetics and spontaneous discharge rates of the auditory nerve fibers in humans. Routinely used in basic and clinical laboratories, this tool will provide a better understanding of auditory disorders such as neuropathies, tinnitus, and hyperacusis, and will help to improve hearing-aid fittings.

Objectives Otitis media with effusion (OME) is a common pathology in children. Effusions contain Metalloproteinases (MMPs), which can lead to atrophy of the tympanic membrane (TM) due to destructive effect on the lamina propria. Not all cases of OME are complicated with atrophy, maybe explained by an inter-individual variation of MMP concentration in effusions. The purpose of this study was to determine the correlation between concentration of MMPs and existence of TM atrophy in children. Participants - Main outcome measures The effusion from thirty middle ears were collected during insertion of VT in children aged 15 months to 10 years, including 11 eardrums with tympanic atrophy and 19 without tympanic atrophy. ELISA tests were used to measure concentrations of MMP-2, MMP-7, MMP-9 and TIMP-2 in the effusions. Correlations between MMP levels and atrophy of eardrum was investigated, as well as correlation with age, gender, number of previous ventilation tube insertion, and viscosity of the glue. Results The mean concentration of MMP-2 was higher in the atrophic group than in effusions without TM atrophy (0.6 ng/mg versus 0.5 ng/mg total protein respectively), while the TIMP-2 concentration was lower in this group. The level of MMP-2 decreased with the age. Finally, a significantly higher concentration of MMP-9 and TIMP-2 was found in high-viscosity effusions. Conclusion This study suggests that MMP-2 activity could play an important role in destruction of the eardrum during OME in infancy. MMP-2 level assessment could be interesting for determining children with risk of lamina propria destruction.