Publications by authors named "Olivier Sterkers"

170 Publications

Thermal Safety of Endoscopic Usage in Robot-Assisted Middle Ear Surgery: An Experimental Study.

Front Surg 2021 14;8:659688. Epub 2021 May 14.

Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

The widespread application of endoscopic ear surgery (EES), performed through the external auditory canal, has revealed the limitations of the one-handed technique. The RobOtol® (Collin ORL, Bagneux, France) otological robotic system has been introduced to enable two-handed procedures; however, the thermal properties of dedicated endoscopes, which are usually used in neurosurgery, called "neuro-endoscopes," have not yet been clarified for the robotic systems. In this study, we aimed to profile the thermal characteristics of two dedicated neuro-endoscopes, as compared to endoscopes used routinely in manual EES, called "oto-endoscopes," and defined by a smaller diameter and shorter length, and to discuss the safe application of robotic assistance in EES. Two neuro-endoscopes (3.3 mm, 25 cm, 0°/30°) were studied using two routine light sources (LED/xenon), and two routine oto-endoscopes (3 mm, 14 cm, 0°/30°) were initially measured to provide a comprehensive comparison. Light intensities and temperatures were measured at different power settings. The thermal distributions were measured in an open environment and a human temporal bone model of EES. The cooling measures were also studied. Light intensity was correlated with stabilized tip temperatures ( < 0.01, = 0.8719). Under 100% xenon power, the stabilized temperatures at the tips of 0°, 30° neuro-endoscopes, and 0°, 30° oto-endoscopes were 96.1, 60.1, 67.8, and 56.4°C, respectively. With 100% LED power, the temperatures decreased by about 10°C, respectively. For the 0° neuro-endoscope, the illuminated area far away 1cm from the tip was below 37°C when using more than 50% both power, while this distance for 30° neuro-endoscope was 0.5 cm. In the EES temporal bone model, the round window area could reach 59.3°C with the 0° neuro-endoscope under 100% xenon power. Suction resulted in a ~1-2°C temperature drop, while a 10 mL saline rinse gave a baseline temperature which lasted for 2.5 min. Neuro-endoscope causes higher thermal releasing in the surgical cavity of ESS, which should be especially cautious in the robotic system usage. Applying submaximal light intensity, a LED source and intermittent rinsing should be considered for the safer robot-assisted EES using a neuro-endoscope that allows a two-handed surgical procedure.
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http://dx.doi.org/10.3389/fsurg.2021.659688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160440PMC
May 2021

Middle ear adenomatous neuroendocrine tumours: Single institution experience with five cases.

Clin Otolaryngol 2021 May 1. Epub 2021 May 1.

APHP, Otology, auditory implants and skull base department, Pitié-Salpêtrière Hospital, Paris, France.

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http://dx.doi.org/10.1111/coa.13791DOI Listing
May 2021

Intraoperative facial nerve electromyography parameters to optimize postoperative facial nerve outcome in patients with large unilateral vestibular schwannoma.

Acta Neurochir (Wien) 2021 Apr 7. Epub 2021 Apr 7.

Department of Otology, Auditory Implants and Skull Base Surgery, Sorbonne Université-APHP6, Groupe Hospitalier Pitié-Salpêtrière, 75013, Paris, France.

Background: Decision-making for large sporadic vestibular schwannomas (VS) resection guided by the intraoperative change in supramaximal facial nerve (FN) amplitude and latency response to optimize post-operative FN outcome.

Methods: Prospectively study of 43 patients, from January to December 2018, of large sporadic VS with preoperative normal FN function at our center. Tumors were removed through retrosigmoid (81%) or translabyrinthine (19%) approaches with FN monitoring. Intraoperative pre- and post-VS resection supramaximal (2 mA) amplitude and latency responses at the proximal FN root were recorded.

Results: Total, near-/subtotal VS resections (TR, NTR, STR) were achieved in 51%, 38%, and 11% of tumors, respectively, guided by no more than 40% decrease in supramaximal amplitude. Pre- and post-resection supramaximal amplitude and latency responses were lower and longer, respectively, in NTR+STR than in TR. At day 8, FN function was grade I-II in 77% of patients and grade III-V in 23%, and after 6 months, it was in grade I-II in 95% and grade III in 5%, and there was no significant difference between TR and NTR+STR. Facial palsy occurred in older patients and in the case of severe FN adhesion. At day 8, pre- and post-resection supramaximal amplitude but not latency responses were different between FN grade III-V and grade I-II. Serviceable hearing was preserved in 28% of large VS.

Conclusions: Intraoperative FN monitoring guided VS resection in large VS so that 49% retained some residual tumor. Accordingly, 95% good postoperative FN function and significant hearing preservation were achieved after 6 months.
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http://dx.doi.org/10.1007/s00701-021-04814-2DOI Listing
April 2021

Cochlear Implantation and Other Treatments in Single-Sided Deafness and Asymmetric Hearing Loss: Results of a National Multicenter Study Including a Randomized Controlled Trial.

Audiol Neurootol 2021 Mar 31:1-11. Epub 2021 Mar 31.

Service d'Otologie, Otoneurologie et ORL pédiatrique, Hôpital Pierre-Paul Riquet, CHU Purpan, Toulouse, France.

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.
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http://dx.doi.org/10.1159/000514085DOI Listing
March 2021

Radiological and Audiological Outcomes of the LISTENT LCI-20PI Cochlear Implant Device.

Otol Neurotol 2021 04;42(4):524-531

Department of Otolaryngology Head and Neck Surgery, Sino-French Joint Clinic Research Center on Otology and Neuro-Otology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University.

Objective: To study the surgical results, intracochlear position of the electrode array (EA) and auditory performance of the LISTENT LCI-20PI cochlear implant device, and daily use status at 3 years.

Study Design: A retrospective study.

Setting: A single-tertiary referral center.

Patients: Between January and December 2016, 20 patients underwent cochlear implantation using the LISTENT LCI-20PI (lateral wall EA).

Intervention: Cochlear implantation.

Main Outcome Measures: Measurement of cochlear size, extent of posterior tympanotomy, and insertion depth. Scalar position of the EA evaluated by 3D reconstruction. Auditory outcomes 1 year after implantation and daily use status at 3 years.

Results: EAs were completely inserted in all cases with an insertion depth of 288 ± 36.8 degrees. One year later, the average sentence recognition score (SRS) was 90 ± 21.7%. EA scalar location was analyzed in 18 patients. Thirteen EAs (72.2%) were fully inserted into the scala tympani (ST) and 5 (27.8%) had shifted from the ST to the scala vestibuli (SV). There was no statistically significant difference in cochlear size, extent of posterior tympanotomy, or insertion depth between these two groups. EAs inserted by cochleostomy had a higher chance of scalar shift than those inserted via the round window (60% vs 15.4%, p = 0.099). SRS at 1 year with full ST insertion was significantly better than in those with scalar shift (99 ± 1.3% vs 83 ± 16.5%, p = 0.002). Three years after implantation, 92% of patients were daily users and 46% were telephone users.

Conclusions: The LISTENT LCI-20PI provided accredited hearing rehabilitation with a short insertion depth. Full insertion into the ST was associated with better cochlear implantation outcomes.
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http://dx.doi.org/10.1097/MAO.0000000000002963DOI Listing
April 2021

Objective improvement in adults with cerebellopontine angle arachnoid cysts after surgical treatment.

Acta Neurochir (Wien) 2021 03 29;163(3):753-758. Epub 2021 Jan 29.

Department of Neurosurgery - AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France.

Background: Intracranial arachnoid cysts are extra-axial benign lesions mainly found in the middle cerebral fossa. Rare case series report various cranial nerve dysfunctions associated with cerebellopontine angle (CPA) cysts and there is no consensus with regard to their surgical management; some reports claiming that subjective improvement in adults with intracranial arachnoid cysts cannot justify surgical treatment.

Methods: This retrospective study included all 12 consecutive adult patients treated by microsurgical fenestration for symptomatic CPA arachnoid cysts between 2010 and 2019 and using a retrosigmoid approach. Demographic, clinical, surgical, and radiological data were collected from medical files.

Results: The main symptoms were audiovestibular in 9 patients (75%) complaining of dizziness and 6 patients (50%) with hearing loss. In addition, 3 patients (25%) reported tinnitus, 3 patients (25%) presented vasovagal syncope, and 1 patient (8.3%) reported facial pain. Surgery improved 5 patients (83%) with pre-operative hearing loss, 7 patients (78%) reporting dizziness, and all patients with vasovagal syncope. All of the patients recovered from at least one symptom. No recurrence was observed with a mean follow-up of 5.5 years.

Conclusion: Although most arachnoid cysts are asymptomatic, the CPA location may lead to cranial nerve impairments. Microsurgical fenestration seems to be a simple, safe, and effective technique.
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http://dx.doi.org/10.1007/s00701-021-04721-6DOI Listing
March 2021

Analysis of forces during robot-assisted and manual manipulations of mobile and fixed footplate in temporal bone specimens.

Eur Arch Otorhinolaryngol 2021 Jan 3. Epub 2021 Jan 3.

Service ORL, Unité Fonctionnelle Implants Auditifs, Sorbonne Université/AP-HP, GHU Pitié-Salpêtrière, Bâtiment Babinski, 52, Boulevard Vincent Auriol, 75013, Paris, France.

Purpose: To evaluate the forces involved in different manipulations, manual or robot-assisted, applied to the ossicular chain, on normal temporal bones and on an anatomical model of otosclerosis.

Methods: Thirteen cadaveric temporal bones, with mobile footplates or with footplates that were fixed using hydroxyapatite cement, were manipulated, manually or using a robotic arm (RobOtol®). "Short contact" of a mobile footplate was the weakest interaction on the incus. "Long contact" was the same manipulation held for 10 s. "Mobilization" was the smallest visualized movement of the mobile footplate, or the movement necessary to regain mobility of the fixed footplate. A six-axis force sensor (Nano17, ATI) measured the maximal peak of forces, summation of forces applied, and yank.

Results: Maximal forces during short (~4 mN) and long contact (~15 mN) were similar for manual and robot-assisted manipulations. For manual manipulation, yank measured during long contact was twice as high compared to robot-assisted manipulation: 6 ± 2.4 (n = 5) and 3 ± 1.3 mN/s (n = 5), respectively (mean ± SD, p < 0.02). For mobilization of the mobile footplate, maximal forces during mobilization were similar during manual and robot-assisted manipulations, respectively: 12 ± 2.5 (n = 6) and 19 ± 7.6 mN (n = 7). Compared with mobilization of a mobile footplate, mobilization of a fixed footplate required ~ 60 and ~ 27 times higher maximal forces for manual and robot-assisted manipulations, respectively: 724 ± 366.4 and 507 ± 283.2 mN. Yank was twice as high during manual manipulation compared to robot-assisted manipulation (p < 0.05).

Conclusion: Robot-assisted manipulation of the ossicular chain was reliable. Our anatomical model of otosclerosis was successfully developed requiring higher forces for stapes mobilization.
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http://dx.doi.org/10.1007/s00405-020-06553-zDOI Listing
January 2021

Robot-assisted Cochlear Implant Electrode Array Insertion in Adults: A Comparative Study With Manual Insertion.

Otol Neurotol 2021 04;42(4):e438-e444

Sorbonne University/AP-HP, GHU Pitié-Salpêtrière, DMU ChIR, Department of Oto-Rhino-Laryngology, Unit of Audiology, Auditory Implants and skull base surgery.

Objective: To describe the first cochlear array insertions using a robot-assisted technique, with different types of straight or precurved electrode arrays, compared with arrays manually inserted into the cochlea.

Study Design: Retrospective review.

Setting: Tertiary otologic center.

Patients: Twenty cochlear implantations in the robot-assisted group and 40 in the manually inserted group.

Interventions: Cochlear implantations using a robot-assisted technique (RobOtol) with straight (eight Cochlear CI522/622, and eight Advanced Bionics Hifocus Slim J) or precurved (four Advanced Bionics Hifocus Mid-Scala) matched to manual cochlear implantations. Three-dimensional reconstruction images of the basilar membrane and the electrode array were obtained from pre- and postimplantation computed tomography.

Main Outcome Measures: Rate and localization of scalar translocations.

Results: For straight electrode arrays, scalar translocations occurred in 19% (3/16) of the robot-assisted group and 31% (10/32) of the manually inserted group. Considering the number of translocated electrodes, this was lower in the robot-assisted group (7%) than in the manually inserted group (16%) (p < 0.0001, χ2 test). For precurved electrode arrays, scalar translocations occurred in 50% (2/4) of the robot-assisted group and 38% (3/8) of the manually inserted group.

Conclusion: This study showed a safe and reliable insertion of different electrode array types with a robot-assisted technique, with a less traumatic robotic insertion of straight electrode arrays when compared with manual insertion.
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http://dx.doi.org/10.1097/MAO.0000000000003002DOI Listing
April 2021

Current Management of Large Vestibular Schwannomas for NF2 Patients in a National Reference Center.

Laryngoscope 2021 01 17;131(1):E98-E107. Epub 2020 Aug 17.

Neurosurgical Department, Pitié-Salpétrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.

Objective: Recently, treatment decision making for large vestibular schwannomas (VS) in patients with neurofibromatosis type 2 (NF2) has become increasingly challenging due to the availability of multiple therapeutic options including surgery, bevacizumab (an anti-VEGF), radiosurgery, and observation; and it often remains an arbitrary decision based on local practices without firm recommendations. Our objective is to discuss the multimodal treatment options for Koos IV VS in a national reference center for NF2.

Study Design: Single-institution retrospective cohort study.

Methods: All NF2 patients with Koos IV VS who visited our center, the National Reference Center for NF2 Rare Disease in Pitié-Salpétrière Hospital of Paris, between January 2016 and December 2018 were included. Clinical charts, radiology, operative reports, and audiograms were reviewed.

Results: Among 54 NF2 patients with Koos IV VS (mean maximum extrameatal diameter: 34 mm; range:17-62 mm), 27 were operated on for 28 VS; 21 were treated with bevacizumab; and six were observed. In the surgical group, VS resections were gross total, near-total, subtotal, or partial in 32%, 25%, 32%, and 11%, respectively; and a good (House-Brackmann grades I-II) facial nerve function was achieved in 81.5% at 1 year. Hearing was preserved in 14%, 78%, and 66% of the surgical (n = 7), bevacizumab (n = 9), and observation (n = 3) patients, respectively.

Conclusion: All therapeutic options, including surgery and/or bevacizumab and occasionally observation, should be proposed to NF2 patients with large VS in the setting of dedicated centers. A decision-making tree is proposed for Koos IV VS management based on tumor evolution, hearing and clinical status of the patient, and contralateral VS size.

Level Of Evidence: 4, case series study, historically controlled study Laryngoscope, 131:E98-E107, 2021.
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http://dx.doi.org/10.1002/lary.28998DOI Listing
January 2021

Pupillometry Assessment of Speech Recognition and Listening Experience in Adult Cochlear Implant Patients.

Front Neurosci 2020 6;14:556675. Epub 2020 Nov 6.

INSERM U1159 Réhabilitation Chirurgicale Mini-Invasive Robotisée De l'Audition, Paris, France.

Objective: The aim of the present study was to investigate the pupillary response to word identification in cochlear implant (CI) patients. Authors hypothesized that when task difficulty (i.e., addition of background noise) increased, pupil dilation markers such as the peak dilation or the latency of the peak dilation would increase in CI users, as already observed in normal-hearing and hearing-impaired subjects.

Methods: Pupillometric measures in 10 CI patients were combined to standard speech recognition scores used to evaluate CI outcomes, namely, speech audiometry in quiet and in noise at +10 dB signal-to-noise ratio (SNR). The main outcome measures of pupillometry were mean pupil dilation, maximal pupil dilation, dilation latency, and mean dilation during return to baseline or retention interval. Subjective hearing quality was evaluated by means of one self-reported fatigue questionnaire, and the Speech, Spatial, and Qualities (SSQ) of Hearing scale.

Results: All pupil dilation data were transformed to percent change in event-related pupil dilation (ERPD, %). Analyses show that the peak amplitudes for both mean pupil dilation and maximal pupil dilation were higher during the speech-in-noise test. Mean peak dilation was measured at 3.47 ± 2.29% noise vs. 2.19 ± 2.46 in quiet and maximal peak value was detected at 9.17 ± 3.25% in noise vs. 8.72 ± 2.93% in quiet. Concerning the questionnaires, the mean pupil dilation during the retention interval was significantly correlated with the spatial subscale score of the SSQ Hearing scale [(8) = -0.84, = 0.0023], and with the global score [(8) = -0.78, = 0.0018].

Conclusion: The analysis of pupillometric traces, obtained during speech audiometry in quiet and in noise in CI users, provided interesting information about the different processes engaged in this task. Pupillometric measures could be indicative of listening difficulty, phoneme intelligibility, and were correlated with general hearing experience as evaluated by the SSQ of Hearing scale. These preliminary results show that pupillometry constitutes a promising tool to improve objective quantification of CI performance in clinical settings.
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http://dx.doi.org/10.3389/fnins.2020.556675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677588PMC
November 2020

Treatment choice in single-sided deafness and asymmetric hearing loss. A prospective, multicentre cohort study on 155 patients.

Clin Otolaryngol 2020 Nov 24. Epub 2020 Nov 24.

Service d'Otologie, Otoneurologie et ORL Pédiatrique, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, France.

Objectives: To describe the treatment choice in a cohort of subjects with single-sided deafness (SSD) and asymmetric hearing loss (AHL). To assess the reliability of the treatment trials.

Design: In this national, multicentre, prospective study, the choice of subjects was made after two consecutive trials of Contralateral Routing Of the Signal (CROS) hearing aids and a Bone Conduction Device (BCD) on a headband. Subjects could proceed with one of these two options, opt for cochlear implantation or decline all treatments.

Setting: Seven tertiary university hospitals.

Participants: One hundred fifty-five subjects with SSD or AHL fulfilling the candidacy criteria for cochlear implantation, with or without associated tinnitus.

Main Outcome Measures: After the two trials, the number of subjects choosing each option was described. Repeated assessments of both generic and auditory-specific quality of life were conducted, as well as hearing assessments (speech recognition in noise and horizontal localization).

Results: CROS was chosen by 75 subjects, followed by cochlear implantation (n = 51), BCD (n = 18) and abstention (n = 11). Patients who opted for cochlear implantation had a poorer quality of life (P = .03). The improvement of quality of life indices after each trial was significantly associated with the final treatment choice (P = .008 for generic indices, P = .002 for auditory-specific indices). The follow-up showed that this improvement had been overestimated in the CROS group, with a long-term retention rate of 52.5%.

Conclusions: More than one third of SSD/AHL subjects are unsatisfied after CROS and BCD trials. Repeated quality of life assessments help counselling the patient for his/her treatment choice.
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http://dx.doi.org/10.1111/coa.13672DOI Listing
November 2020

Management and Outcomes of Sporadic Vestibular Schwannoma: A Longitudinal Study Over 12 Years.

Laryngoscope 2021 03 25;131(3):E970-E976. Epub 2020 Jul 25.

APHP, Groupe Hospitalo-Universitaire Pitié Salpêtrière, Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Sorbonne Université, Paris, France.

Objectives: To evaluate the management of sporadic vestibular schwannomas (VS) with a 12-year follow-up.

Study Design: Retrospective study of all VS patients initially treated in 2005 in a tertiary referent center.

Methods: Initial decision making for microsurgical resection (MSR) or wait-and-scan (WaS) was according to VS size and hearing; subsequently, MSR or stereotactic radiosurgery (SRS) was proposed dependent on VS growth and size, hearing, and patient's age or willingness.

Results: Two hundred and one sporadic VS were included. The first management apportionment was 120 WaS (61.5%), 72 MSR (37%), three SRS (1.5%), and six others refused MSR and were lost to follow-up (LFU). Within 1 year, 95 (47%) VS were surgically removed; 17 (8.5%) were treated by SRS; and 35 (17.5%) were LFU. The proportions for SRS and LFU were virtually unchanged for the following years, and the proportion under MSR increased slightly within 3 years and then remained stable. Finally, at 12 years, 104 (51.5%) cases had been operated on, 21 (10.5%) treated by SRS, 23 (11.5%) still under WaS, and 53 (26.5%) LFU, which were mainly intracanalicular. The initially and subsequently operated cases presented similar hearing preservation rates and good facial nerve function outcomes.

Conclusion: This longitudinal study of a large number of VS, which were diagnosed over a short period of time and followed for 12 years, provides new information on both the natural history of these benign tumors and individual patient concerns. This study recommends use of the WaS policy for small and mid-sized VS before active therapeutic decision making.

Level Of Evidence: 3 Laryngoscope, 131:E970-E976, 2021.
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http://dx.doi.org/10.1002/lary.28888DOI Listing
March 2021

Benefits in noise from sound processor upgrade in thirty-three cochlear implant users for more than 20 years.

Eur Arch Otorhinolaryngol 2021 Mar 25;278(3):827-831. Epub 2020 Jun 25.

UF Implants Auditifs et Explorations Fonctionnelles, Service ORL, Assistance Publique-Hôpitaux de Paris Sorbonne Université, GHU Pitié-Salpêtrière Boulevard de l'Hôpital, Bâtiment Paul Castaigne, 47-83 Bd de l'Hôpital, 75013, Paris, France.

Purpose: Some oldest patients rehabilitated with a cochlear implant more than 20 years ago could still be upgraded with new generations of speech processor (SP). The aim of this study was to show the benefit of a recent generation of SP in this population.

Methods: A monocentric prospective study was designed to evaluate the performance of 33 ancient CI22M users implanted between 1989 and 1997 and upgraded with the late compatible sound processor CP900. Performance was evaluated in quiet and noise with Framatix, an automated adaptative test.

Results: Performance using Framatix significantly improved with the CP900, with a decrease of the median speech perception threshold of 6 dB in quiet (p < 0.05) and 5,3 dB in noise (p < 0.0005). No subjective benefit using the APHAB questionnaire was observed.

Conclusion: Upgrading of cochlear implant recipients who were implanted more than 20 years ago with recent compatible and new technological SP provide benefit in speech recognition in noise.
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http://dx.doi.org/10.1007/s00405-020-06144-yDOI Listing
March 2021

Robot-based assistance in middle ear surgery and cochlear implantation: first clinical report.

Eur Arch Otorhinolaryngol 2021 Jan 26;278(1):77-85. Epub 2020 May 26.

AP-HP, GHU Pitié-Salpêtrière, DMU ChIR, Service ORL, GRC Robotique et Innovation Chirurgicale, Sorbonne Université, Paris, France.

Purpose: Middle ear surgery may benefit from robot-based assistance to hold micro-instruments or an endoscope. However, the surgical gesture performed by one hand may perturb surgeons accustomed to two-handed surgery. A robot-based holder may combine the benefits from endoscopic exposure and a two-handed technique. Furthermore, tremor suppression and accurate tool control might help the surgeon during critical surgical steps. The goal of this work was to study the safety of an otological robot-based assistant under clinical conditions in a limited series of patients.

Methods: The RobOtol system has been used as an endoscope or a micro instrument holder for this series. Eleven cases were operated on with the robot as an endoscope holder for chronic otitis. Twenty-one cases were operated on with the robot as a micro-instrument holder for otosclerosis (9 cases), transtympanic tube placement (2 cases), or cochlear implantation (10 cases).

Results: No complications related to the robot manipulation occurred during surgery nor in postoperative. In the chronic otitis group, all perforations were sealed and 3-month postoperative pure-tone average air-bone gap (PTA ABG) was 15 ± 2.6 dB. In the otosclerosis group, 1-month post-op PTA ABG was 10 ± 1 dB. For cochlear implantation cases, a scala tympani insertion, a vestibular scala translocation occurred and a full scala vestibuli insertion was observed in 7, 2 and 1 case, respectively.

Conclusion: The RobOtol system has reached the clinical stage. It could be used safely and with accurate control as an endoscope holder or a micro instrument holder in 32 cases.
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http://dx.doi.org/10.1007/s00405-020-06070-zDOI Listing
January 2021

Improving facial nerve outcome and hearing preservation by different degrees of vestibular schwannoma resection guided by intraoperative facial nerve electromyography.

Acta Neurochir (Wien) 2020 08 18;162(8):1983-1993. Epub 2020 May 18.

Sorbonne Université, Groupe Hospitalo-Universitaire Pitié-salpêtrière, Paris, France.

Background: Facial nerve (FN) outcome has been improved by deciding upon the degree of vestibular schwannoma (VS) resection guided by intraoperative facial nerve monitoring (IOFM). This study aimed to evaluate hearing and FN outcomes following IOFM-guided VS removal through a retrosigmoid approach (RS).

Methods: Between January 2015 and August 2017, 77 patients undergoing VS resection through RS, regardless of their preoperative hearing or tumor size, were included in this monocentric retrospective study. Total or near-/subtotal resection was decided intraoperatively according to IOFM. Partial resection was planned preoperatively. Pre- and postoperative FN function (House-Brackmann) and hearing level (AAO-HNS and Gardner-Robertson (GR) scales) were reported. Predictive factors for hearing preservation were analyzed according to a score developed to take into account pre-/postoperative hearing evolution.

Results: The mean extrameatal diameter was 17 ± 8.5 mm. VS resection was total, near-/subtotal, and partial in 71%, 21%, and 8% of cases, respectively. Postoperative grade I and II FN function was achieved in 91% of patients. Serviceable (A+B or GR I+II) hearing and hearing with intelligibility (A+B+C or GR I-III) were preserved in 30% and 43% of cases, respectively. In multivariate analysis, preoperative synchronized auditory brainstem responses (ABR) were the only predictive factor (p = 0.006) imparting a five times greater chance of hearing preservation.

Conclusion: IOFM-guided VS excision through RS, whatever the VS size and hearing level, achieved a high rate of good postoperative FN function together with significant hearing preservation, and it should be used if hearing with some intelligibility is still present preoperatively, even in large VS.
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http://dx.doi.org/10.1007/s00701-020-04397-4DOI Listing
August 2020

Management of tegmen defects with mastoid and epitympanic obliteration using S53P4 bioactive glass.

Laryngoscope Investig Otolaryngol 2020 Apr 9;5(2):297-304. Epub 2020 Mar 9.

APHP Département d'Otologie, d'implants auditifs et de base du crâne, auditory Groupe Hospitalo-Universitaire Pitié-Salpêtrière Paris France.

Objective: To evaluate the surgical results and complications in a cohort of patients operated on to repair a tegmen bony defect using either transmastoid approach with obliteration using S53P4 bioactive glass granules (TMA-O), or the classic middle cranial fossa approach (MCFA).

Study Design: A retrospective monocentric study.

Methods: Twenty-five cases (24 patients) were included. Data regarding patient demographics, etiology, intraoperative findings, complications, recurrences, audiometric data, and follow-up were analyzed.

Results: Seven patients were operated with MCFA and 17 patients with TMA-O. One patient was operated on using a combined approach (MCFA + TMA-O). In the preoperative HRCT scan, the size of the defect was estimated to be 6 ± 3.8 mm in the TMA-O group and 6 ± 3.5 mm in the MCFA group ( = .969). Intraoperatively, in the MCFA group, the location of the defect was mostly anterior (86%) with an intact ossicular chain (86%). A discontinuous chain was observed in 15 patients (88%) in the TMA-O group. The mean follow-up time was 22 ± 14 months in the TMA-O group and 24 ± 15 months in the MCFA group ( = .762). In both groups, there were no early postoperative complications or recurrences during follow-up.

Conclusion: Repair of a tegmen bony defect with S53P4 bioactive glass granules seems to be safe and effective, limiting the use of the middle cranial fossa approach to cases with epitympanic defects and with an intact ossicular chain, and it could be used whatever the size of the defect and/or the presence of meningoencephalocele.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lio2.374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178447PMC
April 2020

Metachronous Bilateral Vestibular Schwannomas.

Laryngoscope 2021 01 17;131(1):E250-E254. Epub 2020 Feb 17.

Sorbonne University, Paris, France.

Bilateral vestibular schwannoma (BVS) is the hallmark of neurofibromatosis type 2 (NF2), both of them being present at diagnosis. We report four cases of metachronous BVS, a contralateral intracanalicular vestibular schwannomas (VS) being visible 2 to 13 years after resection of a unilateral VS. NF2 workup was negative except in one case where two NF2 gene mutations were found in tumor analysis. These cases raise the questions of whether the contralateral VS occurred by chance and how to manage it on the only hearing ear. Otologists should be aware of this rare eventuality for decision making of the first unilateral VS. Laryngoscope, 131:E250-E254, 2021.
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http://dx.doi.org/10.1002/lary.28571DOI Listing
January 2021

Long-term residual hearing in cochlear implanted adult patients who were candidates for electro-acoustic stimulation.

Eur Arch Otorhinolaryngol 2020 Mar 4;277(3):705-713. Epub 2019 Dec 4.

Sorbonne Université, Inserm, Réhabilitation chirurgicale mini-invasive et robotisée de l'audition, Paris, France.

Purpose: To evaluate the long-term hearing outcomes in cochlear implanted adults with residual hearing at low frequencies, and the proportion of patients using electro-acoustic stimulation (EAS).

Methods: A monocentric retrospective cohort study was performed in a tertiary referral center. Population demographics, surgical approach, pre- and postoperative hearing at low frequencies, in the implanted and contralateral ear, were recorded as well as duration of EAS use. The percentage hearing preservation was calculated according to the formula S (HEARRING group).

Results: In total, 63 adults (81 ears) with residual hearing underwent cochlear implantation with intent to use EAS processors. Six different types of electrode array were implanted. The mean pure tone audiometry (PTA) shift after cochlear implantation was 16 ± 15 dB HL (range 0-59 dB HL). Half of the implanted ears had minimal hearing preservation or total hearing loss (HL) at 5.5 years and the cumulative risk of total HL was 50% at 7 years. During the follow-up, total HL occurred in 22 ears. The decrease in hearing levels was similar in both implanted and contralateral ear during follow-up (ns, F = 2.46 ± 3, Linear Mixed Model (LMM)). Only 44 patients found a benefit from EAS at the first fitting. At the last visit, EAS processors were fitted in 30% of the cases. The pre- and postoperative mean PTA thresholds were not predictive of EAS use (Cox's proportional hazards analysis).

Conclusions: Postoperative residual hearing was observed in 93% of implanted ears, but only half of them had an initial benefit from EAS. No predictive factors were found to influence the use of EAS processors.
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http://dx.doi.org/10.1007/s00405-019-05745-6DOI Listing
March 2020

Management of sporadic vestibular schwannoma with contralateral nonserviceable hearing.

Laryngoscope 2020 06 23;130(6):E407-E415. Epub 2019 Oct 23.

Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Greater paris university hospitals, Pitié-Salpêtrière University Group Hospital, Paris, France.

Objectives/hypothesis: To outline a possible decision-making process for sporadic vestibular schwannoma (VS) with contralateral nonserviceable hearing at diagnosis.

Study Design: Retrospective case series.

Methods: Diagnosed VS was studied in a tertiary referral center from 1995 to 2013.

Results: Twenty-eight patients were included, with a mean follow-up of 6.9 years (range = 0.5-20 years). Ten were stage 1, 10 were stage 2, five were stage 3, and three were stage 4. Ipsilateral hearing levels were A (n = 3), B (n = 10), C (n = 7) and D (n = 8) American Academy of Otolaryngology-Head and Neck Surgery classification. Contralateral hearing levels were C (n = 11) and D (n = 17). Initial VS management included surveillance (n = 12) or surgery (n = 16), and four patients were later treated with surgery (n = 3) or stereotactic irradiation (n = 1). Hearing was improved by hearing aids and/or etiological treatment (n = 8), restored by contralateral (n = 15) or ipsilateral (n = 4) cochlear implants (CIs), or ipsilateral auditory brainstem implants (ABIs) (n = 3). Finally, 18 CIs were active daily; 14 of them presented high or moderate benefit with mean open-set dissyllabic word scores (WRS) of 58.1% and sentence recognition scores (SRS) of 69.7%, but only one ABI was still active (WRS of 70% and SRS of 87% with lip reading).

Conclusions: When early removal of VS was not necessary, contralateral CI or etiological treatment for hearing loss might be recommended initially. Ipsilateral CI is proposed, whereas VS should be operated on if previous hearing restoration was not successful. ABI should be reserved for the rare cases where a contralateral CI could not be implanted or the cochlear nerve was sectioned during VS removal.

Level Of Evidence: 3 Laryngoscope, 130:E407-E415, 2020.
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http://dx.doi.org/10.1002/lary.28369DOI Listing
June 2020

NF2-Related Intravestibular Schwannomas: Long-Term Outcomes of Cochlear Implantation.

Otol Neurotol 2020 01;41(1):94-99

APHP, GH Pitié-Salpêtrière, Department of Otology, Auditory Implants and Skull Base Surgery, Ile-de-France Reference Center of Cochlear Implant and Auditory Brainstem Implant; Rare Diseases Center of Genetic deafness for adult.

Objective: Intravestibular schwannomas (IVS) are uncommon tumors in Neurofibromatosis type 2 (NF2) and are mainly associated with multiple internal auditory meatus (IAM) and cerebellopontine angle (CPA) tumors. They usually induce profound hearing loss which can be rehabilitated by cochlear implantation (CI). The aim of this study was to analyze the long-term outcomes of CI during the unpredictable evolution of NF2 disease.

Study Design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Three adults with neurofibromatosis type 2 and intravestibular schwannomas, and who were cochlear implant recipients.

Interventions: Periodic radiologic follow-up, tumor resection, and hearing rehabilitation.

Main Outcome Measures: Audiological evolution, tumor evolution, surgical outcome, cochlear implant outcome.

Results: Three NF2 patients (mean age at diagnosis, 26.3 ± 3.2 yr) were identified with IVS in the period between 2000 and 2017. IVS were first observed by serial MRI and profound hearing loss occurred in this ear after 4 ± 1.5 years of follow-up. IVS were removed via a translabyrinthine approach, and ipsilateral cochlear implantations were simultaneously performed. In two patients, large contralateral CPA tumors had previously been removed without hearing preservation, whereas in the third patient, a small, growing contralateral VS was excised via a retrosigmoid approach 6 months after IVS removal/cochlear implantation with serviceable hearing preservation. In all cases, CI provided good hearing outcomes. In two cases, hearing outcomes were even better for more than 5 years when ipsilateral intracanalicular vestibular schwannomas were removed in either the same or subsequent procedures.

Conclusions: Rehabilitation of hearing with CI provides a favorable long-term outcome in patients with NF2-related IVS which could be altered by the occurrence of other intracanalicular and/or CPA NF2-related tumors.
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http://dx.doi.org/10.1097/MAO.0000000000002431DOI Listing
January 2020

EANO guideline on the diagnosis and treatment of vestibular schwannoma.

Neuro Oncol 2020 01;22(1):31-45

Department of Neurosurgery Ludwig-Maximilians University and DKTK partner site, University of Munich, Munich, Germany.

The level of evidence to provide treatment recommendations for vestibular schwannoma is low compared with other intracranial neoplasms. Therefore, the vestibular schwannoma task force of the European Association of Neuro-Oncology assessed the data available in the literature and composed a set of recommendations for health care professionals. The radiological diagnosis of vestibular schwannoma is made by magnetic resonance imaging. Histological verification of the diagnosis is not always required. Current treatment options include observation, surgical resection, fractionated radiotherapy, and radiosurgery. The choice of treatment depends on clinical presentation, tumor size, and expertise of the treating center. In small tumors, observation has to be weighed against radiosurgery, in large tumors surgical decompression is mandatory, potentially followed by fractionated radiotherapy or radiosurgery. Except for bevacizumab in neurofibromatosis type 2, there is no role for pharmacotherapy.
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http://dx.doi.org/10.1093/neuonc/noz153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6954440PMC
January 2020

Cochlear Implant Electrode Migration due to Cholesterol Granuloma: Cues from a Case.

J Int Adv Otol 2019 Dec;15(3):466-468

Department of Otology, Auditory Implants and Skull Base, Pitié Salpêtrière Hospital, Paris, France.

This paper aims to describe a rare case of cochlear implant (CI) failure due to electrode array migration and review the literature on the topic. A 72-year-old woman complained of retroauricolar pain two years after receiving a left CI, with deterioration of the auditory skills and an increased impedance of electrodes. Temporal bone computed tomographic scans revealed a soft density tissue involving the left mastoid and the middle ear. It also revealed a lateral displacement of the array into the middle ear. Surgery with CI re-implantation was performed. The specimen examination disclosed the presence of a cholesterol granuloma. According to the literature, array migration after CI due to cholesterol granuloma is very rare. When patient's auditory performances decline and electrodes impedance increases, computed tomography (CT) scans should be performed to detect possible electrode issues, as in this case. Middle ear and mastoid cholesterol granuloma represent a possible, rare, cause of electrode array migration, even in absence of cochlear erosions.
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http://dx.doi.org/10.5152/iao.2019.6072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937185PMC
December 2019

How to radiologically identify a spontaneous regression of sporadic vestibular schwannoma?

PLoS One 2019 4;14(6):e0217752. Epub 2019 Jun 4.

AP-HP, Department of Neurosurgery, Hôpital Pitié-Salpétrière, Paris, France.

Background: The natural history of sporadic vestibular schwannoma is unpredictable, with tumors growing, non-growing and even showing spontaneous regression in some rare cases.

Objective: This retrospective study aims to describe the radiologic signs characterizing and identifying the shrinking vestibular schwannoma.

Methods: Involution was considered to have occurred if tumor size had decreased by 2 mm or more on its largest diameter. All magnetic resonance imaging scans were reviewed for tumor size, internal auditory meatus size, and tumor characteristics. Volumetric measurements were performed on the first and last scan. Audiometric data were collected at the first and last visit.

Results: Fourteen patients with a confirmed spontaneous regression were included, with a mean follow-up of 5 ± 2.6 years. The mean shrinkage rate was 0.9 ± 0.59 mm/year on 2D measurements, and 0.2 ± 0.17 cm3/year on volumetric measurements, with a relative shrinkage of 40 ± 16.9%. Two remarkable radiologic features were observed: First, a festooned aspect, defined by multiple curves in the tumor outline, noticed in 12 cases (86%); second, the appearance of cerebrospinal fluid filling the internal auditory meatus, associated with an enlargement of the internal auditory meatus compared to the contralateral side, and observed in 10 out of 13 cases with internal auditory meatus invasion (77%). Those two aspects were associated in 64% of cases.

Conclusion: These two newly reported radiologic features could help neurosurgeons, oto-neurosurgeons and neuroradiologists to identify a spontaneous vestibular schwannoma involution at first visit. This could allow any treatment to be postponed, monitoring to be more widely spaced, and patients to be reassured.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217752PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548368PMC
February 2020

Benefits of a contralateral routing of signal device for unilateral Naída CI cochlear implant recipients.

Eur Arch Otorhinolaryngol 2019 Aug 17;276(8):2205-2213. Epub 2019 May 17.

Sorbonne Université, Inserm, Unité de Réhabilitation chirurgicale mini-invasive robotisée de l'audition, Paris, France.

Purpose: Many bilaterally deaf adults are only able to receive one cochlear implant (CI), resulting in suboptimal listening performance, especially in challenging listening environments. Adding a contralateral routing of signal (CROS) device to a unilateral CI is one possibility to alleviate these challenges. This study examined the benefit of such a CROS device.

Methods: Thirteen adult subjects with at least 6 months of CI use, and no or limited benefit of a hearing instrument in the contralateral ear were included in the study. The perceived benefit of a CROS device in everyday listening environments was evaluated up to 1 year after initial fitting using several questionnaires. Speech intelligibility performance was determined using the French matrix sentence test in quiet and in two speech-in-noise setups and was followed for 3 months after CROS fitting.

Results: Subjects indicated high satisfaction with the practical usability of the CROS device and long-term device retention was high. Perceived benefits in everyday listening environments were reported. Formal speech intelligibility tests revealed statistically significant median improvements of 6.93 dB SPL (Wilcoxon Z = 2.380, p = 0.017) in quiet and up to 8.00 dB SNR (Wilcoxon Z = 2.366, p = 0.018) in noise. These benefits were accessible immediately without a need for prolonged acclimatization.

Conclusions: Subjective satisfaction and device retention as well as speech intelligibility benefits in quiet and in noise prove the CROS device to be a valuable addition to a unilateral CI in cases of bilateral deafness where bilateral implantation is not an option.
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http://dx.doi.org/10.1007/s00405-019-05467-9DOI Listing
August 2019

Bioactive glass granules for mastoid and epitympanic surgical obliteration: CT and MRI appearance.

Eur Radiol 2019 Oct 19;29(10):5617-5626. Epub 2019 Mar 19.

AP-HP, Neuroradiology department, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, 75013, Paris, France.

Purpose: To evaluate the appearance of mastoid and epitympanic obliteration using S53P4 bioactive glass (BG) granules in high-resolution computed tomography (HRCT) and MRI.

Materials And Methods: Patients undergoing mastoid and epitympanic obliteration between May 2013 and December 2015 were prospectively included in an uncontrolled clinical study. All patients underwent a temporal HRCT scan 1 year after surgery, aimed at evaluating the attenuation, homogeneity, and osseointegration of the BG granules, as well as the ventilation of the middle ear and the volume of the obliterated paratympanic spaces. If a cholesteatoma was found during surgery, additional MRI, including at least pre- and post-contrast T1-weighted, T2-weighted, and axial non-echo-planar diffusion-weighted (DW) sequences, was performed 1 year after surgery, to study the normal signal of the BG granules and the presence of residual cholesteatoma and/or other temporal bone pathologies.

Results: Seventy cases were included. On 1-year HRCT, the mean attenuation of the BG granules was 888.34 ± 166.10 HU. The obliteration was found to be mostly homogeneous with partial osseointegration. The appearance of the BG granules having a low-intensity signal in T2-weighted imaging and DW MRI was always different from the appearance of cholesteatoma. A longer follow-up has shown no attenuation or signal modification of the BG granules compared with the 1-year imaging.

Conclusion: Radiological follow-up of patients operated on with mastoid and epitympanic obliteration using BG granules is effective using both HRCT and MRI. A cholesteatoma and/or other potential complications could easily be detected due to the specific radiological appearance of the BG granules.

Key Points: • The appearance of mastoid and epitympanic obliteration by S53P4 bioactive glass (BG) granules on high-resolution computed tomography (HRCT) scans was homogeneous with an attenuation significantly higher than the attenuation of cholesteatoma and lower than mastoid bone attenuation. • The granules have a low-intensity signal on non-echo-planar diffusion-weighted sequences and on T2-weighted images and present contrast enhancement allowing the differential diagnosis with cholesteatoma and effective for the detection of other underlying temporal bone pathologies. • The volume and radiological appearance of the obliteration appear to be stable with time.
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http://dx.doi.org/10.1007/s00330-019-06120-zDOI Listing
October 2019

Pig as a large animal model for posterior fossa surgery in oto-neurosurgery: A cadaveric study.

PLoS One 2019 26;14(2):e0212855. Epub 2019 Feb 26.

Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition", Paris, France.

This study proposes a practical model for a new approach to the posterior fossa in common domestic pigs. Several surgical procedures can be simulated in the nonliving pig model, including soft tissue dissection, drilling of temporal bone, dural incision, access to the cerebellopontine angle, exposure of cranial nerves and drilling of the internal auditory canal. The pig model perfectly simulates standard otological and neurosurgical procedures, and we highlight the feasibility of our approach for further experiments in a living pig model with the possibility of reproducing the model for research on cranial nerves in pigs to study their electrophysiological behavior.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212855PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391018PMC
November 2019

Long-Term Cognitive Prognosis of Profoundly Deaf Older Adults After Hearing Rehabilitation Using Cochlear Implants.

J Am Geriatr Soc 2018 08 8;66(8):1553-1561. Epub 2018 Aug 8.

Service de Gériatrie et Sorbonne Université AP-HP, Hôpital Charles Foix, Ivry-sur-Seine, France.

Objectives: To analyze long-term cognitive status and function after cochlear implantation in profoundly deaf individuals.

Design: Prospective observational longitudinal study.

Setting: Ten academic medical centers referent for cochlear implantation.

Participants: Individuals aged 65 and older who qualified for cochlear implantation (N=70).

Measurements: Cognitive tests were administered before cochlear implantation and 1 and 5 or more years after cochlear implantation. Evaluation consisted of 6 tests assessing attention, memory, orientation, executive function, mental flexibility, and fluency. Cognitive status was determined as normal, mild cognitive impairment (MCI), or dementia. Speech perception in quiet and noisy conditions was assessed using disyllabic words, and quality of life was assessed using the Nijmegen Cochlear Implant Questionnaire.

Results: Mean follow-up was 6.8 years (range 5.5-8.5 years). Speech perception scores and quality of life remained stable from 1 to 7 years after cochlear implantation. Of 31 participants (45%) with MCI before cochlear implantation, 2 (6%) developed dementia during follow-up, 19 (61%) remained stable, and 10 (32%) returned to normal cognition. None of the 38 with normal cognition developed dementia during follow-up, although 12 (32%) developed MCI.

Conclusion: MCI is highly prevalent in older adults with profound hearing loss. Nevertheless, we observed a low rate of progression to dementia, and cognitive function improved in some individuals with MCI at baseline. These results highlight that cochlear implantation should be strongly considered in profoundly deaf individuals, even those with MCI, who may have a specific subtype of MCI, with a possible positive effect of hearing rehabilitation on neurocognitive functioning.
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http://dx.doi.org/10.1111/jgs.15445DOI Listing
August 2018

An Optimized Robot-Based Technique for Cochlear Implantation to Reduce Array Insertion Trauma.

Otolaryngol Head Neck Surg 2018 11 7;159(5):900-907. Epub 2018 Aug 7.

1 Sorbonne Université, Inserm, Unité "Réhabilitation chirurgicale mini-invasive et robotisée de l'audition," Paris, France.

Objective: To compare the intracochlear trauma induced by optimized robot-based and manual techniques with a straight electrode array prototype inserted at different lengths.

Study Design: Experimental study.

Setting: Robot-based otologic surgery laboratory.

Subjects And Methods: A prototype array was inserted at different insertion lengths (21 and 25 mm) in 20 temporal bones. The manual insertion was performed with a microforceps. The optimized approach consisted of an optimal axis insertion provided by a robot-based arm controlled by a tracking system, with a constant speed of insertion (0.25 mm/s) achieved by a motorized insertion tool. The electrode position was determined at the level of each electrode by stereomicroscopic cochlea section analysis.

Results: A higher number of electrodes correctly located in the scala tympani was associated with the optimized approach ( P = .03, 2-way analysis of variance). Regardless of the insertion technique used, the array inserted at 25 mm allowed complete insertion of the active stimulating portion of the array in all cases. Insertion depth was greater when the array was inserted to 25 mm versus 21 mm ( P < .001, 2-way analysis of variance). The optimized insertion was associated with less trauma than that from manual insertion regardless the length of the inserted array ( P = .04, 2-way analysis of variance).

Conclusion: Compared with a manual insertion, intracochlear trauma could be reduced with array insertion performed on an optimal axis by using motorized insertion and by applying a constant insertion speed.
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http://dx.doi.org/10.1177/0194599818792232DOI Listing
November 2018

Revision stapes surgery: A review of 102 cases.

Clin Otolaryngol 2018 12 25;43(6):1587-1590. Epub 2018 Jul 25.

AP-HP, GHU Pitié-Salpêtrière, Service ORL, Otologie, implants auditifs et chirurgie de la base du crâne, Paris, France.

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http://dx.doi.org/10.1111/coa.13181DOI Listing
December 2018