Pitch Comparisons between Electrical Stimulation of a Cochlear Implant and Acoustic Stimuli Presented to a Normal-hearing Contralateral Ear

Four cochlear implant users, having normal hearing in the unimplanted ear, compared the pitches of electrical and acoustic stimuli presented to the two ears. Comparisons were between 1,031-pps pulse trains and pure tones or between 12 and 25-pps electric pulse trains and bandpass-filtered acoustic pulse trains of the same rate. Three methods—pitch adjustment, constant stimuli, and interleaved adaptive procedures—were used. For all methods, we showed that the results can be strongly influenced by non-sensory biases arising from the range of acoustic stimuli presented, and proposed a series of checks that should be made to alert the experimenter to those biases. We then showed that the results of comparisons that survived these checks do not deviate consistently from the predictions of a widely-used cochlear frequency-to-place formula or of a computational cochlear model. We also demonstrate that substantial range effects occur with other widely used experimental methods, even for normal-hearing listeners

An Empowerment Model for Individuals with Chronic Tinnitus

Objective: This qualitative study sought to construct a model of empowerment for clinical implementation, based on the first-hand experience of a sample of individuals with chronic tinnitus.Design: The study was conducted in accordance with the inductive approach to data in classic grounded theory (GT). GT aims to build a model of behavior that accounts for the main concern of individuals and how they strive to resolve it. Twenty-one participants with chronic tinnitus (10 females, 11 males, age 31–85, mean: 57.6 years, mean duration of tinnitus: 12 years) were recruited through the patient association France Acouphènes and ENT consultations. Open-ended, tape-recorded interviews addressed the variation in the intrusiveness of tinnitus in daily life. A constant comparison analysis was undertaken to identify a core category and to distinguish stages in behavioral changes toward the tolerance of tinnitus.Results: Participants’ main concern was to limit the intrusiveness of tinnitus day in, day out. They continuously had to handle tinnitus-induced frustration, which was found to be the core category of the analysis accounting for how all the participants tried to deal with the condition. The more they managed to handle their frustration, the better they coped with the condition. Three behavior patterns were identified as facilitating the ongoing management of tinnitus-induced frustration: (1) searching for perspective upon tinnitus; (2) maintaining order in perception despite its interference; and (3) alleviating conflict arising from social interactions. A model of empowerment is presented that is based on four stages toward tolerance of tinnitus. They are dominated by lack of perspective upon tinnitus (circuit 1), preservation of energy through attempts to control its intrusiveness (circuit 2), attempts to detach oneself from the interference of tinnitus through constant activities (circuit 3), and self-induced relief through the fulfillment of meaningful goals (circuit 4).Conclusion: Tolerance of tinnitus requires finding balance between limiting one’s social participation and spontaneity in carrying out meaningful activities. Tolerance can be enhanced by the preservation of one’s energy and the mediating role of enjoyment through the fulfillment of gratifying goals. In patient counseling, it is essential to address the individual’s desire for direct relief from tinnitus through its elimination. Individuals should be made aware that such a desire will likely be thwarted, resulting in the worsening of intrusiveness. Improvement in tolerance is accompanied by the attenuation of niggling self-awareness, a change that is typical of full commitment with valued goals and that helps in alleviating the interference of tinnitus. By understanding the role of frustration, individuals may develop a sense of responsibility in dealing with disabling tinnitus

An Empowerment Model for Individuals with Chronic Tinnitus

Objective: This qualitative study sought to construct a model of empowerment for clinical implementation, based on the first-hand experience of a sample of individuals with chronic tinnitus.Design: The study was conducted in accordance with the inductive approach to data in classic grounded theory (GT). GT aims to build a model of behavior that accounts for the main concern of individuals and how they strive to resolve it. Twenty-one participants with chronic tinnitus (10 females, 11 males, age 31–85, mean: 57.6 years, mean duration of tinnitus: 12 years) were recruited through the patient association France Acouphènes and ENT consultations. Open-ended, tape-recorded interviews addressed the variation in the intrusiveness of tinnitus in daily life. A constant comparison analysis was undertaken to identify a core category and to distinguish stages in behavioral changes toward the tolerance of tinnitus.Results: Participants’ main concern was to limit the intrusiveness of tinnitus day in, day out. They continuously had to handle tinnitus-induced frustration, which was found to be the core category of the analysis accounting for how all the participants tried to deal with the condition. The more they managed to handle their frustration, the better they coped with the condition. Three behavior patterns were identified as facilitating the ongoing management of tinnitus-induced frustration: (1) searching for perspective upon tinnitus; (2) maintaining order in perception despite its interference; and (3) alleviating conflict arising from social interactions. A model of empowerment is presented that is based on four stages toward tolerance of tinnitus. They are dominated by lack of perspective upon tinnitus (circuit 1), preservation of energy through attempts to control its intrusiveness (circuit 2), attempts to detach oneself from the interference of tinnitus through constant activities (circuit 3), and self-induced relief through the fulfillment of meaningful goals (circuit 4).Conclusion: Tolerance of tinnitus requires finding balance between limiting one’s social participation and spontaneity in carrying out meaningful activities. Tolerance can be enhanced by the preservation of one’s energy and the mediating role of enjoyment through the fulfillment of gratifying goals. In patient counseling, it is essential to address the individual’s desire for direct relief from tinnitus through its elimination. Individuals should be made aware that such a desire will likely be thwarted, resulting in the worsening of intrusiveness. Improvement in tolerance is accompanied by the attenuation of niggling self-awareness, a change that is typical of full commitment with valued goals and that helps in alleviating the interference of tinnitus. By understanding the role of frustration, individuals may develop a sense of responsibility in dealing with disabling tinnitus

La perception de l'harmonicité des sons en présence ou en l'absence de surdité neurosensorielle

Le système auditif central d'un sujet normo-entendant fusionne perceptivement les composantes spectrales des sons complexes harmoniques, bien que ces composantes soient initialement séparées par la cochlée. Cette fusion harmonique joue un rôle important dans l'analyse des scènes acoustiques multi-sources, situations dans lesquelles la gêne auditive des patients atteints de surdité neurosensorielle est généralement exacerbée. L'objectif de cette thèse était d'une part de clarifier les mécanismes de la fusion harmonique chez les auditeurs sains, et d'autre part d'étudier l'impact des surdités neurosensorielles sur la sensibilité à l'harmonicité. Une première expérience, menée sur des auditeurs sains, a porté sur la reconnaissance auditive de l'octave harmonique, formée par des sons purs simultanés dont le rapport fréquentiel est égal à 2. L'expérience montre que le mécanisme permettant cette reconnaissance est insensible à la direction d'un écart par rapport à l'octave. Il apparaît par contre que, pour des sons purs présentés consécutivement, l'octave ne représente plus une singularité du point de vue de la discrimination perceptive. Une seconde expérience, incluant des sujets atteints de surdité neurosensorielle légère à moyenne, montre que l'effet de ces surdités sur la sensibilité absolue à l'harmonicité est très variable d'un individu à l'autre, et semble refléter avant tout le niveau d'altération de la discrimination fréquentielle. Cependant, l'expérience fait apparaître chez tous les sujets testés la conservation d'une sensibilité relative à l'harmonicité : le seuil de détection d'une inharmonicité par rapport à l'octave s'avère toujours meilleur que le seuil de détection d'une différence entre des rapports de fréquences inharmoniques, même en présence de pertes tonales moyennes supérieures à 45 dB entre 500 et 4000 Hz.BORDEAUX1-Bib.electronique (335229901) / SudocSudocFranceF

Faisabilité et fiabilité de l'auditory steady state response (ASSR) dans l'évaluation aauditive de l'enfant et de l'adulte

L'ASSR est une réponse électrophysiologique stable évoquée par un stimulus auditif rapide, répétée périodiquement pendant une durée de test prolongée. Il recherche en conduction aérienne, le seuil d'addiction électrophysiologique de chaque oreille sur les 500, 1000, 2000 et 4000 Hz. Un nouveau stimulus, le CE-chirp*, semble prometteur pour cet examen mais peu d'études sont disponibles à son sujet. Il apparaissait nécessaire d'étudier la faisabilité et la fiabilité de l'ASSR, avant de l'intégrer à nos examens cliniques. Les seuils AASR ont été comparés à ceux obtenus avec l'audiométrie et avec les potentiels évoqués auditifs précoces (PEAP), en fonction de l'âge des sujets testés et des conditions de réalisation de l ASSR. L ASSR utilisait le CE-shirp*, calibré en dB HL, le PEAP des clics non filtrés calibrés en dB nHL et l audiométrie des sons purs calibrés en dB HL. Notre étude a concernée 229 sujets normo-entendants ou porteurs de surdité de perception, soit 382 oreilles (sujets non nécessairement testés de façon bilatérale) : 51 % avaient une audition normale et 49 % une surdité. L âge moyen était de 12,5 and [o,5 mois-78 ans]. Quel que soit le groupe de sujets étudié, la différence moyenne de seuils entre l ASSR et l audiométrie, fréquence par fréquence, n excédait pas 6 dB (différence non significative). La différence moyenne de seuils entre l ASSR et le PEAP n excédait pas 5 dB et n était significative que chez les nourrissons âgés de moins de un an, normo-entendants ou porteurs de surdité légère (p<0,00001). En conclusion, l ASSR constitue un examen complémentaire fiable dans l évaluation de l audition, notamment chez le nourrisson ou l enfant porteur de troubles du comportement.The ASSR is an electrophysiological response evoked by a stable fast auditory stimulus, repeated periodically throughout the duration of the test. It searches electrophysiological hearing threshold of each ear at 500, 1000, 2000 and 4000 Hz. A new stimulus, the CEchirp , looks promising for this test, but few studies are available about it. It appeared necessary to study the feasibility and reliability of the ASSR, before associating it with other tests clinics. ASSR thresholds were compared to those obtained with audiometry and auditory brainstem response (ABR), depending on the age on the subjects tested and the conditions of realization of the ASSR. The ASSR was using CE-chirp calibrated in dB HL, the ABR clicks unfiltered calibrated in dB nHL and audiometry pure tone calibrated in dB HL. Our study involved 229 subjects with normal hearing or sensorineural hearing loss and 382 ears (subject not necessarily tested on a bilaterally) : 51 % normal hearing and 49 % hearing loss. The average age was 12.5 years [0.5 months to 78 years]. Whatever the group of subjects, the main difference between ASSR and audiometry thresholds, frequency by frequency, did not exceed 6 dB (no significant difference with p<0.04). The mean difference between ASSR and ABR thresholds not exceed 5 dB and was significant only in infant aged under one year, with normal hearing or mild hearing loss carriers (p<0.001). The ASSR is an additional examination reliable in assessing the hearing including the infant or child with behavioral problems.ABYMES-CHRUPPA-BU (971202102) / SudocSudocFranceF

Déficits auditifs : recherches émergentes et applications chez l'enfant

La déficience auditive est le déficit sensoriel le plus fréquent chez l’enfant.Ses conséquences sur le développement du langage et de la communicationsont importantes.Les surdités peuvent être classées selon le degré de perte auditive (moyennesur les fréquences 500, 1 000, 2 000 et 4 000 Hz de la meilleure oreille) ensurdités légères, moyennes, sévères et profondes. Les surdités sévères et profondescorrespondent à une déficience auditive qui, sans réhabilitation,entraîne l’absence d’acquisition du langage oral. Même les surdités moyennes,qui représentent 50 % des surdités, ont un impact sur les apprentissagesscolaires, le développement cognitif et l’adaptation sociale qui ne doit pasêtre sous-estimée.Les surdités peuvent être également classées selon l’emplacement du défautprimaire (oreille externe, moyenne, interne). À partir de l’audiogrammeobtenu chez l’enfant (comparaison des courbes de conduction aérienne etosseuse), on distingue les surdités de perception (oreille interne, nerf auditif,voies auditives centrales) et les surdités de transmission (oreille moyenneessentiellement).Les surdités de l’enfant peuvent être isolées (non syndromiques) ou syndromiques(c’est-à-dire associées à des anomalies d’autres organes). La prévalencede la surdité augmente avec l’âge. Certains types de surdité, enparticulier les surdités génétiques, apparaissent durant l’enfance ou même àl’âge adulte. La répartition des surdités prélinguales (c’est-à-dire survenantavant l’âge d’apparition du langage) dans les pays développés est aujourd’huiestimée à 10-15 % de surdités syndromiques héréditaires, 60-65 % de surditésisolées héréditaires et 20-25 % de surdités d’autre origine (infections,médicaments, complication de la prématurité…).L’identification des gènes responsables constitue un axe récent de recherchesur l’origine des déficits auditifs. Ces gènes codent pour des protéines quisont impliquées dans les processus cellulaires du fonctionnement de lacochlée, organe de l’audition dans l’oreille interne. Leur connaissance présenteun intérêt pour la pratique clinique quotidienne car elle peut permettrede cibler un diagnostic moléculaire pour le conseil génétique etpronostique.En France, il n’existe pas encore d’organisation générale permettant de réalisersystématiquement le dépistage à la naissance. La rubrique « dépistagenéonatal de la surdité » figure néanmoins dans le carnet de santé depuis 1970. Des outils non invasifs chez le nouveau-né existent depuis quelquesannées (otoémissions acoustiques, potentiels évoqués auditifs automatisés).Si une anomalie est décelée par un test de dépistage en maternité, des testsplus complexes à visée diagnostique doivent être réalisés en milieu spécialisépour évaluer précisément le niveau auditif.Par ailleurs, on sait que la prise en charge doit être précoce afin de se situerpendant la période critique (liée à la plasticité cérébrale), durant laquelle lelangage oral s’organise à partir des sons entendus. Les possibilités de prise encharge évoluent profondément, avec en particulier la réhabilitation des surditésprofondes par implant cochléaire. Toutes ces avancées peuvent contribuerà réduire fortement le handicap lié à cette déficience.De nouveaux défis se posent donc à l’acoustique, discipline déjà ancienne,pour l’amélioration du dépistage, du diagnostic et de la prise en charge qu’ils’agisse d’appareillages prothétiques ou d’implants cochléaires qui présententencore des imperfections multiples dans un environnement bruyant.(...

Effect of Chronic Cortical Stimulation on Chronic Severe Tinnitus: A Prospective Randomized Double-blind Cross-over Trial and Long-term Follow Up

Background: Chronic severe tinnitus can be greatly detrimental to quality of life. Some authors have reported benefit of repetitive transcranial magnetic stimulation, others of electrical cortical stimulation by stimulating the Heschl's gyrus or secondary auditory areas.Objective: To evaluate the efficacy of chronic electrical epidural stimulation of the auditory cortex on severe and disabling tinnitus.Method: In this double-blind randomized cross-over, patients with chronic (at least 2 years), severe (Strukturierte Tinnitus-Interview, STI score > 19), unilateral or strongly lateralized tinnitus were included. After open-phase stimulation for 4 months, patients were randomized into 2 groups for double-blind stimulation with cross-over between significant and non-significant phases and wash-out in between. Each of the 3 phases was 2 weeks in duration. Patients were chronically stimulated and followed if not explanted. A decrease of STI score >35% was considered as clinically significant.Results: None of the 9 patients included achieved significant improvement during the double-blind phase. Four were explanted, 2 owing to lack of effect, one for breast cancer under the stimulator, and another for psychiatric decompensation. Five are still stimulated. Three felt slight to great subjective effectiveness, the remaining 2 reported benefits and still requested stimulation.Conclusions: This study did not find an objective efficiency of chronic cortical stimulation for severe and resistant tinnitus. The discordance between the results in double-blind and open evaluations could be related to a placebo effect of surgery, but may also be explained by a poorly defined target, a too short randomized phase, or inappropriate outcome measures. Clinical trial reference: NCT00486577

Comparison of three types of French speech-in-noise tests: a multi-center study

OBJECTIVE: To compare results on the everyday sentence test 'FIST', the new closed-set sentence test 'FrMatrix', and the digit triplet screening test 'FrDigit3'. DESIGN: First, the FrMatrix was developed and normative values were obtained. Subsequently, speech reception thresholds (SRTs) for the three types of tests were gathered at four study centers representing different geographic regions in Belgium and France. STUDY SAMPLE: Fifty-seven normal-hearing listeners took part in the normative study of the FrMatrix, and 118 subjects, with a wide range of hearing thresholds, participated in the comparative study. RESULTS: Homogenizing the individual words of the FrMatrix with regard to their intelligibility resulted in a reference SRT of -6.0 (±0.6) dB SNR and slope at the SRT of 14.0 %/dB. The within-subject variability was only 0.4 dB. Comparison of the three tests showed high correlations between the SRTs mutually (>0.81). The FrMatrix had the highest discriminative power, both in stationary and in fluctuating noise. For all three tests, differences across the participating study centers were small and not significant. CONCLUSIONS: The FIST, the FrMatrix, and the FrDigit3 provide similar results and reliably evaluate speech recognition performance in noise both in normal-hearing and hearing-impaired listeners.status: publishe