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1.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S11-S18, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32863156

ABSTRACT

OBJECTIVE: Multi-centre study of the National French Registry (EPIIC) of patients with cochlear implants, focusing on infants who were operated-on under the age of 24 months between 2012 and 2016. PATIENTS AND METHODS: A total of 615 profoundly deaf infants, who received cochlear implants (CIs) before their second birthday, were included in the registry by different CI centers. Epidemiological, surgical, speech therapy and school, follow-up data were included in the registry, 12, 24, 36 and 48 months thereafter. The following parameters were studied: type of implantation (uni- or bilateral), complications, cause of deafness, category of auditory perception (CAP), Open-set word recognition score (OSW), speech intelligibility rating, lexical comprehension with EVIP (Peabody), communication mode and type of schooling. Bilateral simultaneous CI (BiCI) and unilateral CI (UniCI) groups were compared. RESULTS: There were 744 implantations. The explantation-reimplantation rate, within the four-year follow-up, was just 3.6%. Mean implantation age was 16.0 months, and similar in the two groups (BiCI/UniCI). A total of 51% of children had their first implant between 12 and 18 months, and 15% before 12 months. Implantation was unilateral in 52% of cases. Fifty-six percent of the bilateral procedures were sequential, with a mean delay of 16.8 months for the second implantation. The cause of deafness was unknown in 52% of cases. Of the 48% (297/615) of attributed cases, 32% had clear genetic causes. The remaining deafness was due to cytomegalovirus (CMV, 8%), inner-ear malformation (5%) and meningitis (3%). The main complications were from infections (47%) and internal device failure (25%). Four years post-operation, 84% of the UniCI and 75% of BiCl groups had a CAP≥5, and 83% of UniCl and 100% BiCI had OSW≥80%. Furthermore 74% of UniCI and 77% of BiCI communicated orally and 85% of UniCI and 90% of BiCI integrated into mainstream schooling. CONCLUSION: The French Registry of cochlear implants (EPIIC) is the only such national registry in the world. Our analysis illustrates the immediate benefits of, either single or double, cochlear implantation for language, perception skills and schooling.


Subject(s)
Auditory Perception , Child Language , Cochlear Implantation/statistics & numerical data , Cochlear Implants/statistics & numerical data , Deafness/rehabilitation , Registries/statistics & numerical data , Age Factors , Cochlear Implantation/adverse effects , Cochlear Implantation/methods , Cochlear Implants/adverse effects , Communication , Correction of Hearing Impairment/instrumentation , Correction of Hearing Impairment/statistics & numerical data , Deafness/etiology , Device Removal/statistics & numerical data , Education of Hearing Disabled/methods , Education of Hearing Disabled/statistics & numerical data , Follow-Up Studies , France , Humans , Infant , Infant, Newborn , Mainstreaming, Education/statistics & numerical data , Reoperation/statistics & numerical data , Schools , Speech Intelligibility , Speech Therapy/statistics & numerical data , Time Factors
2.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S5-S9, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32891589

ABSTRACT

Cochlear and brainstem implants have been included on the list of reimbursable products (LPPR) in France since March of 2009. The implants were initially inscribed for 5 years, after which an application for renewal with the French National Commission for the Evaluation of Medical Devices and Health Technologies (Commission Nationale d'évaluation des dispositifs médicaux et des technologies de santé - CNEDiMTS) was required [Haute Autorité de santé, 2009]. Upon registration to the list of reimbursable products, the companies and the reference centers for cochlear and brainstem implants were asked to set up a post-registration registry called EPIIC. This article reports the evolution in the EPIIC registry of the general indicators for 5051 patients over the five years from 2012-2016.


Subject(s)
Auditory Brain Stem Implants/statistics & numerical data , Cochlear Implants/statistics & numerical data , Registries/statistics & numerical data , Advisory Committees/organization & administration , Age Factors , Aged , Aged, 80 and over , Auditory Brain Stem Implants/economics , Cochlear Implantation/statistics & numerical data , Cochlear Implants/economics , Computer Security , Databases as Topic , Device Approval/legislation & jurisprudence , Device Removal/statistics & numerical data , France , Guidelines as Topic/standards , Health Care Sector/economics , Health Care Sector/legislation & jurisprudence , Humans , Infant , Infant, Newborn , Insurance, Health, Reimbursement , Quality Control , Reference Standards , Time Factors
3.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S45-S49, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32826202

ABSTRACT

This study aims to determine the frequency and causes of cochlear explants with re-implantation (ERI) after 5 years' follow up of the patients included in the French national EPIIC (étude post-inscription des implants cochléaires) registry tracking patients with cochlear implantation. This multicenter, descriptive prospective study was conducted on 5051 patients enrolled in the EPIIC database between January 2012 and December 2016. Ninety-five patients (1.9%) received a primary implant and an ERI during the study. Of these, four benefitted from two ERIs. The number of ERIs was significantly higher in the pediatric population than among adults. The explantation and reimplantation were performed simultaneously in 86% of cases. The reasons for explantation were: in 46.4% of cases linked to a malfunction of the implant, and in 39.3% of cases for medical or surgical reasons. The number of electrodes inserted was significantly higher after the ERI than after the first implantation. There was just one post-ERI infection for these 95 explanted and re-implanted patients. As well as explantation with reimplantation rarely being necessary, it generally presents no major surgical difficulty and in most cases it allows a better integration than in the first implantation.


Subject(s)
Cochlear Implantation/statistics & numerical data , Cochlear Implants/statistics & numerical data , Device Removal/statistics & numerical data , Registries/statistics & numerical data , Reoperation/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Cochlear Implants/adverse effects , France , Humans , Infant , Middle Aged , Prospective Studies , Prosthesis Failure , Replantation/statistics & numerical data , Time Factors , Young Adult
4.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S57-S63, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32792302

ABSTRACT

This study concerns the results of cochlear implantation in children and adults from French cochlear implantation centers, monitored at one, two and three years by the Cochlear Implant French Registry EPIIC. This multicenter study enrolled 2603 subjects (1667 adults and 936 children) implanted in one ear. The following parameters were studied: hearing overall performances, monosyllabic or dissyllabic word perception, speech intelligibility, self-assessment questionnaire of Cochlear Implant (CI) benefits (Abbreviated profile of Hearing aid Benefit); professional activity and schooling. This study confirms the ceiling effect in adults' performances after the 1st year and the progressive growth in children's performances. It also shows that the contralateral hearing aid enhances performances compared to the CI alone condition, in all follow-up sessions. The French register of CIs is the only worldwide register of systematic follow-up on a period of three years and more of all adults and children implanted in a country.


Subject(s)
Cochlear Implantation/statistics & numerical data , Cochlear Implants/statistics & numerical data , Deafness/rehabilitation , Quality of Life , Registries/statistics & numerical data , Adolescent , Adult , Age Factors , Auditory Perception , Child , Child, Preschool , Education , Employment , Follow-Up Studies , France , Humans , Infant , Infant, Newborn , Self-Assessment , Speech Intelligibility , Surveys and Questionnaires , Time Factors , Treatment Outcome
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S19-S25, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32773333

ABSTRACT

OBJECTIVES: To analyze the performance of cochlear implants in French patients aged 65 and over, implanted between 2012 and 2016, using data from the French national registry for cochlear implants (EPIIC). MATERIALS AND METHODS: The French national registry incorporates patient data from before implantation and for three years after implantation, stratified in different age groups (18-39, 40-64years, 65-74years and>75years). Here, we assessed the latter two categories. Hearing was assessed using mono- and disyllabic words in a silent background. The Category of Auditory Performance (CAP) scale was also implemented and subjects took the Abbreviated Profile of Hearing Aid Benefit (Aphab) questionnaire. RESULTS: The population aged over 65 accounted for 38% (n=1193) of the 3178 adult implanted patients. The performance for mono- and disyllabic words in silence, the CAP scores and the APHAB questionnaire answers for ease of communication, background noise and reverberation were dramatically improved at one year post-implantation (P<0.0001 for each score) and remained stable between one and three years thereafter. The percentage improvement was similar across all age groups. The scores for loud-noise intolerance did not change after cochlear implantation in any age group. CONCLUSION: Cochlear implants improve hearing and communication in subjects aged 65 and over, with comparable efficiency to that achieved in younger subjects. Cochlear implantation should thus be proposed whenever hearing aids provide only limited benefit. However, between 2012 and 2016, cochlear implantation was given to less than 1% of the French population aged 65 and over with profound deafness.


Subject(s)
Cochlear Implantation/statistics & numerical data , Cochlear Implants/statistics & numerical data , Hearing Loss/rehabilitation , Registries/statistics & numerical data , Adult , Age Factors , Aged , Aged, 80 and over , Auditory Perception , Cochlear Implantation/methods , Communication , Female , France , Health Surveys , Hearing Loss/etiology , Hearing Tests/methods , Humans , Male , Middle Aged , Noise/adverse effects , Retrospective Studies , Time Factors , Young Adult
6.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S27-S35, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32763084

ABSTRACT

OBJECTIVE: Evaluate in France the outcomes of cochlear implantation outside the selection criteria, off-label. MATERIAL AND METHODS: This is a prospective cohort study including adults and children having received a cochlear implant (CI) in an off-label indication, that is outside the criteria established by the "Haute Autorité de santé (HAS)" in 2012. The data was collected from the "EPIIC" registry on recipients who received CIs in France between 2011 and 2014. Speech audiometry was performed at 60dB preimplantation and after one year of CI use, as well as an evaluation of the scores of the quality of life with the APHAB questionnaire, the scores for CAP and the professional/academic status in pre- and post-implantation conditions. Major and minor complications at surgery have been recorded. RESULTS: In total, 590 patients (447 adults and 143 children) with an off-label indication for CIs were included in this study from the EPIIC registry (11.7% of the whole cohort of EPIIC). For adults, the median percentage of comprehension using monosyllabic word lists was 41% in preimplantation condition versus 53% after one year of CI use (P<0.001) and 60% versus 71% in dissyllabic word lists (P<0.001). The CAP scores were 5 versus 6 in pre- and post-implantation conditions respectively (P<0.001) and the APHAB scores were statistically lower after implantation (P<0.001). In the children cohort, the median percentage of comprehension using monosyllabic word lists was 51% in preimplantation condition and 65% after CI (P<0.001), and 48% versus 82% (P<0.001) for dissyllabic word lists. The CAP scores were 5 versus 7 respectively in pre- and post-CI conditions (P<0.001). Thirty-two minor complications (5.4%) and 17 major complications (2.8%) were reported in our panel of off-label indication patients. CONCLUSION: These results suggest that a revision of the cochlear implantation candidacy criteria is necessary to allow more patients with severe or asymmetric hearing loss to benefit from a CI when there is an impact on quality of life despite the use of an optimal hearing aid.


Subject(s)
Auditory Brain Stem Implantation/statistics & numerical data , Cochlear Implantation/statistics & numerical data , Cochlear Implants/statistics & numerical data , Hearing Loss/rehabilitation , Patient Selection , Registries/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Audiometry, Speech/methods , Child , Child, Preschool , Cochlear Implantation/adverse effects , Cochlear Implants/adverse effects , Female , France/epidemiology , Health Surveys , Humans , Male , Middle Aged , Off-Label Use/statistics & numerical data , Postoperative Complications/epidemiology , Postoperative Period , Preoperative Care , Prospective Studies , Quality of Life , Young Adult
7.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S51-S56, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32739279

ABSTRACT

OBJECTIVES: Assessment of the incidence and results of bilateral cochlear implantation in adults and children in France. MATERIALS AND METHODS: Multicenter retrospective study of data in the French national registry of cochlear implantations from January 1st 2012 to December 31st 2016. Functional results from CAP (Category of Auditory Performance) questionnaires and speech audiometry tests, with mono- and di-syllabic word-lists, were compared before and after implantation. Speech audiometry tests were carried out against a noisy background, except before simultaneous implantations. RESULTS: Nine hundred and forty two bilateral cochlear implantations were performed during this period, that is, 16.4% of all cochlear implantations. Five hundred and eighty eight bilateral implantations were performed sequentially. 59% of the bilateral implantations were performed in children. Bilateral implants significantly improved CAP scores in all cases (P<0.001). Auditory performance, with the two types of word-list, were significantly improved after simultaneous implantation (P<0.01). After sequential implantation, the speech discrimination score, already very good with the first implant, reached 63±26% [0-100] with monosyllabic word lists, and 72±28% [0-100] with dissyllabic words. There were more complications due to surgery in bilateral cases than in the entire population of cochlear recipients (9.1% vs 6.4%, P<0.02). CONCLUSION: Hearing is significantly improved by simultaneous cochlear implantation. For sequential implantation, at one year, when auditory results were already excellent from the first implant, in the bimodal condition CAP scores were significantly improved, although there was no further change in speech audiometry in noise.


Subject(s)
Cochlear Implantation/methods , Cochlear Implants/statistics & numerical data , Deafness/rehabilitation , Registries/statistics & numerical data , Adult , Audiometry, Speech/methods , Auditory Perception , Child , Cochlear Implantation/adverse effects , Cochlear Implantation/statistics & numerical data , Deafness/etiology , Female , France , Humans , Male , Postoperative Complications/epidemiology , Retrospective Studies , Speech Discrimination Tests/statistics & numerical data
8.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137 Suppl 1: S37-S43, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32861600

ABSTRACT

OBJECTIVES: The aim of this study was to evaluate peri- and post-operative complications related to cochlear implantations. We searched for risk factors predicting these complications and analyzed the complications in the youngest and most elderly. STUDY DESIGN: Retrospective analysis of cochlear implant patients. MATERIALS AND METHODS: All patients who underwent cochlear implantation in France between January 2012 and December 2016 were anonymized and registered in the EPIIC database. This population included 3483 adults and 2245 children. Their demographic and surgical data and their incidence of peri- or post-operative complications, including their severity, whether major or minor, were all indicated. RESULTS: The global complication rate was 6.84%. The risk of complication was higher in initial implantation versus reimplantation (P<0.0001). The risk was also higher for bilateral implantation versus unilateral (P<0.0001). Complications were more frequent for patients with cochlear malformation (P=0.002). There was no difference in complication rates across age groups; babies under 1 year old, and the elderly over 80 and even over 90, did not have more complications than the rest of the population. Patients treated in the daily care unit had no more complications than those who were hospitalized for one night or more (P=0.64). CONCLUSION: Cochlear implantation is a safe technique with a low incidence of complications. The absence of increased risk in patients at the extremes of the age spectrum justifies offering this solution to all, without age limitation.


Subject(s)
Cochlear Implantation/adverse effects , Hearing Loss/rehabilitation , Intraoperative Complications/epidemiology , Postoperative Complications/epidemiology , Registries/statistics & numerical data , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , Cochlea/abnormalities , Cochlear Implantation/methods , Day Care, Medical/statistics & numerical data , France/epidemiology , Hearing Loss/etiology , Hospitalization/statistics & numerical data , Humans , Incidence , Infant , Middle Aged , Reoperation/adverse effects , Reoperation/statistics & numerical data , Retrospective Studies , Risk Factors , Young Adult
9.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(1): 17-20, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31563458

ABSTRACT

OBJECTIVE: To assess the feasibility of immediate activation of cochlear implants. MATERIAL AND METHODS: A retrospective study compared speech audiometry results at 6 months post-implantation, implant fitting data and complications, on Student test, between 19 patients receiving day-1 implant activation (immediate activation: IA) and 10 patients with activation at 2 weeks (classical activation: CA). RESULTS: Mean speech comprehension, using Fournier bisyllabic word lists at 60dB 6 months after implantation, was 61.58% in IA and 71% in CA (P>0.05). Mean intelligibility thresholds for 50% word-recognition were respectively 39.74dB and 36.5dB (P>0.05). Speech audiometry results at 6 months were not affected by immediate versus classical activation. Comfort-level settings at 1 month in IA were not significantly different (Student test: P>005) from intraoperative neural response thresholds: i.e., were practically stable. One IA patient required delayed activation at 1 month because of hematoma interfering between the external and internal parts of the implant. There were no other complications. The mean number of fitting sessions during the first year was 6.05 in the IA group and 6.55 in the CA group (P>0.05). CONCLUSION: Given certain precautions during follow-up, immediate activation after cochlear implantation was feasible, and did not impair audiometric results.


Subject(s)
Audiometry, Speech , Cochlear Implantation , Cochlear Implants , Adult , Aged , Feasibility Studies , Female , Humans , Male , Middle Aged , Postoperative Period , Retrospective Studies , Time Factors
10.
J Neuroradiol ; 31(2): 110-5, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15094648

ABSTRACT

After a brief review of Rendu-Osler-Weber disease, we present the results from a series of 13 patients treated by Ethibloc injections for epistaxis. Based on a review of the literature, typical treatments are presented along with discussion of their efficacy and side effects. In our series, 90% of patients improved after only one injection. All patients reported a decrease in hemorrhage, especially patients with recurrent epistaxis. Five of nine patients reported a decrease in the length of the bleeding episodes. Improvement was reported by 85% of patients within one month following Ethibloc injection. Fifty percent of these patients have persistent good results at 4 Year follow-up. Our results indicate that Ethibloc injections are safe and effective as an alternative treatment for patients that have failed standard treatment options.


Subject(s)
Diatrizoate/therapeutic use , Epistaxis/drug therapy , Fatty Acids/therapeutic use , Propylene Glycols/therapeutic use , Sclerosing Solutions/therapeutic use , Telangiectasia, Hereditary Hemorrhagic/drug therapy , Zein/therapeutic use , Adult , Aged , Drug Combinations , Female , Humans , Injections , Male , Middle Aged , Retrospective Studies , Treatment Outcome
11.
Neurochirurgie ; 45(5): 407-12, 1999 Dec.
Article in French | MEDLINE | ID: mdl-10717592

ABSTRACT

Three cases of meningioma revealed by hemorrage are reported. The first patient, 65 presented with a temporal hematoma associated with intraventricular contamination. The diagnosis of a tumoral origin of the hemorrhage was made only few weeks later when the total hematoma resorption was ended. The second patient, 49 presented with a sudden right hemiplegia. CTscan and MRI revealed a left frontal tumor surrounded by hematoma. The third patient, 46, presented with a transient aphasia and superior limb dysesthesia. CT scan showed a temporal hematoma; a carotid angiography revealed a typical meningioma blush. A review of the literature collected 54 additional cases of meningioma associated with hemorrage. Clinical findings and mechanisms are discussed.


Subject(s)
Brain Neoplasms/complications , Cerebral Hemorrhage/etiology , Meningioma/complications , Aged , Aphasia/etiology , Brain Neoplasms/diagnosis , Dysarthria/etiology , Female , Hematoma/etiology , Hemiplegia/etiology , Humans , Magnetic Resonance Imaging , Male , Meningioma/diagnosis , Middle Aged
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