The French MBAA2 sentence recognition in noise test for cochlear implant users.

OBJECTIVE: The "Marginal benefit from acoustic amplification" version 2 (MBAA2) sentence test has been used in France in the routine evaluation of cochlear implant (CI) users for 20 years. Here we present four studies that characterise and validate the test, and compare it with the French matrix sentence test. DESIGN AND SAMPLE: An analytic method was developed to obtain speech recognition threshold in noise (SNR50) from testing at a fixed signal to noise ratios (SNRs). Speech recognition was measured at several fixed SNRs in 18 normal-hearing listeners and 15 CI listeners. Then, the test-retest reliability of the MBAA2 was measured in an additional 15 CI listeners. Finally, list equivalence was evaluated in eight CI listeners. RESULTS: The MBAA2 test produced lower SNR50s and SNR50s were obtained in more CI listeners than with the French matrix test. For the MBAA2, the standard deviation of test-retest differences in CI listeners was around 1 dB SNR. Three lists had deviant difficulty and nine low item-to-total correlations. CONCLUSIONS: We propose to reduce the number of MBAA2 test lists to reduce variability. The MBAA2 test has high test-retest reliability for percent correct and SNR50, and is suitable for the assessment of cochlear implant patients.

Technical aids for speech understanding in cochlear implanted adults using cell-phones.

OBJECTIVES: The present study sought to assess (1) phone use habits and awareness of listening aids in adult cochlear implant bearers, and (2) objective and subjective benefit of listening aids for cell-phone communication. MATERIAL AND METHODS: A questionnaire was sent to 17 cochlear (Cochlear(®)) implanted adults to assess phone use and awareness of available listening aids. Speech perception without lip-reading was assessed in silence and in noise using Fournier dissyllabic word lists recorded on an iPhone 5C(®), with and without listening aids. Subjective benefit was assessed according to listening aid system. RESULTS: Sixty-five percent of adult cochlear implant bearers regularly used a phone with all kinds of correspondent. Eighty-eight percent phoned only in quiet conditions; 53% did not answer unknown callers; 71% never used listening aids. Speech discrimination scores for disyllabic words recorded on the phone were respectively 69%, 63%, 45% and 16% in quiet and 50, 60 and 70dB SPL noise. Speech perception in quiet and noise was improved by listening aids; the Roger system was the most beneficial, followed by the FM system, then the inductive system. CONCLUSION: Listening aids are effective, but little known by adult cochlear implant bearers.

[Use of auditory brain stem implant in a patient with bilateral vestibular schwannoma (type 2 neurofibromatosis]. / Ispol'zovanie slukhovogo implanta stvola golovnogo mozga u bol'nogo s bilateral'noi vestibuliarnoi shvannomoi (neirofibromatoz 2-go tipa).

Surgical technique and functional results of implantation of the acoustic implant of the brain stem (BS) are described for a 16-year-old patient with bilateral vestibular shvannoma (neurofibromatosis of type 2). Initially, a large (IV degree) tumor was removed from the left cerebellopontile angle using the translabyrinthine-transcochlear approach. The function of the facial nerve recovered completely. The BS implant was implanted a year later in the course of removing shvannoma from the right cerebellopontile angle using the above approach. The patient received 22-channel implant Nucleus-CI22M. Speech intelligibility improved by 90-100%. BS implantation is today the only effective method of reestablishment of acoustic sensations in patients with bilateral destruction of the acoustic nerves due to bilateral vestibular shvannoma.

Steady state plasma levels of the enantiomers of trimipramine and of its metabolites in CYP2D6-, CYP2C19- and CYP3A4/5-phenotyped patients.

Steady state plasma concentrations of the (L)- and (D)-enantiomers of trimipramine (TRI), desmethyltrimipramine (DTRI), 2-hydroxytrimipramine (TRIOH) and 2-hydroxydesmethyl-trimipramine (DTRIOH) were measured in 27 patients receiving between 300 and 400 mg/day racemic TRI. The patients were phenotyped with dextromethorphan and mephenytoin, and the 8-hour urinary ratios of dextromethorphan/dextrorphan, dextromethorphan/3-methoxymorphinan, and (S)-mephenytoin/(R)mephenytoin were used as markers of cytochrome P-450IID6 (CYP2D6), CYP3A4/5 and CYP2C19 activities, respectively. One patient was a CYP2D6 and one was a CYP2C19 poor metabolizer. A stereoselectivity in the metabolism of TRI has been found, with a preferential N-demethylation of (D)-TRI and a preferential hydroxylation of (L)-TRI. CYP2D6 appears to be involved in the 2-hydroxylation of (L)-TRI, (L)DTRI and (D)-DTRI, but not of (D)-TRI, as significant correlations were measured between the dextromethorphan/dextrorphan ratios and the (L)-TRI/(L)-TRIOH (r = 0.45, p = 0.019), the (L)-DTRI/(L)-DTRIOH (r = 0.47, p = 0.014), and the (D)-DTRI/(D)-DTRIOH (r = 0.51, p = 0.006), but not with the (D)-TRI/(D)-TRIOH ratios (r = 0.29, NS). CYP2C19, but not CYP2D6, appears to be involved in the demethylation pathway, with a stereoselectivity toward the (D)-enantiomer of TRI, as a significant positive correlation was calculated between the mephenytoin (S)/(R) ratios and the concentrations to dose-to-weight ratios of (D)-TRI (r = 0.69, p = 0.00006). CYP3A4/5 appears to be involved in the metabolism of (L)-TRI to a presently not determined metabolite. The CYP2D6 poor metabolizer had the highest (L)-DTRI and (D)-DTRI concentrations to dose-to-weight ratios, and the CYP2C19 poor metabolizer had the highest (L)-TRI and (D)-TRI concentrations to dose-to-weight ratios of the group.

[Development of different linguistic systems in children with a cochlear implant]. / Développement des différents systèmes linguistiques chez les enfants porteurs d'un implant cochléaire.

The authors have studied a population of 21 pre-lingually deaf children equipped with a cochlear implant for at least 24 months. Their linguistic progression after implantation has been compared with the standard language development in normally hearing children, using a model published by Marie Therese Le Normand in 1996. 3 types of development can be distinguished: Profile 1 (shown by 9 children) in which language development after implantation is rapid and homogeneous: profile 2 (shown by 8 children), in which it is slower and more heterogeneous, with a longer pre-linguistic phase; Profile 3 (shown by 3 children) in which there are diverse problems with development. The authors then searched to establish the influence of the age at implantation and the mode of communication on this development.

Simultaneous determination of human plasma levels of citalopram, paroxetine, sertraline, and their metabolites by gas chromatography-mass spectrometry.

A gas chromatography-mass spectrometry method is presented which allows the simultaneous determination of the plasma concentrations of the selective serotonin reuptake inhibitors citalopram, paroxetine, sertraline, and their pharmacologically active N-demethylated metabolites (desmethylcitalopram, didesmethylcitalopram, and desmethylsertraline) after derivatization with the reagent N-methyl-bis(trifluoroacetamide). No interferences from endogenous compounds are observed following the extraction of plasma samples from six different human subjects. The standard curves are linear over a working range of 10-500 ng/mL for citalopram, 10-300 ng/mL for desmethylcitalopram, 5-60 ng/mL for didesmethylcitalopram, 20-400 ng/mL for sertraline and desmethylsertraline, and 10-200 ng/mL for paroxetine. Recoveries measured at three concentrations range from 81 to 118% for the tertiary amines (citalopram and the internal standard methylmaprotiline), 73 to 95% for the secondary amines (desmethylcitalopram, paroxetine and sertraline), and 39 to 66% for the primary amines (didesmethylcitalopram and desmethylsertraline). Intra- and interday coefficients of variation determined at three concentrations range from 3 to 11% for citalopram and its metabolites, 4 to 15% for paroxetine, and 5 to 13% for sertraline and desmethylsertraline. The limits of quantitation of the method are 2 ng/mL for citalopram and paroxetine, 1 ng/mL for sertraline, and 0.5 ng/mL for desmethylcitalopram, didesmethylcitalopram, and desmethylsertraline. No interferences are noted from 20 other psychotropic drugs. This sensitive and specific method can be used for single-dose pharmacokinetics. It is also useful for therapeutic drug monitoring of these three drugs and could possibly be adapted for the quantitation of the two other selective serotonin reuptake inhibitors on the market, namely fluoxetine and fluvoxamine.

Selection criteria for cochlear implants in children.

OBJECTIVE: To determine the selection criteria for cochlear implantation in children. SETTING: Hospital pediatric implant center. PATIENTS AND INTERVENTIONS: Selection of patients depends on medical evaluation, audiometric data, speech discrimination, communication skills, cognitive skills, and psychosocial factors. Patient selection is based on tonal audiometry, computed tomography, magnetic resonance imaging, and electrophysiologic tests. Side of implantation is chosen according to cochlear structure, duration of deafness, and dominant handedness. RESULTS: Ninety-eight cochlear implantations with the Nucleus multichannel implant have been performed at this center since 1990. CONCLUSION: The selection of children for cochlear implantation require close collaboration between the pediatric surgical team, the educational team, and the family.

[General principles of conception of cochlear implants]. / Principes généraux de conception des implants cochléaires.

Cochlear implants have greatly been developed on last ten years. Their diversity makes their use and choice more complex. The authors expose simply the physiopathology of the implanted auditory system and basic principles of cochlear implants. Cochlear implants are caracterised by the number of channels and electrodes (monochannel, multichannel), the strategy of encoding (analogiq, digital), the transmission of signal (per-cutaneous, electro-magnetic induction), the site of stimulation (extra or intra-cochlear), the signal wave (sinusoid, pulse), the diffusion of current (monopolar, bipolar).