Clinique Roosevelt - 9 rue Jean Goujon - 75008 Paris - Phone : +33(0)1 42 25 02 59 - Fax : +33(0)1 42 56 51 33

Audiology & Psycho-acoustic

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Audiology and Psychoacoustic consultation

arrow1Hearing check up and audiometry
arrow1Tinnitus
arrow1Hyperacusis,
arrow1Listening comprehension difficulties
arrow1Hearing expertise with hearing aid,
arrow1Indication of implant and implantable hearing aid.

 

 

 

Tinnitus

Tinnitus is the perception of noises (ringing, hissing) within the ear or head, in the absence of external sound.

Tinnitus can occur as a symptom of almost all diseases of the ear, sound trauma (often associated with dizziness and hearing problems), or ENT (chronic sinusitis, snoring with sleep apnea), neurological diseases, allergies, cardiovascular diseases (hypertension), or even toxic attack (drugs), general metabolic disorders...

Initially, the clinical check-up consists of diagnosing and treating these diseases. Certain types of tinnitus are, however, perceived without any active disease of the ear or neurological symptoms (isolated tinnitus). Their pathological character does not come from the perception of a more or less intense sound but from their permanent character.

Poorly tolerated, tinnitus can cause sleep disorders, disruption of work and social life, "nervous" fatigue... even depression.


IT IS WRONG TO SAY THAT THERE IS NOTHING TO DO ABOUT IT AND YOU NEED TO LIVE WITH!

The patient has two main fears more or less conscious and expressed, first, that the noise increases and then that he/she will lose his/her hearing. i.e. the perception of surroundings and ability to communicate.

A full check-up of sensorineural hearing pathway is required to:

arrow1Confirm the absence of any pathology and reassure the patient,

arrow1Confirm the absence of relationship with a progressive hearing loss.

The check-up consist of an audiometric test (measure of the hearing), otoacoustic emissions test (evaluations of the sensory cells) and auditory brainstem evoked potentials test (check the integrity of the auditory nerve). An MRI with contrast injection may be necessary.

Free-field psychoacoustic tests are then performed to determine the association to:

arrow1hyperacusis (intolerance to noise), matching filters can be then realized,

arrow1test the sound intelligibility, laterality and speed of analysis as compared to vision. Sensory perception problems are involved in the hyperexcitability of the auditory system and the sensorineural pressure increases tinnitus.

Tinnitus often occurs during a period of intense stress and fatigue, during an emotional shock, and the patient memorizes the sound and can no longer get rid of it.

An interview with the Clinique Roosevelt's specialized psychologist is necessary to explain to the patient:

arrow1the sensory functioning

arrow1the different type of memories

arrow1the stages of perception

arrow1to understand the pathogenesis of tinnitus and the difficulty of living with it

arrow1as well as the possible links with anxiety , depression...

Relaxation and behavioral monitoring help address the meaning of tinnitus, which conditions its tolerance. Following the assessment, more than half of patients feel better and no longer suffer from their tinnitus. For the other half the goal is to learn to manage the tinnitus, forget about it, and live without it.

Deafness: Hearing check up and audiometry

Hearing is a complex sense. Its measurement is not limited to the audiometric test where clinicians produce audiograms by presenting different frequencies of pure tones at different intensities, using headphones.

On top of the complex mechanisms of signal processing of the peripheral ear comes the recognition of sound patterns that depends on the organization of the central auditory pathways.

The audiometric tests will help determine the type of hearing loss and measure hearing loss (thresholds).

Hearing tests should be performed in a quiet non-reverberant room. In a soundproof booth, sound storing and its persistence may be misleading.

A tonal audiogram measures the hearing thresholds, in pure frequency, from the study of the speech frequencies (250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz and 8000Hz) or by air conduction (through headphones) or bone conduction (vibrator).

Speech audiogram test is based upon the ability of the subject to correctly repeat words or phrases at different intensities. Words are transmitted to the patient using a headset or speaker, lip-read is thus impossible. The goal of this test is to determine the intelligibility of speech.

Dichotic speech test assesses the problems of laterality, immediate and working memory, and more generally of sensory organization by presenting different messages to the right and the left ear.

The temporal discrimination test emits a sequence of clicks of very short duration (100 to 500 milliseconds) in order to evaluate the speed of analysis of sound information that is to say the neuroplasticity.

The Bioelectrical impedance analysis'goal is to study the tympano-ossicular system and inform on the condition of the Eustachian tube.

It includes a study of the tympanogram, i.e. changes in eardrum compliance (elasticity) in response to air pressure fluctuations in the ear canal and a study of the acoustic reflex.

The purpose of Otoacoustic emissions (OAE) test is to determine the frequency selectivity and sensitivity of the inner ear by recording the activity of the external ciliated cells from the external auditory canal.

During an ABR (Auditory Brainstem Response) test, the response to an acoustic stimuli of very short duration helps locate and differentiate endocochlear (damages of the cochlea's hair cell) or retrocochlear (damages of the auditory nerve or brainstem structure) sensorineural hearing loss.

There are three types of hearing loss

Conductive hearing loss is the result of disorders in either the outer or middle ear, which prevent sound from getting to the inner ear.

They are often the consequence of tympanic perforations or pathology of the ossicular chain. Conductive hearing loss can be helped surgically with excellent results.

Sensorineural hearing loss is the result of an impairment of the sensory system of the cochlea (endocochlear deafness) or the auditory nerve (retrocochlear deafness).

This type of hearing loss can be successfully treated with conventional or implantable hearing aids.

Mixed hearing loss is the result of both conductive and sensorineural hearing loss which sometimes involve therapeutic strategies combining medical treatment, surgery and hearing aid.

Hearing aid and cochlear implant

Hearing aids have made great strides in terms of miniaturization, anti-feedback electronic system, and adaptation to different deafness by digitization.

The otolaryngologist diagnoses the ear pathology, establishes an indication for a hearing aid - which is then adjusted by the prosthetist- and follows its evolution.

Hearing aids consist of a microphone that receives the sound, an electronic processor that processes the signal and a transducer that sends back the adapted and amplified sound depending on the patient's hearing. The system is powered by a battery.

The purpose of any hearing aid is to vibrate the fluids of the inner ear; the vibration is transmitted to the basilar membrane of the cochlea upon which the sensory cells lay and that in turn, release an electrical impulse to the auditory nerve.

The hearing aid can deliver sound information by air, by vibrating the eardrum and the ossicles (in-the-ear and behind-the-ear) or by bone, by vibrating the skull bone with bone-anchoring hearing aid (BAHA).

The transducer may be more or less close to the eardrum in the external ear canal or implanted (implantable middle ear prosthesis). Middle ear implants deliver their message to the ear by a vibrator implanted on one of the ossicles of the middle ear. Those hearing aids are most frequently semi-implantable (the battery and the processor are external and the acoustic information is transmitted by magnetic induction through a coil) or fully implantable such as pacemakers

These implants are to be distinguished from cochlear implants indicated for total deafness. The acoustic signal is then converted into electrical stimulation and sent directly to the auditory nerve fibers, by electrodes implanted in the inner ear (cochlea).

Implantable prostheses

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(BAHA, Medel-vibrant soundbridge, Otologics, Envoy)

Conventional hearing aids have made remarkable progress but can sometimes be inadequate or inappropriate depending on the type of pathology.

The implantable prostheses have developed in two directions: the bone-anchored hearing aids (BAHA) and middle ear prostheses semi-implantable and today fully implantable.

Our experience began over 15 years ago from our multidisciplinary consultation that encompassed bone-anchored prostheses in the rehabilitation of congenital malformations of the ear and cochlear implants indicated in total deafness. The combination of surgical, audiological, radiological, psychological, and speech therapy skills at the Clinique Roosevelt allows to deal with all types of hearing loss (children and adults) and to optimize the functional results.

In 1998, the first semi-implantable prostheses of Symphonix ® (Siemens) type were introduced, followed by the Otologics ® prostheses, indicated in sensorineural hearing loss in order to overcome certain disadvantages of conventional intra-or ear-tipped prostheses (duct obstruction, feedback, skin tolerance, acoustic distortions, poor rehabilitation of trebles; difficulty of understanding in noise ...).

In practice, we commonly use three types of semi-implantable prostheses for the rehabilitation of moderate to severe hearing loss:

arrow1Bone anchored hearing aid B.A.H.A,

arrow1Vibrant Soundbridge® (Med-el),

arrow1And the Otologics® hearing aid.

As for fully implantable prostheses, two are available:

arrow1Envoy

arrow1and Otologics®.

Each system has specific indications beyond those of conventional hearing aid because it is now possible to cope with "ski-slope" hearing losses (significant loss of high frequencies) and have a solution for total deafness in one ear.

The purpose of any hearing aid is to vibrate the fluids of the inner ear to stimulate the ciliated cells remaining. The vibration energy can be provided by air or bone conduction, the further the vibrating system from the "otic capsule", the greater the energy required. This consideration widely broadens the scope of indications for hearing aids to diseases and hearing losses that were until now unsolved and in many cases improves the results compared to conventional prostheses.

Bone Anchored Hearing Aid (B.A.H.A)

This is a direct bone conduction system from a retro-mastoid-transcutaneous implant made of osseo-integrated titanium.

The results are excellent from a good assessment of cochlear reserve in the conductive or mixed hearing loss (with a bone conduction loss below 45 dB) related to a congenital malformation, chronic otitis with mastoid cavity, recurrent otorrhea; inoperable ankylosis of the ossicular chain (single ear, inoperable, elderly), in cases of eczema of the duct and in case of unilateral deafness.

A free-field hearing test through a vibrator can show the patient the desired result and assist decision-making.

Introduced in France in 1987, it now represents 40% of bone conduction prostheses.

Progress on glasses or conventional vibrators (headband) is important: no absorption of high frequencies by the soft tissues beyond 2500 Hz, a direct and effective conduction without any distortion, without fluctuation due to changes in position; without pain or irritation due to the pressure of a vibrator against the skin as the anchoring ensures the stability of the device and patient safety.

The titanium screws of 3 or 4 mm, is placed under local anesthesia in one surgery time. A Biogaze bandage surrounding the screw, held by a plastic flange is repeated a week later and removed the following week.

The first adjustment is made after six weeks; enough time for a perfect osseo-integration.

For long, the otologist found himself helpless when dealing with unilateral cophosis (total deafness on one side) however it now represents a new indication to restore a pseudostereophony.

The sound is collected by the microphone on the deaf side and transmitted through bone conduction to the healthy opposite ear to eliminate the masking effect of the head (about 30 dB) and restore a sense of binaural hearing particularly interesting for the recent cophoses highly resented by patients (sudden deafness, after a translabyrinthine surgery approach to treat acoustic neuromas ...)

Cochlear implants

The cochlear implant is a device suitable for profound or total deafness.

The sound information is transmitted directly to the auditory nerve fibers in the cochlea in the form of electrical stimulations that are then analyzed and interpreted by the auditory cortical areas of the brain.

The equipment includes an implanted part (receptor and electrodes) and an external part in the form of a BTE (microphone, processor and battery) that transmits information to the internal coil by magnetic induction.

Several implants are available: Neurelec (MXM), Cochlear (NUCLEUS), MEDEL BIONICS (CLARION).... They have proven their efficiency and safety for more than 25 years.


What is the process for a cochlear implant?

Preliminary tests should be made to evaluate the patient's degree of auditory perception.

Our specialized team assesses the prognosis by measuring the patient's ability to analyze the information transmitted. Indeed, the organization of the auditory pathways and the brain plasticity determine the outcome in terms of discrimination. Tests developed at the Clinique Roosevelt allow individual prognosis before surgery.

 

Surgery :

A 48 hour-hospitalization is sufficient for a 1h30min-operation under general anesthesia.The postoperative course is simple, without pain or vertigo, the patient whether an adult or a child (early intervention by the age of 8 months) can leave the following morning. The bandage and stitches are removed after one week.

 

Adjustments :

The first adjustment is made between 15 days and one month after surgery. The processor is set individually according to the wearer's hearing needs. It is programmed using a special computer by our acoustic engineer.

The electrodes inserted into the cochlea to stimulate the auditory nerve are adjusted to respond to a particular intensity or height depending on the patient's auditory responses. It is essential that the auditory perception is pleasant, comfortable and informative.

However, as the auditory perception changes over time, the speech processor can be adjusted again as often as necessary. For children, a true hearing education performed by Speech Language Pathologists (SLPs) is necessary for best results.

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