Biomedical subjects

Colette Boëx

Publications and source records attributed to Colette Boëx.

8 recordsLinked to original sources

PubMed2007

Implications of deep electrode insertion on cochlear implant fitting.

Using long Med-El Combi40+ electrode arrays, it is now possible to cover the whole range of the cochlea, up to about two turns. Such insertion depths have received little attention. To evaluate the contribution of deeply inserted electrodes, five Med-El cochlear implant users were tested on vowel and consonant identification tests with fittings with first one, two, and up to five apical electrodes being deactivated. In addition, subjects performed pitch-ranking experiments, using loudness-balanced stimuli, to identify electrodes creating pitch confusions. Radiographs were taken to measure each electrode insertion depth. All subjects used each modified fitting for two periods of about 3 weeks. During the experiment, the same stimulation rate and frequency range were maintained across all the fittings used for each individual subject. After each trial period the subject had to perform three consonant and three vowel identification tests. All subjects showed deep electrode insertions ranging from 605 degrees to 720 degrees. The two subjects with the deepest electrode insertions showed significantly increased vowel- and consonant-identification performances with fittings with the two or three most apical electrodes deactivated compared to their standard fitting with all available electrodes activated. The other three subjects did not show significant improvements in performance when one or two of their most apical electrodes were deactivated. Four out of five subjects preferred to continue use of a fitting with one or more apical electrodes deactivated. The two subjects with the deepest insertions also showed pitch confusions between their most apical electrodes. Two possible reasons for these results are discussed. One is to reduce neural interactions related to electrodes producing pitch confusions. Another is to improve the alignment of the frequency components of sounds coded by the electrical signals delivered to each electrode to the overall pitch of the auditory perception produced by the electrical stimulation of auditory nerve fibers.

Adult↗

PubMed2006

[Professional occupation after cochlear implantation].

This study verifies whether cochlear implants helps deaf adults to maintain or develop their professional occupations. Sixty-seven patients received a questionnaire concerning their professional activities before and after implantation. At the time of implantation 34 were professionally active. After the implantation 29 remained active, 4 of them reporting positive developments in their careers. Five patients became inactive. The previously inactive patients remained inactive. There was no difference in auditory performances between professionally active or inactive patients. Cochlear implants enable most implanted adults to maintain and even progress in their professions. However, deafness still represents an obstacle to social integration as inactive patients who searched for a job were rejected after the job interviews.

Adolescent↗

PubMed2006

Acoustic to electric pitch comparisons in cochlear implant subjects with residual hearing.

The aim of this study was to assess the frequency-position function resulting from electric stimulation of electrodes in cochlear implant subjects with significant residual hearing in their nonimplanted ear. Six cochlear implant users compared the pitch of the auditory sensation produced by stimulation of an intracochlear electrode to the pitch of acoustic pure tones presented to their contralateral nonimplanted ear. Subjects were implanted with different Clarion electrode arrays, designed to lie close to the inner wall of the cochlea. High-resolution radiographs were used to determine the electrode positions in the cochlea. Four out of six subjects presented electrode insertions deeper than 450 degrees . We used a two-interval (one acoustic, one electric), two-alternative forced choice protocol (2I-2AFC), asking the subject to indicate which stimulus sounded the highest in pitch. Pure tones were used as acoustic stimuli. Electric stimuli consisted of trains of biphasic pulses presented at relatively high rates [higher than 700 pulses per second (pps)]. First, all electric stimuli were balanced in loudness across electrodes. Second, acoustic pure tones, chosen to approximate roughly the pitch sensation produced by each electrode, were balanced in loudness to electric stimuli. When electrode insertion lengths were used to describe electrode positions, the pitch sensations produced by electric stimulation were found to be more than two octaves lower than predicted by Greenwood's frequency-position function. When insertion angles were used to describe electrode positions, the pitch sensations were found about one octave lower than the frequency-position function of a normal ear. The difference found between both descriptions is because of the fact that these electrode arrays were designed to lie close to the modiolus. As a consequence, the site of excitation produced at the level of the organ of Corti corresponds to a longer length than the electrode insertion length, which is used in Greenwood's function. Although exact measurements of the round window position as well as the length of the cochlea could explain the remaining one octave difference found when insertion angles were used, physiological phenomena (e.g., stimulation of the spiral ganglion cells) could also create this difference. From these data, analysis filters could be determined in sound coding strategies to match the pitch percepts elicited by electrode stimulation. This step might be of main importance for music perception and for the fitting of bilateral cochlear implants.

Acoustic Stimulation↗

PubMed2005

Measurements of electrode position inside the cochlea for different cochlear implant systems.

CONCLUSIONS: This study demonstrates that the exact location of an electrode inside the cochlea needs to be assessed using two complementary measures, namely the length and angle of insertion, both of which are mandatory if one wants to prevent erroneous outcomes. Knowledge of the contact position may become very useful when tuning a cochlear implant processor in a patient with contralateral residual hearing, or in cases of binaural implants. OBJECTIVE: Multichannel cochlear implants restore useful hearing to deaf patients. However, several types of intracochlear electrodes are presently available, each featuring a specific technology or design. The aim of this study was to determine precisely the intracochlear position of the contacts for different electrode arrays. MATERIAL AND METHODS: Electrode array insertions were estimated using special radiographs. A total of 26 cochlear implantations were included in the study: 6 Ineraid; 5 Clarion HiFocus I; 11 Clarion HiFocus II; and 4 Med-El Combi40+. In each case, a measurable reference or marker ring placed close to the round window (within 2 mm) could be identified. Insertion lengths and angles were measured and then plotted on a graphl based on 3D reconstructions. RESULTS: Both Clarion HiFocus I and II electrode arrays were found to be placed close to the inner wall of the cochlea. Ineraid and Med-El Combi40+ electrode arrays were both placed close to the organ of Corti, the Med-El Combi40+ arrays demonstrating the deepest insertions overall. In spite of marked differences in the positions of the contacts, we did not find any correlation with speech perception performance for the different types of implants studied.

Adult↗

PubMed2004

FMRI evidence for activation of multiple cortical regions in the primary auditory cortex of deaf subjects users of multichannel cochlear implants.

To investigate the activation of the auditory cortex by fMRI, three deaf subjects users of the Ineraid cochlear implant participated in our study. Possible interference between fMRI acquisition and the implanted electrodes was controlled and safe experimental conditions were obtained. For each subject, electrical stimuli were applied on different intracochlear electrodes, in monopolar mode. Stimulation of each electrode was actually producing auditory sensations of different pitches, as demonstrated by psychophysical pitch-ranking measurements in the same subjects. Because deaf subjects did not hear scanner noise, the data were collected in 'silent background' conditions, i.e. as a result of pure auditory sensations. Functional maps showed activation of the primary auditory cortex, predominantly in the left hemisphere. Stimulation of each different intracochlear electrode revealed different clusters of activation. After cluster grouping, at least three regions have been identified in the auditory cortex of each subject, and comparisons with previous architectonic and functional studies are proposed. However, a tonotopic organization could not be clearly identified within each region. These arguments, obtained without interference with unwanted scanner noise, plead in favor of a functional subdivision of the primary auditory cortex into multiple cortical regions in cochlear implant users.

Adult↗

PubMed2003

Electrical field interactions in different cochlear implant systems.

The goal of this study was to evaluate electrical field interactions produced by the stimulation of different types of intracochlear electrodes in 12 adult subjects (three Ineraid, four Clarion S-Series, three S-Series with the electrode positioning system-EPS and two Clarion HiFocus-I with the EPS). Psychophysical measurements were conducted with biphasic stimuli (813 pulse per second, 153.8 micros/phase). "Perturbation" signals (300 ms) were applied to one electrode chosen at the middle of the array and their effects on detection thresholds of "probe" signals (30 ms) were measured on the neighbor basal electrode. Perturbation levels were set below the detection threshold of the perturbation electrode (-2 dB re threshold). Measurements were first conducted for simultaneous stimulation of the probe and of the perturbation electrodes, for monopolar for all subjects and for bipolar stimulus configurations for both Clarion HiFocus-I subjects. The tested Clarion electrodes did not present lower monopolar interactions than the Ineraid electrodes. Nevertheless, considering the shorter distance between electrodes for the Clarion than for the Ineraid, the tested Clarion electrodes might be more selective than the Ineraid. We did not find any significant monopolar electrical field-interaction differences between subjects who received the S-Series array with and without the EPS. We did not find lower interactions for both subjects who received the HiFocus-I array than for subjects who received the S-Series. Electrical field interactions were lower for bipolar than for monopolar configurations for both HiFocus-I subjects. A second set of measurements was conducted for nonsimultaneous stimulation similar to the one used in continuous interleaved sampling sound strategy. These measurements showed that interactions evaluated for simultaneous biphasic stimuli were larger than for nonsimultaneous stimulation.

Adult↗

PubMed2003

Forward masking in different cochlear implant systems.

The goal of this study was to evaluate, from a psychophysical standpoint, the neural spread of excitation produced by the stimulation of different types of intracochlear electrode arrays: the Ineraid, the Clarion S-Series on its own or with the Electrode Positioning System (EPS), and the Clarion HiFocus-I with the EPS. The EPS is an independent silicone part designed to bring the electrode array close to the modiolus. Forward masking was evaluated in 12 adult subjects (3 Ineraid, 4 Clarion S-Series, 3 Clarion S-Series+EPS, 3 HiFocus-I+EPS) by psychophysical experiments conducted using trains of biphasic stimuli (813 pulses per second, 307.6 micros/phase). Masker signals (+8 dB re: threshold, 300 ms) were applied to the most apical electrode. Probe signals (30 ms, 10-ms postmasker) were delivered to more basal electrodes. Masked and unmasked detection thresholds of probe signals were measured. For both Clarion HiFocus-I subjects, measurements were conducted in both monopolar and bipolar stimulus configurations. No major differences were found in forward masking between the different intracochlear electrode arrays tested in the monopolar configuration at suprathreshold levels equivalent to those used in speech-coding strategies, but significant differences were found between subjects. A significant negative correlation also was found between the level of forward masking and the consonant identification performance. These measurements showed that the neural spread of excitation was more restricted in the bipolar configuration than in the monopolar configuration for HiFocus-I subjects. It was found that CIS strategies implemented without using apical electrodes, which showed high levels of masking, could improve consonant identification.

Adult↗

PubMed2002

Functional MRI of auditory cortex activated by multisite electrical stimulation of the cochlea.

Electrical stimulation of the ear of deaf patients via cochlear implants offers a unique occasion to study activity of central auditory pathways with fMRI, without bias due to scanner noise. Such measurements, however, require one to control the possible interference between fMRI acquisition and the implanted electrodes. A series of measurements on a customized phantom designed to characterize the level of induced currents during MRI acquisition is presented. These experiments demonstrate that the major artifactual contribution is due to radiofrequency interaction and that safe experimental conditions can be obtained with proper shielding of the stimulation cables. The induced currents could be reduced to low levels (<50 microA for a duration <2 ms), below the acoustic perceptual threshold of cochlear implant subjects. Subsequent fMRI experiments on a patient using an Ineraid cochlear implant were conducted. Results revealed bilateral localized activation of the primary auditory cortex. Stimulation of two different intracochlear electrodes elicited activity in two neighboring, but different, regions, in agreement with the known tonotopical organization of the auditory cortex. This work paves the way for fMRI studies of a broad selection of auditory paradigms without interference from unwanted noise.

Artifacts↗