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M Pelizzone

Publications and source records attributed to M Pelizzone.

At least 37 records · Page 2Linked to original sources

Geneva experience with the Ineraid multichannel cochlear implant.

Ineraid is a multichannel intracochlear implant of recent design that can provide high levels of speech recognition to totally deaf patients. We chose this device when it became available in 1985 because of our clinical and research interests. We had no commercial ties and could therefore critically assess the value of this implant in an array of patients, including congenital deafness, ossified cochleas and perilingual children.

Adolescent↗

A case study of a 4-year-old perilingual deaf child implanted with an Ineraid multichannel cochlear implant.

In August 1989, we implanted the first young (age 2-4) perilingual deaf child with the Ineraid multichannel cochlear implant. The child experienced sudden deafness at the age of 3 years 9 months. The time lapse between the onset of deafness and the implantation of the electrode array was only 4 months, but during that time the child completely stopped talking. Electrically evoked auditory brainstem responses were used for diagnosis and follow-up.

Child, Preschool↗

Intracochlear potential distribution with intracochlear and extracochlear electrical stimulation in humans.

Intracochlear potential distributions were measured from subjects implanted with the Ineraid multichannel cochlear implant. The electrode array provided direct accessibility for obtaining measurements. Different modes of stimulation were used. The findings with intracochlear monopolar stimulation seem to confirm that significant low-resistance pathways, in which currents can flow into or out of the cochlea, are located in the basal turn. The results with extracochlear stimulation only show small intracochlear potential gradients. This finding suggests that no substantial currents flow along the auditory nerve fibers when extracochlear stimulation is used. These results concur with the electrically evoked auditory brain stem responses, in that intracochlear stimulation consistently elicited auditory brain stem responses, whereas responses elicited at or near the round window by extracochlear stimulation were weak or absent.

Cochlea↗

Indication of a relation between speech perception and temporal resolution for cochlear implantees.

In order to better understand the reasons for success or failure of a cochlear implant system for various patients, it appears necessary to analyze the patients' basic psychophysical capacities in relation to speech perception. Five patients with intracochlear multichannel Ineraid implants were studied in terms of their performance on temporal analysis in relation to their perception of consonants. For temporal analysis we measured the detection of a silent gap in noise and of an interval between two clicks. For consonant perception we established a confusion matrix based on 12 consonants presented in a vowel-consonant-vowel context using the vowel /a/. The results showed a correlation between temporal resolution for two successive clicks at the most basal cochlear electrode used, and the perception of place of articulation of consonants. This finding indicates that delivering fine temporal coding can be crucial for the success of an implant and that for a given subject, optimal capacity for temporal resolution may serve as a criterion for choosing a basal electrode.

Cochlear Implants↗

Bilateral electrical stimulation of a congenitally-deaf ear and of an acquired-deaf ear.

Two identical multichannel intracochlear prostheses were implanted in the same patient. The first prosthesis, implanted in the congenitally-deaf right ear, elicited clear sound perception but no speech recognition. After 2 years, a second prosthesis, implanted in the acquired-deaf left ear, enabled the patient to understand speech without lip-reading. Brainstem and middle-latency evoked potentials were similar with electrical stimulation of both ears and resembled those evoked by acoustic stimuli in subjects with normal hearing. Cortical electric and magnetic responses differed for right- and left-sided electrical stimulation suggesting that stimulation of the congenitally-deaf ear elicited an abnormal activation of the auditory cortex. These results suggest that only cortical responses were affected by the different histories of deafness of the ears.

Cochlear Implants↗

[The "Ineraid" multichannel cochlear implant].

In Geneva from 1985 to November 1990, we have implanted 21 Ineraid TM multichannel-cochlear implants in 18 totally deaf patients. On the basis of our experience we have divided the patients in 2 categories: optimal cases and difficult cases. Optimal cases had post lingual deafness and adequate anatomical conditions for implantation. They all recovered understanding of free running speech without lip-reading. Difficult cases had ossified cochlea or pre-and-perilingual deafness: results are variable and less predictable. The cochlear implant is both an artificial sense organ and a prosthetic device. With the aid of the prothesis the patient can hear. When the processor stops functionning the patient is again totally deaf. Implanted deaf patients require life-long technical and medical support.

Cochlear Implants↗

Binaural interaction in a cochlear implant patient.

Binaural interaction was demonstrated in electrically evoked brainstem responses (EBRs) of a bilaterally implanted patient. A clear binaural difference waveform (BD), consisting of a negative peak near 3.6 ms followed by a positive peak near 4.4 ms, was found by subtracting the recordings with diotic stimulation from the sum of the recordings with monotic stimulation. These results are consistent with those reported for normal subjects and suggest that neural processing in this patient might resemble those ordinarily used in binaural hearing. They strengthen the argument that EBRs in cochlear implant patients do result from activity in auditory brainstem neurons and suggest a method for aligning the positions of the intracochlear electrodes.

Brain Stem↗

Multi-channel cochlear implant patients with different open speech understanding show some similar basic psychophysical results.

A series of tests was recently undertaken on three multi-channel cochlear implant patients showing different degrees of open speech understanding in order to try to determine underlying differences in inner ear excitation. First we wanted to determine whether these patients showed notable differences in basic psychophysical tasks. This article reports a series of measures including absolute and differential thresholds, simultaneous and forward masking, and some polarity and phase perception. Absolute and differential sensitivities were found to be similar. In forward or simultaneous masking, the patients often showed no masking at all and in cases of masking, no frequency selectivity. In forward masking, their time constants were found to be longer than those in normal hearing. Multi-harmonic signals differing only in phase relations to produce large differences in peak amplitude did not seem to elicit different perceptions. In stimulating with very low-frequency square waves, only negative going fronts were perceived. The similarity of results for the 3 patients in this study suggest that individual differences lie in more complex stimulus processing and perhaps in qualitative aspects of perception.

Adult↗

[Examination of central vision. Visual acuity, contrast sensitivity, color vision].

In the neurophysiological organization of the visual system, form, color, movement, and depth perception are processed separately. Therefore, sensorial examination methods should test each of these basic functions separately, since they may be affected individually or to different extents by pathologic processes. For diagnosis the limit of visual acuity, i.e., the capacity for discrimination must be searched for, using Paliaga's "limits method". Visual acuity can also be tested in infants by the preferential looking method. Contrast sensitivity is tested using sinusoidal grid patterns of varying contrast and spatial frequency. In routine practice, however, this is usually achieved more easily with acuity cards on which contrast is reduced in several stages. The "two-equation method" is a colorimetric test combining two metameric matches, red + green = yellow, and blue + green = cyan, for testing color vision. The test requires an anomaloscope or anomalometer with four light channels. With this method it is possible to test the "red", "green", and "blue" cones and the "red-green" and "blue-yellow" opponents. The test provides a qualitative and quantitative evaluation of color vision disorders. If no colorimeter is available, classic printed test can be used. However, they might never achieve the same qualitative and quantitative precision.

Color Perception Tests↗

Electrically evoked responses in Cochlear implant patients.

Highly reproducible recordings of evoked responses elicited by electrical stimulation of the auditory nerve were obtained in a group of 4 totally deaf patients implanted with a multichannel intracochlear prosthesis. They were compared to auditory evoked responses obtained in a normal-hearing subject tested with the same equipment. The most striking observation drawn from these data is certainly the close resemblance, at all latencies, between evoked responses elicited by electrical stimulation and those elicited by acoustic stimulation. The remarkable correspondence of waveform morphology, waveform amplitude and interpeak latencies provides indirect evidence that the same sequence of events is triggered in the central auditory system in both cases. Those aspects of the responses which differ significantly are easily interpreted by the physical and physiological properties of the different types of stimulation.

Auditory Perception↗

[Recent trends and developments in the clinical study of color vision--the 2-comparison method].

Modern anomaloscopes with four independent light channels (i.e., the Besançon Anomalometer which was presented in 1980 at the DOG) allow accurate examinations of color vision. In our routine clinical examination, we use two metameric equations: the red-green Rayleigh equation and the blue-green Moreland equation. This two-equation method permits the diagnosis of congenital and acquired color vision defects in a precise quantitative way. In both equations the goal of the examination is to measure the absolute matching range. The diagnosis is abnormal color vision if the absolute matching range is shifted and/or enlarged in one or both of the two metameric equations. A computer-controlled clinical examination of color vision, which will make the procedure simpler and shorter for the patient, is presently being developed.

Adolescent↗

Neuromagnetic responses from a deaf subject to stimuli presented through a multichannel cochlear prosthesis.

Neuromagnetic responses to stimuli presented through a 4-channel cochlear prosthesis were recorded from a deaf subject. The topography of the responses agreed with activation of the supratemporal auditory cortex. The responses to tone pips, noise/square-wave sequences, and to intermittent frequency modulation of a continuous tone resembled those obtained from subjects with normal hearing, being consistent with the good performance of this subject with his implant.

Acoustic Stimulation↗

Noninvasive extratympanic electrical stimulation of the auditory nerve.

We have developed a noninvasive technique for extratympanic stimulation of the auditory nerve. 119 ears of 76 subjects with either normal, residual or no hearing were tested. 73% of the subjects with experience of hearing reported definite auditory sensations. Subjects with no certain experience of hearing could not describe accurately the nature of their sensations. Electrical stimulation of normal ears failed to elicit auditory sensations. These results compare well with those of promontory stimulation in cochlear implant candidates.

Adolescent↗

Cortical origin of middle-latency auditory evoked responses in man.

We have recorded middle-latency magnetic evoked responses to 50-ms noise bursts, presented once every 0.9 s, over the right hemisphere of healthy humans. The measurements were carried out with a sensitive 7-channel SQUID gradiometer with a passband of 0.5-2000 Hz. The response consisted of peaks at about 30, 50 and 65 ms. The location of the equivalent source of the 30-ms deflection agrees with activation of the supratemporal auditory cortex, slightly anterior to the source area of the well-known 100-ms deflection.

Acoustic Stimulation↗

Neuromagnetic responses of the human auditory cortex to on- and offsets of noise bursts.

Cortical sources of neuromagnetic responses to noise bursts were compared in 7 healthy humans. The earliest response, P40m, peaking about 40 ms after the stimulus onset, was followed by a prominent deflection in the opposite direction at about 100 ms (N100m) and by another peak at 200 ms (P200m). A sustained field, seen near the end of the 400- to 550-ms stimuli, ended with an off-response of the same polarity as N100m. All deflections could be explained by cortical activity within the Sylvian fissure. The source of P200m was anterior to other sources of the on-response, except P40m. When noise bursts, or pauses of equal duration in a continuous noise were presented to the subject, striking similarities were found between the 100-ms deflections of the on- and off-responses: both peaked at about the same latency; their estimated sources were closed to each other in the supratemporal plane and their amplitudes depended in a similar way on the interstimulus interval (1.1-8.8 s). However, only the on-response was preceded by P40m, suggesting that P40m and N100m are not causally linked. N100m seems to reflect cortical activity related to any abrupt change in the auditory environment.

Auditory Cortex↗

Activation of the auditory cortex by cochlear stimulation in a deaf patient.

We have recorded cerebral electric and magnetic responses to electric stimulation of the auditory nerve in a deaf patient with multichannel cochlear prosthesis. The electric response peaked with a vertex-negative deflection at 65 ms. Clear magnetic responses, coinciding with the vertex potential, were obtained only over the hemisphere ipsilateral to the stimulation; the field pattern indicated activation of the auditory cortex within the Sylvian fissure. The results suggest modification of the central auditory pathways in this patient deaf from early childhood.

Auditory Cortex↗

Interpretation of neuromagnetic responses: two simple models for extended current sources in the human auditory cortex.

The usefulness of dipole models in interpreting neuromagnetic field patterns was studied. By statistical means it turned out to be difficult to differentiate between a point-like source and an extended source at the auditory cortex. A single dipole is an appropriate source model for localized cortical activity extending up to a few square centimeters. Additional information about the source configuration can be obtained by focusing the analysis on areas where the differences between patterns produced by different sources should theoretically be the largest.

Auditory Cortex↗

Vowel and consonant identification tests can be used to compare performances in a multilingual group of cochlear implant patients.

Vowel and consonant identification tests were conducted in the sound-only condition in a multilingual group of 13 totally deaf patients who are users of the Ineraid multichannel cochlear implant. Native languages ranged across French, German, Italian, Spanish, Albanian and Swahili. We found high correlations (r > -0.83) among vowel or consonant identification scores and 'subjective ranking' scores established on the basis of a subjective evaluation of the patient's speech reception abilities in the sound-only condition. Detailed analysis demonstrates that the identification of vowel and consonant is dominated by the perception of acoustic cues characteristic of the set of stimuli used as well as by the strengths and weaknesses of the speech processing of the cochlear implant system. We did not find any systematic pattern in the results that could be related to the native language of the patients. These results suggest that vowel as well as consonant identification tests are effective means to compare the performance of cochlear implant patients even across different native languages. They also indicate that, in the future, one can conduct a fewer number of the many different (e.g. nonsense-syllable, word, sentence, speech-tracking) tests when evaluating the speech recognition abilities of patients with the implant.

Adolescent↗