Abstract:
OBJECTIVES. The current settings of cochlear implants (CIs) do not respect specific cochlear tonotopy, resulting in tonotopic mismatch and potentially decreased auditory performance. The development of new implant settings adapted to individual tonotopy, called anatomybased fitting (ABF), could improve the auditory information coding, particularly by making surrounding sounds more recognizable. This study aimed to evaluate whether ABF allows better environmental sound recognition in new CI users compared to the conventional setting (CS); and to investigate the effect of ABF on speech recognition in quiet and noise. METHODS. A prospective, randomized, double-blind, two-period cross-over study in 17 new CI users was performed between March 2022 and August 2024. Adult subjects were recruited from candidates selected for cochlear implantation within a single French university hospital. Newly implanted adult recipients of a MED-EL cochlear implant with an electrode array insertion angle greater than 540° were eligible. Subjects were randomized to receive either ABF or CS for 6 weeks, then switched to the other setting for the same duration. Audiometric testing, including Environmental Sound Identification Test (Test d'Identification des Sons de l'Environnement, TISE), speech audiometry in quiet using Fournier lists, and speech audiometry in noise (Vocale Rapide dans le Bruit, VRB) was performed at 6 and 12 weeks. RESULTS. Sixteen subjects (mean age 60 years [SD=15.1]) were analyzed. ABF showed a significant improvement in the TISE score (mean effect (ME)=1.2, 95% confidence interval (CI95%)=[0.3;2.0], standardized effect size (SES)=0.97, p=0.016). Speech recognition in quiet was statistically better with CS (ME=3.6, CI95%=[1.8;5.3], SES=1.4, p=0.001) while no statistically significant difference was found for speech recognition in noise (CI95%=[- 2.8;0.1], p=0.08). CONCLUSION. In newly implanted cochlear implant users, ABF improved environmental sound recognition, suggesting improved perceived sound naturalness in the first weeks after implantation. This benefit did not extend to speech recognition in quiet and remains inconclusive in noise due to floor effect.

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OBJECTIVES: Temporal bone drilling simulators are valuable tools for developing anatomical knowledge and drill handling motor skills. However, there are currently no simulators focusing on learning fine microsurgical gestures using micro-instruments. The aim of this study was to validate a training kit and simulation program dedicated to otologic microsurgery. MATERIALS AND METHODS: A prospective single-center comparative study was conducted. The Micro-TRAIN kit comprised a mannequin and six interchangeable exercise modules. Two simulation sessions were conducted two months apart, with debriefing for two selected subgroups after the first session. Progression in performance, assessed by task completion time, execution time and technical skills, was evaluated in three groups: 10 novices, 10 intermediate level and 5 experts. Content validity, face validity and participant satisfaction were also assessed. RESULTS: In session 1, there were significant differences in performance between the three groups (P<0.005). Both the novice and intermediate groups showed improvement between sessions. Improvement in total score in the intermediate group was statistically significant (P=0.0019) and suggestive in the novice group (P=0.0059). Participants who received debriefing tended to improve more (novices: P=0.012; intermediate: P=0.036). Experts rated the simulator's realism and relevance as above 8/10. CONCLUSION: This study confirmed the content, face and construct validity of the Micro-TRAIN simulator. It is an effective tool for acquiring microsurgical skills in otologic surgery.

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Transtympanic administration is used clinically for the injection of gentamicin and/or corticosteroids. This atraumatic route is based on passive diffusion through the round window membrane (RWM). The main limitation of this method is related to the clearance through the Eustachian tube, making the concentration of the therapeutic agent at the intracochlear level uncertain and limited. Moreover, this technique remains unsuitable for molecules of high molecular weight or in the case of gene therapies. The purpose was to study a new technique of intracochlear administration in an atraumatic, direct and controlled manner by laser-assisted bioprinting (LAB). LAB was used to deliver dexamethasone phosphate with thermosensitive hydrogel on the mouse RWM. After validation of the regularity and homogeneity of the pattern, the diffusion in vivo of the dexamethasone into the perilymph after LAB has been confirmed by ELISA. Auditory function measurements showed no hearing impairment suggesting that bioprinting does not induce significant cochlear damage. Hence, the present proof of concept study introduces a promising approach for inner ear drug delivery.

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INTRODUCTION: Presbycusis is the physiological decrease in hearing due to advancing age and begins well before the sixth decade. These recommendations recall the principles of early diagnosis of presbycusis and the means of optimal rehabilitation as soon as the first symptoms appear. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of ENT physicians, audiologists, geriatricians and hearing specialists from all over France. They are classified as grade A, B, C or professional agreement according to a decreasing level of scientific evidence. RESULTS: The diagnosis of presbycusis is more difficult at the beginning of its evolution but a certain number of tools are available for its early diagnosis and its face-to-face or remote management. CONCLUSION: In the case of a clinical profile suggestive of presbycusis in a young subject, especially if there are several family cases, it is recommended to propose a genetic investigation. Free-field speech audiometry in noise is recommended to measure intelligibility in a realistic environment. Questionnaires in addition to audiometric tests would allow the best assessment of the patient's disability. Hearing rehabilitation with a hearing aid or cochlear implant may slow or prevent cognitive decline. Combined auditory and cognitive rehabilitation should be offered regardless of the time since the hearing was fitting. It is recommended to integrate programs accessible via smartphones, tablets or the Internet, that include different training domains to complement face-to-face sessions.

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INTRODUCTION: The HHIE-S (Hearing Handicap Inventory for the Elderly - Screening) is widely used for hearing-loss disorder in the elderly. The main objective of the present study was to validate a French version. The secondary objective was to determinate a cut-off score as indication for hearing rehabilitation. METHODS: We translated the HHIE-S into French, respecting the cross-cultural adaptation process for medical questionnaires. An observational study assessed the translation (10 questions, scored from 0 to 40) used for screening purposes in a prospective cohort, aged ≥60 years, with comparison to pure tone, speech-in-silence and speech-in-noise audiometry. Subjects were considered hearing-impaired if the pure-tone average at 500, 1,000, 2,000 and 4,000 Hz was >20 dB HL in one or both ears. RESULTS: We tested 294 subjects (mean age =67±6 years). Hearing loss prevalence was 34.7 %. Cronbach's alpha (test reliability) was high (0.84). Taking HHIE-S score >8/40 as cut-off defining hearing loss, sensitivity was 80.4%, specificity 85.4 %, positive predictive value 74.5 % and negative predictive value 89.1 %. Seventy-three subjects (24.8 %) had theoretic indications for hearing aids, optimally detected by HHIE-S score >16/40 (88,4 %). CONCLUSION: Our study validated the French version of the HHIE-S. This tool could be useful in screening for age-induced hearing loss in the elderly French population.

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OBJECTIVES: This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs. MATERIAL AND METHODS: The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence. RESULTS: Eight tests of speech audiometry in noise can be used in France. CONCLUSION: To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

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INTRODUCTION: Childhood otitis media with effusion (OME) is a frequent disease often misunderstood by parents. Information on the Internet is of variable quality and readability. The aim of this study was to measure the quality and readability of French websites related to OME. MATERIAL AND METHODS: An advanced Google search was conducted using the terms 'Otite séro-muqueuse OR Otite séreuse'. Quality was assessed on DISCERN criteria. Readability was assessed using Flesch Reading Ease Scoring (FRES), Flesch-Kincaid Grade Level (FKGL), the Simple Measure of Gobbledygook (SMOG) and a Fry graph. Medians and standard deviations were calculated. Correlation between quality and readability was assessed on Spearman r coefficient. RESULTS: The first ten websites meeting inclusion and exclusion criteria were evaluated. One had been updated during the last 12 months. Median DISCERN score was 49±13.7/80. Median FRES score was 46±9.5/100. Median USA grade-level estimated by FKGL and SMOG respectively was 11±1.7 and 12±1.5. Six websites had Fry score>12. One website showed high quality. One had a readability score in the target range (below 9th grade reading level (age 14-15)) according to FRES and FKGL. A suggestive correlation was found between lower SMOG readability and higher quality: r=0.72 (P=0.024). Three websites followed the most recent scientific guidelines. CONCLUSION: Online information about OME was of variable quality and readability. Good quality information tended to be less easily understandable by parents.

Abstract:
INTRODUCTION: Musical Ear Syndrome (MES) is an uncommon phenomenon described as the perception of auditory musical sensations not corresponding to any external stimulus. It seems to be more frequent in case of profound hearing loss. Our objective was to evaluate prevalence, characteristics and risk factors in a population of cochlear implant patients. METHODS: A retrospective study was conducted in cochlear implant patients, who were adult (>18 years) in 2020 and underwent cochlear implantation between 1993 and 2019. We analyzed the presence and characteristics of MES. RESULTS: 118 of the 358 patients (33%) perceived or had perceived auditory musical sensations: 71 (19.8%) before, 100 (28%) after, and 53 (14.8%) both before and after implantation. The musical auditory sensations were usually short and well-tolerated, resembling instrumental music, and occurring several times a day. Thirteen patients (11%) considered them intolerable. Fatigue was a triggering factor in 40 patients (33.9%). Personal and medical characteristics, type of implantation, make of implant, etiology and tinnitus did not emerge as risk factors. On the other hand, MES+ patients were significatively younger (56±17.4 years versus 61.9±17.9 years; P=0.0009). Despite the phenomenon, patients were satisfied with implant functioning and subjective auditory performance was not affected. CONCLUSION: Prevalence of Musical Ear Syndrome was high in cochlear implant patients, and especially in younger subjects. It is essential to improve knowledge of this phenomenon.

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Abstract:
Osteomas of the middle ear are rare benign tumors. Their consequences and symptoms are due to their specific location, such as the promontory or the epitympanum and their contact with the facial nerve, the semicircular canal, the ossicles, and the oval or round windows. We report a very unusual case of middle ear osteoma (MEO) in a 23-year-old male patient causing a right mixed hearing loss by contacting and overwhelming the incus and stapes. The lesion was also closely attached to the tympanic portion of the fallopian canal. Since the stapes was not clearly visible behind the lesion, careful observation was preferred to surgery owing to the high risk of inner ear damage and facial palsy with removal of the lesion. MEOs are rarely situated at this critical site. Regular clinical and computerized tomography monitoring is warranted to check their growth. This case also supports the etiological theory of chronic middle ear inflammation causing osteomas.