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Assessment of the incidence and results of bilateral cochlear implantation in adults and children in France.Multicenter retrospective study of data in the French national registry of cochlear implantations from January 1st 2012 to December 31st 2016. Functional results from CAP (Category of Auditory Performance) questionnaires and speech audiometry tests, with mono- and di-syllabic word-lists, were compared before and after implantation. Speech audiometry tests were carried out against a noisy background, except before simultaneous implantations.Nine hundred and forty two bilateral cochlear implantations were performed during this period, that is, 16.4% of all cochlear implantations. Five hundred and eighty eight bilateral implantations were performed sequentially. 59% of the bilateral implantations were performed in children. Bilateral implants significantly improved CAP scores in all cases (P0.001). Auditory performance, with the two types of word-list, were significantly improved after simultaneous implantation (P0.01). After sequential implantation, the speech discrimination score, already very good with the first implant, reached 63±26% [0-100] with monosyllabic word lists, and 72±28% [0-100] with dissyllabic words. There were more complications due to surgery in bilateral cases than in the entire population of cochlear recipients (9.1% vs 6.4%, P0.02).Hearing is significantly improved by simultaneous cochlear implantation. For sequential implantation, at one year, when auditory results were already excellent from the first implant, in the bimodal condition CAP scores were significantly improved, although there was no further change in speech audiometry in noise.

This study concerns the results of cochlear implantation in children and adults from French cochlear implantation centers, monitored at one, two and three years by the Cochlear Implant French Registry EPIIC. This multicenter study enrolled 2603 subjects (1667 adults and 936 children) implanted in one ear. The following parameters were studied: hearing overall performances, monosyllabic or dissyllabic word perception, speech intelligibility, self-assessment questionnaire of Cochlear Implant (CI) benefits (Abbreviated profile of Hearing aid Benefit); professional activity and schooling. This study confirms the ceiling effect in adults’ performances after the 1st year and the progressive growth in children's performances. It also shows that the contralateral hearing aid enhances performances compared to the CI alone condition, in all follow-up sessions. The French register of CIs is the only worldwide register of systematic follow-up on a period of three years and more of all adults and children implanted in a country. 137;Supplement 1

Objectives :To analyze the performance of cochlear implants in French patients aged 65 and over, implanted between 2012 and 2016, using data from the French national registry for cochlear implants (EPIIC). Materials and methods : The French national registry incorporates patient data from before implantation and for three years after implantation, stratified in different age groups (18–39, 40–64 years, 65–74 years and > 75 years). Here, we assessed the latter two categories. Hearing was assessed using mono- and disyllabic words in a silent background. The Category of Auditory Performance (CAP) scale was also implemented and subjects took the Abbreviated Profile of Hearing Aid Benefit (Aphab) questionnaire. Results : The population aged over 65 accounted for 38% (n = 1193) of the 3178 adult implanted patients. The performance for mono- and disyllabic words in silence, the CAP scores and the APHAB questionnaire answers for ease of communication, background noise and reverberation were dramatically improved at one year post-implantation (P < 0.0001 for each score) and remained stable between one and three years thereafter. The percentage improvement was similar across all age groups. The scores for loud-noise intolerance did not change after cochlear implantation in any age group. Conclusion : Cochlear implants improve hearing and communication in subjects aged 65 and over, with comparable efficiency to that achieved in younger subjects. Cochlear implantation should thus be proposed whenever hearing aids provide only limited benefit. However, between 2012 and 2016, cochlear implantation was given to less than 1% of the French population aged 65 and over with profound deafness.

This study aims to determine the frequency and causes of cochlear explants with re-implantation (ERI) after 5 years’ follow up of the patients included in the French national EPIIC (étude post-inscription des implants cochléaires) registry tracking patients with cochlear implantation. This multicenter, descriptive prospective study was conducted on 5051 patients enrolled in the EPIIC database between January 2012 and December 2016. Ninety-five patients (1.9%) received a primary implant and an ERI during the study. Of these, four benefitted from two ERIs. The number of ERIs was significantly higher in the pediatric population than among adults. The explantation and reimplantation were performed simultaneously in 86% of cases. The reasons for explantation were: in 46.4% of cases linked to a malfunction of the implant, and in 39.3% of cases for medical or surgical reasons. The number of electrodes inserted was significantly higher after the ERI than after the first implantation. There was just one post-ERI infection for these 95 explanted and re-implanted patients. As well as explantation with reimplantation rarely being necessary, it generally presents no major surgical difficulty and in most cases it allows a better integration than in the first implantation. 137;Supplement 1

Resume Objectifs La place de l’endoscopie sous sommeil induit (ESSI) dans la prise en charge du syndrome d’apnees-hypopnees obstructives du sommeil (SAHOS) n’est pas encore bien definie chez l’enfant. L’objectif principal de cette etude est de decrire la modification de localisation des obstacles des voies aeriennes superieures (VAS) induite par l’ESSI, et la modification de prise en charge therapeutique qui en decoule dans une population pediatrique presentant un SAHOS. Les objectifs secondaires sont de rechercher une correlation entre le nombre de sites obstructifs retrouves, l’indice d’apnees-hypopnees (IAH), et le type de SAHOS. Materiels et methodes Etude retrospective monocentrique portant sur 31 enfants de 5,5 ± 2,6 ans presentant un SAHOS ayant beneficie d’une ESSI d’octobre 2015 a juin 2018. La modification de localisation des obstacles des VAS et de prise en charge apres ESSI a ete relevee. Une correlation entre le nombre de sites obstructifs et l’IAH, d’une part, et entre le nombre de sites obstructifs et le type de SAHOS, d’autre part, a ete recherchee. Resultats La localisation des obstacles des VAS a ete modifiee pour 77 % des enfants (n = 24), avec une modification de la prise en charge therapeutique chez 45,2 % des enfants (n = 14). On ne retrouvait pas de correlation statistique entre le nombre de sites obstructifs a l’ESSI et l’IAH : coefficient de Spearman 0,20 (p = 0,26). Les patients presentant un SAHOS de type III ne presentaient pas plus de sites obstructifs que les autres : respectivement 2,0 versus 1,8 (p = 0,40). Conclusion L’ESSI induit une modification significative dans la localisation et la prise en charge des obstacles des VAS chez les enfants presentant un SAHOS. Sa realisation systematique, en particulier en cas de SAHOS de type I, permettrait une classification pre-therapeutique plus precise, et un traitement adapte a la realite de l’obstruction des voies aeriennes.

Resume Objectifs La polygraphie ventilatoire (PV) peut constituer un defi technique pour le diagnostic de syndrome d’apnees hypopnees obstructives du sommeil (SAHOS) de l’enfant : acceptation de l’appareil, desadaptations des capteurs. Chez l’enfant, la detection automatique des evenements respiratoires n’a jamais ete evaluee. Le premier objectif de cette etude est de determiner la faisabilite de la PV pediatrique dans un service d’ORL. Le deuxieme objectif est d’evaluer la fiabilite de l’analyse automatique pour la detection des evenements respiratoires obstructifs et centraux chez l’enfant. Methodes Etude retrospective monocentrique portant sur 50 enfants (32 garcons, 18 filles) de 5,5 ± 2,3 ans ayant beneficie d’une PV dans un service d’ORL entre janvier et aout 2016 pour suspicion de SAHOS. Une interpretation manuelle a ete realisee par un ORL forme a la lecture de la PV chez l’enfant, et comparee a l’analyse automatique. Resultats L’appareillage etait bien accepte dans 98 % des cas. La qualite du signal etait superieure a 50 % dans 76 % des cas, avec une qualite moyenne de signal de 70,8 % (86 % chez les enfants de plus de 3 ans, 25 % chez les enfants de moins de 3 ans, p = 0,0013). On retrouvait une absence de correlation statistique entre la lecture manuelle et automatique, a l’exception de la detection des apnees centrales (coefficient de Spearman 0,43, p = 0,0015). 100 % des enfants presentaient un SAHOS d’apres la lecture automatique, contre 32 % d’apres la lecture manuelle (p Conclusion La PV pediatrique est realisable en pratique courante dans un service d’ORL, avec une bonne acceptation et une qualite de signal satisfaisante chez l’enfant de plus de 3 ans. La detection automatique des evenements respiratoires chez l’enfant n’est pas fiable sauf pour les apnees centrales.