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Oh S, Lee S, Kim SW, Kim CY, Jeong EY, Lee J, Kwon DA, Jeong JW. Softening implantable bioelectronics: Material designs, applications, and future directions. Biosens Bioelectron 2024; 258:116328. [PMID: 38692223 DOI: 10.1016/j.bios.2024.116328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/30/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Implantable bioelectronics, integrated directly within the body, represent a potent biomedical solution for monitoring and treating a range of medical conditions, including chronic diseases, neural disorders, and cardiac conditions, through personalized medical interventions. Nevertheless, contemporary implantable bioelectronics rely heavily on rigid materials (e.g., inorganic materials and metals), leading to inflammatory responses and tissue damage due to a mechanical mismatch with biological tissues. Recently, soft electronics with mechanical properties comparable to those of biological tissues have been introduced to alleviate fatal immune responses and improve tissue conformity. Despite their myriad advantages, substantial challenges persist in surgical handling and precise positioning due to their high compliance. To surmount these obstacles, softening implantable bioelectronics has garnered significant attention as it embraces the benefits of both rigid and soft bioelectronics. These devices are rigid for easy standalone implantation, transitioning to a soft state in vivo in response to environmental stimuli, which effectively overcomes functional/biological problems inherent in the static mechanical properties of conventional implants. This article reviews recent research and development in softening materials and designs for implantable bioelectronics. Examples featuring tissue-penetrating and conformal softening devices highlight the promising potential of these approaches in biomedical applications. A concluding section delves into current challenges and outlines future directions for softening implantable device technologies, underscoring their pivotal role in propelling the evolution of next-generation bioelectronics.
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Affiliation(s)
- Subin Oh
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Simok Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Sung Woo Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Choong Yeon Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Eun Young Jeong
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Juhyun Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Do A Kwon
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea; Department of Materials Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea
| | - Jae-Woong Jeong
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, 34141, Republic of Korea; KAIST Institute for Health Science and Technology, Daejeon, 34141, Republic of Korea.
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Callejón-Leblic MA, Lazo-Maestre M, Fratter A, Ropero-Romero F, Sánchez-Gómez S, Reina-Tosina J. A full-head model to investigate intra and extracochlear electric fields in cochlear implant stimulation. Phys Med Biol 2024; 69:155010. [PMID: 38925131 DOI: 10.1088/1361-6560/ad5c38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/26/2024] [Indexed: 06/28/2024]
Abstract
Objective.Despite the widespread use and technical improvement of cochlear implant (CI) devices over past decades, further research into the bioelectric bases of CI stimulation is still needed. Various stimulation modes implemented by different CI manufacturers coexist, but their true clinical benefit remains unclear, probably due to the high inter-subject variability reported, which makes the prediction of CI outcomes and the optimal fitting of stimulation parameters challenging. A highly detailed full-head model that includes a cochlea and an electrode array is developed in this study to emulate intracochlear voltages and extracochlear current pathways through the head in CI stimulation.Approach.Simulations based on the finite element method were conducted under monopolar, bipolar, tripolar (TP), and partial TP modes, as well as for apical, medial, and basal electrodes. Variables simulated included: intracochlear voltages, electric field (EF) decay, electric potentials at the scalp and extracochlear currents through the head. To better understand CI side effects such as facial nerve stimulation, caused by spurious current leakage out from the cochlea, special emphasis is given to the analysis of the EF over the facial nerve.Main results.The model reasonably predicts EF magnitudes and trends previously reported in CI users. New relevant extracochlear current pathways through the head and brain tissues have been identified. Simulated results also show differences in the magnitude and distribution of the EF through different segments of the facial nerve upon different stimulation modes and electrodes, dependent on nerve and bone tissue conductivities.Significance.Full-head models prove useful tools to model intra and extracochlear EFs in CI stimulation. Our findings could prove useful in the design of future experimental studies to contrast FNS mechanisms upon stimulation of different electrodes and CI modes. The full-head model developed is freely available for the CI community for further research and use.
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Affiliation(s)
- M A Callejón-Leblic
- Otorhinolaryngology Department, Virgen Macarena University Hospital, Seville 41009, Spain
- Oticon Medical, 28108 Madrid, Spain
- Dept. Signal Theory and Communications, Biomedical Engineering Group, University of Seville, Seville 41092, Spain
| | - M Lazo-Maestre
- Otorhinolaryngology Department, Virgen Macarena University Hospital, Seville 41009, Spain
| | - A Fratter
- Oticon Medical, 06220 Vallauris, France
| | - F Ropero-Romero
- Otorhinolaryngology Department, Virgen Macarena University Hospital, Seville 41009, Spain
| | - S Sánchez-Gómez
- Otorhinolaryngology Department, Virgen Macarena University Hospital, Seville 41009, Spain
| | - J Reina-Tosina
- Dept. Signal Theory and Communications, Biomedical Engineering Group, University of Seville, Seville 41092, Spain
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He LT, Xu XR, Guan RR, Zhao W, Sun JQ, Sun JW, Guo XT. Sensory intelligence for extraction of abstract auditory rules from a speech sound stream in children with cochlear implants. Clin Neurophysiol 2024; 166:1-10. [PMID: 39068766 DOI: 10.1016/j.clinph.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Sensory intelligence in the brain helps listeners automatically extract abstract auditory rules formed by invariant acoustic features from complex speech sound streams, presumably serving as the neural basis for speech comprehension. However, whether this intelligence is deficient in children with cochlear implants (CIs) remains unclear. METHODS Mandarin Chinese monosyllables shared a flat lexical tone contour to form an abstract auditory rule but differed in other acoustic features to construct a complex speech sound stream. The abstract rule was occasionally violated by monosyllables with a rising or falling lexical tone. RESULTS In normal hearing (NH) children, the abstract auditory rule could be extracted, as revealed by a mismatch negativity (MMN) and a late discriminative negativity (LDN). However, the MMN and LDN were only evoked in CI children with good hearing and speech performance. NH children with a higher speech perception or spatial hearing score had a greater MMN. The LDN was attenuated with increasing age in NH children. CONCLUSIONS The sensory intelligence for extraction of auditory abstract rules, associated with speech perception, is deficient in CI children. This intelligence may gradually develop during childhood and adolescence. SIGNIFICANCE Deficient sensory intelligence in CI children may aid in understanding poor speech comprehension in complex environments.
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Affiliation(s)
- Liu-Ting He
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Xin-Ran Xu
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Rui-Rui Guan
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Wan Zhao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China
| | - Jia-Qiang Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Jing-Wu Sun
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Xiao-Tao Guo
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230001, China.
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Duan W, Robles UA, Poole‐Warren L, Esrafilzadeh D. Bioelectronic Neural Interfaces: Improving Neuromodulation Through Organic Conductive Coatings. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2306275. [PMID: 38115740 PMCID: PMC11251570 DOI: 10.1002/advs.202306275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/07/2023] [Indexed: 12/21/2023]
Abstract
Integration of bioelectronic devices in clinical practice is expanding rapidly, focusing on conditions ranging from sensory to neurological and mental health disorders. While platinum (Pt) electrodes in neuromodulation devices such as cochlear implants and deep brain stimulators have shown promising results, challenges still affect their long-term performance. Key among these are electrode and device longevity in vivo, and formation of encapsulating fibrous tissue. To overcome these challenges, organic conductors with unique chemical and physical properties are being explored. They hold great promise as coatings for neural interfaces, offering more rapid regulatory pathways and clinical implementation than standalone bioelectronics. This study provides a comprehensive review of the potential benefits of organic coatings in neuromodulation electrodes and the challenges that limit their effective integration into existing devices. It discusses issues related to metallic electrode use and introduces physical, electrical, and biological properties of organic coatings applied in neuromodulation. Furthermore, previously reported challenges related to organic coating stability, durability, manufacturing, and biocompatibility are thoroughly reviewed and proposed coating adhesion mechanisms are summarized. Understanding organic coating properties, modifications, and current challenges of organic coatings in clinical and industrial settings is expected to provide valuable insights for their future development and integration into organic bioelectronics.
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Affiliation(s)
- Wenlu Duan
- The Graduate School of Biomedical EngineeringUNSWSydneyNSW2052Australia
| | | | - Laura Poole‐Warren
- The Graduate School of Biomedical EngineeringUNSWSydneyNSW2052Australia
- Tyree Foundation Institute of Health EngineeringUNSWSydneyNSW2052Australia
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Alahmadi A, Abdelsamad Y, Yousef M, Almuhawas F, Hafez A, Alzhrani F, Hagr A. Cochlear Implantation: Long-Term Effect of Early Activation on Electrode Impedance. J Clin Med 2024; 13:3299. [PMID: 38893010 PMCID: PMC11172931 DOI: 10.3390/jcm13113299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: The growing adoption of cochlear implants (CIs) necessitates understanding the factors influencing long-term performance and improved outcomes. This work investigated the long-term effect of early activation of CIs on electrode impedance in a large sample of CI users at different time points. Methods: A retrospective study on 915 ears from CI patients who were implanted between 2015 and 2020. According to their CI audio processor activation time, the patients were categorized into early activation (activated 1 day after surgery, n = 481) and classical activation (activated 4 weeks after surgery, n = 434) groups. Then, the impact of the activation times on the electrode impedance values, along the electrode array contacts, at different time points up to two years was studied and analyzed. Results: The early activation group demonstrated lower impedance values across all the electrode array sections compared to the classical activation at 1 month, 1 year, and 2 years post-implantation. At 1 month, early activation was associated with a reduction of 0.34 kΩ, 0.46 kΩ, and 0.37 kΩ in the apical, middle, and basal sections, respectively. These differences persisted at subsequent intervals. Conclusions: Early activation leads to sustained reductions in the electrode impedance compared to classical activation (CA), suggesting that earlier activation might positively affect long-term CI outcomes.
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Affiliation(s)
- Asma Alahmadi
- King Abdullah Ear Specialist Center (KAESC), King Saud Medical City, King Saud University, Riyadh 11411, Saudi Arabia; (M.Y.); (F.A.); (F.A.); (A.H.)
| | - Yassin Abdelsamad
- Research Department, MED-EL GmbH, Riyadh 11563, Saudi Arabia; (Y.A.); (A.H.)
| | - Medhat Yousef
- King Abdullah Ear Specialist Center (KAESC), King Saud Medical City, King Saud University, Riyadh 11411, Saudi Arabia; (M.Y.); (F.A.); (F.A.); (A.H.)
- Audio Vestibular Unit, ENT Department, Menoufia University, Menoufia 32928, Egypt
| | - Fida Almuhawas
- King Abdullah Ear Specialist Center (KAESC), King Saud Medical City, King Saud University, Riyadh 11411, Saudi Arabia; (M.Y.); (F.A.); (F.A.); (A.H.)
| | - Ahmed Hafez
- Research Department, MED-EL GmbH, Riyadh 11563, Saudi Arabia; (Y.A.); (A.H.)
| | - Farid Alzhrani
- King Abdullah Ear Specialist Center (KAESC), King Saud Medical City, King Saud University, Riyadh 11411, Saudi Arabia; (M.Y.); (F.A.); (F.A.); (A.H.)
| | - Abdulrahman Hagr
- King Abdullah Ear Specialist Center (KAESC), King Saud Medical City, King Saud University, Riyadh 11411, Saudi Arabia; (M.Y.); (F.A.); (F.A.); (A.H.)
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Gaultier C, Goehring T. Recovering speech intelligibility with deep learning and multiple microphones in noisy-reverberant situations for people using cochlear implants. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:3833-3847. [PMID: 38884525 DOI: 10.1121/10.0026218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/10/2024] [Indexed: 06/18/2024]
Abstract
For cochlear implant (CI) listeners, holding a conversation in noisy and reverberant environments is often challenging. Deep-learning algorithms can potentially mitigate these difficulties by enhancing speech in everyday listening environments. This study compared several deep-learning algorithms with access to one, two unilateral, or six bilateral microphones that were trained to recover speech signals by jointly removing noise and reverberation. The noisy-reverberant speech and an ideal noise reduction algorithm served as lower and upper references, respectively. Objective signal metrics were compared with results from two listening tests, including 15 typical hearing listeners with CI simulations and 12 CI listeners. Large and statistically significant improvements in speech reception thresholds of 7.4 and 10.3 dB were found for the multi-microphone algorithms. For the single-microphone algorithm, there was an improvement of 2.3 dB but only for the CI listener group. The objective signal metrics correctly predicted the rank order of results for CI listeners, and there was an overall agreement for most effects and variances between results for CI simulations and CI listeners. These algorithms hold promise to improve speech intelligibility for CI listeners in environments with noise and reverberation and benefit from a boost in performance when using features extracted from multiple microphones.
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Affiliation(s)
- Clément Gaultier
- Cambridge Hearing Group, Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
| | - Tobias Goehring
- Cambridge Hearing Group, Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, CB2 7EF, United Kingdom
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Brooks KA, Altartoor K, Vivas EX. Quality of Life With Cochlear Implantation Using the CIQOL-35 at a Tertiary Urban Medical Center: Our Experience. Otol Neurotol 2024; 45:507-512. [PMID: 38518763 DOI: 10.1097/mao.0000000000004167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Assessment of quality-of-life (QOL) outcomes after cochlear implantation (CI) using the Cochlear Implant Quality of Life-35 questionnaire (CIQOL-35). STUDY DESIGN Retrospective cohort. SETTING Single-institution tertiary care center. PATIENTS Patients 18 years and older who have undergone CI and CIQOL-35 survey. INTERVENTIONS Implementing CIQOL-35 from 2019 to 2022 to measure change in QOL after CI. Statistical analysis included nonparametric, univariate, and multivariate analyses. Significance was set at 0.05. MAIN OUTCOME MEASURES Differences in QOL among CI patients in each of the CIQOL-35 domains. RESULTS Ninety-three patients (40 female, 53 male) aged 20 to 93 years (median 70 years) turned in 164 QOL surveys (68 preactivation, 96 postactivation). Postactivation median QOL was 5 to 15 points higher across all domains ( p < 0.001). QOL score distributions among unilateral CI only, bilateral CI, and unilateral CI with contralateral hearing aid users were not statistically different ( p > 0.05). Multivariate analysis identified that male sex ( β = -2.0; 95% confidence interval, -3.9 to -0.1) was a negative predictor for environment scores and not being married ( β = 2.0; 95% confidence interval, 0.02 to 4.0) was a positive predictor for entertainment scores. Median follow-up time was 13 months post-CI (interquartile range [IQR], 7.1-21.5 months). CONCLUSIONS CI patients experienced improved QOL postactivation among all QOL domains, whereas specific CI use pattern in regard to unilateral, bilateral, or bimodal did not affect QOL. Multivariate analysis identified marital status and sex as possible QOL predictors.
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Affiliation(s)
- Kaitlyn A Brooks
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia
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Paisa R, Andersen J, Ganis F, Percy-Smith LM, Serafin S. A Concert-Based Study on Melodic Contour Identification among Varied Hearing Profiles-A Preliminary Report. J Clin Med 2024; 13:3142. [PMID: 38892853 PMCID: PMC11172703 DOI: 10.3390/jcm13113142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background: This study investigated how different hearing profiles influenced melodic contour identification (MCI) in a real-world concert setting with a live band including drums, bass, and a lead instrument. We aimed to determine the impact of various auditory assistive technologies on music perception in an ecologically valid environment. Methods: The study involved 43 participants with varying hearing capabilities: normal hearing, bilateral hearing aids, bimodal hearing, single-sided cochlear implants, and bilateral cochlear implants. Participants were exposed to melodies played on a piano or accordion, with and without an electric bass as a masker, accompanied by a basic drum rhythm. Bayesian logistic mixed-effects models were utilized to analyze the data. Results: The introduction of an electric bass as a masker did not significantly affect MCI performance for any hearing group when melodies were played on the piano, contrary to its effect on accordion melodies and previous studies. Greater challenges were observed with accordion melodies, especially when accompanied by an electric bass. Conclusions: MCI performance among hearing aid users was comparable to other hearing-impaired profiles, challenging the hypothesis that they would outperform cochlear implant users. A cohort of short melodies inspired by Western music styles was developed for future contour identification tasks.
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Affiliation(s)
- Razvan Paisa
- Multisensory Experience Lab, Aalborg University Copenhagen, A.C. Meyers Vænge 15, 2450 Copenhagen, Denmark; (F.G.); (S.S.)
| | - Jesper Andersen
- The Royal Danish Academy for Music, Rosenørns Alle 22, 1970 Frederiksberg, Denmark;
| | - Francesco Ganis
- Multisensory Experience Lab, Aalborg University Copenhagen, A.C. Meyers Vænge 15, 2450 Copenhagen, Denmark; (F.G.); (S.S.)
| | | | - Stefania Serafin
- Multisensory Experience Lab, Aalborg University Copenhagen, A.C. Meyers Vænge 15, 2450 Copenhagen, Denmark; (F.G.); (S.S.)
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Guérit F, Middlebrooks JC, Gransier R, Richardson ML, Wouters J, Carlyon RP. Exploring the Use of Interleaved Stimuli to Measure Cochlear-Implant Excitation Patterns. J Assoc Res Otolaryngol 2024; 25:201-213. [PMID: 38459245 PMCID: PMC11018570 DOI: 10.1007/s10162-024-00937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/15/2024] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Attempts to use current-focussing strategies with cochlear implants (CI) to reduce neural spread-of-excitation have met with only mixed success in human studies, in contrast to promising results in animal studies. Although this discrepancy could stem from between-species anatomical and aetiological differences, the masking experiments used in human studies may be insufficiently sensitive to differences in excitation-pattern width. METHODS We used an interleaved-masking method to measure psychophysical excitation patterns in seven participants with four masker stimulation configurations: monopolar (MP), partial tripolar (pTP), a wider partial tripolar (pTP + 2), and, importantly, a condition (RP + 2) designed to produce a broader excitation pattern than MP. The probe was always in partial-tripolar configuration. RESULTS We found a significant effect of stimulation configuration on both the amount of on-site masking (mask and probe on same electrode; an indirect indicator of sharpness) and the difference between off-site and on-site masking. Differences were driven solely by RP + 2 producing a broader excitation pattern than the other configurations, whereas monopolar and the two current-focussing configurations did not statistically differ from each other. CONCLUSION A method that is sensitive enough to reveal a modest broadening in RP + 2 showed no evidence for sharpening with focussed stimulation. We also showed that although voltage recordings from the implant accurately predicted a broadening of the psychophysical excitation patterns with RP + 2, they wrongly predicted a strong sharpening with pTP + 2. We additionally argue, based on our recent research, that the interleaved-masking method can usefully be applied to non-human species and objective measures of CI excitation patterns.
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Affiliation(s)
- François Guérit
- Cambridge Hearing Group, MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, England.
| | - John C Middlebrooks
- Department of Otolaryngology, University of California at Irvine, Irvine, CA, USA
- Department of Neurobiology and Behavior, University of California at Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, University of California at Irvine, Irvine, CA, USA
| | - Robin Gransier
- Department of Neurosciences, ExpORL KU Leuven, Leuven, Belgium
- Leuven Brain Institute KU Leuven, Leuven, Belgium
| | - Matthew L Richardson
- Department of Otolaryngology, University of California at Irvine, Irvine, CA, USA
| | - Jan Wouters
- Department of Neurosciences, ExpORL KU Leuven, Leuven, Belgium
- Leuven Brain Institute KU Leuven, Leuven, Belgium
| | - Robert P Carlyon
- Cambridge Hearing Group, MRC Cognition & Brain Sciences Unit, University of Cambridge, Cambridge, England
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Fletcher MD, Perry SW, Thoidis I, Verschuur CA, Goehring T. Improved tactile speech robustness to background noise with a dual-path recurrent neural network noise-reduction method. Sci Rep 2024; 14:7357. [PMID: 38548750 PMCID: PMC10978864 DOI: 10.1038/s41598-024-57312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
Many people with hearing loss struggle to understand speech in noisy environments, making noise robustness critical for hearing-assistive devices. Recently developed haptic hearing aids, which convert audio to vibration, can improve speech-in-noise performance for cochlear implant (CI) users and assist those unable to access hearing-assistive devices. They are typically body-worn rather than head-mounted, allowing additional space for batteries and microprocessors, and so can deploy more sophisticated noise-reduction techniques. The current study assessed whether a real-time-feasible dual-path recurrent neural network (DPRNN) can improve tactile speech-in-noise performance. Audio was converted to vibration on the wrist using a vocoder method, either with or without noise reduction. Performance was tested for speech in a multi-talker noise (recorded at a party) with a 2.5-dB signal-to-noise ratio. An objective assessment showed the DPRNN improved the scale-invariant signal-to-distortion ratio by 8.6 dB and substantially outperformed traditional noise-reduction (log-MMSE). A behavioural assessment in 16 participants showed the DPRNN improved tactile-only sentence identification in noise by 8.2%. This suggests that advanced techniques like the DPRNN could substantially improve outcomes with haptic hearing aids. Low-cost haptic devices could soon be an important supplement to hearing-assistive devices such as CIs or offer an alternative for people who cannot access CI technology.
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Affiliation(s)
- Mark D Fletcher
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
| | - Samuel W Perry
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
- Institute of Sound and Vibration Research, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Iordanis Thoidis
- School of Electrical and Computer Engineering, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Carl A Verschuur
- University of Southampton Auditory Implant Service, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Tobias Goehring
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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Abari J, Tekin AM, Bahşi I, Topsakal V. More than 40 years of cochlear implant research: A bibliometric analysis. Cochlear Implants Int 2024:1-9. [PMID: 38512716 DOI: 10.1080/14670100.2024.2330793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Cochlear implantation is the most effective treatment for patients with severe-to-profound sensorineural hearing loss. Much scientific work has been published since their inception. There is a need for a critical reflection on how and what we publish on cochlear implantation. METHODS All Science Citation Index Expanded featured articles between 1980 and 2022 with the word 'cochlear implants' or 'cochlear implantation' were collected from the Web of Science database. Separate characteristics, such as the publication dates, the journals, the number of citations, the countries of origin, the authors, the institutions and co-occurring keywords, were assessed. RESULTS 13,934 articles were included in the data analysis. The journals of of Otology and Neurotology, Ear and Hearing and of Pediatric Otorhinolaryngology represent the top three most publishing journals. Hannover Medical School, the University of Melbourne and the University of Northern Iowa represent the top three most publishing institutions. DISCUSSION The amount of scientific publications on cochlear implant technology has increased for the last 40 years. Besides the focus on speech perception, the research landscape on cochlear implantation is broad and diverse. The number of countries and institutions contributing to these publications is limited. CONCLUSION This bibliometric analysis serves as a quantitative overview of the research landscape on cochlear implantation.
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Affiliation(s)
- Jaouad Abari
- Department of Otolaryngology and Head & Neck Surgery, Vrije Universiteit Brussel, University Hospital UZ Brussel, Brussels, Belgium
| | - Ahmet M Tekin
- Department of Otolaryngology and Head & Neck Surgery, Vrije Universiteit Brussel, University Hospital UZ Brussel, Brussels, Belgium
| | - Ilhan Bahşi
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Vedat Topsakal
- Department of Otolaryngology and Head & Neck Surgery, Vrije Universiteit Brussel, University Hospital UZ Brussel, Brussels, Belgium
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Viswanathan V, Heinz MG, Shinn-Cunningham BG. Impact of Reduced Spectral Resolution on Temporal-Coherence-Based Source Segregation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.11.584489. [PMID: 38586037 PMCID: PMC10998286 DOI: 10.1101/2024.03.11.584489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Hearing-impaired listeners struggle to understand speech in noise, even when using cochlear implants (CIs) or hearing aids. Successful listening in noisy environments depends on the brain's ability to organize a mixture of sound sources into distinct perceptual streams (i.e., source segregation). In normal-hearing listeners, temporal coherence of sound fluctuations across frequency channels supports this process by promoting grouping of elements belonging to a single acoustic source. We hypothesized that reduced spectral resolution-a hallmark of both electric/CI (from current spread) and acoustic (from broadened tuning) hearing with sensorineural hearing loss-degrades segregation based on temporal coherence. This is because reduced frequency resolution decreases the likelihood that a single sound source dominates the activity driving any specific channel; concomitantly, it increases the correlation in activity across channels. Consistent with our hypothesis, predictions from a physiologically plausible model of temporal-coherence-based segregation suggest that CI current spread reduces comodulation masking release (CMR; a correlate of temporal-coherence processing) and speech intelligibility in noise. These predictions are consistent with our behavioral data with simulated CI listening. Our model also predicts smaller CMR with increasing levels of outer-hair-cell damage. These results suggest that reduced spectral resolution relative to normal hearing impairs temporal-coherence-based segregation and speech-in-noise outcomes.
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Affiliation(s)
- Vibha Viswanathan
- Neuroscience Institute, Carnegie Mellon University, Pitttsburgh, PA 15213
| | - Michael G. Heinz
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN 47907
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Herrada J, Medel V, Dragicevic C, Maass JC, Stott CE, Delano PH. A frequency peak at 3.1 kHz obtained from the spectral analysis of the cochlear implant electrocochleography noise. PLoS One 2024; 19:e0299911. [PMID: 38451925 PMCID: PMC10919660 DOI: 10.1371/journal.pone.0299911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION The functional evaluation of auditory-nerve activity in spontaneous conditions has remained elusive in humans. In animals, the frequency analysis of the round-window electrical noise recorded by means of electrocochleography yields a frequency peak at around 900 to 1000 Hz, which has been proposed to reflect auditory-nerve spontaneous activity. Here, we studied the spectral components of the electrical noise obtained from cochlear implant electrocochleography in humans. METHODS We recruited adult cochlear implant recipients from the Clinical Hospital of the Universidad de Chile, between the years 2021 and 2022. We used the AIM System from Advanced Bionics® to obtain single trial electrocochleography signals from the most apical electrode in cochlear implant users. We performed a protocol to study spontaneous activity and auditory responses to 0.5 and 2 kHz tones. RESULTS Twenty subjects including 12 females, with a mean age of 57.9 ± 12.6 years (range between 36 and 78 years) were recruited. The electrical noise of the single trial cochlear implant electrocochleography signal yielded a reliable peak at 3.1 kHz in 55% of the cases (11 out of 20 subjects), while an oscillatory pattern that masked the spectrum was observed in seven cases. In the other two cases, the single-trial noise was not classifiable. Auditory stimulation at 0.5 kHz and 2.0 kHz did not change the amplitude of the 3.1 kHz frequency peak. CONCLUSION We found two main types of noise patterns in the frequency analysis of the single-trial noise from cochlear implant electrocochleography, including a peak at 3.1 kHz that might reflect auditory-nerve spontaneous activity, while the oscillatory pattern probably corresponds to an artifact.
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Affiliation(s)
- Javiera Herrada
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Vicente Medel
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Constantino Dragicevic
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Juan C. Maass
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Carlos E. Stott
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Paul H. Delano
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro Avanzado de Ingeniería Eléctrica y Electrónica, AC3E, Universidad Técnica Federico Santa María, Valparaíso, Chile
- Biomedical Neuroscience Institute, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Mendia C, Peineau T, Zamani M, Felgerolle C, Yahiaoui N, Christophersen N, Papal S, Maudoux A, Maroofian R, Patni P, Nouaille S, Bowl MR, Delmaghani S, Galehdari H, Vona B, Dulon D, Vitry S, El-Amraoui A. Clarin-2 gene supplementation durably preserves hearing in a model of progressive hearing loss. Mol Ther 2024; 32:800-817. [PMID: 38243601 PMCID: PMC10928142 DOI: 10.1016/j.ymthe.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
Hearing loss is a major health concern affecting millions of people worldwide with currently limited treatment options. In clarin-2-deficient Clrn2-/- mice, used here as a model of progressive hearing loss, we report synaptic auditory abnormalities in addition to the previously demonstrated defects of hair bundle structure and mechanoelectrical transduction. We sought an in-depth evaluation of viral-mediated gene delivery as a therapy for these hearing-impaired mice. Supplementation with either the murine Clrn2 or human CLRN2 genes preserved normal hearing in treated Clrn2-/- mice. Conversely, mutated forms of CLRN2, identified in patients with post-lingual moderate to severe hearing loss, failed to prevent hearing loss. The ectopic expression of clarin-2 successfully prevented the loss of stereocilia, maintained normal mechanoelectrical transduction, preserved inner hair cell synaptic function, and ensured near-normal hearing thresholds over time. Maximal hearing preservation was observed when Clrn2 was delivered prior to the loss of transducing stereocilia. Our findings demonstrate that gene therapy is effective for the treatment of post-lingual hearing impairment and age-related deafness associated with CLRN2 patient mutations.
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Affiliation(s)
- Clara Mendia
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France; Sorbonne Université, Collège Doctoral, 75005 Paris, France
| | - Thibault Peineau
- Institut de l'Audition and Université de Bordeaux, Laboratoire de Neurophysiologie de la Synapse Auditive, Bordeaux Neurocampus, 33076 Bordeaux, France
| | - Mina Zamani
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz 6135783151, Iran
| | - Chloé Felgerolle
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Nawal Yahiaoui
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Nele Christophersen
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, 37075 Göttingen, Germany; Institute of Human Genetics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Samantha Papal
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Audrey Maudoux
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Reza Maroofian
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, WC1E 6BT London, UK
| | - Pranav Patni
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Sylvie Nouaille
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Michael R Bowl
- UCL Ear Institute, University College London, 332 Gray's Inn Road, WC1X 8EE London, UK
| | - Sedigheh Delmaghani
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France
| | - Hamid Galehdari
- Department of Biology, Faculty of Science, Shahid Chamran University of Ahvaz, Ahvaz 6135783151, Iran
| | - Barbara Vona
- Institute for Auditory Neuroscience and InnerEarLab, University Medical Center Göttingen, 37075 Göttingen, Germany; Institute of Human Genetics, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Didier Dulon
- Institut de l'Audition and Université de Bordeaux, Laboratoire de Neurophysiologie de la Synapse Auditive, Bordeaux Neurocampus, 33076 Bordeaux, France
| | - Sandrine Vitry
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France.
| | - Aziz El-Amraoui
- Institut Pasteur, Université Paris Cité, INSERM AO06, Institut de l'Audition, Unit Progressive Sensory Disorders, Pathophysiology and Therapy, 63 rue de Charenton, 75012 Paris, France.
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Shahidi LK, Collins LM, Mainsah BO. Objective intelligibility measurement of reverberant vocoded speech for normal-hearing listeners: Towards facilitating the development of speech enhancement algorithms for cochlear implants. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 155:2151-2168. [PMID: 38501923 PMCID: PMC10959555 DOI: 10.1121/10.0025285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/24/2024] [Indexed: 03/20/2024]
Abstract
Cochlear implant (CI) recipients often struggle to understand speech in reverberant environments. Speech enhancement algorithms could restore speech perception for CI listeners by removing reverberant artifacts from the CI stimulation pattern. Listening studies, either with cochlear-implant recipients or normal-hearing (NH) listeners using a CI acoustic model, provide a benchmark for speech intelligibility improvements conferred by the enhancement algorithm but are costly and time consuming. To reduce the associated costs during algorithm development, speech intelligibility could be estimated offline using objective intelligibility measures. Previous evaluations of objective measures that considered CIs primarily assessed the combined impact of noise and reverberation and employed highly accurate enhancement algorithms. To facilitate the development of enhancement algorithms, we evaluate twelve objective measures in reverberant-only conditions characterized by a gradual reduction of reverberant artifacts, simulating the performance of an enhancement algorithm during development. Measures are validated against the performance of NH listeners using a CI acoustic model. To enhance compatibility with reverberant CI-processed signals, measure performance was assessed after modifying the reference signal and spectral filterbank. Measures leveraging the speech-to-reverberant ratio, cepstral distance and, after modifying the reference or filterbank, envelope correlation are strong predictors of intelligibility for reverberant CI-processed speech.
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Affiliation(s)
- Lidea K Shahidi
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27701, USA
| | - Leslie M Collins
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27701, USA
| | - Boyla O Mainsah
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina 27701, USA
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Wagner TM, Wagner L, Plontke SK, Rahne T. Enhancing Cochlear Implant Outcomes across Age Groups: The Interplay of Forward Focus and Advanced Combination Encoder Coding Strategies in Noisy Conditions. J Clin Med 2024; 13:1399. [PMID: 38592239 PMCID: PMC10931918 DOI: 10.3390/jcm13051399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Hearing in noise is challenging for cochlear implant users and requires significant listening effort. This study investigated the influence of ForwardFocus and number of maxima of the Advanced Combination Encoder (ACE) strategy, as well as age, on speech recognition threshold and listening effort in noise. Methods: A total of 33 cochlear implant recipients were included (age ≤ 40 years: n = 15, >40 years: n = 18). The Oldenburg Sentence Test was used to measure 50% speech recognition thresholds (SRT50) in fluctuating and stationary noise. Speech was presented frontally, while three frontal or rear noise sources were used, and the number of ACE maxima varied between 8 and 12. Results: ForwardFocus significantly improved the SRT50 when noise was presented from the back, independent of subject age. The use of 12 maxima further improved the SRT50 when ForwardFocus was activated and when noise and speech were presented frontally. Listening effort was significantly worse in the older age group compared to the younger age group and was reduced by ForwardFocus but not by increasing the number of ACE maxima. Conclusion: Forward Focus can improve speech recognition in noisy environments and reduce listening effort, especially in older cochlear implant users.
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Affiliation(s)
- Telse M. Wagner
- Department of Otorhinolaryngology, University Medicine Halle, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany; (L.W.); (S.K.P.); (T.R.)
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17
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Vohra V, Andresen NS, Carver C, Dunham R, Marsiglia D, Yeagle J, Della Santina CC, Creighton FX, Bowditch SP, Sun DQ. Cochlear Implant Electrode Array Design and Speech Understanding. Otol Neurotol 2024; 45:136-142. [PMID: 38152035 DOI: 10.1097/mao.0000000000004083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE Cochlear implant electrode arrays are categorized based on their design as lateral wall (LW) and perimodiolar (PM) electrode arrays. The objective of this study was to investigate the effect of LW versus PM designs on postoperative speech perception across multiple manufacturers and over long follow-up durations. DESIGN Retrospective cohort study. SETTING Single academic medical center. PARTICIPANTS A total of 478 adult cochlear implant recipients, implanted between the years 1992 and 2017. INTERVENTIONSS PM versus LW cochlear implants. MAIN OUTCOMES AND MEASURES Postoperative Consonant-Nucleus-Consonant Word (CNC-w) and Hearing in Noise Test (HINT) scores between 6 months and 5 years. RESULTS Across 478 patients, approximately one-third received LW (n = 176, 36.8%), whereas 302 patients received a PM array (63.2%). The PM group had higher CNC-w scores from 6 months to 2 years (52 [interquartile range, 38-68] versus 48 [31-62], p = 0.036) and from 2 to 5 years (58 [43-72] versus 48 [33-66], p < 0.001). Multivariable analysis of patient-averaged scores indicated that the PM group had greater improvement from preoperative scores at all time points after the initial 6 months for both CNC-w ( β = 4.4 [95% confidence interval, 0.6-8.3], p = 0.023) and HINT testing ( β = 4.5 [95% confidence interval, 0.3-8.7], p = 0.038). CONCLUSIONS This study indicates that PM electrode arrays are associated with small increases in postoperative speech perception scores, relative to LW arrays, when assessed across manufacturers, over long time durations, and using multiple outcome instruments. These findings may help guide surgeon selection and patient counseling of cochlear implant arrays.
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Affiliation(s)
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Carver
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Dunham
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dawn Marsiglia
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenifer Yeagle
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles C Della Santina
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Francis X Creighton
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen P Bowditch
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery and Cochlear Implant Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Nourski KV, Steinschneider M, Rhone AE, Berger JI, Dappen ER, Kawasaki H, Howard III MA. Intracranial electrophysiology of spectrally degraded speech in the human cortex. Front Hum Neurosci 2024; 17:1334742. [PMID: 38318272 PMCID: PMC10839784 DOI: 10.3389/fnhum.2023.1334742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Cochlear implants (CIs) are the treatment of choice for severe to profound hearing loss. Variability in CI outcomes remains despite advances in technology and is attributed in part to differences in cortical processing. Studying these differences in CI users is technically challenging. Spectrally degraded stimuli presented to normal-hearing individuals approximate input to the central auditory system in CI users. This study used intracranial electroencephalography (iEEG) to investigate cortical processing of spectrally degraded speech. Methods Participants were adult neurosurgical epilepsy patients. Stimuli were utterances /aba/ and /ada/, spectrally degraded using a noise vocoder (1-4 bands) or presented without vocoding. The stimuli were presented in a two-alternative forced choice task. Cortical activity was recorded using depth and subdural iEEG electrodes. Electrode coverage included auditory core in posteromedial Heschl's gyrus (HGPM), superior temporal gyrus (STG), ventral and dorsal auditory-related areas, and prefrontal and sensorimotor cortex. Analysis focused on high gamma (70-150 Hz) power augmentation and alpha (8-14 Hz) suppression. Results Chance task performance occurred with 1-2 spectral bands and was near-ceiling for clear stimuli. Performance was variable with 3-4 bands, permitting identification of good and poor performers. There was no relationship between task performance and participants demographic, audiometric, neuropsychological, or clinical profiles. Several response patterns were identified based on magnitude and differences between stimulus conditions. HGPM responded strongly to all stimuli. A preference for clear speech emerged within non-core auditory cortex. Good performers typically had strong responses to all stimuli along the dorsal stream, including posterior STG, supramarginal, and precentral gyrus; a minority of sites in STG and supramarginal gyrus had a preference for vocoded stimuli. In poor performers, responses were typically restricted to clear speech. Alpha suppression was more pronounced in good performers. In contrast, poor performers exhibited a greater involvement of posterior middle temporal gyrus when listening to clear speech. Discussion Responses to noise-vocoded speech provide insights into potential factors underlying CI outcome variability. The results emphasize differences in the balance of neural processing along the dorsal and ventral stream between good and poor performers, identify specific cortical regions that may have diagnostic and prognostic utility, and suggest potential targets for neuromodulation-based CI rehabilitation strategies.
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Affiliation(s)
- Kirill V. Nourski
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
| | - Mitchell Steinschneider
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Departments of Neurology and Neuroscience, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ariane E. Rhone
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Joel I. Berger
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Emily R. Dappen
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
| | - Hiroto Kawasaki
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
| | - Matthew A. Howard III
- Department of Neurosurgery, The University of Iowa, Iowa City, IA, United States
- Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, United States
- Pappajohn Biomedical Institute, The University of Iowa, Iowa City, IA, United States
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MacIntyre AD, Carlyon RP, Goehring T. Neural Decoding of the Speech Envelope: Effects of Intelligibility and Spectral Degradation. Trends Hear 2024; 28:23312165241266316. [PMID: 39183533 PMCID: PMC11345737 DOI: 10.1177/23312165241266316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/23/2024] [Accepted: 06/16/2024] [Indexed: 08/27/2024] Open
Abstract
During continuous speech perception, endogenous neural activity becomes time-locked to acoustic stimulus features, such as the speech amplitude envelope. This speech-brain coupling can be decoded using non-invasive brain imaging techniques, including electroencephalography (EEG). Neural decoding may provide clinical use as an objective measure of stimulus encoding by the brain-for example during cochlear implant listening, wherein the speech signal is severely spectrally degraded. Yet, interplay between acoustic and linguistic factors may lead to top-down modulation of perception, thereby complicating audiological applications. To address this ambiguity, we assess neural decoding of the speech envelope under spectral degradation with EEG in acoustically hearing listeners (n = 38; 18-35 years old) using vocoded speech. We dissociate sensory encoding from higher-order processing by employing intelligible (English) and non-intelligible (Dutch) stimuli, with auditory attention sustained using a repeated-phrase detection task. Subject-specific and group decoders were trained to reconstruct the speech envelope from held-out EEG data, with decoder significance determined via random permutation testing. Whereas speech envelope reconstruction did not vary by spectral resolution, intelligible speech was associated with better decoding accuracy in general. Results were similar across subject-specific and group analyses, with less consistent effects of spectral degradation in group decoding. Permutation tests revealed possible differences in decoder statistical significance by experimental condition. In general, while robust neural decoding was observed at the individual and group level, variability within participants would most likely prevent the clinical use of such a measure to differentiate levels of spectral degradation and intelligibility on an individual basis.
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Affiliation(s)
| | - Robert P. Carlyon
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Tobias Goehring
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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Atak HBO, Sennaroglu G, Sennaroglu L. Speech recognition and quality of life outcomes of adults with cochlear implants following a quarter-century of deafness: what should be the maximum duration? Eur Arch Otorhinolaryngol 2023; 280:4903-4913. [PMID: 37672104 DOI: 10.1007/s00405-023-08214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE This study was aimed at examining the pre- and post-cochlear implant (CI) speech recognition and quality of life results of postlingually deaf adult CI users with a duration of deafness (DoD) > 25 years and determining the maximum DoD limit. METHODS We enrolled 54 postlingually deaf CI users and divided them into ages ≤ 60 and > 60 years and DoDs ≤ 25 and > 25 years. All participants were evaluated using multisensory measures (auditory and auditory + visual) and open-set Speech Recognition Test (SRT) before CI and 3 years postoperatively. They were administered with The Hearing Handicap Inventory for the Elderly (HHIE) to determine the effects of hearing impairment on daily life. RESULTS DoD and open-set SRT for auditory and auditory + visual stimuli showed a strong negative linear relationship (r = - 0.506, p < 0.01). Open-set SRT scores of patients with DoD aged ≤ 25 and > 25 years (p < 0.01) differed significantly. The chronological age and HHIE scores in social and emotional subfactors showed a strong negative linear relationship (r = - 0.519, p < 0.01). CONCLUSIONS The present study showed that the number of years was a major factor determining that postlingual adults with profound hearing loss had hearing loss. The results support CI use as soon as possible in adults to prevent degeneration of the auditory pathways and possible central remodeling. However, auditory rehabilitation outcomes in adults using CI vary widely. Investigating the causes of this variability contributes to audiology.
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Affiliation(s)
- Hilal Burcu Ozkan Atak
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey.
| | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, 06100, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Hacettepe University, Ankara, Turkey
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Abyzova E, Dogadina E, Rodriguez RD, Petrov I, Kolesnikova Y, Zhou M, Liu C, Sheremet E. Beyond Tissue replacement: The Emerging role of smart implants in healthcare. Mater Today Bio 2023; 22:100784. [PMID: 37731959 PMCID: PMC10507164 DOI: 10.1016/j.mtbio.2023.100784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
Smart implants are increasingly used to treat various diseases, track patient status, and restore tissue and organ function. These devices support internal organs, actively stimulate nerves, and monitor essential functions. With continuous monitoring or stimulation, patient observation quality and subsequent treatment can be improved. Additionally, using biodegradable and entirely excreted implant materials eliminates the need for surgical removal, providing a patient-friendly solution. In this review, we classify smart implants and discuss the latest prototypes, materials, and technologies employed in their creation. Our focus lies in exploring medical devices beyond replacing an organ or tissue and incorporating new functionality through sensors and electronic circuits. We also examine the advantages, opportunities, and challenges of creating implantable devices that preserve all critical functions. By presenting an in-depth overview of the current state-of-the-art smart implants, we shed light on persistent issues and limitations while discussing potential avenues for future advancements in materials used for these devices.
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Affiliation(s)
- Elena Abyzova
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
| | - Elizaveta Dogadina
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | | | - Ilia Petrov
- Tomsk Polytechnic University, Lenin ave. 30, Tomsk, Russia, 634050
| | | | - Mo Zhou
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
| | - Chaozong Liu
- Institute of Orthopaedic & Musculoskeletal Science, University College London, Royal National Orthopaedic Hospital, Stanmore, HA7 4LP, UK
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Swords C, Geerardyn A, Zhu M, O'Malley JT, Wu P, Arenberg JG, Podury A, Brassett C, Bance M, Quesnel AM. Incomplete Partition Type II Cochlear Malformations: Delineating the Three-Dimensional Structure from Digitized Human Histopathological Specimens. Otol Neurotol 2023; 44:881-889. [PMID: 37621122 PMCID: PMC10803064 DOI: 10.1097/mao.0000000000003999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
HYPOTHESIS There are clinically relevant differences in scalae anatomy and spiral ganglion neuron (SGN) quantity between incomplete partition type II (IP-II) and normal cochleae. BACKGROUND IP-II is a commonly implanted cochlear malformation. Detailed knowledge of intracochlear three-dimensional (3D) morphology may assist with cochlear implant (CI) electrode selection/design and enable optimization of audiologic programming based on SGN maps. METHODS IP-II (n = 11) human temporal bone histological specimens were identified from the National Institute on Deafness and Other Communication Disorders National Temporal Bone Registry and digitized. The cochlear duct, scalae, and surgically relevant anatomy were reconstructed in 3D. A machine learning algorithm was applied to map the location and number of SGNs. RESULTS 3D scalae morphology of the basal turn was normal. Scala tympani (ST) remained isolated for 540 degrees before fusing with scala vestibuli. Mean ST volume reduced below 1 mm 2 after the first 340 degrees. Scala media was a distinct endolymphatic compartment throughout; mean ± standard deviation cochlear duct length was 28 ± 3 mm. SGNs were reduced compared with age-matched norms (mean, 48%; range, 5-90%). In some cases, SGNs failed to ascend Rosenthal's canal, remaining in an abnormal basalward modiolar location. Two forms of IP-II were seen: type A and type B. A majority (98-100%) of SGNs were located in the basal modiolus in type B IP-II, compared with 76 to 85% in type A. CONCLUSION Hallmark features of IP-II cochleae include the following: 1) fusion of the ST and scala vestibuli at a mean of 540 degrees, 2) highly variable and overall reduced SGN quantity compared with normative controls, and 3) abnormal SGN distribution with cell bodies failing to ascend Rosenthal's canal.
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Affiliation(s)
| | | | | | | | | | | | | | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Manohar Bance
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Van Opstal AJ, Noordanus E. Towards personalized and optimized fitting of cochlear implants. Front Neurosci 2023; 17:1183126. [PMID: 37521701 PMCID: PMC10372492 DOI: 10.3389/fnins.2023.1183126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
A cochlear implant (CI) is a neurotechnological device that restores total sensorineural hearing loss. It contains a sophisticated speech processor that analyzes and transforms the acoustic input. It distributes its time-enveloped spectral content to the auditory nerve as electrical pulsed stimulation trains of selected frequency channels on a multi-contact electrode that is surgically inserted in the cochlear duct. This remarkable brain interface enables the deaf to regain hearing and understand speech. However, tuning of the large (>50) number of parameters of the speech processor, so-called "device fitting," is a tedious and complex process, which is mainly carried out in the clinic through 'one-size-fits-all' procedures. Current fitting typically relies on limited and often subjective data that must be collected in limited time. Despite the success of the CI as a hearing-restoration device, variability in speech-recognition scores among users is still very large, and mostly unexplained. The major factors that underly this variability incorporate three levels: (i) variability in auditory-system malfunction of CI-users, (ii) variability in the selectivity of electrode-to-auditory nerve (EL-AN) activation, and (iii) lack of objective perceptual measures to optimize the fitting. We argue that variability in speech recognition can only be alleviated by using objective patient-specific data for an individualized fitting procedure, which incorporates knowledge from all three levels. In this paper, we propose a series of experiments, aimed at collecting a large amount of objective (i.e., quantitative, reproducible, and reliable) data that characterize the three processing levels of the user's auditory system. Machine-learning algorithms that process these data will eventually enable the clinician to derive reliable and personalized characteristics of the user's auditory system, the quality of EL-AN signal transfer, and predictions of the perceptual effects of changes in the current fitting.
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Interobserver variability of cochlear duct measurements in pediatric cochlear implant candidates. Eur Arch Otorhinolaryngol 2023; 280:1647-1651. [PMID: 36074160 PMCID: PMC9988785 DOI: 10.1007/s00405-022-07639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/31/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The objective of the study was to evaluate the proposed cochlear duct length estimation based on the cochlear 'A value'. Furthermore, we assessed the interobserver variability between radiology and otolaryngology attending physicians and otolaryngology trainees. METHODS Thirteen pediatric cochlear implant candidates were retrospectively analyzed by three otolaryngology physicians (attending physician, second year, and fourth year trainees) and a radiology attending. The cochlear duct length was calculated based on the formula of Grover et al. The differences in acquired measurements between observers were compared using the Wilcoxon matched signed-rank test. RESULTS The differences in measurements between the attending otolaryngologist and radiologist were not statistically different, while several significant differences were observed with regard to measurements of attending doctors compared to both residents. In particular, a significant difference between the second year otolaryngology resident and otolaryngology and radiology attending was observed for one side (right ear p = 0.034 and p = 0.012, respectively). Moreover, the fourth year resident calculated significantly different cochlear duct measurements when compared to the attending otolaryngologist (left ear p = 0.014) and radiologist (right ear p = 0.047). Interestingly, differently experienced otolaryngology residents provided significantly different measurements for both ears. CONCLUSIONS Based on these results, cochlear duct length measurement according to the proposed method may be a reliable and cost-effective method. Indeed, otolaryngology training may be sufficient to provide measurements comparable to radiologists. On the other hand, additional efforts should be invested during otolaryngology training in terms of the evaluation of radiological imaging which may increase the capabilities of otolaryngology residents in this regard.
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Britt AF, Poupore NS, Nguyen SA, White DR. Improving Pneumococcal Vaccination Rates in Cochlear Implant Programs: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:291-299. [PMID: 35852861 DOI: 10.1177/01945998221113310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the literature on pneumococcal vaccination compliance rates among cochlear implant (CI) patients and to examine the utility of intervention programs on increasing vaccination rates. DATA SOURCES PubMed, Scopus, and CINAHL. REVIEW METHODS A systematic review was performed following PRISMA guidelines. Studies of pneumococcal vaccination rates at baseline and before and after the implementation of a quality improvement (QI) intervention were included. A total of 641 studies were screened, and 13 studies met inclusion criteria. Meta-analyses of pneumococcal vaccination rates pre- and post-QI intervention in CI patients were performed. RESULTS A total of 12,973 children and adults were included. The baseline PCV13 and PPSV23 vaccination rates were 53.45% (95% CI, 37.02%-69.51%) and 42.53% (95% CI, 31.94%-53.48%), respectively. Comparing children and adults, PCV13 and PPSV23 baseline vaccination rates were not statistically significant. The PPSV23 vaccine rate after QI initiatives was significantly higher than the baseline rate at 83.52% (95% CI, 57.36%-98.46%). After these interventions, patients had a 15.71 (95% CI, 4.32-57.20, P < .001) increased odds of receiving PPSV23 vaccination compared to before QI implementation. CONCLUSIONS The baseline rates of PCV13 and PPSV23 are highly variable and lower than expected, given current vaccination recommendations for CI patients. QI programs appear successful in increasing compliance rates with the PPSV23 vaccination; however, they are still far from full compliance. Further intervention programs with stricter surveillance, monitoring, and follow-up systems are needed to achieve improved compliance with the PCV13 and PPSV23 vaccination in CI recipients.
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Affiliation(s)
- Annie F Britt
- Medical University of South Carolina School of Medicine, Charleston, South Carolina, USA
| | - Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, South Carolina, USA
- University of South Carolina School of Medicine Greenville, South Carolina, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, South Carolina, USA
| | - David R White
- Medical University of South Carolina, Department of Otolaryngology-Head and Neck Surgery, Charleston, South Carolina, USA
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Polymeric fiber sensors for insertion forces and trajectory determination of cochlear implants in hearing preservation. Biosens Bioelectron 2023; 222:114866. [PMID: 36463651 DOI: 10.1016/j.bios.2022.114866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
The level of hearing restoration in patients with severe to profound sensorineural hearing loss by means of cochlear implants (CIs) has drastically risen since the introduction of these neuroprosthetics. The proposed CI integrated with polymer optical fiber Bragg gratings (POFBGs) enables real-time evaluation of insertion forces and trajectory determination during implantation irrespective of the speed of insertion, as well as provides high signal quality, low stiffness levels, minimum induced stress even under forces of high magnitudes and exhibits significant reduction of the risk of fiber breakage inside the constricted cochlear geometry. As such, the proposed device opens new avenues towards atraumatic cochlear implantations and provides a direct route for the next generation of CIs with intraoperative insertion force assessment and path planning capacity crucial for surgical navigation. Hence, adaptation of this technology to clinical reality holds promising prospects for the hearing impaired.
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Archer-Boyd AW, Harland A, Goehring T, Carlyon RP. An online implementation of a measure of spectro-temporal processing by cochlear-implant listeners. JASA EXPRESS LETTERS 2023; 3:014402. [PMID: 36725534 DOI: 10.1121/10.0016838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The spectro-temporal ripple for investigating processor effectiveness (STRIPES) test is a psychophysical measure of spectro-temporal resolution in cochlear-implant (CI) listeners. It has been validated using direct-line input and loudspeaker presentation with listeners of the Advanced Bionics CI. This article investigates the suitability of an online application using wireless streaming (webSTRIPES) as a remote test. It reports a strong across-listener correlation between STRIPES thresholds obtained using laboratory testing with loudspeaker presentation vs remote testing with streaming presentation, with no significant difference in STRIPES thresholds between the two measures. WebSTRIPES also produced comparable and robust thresholds with users of the Cochlear CI.
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Affiliation(s)
- Alan W Archer-Boyd
- Cambridge Hearing Group, MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom , , ,
| | - Andrew Harland
- Cambridge Hearing Group, MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom , , ,
| | - Tobias Goehring
- Cambridge Hearing Group, MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom , , ,
| | - Robert P Carlyon
- Cambridge Hearing Group, MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge CB2 7EF, United Kingdom , , ,
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Garcia C, Deeks JM, Goehring T, Borsetto D, Bance M, Carlyon RP. SpeedCAP: An Efficient Method for Estimating Neural Activation Patterns Using Electrically Evoked Compound Action-Potentials in Cochlear Implant Users. Ear Hear 2022; 44:627-640. [PMID: 36477611 PMCID: PMC10097494 DOI: 10.1097/aud.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Electrically evoked compound action-potentials (ECAPs) can be recorded using the electrodes in a cochlear implant (CI) and represent the synchronous responses of the electrically stimulated auditory nerve. ECAPs can be obtained using a forward-masking method that measures the neural response to a probe and masker electrode separately and in combination. The panoramic ECAP (PECAP) analyses measured ECAPs obtained using multiple combinations of masker and probe electrodes and uses a nonlinear optimization algorithm to estimate current spread from each electrode and neural health along the cochlea. However, the measurement of ECAPs from multiple combinations of electrodes is too time consuming for use in clinics. Here, we propose and evaluate SpeedCAP, a speedy method for obtaining the PECAP measurements that minimizes recording time by exploiting redundancies between multiple ECAP measures. DESIGN In the first study, 11 users of Cochlear Ltd. CIs took part. ECAPs were recorded using the forward-masking artifact-cancelation technique at the most comfortable loudness level (MCL) for every combination of masker and probe electrodes for all active electrodes in the users' MAPs, as per the standard PECAP recording paradigm. The same current levels and recording parameters were then used to collect ECAPs in the same users with the SpeedCAP method. The ECAP amplitudes were then compared between the two conditions, as were the corresponding estimates of neural health and current spread calculated using the PECAP method previously described by Garcia et al. The second study measured SpeedCAP intraoperatively in 8 CI patients and with all maskers and probes presented at the same current level to assess feasibility. ECAPs for the subset of conditions where the masker and probe were presented on the same electrode were compared with those obtained using the slower approach leveraged by the standard clinical software. RESULTS Data collection time was reduced from ≈45 to ≈8 minutes. There were no significant differences between normalized root mean squared error (RMSE) repeatability metrics for post-operative PECAP and SpeedCAP data, nor for the RMSEs calculated between PECAP and SpeedCAP data. The comparison achieved 80% power to detect effect sizes down to 8.2% RMSE. When between-participant differences were removed, both the neural-health (r = 0.73) and current-spread (r = 0.65) estimates were significantly correlated (p < 0.0001, df = 218) between SpeedCAP and PECAP conditions across all electrodes, and showed RMSE errors of 12.7 ± 4.7% and 16.8 ± 8.8%, respectively (with the ± margins representing 95% confidence intervals). Valid ECAPs were obtained in all patients in the second study, demonstrating intraoperative feasibility of SpeedCAP. No significant differences in RMSEs were detectable between post- and intra-operative ECAP measurements, with the comparison achieving 80% power to detect effect sizes down to 13.3% RMSE. CONCLUSIONS The improved efficiency of SpeedCAP provides time savings facilitating multi-electrode ECAP recordings in routine clinical practice. SpeedCAP data collection is sufficiently quick to record intraoperatively, and adds no more than 8.2% error to the ECAP amplitudes. Such measurements could thereafter be submitted to models such as PECAP to provide patient-specific patterns of neural activation to inform programming of clinical MAPs and identify causes of poor performance at the electrode-nerve interface of CI users. The speed and accuracy of these measurements also opens up a wide range of additional research questions to be addressed.
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Affiliation(s)
- Charlotte Garcia
- Cambridge Hearing Group, Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - John M Deeks
- Cambridge Hearing Group, Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Tobias Goehring
- Cambridge Hearing Group, Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Daniele Borsetto
- Cambridge Hearing Group, Cambridge Universities Hospitals Foundation Trust, University of Cambridge, Cambridge, United Kingdom
| | - Manohar Bance
- Cambridge Hearing Group, Cambridge Universities Hospitals Foundation Trust, University of Cambridge, Cambridge, United Kingdom
| | - Robert P Carlyon
- Cambridge Hearing Group, Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
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Silva VAR, Pauna HF, Lavinsky J, Hyppolito MA, Vianna MF, Leal M, Massuda ET, Hamerschmidt R, Bahmad Jr F, Cal RV, Sampaio ALL, Felix F, Chone CT, Castilho AM. Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment. Braz J Otorhinolaryngol 2022; 89:190-206. [PMID: 36528468 PMCID: PMC9874354 DOI: 10.1016/j.bjorl.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. CONCLUSIONS In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil,Corresponding author.
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mariana Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Recife, PE, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Rogério Hamerschmidt
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Fayez Bahmad Jr
- Universidade de Brasília (UnB), Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brazil,Instituto Brasiliense de Otorrinolaringologia (IBO), Brasília, DF, Brazil
| | - Renato Valério Cal
- Centro Universitário do Estado do Pará (CESUPA), Departamento de Otorrinolaringologia, Belém, PA, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Felippe Felix
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Coles L, Oluwasanya PW, Karam N, Proctor CM. Fluidic enabled bioelectronic implants: opportunities and challenges. J Mater Chem B 2022; 10:7122-7131. [PMID: 35959561 PMCID: PMC9518646 DOI: 10.1039/d2tb00942k] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022]
Abstract
Bioelectronic implants are increasingly facilitating novel strategies for clinical diagnosis and treatment. The integration of fluidic technologies into such implants enables new complementary routes for sensing and therapy alongside electrical interaction. Indeed, these two technologies, electrical and fluidic, can work synergistically in a bioelectronics implant towards the fabrication of a complete therapeutic platform. In this perspective article, the leading applications of fluidic enabled bioelectronic implants are highlighted and methods of operation and material choices are discussed. Furthermore, a forward-looking perspective is offered on emerging opportunities as well as critical materials and technological challenges.
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Affiliation(s)
- Lawrence Coles
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Pelumi W Oluwasanya
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Nuzli Karam
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
| | - Christopher M Proctor
- Electrical Engineering Division, Department of Engineering, University of Cambridge, Cambridge, UK.
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Herbert CJ, Pisoni DB, Kronenberger WG, Nelson RF. Exceptional Speech Recognition Outcomes After Cochlear Implantation: Lessons From Two Case Studies. Am J Audiol 2022; 31:552-566. [PMID: 35944073 PMCID: PMC9886164 DOI: 10.1044/2022_aja-21-00261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Individual differences and variability in outcomes following cochlear implantation (CI) in patients with hearing loss remain significant unresolved clinical problems. Case reports of specific individuals allow for detailed examination of the information processing mechanisms underlying variability in outcomes. Two adults who displayed exceptionally good postoperative CI outcomes shortly after activation were administered a novel battery of auditory, speech recognition, and neurocognitive processing tests. METHOD A case study of two adult CI recipients with postlingually acquired hearing loss who displayed excellent postoperative speech recognition scores within 3 months of initial activation. Preoperative City University of New York sentence testing and a postoperative battery of sensitive speech recognition tests were combined with auditory and visual neurocognitive information processing tests to uncover their strengths, weaknesses, and milestones. RESULTS Preactivation CUNY auditory-only (A) scores were < 5% correct while the auditory + visual (A + V) scores were > 74%. Acoustically with their CIs, both participants' scores on speech recognition, environmental sound identification and speech in noise tests exceeded average CI users scores by 1-2 standard deviations. On nonacoustic visual measures of language and neurocognitive functioning, both participants achieved above average scores compared with normal hearing adults in vocabulary knowledge, rapid phonological coding of visually presented words and nonwords, verbal working memory, and executive functioning. CONCLUSIONS Measures of multisensory (A + V) speech recognition and visual neurocognitive functioning were associated with excellent speech recognition outcomes in two postlingual adult CI recipients. These neurocognitive information processing domains may underlie the exceptional speech recognition performance of these two patients and offer new directions for research explaining variability in postimplant outcomes. Results further suggest that current clinical outcome measures should be expanded beyond the conventional speech recognition measures to include more sensitive robust tests of speech recognition as well as neurocognitive measures of working memory, vocabulary, lexical access, and executive functioning.
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Affiliation(s)
- Carolyn J. Herbert
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - David B. Pisoni
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis,Department of Psychological and Brain Sciences, Indiana University Bloomington
| | - William G. Kronenberger
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis,Department of Psychiatry, Indiana University School of Medicine, Indianapolis
| | - Rick F. Nelson
- DeVault Otologic Research Laboratory, Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
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Fullerton AM, Vickers DA, Luke R, Billing AN, McAlpine D, Hernandez-Perez H, Peelle JE, Monaghan JJM, McMahon CM. Cross-modal functional connectivity supports speech understanding in cochlear implant users. Cereb Cortex 2022; 33:3350-3371. [PMID: 35989307 PMCID: PMC10068270 DOI: 10.1093/cercor/bhac277] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/12/2022] Open
Abstract
Sensory deprivation can lead to cross-modal cortical changes, whereby sensory brain regions deprived of input may be recruited to perform atypical function. Enhanced cross-modal responses to visual stimuli observed in auditory cortex of postlingually deaf cochlear implant (CI) users are hypothesized to reflect increased activation of cortical language regions, but it is unclear if this cross-modal activity is "adaptive" or "mal-adaptive" for speech understanding. To determine if increased activation of language regions is correlated with better speech understanding in CI users, we assessed task-related activation and functional connectivity of auditory and visual cortices to auditory and visual speech and non-speech stimuli in CI users (n = 14) and normal-hearing listeners (n = 17) and used functional near-infrared spectroscopy to measure hemodynamic responses. We used visually presented speech and non-speech to investigate neural processes related to linguistic content and observed that CI users show beneficial cross-modal effects. Specifically, an increase in connectivity between the left auditory and visual cortices-presumed primary sites of cortical language processing-was positively correlated with CI users' abilities to understand speech in background noise. Cross-modal activity in auditory cortex of postlingually deaf CI users may reflect adaptive activity of a distributed, multimodal speech network, recruited to enhance speech understanding.
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Affiliation(s)
- Amanda M Fullerton
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Deborah A Vickers
- Cambridge Hearing Group, Sound Lab, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 OSZ, United Kingdom.,Speech, Hearing and Phonetic Sciences, University College London, London WC1N 1PF, United Kingdom
| | - Robert Luke
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Addison N Billing
- Institute of Cognitive Neuroscience, University College London, London WCIN 3AZ, United Kingdom.,DOT-HUB, Department of Medical Physics and Biomedical Engineering, University College London, London WC1E 6BT, United Kingdom
| | - David McAlpine
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Heivet Hernandez-Perez
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Jonathan E Peelle
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO 63110, United States
| | - Jessica J M Monaghan
- National Acoustic Laboratories, Australian Hearing Hub, Sydney 2109, Australia.,Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia
| | - Catherine M McMahon
- Department of Linguistics and Macquarie University Hearing, Australian Hearing Hub, Macquarie University, Sydney 2109, Australia.,HEAR Centre, Macquarie University, Sydney 2109, Australia
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Sahai I, Ghosh B, Anjankar A. A Spectrum of Intraoperative and Postoperative Complications of Cochlear Implants: A Critical Review. Cureus 2022; 14:e28151. [PMID: 36148185 PMCID: PMC9482671 DOI: 10.7759/cureus.28151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022] Open
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Conversations in Cochlear Implantation: The Inner Ear Therapy of Today. Biomolecules 2022; 12:biom12050649. [PMID: 35625577 PMCID: PMC9138212 DOI: 10.3390/biom12050649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/01/2023] Open
Abstract
As biomolecular approaches for hearing restoration in profound sensorineural hearing loss evolve, they will be applied in conjunction with or instead of cochlear implants. An understanding of the current state-of-the-art of this technology, including its advantages, disadvantages, and its potential for delivering and interacting with biomolecular hearing restoration approaches, is helpful for designing modern hearing-restoration strategies. Cochlear implants (CI) have evolved over the last four decades to restore hearing more effectively, in more people, with diverse indications. This evolution has been driven by advances in technology, surgery, and healthcare delivery. Here, we offer a practical treatise on the state of cochlear implantation directed towards developing the next generation of inner ear therapeutics. We aim to capture and distill conversations ongoing in CI research, development, and clinical management. In this review, we discuss successes and physiological constraints of hearing with an implant, common surgical approaches and electrode arrays, new indications and outcome measures for implantation, and barriers to CI utilization. Additionally, we compare cochlear implantation with biomolecular and pharmacological approaches, consider strategies to combine these approaches, and identify unmet medical needs with cochlear implants. The strengths and weaknesses of modern implantation highlighted here can mark opportunities for continued progress or improvement in the design and delivery of the next generation of inner ear therapeutics.
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Current Opinions in Otorhinolaryngology in Japan. JOURNAL OF OTORHINOLARYNGOLOGY, HEARING AND BALANCE MEDICINE 2022. [DOI: 10.3390/ohbm3020002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The field of otolaryngology has developed through the continuous efforts of otolaryngologists around the world [...]
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Rapport F, Lo CY, Elks B, Warren C, Clay-Williams R. Cochlear implant aesthetics and its impact on stigma, social interaction and quality of life: a mixed-methods study protocol. BMJ Open 2022; 12:e058406. [PMID: 35321898 PMCID: PMC8943735 DOI: 10.1136/bmjopen-2021-058406] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/01/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Awareness of the benefits of cochlear implants is low, and barriers such as fear of surgery and ongoing rehabilitation have been noted. Perceived stigma associated with hearing loss also plays a key role, with many adults not wanting to appear old or be identified as a person with a disability. In effect, a cochlear implant makes deafness visible. New technologies have led to a smaller external profile for some types of cochlear implants, but qualitative assessments of benefit have not been explored. This study will examine cochlear implant aesthetics and cosmetics, and its impact on perceived stigma, social interactions, communication and quality of life. A particular focus will be the examination of totally implantable device concepts. A secondary aim is to understand what research techniques are best suited and most appealing for cochlear implant recipients, to assist in future study design and data collection methods. METHODS AND ANALYSIS This study utilises a mixed-methods design. Three datasets will be collected from each participant with an expected sample size of 10-15 participants to allow for data saturation of themes elicited. Each participant will complete a demographic questionnaire, a quickfire survey (a short concise questionnaire on a topic of research familiarity and preference) and a semi-structured interview. Questionnaire and quickfire survey data will be analysed using descriptive statistics. Interviews will be transcribed and analysed thematically. All participants will be adults with more than 1 year of experience using cochlear implants. ETHICS AND DISSEMINATION This study has been granted ethical approval from Macquarie University (HREC: 520211056232432) and meets the requirements set out in the National Statement on Ethical Conduct in Human Research. Study findings will be disseminated widely through international peer-reviewed journal articles, public and academic presentations, plain language summaries for participants and an executive summary for the project funder. This work was supported by Cochlear Limited (Cochlear Ltd). The funder will have no role in conducting or reporting on the study.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chi Yhun Lo
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Beth Elks
- Cochlear Limited, Macquarie University, Sydney, New South Wales, Australia
| | - Chris Warren
- Cochlear Limited, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Yao X, Liu H, Si J, Ding X, Zhao Y, Zheng Y. Research Status and Future Development of Cochlear Reimplantation. Front Neurosci 2022; 16:824389. [PMID: 35386590 PMCID: PMC8978799 DOI: 10.3389/fnins.2022.824389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Cochlear implants are the most successful sensory prostheses worldwide, and they can be useful for patients with severe and profound hearing impairment. However, various complications, including infection, pain, and device failure which is mainly due to falls and trauma, are associated with the use of cochlear implants. Reimplantation is required to replace the initial device in severe complications. Nevertheless, reimplantation can present certain surgical risks and may impose a significant economic and psychological burden on patients and their families; therefore, it requires greater attention and focus. This article presents a review of the literature on cochlear reimplantation and summarizes the current status, knowledge gaps, and future research directions on cochlear reimplantation. Since 1980s, cochlear reimplantation techniques can be considered to be relatively mature; however, some clinical and scientific problems remain unresolved, including the lack of a unified definition of cochlear reimplantation, non-standardized calculation of the reimplantation rat, and insufficient effect assessment. This review highlights the urgent need to establish an international consensus statement on cochlear reimplantation research to standardize the definition, calculation formulas of reimplantation rate, and follow-up systems.
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Affiliation(s)
- Xinyi Yao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Haotian Liu
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jinyuan Si
- Department of Otolaryngology-Head and Neck Surgery, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Xiuyong Ding
- Department of Otolaryngology-Head and Neck Surgery, XuanWu Hospital of Capital Medical University, Beijing, China
| | - Yu Zhao
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yun Zheng
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, China
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