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Wang R, Xu K, Luo J, Chao X, Hu F, Zhang D, Chen Y, Li Y, Fan Z, Wang H, Xu L. Vestibular function and hearing preservation in children following a minimally invasive cochlear implantation. Eur Arch Otorhinolaryngol 2024; 281:4029-4038. [PMID: 38341823 PMCID: PMC11266237 DOI: 10.1007/s00405-024-08504-4] [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: 10/17/2023] [Accepted: 01/24/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE This retrospective cohort study aimed to investigate the effect of minimally invasive cochlear implantation (CI) on the vestibular function (VF) and residual hearing (RH) as well as their relationship in pediatric recipients before and after surgery. METHODS Twenty-four pediatric patients with preoperative low frequency residual hearing (LFRH) (250 or 500 Hz ≤ 80 dB HL) who underwent minimally invasive CI were enrolled. Pure-tone thresholds, the cervical/ocular vestibular-evoked myogenic potential (cVEMP/oVEMP), and video head impulse test (vHIT) were all evaluated in the 24 pediatric patients with preoperative normal VF before and at 1 and 12 months after surgery. The relationship between changes in hearing and VF was analyzed preoperatively and at 1 and 12 months postoperatively. RESULTS There were no significant differences on VF preservation and hearing preservation (HP) at both 1 and 12 months post-CI (p > 0.05). At 1 month post-CI, the correlations of the variations in vestibulo-ocular reflex (VOR) gains of horizontal semicircular canal (HSC) and posterior semicircular canal (PSC) and the shift in 250 Hz threshold were negatively correlated (r = - 0.41, p = 0.04 and r = - 0.43, p = 0.04, respectively). At 12 months post-CI, the shift in 250 Hz threshold negatively correlated to the variations in VOR gain of superior semicircular canal (SSC) (r = - 0.43, p = 0.04); the HP positively correlated to the variation in oVEMP-amplitude ratio (AR) (r = 0.41, p = 0.04). CONCLUSION Our study confirmed that there were partial correlations between VF preservation and HP both in the short- and long-terms after atraumatic CI surgery, especially with the 250 Hz threshold. Regarding the variation of PSC function, the correlation with hearing status was variable with time after atraumatic CI surgery. Minimally invasive techniques for HP are successful and effective for the preservation of VF in pediatric patients both in the short- and long-terms.
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Affiliation(s)
- Ruijie Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Kaifan Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Jianfen Luo
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Xiuhua Chao
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Fangxia Hu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China
| | - Daogong Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Yueling Chen
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Yuanling Li
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China
| | - Lei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, 250022, People's Republic of China.
- Department of Auditory Implantation, Shandong Provincial ENT Hospital, Jinan, China.
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Nieratschker M, Yildiz E, Gerlitz M, Bera S, Gadenstaetter AJ, Kramer AM, Kwiatkowska M, Mistrik P, Landegger LD, Braun S, Schlingensiepen R, Honeder C, Arnoldner C, Rommelspacher H. A preoperative dose of the pyridoindole AC102 improves the recovery of residual hearing in a gerbil animal model of cochlear implantation. Cell Death Dis 2024; 15:531. [PMID: 39060244 PMCID: PMC11282255 DOI: 10.1038/s41419-024-06854-9] [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: 02/08/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
Sensorineural hearing loss (SNHL) is the most common sensory deficit worldwide. Due to the heterogeneity of causes for SNHL, effective treatment options remain scarce, creating an unmet need for novel drugs in the field of otology. Cochlear implantation (CI) currently is the only established method to restore hearing function in profound SNHL and deaf patients. The cochlear implant bypasses the non-functioning sensory hair cells (HCs) and electrically stimulates the neurons of the cochlear nerve. CI also benefits patients with residual hearing by combined electrical and auditory stimulation. However, the insertion of an electrode array into the cochlea induces an inflammatory response, characterized by the expression of pro-inflammatory cytokines, upregulation of reactive oxygen species, and apoptosis and necrosis of HCs, putting residual hearing at risk. Here, we characterize the small molecule AC102, a pyridoindole, for its protective effects on residual hearing in CI. In a gerbil animal model of CI, AC102 significantly improves the recovery of hearing thresholds across multiple frequencies and confines the cochlear trauma to the directly mechanically injured area. In addition, AC102 significantly preserves auditory nerve fibers and inner HC synapses throughout the whole cochlea. In vitro experiments in an ethanol challenged HT22 cell-line revealed significant and dose-responsive anti-apoptotic effects following the treatment of with AC102. Further, AC102 treatment resulted in significant downregulation of the expression of pro-inflammatory cytokines in an organotypic ex vivo model of electrode insertion trauma (EIT). These results suggest that AC102's effects are likely elicited during the inflammatory phase of EIT and mediated by anti-apoptotic and anti-inflammatory properties, highlighting AC102 as a promising compound for hearing preservation during CI. Moreover, since the inflammatory response in CI shares similarities to that in other etiologies of SNHL, AC102 may be inferred as a potential general treatment option for various inner ear conditions.
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Affiliation(s)
- Michael Nieratschker
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Erdem Yildiz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Gerlitz
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Anselm J Gadenstaetter
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Anne-Margarethe Kramer
- Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Lukas D Landegger
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Clemens Honeder
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
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Vecchi JT, Claussen AD, Hansen MR. Decreasing the physical gap in the neural-electrode interface and related concepts to improve cochlear implant performance. Front Neurosci 2024; 18:1425226. [PMID: 39114486 PMCID: PMC11303154 DOI: 10.3389/fnins.2024.1425226] [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: 04/29/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Cochlear implants (CI) represent incredible devices that restore hearing perception for those with moderate to profound sensorineural hearing loss. However, the ability of a CI to restore complex auditory function is limited by the number of perceptually independent spectral channels provided. A major contributor to this limitation is the physical gap between the CI electrodes and the target spiral ganglion neurons (SGNs). In order for CI electrodes to stimulate SGNs more precisely, and thus better approximate natural hearing, new methodologies need to be developed to decrease this gap, (i.e., transitioning CIs from a far-field to near-field device). In this review, strategies aimed at improving the neural-electrode interface are discussed in terms of the magnitude of impact they could have and the work needed to implement them. Ongoing research suggests current clinical efforts to limit the CI-related immune response holds great potential for improving device performance. This could eradicate the dense, fibrous capsule surrounding the electrode and enhance preservation of natural cochlear architecture, including SGNs. In the long term, however, optimized future devices will likely need to induce and guide the outgrowth of the peripheral process of SGNs to be in closer proximity to the CI electrode in order to better approximate natural hearing. This research is in its infancy; it remains to be seen which strategies (surface patterning, small molecule release, hydrogel coating, etc.) will be enable this approach. Additionally, these efforts aimed at optimizing CI function will likely translate to other neural prostheses, which face similar issues.
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Affiliation(s)
- Joseph T. Vecchi
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, Iowa City, IA, United States
- Department of Otolaryngology Head-Neck Surgery, Carver College of Medicine, Iowa City, IA, United States
| | - Alexander D. Claussen
- Department of Otolaryngology Head-Neck Surgery, Carver College of Medicine, Iowa City, IA, United States
| | - Marlan R. Hansen
- Department of Molecular Physiology and Biophysics, Carver College of Medicine, Iowa City, IA, United States
- Department of Otolaryngology Head-Neck Surgery, Carver College of Medicine, Iowa City, IA, United States
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Andonie RR, Wimmer W, Schraivogel S, Mantokoudis G, Caversaccio M, Weder S. Electrocochleography in Cochlear Implant Recipients: Correlating Maximum Response With Residual Hearing. Ear Hear 2024:00003446-990000000-00314. [PMID: 39010266 DOI: 10.1097/aud.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Electrocochleography (ECochG) is increasingly recognized as a biomarker for assessing inner ear function in cochlear implant patients. This study aimed to objectively determine intraoperative cochlear microphonic (CM) amplitude patterns and correlate them with residual hearing in cochlear implant recipients, addressing the limitations in current ECochG analysis that often depends on subjective visual assessment and overlook the intracochlear measurement location. DESIGN In this prospective study, we investigated intraoperative pure-tone ECochG following complete electrode insertion in 31 patients. We used our previously published objective analysis method to determine the maximum CM amplitude and the associated electrode position for each electrode array. Using computed tomography, we identified electrode placement and determined the corresponding tonotopic frequency using Greenwood's function. Based on this, we calculated the tonotopic shift, that is, the difference between the stimulation frequency and the estimated frequency of the electrode with the maximum CM amplitude. We evaluated the association between CM amplitude, tonotopic shift, and preoperative hearing thresholds using linear regression analysis. RESULTS CM amplitudes showed high variance, with values ranging from -1.479 to 4.495 dBµV. We found a statistically significant negative correlation ( ) between maximum CM amplitudes and preoperative hearing thresholds. In addition, a significant association ( ) between the tonotopic shift and preoperative hearing thresholds was observed. Tonotopic shifts of the maximum CM amplitudes occurred predominantly toward the basal direction. CONCLUSIONS The combination of objective signal analysis and the consideration of intracochlear measurement locations enhances the understanding of cochlear health and overcomes the obstacles of current ECochG analysis. We could show the link between intraoperative CM amplitudes, their spatial distributions, and preoperative hearing thresholds. Consequently, our findings enable automated analysis and bear the potential to enhance specificity of ECochG, reinforcing its role as an objective biomarker for cochlear health.
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Affiliation(s)
- Raphael R Andonie
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Schraivogel
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of Otorhinolaryngology, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lee C, Hartsock JJ, Salt AN, Lichtenhan JT. A Guinea Pig Model Suggests That Objective Assessment of Acoustic Hearing Preservation in Human Ears With Cochlear Implants Is Confounded by Shifts in the Spatial Origin of Acoustically Evoked Potential Measurements Along the Cochlear Length. Ear Hear 2024; 45:666-678. [PMID: 38178312 DOI: 10.1097/aud.0000000000001457] [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: 01/06/2024]
Abstract
OBJECTIVES Our recent empirical findings have shown that the auditory nerve compound action potential (CAP) evoked by a low-level tone burst originates from a narrow cochlear region tuned to the tone burst frequency. At moderate to high sound levels, the origins shift to the most sensitive audiometric regions rather than the extended high-frequency regions of the cochlear base. This means that measurements evoked from extended high-frequency sound stimuli can shift toward the apex with increasing level. Here we translate this study to understand the spatial origin of acoustically evoked responses from ears that receive cochlear implants, an emerging area of research and clinical practice that is not completely understood. An essential step is to first understand the influence of the cochlear implant in otherwise naive ears. Our objective was to understand how function of the high-frequency cochlear base, which can be excited by the intense low-frequency sounds that are frequently used for objective intra- and postoperative monitoring, can be influenced by the presence of the cochlear implant. DESIGN We acoustically evoked responses and made measurements with an electrode placed near the guinea pig round window. The cochlear implant was not utilized for either electrical stimulation or recording purposes. With the cochlear implant in situ, CAPs were acoustically evoked from 2 to 16 kHz tone bursts of various levels while utilizing the slow perfusion of a kainic acid solution from the cochlear apex to the cochlear aqueduct in the base, which sequentially reduced neural responses from finely spaced cochlear frequency regions. This cochlear perfusion technique reveals the spatial origin of evoked potential measurements and provides insight on what influence the presence of an implant has on acoustical hearing. RESULTS Threshold measurements at 3 to 11 kHz were elevated by implantation. In an individual ear, thresholds were elevated and lowered as cochlear implant was respectively inserted and removed, indicative of "conductive hearing loss" induced by the implant. The maximum threshold elevation occurred at most sensitive region of the naive guinea pig ear (33.66 dB at 8 kHz), making 11 kHz the most sensitive region to acoustic sounds for guinea pig ears with cochlear implants. Conversely, the acute implantation did not affect the low-frequency, 500 Hz thresholds and suprathreshold function, as shown by the auditory nerve overlapped waveform. As the sound pressure level of the tone bursts increased, mean data show that the spatial origin of CAPs along the cochlear length shifted toward the most sensitive cochlear region of implanted ears, not the extended high-frequency cochlear regions. However, data from individual ears showed that after implantation, measurements from moderate to high sound pressure levels originate in places that are unique to each ear. CONCLUSIONS Alterations to function of the cochlear base from the in situ cochlear implant may influence objective measurements of implanted ears that are frequently made with intense low-frequency sound stimuli. Our results from guinea pigs advance the interpretation of measurements used to understand how and when residual acoustic hearing is lost in human ears receiving a cochlear implant.
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Affiliation(s)
- Choongheon Lee
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Jared J Hartsock
- Department of Cochlear Surgery, Turner Scientific, Inc., Jacksonville, Illinois, USA
| | - Alec N Salt
- Department of Pharmacokinetics, Turner Scientific, Inc., Jacksonville, Illinois, USA
| | - Jeffery T Lichtenhan
- Department of Otolaryngology, University of South Florida Morsani School of Medicine, Tampa, Florida, USA
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Gerbert M, Ernst A, Seidl R, Decker L, Scholz S, Lauer G, Mittmann P. Preservation of Residual Hearing: Long-Term Results With a Mid-Scala Electrode. J Otolaryngol Head Neck Surg 2024; 53:19160216241250351. [PMID: 38888946 PMCID: PMC11155315 DOI: 10.1177/19160216241250351] [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: 02/29/2024] [Accepted: 03/30/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE The long-term preservation of residual hearing after cochlear implantation has become a major goal over the past few years. The aim of the present study was to evaluate residual hearing in the long-term follow-up using mid-scala electrodes. METHODS In this retrospective, single-center study, we collected data from 27 patients who were implanted between 2014 and 2015 with residual hearing in the low-frequency range using a mid-scala electrode. Measurements of the hearing thresholds were carried out directly postoperatively (day 1 after surgery) and in the long-term follow-up 43.7 ± 6.9 months. The calculation of the extent of audiological hearing preservation was determined using the HEARRING group formula by Skarsynski. RESULTS Postoperative preservation of residual hearing was achieved in 69.2% of the cases in the low-frequency range between 250 Hz and 1 kHz, of which 89.5% of the patients had frequencies that suggested using electroacoustic stimulation (EAS). In the long-term follow-up, 30.8% of the patients showed residual hearing; however, 57.1% had apparently benefited from EAS. CONCLUSION Preservation of residual hearing is feasible in the long term using mid-scala electrodes. Postoperatively, there is over the half of patients who benefit from an EAS strategy. The long-term follow-up shows a certain decrease in residual hearing. However, these results are comparable to studies relating to other types of electrodes. Further research should be conducted in future to better evaluate hearing loss in long-term follow-up, compared to direct postoperative audiological results.
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Affiliation(s)
- Martin Gerbert
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Arne Ernst
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Rainer Seidl
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lars Decker
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Sandra Scholz
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Gina Lauer
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology, Head and Neck Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
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Andonie RR, Wimmer W, Wildhaber RA, Caversaccio M, Weder S. Real-Time Feature Extraction From Electrocochleography With Impedance Measurements During Cochlear Implantation Using Linear State-Space Models. IEEE Trans Biomed Eng 2023; 70:3137-3146. [PMID: 37195836 DOI: 10.1109/tbme.2023.3276993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Electrocochleography (ECochG) is increasingly used to monitor the inner ear function of cochlear implant (CI) patients during surgery. Current ECochG-based trauma detection shows low sensitivity and specificity and depends on visual analysis by experts. Trauma detection could be improved by including electric impedance data recorded simultaneously with the ECochG. However, combined recordings are rarely used because the impedance measurements produce artifacts in the ECochG. In this study, we propose a framework for automated real-time analysis of intraoperative ECochG signals using Autonomous Linear State-Space Models (ALSSMs). We developed ALSSM based algorithms for noise reduction, artifact removal, and feature extraction in ECochG. Feature extraction includes local amplitude and phase estimations and a confidence metric over the presence of a physiological response in a recording. We tested the algorithms in a controlled sensitivity analysis using simulations and validated them with real patient data recorded during surgeries. The results from simulation data show that the ALSSM method provides improved accuracy in the amplitude estimation together with a more robust confidence metric of ECochG signals compared to the state-of-the-art methods based on the fast Fourier transform (FFT). Tests with patient data showed promising clinical applicability and consistency with the findings from the simulations. We showed that ALSSMs are a valid tool for real-time analysis of ECochG recordings. Removal of artifacts using ALSSMs enables simultaneous recording of ECochG and impedance data. The proposed feature extraction method provides the means to automate the assessment of ECochG. Further validation of the algorithms in clinical data is needed.
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Schuerch K, Wimmer W, Rummel C, Caversaccio MD, Weder S. Objective evaluation of intracochlear electrocochleography: repeatability, thresholds, and tonotopic patterns. Front Neurol 2023; 14:1181539. [PMID: 37621854 PMCID: PMC10446839 DOI: 10.3389/fneur.2023.1181539] [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: 03/07/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Intracochlear electrocochleography (ECochG) is increasingly being used to measure residual inner ear function in cochlear implant (CI) recipients. ECochG signals reflect the state of the inner ear and can be measured during implantation and post-operatively. The aim of our study was to apply an objective deep learning (DL)-based algorithm to assess the reproducibility of longitudinally recorded ECochG signals, compare them with audiometric hearing thresholds, and identify signal patterns and tonotopic behavior. Methods We used a previously published objective DL-based algorithm to evaluate post-operative intracochlear ECochG signals collected from 21 ears. The same measurement protocol was repeated three times over 3 months. Additionally, we measured the pure-tone thresholds and subjective loudness estimates for correlation with the objectively detected ECochG signals. Recordings were made on at least four electrodes at three intensity levels. We extracted the electrode positions from computed tomography (CT) scans and used this information to evaluate the tonotopic characteristics of the ECochG responses. Results The objectively detected ECochG signals exhibited substantial repeatability over a 3-month period (bias-adjusted kappa, 0.68; accuracy 83.8%). Additionally, we observed a moderate-to-strong dependence of the ECochG thresholds on audiometric and subjective hearing levels. Using radiographically determined tonotopic measurement positions, we observed a tendency for tonotopic allocation with a large variance. Furthermore, maximum ECochG amplitudes exhibited a substantial basal shift. Regarding maximal amplitude patterns, most subjects exhibited a flat pattern with amplitudes evenly distributed over the electrode carrier. At higher stimulation frequencies, we observed a shift in the maximum amplitudes toward the basal turn of the cochlea. Conclusions We successfully implemented an objective DL-based algorithm for evaluating post-operative intracochlear ECochG recordings. We can only evaluate and compare ECochG recordings systematically and independently from experts with an objective analysis. Our results help to identify signal patterns and create a better understanding of the inner ear function with the electrode in place. In the next step, the algorithm can be applied to intra-operative measurements.
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Affiliation(s)
- Klaus Schuerch
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Prenzler NK, Salcher R, Lenarz T, Gaertner L, Lesinski-Schiedat A, Warnecke A. Deep intracochlear injection of triamcinolone-acetonide with an inner ear catheter in patients with residual hearing. Front Neurosci 2023; 17:1202429. [PMID: 37564369 PMCID: PMC10410142 DOI: 10.3389/fnins.2023.1202429] [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: 04/08/2023] [Accepted: 07/10/2023] [Indexed: 08/12/2023] Open
Abstract
Introduction In a previous study, an inner ear catheter was used to deliver low- and high-dose steroids into the cochlea prior to cochlear implant electrode insertion. With this approach, more apical regions of the cochlea could be reached and a reduction of electrode impedances in the short term was achieved in cochlear implant recipients. Whether intracochlear application of drugs via the catheter is a safe method also for patients with residual hearing has not been investigated hitherto. The aim of the present study was therefore to investigate the effect of intracochlear triamcinolone application in cochlear implant recipients with residual hearing. Patients and methods Patients with residual hearing were administered triamcinolone-acetonide (4 mg/ml; n = 10) via an inner ear catheter just prior to insertion of a MED-EL FLEX28 electrode. Impedances were measured at defined time points (intra-operatively, post-operatively and at first fitting) and retrospectively compared with a control group (no steroid application) and low- and high-dose group. Hearing thresholds were measured preoperatively, 3 days after surgery and at first fitting by pure tone audiometry. Pre- to postoperative hearing loss was determined at first fitting and compared to results from a previous study. Results The median hearing loss after implantation (125-1,500 Hz) was 20.6 dB. Four patients (40%) showed a median hearing loss of less than 15 dB, three patients (30%) between 15 and 30 dB and three patients (30%) more than 30 dB. The median hearing loss was similar to the results obtained from our previous study showing a median hearing loss of 24 dB when using FLEX28 electrode arrays. Conclusion No difference in residual hearing loss was found when comparing application of triamcinolone-acetonide using an inner ear catheter prior to the insertion of a FLEX28 electrode array to the use of the FLEX28 electrode array without the catheter. Thus, we conclude that application of drugs to the cochlea with an inner ear catheter could be a feasible approach in patients with residual hearing.
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Affiliation(s)
- Nils K. Prenzler
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
| | - Rolf Salcher
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
- Cluster of Excellence “Hearing 4 All” (DFG Exc. 2177), Hannover Medical School, Hanover, Germany
| | - Lutz Gaertner
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
| | - Anke Lesinski-Schiedat
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
| | - Athanasia Warnecke
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medical School, Hanover, Germany
- Cluster of Excellence “Hearing 4 All” (DFG Exc. 2177), Hannover Medical School, Hanover, Germany
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Jeon EK, Mussoi BS, Brown CJ, Abbas PJ. Acoustic Change Complex Recorded in Hybrid Cochlear Implant Users. Audiol Neurootol 2022; 28:151-157. [PMID: 36450234 PMCID: PMC10227181 DOI: 10.1159/000527671] [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: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Expanding cochlear implant (CI) candidacy criteria and advances in electrode arrays and soft surgical techniques have increased the number of CI recipients who have residual low-frequency hearing. Objective measures such as obligatory cortical auditory-evoked potentials (CAEPs) may help clinicians make more tailored recommendations to recipients regarding optimal listening mode. As a step toward this goal, this study investigated how CAEPs measured from hybrid CI users differ in two listening modes: acoustic alone (A-alone) versus acoustic plus electric (A + E). METHODS Eight successful hybrid CI users participated in this study. Two CAEPs, the P1-N1-P2 and the acoustic change complex (ACC), were measured simultaneously in response to the onset and change of a series of different and spectrally complex acoustic signals, in each of the two listening modes (A-alone and A + E). We examined the effects of listening mode and stimulus type on the onset and ACC N1-P2 amplitudes and peak latencies. RESULTS ACC amplitudes in hybrid CI users significantly differed as a function of listening mode and stimulus type. ACC responses in A + E were larger than those in the A-alone mode. This was most evident for stimuli involving a change from low to high frequency. CONCLUSIONS Results of this study showed that the ACC varies as a function of listening mode and stimulus type. This finding suggests that the ACC can be used as a physiologic, objective measure of the benefit of hybrid CIs, potentially supporting clinicians in making clinical recommendations on individualized listening mode, or to document subjective preference for a given listening mode. Further research into this potential clinical application in a range of hybrid recipients and/or long electrode users who have residual low-frequency hearing is warranted.
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Affiliation(s)
- Eun Kyung Jeon
- Department of Communication Sciences and Disorders, Iowa City, Iowa, United States
| | | | - Carolyn J. Brown
- Department of Communication Sciences and Disorders, Iowa City, Iowa, United States
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, Iowa, United States
| | - Paul J. Abbas
- Department of Communication Sciences and Disorders, Iowa City, Iowa, United States
- Department of Otolaryngology – Head and Neck Surgery, University of Iowa, Iowa City, Iowa, United States
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Geographic Variations in Medicare Cochlear Implantations in the United States. Otol Neurotol 2022; 43:1022-1026. [PMID: 36006783 DOI: 10.1097/mao.0000000000003660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe national practice patterns and detail geographic and temporal changes in cochlear implantations (CIs) in the Medicare population. STUDY DESIGN Cross-sectional analysis. SETTING Medicare B Public Use Files. PATIENTS Medicare B fee-for-service patients who underwent CI from 2012 to 2019. INTERVENTIONS Cochlear implantations (Current Procedural Terminology code 69930). MAIN OUTCOME MEASURES Medicare Part B Public Use Files were used to identify all individual providers who performed CIs from 2012 to 2019. The total number of CIs performed annually was calculated for hospital referral regions (HRRs) as well as U.S. census regions to describe geographic variations and changes over the study period. Average Medicare reimbursement rates were tabulated. RESULTS From 2012 of 2019, the number of CIs performed in the Medicare population increased from 1,239 to 2,429, representing a 96.0% increase. In each of the four U.S. census regions, there was a statistically significant increase in the number of CIs performed over the study period. However, of 306 HRR in the United States, cochlear implants were performed in only 117 (38.2%), with the median number of CIs in each HRRs 16.7 (interquartile range, 13-24.2) per year. The median weighted average Medicare reimbursement was $1205.49 (interquartile range, 1161.65-1253.46). CONCLUSIONS The number of CIs in the Medicare population has increased from 2012 to 2019. However, widespread geographic variations continue to persist in the United States and represent opportunities toward identifying and acting on the etiologies of persistent disparities in CI.
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