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Koyama H, Kashio A, Yamasoba T. Prediction of Cochlear Implant Fitting by Machine Learning Techniques. Otol Neurotol 2024; 45:643-650. [PMID: 38769101 DOI: 10.1097/mao.0000000000004205] [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: 05/22/2024]
Abstract
OBJECTIVE This study aimed to evaluate the differences in electrically evoked compound action potential (ECAP) thresholds and postoperative mapping current (T) levels between electrode types after cochlear implantation, the correlation between ECAP thresholds and T levels, and the performance of machine learning techniques in predicting postoperative T levels. STUDY DESIGN Retrospective case review. SETTING Tertiary hospital. PATIENTS We reviewed the charts of 124 ears of children with severe-to-profound hearing loss who had undergone cochlear implantation. INTERVENTIONS We compared ECAP thresholds and T levels from different electrodes, calculated correlations between ECAP thresholds and T levels, and created five prediction models of T levels at switch-on and 6 months after surgery. MAIN OUTCOME MEASURES The accuracy of prediction in postoperative mapping current (T) levels. RESULTS The ECAP thresholds of the slim modiolar electrodes were significantly lower than those of the straight electrodes on the apical side. However, there was no significant difference in the neural response telemetry thresholds between the two electrodes on the basal side. Lasso regression achieved the most accurate prediction of T levels at switch-on, and the random forest algorithm achieved the most accurate prediction of T levels 6 months after surgery in this dataset. CONCLUSION Machine learning techniques could be useful for accurately predicting postoperative T levels after cochlear implantation in children.
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Affiliation(s)
- Hajime Koyama
- Department of Otorhinolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Dambon J, Munder P, Mewes A, Böhnke B, Beyer A, Kolonko J, Brademann G, Hey M. Optimizing the efficiency of ECAP measurements due to interpolation. Acta Otolaryngol 2023; 143:971-978. [PMID: 38189322 DOI: 10.1080/00016489.2023.2298467] [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: 10/11/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Thresholds of electrically evoked compound action potentials (TECAP) may serve as starting points for electrophysiologically based fitting of cochlear implants. Absent TECAP data at single electrodes reduces the number of data points available for fitting and can be substituted by interpolation of measured data points. AIM To compare complete TECAP profiles with interpolated TECAP profiles of 5/22 (∼22.7%) and 11/22 (50%) electrode contacts. MATERIAL AND METHODS Single-centre, retrospective, observational study of data from 624 ears implanted with a Slim Modiolar (CI ×32) or Contour Advance (CI ×12, CI24RE(CA)) electrode array (Cochlear Ltd). The deviation of the complete measured TECAP profile from the same profile with missing and therefore interpolated TECAP values was quantified. RESULTS Interpolated TECAP profiles significantly differ from complete measured profiles especially at the basal and apical electrodes. Reference data for Slim Modiolar and Contour Advance electrodes mean profiles are provided. CONCLUSIONS AND SIGNIFICANCE Reducing the number of measured TECAP electrodes has to be weighted against losses in the TECAP accuracy of interpolated values. A clinically acceptable compromise may be a reduction from 22 to 11 even non-equidistant data points. While reducing ECAP measurement time, it is accompanied by a minimal loss of accuracy of the TECAP threshold profile.
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Affiliation(s)
- Jan Dambon
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Patrick Munder
- itap - Institut für technische und angewandte Physik GmbH, Oldenburg, Germany
| | - Alexander Mewes
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Britta Böhnke
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Annika Beyer
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Johannes Kolonko
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Goetz Brademann
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Matthias Hey
- Department of Otorhinolaryngology, Head and Neck Surgery, Audiology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
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Park B, Thak PK, Park E, Choi SJ, Lee J, Kwak S, Jung HH, Im GJ. Dynamic Range and Neural Response Threshold in Cochlear Implant Mapping Can Be Useful in Predicting Prognosis Related to Postoperative Speech Perception. J Audiol Otol 2023; 27:212-218. [PMID: 37872755 PMCID: PMC10603277 DOI: 10.7874/jao.2023.00374] [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: 08/18/2023] [Revised: 09/13/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To analyze mapping changes in dynamic range (DR) and neural response threshold (NRT) as prognostic factors for cochlear implant (CI). To analyze whether postoperative speech perception performance could be predicted using DR change and initial NRT. SUBJECTS AND METHODS The speech comprehension data of 33 patients with CI were retrospectively analyzed after 1, 3, 6, and 12 months of device use. All subjects were adult, postlingually hearing-impaired, and Cochlear Nucleus CI users. Speech perception performance was evaluated using aided pure tone audiometry, consonant, vowel, one-word, two-word, and sentence tests. RESULTS The averages of initial NRT and DR changes were 197.8±25.9 CU (104-236) and 22.2±18.4 CU (-15-79), respectively. The initial DR was 40.8±16.6 CU. The postoperative DR was 50.3±16.4 CU at 3 months, 58±12.3 CU at 6 months, and 62.9±10.4 CU at 12 months. A gradual increase of DR was observed during the first year of CI. Compared with the initial DR, significant increases in DR were observed at 3 (p<0.05), 6 (p<0.001), and 12 (p<0.001) months. Compared with initial speech performance outcomes, a significant gain in all performance outcomes was achieved at 12 months (p<0.001). CONCLUSIONS Patients with low NRT after CI surgery could initially set DR to a wider range and had better final speech perception outcomes. Conversely, patients with high NRT after CI surgery had to set up a gradual increase in DR while adjusting the T-C level, and the final speech perception outcomes were worse. DR and NRT, the main CI mapping variables, can help predict prognosis related to speech perception outcomes after CI surgery. In conclusion, the post-CI speech perception is better with a lower initial NRT, wider final DR, or younger age.
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Affiliation(s)
- Bongil Park
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Pyung Kon Thak
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Euyhyun Park
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Soo Jeong Choi
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Juhyun Lee
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Sooun Kwak
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hak Hyun Jung
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Gi Jung Im
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
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Relationship between electrically evoked compound action potential thresholds and behavioral T-levels in implanted children with cochlear nerve deficiency. Sci Rep 2023; 13:4309. [PMID: 36922582 PMCID: PMC10017809 DOI: 10.1038/s41598-023-31411-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/11/2023] [Indexed: 03/17/2023] Open
Abstract
It is challenging to program children with cochlear nerve deficiency (CND) due to limited auditory and speech abilities or concurrent neurological deficits. Electrically evoked compound action potential (ECAP) thresholds have been widely used by many audiologists to help cochlear implant programming for children who cannot cooperate with behavioral testing. However, the relationship between ECAP thresholds and behavioral levels of cochlear nerve in children with CND remains unclear. This study aimed to investigate how well ECAP thresholds are related to behavioral thresholds in the MAP for children with CND. This study included 29 children with CND who underwent cochlear implantation. For each participant, ECAP thresholds and behavioral T-levels were measured at three electrode locations across the electrode array post-activation. The relationship between ECAP thresholds and behavioral T-levels was analyzed using Pearson's correlation coefficient. The results showed that ECAP thresholds were significantly correlated with behavioral T-levels at the basal, middle, and apical electrodes. ECAP thresholds were equal to or higher than the behavioral T-levels for all tested electrodes, and fell within MAP's dynamic range for approximately 90% of the tested electrodes. Moreover, the contour of the ECAP thresholds was similar to the contour of T-levels across electrodes for most participants. ECAP thresholds can help audiologists select stimulation levels more efficiently for children with CND who cannot provide sufficient behavioral response.
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Claussen AD, Quevedo RV, Kirk JR, Higgins T, Mostaert B, Rahman MT, Oleson J, Hernandez R, Hirose K, Hansen MR. Chronic cochlear implantation with and without electric stimulation in a mouse model induces robust cochlear influx of CX3CR1 +/GFP macrophages. Hear Res 2022; 426:108510. [PMID: 35527124 PMCID: PMC9596618 DOI: 10.1016/j.heares.2022.108510] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/27/2022] [Accepted: 04/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cochlear implantation is an effective auditory rehabilitation strategy for those with profound hearing loss, including those with residual low frequency hearing through use of hybrid cochlear implantation techniques. Post-mortem studies demonstrate the nearly ubiquitous presence of intracochlear fibrosis and neo-ossification following cochlear implantation. Current evidence suggests post-implantation intracochlear fibrosis is associated with delayed loss of residual acoustic hearing in hybrid cochlear implant (CI) recipients and may also negatively influence outcomes in traditional CI recipients. This study examined the contributions of surgical trauma, foreign body response and electric stimulation to intracochlear fibrosis and the innate immune response to cochlear implantation and the hierarchy of these contributions. METHODS Normal hearing CX3CR1+/GFP mice underwent either round window opening (sham), acute CI insertion or chronic CI insertion with no, low- or high-level electric stimulation. Electric stimulation levels were based on neural response telemetry (NRT), beginning post-operative day 7 for 5 h per day. Subjects (n=3 per timepoint) were sacrificed at 4 h, 1,4,7,8,11,14 and 21 days. An unoperated group (n=3) served as controls. Cochleae were harvested at each time-point and prepared for immunohistochemistry with confocal imaging. The images were analyzed to obtain CX3CR1+ macrophage cell number and density in the lateral wall (LW), scala tympani (ST) and Rosenthal's canal (RC). RESULTS A ST peri-implant cellular infiltrate and fibrosis occurred exclusively in the chronically implanted groups starting on day 7 with a concurrent infiltration of CX3CR1+ macrophages not seen in the other groups. CX3CR1+ macrophage infiltration was seen in the LW and RC in all experimental groups within the first week, being most prominent in the 3 chronically implanted groups during the second and third week. CONCLUSIONS The cochlear immune response was most prominent in the presence of chronic cochlear implantation, regardless of electric stimulation level. Further, the development of intracochlear ST fibrosis was dependent on the presence of the indwelling CI foreign body. An innate immune response was evoked by surgical trauma alone (sham and acute CI groups) to a lesser degree. These data suggest that cochlear inflammation and intrascalar fibrosis after cochlear implantation are largely dependent on the presence of a chronic indwelling foreign body and are not critically dependent on electrical stimulation. Also, these data support a role for surgical trauma in inciting the initial innate immune response.
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Affiliation(s)
- Alexander D Claussen
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States; Department of Otolaryngology Head and Neck Surgery, University of California San Diego, San Diego, CA 92103, United States.
| | - René Vielman Quevedo
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States; Department of Biomedical Sciences, Creighton University, Omaha, NE 68178, United States
| | | | - Timon Higgins
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Brian Mostaert
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Muhammad Taifur Rahman
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
| | - Jacob Oleson
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Reyna Hernandez
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA 52242, United States
| | - Keiko Hirose
- Department of Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Marlan R Hansen
- Department of Otolaryngology Head and Neck Surgery, University of Iowa, Iowa City, IA 52242, United States
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Pan T, Adeyemo A, Armstrong DG, Petfield JL. Neurophysiological Intraoperative Monitoring in Patients with Cochlear Implant Undergoing Posterior Spinal Fusion: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00016. [PMID: 35050944 DOI: 10.2106/jbjs.cc.21.00609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE Transcranial electric stimulation motor-evoked potentials (tcMEPs) are the most sensitive technique in multimodality intraoperative neuromonitoring (IONM) for posterior spinal fusion (PSF). The presence of a cochlear implant (CI) is considered a contraindication to IONM because of theoretical risk of implant device and local tissue damage from voltages induced by tcMEPs. We present the case of a 10-year-old girl with CI who underwent successful PSF with tcMEP and monopolar electrocautery (MoEC) without perioperative complications or CI damage. CONCLUSION With proper precautions, such as MoEC usage at a minimal voltage, motor-evoked potential monitoring can be safely performed in pediatric patients with CI undergoing PSF.
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Affiliation(s)
- Tommy Pan
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Adeshina Adeyemo
- Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
| | - Douglas G Armstrong
- Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
| | - Joseph L Petfield
- Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, Pennsylvania
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Tsai P, Wisener N, Papsin B, Cushing S, Gordon K. Toward a method of achieving balanced stimulation of bilateral auditory nerves: Evidence from children receiving matched and unmatched bilateral cochlear implants simultaneously. Hear Res 2022; 416:108445. [DOI: 10.1016/j.heares.2022.108445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/13/2022] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
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