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Kumari A, Sahoo L, Patnaik U, Sahoo KS, Rao NPC, Kumar M, Thakur S. Comparison of Intraoperative Neural Response Telemetry Results and Postoperative Neural Response Telemetry Results in Case of Children with Congenital Bilateral Severe to Profound Sensorineural Hearing Loss Undergoing Single Sided Cochlear Implantation. Indian J Otolaryngol Head Neck Surg 2023; 75:336-342. [PMID: 37206791 PMCID: PMC10188783 DOI: 10.1007/s12070-022-03284-x] [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: 08/20/2021] [Revised: 08/20/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023] Open
Abstract
Aim and Objectives This study is designed to compare the Intra Operative Neural Response Telemetry (NRT) results with Post-Operative NRT results of the cochlear implanted children, to assess the importance of Intra Operative NRT thresholds in device activation and/or switch on of the audio processor and to evaluate the importance of Intra and post operative AutoNRT results in predicting behavioural thresholds during mapping of prelingual Cochlear Implanted children. Materials and methods A total of thirty (30) children (16 boys, 14 girls) with congenital Bilateral (B/L) severe to profound Sensorineural hearing loss (SNHL) were included in this study. Children between the age range of 12 to 60 months were participated in this study. All the participants were implanted with Nucleus 24 cochlear implant system. In each patient, the intra operative NRT-thresholds were measured for all 22 active electrodes. Then Intra Operative NRT thresholds were correlated with Post-Operative NRT thresholds at the time of switch on and the behavioural map after six months of switch on of the device (Audio Processor). Results There is a significant enhancement observed in thresholds of postoperative NRT responses which were raised or absent during intraoperative session. There is a gain in NRT thresholds marked after 6 months of postoperative follow up in comparison with first measurement at the time of Switch On of the device but the change not that significant. During postoperative mapping, there was a significant positive correlation noticed between neural response telemetry level measurements and behavioural threshold level. Conclusion Absent or elevated NRT responses during intraoperative testing for some electrodes especially basal electrodes does not mean that electrode is out of order or outside the cochlea, because an improvement in NRT thresholds usually occurs postoperatively. In case of children with congenital B/L severe to profound SNHL, the NRT values have a very useful role in predicting the behavioural thresholds. Combination of NRT values with behavioural thresholds and observations of Auditory Verbal Therapist can help in providing best suitable Map to the recipient. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03284-x.
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Affiliation(s)
| | | | | | | | - NPC Rao
- Department of ENT, CHSC, AFMC, Pune, India
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Sawaf T, Vovos R, Hadford S, Woodson E, Anne S. Utility of intraoperative neural response telemetry in pediatric cochlear implants. Int J Pediatr Otorhinolaryngol 2022; 162:111298. [PMID: 36088734 DOI: 10.1016/j.ijporl.2022.111298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/19/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative Threshold (T) and Comfort (C) levels and their correlation over time after cochlear implantation (CI). METHODS A retrospective chart review was conducted of patients less than 18 years of age who had CI with a Cochlear™ device and NRT at an academic center from 2010 to 2019. Data collected included demographics, extrapolated NRT threshold (tNRT) and slope of amplitude for electrodes 1, 6/7, 11/12, 16, and 22, and postoperative T and C levels at initial activation and 1 month, 3 months, and 1 year post-activation. Associations between T and C levels and slope of amplitude or tNRT were assessed using Spearman's rank correlation. RESULTS 39 patients (65 CIs) were included. Intraoperative tNRT correlated strongly with T and C levels at 1 month, 3 months, and 1 year post-activation on nearly all electrodes. Electrodes 6/7 and 11/12 at 3 months and electrodes 6/7 at 1 year did not correlate with T and C levels. There was no significant relationship between the slope of amplitude for nearly all electrodes and the T or C levels post-activation. CONCLUSION NRT is invaluable in children, with significant correlation found between tNRT and T and C levels over time on nearly all electrodes. There are changes in T and C levels in electrodes 6/7 and 11/12 over time, and close surveillance is beneficial to tailor programming as needed.
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Affiliation(s)
- Tuleen Sawaf
- Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rachel Vovos
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Stephen Hadford
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Erika Woodson
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA.
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Maggu AR. Auditory Evoked Potentials in Communication Disorders: An Overview of Past, Present, and Future. Semin Hear 2022; 43:137-148. [PMID: 36313051 PMCID: PMC9605805 DOI: 10.1055/s-0042-1756160] [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: 06/16/2023] Open
Abstract
This article provides a brief overview of auditory evoked potentials (AEPs) and their application in the areas of research and clinics within the field of communication disorders. The article begins with providing a historical perspective within the context of the key scientific developments that led to the emergence of numerous types of AEPs. Furthermore, the article discusses the different AEP techniques in the light of their feasibility in clinics. As AEPs, because of their versatility, find their use across disciplines, this article also discusses some of the research questions that are currently being addressed using AEP techniques in the field of communication disorders and beyond. At the end, this article summarizes the shortcomings of the existing AEP techniques and provides a general perspective toward the future directions. The article is aimed at a broad readership including (but not limited to) students, clinicians, and researchers. Overall, this article may act as a brief primer for the new AEP users, and as an overview of the progress in the field of AEPs along with future directions, for those who already use AEPs on a routine basis.
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Affiliation(s)
- Akshay R. Maggu
- Department of Speech-Language-Hearing Sciences, Hofstra University, Hempstead, New York
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Gärtner L, Spitzer P, Lauss K, Takanen M, Lenarz T, Hoth S. Optimized SNR-based ECAP threshold determination is comparable to the judgement of human evaluators. PLoS One 2021; 16:e0259347. [PMID: 34723991 PMCID: PMC8559956 DOI: 10.1371/journal.pone.0259347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
In cochlear implant (CI) users, measurements of electrically evoked compound action potentials (ECAPs) prove the functionality of the neuron-electrode interface. Objective measures, e.g., the ECAP threshold, may serve as a basis for the clinical adjustment of the device for the optimal benefit of the CI user. As for many neural responses, the threshold determination often is based on the subjective assessment of the clinical specialist, whose decision-making process could be aided by autonomous computational algorithms. To that end, we extended the signal-to-noise ratio (SNR) approach for ECAP threshold determination to be applicable for FineGrain (FG) ECAP responses. The new approach takes advantage of two features: the FG stimulation paradigm with its enhanced resolution of recordings, and SNR-based ECAP threshold determination, which allows defining thresholds independently of morphology and with comparably low computational power. Pearson's correlation coefficient r between the ECAP threshold determined by five experienced evaluators and the threshold determined with the FG-SNR algorithm was in the range of r = 0.78-0.93. Between evaluators, r was in a comparable range of 0.84-0.93. A subset of the parameters of the algorithm was varied to identify the parameters with the highest potential to improve the FG-SNR formalism in the future. The two steps with the strongest influence on the agreement between the threshold estimate of the evaluators and the algorithm were the removal of undesired frequency components (denoising of the response traces) and the exact determination of the two time windows (signal and noise and noise only)."The parameters were linked to the properties of an ECAP response, indicating how to adjust the algorithm for the automatic detection of other neurophysiological responses.
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Affiliation(s)
- Lutz Gärtner
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Philipp Spitzer
- Research and Development, MED-EL Medical Electronics, Innsbruck, Austria
| | - Kathrin Lauss
- Research and Development, MED-EL Medical Electronics, Innsbruck, Austria
| | - Marko Takanen
- Research and Development, MED-EL Medical Electronics, Innsbruck, Austria
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Hannover, Germany
| | - Sebastian Hoth
- Funktionsbereich Audiologie, Universitäts-HNO-Klinik, Heidelberg, Germany
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Dziemba OC, Aristeidou A, Brill S. Slope of electrically evoked compound action potential amplitude growth function is site-dependent. Cochlear Implants Int 2020; 22:136-147. [PMID: 33297870 DOI: 10.1080/14670100.2020.1853956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES In human cochlear implant (CI) recipients, the slope of the electrically evoked compound action potential (ECAP) amplitude growth function (AGF) is not very well investigated, in comparison to the threshold derived from the AGF. This is despite the fact that it was shown in animal experiments that the slope correlates with the number of excitable neurons. The rationale of this study was to establish baseline data of the AGF slope for possible clinical applications, while investigating stability over time and dependence on cochlear site. DESIGN ECAP AGFs of 16 ears implanted with MED-EL CIs were recorded on all electrode contacts during the normal clinical routine at 4 different points in time. RESULTS Due to patient availability, not all 16 ears could be measured at all 4 points in time. A dependence of the slope on the electrode position was visible and statistically significant: At the three electrode contacts at the apical end of the array, the slope is greater compared to the medial and basal region of the cochlea. CONCLUSION The three most apical electrode contacts show greater slopes of ECAP AGF recordings. Our data of the cohort slopes show mild effects between the 4 different points in time.
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Affiliation(s)
- Oliver C Dziemba
- Department of ENT, Head & Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Aristotelis Aristeidou
- Department of ENT, Head & Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Brill
- MED-EL Elektromedizinische Geräte Deutschland GmbH, Starnberg, Germany
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Tay SY, Anicete R, Tan KKH. A Ten-Year Review of Audiological Performance in Children with Inner Ear Abnormalities after Cochlear Implantation in Singapore. Int J Otolaryngol 2019; 2019:6483714. [PMID: 31885597 PMCID: PMC6915011 DOI: 10.1155/2019/6483714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/26/2019] [Accepted: 11/08/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate children with inner ear malformations following cochlear implantation (CI) in a tertiary pediatric hospital in Singapore to identify factors influencing outcomes after CI. METHODS This is a retrospective cohort study of children aged 0 to 18 years, who had CI between 2000 and 2013. Demographic information, data on risk factors, type of inner ear malformation (IEM), age at implantation, speech pre- and postimplantation, and duration of follow-up were collected from clinical records. Operative details and audiological outcomes were also analyzed. RESULTS A total of 70 children underwent 83 CI surgeries. The mean age of the patients was 4.05 ± 3.17 years (range 1-18 years). Twenty patients (28.57%) had abnormal CT scan findings. CSF gusher occurred in 15 out of 26 CI (57.69%) in the group with IEM. Nine out of twenty patients (45.00%) had poor IT-MAIS scores prior to implantation. The average preoperative IT-MAIS score for children with anomalous inner ear anatomy was 14.1. The older CI patients, 3/20 (15.00%), mean age 8.33 years (range 7-10 years), were mostly referred for persistently unclear speech following hearing aids. Eleven patients (55.00%) had good speech and aided hearing threshold within speech limits after CI and were eligible for reintegration into mainstream schools. Five patients (25.00%) had improvement in speech but continued to receive education in special schools. Four patients (20.00%) had poor progress after surgery. CONCLUSION The presence of absent cochlear nerve, electrode folding, and underlying neurological disorders seemed to be associated with poorer outcomes.
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Affiliation(s)
- Sok Yan Tay
- Department of Otolaryngology, Head and Neck Surgery, National University Hospital System (NUHS), Singapore
| | - Rosslyn Anicete
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore
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Motasaddi Zarandy M, Nourizadeh N, Mobedshahi F, Jafarzadeh S. Relationship between Electrically Evoked Compound Action Potential Thresholds and Auditory, Language, and Speech Progress after Cochlear Implant Surgery. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2018; 30:185-188. [PMID: 30083523 PMCID: PMC6064758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Electrically evoked compound action potential (ECAP) is an objective auditory response that can be used in the programing of cochlear implants. The aims of this study were to monitor ECAP thresholds and auditory, language and speech progress for 6 months after cochlear implant surgery and to evaluate any relationship between them. MATERIALS AND METHODS Ten children with a mean age of 4.2 (±0.6) years and bilateral congenital and profound sensorineural hearing loss underwent cochlear implant surgery and post-operation auditory and speech training. The auditory, language, and speech abilities (Newsha level) and ECAP thresholds (for apical, medial and basal region of cochlea) were evaluated 1, 3 and 6 months after surgery. RESULTS ECAP threshold showed no significant improvement in any of the evaluated areas in the 6 months after surgery (P>0.05); however, the Newsha level improved for all patients (P=0.00). CONCLUSION There was no relationship between ECAP thresholds and auditory, language, and speech abilities (Newsha level) in the first 6 months after surgery. ECAP thresholds may be a poor indicator of improvement in auditory, language, and speech abilities, and depend on many factors.
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Affiliation(s)
- Masoud Motasaddi Zarandy
- Department of Ear, Nose and Throat, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Navid Nourizadeh
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Farzad Mobedshahi
- Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:
| | - Sadegh Jafarzadeh
- Department of Audiology, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
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Tanamati LF, Goffi-Gomez MVS, Muniz LF, Samuel PA, Wiemes GRM, Lima DP, Curi SB, Onuki LC, Queiroz CF, Capistrano AKB, Moret ALM, Kimura MYT, Oyanguren V, Mauch H. Use of remote control in the intraoperative telemetry of cochlear implant: multicentric study. Braz J Otorhinolaryngol 2018; 85:502-509. [PMID: 29858159 PMCID: PMC9443058 DOI: 10.1016/j.bjorl.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/18/2018] [Accepted: 04/09/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction The conventional evaluation of neural telemetry and impedance requires the use of the computer coupled to an interface, with software that provides visualization of the stimulus and response. Recently, a remote control (CR220®) was launched in the market, that allows the performance of intraoperative tests with minimal instrumentation. Objective To evaluate the agreement of the impedance values and neural telemetry thresholds, and the time of performance in the conventional procedure and by the remote control. Methods Multicentric prospective cross-sectional study. Intraoperative evaluations of cochlear implants compatible with the use of CR220® were included. The tests were carried out in the 22 electrodes to compare the time of performance in the two situations. The agreement of the neural telemetry threshold values obtained from five electrodes was analyzed, and the agreement of impedance was evaluated by the number of electrodes with altered values in each procedure. Results There were no significant difference between the impedance values. There was a moderate to strong correlation between the electrically-evoked compound action potential thresholds. The mean time to perform the procedures using the CR220 was significantly lower than that with the conventional procedure. Conclusion The use of the CR220 provided successful records for impedance telemetry and automatic neural response telemetry.
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Affiliation(s)
| | | | | | - Paola Angélica Samuel
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil
| | | | | | - Sílvia Badur Curi
- Universidade de Campinas (UNICAMP), Faculdade de Medicina, Hospital das Clínicas, Campinas, SP, Brazil
| | - Lucia Cristina Onuki
- Universidade de Campinas (UNICAMP), Faculdade de Medicina, Hospital das Clínicas, Campinas, SP, Brazil
| | - Carla Fortunato Queiroz
- Universidade do Paraná (UFPR), Faculdade de Medicina, Hospital das Clínicas, Curitiba, PR, Brazil
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Almosnino G, Anne S, Schwartz SR. Use of Neural Response Telemetry for Pediatric Cochlear Implants: Current Practice. Ann Otol Rhinol Laryngol 2018; 127:367-372. [PMID: 29649894 DOI: 10.1177/0003489418767692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Evaluate usage trends of neural response telemetry (NRT) in cochlear implant centers across the nation and assess reported benefits of intraoperative NRT for pediatric cochlear implant recipients. STUDY DESIGN Survey. STUDY PARTICIPANTS All US cochlear implant centers (n = 110). METHODS A 15-question multiple-choice survey was distributed electronically to all centers. The survey captured demographic information of all centers, practice patterns surrounding the use of NRT, and the extent to which intraoperative NRT is of benefit. RESULTS Thirty-two invited participants (29%) completed the survey. A majority of participants reported practicing in an academic center (66%), followed by a hospital setting (19%) and private practice (16%). Seventy-two percent of survey participants reported using NRT for pediatric cochlear implant recipients. Sixty-three percent felt it improved the ability to program at initial activation, and 50% of participants felt that NRT improves satisfaction at initial activation. CONCLUSION This study suggests that a majority of surgeons use intraoperative NRT for pediatric cochlear implantation as an additional measure to ensure appropriate electrode placement and improve device activation. Larger studies are needed to better establish the relationship between intraoperative NRT and postoperative outcomes and justify the additional costs associated with intraoperative NRT.
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Affiliation(s)
- Galit Almosnino
- 1 Department of Otolaryngology/Head and Neck Surgery Section of Otology/Neurotology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Samantha Anne
- 2 Department of Pediatric Otolaryngology, Head and Neck Institute, Cleveland Clinic, Ohio, USA
| | - Seth R Schwartz
- 1 Department of Otolaryngology/Head and Neck Surgery Section of Otology/Neurotology, Virginia Mason Medical Center, Seattle, Washington, USA
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Abstract
OBJECTIVE To assess cochlear implant (CI) outcomes, and factors affecting outcomes, for children with aplasia/ hypoplasia of the cochlea nerve. We also developed a new grading system for the nerves of the internal auditory meatus (IAM) and cochlea nerve classification. STUDY DESIGN Retrospective patient review. SETTING Tertiary referral hospital and cochlear implant program. PATIENTS Children 0 to 16 years inclusive with a CI who had absent/hypoplastic cochlea nerve on magnetic resonance imaging (MRI). INTERVENTION Cochlear implant. MAIN OUTCOME MEASURES MRI, trans-tympanic electrical auditory brainstem response, intraoperative electrical auditory brainstem response, Neural Response Telemetry, Categories of Auditory Perception score, Main mode of communication. RESULTS Fifty CI recipients (26 males and 24 females) were identified, 21 had bilateral CIs, 27 had developmental delay. MRI showed cochlea nerve aplasia in 64 ears, hypoplasia in 25 ears, and a normal nerve in 11 ears. Main mode of communication was analyzed for 41 children: 21 (51%) used verbal language (15 speech alone, 5 speech plus some sign, 1 bilingual in speech and sign), and 20 (49%) used sign language (10 sign alone, 9 sign plus some speech, 1 tactile sign). Seventy-three percent of children used some verbal language. Cochlea nerve aplasia/ hypoplasia and developmental delay were both significant factors affecting main mode of communication. Categories of Auditory Performance scores were available for 59 CI ears; 47% with CN Aplasia (IAM nerve grades 0-III) and 89% with CN hypoplasia (IAM nerve grade IV) achieved Categories of Auditory Performance scores of 5 to 7 (some verbal understanding) (p = 0.003). CONCLUSION Our results are encouraging and useful when counselling families regarding the likelihood of language outcomes and auditory understanding.
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Caldas FF, Cardoso CC, Barreto MADSC, Teixeira MS, Hilgenberg AMDS, Serra LSM, Bahmad F. Analysis of electrically evoked compound action potential of the auditory nerve in children with bilateral cochlear implants. Braz J Otorhinolaryngol 2016; 82:123-30. [PMID: 26727607 PMCID: PMC9449066 DOI: 10.1016/j.bjorl.2014.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 12/24/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction The cochlear implant device has the capacity to measure the electrically evoked compound action potential of the auditory nerve. The neural response telemetry is used in order to measure the electrically evoked compound action potential of the auditory nerve. Objective To analyze the electrically evoked compound action potential, through the neural response telemetry, in children with bilateral cochlear implants. Methods This is an analytical, prospective, longitudinal, historical cohort study. Six children, aged 1–4 years, with bilateral cochlear implant were assessed at five different intervals during their first year of cochlear implant use. Results There were significant differences in follow-up time (p = 0.0082) and electrode position (p = 0.0019) in the T-NRT measure. There was a significant difference in the interaction between time of follow-up and electrode position (p = 0.0143) when measuring the N1-P1 wave amplitude between the three electrodes at each time of follow-up. Conclusion The electrically evoked compound action potential measurement using neural response telemetry in children with bilateral cochlear implants during the first year of follow-up was effective in demonstrating the synchronized bilateral development of the peripheral auditory pathways in the studied population.
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Telmesani LM, Said NM. Electrically evoked compound action potential (ECAP) in cochlear implant children: Changes in auditory nerve response in first year of cochlear implant use. Int J Pediatr Otorhinolaryngol 2016; 82:28-33. [PMID: 26857311 DOI: 10.1016/j.ijporl.2015.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
Abstract
AIM Recording of the electrically evoked compound action potential (ECAP) of the auditory nerve in cochlear implant (CI) patients represents an option to assess changes in auditory nerve responses and the interaction between the electrode bundle and the neural tissue over time. The aim of the present work is to assess ECAP changes during the first year of cochlear implant for the purpose of predicting thresholds and adjustment of the patients' programs over time. METHOD Data were collected from 25 children using Cochlear Nucleus 24 implants. ECAP thresholds were examined at the time of surgery, at initial stimulation, and 3, 6 and 12 months post-stimulation. Five electrodes located at basal, middle, and apical positions in the cochlea were tested at each time interval and ECAP thresholds were analyzed and compared. RESULTS There was a significant decrease in ECAP thresholds between the intraoperative measure and fitting time at all electrode sites. Mean ECAP thresholds measured at 3, 6 and 12 months post-stimulation remained similar to initial stimulation levels. Although there was no significant difference in ECAP thresholds recorded at fitting time and 12 months follow up session, there was significant increase in behavioral T and C levels from initial stimulation to the 12 months' time point. CONCLUSION Most electrodes undergo non-significant change in ECAP thresholds over time, and therefore thresholds obtained on the day of initial stimulation can be used to estimate the patients' map levels at any time. On the other hand, intraoperative thresholds demonstrated significant change relative to postoperative recording times, limiting the ability to use intraoperatively recorded ECAP thresholds to predict postoperative measurements.
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Affiliation(s)
- Laila M Telmesani
- Otology& Neuro-otology, Otorhinolaryngology Department, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia
| | - Nithreen M Said
- Audiology, Otolaryngology Department, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia; Audiology, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Carvalho B, Hamerschmidt R, Wiemes G. Intraoperative Neural Response Telemetry and Neural Recovery Function: a Comparative Study between Adults and Children. Int Arch Otorhinolaryngol 2014; 19:10-5. [PMID: 25992145 PMCID: PMC4392512 DOI: 10.1055/s-0034-1372509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/11/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Neural response telemetry (NRT) is a method of capturing the action potential of the distal portion of the auditory nerve in cochlear implant (CI) users, using the CI itself to elicit and record the answers. In addition, it can also measure the recovery function of the auditory nerve (REC), that is, the refractory properties of the nerve. It is not clear in the literature whether the responses from adults are the same as those from children. Objective To compare the results of NRT and REC between adults and children undergoing CI surgery. Methods Cross-sectional, descriptive, and retrospective study of the results of NRT and REC for patients undergoing IC at our service. The NRT is assessed by the level of amplitude (microvolts) and REC as a function of three parameters: A (saturation level, in microvolts), t0 (absolute refractory period, in seconds), and tau (curve of the model function), measured in three electrodes (apical, medial, and basal). Results Fifty-two patients were evaluated with intraoperative NRT (26 adults and 26 children), and 24 with REC (12 adults and 12 children). No statistically significant difference was found between intraoperative responses of adults and children for NRT or for REC's three parameters, except for parameter A of the basal electrode. Conclusion The results of intraoperative NRT and REC were not different between adults and children, except for parameter A of the basal electrode.
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Affiliation(s)
- Bettina Carvalho
- ENT Department, Instituto Paranaense de Otorrinolaringologia - IPO, Curitiba, Brazil
| | - Rogerio Hamerschmidt
- ENT Department, Instituto Paranaense de Otorrinolaringologia - IPO, Curitiba, Brazil
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Nehmé A, El Zir E, Moukarzel N, Haidar H, Vanpoucke F, Arnold L. Measures of the electrically evoked compound action potential threshold and slope in HiRes 90KTMusers. Cochlear Implants Int 2014; 15:53-60. [DOI: 10.1179/1754762813y.0000000039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Vlahović S, Šindija B, Aras I, Glunčić M, Trotić R. Differences between electrically evoked compound action potential (ECAP) and behavioral measures in children with cochlear implants operated in the school age vs. operated in the first years of life. Int J Pediatr Otorhinolaryngol 2012; 76:731-9. [PMID: 22398117 DOI: 10.1016/j.ijporl.2012.02.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/09/2012] [Accepted: 02/11/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to identify the differences in the NRT measures, behavioral measures, and their relationship between the group of congenitally deaf children operated in the first years of life and the group of children operated in the school age. METHODS The study included 40 congenitally deaf children with cochlear implants divided into two groups. Group 1 was composed of 20 children (mean age at operation 2.3 years, range 1.4-4.6 years) and Group 2 was composed of 20 children (mean age at operation 11.3 years, range 7.0-17.1 years). The ECAP was recorded using the Nucleus 24 neural response telemetry (NRT) system. In each child, the responses were evoked by the apical, middle and basal electrodes. The analyzed parameters were: the ECAP threshold (T-NRT), N1P2 amplitude, N1 latency, slope of the amplitude growth function, response morphology, threshold (T-) level, maximum comfort (C-) level, dynamic range (DR), T-NRT as a percentage of the map DR, the correlation between the T-NRT and the T- and C-levels. The recordings of parameters were performed two years after implantations. RESULTS The T-NRT, DR, T-NRT as a percentage of the map DR and the correlation between T-NRT and C-levels were significantly different between both groups of children. There were no statistically significant differences between the groups with respect to the amplitude, latency, slope and morphology recorded using the same electrodes. However, intragroup differences regarding NRT measures and behavioral measures with respect to the position of stimulating electrode were more prominent in Group 2 than in the Group 1. CONCLUSIONS Results of this study have also found a great variability of NRT and MAP measures within and across patients in both groups of children, but it was still more pronounced in the group of school children. NRT profile across electrodes follows MAP profiles better in the Group 1 then in the Group 2. Overall findings of NRT and MAP measures are not consistent and unambiguous as we expected, but still suggest potential differences between results in children operated in first years of life, and those operated in school age.
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Affiliation(s)
- Sanja Vlahović
- Polyclinics for Rehabilitation of Hearing and Speech SUVAG, Ljudevita Posavskog 10, HR-10000 Zagreb, Croatia.
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