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Schrank L, Nachtigäller P, Müller J, Hempel JM, Canis M, Spiegel JL, Rader T. ART and AutoART ECAP measurements and cochlear nerve anatomy as predictors in adult cochlear implant recipients. Eur Arch Otorhinolaryngol 2024; 281:3461-3473. [PMID: 38219245 PMCID: PMC11211163 DOI: 10.1007/s00405-023-08444-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE The purpose of this retrospective study is to compare the results of electrically evoked compound action potential (ECAP) measurements using automatic auditory response telemetry (AutoART) with those obtained by ART in adults. The study also aimed to evaluate the predictive value of intraoperative ART and AutoART ECAPs for speech intelligibility (SI) and hearing success (HS), and to determine if cochlear nerve (CN) cross-sectional area (CSA) obtained preoperatively by magnetic resonance imaging (MRI) scans could predict ART and AutoART ECAPs and SI and HS outcome. METHODS The study analyzed and correlated ART and AutoART ECAP thresholds at electrodes E2, E6, and E10, as well as averaged ECAP thresholds over electrodes E1-E12, using data from 32 implants. Correlations were also examined for ART and AutoART ECAP slopes. In addition, averaged ART and AutoART ECAP thresholds and slopes over all 12 electrodes for each participant were correlated with CN CSA measured from MRI sequences. SI of the monosyllabic Freiburg Speech Test at 65 dB sound pressure level was examined along with averaged ART and AutoART thresholds and slopes over all 12 electrodes. A parallel analysis was performed for HS, derived from the difference between baseline and 6-month SI. Finally, correlations between CN CSA and SI, as well as CN CSA and HS were examined. RESULTS The results of the study showed a significant positive correlation between ART and AutoART ECAP thresholds and as well as slopes for E2, E6, E10 and averaged thresholds and slopes of E1-E12. However, no significant correlation was observed between ART and AutoART averaged ECAP thresholds and slopes and either SI and HS or CN CSA. Furthermore, no significant correlation was found between CN CSA and SI and HS. CONCLUSION While AutoART is a reliable and safe program for measuring ECAPs in adults, the study found no preoperative prognostic information on intraoperative ECAP results using parameters extracted from current MRI sequences or pre-/intraoperative information on subsequent hearing outcome using ECAP and CN CSA.
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Affiliation(s)
- Leonhard Schrank
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Pascal Nachtigäller
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Joachim Müller
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - John-Martin Hempel
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Tobias Rader
- Division of Audiology, Department of Otorhinolaryngology, LMU University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Ries M, Kelava I, Ajduk J, Košec A, Žaja R, Trotić R. Correlation between neural response telemetry measurements and fitting levels. Int J Pediatr Otorhinolaryngol 2024; 182:112001. [PMID: 38885546 DOI: 10.1016/j.ijporl.2024.112001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION The neural response telemetry (NRT) is a standard procedure in cochlear implantation mostly used to determine the functionality of implanted device and to check auditory nerve responds to the stimulus. Correlation between NRT measurements and subjective threshold (T) and maximum comfort (C) levels has been reported but results are inconsistent, and it is still not clear which of the NRT measurements could be the most useful in predicting fitting levels. PURPOSE In our study we aimed to investigate which NRT measurement corresponds better to fitting levels. Impedance (IMP), Evoked Action Potential (ECAP) threshold and amplitude growth function (AGF) slope values were included in the study. Also, we tried to identify cochlear area at which the connection between NRT measurements and fitting levels would be the most pronounced. MATERIALS AND METHODS Thirty-one children implanted with Cochlear device were included in this retrospective study. IMP, ECAP thresholds and AGF were obtained intra-operatively and 12 months after surgery at electrodes 5, 11 and 19 as representative for each part of cochlea. Subjective T and C levels were obtained 12 months after the surgery during cochlear fitting. RESULTS ECAP thresholds obtained 12 months after surgery showed statistically significant correlation to both T and C levels at all 3 selected electrodes. IMP correlated with C levels while AGF showed tendency to correlate with T levels. However, these correlations were not statistically significant for all electrodes. CONCLUSION ECAP threshold measurements correlated to T and C values better than AGF slope and IMP. Measurements obtained twelve months after surgery seems to be more predictive of T and C values compared to intra-operative measurements. The best correlation between ECAP threshold and T and C values was found at electrode 11 suggesting NRT measurements at mid-portion cochlear region to be the most useful in predicting fitting levels.
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Affiliation(s)
- Mihael Ries
- Department of Otorhinolaryngology, Sisters of Charity University Hospital Center, Vinogradska Cesta 29, Zagreb, Croatia; School of Medicine, University of Zagreb, Šalata 3a, Zagreb, Croatia
| | - Iva Kelava
- Department of Otorhinolaryngology, Sisters of Charity University Hospital Center, Vinogradska Cesta 29, Zagreb, Croatia.
| | - Jakov Ajduk
- Department of Otorhinolaryngology, Sisters of Charity University Hospital Center, Vinogradska Cesta 29, Zagreb, Croatia; School of Medicine, University of Zagreb, Šalata 3a, Zagreb, Croatia
| | - Andro Košec
- Department of Otorhinolaryngology, Sisters of Charity University Hospital Center, Vinogradska Cesta 29, Zagreb, Croatia; School of Medicine, University of Zagreb, Šalata 3a, Zagreb, Croatia
| | - Roko Žaja
- School of Medicine, University of Zagreb, Šalata 3a, Zagreb, Croatia
| | - Robert Trotić
- Department of Otorhinolaryngology, Sisters of Charity University Hospital Center, Vinogradska Cesta 29, Zagreb, Croatia
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Sunwoo W, Goo W, Oh SH. Electrically Evoked Auditory Brainstem Response Using Extracochlear Stimulation at Different Cochlear Sites: A Comparison With Intracochlear Stimulation. Clin Exp Otorhinolaryngol 2024; 17:99-108. [PMID: 38273767 DOI: 10.21053/ceo.2023.00034] [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: 10/31/2023] [Accepted: 01/26/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES The distribution and extent of excitable spiral ganglion neurons (SGNs) have been investigated using the electrically evoked auditory brainstem response (EABR) during preoperative and perioperative periods. In this study, we investigated the EABR with extracochlear stimulation (eEABR) as a preoperative test to estimate these factors. METHODS Sixteen male Sprague-Dawley rats were used in this study. Experiments were conducted in nine rats with normal hearing and seven rats that were partially deafened with ouabain treatment. Each experiment involved the following steps: extracochlear stimulating electrode placement at three different sites along the axis of the cochlea and eEABR recordings; cochleostomy and four-channel intracochlear array implantation, followed by EABR recordings with various electrode pair combinations; and after electrophysiological measurements, harvest of the cochleae for histopathological evaluation. The slope characteristics of the amplitude growth function measured from eEABR and EABR, frequency-specific auditory thresholds, and the density of SGNs were compared. RESULTS Similar trends were observed in slope changes on different sites of stimulation with both types of stimulation in normal-hearing animals-specifically, a monotonically increasing slope with increasing distance between bipolar pairs. In addition, eEABR slopes showed significant correlations with EABR slopes when the expected cochlear regions of stimulation were similar in normal-hearing animals. In partially deaf animals, the auditory thresholds at several frequencies had a significant correlation with the eEABR slopes of each extracochlear electrode at the apical, middle, and basal cochlear positions. This indicated that increasing the regions of cochlear stimulation had a differential impact on eEABR slopes, depending on the neural conditions. CONCLUSION Our results indicated that eEABR slopes showed significant spatial correlations with the functionality of the auditory nerve. Therefore, eEABR tests at various cochlear positions might be used for estimating the extent of excitable SGNs in cochlear implant candidates prior to implantation.
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Affiliation(s)
- Woongsang Sunwoo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woonhoe Goo
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Said NM, Telmesani LS, Telmesani LM. Effect of congenital inner ear malformations (IEMs) on electrically evoked compound action potential (ECAP) responses in cochlear implant children. Eur Arch Otorhinolaryngol 2023; 280:5193-5204. [PMID: 37606729 DOI: 10.1007/s00405-023-08196-2] [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: 06/17/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE The study was designed to assess the electrically evoked compound action potential (ECAP) responses in children with inner ear malformations compared to children with normal inner ear anatomy. METHODS The study included 235 prelingual deaf children who were implanted in cochlear implant unit in King Fahad University hospital-Imam Abdulrahman Bin Faisel University. Subjects were using either Cochlear Nucleus or Medel cochlear implant devices. We had 171 (64.5%) subjects with normal inner ear anatomy and 94 (35.5%) subjects with inner ear malformations (IEMs) and they were classified into 6 groups according to inner ear anatomy. Fourteen subjects (14.9%) subjects had enlarged vestibular aqueduct (EVA), 30 (32%) subjects had Mondini deformity, 25 (26.6%) subjects had incomplete partition type two (IPII), 9 (9.6%) subjects had incomplete partition type one (IPI) and 16 (17%) subjects had hypoplastic cochlea type III or IV. Intraoperative electrically evoked compound action potential (ECAP) responses were analyzed and compared in all subjects. RESULTS AND CONCLUSIONS Measurable ECAP responses can be elicited in patients with IEMs in most of the channels. Severe malformations can affect the prevalence of measuring ECAP and getting identifiable waveform morphology. Additionally, increased thresholds and lower slope of AGF was observed in IEMs specially in more severe malformations (e.g. IPI). IPI patients with better word recognition scores tended to show more identifiable ECAP measurements. This could suggest the presence of some correlation between ECAP responses and patients' performance after cochlear implantation.
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Affiliation(s)
- Nithreen M Said
- Audiovestibular Medicine Unit, Otorhinolaryngology Department, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
- Audio-Vestibular Medicine Unit, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Lena S Telmesani
- Otorhinolaryngology Department, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laila M Telmesani
- Otorhinolaryngology Department, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Mussoi BS, Woodson E, Sydlowski S. Intraoperative Electrically Evoked Compound Action Potential Growth and Maximum Amplitudes in Hearing Preservation Cochlear Implant Recipients. Otol Neurotol 2023; 44:e216-e222. [PMID: 36946363 DOI: 10.1097/mao.0000000000003829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Electrically evoked compound action potentials (eCAPs) obtained from cochlear implant (CI) recipients reflect responsiveness of the auditory nerve to electrical stimulation. The recent use of atraumatic electrode arrays and expansion of CI candidacy to listeners with greater residual hearing may lead to increased clinical utility of intraoperative eCAP recordings. OBJECTIVES To examine the effect of electrode array (slim modiolar versus slim straight) on suprathreshold intraoperative eCAP recordings in hearing preservation CI recipients. A secondary goal was to examine potential clinical applications of intraoperative eCAPs for predicting immediate hearing preservation and speech perception outcomes. METHODS Retrospective study of 113 adult hearing preservation CI candidates implanted from 2015 to 2019 with either a slim modiolar or slim straight electrode array. Intraoperative eCAP growth functions and maximum amplitudes were obtained at several intracochlear electrodes and examined as a function of implanted array and hearing preservation status, while controlling for electrode impedance. RESULTS From basal to apical electrodes, progressively larger eCAP amplitudes and steeper slopes were recorded. Steeper eCAP slopes at apical electrodes were also seen for recipients of the slim modiolar array (versus slim straight). Suprathreshold eCAP responses did not differ as a function of hearing preservation and were not associated with speech recognition. CONCLUSIONS More robust eCAP responses were obtained from apical electrodes, which is consistent with better low-frequency thresholds in hearing preservation recipients. This effect was compounded by type of electrode array. Results also suggest that intraoperative, suprathreshold eCAPs cannot be used to predict the success of hearing preservation surgery or performance with the CI.
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Affiliation(s)
- Bruna S Mussoi
- Speech Pathology and Audiology, Kent State University, Kent, Kaiser Permanente Southern California, San Diego, CA
| | - Erika Woodson
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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Gärtner L, Klötzer K, Lenarz T, Scheper V. Correlation of Electrically Evoked Compound Action Potential Amplitude Growth Function Slope and Anamnestic Parameters in Cochlear Implant Patients-Identification of Predictors for the Neuronal Health Status. Life (Basel) 2021; 11:life11030203. [PMID: 33807687 PMCID: PMC7999542 DOI: 10.3390/life11030203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 01/04/2023] Open
Abstract
Cochlear implants (CI) are the treatment of choice in profoundly deaf patients. Measuring the electrically evoked compound action potential (ECAP) has become an important tool for verifying the function of the spiral ganglion neurons (SGN), which are the target cells of the CI stimulation. ECAP measurement is only possible after electrode insertion. No information about the neuronal health status is available before cochlear implantation. We investigated possible correlations between the ECAP amplitude growth function (AGF) slope and anamnestic parameters to identify possible predictors for SGN health status and therefore for CI outcome. The study included patients being implanted with various electrode array lengths. Correlation analysis was performed for the mean AGF slope of the whole array, for separate electrodes as well as for grouped electrodes of the apical, medial, and basal region, with duration of deafness, age at implantation, residual hearing (grouped for electrode length), and etiology. The mean ECAP AGF slopes decreased from apical to basal. They were not correlated to the length of the electrode array or any etiology. For the mean of the full array or when grouped for the apical, middle, and basal part, the ECAP AGF slope was negatively correlated to the duration of hearing loss and the age at implantation. Since a significant negative correlation of the ECAP AGF slope and age at cochlear implantation and duration of deafness was observed, this study supports the statement that early implantation of a CI is recommended for sensorineural hearing loss. Additional factors such as the cochlear coverage and insertion angle influence the ECAP AGF slope and performance of the patient and should be included in future multifactorial analysis to study predictive parameters for the CI outcome.
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Affiliation(s)
- Lutz Gärtner
- Department of Otolaryngology, Hannover Medical School, 30625 Hannover, Germany; (L.G.); (K.K.); (T.L.)
| | - Katharina Klötzer
- Department of Otolaryngology, Hannover Medical School, 30625 Hannover, Germany; (L.G.); (K.K.); (T.L.)
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, 30625 Hannover, Germany; (L.G.); (K.K.); (T.L.)
- Cluster of Excellence “Hearing4All”, 30625 Hannover, Germany
| | - Verena Scheper
- Department of Otolaryngology, Hannover Medical School, 30625 Hannover, Germany; (L.G.); (K.K.); (T.L.)
- Cluster of Excellence “Hearing4All”, 30625 Hannover, Germany
- Correspondence: ; Tel.: +49-511-532-4369
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