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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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Wang B, Guo X, Wei C, Cao K. Preoperative EABR evaluation of auditory pathway integrity in patients with different etiology and postoperative effect estimation. Eur Arch Otorhinolaryngol 2024; 281:1185-1193. [PMID: 37615702 DOI: 10.1007/s00405-023-08198-0] [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: 05/04/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES To evaluate the effect of electrical auditory brainstem response (EABR) on the integrity evaluation of auditory pathway and the prediction of postoperative effect of cochlear implantation in patients with different etiology of hearing loss. METHODS A total of 580 patients with neuropathic deafness who underwent cochlear implantation surgery from August 2011 to December 2020 were selected for EABR test. The preoperative EABR waveform was analyzed, and parameters such as V wave amplitude, threshold, latency and interval of each wave, and slope of V wave I/O curve were measured. Neural response telemetry (NRT) test was performed during MAP 1 month after operation, and C and T values of the machine were recorded. RESULTS The total EABR extraction rate was 98.45% among 580 patients, including 100% for the normal structure group and enlarged vestibular aqueduct group (LVAS), 92.44% for other malformed group. The average threshold of V wave in patients with normal cochlear structure was significantly better than the malformation groups (p < 0.05). The total extraction rate of NRT was 78.62%, including 99.72% in the group with normal structure, 95.65% in the LVAS group, 1.85-88.24% in the group with other malformations, and 0% in the cochlear ossification group. The correlation analysis showed a statistically significant correlation between the average preoperative EABR threshold and the C value of NRT. CONCLUSIONS Preoperative EABR could evaluate the integrity of auditory conduction pathway of patients with cochlear implantation and predict the postoperative hearing rehabilitation effect.
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Affiliation(s)
- Bin Wang
- Department of Otolaryngology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Xiaohui Guo
- Department of Ophthalmology, the Third Medical Center of PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Chaogang Wei
- Department of Otolaryngology-Head and Neck Surgery, Peking University First Hospital, No. 8 Xishku Street, Xicheng District, 100034, Beijing, China
| | - Keli Cao
- Department of Otolaryngology, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China.
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Fernandez NM, Vernetta CDP, Garrido LC, Gomez MD, Perez CM. Electrically Evoked Auditory Brainstem Response over Round Window by Bipolar Stimulation. J Int Adv Otol 2018; 14:370-374. [PMID: 30325333 DOI: 10.5152/iao.2018.5046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Auditory brainstem potentials can be elicited by electrical stimulation of the round window (RW). In this technique, extracochlear stimulation is objectively used in the selection of cochlear implant (CI) candidates to avoid cochlear damage. However, until now, its use is limited due to the large artifacts generated by electrical stimulation. Our objective was to obtain reliable and reproducible electrically evoked auditory brainstem responses (eEABRs) using a new method of stimulation. MATERIALS AND METHODS This was a prospective study including subjects who underwent electrical stimulation on RW during CI surgery between 2013 and 2016. A "Stimulator Box," which produces electric stimuli identical to those provided by a CI, and an evoked potential recording equipment were used. The results obtained with monopolar and bipolar electrodes were compared. RESULTS RW eEABR recordings of 49 subjects (mean age, 34 years) were characterized by their stability and by having wave V between 3 and 5.5 ms. A higher percentage of responses were obtained on increasing the phase duration instead of the pulse amplitude. A significantly greater percentage of positive responses were obtained using bipolar stimulation than using monopolar stimulation (p<0.001). CONCLUSION Using extracochlear electrical stimulation technique, described herein, and bipolar electrical stimulation probe allows for reliable and reproducible eEABR recordings in CI candidates.
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Utilization of Nerve Integrity Monitor for Promontory Stimulation Testing Prior to Cochlear Implant. Otol Neurotol 2018; 39:e60-e62. [PMID: 29315178 DOI: 10.1097/mao.0000000000001669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate the feasibility of a nerve integrity monitor as a tool for promontory stimulation testing in patients with profound sensorineural hearing loss considering cochlear implantation. PATIENTS Adult patients considered for cochlear implantation with no auditory response on audiometric testing INTERVENTION:: Promontory stimulation testing using the nerve integrity monitor. MAIN OUTCOME MEASURE By using a facial nerve stimulator and the nerve integrity monitor, transtympanic promontory stimulation testing was performed to assess auditory nerve function and determine candidacy for cochlear implantation. Patients indicated if they heard the stimulus. RESULTS Of the four patients completing the promontory stimulation tests, three patients heard the stimulus and one patient did not hear the stimulus. Of the three patients with a positive stimulation test, two patients have a history of progressive profound sensorineural hearing loss and one patient had a history of severe blunt temporal bone trauma. Two of these patients proceeded with cochlear implantation. The patient who had a negative promontory stimulation test has a history of neurofibromatosis type 2. CONCLUSION The nerve integrity monitor is a convenient tool that can be used in the clinic setting to perform promontory stimulation tests and aid in determining cochlear implant candidates, specifically in those patients who require verification of auditory nerve function. This tool is a feasible and reasonable method for promontory stimulation testing.
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Cochlear implantation versus auditory brainstem implantation in bilateral total deafness after head trauma: personal experience and review of the literature. Otol Neurotol 2014; 35:260-70. [PMID: 24448286 DOI: 10.1097/mao.0000000000000235] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effectiveness of cochlear implant (CI) in hearing restoration after temporal bone (TB) fractures and investigate the adequacy of auditory brainstem implant (ABI) indication for TB fractures. STUDY DESIGN Retrospective clinical study; a systematic review of the literature in PubMed was also performed to identify all published cases of bilateral TB fractures or bilateral deafness after head trauma treated by means of CI or ABI. SETTINGS Quaternary otology and skull base surgery referral center. PATIENTS Eleven consecutive patients presented with bilateral severe-to-profound sensorineural hearing loss after head trauma. INTERVENTIONS CI as primary intervention or following a previous treatment. MAIN OUTCOME MEASURES CI performances were evaluated in the auditory-only condition in both closed-set and open-set formats. RESULTS Fourteen CI were placed, 11 as primary treatment and 3 after ABI failure. At the last follow-up, all patients gained useful open-set speech perception. In secondary CI, all patients obtained better auditory results with the CI if compared with ABI. CI performance did not decrease with time in any case. CONCLUSION Cochlear implantation after TB fractures has proved to have excellent audiometric results. The aim of the initial evaluation of a patient with bilateral anacoustic ears from head trauma should always be to rehabilitate their hearing with a CI. The incidence of labyrinthitis ossificans, negative electrophysiologic testing, the risk of postoperative meningitis or facial nerve stimulation should not be the determinant factors that favor ABI placement.
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Kuo SCL, Gibson WPR. The role of the promontory stimulation test in cochlear implantation. Cochlear Implants Int 2013; 3:19-28. [DOI: 10.1179/cim.2002.3.1.19] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The transtympanic promontory stimulation test in patients with auditory deprivation: correlations with electrical dynamics of cochlear implant and speech perception. Eur Arch Otorhinolaryngol 2012; 270:1809-15. [DOI: 10.1007/s00405-012-2125-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
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Kileny PR, Kim AH, Wiet RM, Telian SA, Arts HA, El-Kashlan H, Zwolan TA. The predictive value of transtympanic promontory EABR in congenital temporal bone malformations. Cochlear Implants Int 2011; 11 Suppl 1:181-6. [PMID: 21756608 DOI: 10.1179/146701010x12671177818669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Paul R Kileny
- University of Michigan Health System Otolaryngology, Head and Neck Surgery, Ann Arbor, Michigan 48109, USA.
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Abstract
BACKGROUND Although a transtympanic electrode is commonly used for electrocochleography and electrically evoked auditory brainstem response, the variability of responses among healthy subjects is wide. The manubrium is the typical guidepost for electrode placement. This study addresses the hypothesis that electrode position relative to the round window niche is widely variable. STUDY DESIGN : Postmortem anatomic dissection of 41 bequeathed adult crania (82 temporal bones). METHODS Drill marks were made on the medial wall of the mesotympanum from 2 manubrium-based positions: 1.5 to 2 mm posterior to the umbo, and halfway between the umbo and the annulus posteroinferior. RESULTS Distances to the lip of the round window niche ranged from 0.8 to 3.5 mm and from 1.8 to 4.5 mm for the 2 electrode sites, respectively. The posteriorly determined site was uniform on the promontory, but the posteroinferior site was into hypotympanic trabeculations in 81% of ears and into the jugular plate in 6%. Distances from the electrode sites to round window niche were not obviously associated with either the orientation of the manubrium in the head or the mastoid size. CONCLUSION The location of a transtympanic positioned electrode using the manubrium as guidepost is not accurately predictable relative to the round window niche.
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Role of Electrically Evoked Auditory Brainstem Response in Cochlear Implantation of Children With Inner Ear Malformations. Otol Neurotol 2008; 29:626-34. [DOI: 10.1097/mao.0b013e31817781f5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brown CJ. Clinical uses of electrically evoked auditory nerve and brainstem responses. Curr Opin Otolaryngol Head Neck Surg 2003; 11:383-7. [PMID: 14502071 DOI: 10.1097/00020840-200310000-00013] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current thinking relative to clinical applications for the electrically evoked compound action potential and the electrically evoked auditory brainstem response with the focus on works published between 1998 and 2003. RECENT FINDINGS During the period of this review, a considerable body of research has been published describing how the electrically evoked compound action potential can be measured and how the electrically evoked compound action potential may be used in the clinical treatment of cochlear implant patients. During this same period, there has been a decline in the number of studies reporting potential clinical applications for the electrically evoked auditory brainstem response. Perhaps the strongest clinical application for the electrically evoked compound action potential today is as a tool to facilitate the process of fitting the speech processor of the cochlear implant. This is particularly important for pediatric patients who may not be able to be programmed using traditional behavioral techniques. The accuracy of these predictions is discussed in addition to the limitations of the studies reviewed. SUMMARY The introduction of cochlear implants with the capability of measuring the response of the auditory nerve to electrical stimulation from an intracochlear electrode has tremendous potential to impact clinical practice. Research into how best to use this information is ongoing.
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Affiliation(s)
- Carolyn J Brown
- Department of Speech Pathology and Audiology, University of Iowa, Iowa City 52242, USA.
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Sauvaget E, Péréon Y, Nguyen The Tich S, Bordure P. Electrically evoked auditory potentials: comparison between transtympanic promontory and round-window stimulations. Neurophysiol Clin 2002; 32:269-74. [PMID: 12448184 DOI: 10.1016/s0987-7053(02)00308-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Electrically evoked auditory potential (eEAP) techniques have been developed in order to assess electrical excitability of auditory nervous pathways in deaf patients before cochlear implantation. The aim of this study was to compare eEAPs recorded after a transtympanic promontory stimulation with those obtained after a round-window stimulation during a surgical approach. DESIGN eEAPs were recorded after promontory and round-window stimulation in 10 deaf subjects (i.e. 14 ears) who were candidates for cochlear implantation. RESULTS eEAPs were successfully recorded in 13 out of 14 (93%) and 11 out of 14 (79%) ears after promontory stimulation and round-window stimulation, respectively. Similar waveforms, latencies, thresholds and eV amplitudes were observed in both cases. CONCLUSIONS Both tests provide objective and useful information for the patient selection process before cochlear implantation. Transtympanic stimulation should be preferred in clinical practice as it is less invasive than round-window stimulation and does not require surgical exposure.
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Affiliation(s)
- Elisabeth Sauvaget
- Service d'ORL et de chirurgie cervico-faciale, Hôtel-dieu, Nantes, France.
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Chen JM, Shipp D, Al-Abidi A, Ng A, Nedzelski JM. Does choosing the "worse" ear for cochlear implantation affect outcome? Otol Neurotol 2001; 22:335-9. [PMID: 11347636 DOI: 10.1097/00129492-200105000-00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether choosing the "better" ear or the "worse" ear for cochlear implantation impacts performance outcome. DESIGN Retrospective cohort study. SETTING University teaching hospital-cochlear implant program. METHODS Two groups of cochlear implantees were selected and matched based on clinical parameters, including duration of deafness/age at implantation, implant types, and processing strategies. Nineteen patients received an implant in his or her "better" ear of the two that had been amplified. An equal number of patients received an implant in the "worse" ear--an ear that was not amplified or was chosen to avoid causing oscillopsia; or if the patient was not willing to relinquish his or her hearing aid in the "better" ear based on subjective or objective criteria. Standard speech perception testing was performed. RESULTS The average open-set speech perception responses at 1 year after implantation were as follows: word recognition score 40.4% and sentence recognition score 81% in the aided subjects (better ears); word recognition score 41.5% and sentence recognition score 84.5% in the unaided group (worse ears). CONCLUSION No differences were found between the two groups of implantees. Choosing the "worse" ear for implantation did not appear to have a negative impact on performance outcome in this match-paired study.
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Affiliation(s)
- J M Chen
- Department of Otolaryngology, Sunnybrook and Women's College Health Science Center, Toronto, Ontario, Canada
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Facer GW, Peterson A, Brey RH, Marion M, Cevette M, Balko K, Green JD, Rose D, Pool A. The Mayo Clinic Experience with the Cochlear Implant. EAR, NOSE & THROAT JOURNAL 1994. [DOI: 10.1177/014556139407300307] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The implantati on of a cochlear electronic prosthetic device is an accept able means of improving the communication ability of pre- and postlinguaIIy deafened children and adults. A significant number of patients in this series are in the senior citizen age group. It has been beneficial in improving communication ability in selected profoundly deafened individuals. There has been a significant improvement in the cochlear electronic prosthetic device since the initial report of Djourno1 in 1957.
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