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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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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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Danieli F, Reis ACMB, Massuda ET, Amaral MSAD, Hoen M, Gnansia D, Hyppolito MÂ. Clinical implications of intraoperative eABRs to the Evo®-CI electrode array recipients. Braz J Otorhinolaryngol 2021; 88 Suppl 1:S108-S117. [PMID: 34034979 PMCID: PMC9734272 DOI: 10.1016/j.bjorl.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/30/2021] [Accepted: 04/26/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Electrically evoked auditory brainstem responses provide reliable clinical information to assist professionals in the auditory rehabilitation of cochlear implant users. OBJECTIVE This study aimed to investigate intraoperative evoked auditory brainstem response recordings in Evo®-cochlear implant electrode array recipients and its correlation with their behavioral levels and auditory performance. METHODS This is a retrospectivey study. Intraoperative evoked auditory brainstem responses were recorded in adult Evo®-cochlear implant electrode array recipients. Wave V latencies, amplitudes and interpeak III-V intervals were recorded in three different electrode locations and compared to the sentence recognition scores obtained from subjects after six months of device use. Evoked auditory brainstem responses thresholds were also recorded and compared to the behaviorally determined levels of the subjects in the sound processor activation. RESULTS Evoked auditory brainstem responses thresholds were significantly correlated with both, behavioral T- and C-levels and they were recorded at audible electrical stimulation levels in all subjects. There was a significant correlation between interpeak III-V interval recorded in the apical electrode and sentence recognition scores of the subjects. CONCLUSIONS Intraoperative evoked auditory brainstem responses can be used to establish audible levels for fitting the sound processor in Evo®-cochlear implant recipients and it could help professionals to plan further actions aiming to improve their auditory performance.
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Affiliation(s)
- Fabiana Danieli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Programa de Pós-Graduação do Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil; Oticon Medical, Departamento Clínico, São Paulo, SP, Brazil.
| | | | - Eduardo Tanaka Massuda
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Maria Stella Arantes do Amaral
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Michel Hoen
- Oticon Medical, Department of Scientific and Clinical Research, Vallauris, France
| | - Dan Gnansia
- Oticon Medical, Department of Scientific and Clinical Research, Vallauris, France
| | - Miguel Ângelo Hyppolito
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia, Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
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Evaluation of Intraoperative Testing During Cochlear Implantation From a Time and Cost Perspective: A Single-Center Experience in the United States. Otol Neurotol 2018; 39:842-846. [PMID: 29995004 DOI: 10.1097/mao.0000000000001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To measure the time spent performing intraoperative testing during cochlear implantation (CI) and determine the impact on hospital charges. STUDY DESIGN Prospective study. SETTING Tertiary referral hospital. PATIENTS Twenty-two children (7 mo-18 yr) who underwent a total of 22 consecutive primary and/or revision CIs by a single surgeon from December 2016 to July 2017. INTERVENTION The time spent performing intraoperative testing, including evoked compound action potentials (ECAP) and electrical impedances (EI), was recorded for each case. The audiologist performing the testing was unaware of the time measurement and subsequent evaluations with regard to cost data. Billing information was used to determine if the testing contributed to increased operative charges to the patient. OUTCOME MEASURES Whether intraoperative testing had an impact on operative charges to the patient. RESULTS The average time spent in testing (ECAPs/EIs in all cases) was 6.7 minutes (range, 2-26 min). No correlation was found between testing time and preoperative computed tomography findings, the audiologist performing testing, or the electrode type used (p > 0.05). Based on billing data, including time spent in the operating room (OR), 5/22 (23%) cases incurred greater charges than if intraoperative testing had not been performed. CONCLUSION Our data suggest that intraoperative testing increases time in the OR and can contribute to increased hospital charges for CI patients. By using testing selectively, costs incurred by patients and hospitals may be reduced. This is of interest in a healthcare environment that is increasingly focused on cost, quality, and outcomes.
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Incerti PV, Ching TYC, Hou S, Van Buynder P, Flynn C, Cowan R. Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation. Int J Audiol 2017; 57:S27-S40. [PMID: 28885072 DOI: 10.1080/14992027.2017.1370139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We investigated effects of aetiology and age at implantation on changes in threshold (T) levels, comfortable (C) levels and dynamic range (DR) for cochlear implants (CIs) in children over the first five years of life. DESIGN Information was collected at 6 months post-activation of CIs, and at 3 and 5 years of age. STUDY SAMPLE One hundred and sixty-one children participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS Children with neural and structural cochlear lesions had higher T-levels and C-levels as compared to those without these conditions. Parameter settings varied from manufacturer's defaults more often in the former than in the latter group. Investigation of the effect of age at implantation for children without neural and structural cochlear lesions showed that those implanted at ≤12 months of age had higher T-levels and narrower DR at 6 months post-activation, as compared to the later-implanted group. For both early- and later-implanted groups, the C-levels at 6 months post-activation were lower than those at age 3 and 5 years. There were no significant differences in T-levels, C-levels, or DR between age 3 and 5 years. CONCLUSIONS Aetiology and age at implantation had significant effects on T-levels and C-levels.
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Affiliation(s)
- Paola V Incerti
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
| | - Teresa Y C Ching
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Sanna Hou
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Patricia Van Buynder
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Christopher Flynn
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia
| | - Robert Cowan
- b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
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Wang Y, Pan T, Deshpande SB, Ma F. The Relationship Between EABR and Auditory Performance and Speech Intelligibility Outcomes in Pediatric Cochlear Implant Recipients. Am J Audiol 2015; 24:226-34. [PMID: 25677645 DOI: 10.1044/2015_aja-14-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 02/01/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The primary purpose of the present study was to investigate the relationship between postimplant electrically evoked auditory brainstem response (EABR) measures (wave V threshold, wave V latency, input-output functions) and auditory performance and speech intelligibility outcomes measured using parental rating scales, such as Categories of Auditory Performance (CAP; Archbold, Lutman, & Marshall, 1995) and the Speech Intelligibility Rating scale (SIR; Allen, Nikolopoulos, Dyar, & O'Donoghue, 2001), respectively. The secondary purpose was to evaluate the relationship between age at implantation and ratings on the CAP and SIR. METHOD Forty children with congenital sensorineural hearing loss participated. Preimplant parental ratings on the CAP and SIR were obtained, and all the children underwent cochlear implantation. Intracochlear EABRs were recorded postimplantation. Postimplant parental ratings on the CAP and SIR were obtained. The relationships between EABR parameters and auditory performance and speech intelligibility outcomes were studied. The effect of age at implantation on auditory performance and speech intelligibility outcomes was also investigated. RESULTS A significant negative correlation was found between EABR wave V thresholds and SIR growth (r = -.415, p = .016). Children with better CAP growths tended to have lower wave V thresholds than those with poorer CAP growths. Age at implantation had an effect on the auditory performance as measured using the CAP. CONCLUSIONS The present study provides evidence for the relationship between wave V thresholds of the intracochlear EABR and auditory performance and speech intelligibility outcomes measured using parental rating scales in pediatric cochlear implant recipients. Data also indicate that early intervention has a positive impact on auditory performance outcomes.
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Affiliation(s)
- Yu Wang
- Peking University Third Hospital, Beijing, China
| | - Tao Pan
- Peking University Third Hospital, Beijing, China
| | | | - Furong Ma
- Peking University Third Hospital, Beijing, China
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van der Beek FB, Briaire JJ, Frijns JHM. Population-based prediction of fitting levels for individual cochlear implant recipients. Audiol Neurootol 2014; 20:1-16. [PMID: 25413720 DOI: 10.1159/000362779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study analyzed the predictability of fitting levels for cochlear implant recipients based on a review of the clinical levels of the recipients. DESIGN Data containing threshold levels (T-levels) and maximum comfort levels (M-levels) for 151 adult subjects using a CII/HiRes 90K cochlear implant with a HiFocus 1/1 J electrode were used. The 10th, 25th, 50th, 75th and 90th percentiles of the T- and M-levels are reported. Speech perception of the subjects, using a HiRes speech coding strategy, was measured during routine clinical follow-up. RESULTS T-levels for most subjects were between 20 and 35% of their M-levels and were rarely (<1/50) below 10% of the M-levels. Furthermore, both T- and M-levels showed an increase over the first year of follow-up. Interestingly, levels expressed in linear charge units showed a clear increase in dynamic range (DR) over 1 year (29.8 CU; SD 73.0), whereas the DR expressed in decibels remained stable. T-level and DR were the only fitting parameters for which a significant correlation with speech perception (r = 0.34, p < 0.01, and r = 0.33, p < 0.01, respectively) could be demonstrated. Additionally, analysis showed that T- and M-level profiles expressed in decibels were independent of the subjects' across-site mean levels. Using mixed linear models, predictive models were obtained for the T- and M-levels of all separate electrode contacts. CONCLUSIONS On the basis of the data set from 151 subjects, clinically applicable predictive models for T- and M-levels have been obtained. Based on one psychophysical measurement and a population-based T- or M-level profile, individual recipients' T- and M-levels can be approximated with a closed-set formula. Additionally, the analyzed fitting level data can serve as a reference for future patients.
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Affiliation(s)
- Feddo B van der Beek
- Department of Otolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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Moura ACGD, Goffi-Gomez MVS, Couto MIV, Brito R, Tsuji RK, Befi-Lopes DM, Matas CG, Bento RF. Longitudinal Analysis of the Absence of Intraoperative Neural Response Telemetry in Children using Cochlear Implants. Int Arch Otorhinolaryngol 2014; 18:362-8. [PMID: 25992123 PMCID: PMC4296982 DOI: 10.1055/s-0034-1372510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/10/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Currently the cochlear implant allows access to sounds in individuals with profound hearing loss. The objective methods used to verify the integrity of the cochlear device and the electrophysiologic response of users have noted these improvements. Objective To establish whether the evoked compound action potential of the auditory nerve can appear after electrical stimulation when it is absent intraoperatively. Methods The clinical records of children implanted with the Nucleus Freedom (Cochlear Ltd., Australia) (CI24RE) cochlear implant between January 2009 and January 2010 with at least 6 months of use were evaluated. The neural response telemetry (NRT) thresholds of electrodes 1, 6, 11, 16, and 22 during surgery and after at least 3 months of implant use were analyzed and correlated with etiology, length of auditory deprivation, and chronological age. These data were compared between a group of children exhibiting responses in all of the tested electrodes and a group of children who had at least one absent response. Results The sample was composed of clinical records of 51 children. From these, 21% (11) showed no NRT in at least one of the tested electrodes. After an average of 4.9 months of stimulation, the number of individuals exhibiting absent responses decreased from 21 to 11% (n = 6). Conclusion It is feasible that absent responses present after a period of electrical stimulation. In our sample, 45% (n = 5) of the patients with intraoperative absence exhibited a positive response after an average of 4.9 months of continued electrical stimulation.
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Affiliation(s)
| | | | - Maria Ines Vieira Couto
- Physical Therapy, Speech, Occupational Therapy Department Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rubens Brito
- ENT Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Robinson Koji Tsuji
- ENT Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Debora Maria Befi-Lopes
- Physical Therapy, Speech, Occupational Therapy Department Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Carla Gentile Matas
- Physical Therapy, Speech, Occupational Therapy Department Faculdade de Medicina da Universidade de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Ferreira Bento
- ENT Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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Raghunandhan S, Ravikumar A, Kameswaran M, Mandke K, Ranjith R. A clinical study of electrophysiological correlates of behavioural comfort levels in cochlear implantees. Cochlear Implants Int 2014; 15:145-60. [PMID: 24606544 DOI: 10.1179/1754762814y.0000000064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioural responses may be tedious for audiologists in such cases, wherein matching an effective Measurable Auditory Percept (MAP) and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed to (a) study the trends in multi-modal electrophysiological tests and behavioural responses sequentially over the first year of implant use; (b) generate normative data from the above; (c) correlate the multi-modal electrophysiological thresholds levels with behavioural comfort levels; and (d) create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. METHODS This prospective study included 10 profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90 K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, impedance telemetry, neural response imaging, electrically evoked stapedial response telemetry (ESRT), and electrically evoked auditory brainstem response (EABR) tests at 1, 4, 8, and 12 months of implant use, in conjunction with behavioural mapping. Trends in electrophysiological and behavioural responses were analyzed using paired t-test. By Karl Pearson's correlation method, electrode-wise correlations were derived for neural response imaging (NRI) thresholds versus most comfortable level (M-levels) and offset based (apical, mid-array, and basal array) correlations for EABR and ESRT thresholds versus M-levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-levels were compared with the behaviourally recorded M-levels among the cohort, using Cronbach's alpha reliability test method for confirming the efficacy of this method. RESULTS NRI, ESRT, and EABR thresholds showed statistically significant positive correlations with behavioural M-levels, which improved with implant use over time. These correlations were used to derive predicted M-levels using regression analysis. On an average, predicted M-levels were found to be statistically reliable and they were a fair match to the actual behavioural M-levels. When applied in clinical practice, the predicted values were found to be useful for programming members of the study group. However, individuals showed considerable deviations in behavioural M-levels, above and below the electrophysiologically predicted values, due to various factors. While the current method appears helpful as a reference to predict initial maps in 'difficult to Map' subjects, it is recommended that behavioural measures are mandatory to further optimize the maps for these individuals. CONCLUSION The study explores the trends, correlations and individual variabilities that occur between electrophysiological tests and behavioural responses, recorded over time among a cohort of cochlear implantees. The statistical method shown may be used as a guideline to predict optimal behavioural levels in difficult situations among future implantees, bearing in mind that optimal M-levels for individuals can vary from predicted values. In 'Difficult to MAP' scenarios, following a protocol of sequential behavioural programming, in conjunction with electrophysiological correlates will provide the best outcomes.
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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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Electrophysiological Correlates of Behavioral Comfort Levels in Cochlear Implantees: A Prospective Study. Indian J Otolaryngol Head Neck Surg 2013; 67:210-22. [PMID: 26405653 DOI: 10.1007/s12070-013-0679-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 10/03/2013] [Indexed: 10/26/2022] Open
Abstract
Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioral responses may be tedious for audiologists in such cases, wherein matching an effective MAP and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed, (a) to study the trends in multi-modal electrophysiological tests and behavioral responses sequentially over the first year of implant use, (b) to generate normative data from the above, (c) to correlate the multi-modal electrophysiological thresholds levels with behavioral comfort levels, and (d) to create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. This prospective study included ten profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, Impedance Telemetry, Neural Response Imaging, Electrically Evoked Stapedial Response Telemetry and Electrically Evoked Auditory Brainstem Response tests at 1, 4, 8 and 12 months of implant use, in conjunction with behavioral Mapping. Trends in electrophysiological and behavioral responses were analyzed using paired t test. By Karl Pearson's correlation method, electrode-wise correlations were derived for NRI thresholds versus Most Comfortable Levels (M-Levels) and offset based (apical, mid-array and basal array) correlations for EABR and ESRT thresholds versus M-Levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-Levels were compared with the behaviorally recorded M-Levels among the cohort, using Cronbach's Alpha Reliability test method for confirming the efficacy of this method. NRI, ESRT and EABR thresholds showed statistically significant positive correlations with behavioral M-Levels, which improved with implant use over time. These correlations were used to derive predicted M-Levels using regression analysis. Such predicted M-Levels were found to be in proximity to the actual behavioral M-Levels recorded among this cohort and proved to be statistically reliable. When clinically applied, this method was found to be successful among subjects of our study group. Although there existed disparities of a few clinical units, between the actual and predicted comfort levels among the subjects, this statistical method was able to provide a working MAP, close to the behavioral MAP used by these children. The results help to infer that behavioral measurements are mandatory to program cochlear implantees, but in cases where they are difficult to obtain, this study method may be used as reference for obtaining additional inputs, in order to set an optimal MAP. The study explores the trends and correlations between electrophysiological tests and behavioral responses, recorded over time among a cohort of cochlear implantees and provides a statistical method which may be used as a guideline to predict optimal behavioral levels in difficult situations among future implantees. In 'Difficult to MAP' scenarios, following a protocol of sequential behavioral programming, in conjunction with electrophysiological correlates will provide the best outcomes.
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From nucleus 24 to 513: changing cochlear implant design affects auditory response thresholds. Otol Neurotol 2013; 34:436-42. [PMID: 23370566 DOI: 10.1097/mao.0b013e3182804784] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We asked how thresholds of auditory activity evoked by a recent research cochlear implant, the Nucleus 513, compared with those evoked by previous generations of devices from the same manufacturer. STUDY DESIGN Prospective repeated measures. SETTING Tertiary pediatric hospital. PATIENTS A total of 182 children receiving unilateral or bilateral Nucleus cochlear implants. INTERVENTIONS Of 182 children, 39 received the N24M straight array, the oldest device in this study, 20 received the N24RCS Contour, the next device released, 57 received the 24RE Freedom, released after the N24RCS, and 66 received the N513 Leap electrode array, the newest device. MAIN OUTCOME MEASURES Behavioral thresholds and auditory nerve response thresholds were evoked by an apical, mid-array, and basal electrode and measured in 203 ears. RESULTS In general, auditory nerve thresholds decreased with newer devices. Responses evoked by the mid-array electrode had higher thresholds than responses to the other electrodes in most devices and highest in the operating room for the N513. Apical electrodes evoked the lowest thresholds at the level of the auditory nerve. Auditory nerve response thresholds decreased from the operating room to initial device activation with the 2 newest devices (N24RE and N513) tending to show the largest changes. Behavioral thresholds were at lowest levels for the 2 newest devices studied and, unlike auditory nerve response thresholds, decreased with age for all devices. CONCLUSION Evolving cochlear implant electrode design significantly affects auditory thresholds, but these changes do not occur uniformly along the array.
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Gordon KA, Chaikof MH, Salloum C, Goulding G, Papsin B. Toward a method for programming balanced bilateral cochlear implant stimulation levels in children. Cochlear Implants Int 2013; 13:220-7. [DOI: 10.1179/1754762811y.0000000022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Akhoun I, Berger-Vachon C, Collet L. Approche empirique pour déterminer les générateurs neurophysiologiques sous-jacents des potentiels évoqués auditifs engendrés par des sons de parole (Speech ABR). Ing Rech Biomed 2010. [DOI: 10.1016/j.irbm.2009.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Evolution of Cochlear Implant Arrays Result in Changes in Behavioral and Physiological Responses in Children. Otol Neurotol 2009; 30:908-15. [DOI: 10.1097/mao.0b013e3181b236b0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tanamati LF, Bevilacqua MC, Costa OA. Longitudinal study of the ecap measured in children with cochlear implants. Braz J Otorhinolaryngol 2009; 75:90-6. [PMID: 19488566 PMCID: PMC9442250 DOI: 10.1016/s1808-8694(15)30837-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Accepted: 11/04/2007] [Indexed: 11/29/2022] Open
Abstract
In children with cochlear implant (CI), the recording of the electrically evoked compound action potential (ECAP) of the auditory nerve represents an option to assess changes in auditory nerve responses and the interaction between the electrode bundle and the neural tissue over time. Aim: To study ECAP in children during the first year of CI use. Materials and methods: The ECAP characteristics have been analyzed in 13 children implanted younger than three years of age. Series study. Results: During the first year of CI use there was a significant statistical raise in the N1 peak amplitude, in basal electrodes, between the second and third return visits. There were not any significant differences obtained for N1 peak, latency, slope, p-NRT or recovery time, in the return visits. Conclusion: During the first year of CI use, the electrical stimulation provided by the intracochlear electrodes did not cause significant changes to ECAP characteristics, except for an increase in N1 peak amplitude.
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Davids T, Valero J, Papsin BC, Harrison RV, Gordon KA. Effects of stimulus manipulation on electrophysiological responses in pediatric cochlear implant users. Part I: Duration effects. Hear Res 2008; 244:7-14. [DOI: 10.1016/j.heares.2008.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 05/24/2008] [Accepted: 06/24/2008] [Indexed: 10/21/2022]
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Remote Intraoperative Monitoring During Cochlear Implant Surgery Is Feasible and Efficient. Otol Neurotol 2008; 29:495-8. [DOI: 10.1097/mao.0b013e3181692838] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mens LHM. Advances in cochlear implant telemetry: evoked neural responses, electrical field imaging, and technical integrity. Trends Amplif 2007; 11:143-59. [PMID: 17709572 PMCID: PMC4111364 DOI: 10.1177/1084713807304362] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
During the last decade, cochlear implantation has evolved into a well-established treatment of deafness, predominantly because of many improvements in speech processing and the controlled excitation of the auditory nerve. Cochlear implants now also feature telemetry, which is highly useful to monitor the proper functioning of the implanted electronics and electrode contacts. Telemetry can also support the clinical management in young children and difficult cases where neural unresponsiveness is suspected. This article will review recent advances in the telemetry of the electrically evoked compound action potential that have made these measurements simple and routine procedures in most cases. The distribution of the electrical stimulus itself sampled by "electrical field imaging" reveals general patterns of current flow in the normal cochlea and gross abnormalities in individual patients; models have been developed to derive more subtle insights from an individual electrical field imaging. Finally, some thoughts are given to the extended application of telemetry, for example, in monitoring the neural responses or in combination with other treatments of the deaf ear.
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Affiliation(s)
- Lucas H M Mens
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
More than 60,000 people worldwide use cochlear implants as a means to restore functional hearing. Although individual performance variability is still high, an average implant user can talk on the phone in a quiet environment. Cochlear-implant research has also matured as a field, as evidenced by the exponential growth in both the patient population and scientific publication. The present report examines current issues related to audiologic, clinical, engineering, anatomic, and physiologic aspects of cochlear implants, focusing on their psychophysical, speech, music, and cognitive performance. This report also forecasts clinical and research trends related to presurgical evaluation, fitting protocols, signal processing, and postsurgical rehabilitation in cochlear implants. Finally, a future landscape in amplification is presented that requires a unique, yet complementary, contribution from hearing aids, middle ear implants, and cochlear implants to achieve a total solution to the entire spectrum of hearing loss treatment and management.
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Affiliation(s)
- Fan-Gang Zeng
- Department of Anatomy and Neurobiology, University of California, Irvine, 92697, USA.
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