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Goffi-Gomez MVS, Corrêa FMDS, Magalhães AT, Hoshino AC, Samuel P, Sadowski T, Colalto C, Tsuji RK, Brito Neto R. Is the spread of excitation different between adults and children cochlear implants users? Eur Arch Otorhinolaryngol 2024; 281:3491-3498. [PMID: 38240771 DOI: 10.1007/s00405-024-08451-0] [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: 07/31/2023] [Accepted: 01/02/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE While cochlea is adult size at birth, etiologies and bone density may differ between children and adults. Differences in neural response thresholds (tNRT) and the spread of excitation (SOE) width may impact the use of artificial intelligence algorithms in speech processor fitting. AIM To identify whether neural response telemetry threshold and spread of excitation width are similar in adults and children. METHODS Retrospective cross-sectional study approved by the Ethical Board. Intraoperative tNRT and SOE recordings of consecutive cochlear implant surgeries in adults and children implanted with Cochlear devices (Cochlear™, Australia) were selected. SOE was recorded on electrode 11 (or adjacent, corresponding to the medial region of the cochlea) through the standard forward-masking technique in Custom Sound EP software, which provides SOE width in millimeters. Statistical comparison between adults and children was performed using the Mann-Whitney test (p ≤ 0.05). RESULTS Of 1282 recordings of intraoperative evaluations, 414 measurements were selected from children and adults. Despite the tNRT being similar between adults and children, SOE width was significantly different, with lower values in children with perimodiolar arrays. Besides, it was observed that there is a difference in the electrode where the SOE function peak occurred, more frequently shifted to electrode 12 in adults implanted. In straight arrays, there was no difference in any of the parameters analyzed on electrode 11. CONCLUSION Although eCAP thresholds are similar, SOE measurements differ between adults and children in perimodiolar electrodes.
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Affiliation(s)
- Maria Valéria Schmidt Goffi-Gomez
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil.
| | - Francyelle Machado da Silva Corrêa
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Ana Tereza Magalhães
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Ana Cristina Hoshino
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Paola Samuel
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Tatiana Sadowski
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Claudia Colalto
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Robinson Koji Tsuji
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
| | - Rubens Brito Neto
- ENT Department, Cochlear Implant Group at Clinical Hospital of the Medical School at University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, Brazil
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Yathiraj A, Manjula P, Geetha C, Jawahar Antony P, Megha. Comparison of electrically evoked stapedial reflexes in patients with cochlear implants surgically implanted using Veria and posterior tympanotomy approaches. J Laryngol Otol 2024:1-6. [PMID: 38311334 DOI: 10.1017/s0022215124000227] [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: 02/10/2024]
Abstract
OBJECTIVE The study aimed to compare ipsilateral and contralateral electrically evoked stapedial reflex thresholds in children with a unilateral cochlear implant surgically implanted either through Veria or posterior tympanotomy approaches. METHODS Forty-nine children using cochlear implants were studied, of whom 27 underwent the Veria approach and 22 underwent the posterior tympanotomy approach. The electrically evoked stapedius reflex thresholds were measured ipsilaterally and contralaterally by stimulating four equally spaced electrodes. RESULTS The ipsilateral electrically evoked stapedius reflex threshold was absent in all four electrodes in the children implanted using the Veria approach. However, the ipsilateral electrically evoked stapedius reflex threshold was present in 70 per cent of the children implanted using the posterior tympanotomy approach. The contralateral electrically evoked stapedius reflex threshold was present in most of the children for both surgical approaches. CONCLUSION The presence of the ipsilateral electrically evoked stapedius reflex threshold varies depending on the surgical technique used for cochlear implantation. However, contralateral reflexes are present in the majority of children using cochlear implants, irrespective of the surgical approach.
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Affiliation(s)
- A Yathiraj
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
| | - P Manjula
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
| | - C Geetha
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
| | - P Jawahar Antony
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
| | - Megha
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
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Holder JT, Henry MR, MacDonald AE, Gifford RH. Cochlear Implant Upper Stimulation Levels: eSRT vs. Loudness Scaling. Otol Neurotol 2023; 44:e667-e672. [PMID: 37621113 PMCID: PMC10637929 DOI: 10.1097/mao.0000000000003988] [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] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To assess the difference in speech recognition and sound quality between programming upper stimulation levels using behavioral measures (loudness scaling) and electrically evoked stapedial reflex thresholds (eSRTs). STUDY DESIGN Double-blinded acute comparison study. SETTING Cochlear implant (CI) program at a tertiary medical center. PATIENTS Eighteen adult (mean age = 60 years) CI users and 20 ears. MAIN OUTCOME MEASURES Speech recognition scores and sound quality ratings. RESULTS Mean word and sentence in noise recognition scores were 8 and 9 percentage points higher, respectively, for the eSRT-based map. The sound quality rating was 1.4 points higher for the eSRT-based map. Sixteen out of 20 participants preferred the eSRT-based map. CONCLUSIONS Study results show significantly higher speech recognition and more favorable sound quality using an eSRT-based map compared with a loudness-scaling map using a double-blinded testing approach. Additionally, results may be understated as 18 of 20 ears had eSRTs measured before study enrollment. Results underscore the importance of incorporating eSRTs into standard clinical practice to promote best outcomes for CI recipients.
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Affiliation(s)
- Jourdan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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Franke-Trieger A, Mattheus W, Seebacher J, Zelger P, Zahnert T, Neudert M. Stapedius reflex thresholds obtained in a free sound field as an indicator for over- and understimulation in cochlear implant listeners. Int J Audiol 2023:1-8. [PMID: 37656611 DOI: 10.1080/14992027.2023.2245141] [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: 09/15/2022] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The goal of this study was to determine open field stapedius reflex thresholds (oSRTs) in CI patients with fittings based on subjective loudness ratings. A further objective was to compare these oSRTs and those of eSRT-based fittings that are similar to the oSRTs of normal hearing. DESIGN Impedance measurements of the ear drum were taken while subjects were wearing their audio processors. The stapedius reflex was elicited by electrical stimulation transmitted through the activated CI system in response to an acoustic stimulus presented in the free sound field. STUDY SAMPLE Subjects were 50 experienced CI users (n = 57 ears) with CI fittings based on subjective loudness scaling. RESULTS A reference range for the oSRTs was defined that was identified in CI patients with eSRT-based fittings. Sound levels for stapedius reflex detection were inside the reference target range in 70% of the cases, below the reference range (i.e. down to 40 dB HL) in 20% of the cases, and above the reference range in 10% of the cases. CONCLUSION Stapedius reflex detection in a free sound field may help detect fittings with too high or too low stimulation levels that might reduce audiological performance.
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Affiliation(s)
- Annett Franke-Trieger
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Willy Mattheus
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Zelger
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Zahnert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus Neudert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Feeney MP, Schairer KS, Putterman DB, Garinis AC, Vachhani JJ, Keefe DH, Fitzpatrick DF, Kolberg E. Automated Adaptive Wideband Acoustic Stapedius Reflex Thresholds in Adults With Normal Hearing and Sensorineural Hearing Loss. Ear Hear 2023; 44:740-750. [PMID: 36631948 PMCID: PMC11098448 DOI: 10.1097/aud.0000000000001321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES This study compared the measurement of the acoustic stapedius reflex threshold (ART) obtained using a traditional method with that obtained using an automated adaptive wideband (AAW) method. Participants included three groups of adults with normal hearing (NH), mild sensorineural hearing loss (SNHL), or moderate SNHL. The purpose of the study was to compare ARTs for the three groups and to determine which method had the best performance in detecting SNHL. DESIGN Ipsilateral and contralateral ARTs were obtained using 0.5, 1, and 2 kHz tonal activators, and broadband noise (BBN) activators on a traditional admittance system (Clinical) at tympanometric peak pressures (TPP) and on an experimental wideband system using an AAW method at both ambient pressure and TPP. ART data previously reported for 39 NH adults with a mean age of 47.7 years were compared with data for 25 participants with mild SNHL with a mean age of 63.8 years, and 20 participants with moderate SNHL with a mean age of 65.7 years. Differences in ARTs between the normal-hearing and SNHL groups for the three methods were examined using a General Linear Model Repeated-Measures test. A receiver operating characteristic curve (ROC) analysis was also used to determine the ability of an ART test to detect SNHL. RESULTS For the 0.5 kHz activator condition, there were no significant group mean differences in ART between NH and SNHL groups for either ipsilateral or contralateral activator presentation modes for the Clinical or AAW methods. There were significant group mean differences for the 1 and 2 kHz tonal activators and BBN activator for both ipsilateral and contralateral modes with greater differences in ART between groups for the AAW method than the Clinical method. In these conditions, the mean ART was lower for the AAW tests relative to the Clinical test. The greatest difference between groups was for the ipsilateral AAW tests for the comparison of NH with moderate SNHL for the BBN activator. This difference was approximately 20 dB for the AAW tests and 8 dB for the Clinical test. The ROC analysis showed that the area under the ROC curve (AUC) increased with the frequency of the activator stimulus and with the degree of hearing loss and was maximal for the BBN activator for both the AAW and Clinical methods for both ipsilateral and contralateral presentations. CONCLUSIONS For ipsilateral and contralateral ART tests for activator frequencies above 0.5 kHz and BBN, listeners with SNHL generally had elevated ARTs compared with those with NH. The AAW method resulted in greater differences between SNHL groups and NH than the Clinical method. The AUC for detecting SNHL also increased with activator frequency and degree of hearing loss and was greatest for the BBN activator for the AAW method in both the ambient and TPP conditions. The results are encouraging for the use of an AAW ART method for the assessment of individuals with SNHL.
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Affiliation(s)
- M. Patrick Feeney
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Kim S. Schairer
- Hearing & Balance Research Program James H. Quillen VA Medical Center, Mountain Home, TN
- Department of Audiology & Speech Language Pathology, East Tennessee State University, Johnson City, TN
| | - Daniel B. Putterman
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Angela C. Garinis
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Jay J. Vachhani
- VA Portland Health Care System, National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | | | | | - Elizabeth Kolberg
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, and Johns Hopkins Cochlear Center for Hearing and Public Health, Johns Hopkins University, Baltimore, MD
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Cortical Auditory Evoked Potentials Recorded Directly Through the Cochlear Implant in Cochlear Implant Recipients: a Feasibility Study. Ear Hear 2022; 43:1426-1436. [DOI: 10.1097/aud.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Palani S, Alexander A, Sreenivasan A. Evaluation of the Electrically-Evoked Stapedial Reflex Threshold in Pediatric Cochlear Implant Users with High-Frequency Probe Tones. Int Arch Otorhinolaryngol 2022; 26:e566-e573. [DOI: 10.1055/s-0042-1742332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 10/17/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Measurement of the electrically-evoked stapedial reflex threshold (ESRT) is an objective tool used to set the comfort levels in pediatric cochlear implant (PCI) users. The levels of ESRT have a strong correlation with comfort levels. However, the clinical utility of ESRT is limited because the ESRT response is not observed in all cochlear implant users.
Objective To assess the effects of probe-tone frequency on ESRT and its relationship with the behavioral comfort levels in PCI users.
Methods A total of 14 PCI users aged between 5 and 8 years participated in the study. The ESRT levels were measured using high-frequency probe tones (678 Hz and 1,000 Hz), and the default 226 Hz probe tone. The ESRT was measured with single-electrode stimulation across the three electrode locations (basal [E01]; middle [E11]; and apical [E22]). The ESRT levels measured with different probe tone frequencies were compared with the behavioral comfort levels.
Results The mean ESRT levels using 1,000Hz and 678 Hz were lower than those measured using 226 Hz, but there was no main effect of probe-tone frequency (p > 0.05). A significantly high incidence of successful ESRT measurements occurred with higher-frequency probe tone (p < 0.039). Additionally, ESRT using higher probe tones significantly correlated with comfort levels.
Conclusion The ESRT with higher probe tones was correlated with behavioral comfort levels and increased the success rate of the measurements. Higher-frequency probe tones may be useful whenever ESRT with 226 Hz is not measurable.
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Affiliation(s)
- Saravanan Palani
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Arun Alexander
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anuprasad Sreenivasan
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Guo H, Lin B, Chen T, Li Y, Guo M. The optimal probe tone frequency for eSRT measurements at individual electrodes in children with cochlear implants. Acta Otolaryngol 2021; 141:1055-1062. [PMID: 34802365 DOI: 10.1080/00016489.2021.1998614] [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: 10/19/2022]
Abstract
BACKGROUND Higher probe tone frequencies have been shown to increase the elicitation rates in electrically evoked stapedius reflex threshold (eSRT) measurements. OBJECTIVES To determine the optimal probe tone frequency for contralateral eSRT measurements at individual electrodes in children with unilateral cochlear implants and to assess the relationship between eSRTs for this frequency and most comfortable levels (M-levels). MATERIALS AND METHODS Contralateral eSRT measurements with three probe tone frequencies (226, 678, and 1000 Hz) at individual electrodes were performed on 26 paediatric Advanced Bionics cochlear implant recipients. RESULTS The elicitation rates of eSRTs for 226, 678, and 1000 Hz probe tones were 73.08% (57/78), 88.46% (69/78), and 88.46% (69/78), respectively. The average eSRT for the 1000 Hz probe tone was significantly lower than those for 226 and 678 Hz probe tones (p<.001 and p=.009, respectively). ESRTs for the 1000 Hz probe tone and M-levels were significantly correlated at all tested electrodes (all p<.001). CONCLUSIONS AND SIGNIFICANCE The optimal probe tone frequency for contralateral eSRT measurement at individual electrodes in children with unilateral cochlear implants is 1000 Hz. ESRTs for the 1000 Hz probe tone are significantly correlated with M-levels and can be used to guide the M-levels setting in these children.
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Affiliation(s)
- Haowei Guo
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Biyu Lin
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ting Chen
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yanping Li
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Mingyong Guo
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
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Wideband Acoustic Immittance in Cochlear Implant Recipients: Reflectance and Stapedial Reflexes. Ear Hear 2021; 41:883-895. [PMID: 31688195 DOI: 10.1097/aud.0000000000000810] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES to characterize differences in wideband power reflectance for ears with and without cochlear implants (CIs), to describe electrically evoked stapedial reflex (eSR)-induced changes in reflectance, and to evaluate the benefit of a broadband probe for reflex threshold determination for CI recipients. It was hypothesized that reflectance patterns in ears with CIs would be consistent with increased middle ear stiffness and that reflex thresholds measured with a broadband probe would be lower compared with thresholds obtained with a single-frequency probe. DESIGN Eleven CI recipients participated in both wideband reflectance and eSR testing. Ipsilateral reflexes were measured with three probes: a broadband chirp (swept from 200 to 8000 Hz), a 226 Hz tone, and a 678 Hz tone. Wideband reflectance measures acquired from 28 adults without CIs and with normal middle ear function served as a normative data set for comparison. RESULTS Considering the group data, average reflectance was significantly greater for ears with CIs across 250 to 891 Hz and 4238 to 4490 Hz compared with the normative data set, although individual reflectance curves were variable. Some CI recipients also had low 226 Hz admittance, which contributed to the group finding, considering the control group had clinically normal 226 Hz admittance by design. Electrically evoked stapedial reflexes were measurable in nine of 14 ears (64.3%) and in 24 of 46 electrodes (52.5%) tested. Reflex-induced changes in reflectance patterns were unique to the participant/ear, but similar across activators (electrodes) within a given ear. In addition, reflectance values at or above 1000 Hz were affected most by activating the stapedial reflex, even in ears with clinically normal 226 Hz admittance. This is a higher-frequency range than has been reported for acoustically evoked reflex-induced reflectance changes and is consistent with increased middle ear stiffness at rest. Electrically evoked reflexes could be measured more often with the 678 Hz or the broadband probe compared with the 226 Hz probe tone. Although reflex thresholds were lower with the broadband probe compared with the 678 Hz probe in 16 of 24 conditions, this was not a statistically significant finding (Wilcoxon signed-rank test; p = 0.072). CONCLUSIONS The applications of wideband acoustic immittance measurements (reflectance and reflexes) should also be considered for ears with CIs. Further work is needed to describe changes across time in ears with CIs to more fully understand the reflectance pattern indicating increased middle ear stiffness and to optimize measuring eSRs with a broadband probe.
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Charroó LE, Bermejo S, Paz Cordovez AS, Rodríguez C, Finley CC, Saoji AA. Effect of Number of Electrodes Used to Elicit Electrical Stapedius Reflex Thresholds in Cochlear Implants. Audiol Neurootol 2021; 26:164-172. [PMID: 33434909 DOI: 10.1159/000510467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION When mapping cochlear implant (CI) patients with limited reporting abilities, the lowest electrical stimulus level that produces a stapedial reflex (i.e., the electrical stapedius reflex threshold [eSRT]) can be measured to estimate the upper bound of stimulation on individual or a subset of CI electrodes. However, eSRTs measured for individual electrodes or a subset of electrodes cannot be used to predict the global adjustment of electrical stimulation levels needed to achieve comfortable loudness sensations that can be readily used in a speech coding strategy. In the present study, eSRTs were measured for 1-, 4-, and 15-electrode stimulation to (1) determine changes in eSRT levels as a function of the electrode stimulation mode and (2) determine which stimulation mode eSRT levels best approximate comfortable loudness levels from patients' clinical maps. METHODS eSRTs were measured with the 3 different electrical stimulation configurations in 9 CI patients and compared with behaviorally measured, comfortable loudness levels or M-levels from patients' clinical maps. RESULTS A linear, mixed-effects, repeated-measures analysis revealed significant differences (p < 0.01) between eSRTs measured as a function of the stimulation mode. No significant differences (p = 0.059) were measured between 15-electrode eSRTs and M-levels from patients' clinical maps. The eSRTs measured for 1- and 4-electrode stimulation differed significantly (p < 0.05) from the M-levels on the corresponding electrodes from the patients' clinical map. CONCLUSION eSRT profiles based on 1- or 4-electrode stimulation can be used to determine comfortable loudness level on either individual or a subset of electrodes, and 15-electrode eSRT profiles can be used to determine the upper bound of electrical stimulation that can be used in a speech coding strategy.
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Affiliation(s)
| | | | | | | | | | - Aniket A Saoji
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA,
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11
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Pitt C, Muñoz K, Schwartz S, Kunz JM. The Long-Term Stability of the Electrical Stapedial Reflex Threshold. Otol Neurotol 2021; 42:188-196. [PMID: 33885266 DOI: 10.1097/mao.0000000000002964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To 1) describe changes in the electrical stapedial reflex threshold (eSRT), within and across patients over time and 2) to identify the clinical relationship between eSRT and an individual's upper limit of loudness. STUDY DESIGN Retrospective chart review and analysis using a multilevel modeling approach to describe changes in eSRT over time. SETTING Secondary care center. PATIENTS Two-hundred five cochlear implant recipients treated at the cochlear implant center during a 3-year time period. INTERVENTION(S) Cochlear implantation, eSRT testing, and, electrical upper limits of loudness. MAIN OUTCOME MEASURE(S) The eSRT over multiple appointments and the cochlear implant recipients' final upper limits of loudness. RESULTS Analysis of the eSRT testing indicated stability over time; no global trend was seen in trajectory across the population, b = -0.010, p = 0.899. The relationship between eSRT and user upper limits of loudness revealed a mean decrease of 19.47, units for manufacturer 1, 30.53 units for manufacturer 2, and 0.7 units for manufacturer 3. CONCLUSION Electrical stapedial reflex thresholds remain consistent for individual subjects over time with implant experience being the only variable correlated with eSRT stability (increase in 5% of one standard deviation with each year of experience). In addition, a clinical relationship between eSRT and behaviorally set upper limits of loudness was identified for all three cochlear implant manufacturers available in the United States.
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Affiliation(s)
- Cache Pitt
- Department of Communication Disorders and Deaf Education
| | - Karen Muñoz
- Department of Communication Disorders and Deaf Education
| | - Sarah Schwartz
- Department of Psychology, Utah State University, Logan, Utah
| | - John M Kunz
- Department of Communication Disorders and Deaf Education
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Browning LM, Nie Y, Rout A, Heiner M. Audiologists' preferences in programming cochlear implants: A preliminary report. Cochlear Implants Int 2020; 21:179-191. [PMID: 31900086 DOI: 10.1080/14670100.2019.1708553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There is little data available addressing how clinical audiologists handle cochlear implant (CI) programming between device manufacturers and make decisions on related services, particularly in the United States. Objectives: This study sought to understand the techniques and settings professionals use with their patients, how they approach bimodal fitting, which tests they use to evaluate patient and device performance, and their overall preferences of (re)habilitative options. Methods: A questionnaire was developed and distributed to CI audiologists throughout the United States electronically. Results: All respondents reported either always or almost always using Cochlear's default signal processing strategy in contrast to the 64% reported for Med-El and 40% for Advanced Bionics. A trend of less use of electrically evoked stapedial reflex threshold (eSRT) than electrically evoked compound action potentials (eCAP) for objective measures was revealed. Higher likelihood of performing speech recognition tests in quiet than in noise was revealed. Preferences for bimodal fitting trend toward using a partner company's hearing aid, although preferences were comparable in adopting four types of hearing aid formulas surveyed in the questionnaire. Conclusions: These data confirm high variability among audiologists' CI programming practices, and documenting these differences is an important step to understanding how to best treat patients.
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Affiliation(s)
- Leanne M Browning
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Yingjiu Nie
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Ayasakanta Rout
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Meredith Heiner
- Department of Audiology, Virginia Commonwealth University Health System, Richmond, VA, USA
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Effect of Probe-Tone Frequency on Ipsilateral and Contralateral Electrical Stapedius Reflex Measurement in Children With Cochlear Implants. Ear Hear 2019; 40:732-740. [DOI: 10.1097/aud.0000000000000656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Entwisle LK, Warren SE, Messersmith JJ. Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss. Semin Hear 2018; 39:390-404. [PMID: 30374210 DOI: 10.1055/s-0038-1670705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Cochlear implants (CIs) have proven to be a useful treatment option for individuals with severe-to-profound hearing loss by providing improved access to one's surrounding auditory environment. CIs differ from traditional acoustic amplification by providing information to the auditory system via electrical stimulation. Both postlingually deafened adults and prelingually deafened children can benefit from a CI; however, outcomes with a CI can vary. Numerous factors can impact performance outcomes with a CI. It is important for the audiologist to understand what factors might play a role and impact performance outcomes with a CI so that they can effectively counsel the recipient and their family, as well as establish appropriate and realistic expectations with a CI. This review article will discuss the CI candidacy process, CI programming and postoperative follow-up care, as well as considerations across the lifespan that may affect performance outcomes with a CI.
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Affiliation(s)
- Lavin K Entwisle
- Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, South Dakota.,Department of Otolaryngology, New York University School of Medicine, New York, New York
| | - Sarah E Warren
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee
| | - Jessica J Messersmith
- Department of Communication Sciences and Disorders, University of South Dakota, Vermillion, South Dakota
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