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Garcia A, Haleem A, Poe S, Gosh D, Christian Brown M, Herrmann BS, Lee DJ. Auditory Brainstem Implant Outcomes in Tumor and Nontumor Patients: A Systematic Review. Otolaryngol Head Neck Surg 2024; 170:1648-1658. [PMID: 38329219 DOI: 10.1002/ohn.662] [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: 08/22/2023] [Revised: 12/03/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To elucidate the differences in auditory performance between auditory brainstem implant (ABI) patients with tumor or nontumor etiologies. DATA SOURCES PubMed, Embase, and Web of Science Core Collection from 1990 to 2021. REVIEW METHODS We included published studies with 5 or more pediatric or adult ABI users. Auditory outcomes and side effects were analyzed with weighted means for closed-set, open-set speech, and categories of auditory performance (CAP) scores. Overall performance was compared using an Adult Pediatric Ranked Order Speech Perception (APROSPER) scale created for this study. RESULTS Thirty-six studies were included and underwent full-text review. Data were extracted for 662 tumor and 267 nontumor patients. 83% were postlingually deafened and 17% were prelingually deafened. Studies that included tumor ABI patients had a weighted mean speech recognition of 39.2% (range: 19.6%-83.3%) for closed-set words, 23.4% (range: 17.2%-37.5%) for open-set words, 21.5% (range: 2.7%-48.4%) for open-set sentences, and 3.1 (range: 1.0-3.2) for CAP scores. Studies including nontumor ABI patients had a weighted mean speech recognition of 79.8% (range: 31.7%-84.4%) for closed-set words, 53.0% (range: 14.6%-72.5%) for open-set sentences, and 2.30 (range: 2.0-4.7) for CAP scores. Mean APROSPER results indicate better auditory performance among nontumor versus tumor patients (3.5 vs 3.0, P = .04). Differences in most common side effects were also observed between tumor and nontumor ABI patients. CONCLUSION Auditory performance is similar for tumor and nontumor patients for standardized auditory test scores. However, the APROSPER scale demonstrates better ABI performance for nontumor compared to tumor patients.
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Affiliation(s)
- Alejandro Garcia
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Sonja Poe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Deborah Gosh
- Howe Library, Massachusetts Eye and Ear, Boston, MA, USA
| | - M Christian Brown
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Barbara S Herrmann
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Audiology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Eaton Peabody Laboratories (EPL), Massachusetts Eye and Ear, Boston, Massachusetts, USA
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McInturff S, Adenis V, Coen FV, Lacour SP, Lee DJ, Brown MC. Sensitivity to Pulse Rate and Amplitude Modulation in an Animal Model of the Auditory Brainstem Implant (ABI). J Assoc Res Otolaryngol 2023; 24:365-384. [PMID: 37156973 PMCID: PMC10335994 DOI: 10.1007/s10162-023-00897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 03/19/2023] [Indexed: 05/10/2023] Open
Abstract
The auditory brainstem implant (ABI) is an auditory neuroprosthesis that provides hearing by electrically stimulating the cochlear nucleus (CN) of the brainstem. Our previous study (McInturff et al., 2022) showed that single-pulse stimulation of the dorsal (D)CN subdivision with low levels of current evokes responses that have early latencies, different than the late response patterns observed from stimulation of the ventral (V)CN. How these differing responses encode more complex stimuli, such as pulse trains and amplitude modulated (AM) pulses, has not been explored. Here, we compare responses to pulse train stimulation of the DCN and VCN, and show that VCN responses, measured in the inferior colliculus (IC), have less adaption, higher synchrony, and higher cross-correlation. However, with high-level DCN stimulation, responses become like those to VCN stimulation, supporting our earlier hypothesis that current spreads from electrodes on the DCN to excite neurons located in the VCN. To AM pulses, stimulation of the VCN elicits responses with larger vector strengths and gain values especially in the high-CF portion of the IC. Additional analysis using neural measures of modulation thresholds indicate that these measures are lowest for VCN. Human ABI users with low modulation thresholds, who score best on comprehension tests, may thus have electrode arrays that stimulate the VCN. Overall, the results show that the VCN has superior response characteristics and suggest that it should be the preferred target for ABI electrode arrays in humans.
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Affiliation(s)
- Stephen McInturff
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, USA.
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA.
| | - Victor Adenis
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Florent-Valéry Coen
- Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202, Geneva, Switzerland
| | - Stéphanie P Lacour
- Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202, Geneva, Switzerland
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - M Christian Brown
- Eaton-Peabody Laboratories, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
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Veronese S, Cambiaghi M, Tommasi N, Sbarbati A, Galvin JJ. Ten-year follow-up of auditory brainstem implants: From intra-operative electrical auditory brainstem responses to perceptual results. PLoS One 2023; 18:e0282261. [PMID: 36862753 PMCID: PMC9980821 DOI: 10.1371/journal.pone.0282261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
The auditory brainstem implant (ABI) can provide hearing sensation to individuals where the auditory nerve is damaged. However, patient outcomes with the ABI are typically much poorer than those for cochlear implant recipients. A major limitation to ABI outcomes is the number of implanted electrodes that can produce auditory responses to electric stimulation. One of the greatest challenges in ABI surgery is the intraoperative positioning of the electrode paddle, which must fit snugly within the cochlear nucleus complex. While there presently is no optimal procedure for intraoperative electrode positioning, intraoperative assessments may provide useful information regarding viable electrodes that may be included in patients' clinical speech processors. Currently, there is limited knowledge regarding the relationship between intraoperative data and post-operative outcomes. Furthermore, the relationship between initial ABI stimulation with and long-term perceptual outcomes is unknown. In this retrospective study, we reviewed intraoperative electrophysiological data from 24 ABI patients (16 adults and 8 children) obtained with two stimulation approaches that differed in terms of neural recruitment. The interoperative electrophysiological recordings were used to estimate the number of viable electrodes and were compared to the number of activated electrodes at initial clinical fitting. Regardless of the stimulation approach, the intraoperative estimate of viable electrodes greatly overestimated the number of active electrodes in the clinical map. The number of active electrodes was associated with long-term perceptual outcomes. Among patients with 10-year follow-up, at least 11/21 active electrodes were needed to support good word detection and closed-set recognition and 14/21 electrodes to support good open-set word and sentence recognition. Perceptual outcomes were better for children than for adults, despite a lower number of active electrodes.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, Verona University, Verona, Italy
- * E-mail:
| | - Marco Cambiaghi
- Department of Neuroscience, Biomedicine and Movement Sciences, Verona University, Verona, Italy
| | - Nicola Tommasi
- Centre of Economic Documentation (CIDE), Verona University, Verona, Italy
| | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, Verona University, Verona, Italy
| | - John J. Galvin
- House Institute Foundation, Los Angeles, California, United States of America
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McInturff S, Coen FV, Hight AE, Tarabichi O, Kanumuri VV, Vachicouras N, Lacour SP, Lee DJ, Brown MC. Comparison of Responses to DCN vs. VCN Stimulation in a Mouse Model of the Auditory Brainstem Implant (ABI). J Assoc Res Otolaryngol 2022; 23:391-412. [PMID: 35381872 PMCID: PMC9085982 DOI: 10.1007/s10162-022-00840-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/31/2022] [Indexed: 10/18/2022] Open
Abstract
The auditory brainstem implant (ABI) is an auditory neuroprosthesis that provides hearing to deaf patients by electrically stimulating the cochlear nucleus (CN) of the brainstem. Whether such stimulation activates one or the other of the CN's two major subdivisions is not known. Here, we demonstrate clear response differences from the stimulation of the dorsal (D) vs. ventral (V) subdivisions of the CN in a mouse model of the ABI with a surface-stimulating electrode array. For the DCN, low levels of stimulation evoked multiunit responses in the inferior colliculus (IC) that were unimodally distributed with early latencies (avg. peak latency of 3.3 ms). However, high levels of stimulation evoked a bimodal distribution with the addition of a late latency response peak (avg. peak latency of 7.1 ms). For the VCN, in contrast, electrical stimulation elicited multiunit responses that were usually unimodal and had a latency similar to the DCN's late response. Local field potentials (LFP) from the IC showed components that correlated with early and late multiunit responses. Surgical cuts to sever the output of the DCN, the dorsal acoustic stria (DAS), gave insight into the origin of these early and late responses. Cuts eliminated early responses but had little-to-no effect on late responses. The early responses thus originate from cells that project through the DAS, such as DCN's pyramidal and giant cells. Late responses likely arise from the spread of stimulation from a DCN-placed electrode array to the VCN and could originate in bushy and/or stellate cells. In human ABI users, the spread of stimulation in the CN may result in abnormal response patterns that could hinder performance.
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Affiliation(s)
- Stephen McInturff
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA.
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA.
| | - Florent-Valéry Coen
- Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202, Geneva, Switzerland
| | - Ariel E Hight
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA
| | - Osama Tarabichi
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Vivek V Kanumuri
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Nicolas Vachicouras
- Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202, Geneva, Switzerland
| | - Stéphanie P Lacour
- Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202, Geneva, Switzerland
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - M Christian Brown
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear, Boston, MA, 02114, USA
- Program in Speech and Hearing Bioscience and Technology, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Safety of 3 Tesla Magnetic Resonance Imaging in Patients with Auditory Brainstem Implants. Otol Neurotol 2021; 43:e263-e267. [PMID: 34855679 DOI: 10.1097/mao.0000000000003399] [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 evaluate the safety of 3 Tesla (T) magnetic resonance imaging (MRI) in patients with auditory brainstem implants (ABI) with the magnet removed at implantation and report incidence of complications. STUDY DESIGN Retrospective chart review. SETTING Tertiary neurotology ambulatory practice. PATIENTS Patients with diagnosis of Neurofibromatosis, type 2 (NF2) with functional ABIs. INTERVENTIONS Observational recordings. MAIN OUTCOME MEASURES Of the 89 patients meeting inclusion criteria, 7 patients underwent 3T MRI, with a total of 39 scans done. Three patients had 1 scan each, one patient had 4 scans, one patient had 5 scans, one patient had 6 scans, and one patient had 21 scans. The mean time between ABI placement and first 3 T scan was 118 ± 73 months. The most common indication for imaging was surveillance of NF2 lesions. The most frequent scans were MRI brain (25.6%), followed by MRI of cervical (15%), thoracic (15%) and lumbar (15%) spine, and MRI IAC (8%). There were no reported complications for any of the scans. No scans were interrupted due to patient discomfort. There were no device malfunctions. CONCLUSIONS 3 T MRIs are safe in patients with ABIs as long as the magnet is removed. It is recommended that the magnet be removed at the time of implantation in all NF2 patients, who require frequent surveillance.
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Bhatt PR, Alyono JC, Fischbein NJ, Penta M. Imaging of the Postoperative Temporal Bone. Neuroimaging Clin N Am 2021; 32:175-192. [PMID: 34809837 DOI: 10.1016/j.nic.2021.08.006] [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
Evaluation of the postoperative temporal bone can be difficult given the complex anatomy of this region and the myriad surgical approaches for management of a variety of conditions. This article provides an understanding of common postsurgical changes of the temporal bone and their typical imaging appearances. Ultimately, greater radiologist knowledge of postoperative temporal bone imaging findings will help to serve patients and referring clinicians with prompt diagnosis and recognition of expected postintervention changes compared with postoperative complications and/or disease recurrence.
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Affiliation(s)
- Paraag R Bhatt
- Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA.
| | - Jennifer C Alyono
- Department of Otolaryngology, Head and Neck Surgery, Stanford University, 801 Welch Road, MC 5739, Stanford, CA 94305, USA
| | - Nancy J Fischbein
- Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA
| | - Mrudula Penta
- Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA
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Regodić M, Freyschlag CF, Kerschbaumer J, Galijašević M, Hörmann R, Freysinger W. Novel microscope-based visual display and nasopharyngeal registration for auditory brainstem implantation: a feasibility study in an ex vivo model. Int J Comput Assist Radiol Surg 2021; 17:261-270. [PMID: 34792744 PMCID: PMC8784369 DOI: 10.1007/s11548-021-02514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022]
Abstract
Purpose An auditory brainstem implant (ABI) represents an alternative for patients with profound hearing loss who are constrained from receiving a cochlear implant. The positioning of the ABI electrode influences the patient’s auditory capacity and, therefore, quality of life and is challenging even with available intraoperative electrophysiological monitoring. This work aims to provide and assess the feasibility of visual-spatial assistance for ABI positioning. Methods The pose of the forceps instrument that grasps the electrode was electromagnetically navigated and interactively projected in the eyepieces of a surgical microscope with respect to a target point. Intraoperative navigation was established with an experimental technique for automated nasopharyngeal patient registration. Two ABI procedures were completed in a human specimen head. Results An intraoperative usability study demonstrated lower localization error when using the proposed visual display versus standard cross-sectional views. The postoperative evaluations of the preclinical study showed that the center of the electrode was misplaced to the planned position by 1.58 mm and 3.16 mm for the left and the right ear procedure, respectively. Conclusion The results indicate the potential to enhance intraoperative feedback during ABI positioning with the presented system. Further improvements consider estimating the pose of the electrode itself to allow for better orientation during placement. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-021-02514-x.
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Affiliation(s)
- Milovan Regodić
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria. .,Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
| | | | | | - Malik Galijašević
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Freysinger
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
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Adult Auditory Brainstem Implant Outcomes and Three-Dimensional Electrode Array Position on Computed Tomography. Ear Hear 2021; 42:1741-1754. [PMID: 34282087 DOI: 10.1097/aud.0000000000001064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Factors contributing to auditory brainstem implant (ABI) outcomes are poorly understood. The aims of this study are to (1) characterize ABI electrode array position on postoperative imaging and (2) determine if variability in position is related to perceptual outcomes. DESIGN Retrospective cohort study. Subjects were selected from the adult ABI recipient population at Massachusetts Eye and Ear. Postoperative three-dimensional (3D) computed tomography (CT) reconstruction of the head was used to measure ABI array position in 20 adult ABI recipients (17 with Neurofibromatosis Type 2 (NF2) and three non-NF2 recipients). Three-dimensional electrode array position was determined based on angles from the horizontal using posterior and lateral views and on distances between the proximal array tip superiorly from the basion (D1), laterally (D2P) and posteriorly (D2L) from the midline. Array position was correlated with perceptual data (in 15 of the 20 recipients who used their ABI). Perceptual data included the number of electrodes that provided auditory sensation, location and type of side effects, level of speech perception (from no sound to open-set word recognition of monosyllables) and the amount of charge required for auditory perception. RESULTS Although the 3D orientation of the ABI array exhibited a variety of angles, all arrays were posteriorly tilted from the lateral view and most were medially tilted from the posterior view. ABI position relative to the basion from posterior showed mean distances of 1.71 ± 0.42 and 1.1 ± 0.29 cm for D1 and D2, respectively, and a mean D2 of 1.30 ± 0.45 cm from the lateral view. A strong linear negative correlation was found between the number of active electrodes and the distance of the proximal array tip laterally from the basion (D2P; rs = -0.73, p = 0.006) when measured in the posterior view. Although side effects were experienced in all recipients and varied in type and location across the array, electrodes in the middle part of the array tended to elicit auditory sensations while the proximal and distal tips of the array tended to elicit nonauditory side effects. Arrays with and without low charge thresholds appeared to generally overlap in position. However, the two recipients with the best (open-set) speech perception had low charge thresholds and had arrays that were tilted superiorly in the posterior view. CONCLUSION ABI recipients with better speech perception appear to share a profile of arrays that are tilted superiorly as compared to recipients with lower speech perception levels. These ABI recipients have a high number of active electrodes (10 or more) and require less electrical charge on individual electrodes to achieve optimal stimulation.
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Shetty KR, Ridge SE, Kanumuri V, Zhu A, Brown MC, Lee DJ. Clinical and scientific innovations in auditory brainstem implants. World J Otorhinolaryngol Head Neck Surg 2021; 7:109-115. [PMID: 33997720 PMCID: PMC8103538 DOI: 10.1016/j.wjorl.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/27/2020] [Accepted: 02/10/2021] [Indexed: 12/03/2022] Open
Abstract
The auditory brainstem implant (ABI) was originally developed to provide rehabilitation of retrocochlear deafness caused by neurofibromatosis type 2 (NF2). Recent studies of the ABI have investigated outcomes in non-NF2 cohorts, such as patients with cochlear nerve aplasia or cochlear ossification and more recently, intractable tinnitus. New technologies that improve the ABI-neural tissue interface are being explored as means to improve performance and decrease side effects. Innovative discoveries in optogenetics and bioengineering present opportunities to continually evolve this technology into the future, enhancing spatial selectivity of neuronal activation in the cochlear nucleus and preventing side effects through reduction in activation of non-target neuronal circuitry. These advances will improve surgical planning and ultimately improve patients’ audiological capabilities. ABI research has rapidly increased in the 21st century and applications of this technology are likely to continually evolve. Herein, we aim to characterize ongoing clinical, basic science, and bioengineering advances in ABIs and discuss future directions of this technology.
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Affiliation(s)
- Kunal R Shetty
- Department of Otorhinolaryngology Head and Neck Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.,Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Sarah E Ridge
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Vivek Kanumuri
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Angela Zhu
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - M Christian Brown
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
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Lachowska M, Pastuszka A, Mikołajewska L, Kunert P, Niemczyk K. Detailed insight in intraoperative eABR measurements to assist auditory brainstem implantation in a patient with neurofibromatosis type 2. Acta Neurol Belg 2020; 120:1371-1378. [PMID: 31749088 DOI: 10.1007/s13760-019-01248-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
Auditory brainstem implant (ABI) is used to provide auditory sensations in patients with neurofibromatosis type 2 who lost their hearing due to a surgical removal of the tumor. ABI surgery, implant activation and follow-up sessions present unique challenges including the exact placement of the electrode pad in the lateral recess of the IVth ventricle, identification of electrodes that trigger non-auditory sensation and their deactivation which lowers the number of electrodes responsible for hearing, changes of T- and C-levels across follow-up sessions. We present a complete procedure using an example case starting from the surgical part with the detailed description of intraoperative eABR measurement as a guidance for pad placement to the ABI activation and first fitting sessions with auditory sensation assessment. Since the first ABI electrode pad position presented non-satisfactory intraoperative eABR results it was decided to move the pad slightly which resulted in better eABR (more electrodes with auditory responses). The discussed patient demonstrated great auditory and speech perception results after the first ABI fitting (which included three sessions over 2 consecutive days). Repositioning of the ABI electrode pad during the surgery was carried out taking into account the intraoperative eABR results and this led to an overall positive outcome for the patient. The placement of ABI electrode pad is crucial for later auditory results. This study provides detailed insight in this very specialized procedure that is not performed in every clinic and adds to the knowledge of intraoperative navigation using eABR measurements during ABI surgery.
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Affiliation(s)
| | | | - Lidia Mikołajewska
- Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
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Epprecht L, Qureshi A, Kozin ED, Vachicouras N, Huber AM, Kikinis R, Makris N, Brown MC, Reinshagen KL, Lee DJ. Human Cochlear Nucleus on 7 Tesla Diffusion Tensor Imaging: Insights Into Micro-anatomy and Function for Auditory Brainstem Implant Surgery. Otol Neurotol 2020; 41:e484-e493. [PMID: 32176138 PMCID: PMC7392811 DOI: 10.1097/mao.0000000000002565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The cochlear nucleus (CN) is the target of the auditory brainstem implant (ABI). Most ABI candidates have Neurofibromatosis Type 2 (NF2) and distorted brainstem anatomy from bilateral vestibular schwannomas. The CN is difficult to characterize as routine structural MRI does not resolve detailed anatomy. We hypothesize that diffusion tensor imaging (DTI) enables both in vivo localization and quantitative measurements of CN morphology. STUDY DESIGN We analyzed 7 Tesla (T) DTI images of 100 subjects (200 CN) and relevant anatomic structures using an MRI brainstem atlas with submillimetric (50 μm) resolution. SETTING Tertiary referral center. PATIENTS Young healthy normal hearing adults. INTERVENTION Diagnostic. MAIN OUTCOME MEASURES Diffusion scalar measures such as fractional anisotropy (FA), mean diffusivity (MD), mode of anisotropy (Mode), principal eigenvectors of the CN, and the adjacent inferior cerebellar peduncle (ICP). RESULTS The CN had a lamellar structure and ventral-dorsal fiber orientation and could be localized lateral to the inferior cerebellar peduncle (ICP). This fiber orientation was orthogonal to tracts of the adjacent ICP where the fibers run mainly caudal-rostrally. The CN had lower FA compared to the medial aspect of the ICP (0.44 ± 0.09 vs. 0.64 ± 0.08, p < 0.001). CONCLUSIONS 7T DTI enables characterization of human CN morphology and neuronal substructure. An ABI array insertion vector directed more caudally would better correspond to the main fiber axis of CN. State-of-the-art DTI has implications for ABI preoperative planning and future image guidance-assisted placement of the electrode array.
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Affiliation(s)
- Lorenz Epprecht
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahad Qureshi
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott D Kozin
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicolas Vachicouras
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft, Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Alexander M Huber
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, Massachusetts, USA
- Fraunhofer Institut for Medical Image Computing, University of Bremen, Bremen, Germany
| | - Nikos Makris
- Surgical Planning Laboratory, Harvard Medical School, Boston, Massachusetts, USA
- MGH Morphometric Analysis Center, Harvard Medical School
| | - M Christian Brown
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine L Reinshagen
- Department of Radiology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel J Lee
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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12
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Tarabichi O, Kanumuri VV, Klug J, Vachicouras N, Duarte MJ, Epprecht L, Kozin ED, Reinshagen K, Lacour SP, Brown MC, Lee DJ. Three-Dimensional Surface Reconstruction of the Human Cochlear Nucleus: Implications for Auditory Brain Stem Implant Design. J Neurol Surg B Skull Base 2020; 81:114-120. [PMID: 32206528 DOI: 10.1055/s-0039-1677863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022] Open
Abstract
Objective The auditory brain stem implant (ABI) is a neuroprosthesis placed on the surface of the cochlear nucleus (CN) to provide hearing sensations in children and adults who are not candidates for cochlear implantation. Contemporary ABI arrays are stiff and do not conform to the curved brain stem surface. Recent advancements in microfabrication techniques have enabled the development of flexible surface arrays, but these have only been applied in animal models. Herein, we measure the surface curvature of the human CN and adjoining regions to assist in the design and placement of next-generation conformable clinical ABI arrays. Three-dimensional (3D) reconstructions from ultrahigh T1-weighted brain magnetic resonance imaging (MRI) sequences and histologic reconstructions based on postmortem adult human brain stem specimens were used. Design This is a retrospective review of radiologic data and postmortem histologic axial sections. Setting This is set at the tertiary referral center. Participants Data were acquired from healthy adults. Main Outcome Measures The main outcome measures are principal curvature values (Kmin and Kmax) and global radius of curvature. Results The CN was successfully extracted and rendered as a 3D surface in all cases. Significant curvatures of the CN in both histologic and radiographic reconstructions were found with global radius of curvature ranging from 2.08 to 8.5 mm. In addition, local curvature analysis revealed that the surface is highly complex. Conclusion Detailed rendering of the human CN is feasible using histology and 3D MRI reconstruction and highlights complex surface topography that is not recapitulated by contemporary stiff ABI arrays.
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Affiliation(s)
- Osama Tarabichi
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Vivek V Kanumuri
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Julian Klug
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Faculty of Medicine, University of Geneva, Switzerland
| | - Nicolas Vachicouras
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprostheses, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Maria J Duarte
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Lorenz Epprecht
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Elliott D Kozin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Katherine Reinshagen
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprostheses, École Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - M Christian Brown
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Daniel J Lee
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, United States
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13
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14
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Zhu A, Qureshi AA, Kozin ED, Lee DJ. Concepts in Neural Stimulation: Electrical and Optical Modulation of the Auditory Pathways. Otolaryngol Clin North Am 2019; 53:31-43. [PMID: 31685241 DOI: 10.1016/j.otc.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Understanding the mechanisms of neural stimulation is necessary to improve the management of sensory disorders. Neurons can be artificially stimulated using electrical current, or with newer stimulation modalities, including optogenetics. Electrical stimulation forms the basis for all neuroprosthetic devices that are used clinically. Off-target stimulation and poor implant performance remain concerns for patients with electrically based neuroprosthetic devices. Optogenetic techniques may improve cranial nerve stimulation strategies used by various neuroprostheses and result in better patient outcomes. This article reviews the fundamentals of neural stimulation and provides an overview of recent major advancements in light-based neuromodulation."
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Affiliation(s)
- Angela Zhu
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Ahad A Qureshi
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
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15
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Vachicouras N, Tarabichi O, Kanumuri VV, Tringides CM, Macron J, Fallegger F, Thenaisie Y, Epprecht L, McInturff S, Qureshi AA, Paggi V, Kuklinski MW, Brown MC, Lee DJ, Lacour SP. Microstructured thin-film electrode technology enables proof of concept of scalable, soft auditory brainstem implants. Sci Transl Med 2019; 11:eaax9487. [PMID: 31619546 DOI: 10.1126/scitranslmed.aax9487] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022]
Abstract
Auditory brainstem implants (ABIs) provide sound awareness to deaf individuals who are not candidates for the cochlear implant. The ABI electrode array rests on the surface of the cochlear nucleus (CN) in the brainstem and delivers multichannel electrical stimulation. The complex anatomy and physiology of the CN, together with poor spatial selectivity of electrical stimulation and inherent stiffness of contemporary multichannel arrays, leads to only modest auditory outcomes among ABI users. Here, we hypothesized that a soft ABI could enhance biomechanical compatibility with the curved CN surface. We developed implantable ABIs that are compatible with surgical handling, conform to the curvature of the CN after placement, and deliver efficient electrical stimulation. The soft ABI array design relies on precise microstructuring of plastic-metal-plastic multilayers to enable mechanical compliance, patterning, and electrical function. We fabricated soft ABIs to the scale of mouse and human CN and validated them in vitro. Experiments in mice demonstrated that these implants reliably evoked auditory neural activity over 1 month in vivo. Evaluation in human cadaveric models confirmed compatibility after insertion using an endoscopic-assisted craniotomy surgery, ease of array positioning, and robustness and reliability of the soft electrodes. This neurotechnology offers an opportunity to treat deafness in patients who are not candidates for the cochlear implant, and the design and manufacturing principles are broadly applicable to implantable soft bioelectronics throughout the central and peripheral nervous system.
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Affiliation(s)
- Nicolas Vachicouras
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Osama Tarabichi
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Vivek V Kanumuri
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Christina M Tringides
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Jennifer Macron
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Florian Fallegger
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Yohann Thenaisie
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Lorenz Epprecht
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Stephen McInturff
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Ahad A Qureshi
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Valentina Paggi
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland
| | - Martin W Kuklinski
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - M Christian Brown
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel J Lee
- Eaton-Peabody Laboratories and Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, MA 02115, USA.
| | - Stéphanie P Lacour
- Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL), 1202 Geneva, Switzerland.
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16
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Batuk MO, Aslan F, Sennaroglu G, Akgoz A, Bilginer B, Sennaroglu L. Contralateral non-auditory stimulation in auditory brainstem implantation: A case report. Int J Pediatr Otorhinolaryngol 2019; 125:71-78. [PMID: 31260811 DOI: 10.1016/j.ijporl.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/12/2019] [Accepted: 06/24/2019] [Indexed: 01/17/2023]
Affiliation(s)
| | - Filiz Aslan
- Department of Audiology, Hacettepe University, Ankara, Turkey
| | | | - Ayca Akgoz
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Burcak Bilginer
- Department of Neurosurgery, Hacettepe University, Ankara, Turkey
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17
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Wong K, Kiringoda R, Kanumuri VV, Barber SR, Franck K, Sahani N, Brown MC, Herrmann BS, Lee DJ. Effect of anesthesia on evoked auditory responses in pediatric auditory brainstem implant surgery. Laryngoscope 2019; 130:507-513. [PMID: 31095742 DOI: 10.1002/lary.28008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/04/2019] [Accepted: 03/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Electrically evoked auditory brainstem responses (EABR) guide placement of the multichannel auditory brainstem implant (ABI) array during surgery. EABRs are also recorded under anesthesia in nontumor pediatric ABI recipients prior to device activation to confirm placement and guide device programming. We examine the influence of anesthesia on evoked response morphology in pediatric ABI users by comparing intraoperative with postoperative EABR recordings. STUDY DESIGN Retrospective review. METHODS Seven children underwent ABI surgery by way of retrosigmoid craniotomy. General anesthesia included inhaled sevoflurane induction and propofol maintenance during which EABRs were recorded to confirm accurate positioning of the ABI. A mean of 7.7 ± 2.8 weeks following surgery, the ABI was activated under general anesthesia or sedation (dexmedetomidine) and EABR recordings were made. A qualitative analysis of intraoperative and postoperative waveform morphology was performed. RESULTS Seven subjects (mean age 20.6 months) underwent nine ABI surgeries (seven primary, two revisions) and nine activations. EABRs were observed in eight of nine postoperative recordings. In three cases, intraoperative EABRs during general anesthesia were similar to postoperative EABRs with sedation. In one case, sevoflurane and propofol were used for intra- and postoperative recordings, and waveforms were also similar. In four cases, amplitude and latency changes were observed for intraoperative versus postoperative EABRs. CONCLUSION Similarity of EABR morphology in the anesthetized versus sedated condition suggests that anesthesia does not have a large effect on far-field evoked potentials. Changes in EABR waveform morphology observed postoperatively may be influenced by other factors such as movements of the surface array. LEVEL OF EVIDENCE 4 Laryngoscope, 130:507-513, 2020.
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Affiliation(s)
- Kevin Wong
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ruwan Kiringoda
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Vivek V Kanumuri
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Samuel R Barber
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Kevin Franck
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Audiology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Nita Sahani
- Department of Anesthesiology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - M Christian Brown
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Barbara S Herrmann
- Department of Audiology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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18
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Guex AA, Hight AE, Narasimhan S, Vachicouras N, Lee DJ, Lacour SP, Brown MC. Auditory brainstem stimulation with a conformable microfabricated array elicits responses with tonotopically organized components. Hear Res 2019; 377:339-352. [PMID: 30867111 DOI: 10.1016/j.heares.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/11/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
Auditory brainstem implants (ABIs) restore hearing to deaf individuals not eligible for cochlear implants. Speech comprehension in ABI users is generally poor compared to that of cochlear implant users, and side effects are common. The poor performance may result from activating broad areas and multiple neuronal populations of the cochlear nucleus, however detailed studies of the responses to surface stimulation of the cochlear nucleus are lacking. A conformable electrode array was microfabricated to fit on the rat's dorsal cochlear nucleus (DCN). It hosts 20 small electrodes (each 100 μm diam.). The array was tested by recording evoked potentials and neural activity along the tonotopic axis of the inferior colliculus (IC). Almost all bipolar electrode pairs elicited responses, in some cases with an even, or relatively constant, pattern of thresholds and supra-threshold measures along the long axis of the array. This pattern suggests that conformable arrays can provide relatively constant excitation along the surface of the DCN and thus might decrease the ABI side effects caused by spread of high current to adjacent structures. We also examined tonotopic patterns of the IC responses. Compared to sound-evoked responses, electrically-evoked response mappings had less tonotopic organization and were broader in width. They became more tonotopic when the evoked activity common to all electrodes and the late phase of response were subtracted out, perhaps because the remaining activity is from tonotopically organized principal cells of the DCN. Responses became less tonotopic when inter-electrode distance was increased from 400 μm to 800 μm but were relatively unaffected by changing to monopolar stimulation. The results illustrate the challenges of using a surface array to present tonotopic cues and improve speech comprehension in humans who use the ABI.
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Affiliation(s)
- Amélie A Guex
- Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, School of Engineering, Institute of Microengineering & Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Ariel Edward Hight
- Eaton-Peabody Laboratories and Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Shreya Narasimhan
- Eaton-Peabody Laboratories and Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Nicolas Vachicouras
- Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, School of Engineering, Institute of Microengineering & Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Daniel J Lee
- Eaton-Peabody Laboratories and Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Stéphanie P Lacour
- Laboratory for Soft Bioelectronic Interfaces, Centre for Neuroprosthetics, School of Engineering, Institute of Microengineering & Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - M Christian Brown
- Eaton-Peabody Laboratories and Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
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19
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Wong K, Kozin ED, Kanumuri VV, Vachicouras N, Miller J, Lacour S, Brown MC, Lee DJ. Auditory Brainstem Implants: Recent Progress and Future Perspectives. Front Neurosci 2019; 13:10. [PMID: 30760974 PMCID: PMC6361749 DOI: 10.3389/fnins.2019.00010] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
The auditory brainstem implant (ABI) was first developed nearly 40 years ago and provides auditory rehabilitation to patients who are deaf and ineligible for cochlear implant surgery due to abnormalities of the cochlea and cochlear nerve. The aims of the following review are to describe the history of the ABI and innovations leading up to the modern ABI system, as well as highlight areas of future development in implant design.
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Affiliation(s)
- Kevin Wong
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Vivek V Kanumuri
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Nicolas Vachicouras
- Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Jonathan Miller
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Stéphanie Lacour
- Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - M Christian Brown
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, United States.,Department of Otology and Laryngology, Harvard Medical School, Boston, MA, United States
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20
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Zhou Q, Yang Z, Wang Z, Wang B, Wang X, Zhao C, Zhang S, Wu T, Li P, Li S, Zhao F, Liu P. Awake craniotomy for assisting placement of auditory brainstem implant in NF2 patients. Acta Otolaryngol 2018; 138:548-553. [PMID: 29361882 DOI: 10.1080/00016489.2018.1424998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Auditory brainstem implants (ABIs) may be the only opportunity for patients with NF2 to regain some sense of hearing sensation. However, only a very small number of individuals achieved open-set speech understanding and high sentence scores. Suboptimal placement of the ABI electrode array over the cochlear nucleus may be one of main factors for poor auditory performance. In the current study, we present a method of awake craniotomy to assist with ABI placement. METHODS Awake surgery and hearing test via the retrosigmoid approach were performed for vestibular schwannoma resections and auditory brainstem implantations in four patients with NF2. Auditory outcomes and complications were assessed postoperatively. RESULTS Three of 4 patients who underwent awake craniotomy during ABI surgery received reproducible auditory sensations intraoperatively. Satisfactory numbers of effective electrodes, threshold levels and distinct pitches were achieved in the wake-up hearing test. In addition, relatively few electrodes produced non-auditory percepts. There was no serious complication attributable to the ABI or awake craniotomy. CONCLUSIONS It is safe and well tolerated for neurofibromatosis type 2 (NF2) patients using awake craniotomy during auditory brainstem implantation. This method can potentially improve the localization accuracy of the cochlear nucleus during surgery.
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Affiliation(s)
- Qiangyi Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhijun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhenmin Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Bo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingchao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chi Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shun Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Tao Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shiwei Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fu Zhao
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China
| | - Pinan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China
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