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Ding L, Zhang L, Li J, Lin T. Electrode-Modiolus Distance Affects Speech Perception for Lateral Wall Electrodes. Otol Neurotol 2023; 44:e702-e709. [PMID: 37939358 DOI: 10.1097/mao.0000000000004019] [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: 11/10/2023]
Abstract
OBJECTIVES The goal of this study was to use cone-beam computed tomography to locate the electrode-modiolus distance (EMD) and correlate this with speech perception in cochlear implant (CI) recipients of the 31.5-mm lateral wall (LW) electrode arrays. STUDY DESIGN Retrospective review. PATIENTS Forty-five child CI recipients with prelingual profound sensorineural hearing loss of inserted 31.5-mm LW arrays listening with a CI-alone device. INTERVENTIONS Stepwise forward multiple linear regression was performed to control and reduce the variability in implant performance to determine whether EMD affects speech perception. MAIN OUTCOME MEASURES Electrode location (angular insertion depth [AID], EMD), together with the electrode impedance (EI), surgical approach, sex, CI age, and preimplant hearing aid usage were estimated as independent variables. The dependent variables were the Meaningful Use of Speech Scale (MUSS) and parents' evaluation of children's aural/oral performance (PEACH) assessed with the CI alone at 12 months postactivation. RESULTS EMD and CI age were predictive variables for PEACH/MUSS. A negative correlation was found between AID and EMD (r = -0.56, p < 0.01), whereas EMD had a moderately positive correlation with EI (r = 0.32, p < 0.01). CONCLUSIONS The best "location-related" predictor of postoperative speech perception was EMD with a 31.5-mm array among CI-alone users.
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Affiliation(s)
- Ling Ding
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Luguang Zhang
- Department of Medical Imaging, The Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tao Lin
- Department of Neurosurgery, Shandong Second Provincial General Hospital, Jinan, Shandong, 250022, China
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Zamaninezhad L, Mert B, Benav H, Tillein J, Garnham C, Baumann U. Factors influencing the relationship between cochlear health measures and speech recognition in cochlear implant users. Front Integr Neurosci 2023; 17:1125712. [PMID: 37251736 PMCID: PMC10213548 DOI: 10.3389/fnint.2023.1125712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background One factor which influences the speech intelligibility of cochlear implant (CI) users is the number and the extent of the functionality of spiral ganglion neurons (SGNs), referred to as "cochlear health." To explain the interindividual variability in speech perception of CI users, a clinically applicable estimate of cochlear health could be insightful. The change in the slope of the electrically evoked compound action potentials (eCAP), amplitude growth function (AGF) as a response to increased interphase gap (IPG) (IPGEslope) has been introduced as a potential measure of cochlear health. Although this measure has been widely used in research, its relationship to other parameters requires further investigation. Methods This study investigated the relationship between IPGEslope, demographics and speech intelligibility by (1) considering the relative importance of each frequency band to speech perception, and (2) investigating the effect of the stimulus polarity of the stimulating pulse. The eCAPs were measured in three different conditions: (1) Forward masking with anodic-leading (FMA) pulse, (2) Forward masking with cathodic-leading (FMC) pulse, and (3) with alternating polarity (AP). This allowed the investigation of the effect of polarity on the diagnosis of cochlear health. For an accurate investigation of the correlation between IPGEslope and speech intelligibility, a weighting function was applied to the measured IPGEslopes on each electrode in the array to consider the relative importance of each frequency band for speech perception. A weighted Pearson correlation analysis was also applied to compensate for the effect of missing data by giving higher weights to the ears with more successful IPGEslope measurements. Results A significant correlation was observed between IPGEslope and speech perception in both quiet and noise for between-subject data especially when the relative importance of frequency bands was considered. A strong and significant correlation was also observed between IPGEslope and age when stimulation was performed with cathodic-leading pulses but not for the anodic-leading pulse condition. Conclusion Based on the outcome of this study it can be concluded that IPGEslope has potential as a relevant clinical measure indicative of cochlear health and its relationship to speech intelligibility. The polarity of the stimulating pulse could influence the diagnostic potential of IPGEslope.
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Affiliation(s)
| | - Berkutay Mert
- ENT/Audiological Acoustics, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | | | | | | | - Uwe Baumann
- ENT/Audiological Acoustics, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
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Pisa JFD, Almutairi WH, Mackie K, Stangherlin D, Sulkers J, Hochman JB. Impedance Change as an Indicator of Cochlear Implant Failure. Otol Neurotol 2023; 44:e211-e215. [PMID: 36764700 DOI: 10.1097/mao.0000000000003819] [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: 02/12/2023]
Abstract
OBJECTIVE In February 2020, Advanced Bionics initiated a field action notice to remove the MS Ultra (V1) implant from circulation. In this study, we quantify a single site's incidence with device failure and examine the relationship between impedance change and declining speech perception. STUDY DESIGN Retrospective/cohort study. SETTING Tertiary healthcare center. PATIENTS Forty-nine adult patients (52 devices) were implanted between October 2017 and December 2019, with the following exclusion criteria: <18 years of age, medical/surgical failures, and lack of English-language proficiency. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES Postoperative speech perception (AzBio sentence test) scores at 12 months postactivation were compared with repeat testing at 6- to 12-month intervals. Degree of change in impedances from 1 month postactivation was analyzed at similar intervals. Device failures were suspected when impedance levels on three or more electrodes dropped to <3.5 kΩ and AzBio scores declined >15%. Device failures were confirmed through analyses completed by the manufacturer. RESULTS To date, 21% (11/52) of devices have met all three criteria for a confirmed failure with an average decline in speech perception of 27.7 ± 22%. The average length of time for detection of device failure was 21.9 ± 5 months postimplantation. An additional 7 devices (13%) are currently being monitored for failure but have not yet met full criteria. There was no predictive relationship between degree of impedance change and speech perception scores. Electrodes along the entire array (channels 1-16) can be affected. CONCLUSIONS Impedance values can be used as a reliable indicator of device malfunction, thus facilitating patient counseling and early intervention. No correlation was identified between impedance changes and speech perception scores.
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Affiliation(s)
| | | | - Kristy Mackie
- Central Speech and Hearing Clinic, Winnipeg, Manitoba, Canada
| | | | - Jacob Sulkers
- Central Speech and Hearing Clinic, Winnipeg, Manitoba, Canada
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Changes in the Electrically Evoked Compound Action Potential over time After Implantation and Subsequent Deafening in Guinea Pigs. J Assoc Res Otolaryngol 2022; 23:721-738. [PMID: 35948695 PMCID: PMC9789241 DOI: 10.1007/s10162-022-00864-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/12/2022] [Indexed: 01/06/2023] Open
Abstract
The electrically evoked compound action potential (eCAP) is a direct measure of the responsiveness of the auditory nerve to electrical stimulation from a cochlear implant (CI). CIs offer a unique opportunity to study the auditory nerve's electrophysiological behavior in individual human subjects over time. In order to understand exactly how the eCAP relates to the condition of the auditory nerve, it is crucial to compare changes in the eCAP over time in a controlled model of deafness-induced auditory nerve degeneration. In the present study, 10 normal-hearing young adult guinea pigs were implanted and deafened 4 weeks later, so that the effect of deafening could be monitored within-subject over time. Following implantation, but before deafening, most examined eCAP characteristics significantly changed, suggesting increasing excitation efficacy (e.g., higher maximum amplitude, lower threshold, shorter latency). Conversely, inter-phase gap (IPG) effects on these measures - within-subject difference measures that have been shown to correlate well with auditory nerve survival - did not vary for most eCAP characteristics. After deafening, we observed an initial increase in excitability (steeper slope of the eCAP amplitude growth function (AGF), lower threshold, shorter latency and peak width) which typically returned to normal-hearing levels within a week, after which a slower process, probably reflecting spiral ganglion cell loss, took place over the remaining 6 weeks (e.g., decrease in maximum amplitude, AGF slope, peak area, and IPG effect for AGF slope; increase in IPG effect for latency). Our results suggest that gradual changes in peak width and latency reflect the rate of neural degeneration, while peak area, maximum amplitude, and AGF slope reflect neural population size, which may be valuable for clinical diagnostics.
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Hoffmann JAC, Warnecke A, Timm ME, Kludt E, Prenzler NK, Gärtner L, Lenarz T, Salcher RB. Cochlear Implantation in Obliterated Cochlea: A Retrospective Analysis and Comparison between the IES Stiff Custom-Made Device and the Split-Array and Regular Electrodes. J Clin Med 2022; 11:jcm11206090. [PMID: 36294411 PMCID: PMC9605638 DOI: 10.3390/jcm11206090] [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: 09/19/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Anatomical malformations, obliterations of the cochlea, or re-implantations pose particular challenges in cochlear implantation. Treatment methods rely on radiological and intraoperative findings and include incomplete insertion, the implantation of a double array, and radical cochleostomy. In addition, a stiff electrode array, e.g., the IE stiff (IES) custom-made device (CMD, MED-EL), was prescribed individually for those special cases and pre-inserted prior to facilitate cochlear implantation in challenging cases. Data on outcomes after implantation in obliterated cochleae are usually based on individual case reports since standardised procedures are lacking. A retrospective analysis was conducted to analyse our cases on obliterated cochleae treated with MED-EL devices in order to allow the different cases to be compared. Impedances and speech perception data of patients treated with the IES CMD and the double array were retrospectively compared to patients treated with a STANDARD or FLEX electrode array (the REGULAR group). Patients with a Split-Array CMD had a poor speech perception when compared to patients treated with the IES CMD device. Thus, the IES CMD can successfully be used in patients with obliterated cochleae who would otherwise be non-users, candidates for a Split-Array CMD, or candidates for partial insertion with insufficient cochlear coverage.
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Affiliation(s)
| | - Athanasia Warnecke
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Max Eike Timm
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Eugen Kludt
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Nils Kristian Prenzler
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Lutz Gärtner
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
| | - Rolf Benedikt Salcher
- Department of Otorhinolaryngology, Head and Neck Surgery, Hannover Medial School, 30625 Hannover, Germany
- Cluster of Excellence “Hearing4all”, Hannover Medical School, 30625 Hannover, Germany
- Correspondence:
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Caswell-Midwinter B, Doney EM, Arjmandi MK, Jahn KN, Herrmann BS, Arenberg JG. The Relationship Between Impedance, Programming and Word Recognition in a Large Clinical Dataset of Cochlear Implant Recipients. Trends Hear 2022; 26:23312165211060983. [PMID: 35018875 PMCID: PMC8761885 DOI: 10.1177/23312165211060983] [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] [Indexed: 11/15/2022] Open
Abstract
Cochlear implant programming typically involves measuring electrode impedance, selecting a speech processing strategy and fitting the dynamic range of electrical stimulation. This study retrospectively analyzed a clinical dataset of adult cochlear implant recipients to understand how these variables relate to speech recognition. Data from 425 implanted post-lingually deafened ears with Advanced Bionics devices were analyzed. A linear mixed-effects model was used to infer how impedance, programming and patient factors were associated with monosyllabic word recognition scores measured in quiet. Additional analyses were conducted on subsets of data to examine the role of speech processing strategy on scores, and the time taken for the scores of unilaterally implanted patients to plateau. Variation in basal impedance was negatively associated with word score, suggesting importance in evaluating the profile of impedance. While there were small, negative bivariate correlations between programming level metrics and word scores, these relationships were not clearly supported by the model that accounted for other factors. Age at implantation was negatively associated with word score, and duration of implant experience was positively associated with word score, which could help to inform candidature and guide expectations. Electrode array type was also associated with word score. Word scores measured with traditional continuous interleaved sampling and current steering speech processing strategies were similar. The word scores of unilaterally implanted patients largely plateaued within 6-months of activation. However, there was individual variation which was not related to initially measured impedance and programming levels.
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Affiliation(s)
- Benjamin Caswell-Midwinter
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | | | - Meisam K Arjmandi
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Kelly N Jahn
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA
| | - Barbara S Herrmann
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
| | - Julie G Arenberg
- Department of Otolaryngology - Head and Neck Surgery, 1811Harvard Medical School, Boston, MA, USA.,Eaton-Peabody Laboratories, Boston, MA, USA.,Massachusetts Eye and Ear, 1866Audiology Division, Boston, MA, USA
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