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Yamazaki H, Moroto S, Yamazaki T, Tamaya R, Fujii N, Fujiwara K, Yamamoto N, Naito Y. Significant influence of prelingual deafness but less impact of elderly age at implantation on long-term psychoacoustic CI programming parameters. Auris Nasus Larynx 2024; 51:846-852. [PMID: 39084004 DOI: 10.1016/j.anl.2024.07.007] [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: 06/04/2024] [Revised: 07/08/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE This study aimed to elucidate the long-term impact of prelingual deafness and elderly age at cochlear implantation on cochlear implant (CI) programming parameters and CI thresholds METHODS: We retrospectively reviewed patients who underwent cochlear implantation less than 5 years (Prelingual group) and equal and more than 18 years in our institute. The latter group was further divided into Adult and Elderly groups according to whether the patient was younger or older than 65 at implantation. From 152, 69, and 55 patients in the Prelingual, Adult, and Elderly groups, 242, 92, and 58 ears were included. We compared CI thresholds and CI programming parameters, including impedances, T/C levels, and dynamic ranges for 8 years after implantation between the Prelingual, Adult, and Elderly groups. RESULTS The Prelingual group showed consistently lower CI thresholds than the Adult and Elderly groups during the postoperative 2-8 years, but no difference was detected between the Elderly and Adult groups, except at the postoperative 4 years. The elderly group's CI thresholds did not deteriorate until postoperative 8 years. The Prelingual group showed consistently larger T/C levels (minimum/maximum current strength from CI), especially C levels, than the other two groups. At the same time, there was no significant difference between the Elderly and Adult groups except for smaller dynamic ranges in the Elderly group until postoperative 2 years. These results in the CI programming parameters might explain the lower CI thresholds in the Prelingual group than in the other groups. Focusing on CI maps 1 and 3 years after implantation, the strength of the T/C levels was similar for all channels in the Prelingual group, but the Adult and Elderly groups showed larger electrical stimuli in channels responsible for the middle frequencies than those for the lower or higher frequencies. CONCLUSIONS Our results suggest a significant influence of prelingual deafness but less impact of elderly age at implantation on long-term CI programming parameters and CI thresholds. The larger C levels and lower CI thresholds in the Prelingual group than in the Adult and Elderly groups implied that CI children with prelingual deafness tolerate and prefer larger CI stimuli, which may reflect the CI-dependent development of their auditory system before the critical period. No age-related reduction in hearing thresholds was observed in the Elderly group, probably because the CI compensates for age-related dysfunction of the peripheral auditory system.
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Affiliation(s)
- Hiroshi Yamazaki
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Hearing Research Division, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan; Foundation for Biomedical Research and Innovation at Kobe, Kobe City, Japan; Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Saburo Moroto
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Comprehensive Ear and Hearing Center, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomoko Yamazaki
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Comprehensive Ear and Hearing Center, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Rinko Tamaya
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Comprehensive Ear and Hearing Center, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Naoko Fujii
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Comprehensive Ear and Hearing Center, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keizo Fujiwara
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Norio Yamamoto
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Comprehensive Ear and Hearing Center, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasushi Naito
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan; Comprehensive Ear and Hearing Center, Kobe City Medical Center General Hospital, Kobe, Japan
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Mushtaq F, Soulby A, Boyle P, Papoutselou E, Nunn T, Hartley DEH. Self-Assessment of Cochlear Health by New Cochlear Implant Recipients: Daily Impedance, Electrically Evoked Compound Action Potential and Electrocochleography Measurements Over the First Three Postoperative Months. Otol Neurotol 2024; 45:e517-e524. [PMID: 38918070 DOI: 10.1097/mao.0000000000004227] [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: 06/27/2024]
Abstract
HYPOTHESES In newly implanted cochlear implant (CI) users, electrically evoked compound action (eCAPs) and electrocochleography (ECochGs) will remain stable over time. Electrode impedances will increase immediately postimplantation due to the initial inflammatory response, before decreasing after CI switch-on and stabilizing thereafter. BACKGROUND The study of cochlear health (CH) has several applications, including explaining variation in CI outcomes, informing CI programming strategies, and evaluating the safety and efficacy of novel biological treatments for hearing loss. Very early postoperative CH patterns have not previously been intensively explored through longitudinal daily testing. Thanks to technological advances, electrode impedances, eCAPs, and ECochGs can be independently performed by CI users at home to monitor CH over time. METHODS A group of newly implanted CI users performed daily impedances, eCAPs, and ECochGs for 3 months at home, starting from the first day postsurgery (N = 7) using the Active Insertion Monitoring system by Advanced Bionics. RESULTS Measurement validity of 93.5, 93.0, and 81.6% for impedances, eCAPs, and ECochGs, respectively, revealed high participant compliance. Impedances increased postsurgery before dropping and stabilizing after switch-on. eCAPs showed good stability, though statistical analyses revealed a very small but significant increase in thresholds over time. Most ECochG thresholds did not reach the liberal signal-to-noise criterion of 2:1, with low threshold stability over time. CONCLUSION Newly implanted CI recipients can confidently and successfully perform CH recordings at home, highlighting the valuable role of patients in longitudinal data collection. Electrode impedances and eCAPs are promising objective measurements for evaluating CH in newly implanted CI users.
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Affiliation(s)
| | - Andrew Soulby
- St. Thomas' Hearing Implant Centre, St. Thomas' Hospital, London, United Kingdom
| | - Patrick Boyle
- Advanced Bionics GmbH, European Research Center, Hannover, Germany
| | | | - Terry Nunn
- St. Thomas' Hearing Implant Centre, St. Thomas' Hospital, London, United Kingdom
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Zhang L, Schmidt FH, Oberhoffner T, Ehrt K, Cantré D, Großmann W, Schraven SP, Mlynski R. Transimpedance Matrix Can Be Used to Estimate Electrode Positions Intraoperatively and to Monitor Their Positional Changes Postoperatively in Cochlear Implant Patients. Otol Neurotol 2024; 45:e289-e296. [PMID: 38346796 DOI: 10.1097/mao.0000000000004145] [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: 03/14/2024]
Abstract
OBJECTIVE Accurate positioning of the electrode array during cochlear implant (CI) surgery is crucial for achieving optimal hearing outcomes. Traditionally, postoperative radiological imaging has been used to assess electrode position. Transimpedance matrix (TIM) measurements have also emerged as a promising method for assessing electrode position. This involves utilizing electric field imaging to create an electric distance matrix by analyzing voltage variations among adjacent electrodes. This study aimed to investigate the feasibility of using intraoperative TIM measurements to estimate electrode position and monitor postoperative changes. STUDY DESIGN Retrospective cohort study. SETTING University Medical center, tertiary academic referral center. PATIENTS Patients undergoing CI (CI622) surgery between January 2019 and June 2022. INTERVENTION CI electrode positions and maximal angular insertion depths (maxAID) were determined using X-ray imaging according to Stenvers' projection. The mean gradient phase (MGP) was extracted from the TIM, and a correlation between the MGP and maxAID was examined. A model was then built to estimate the maxAID using the MGP, and changes in electrode location over time were assessed using this model. MAIN OUTCOME MEASURES Twenty-four patients were included in this study. A positive correlation between the maxAID and the MGP ( R = 0.7, p = 0.0001) was found. The established model was able to predict the maxAID with an accuracy of 27.7 ± 4.4°. Comparing intraoperative and postoperative TIM measurements, a decrease of 24.1° ± 10.7° in maxAID over time was observed. CONCLUSION TIM measurements are useful for estimating the insertion depth of the electrode and monitoring changes in the electrode's position over time.
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Affiliation(s)
- Lichun Zhang
- Departments of Otorhinolaryngology, Head and Neck Surgery, "Otto Körner,"
| | | | - Tobias Oberhoffner
- Departments of Otorhinolaryngology, Head and Neck Surgery, "Otto Körner,"
| | - Karsten Ehrt
- Departments of Otorhinolaryngology, Head and Neck Surgery, "Otto Körner,"
| | - Daniel Cantré
- Radiology, Rostock University Medical Center, Rostock, Germany
| | - Wilma Großmann
- Departments of Otorhinolaryngology, Head and Neck Surgery, "Otto Körner,"
| | | | - Robert Mlynski
- Departments of Otorhinolaryngology, Head and Neck Surgery, "Otto Körner,"
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Soncini A, Franzini S, Di Marco F, Riccardi P, Bacciu A, Pasanisi E, Di Lella F. Early fitting in cochlear implant surgery: preliminary results. Eur Arch Otorhinolaryngol 2024; 281:61-66. [PMID: 37417997 PMCID: PMC10764441 DOI: 10.1007/s00405-023-08076-9] [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: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Cochlear implants are usually activated 3-5 weeks after surgery; to date, no universal protocol exists regarding switch on and fitting of these devices. The aim of the study was to assess safety and functional results of activation and fitting of cochlear implant within 24 h following surgery. METHODS In this retrospective case-control study, 15 adult patients who underwent cochlear implant surgery, for a total of 20 cochlear implant procedures were analyzed. In particular, clinical safety and feasibility were investigated by examinating patients at activation and at each follow-up. Values of electrodes' impedance and most comfortable loudness (MCL) were analyzed from the time of surgery to 12 months after activation. Free-field pure tone average (PTA) was also recorded. RESULTS No major or minor complications were reported and all patients could perform the early fitting. Activation modality influenced impedance values only in the short term but the differences were not statistically significant (p > 0.05). Mean MCL values in the early fitting group were lower than MCL of the late fitting in all follow-up sessions, and the difference was statistically significant (p < 0.05). The mean PTA was lower in the early fitting group but the difference was not statistically significant (p < 0.05). CONCLUSIONS Early fitting of cochlear implants is safe, allows for an early rehabilitation and can have possible beneficial effects on stimulation levels and dynamic range.
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Affiliation(s)
- Arianna Soncini
- Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43121, Parma, Italy.
| | - Sebastiano Franzini
- Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43121, Parma, Italy
| | - Francesca Di Marco
- Advanced Bionics Italia, Via Privata Raimondo Montecuccoli, 30, 20147, Milan, MI, Italy
| | - Pasquale Riccardi
- Advanced Bionics Italia, Via Privata Raimondo Montecuccoli, 30, 20147, Milan, MI, Italy
| | - Andrea Bacciu
- Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43121, Parma, Italy
| | - Enrico Pasanisi
- Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43121, Parma, Italy
| | - Filippo Di Lella
- Department of Medicine and Surgery, University of Parma, via Gramsci 14, 43121, Parma, Italy
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Söderqvist S, Sivonen V, Koivisto J, Aarnisalo A, Sinkkonen ST. Spread of the intracochlear electrical field: Implications for assessing electrode array location in cochlear implantation. Hear Res 2023; 434:108790. [PMID: 37196460 DOI: 10.1016/j.heares.2023.108790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
The electrode-generated intracochlear electrical field (EF) spreads widely along the scala tympani surrounded by poorly-conducting tissue and it can be measured with monopolar transimpedance matrix (TIMmp). Bipolar TIM (TIMbp) allows estimations of local potential differences. With TIMmp, the correct alignment of the electrode array can be assessed, and TIMbp may be useful in more subtle evaluations of the electrode array's intracochlear location. In this temporal bone study, we investigated the effect of the cross-sectional scala area (SA) and the electrode-medial-wall distance (EMWD) on both TIMmp and TIMbp using three types of electrode arrays. Also, multiple linear regressions based on the TIMmp and TIMbp measurements were used to estimate the SA and EMWD. Six cadaver temporal bones were consecutively implanted with a lateral-wall electrode array (Slim Straight) and with two different precurved perimodiolar electrode arrays (Contour Advance and Slim Modiolar) for variation in EMWD. The bones were imaged with cone-beam computed tomography with simultaneous TIMmp and TIMbp measurements. The results from imaging and EF measurements were compared. SA increased from apical to basal direction (r = 0.96, p < 0.001). Intracochlear EF peak negatively correlated with SA (r = -0.55, p < 0.001) irrespective of the EMWD. The rate of the EF decay did not correlate with SA but it was faster in the proximity of the medial wall than in more lateral positions (r = 0.35, p < 0.001). For a linear comparison between the EF decaying proportionally to squared distance and anatomic dimensions, a square root of inverse TIMbp was applied and found to be affected by both SA and EMWD (r = 0.44 and r = 0.49, p < 0.001 for both). A regression model confirmed that together TIMmp and TIMbp can be used to estimate both SA and EMWD (R2 = 0.47 and R2 = 0.44, respectively, p < 0.001 for both). In TIMmp, EF peaks grow from basal to apical direction and EF decay is steeper in the proximity of the medial wall than in more lateral positions. Local potentials measured via TIMbp correlate with both SA and EMWD. Altogether, TIMmp and TIMbp can be used to assess the intracochlear and intrascalar position of the electrode array, and they may reduce the need for intra- and postoperative imaging in the future.
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Affiliation(s)
- Samuel Söderqvist
- Department of Otorhinolaryngology - Head and Neck Surgery and Tauno Palva Laboratory, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, Helsinki 00130, Finland.
| | - Ville Sivonen
- Department of Otorhinolaryngology - Head and Neck Surgery and Tauno Palva Laboratory, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, Helsinki 00130, Finland
| | - Juha Koivisto
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Antti Aarnisalo
- Department of Otorhinolaryngology - Head and Neck Surgery and Tauno Palva Laboratory, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, Helsinki 00130, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery and Tauno Palva Laboratory, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, Helsinki 00130, Finland
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Schwitzer S, Gröschel M, Hessel H, Ernst A, Basta D. Short-term overstimulation affects peripheral but not central excitability in an animal model of cochlear implantation. Cochlear Implants Int 2023:1-10. [PMID: 37127529 DOI: 10.1080/14670100.2023.2202940] [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: 05/03/2023]
Abstract
Objective: A smallbut persistent proportion of individuals do not gain the expected benefit from cochlear implants(CI). A step-change in the understanding of factors affecting outcomes could come through data science. This study evaluates clinical data capture to assess the quality and utility of Cl user's health records for data science, by assessing the recording of otitis media. Otitis media was selected as it is associated with the development of sensorineural hearing loss and may affect cochlear implant outcomes.Methods: A retrospective service improvement project ·evaluating the medical records of 594 people with a Cl under the care of the University of Southampton Auditory Implant Service between 2014 and 2020.Results: The clinicalrecords are suitable for data science research. Of the cohort studied 20% of Adults and more than 40% of the paediatric cases have a history of middle ear inflammation.Discussion: Data science has potentialto improve cochlear implant outcomes and improve understanding of the mechanisms underlying poor performance, through retrospective secondary analysis of real-world data.Conclusion: Implant centres and the British Cochlear Implant Group National Hearing Implant Registry are urged to consider the importance of consistently and accurate recording of patient data over time for each Cl user. Data where links to hearing loss have been identified, such as middle ear inflammation, may be particularly valuable in future analyses and to inform clinical trials.
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Affiliation(s)
- Susanne Schwitzer
- Department of ENT at Unfallkrankenhaus Berlin, Charité Medical School, University of Berlin, Berlin, Germany
| | - Moritz Gröschel
- Department of ENT at Unfallkrankenhaus Berlin, Charité Medical School, University of Berlin, Berlin, Germany
| | - Horst Hessel
- Cochlear Deutschland GmbH & Co. KG, Hannover, Germany
| | - Arne Ernst
- Department of ENT at Unfallkrankenhaus Berlin, Charité Medical School, University of Berlin, Berlin, Germany
| | - Dietmar Basta
- Department of ENT at Unfallkrankenhaus Berlin, Charité Medical School, University of Berlin, Berlin, Germany
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Meghanadh KR, Saxena U, Kumar SBR, Chacko G, N V, S S, Mehta G. Electrode impedances in children with cochlear implants: Comparison between intra-operative Switch ON and post-operative Switch ON. Cochlear Implants Int 2023; 24:65-72. [PMID: 37354550 DOI: 10.1080/14670100.2023.2172827] [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] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Intra-operative Switch ON (IOSO) is a novel clinical approach of activating the cochlear implant during the surgery adopted at our cochlear implantation center.We compared the electrode impedances in two conditions of Switch ON of cochlear implants; IOSO and post-operative Switch ON (POSO, 21st day of surgery). METHODS Electrode impedances of 185 cochlear implants, 93 of whom received IOSO and 92 POSO, recorded over 10 years were analyzed retrospectively. RESULTS Electrode impedances of IOSO group were significantly lower than POSO group at Switch ON and 3rd, 6th, 9th, and 12th months post cochlear implantation. In IOSO group, 3rd month's electrode impedances were high when compared to electrode impedances at Switch ON. Beyond the 3rd months, electrode impedance remained unchanged. In POSO group, there were no significant differences in electrode impedances between any measurement schedule. CONCLUSIONS To our knowledge, this is the first study to investigate in detail the electrode impedances of the two above-said conditions of Switch ON in the process of cochlear implantation. This study concludes that timing of CI Switch ON has a significant effect on the electrode impedances. These results may affect the choice of cochlear implant Switch ON timing.
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Affiliation(s)
- K R Meghanadh
- Department of ENT, MAA ENT Hospitals, Hyderabad, Telangana, India
| | - Udit Saxena
- Department of ENT, MAA ENT Hospitals, Hyderabad, Telangana, India
- Department of Audiology, MAA Institute of Speech & Hearing, Hyderabad, Telangana, India
- Audiology and Speech-Language Pathology College, GMERS Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - S B Rathna Kumar
- Department of Audiology, AYJNISHD, Mumbai, Maharashtra, India
- Department of Applied Linguistics, University of Hyderabad, Hyderabad, Telangana, India
| | - Gish Chacko
- Department of ENT, MAA ENT Hospitals, Hyderabad, Telangana, India
- Department of Audiology, MAA Institute of Speech & Hearing, Hyderabad, Telangana, India
| | - Vikas N
- Department of Audiology, MAA Institute of Speech & Hearing, Hyderabad, Telangana, India
| | - Sandhra S
- Department of Audiology, MAA Institute of Speech & Hearing, Hyderabad, Telangana, India
| | - Gunjan Mehta
- Audiology and Speech-Language Pathology College, GMERS Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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Mushtaq F, Soulby A, Boyle P, Nunn T, Hartley DEH. Self-assessment of cochlear health by cochlear implant recipients. Front Neurol 2022; 13:1042408. [DOI: 10.3389/fneur.2022.1042408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
Recent technological advances in cochlear implant (CI) telemetry have enabled, for the first time, CI users to perform cochlear health (CH) measurements through self-assessment for prolonged periods of time. This is important to better understand the influence of CH on CI outcomes, and to assess the safety and efficacy of future novel treatments for deafness that will be administered as adjunctive therapies to cochlear implantation. We evaluated the feasibility of using a CI to assess CH and examined patterns of electrode impedances, electrically-evoked compound action potentials (eCAPs) and electrocochleography (ECochGs), over time, in a group of adult CI recipients. Fifteen subjects were trained to use the Active Insertion Monitoring tablet by Advanced Bionics, at home for 12 weeks to independently record impedances twice daily, eCAPs once weekly and ECochGs daily in the first week, and weekly thereafter. Participants also completed behavioral hearing and speech assessments. Group level measurement compliance was 98.9% for impedances, 100% for eCAPs and 99.6% for ECochGs. Electrode impedances remained stable over time, with only minimal variation observed. Morning impedances were significantly higher than evening measurements, and impedances increased toward the base of the cochlea. eCAP thresholds were also highly repeatable, with all subjects showing 100% measurement consistency at, at least one electrode. Just over half of all subjects showed consistently absent thresholds at one or more electrodes, potentially suggesting the existence of cochlear dead regions. All subjects met UK NICE guidelines for cochlear implantation, so were expected to have little residual hearing. ECochG thresholds were, unsurprisingly, highly erratic and did not correlate with audiometric thresholds, though lower ECochG thresholds showed more repeatability over time than higher thresholds. We conclude that it is feasible for CI users to independently record CH measurements using their CI, and electrode impedances and eCAPs are promising measurements for objectively assessing CH.
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Sawaf T, Vovos R, Hadford S, Woodson E, Anne S. Utility of intraoperative neural response telemetry in pediatric cochlear implants. Int J Pediatr Otorhinolaryngol 2022; 162:111298. [PMID: 36088734 DOI: 10.1016/j.ijporl.2022.111298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/19/2022] [Accepted: 08/27/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the relationship between intraoperative neural response telemetry (NRT) and postoperative Threshold (T) and Comfort (C) levels and their correlation over time after cochlear implantation (CI). METHODS A retrospective chart review was conducted of patients less than 18 years of age who had CI with a Cochlear™ device and NRT at an academic center from 2010 to 2019. Data collected included demographics, extrapolated NRT threshold (tNRT) and slope of amplitude for electrodes 1, 6/7, 11/12, 16, and 22, and postoperative T and C levels at initial activation and 1 month, 3 months, and 1 year post-activation. Associations between T and C levels and slope of amplitude or tNRT were assessed using Spearman's rank correlation. RESULTS 39 patients (65 CIs) were included. Intraoperative tNRT correlated strongly with T and C levels at 1 month, 3 months, and 1 year post-activation on nearly all electrodes. Electrodes 6/7 and 11/12 at 3 months and electrodes 6/7 at 1 year did not correlate with T and C levels. There was no significant relationship between the slope of amplitude for nearly all electrodes and the T or C levels post-activation. CONCLUSION NRT is invaluable in children, with significant correlation found between tNRT and T and C levels over time on nearly all electrodes. There are changes in T and C levels in electrodes 6/7 and 11/12 over time, and close surveillance is beneficial to tailor programming as needed.
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Affiliation(s)
- Tuleen Sawaf
- Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Rachel Vovos
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Stephen Hadford
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Erika Woodson
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA
| | - Samantha Anne
- Cleveland Clinic, Head and Neck Institute, 9500 Euclid Avenue, Cleveland, OH, 44995, USA.
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Brotto D, Caserta E, Sorrentino F, Favaretto N, Marioni G, Martini A, Bovo R, Gheller F, Trevisi P. Long-Term Impedance Trend in Cochlear Implant Users with Genetically Determined Congenital Profound Hearing Loss. J Am Acad Audiol 2022; 33:105-114. [PMID: 35577055 DOI: 10.1055/s-0041-1739290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Impedance is a basic parameter registered at any cochlear implant (CI) fitting section. It is useful in monitoring electrode functioning and the status of the surrounding anatomical structures. PURPOSE The main aim of this study is to evaluate the 5-year impedance-value trend in patients affected by congenital genetically determined profound hearing loss implanted with Cochlear Nucleus devices. RESEARCH DESIGN Observational, retrospective, monocentric study. STUDY SAMPLE Twenty-seven consecutive patients (9 females: 12.0 ± 7.6 years old; range: 4.2-40.4) with genetic diagnosis of GJB2 mutation causing congenital profound hearing loss who underwent cochlear implantation from 2010 to 2020 with good auditory benefit. INTERVENTION Impedance values of the CIs were obtained from the CIs' programming software that registers those parameters for each follow-up section of each patient. DATA COLLECTION AND ANALYSIS Impedance values were measured over time (activation, 6, 12, 24, and 60 months after cochlear implantation), for each of the 22 electrodes, in common ground, monopolar 1, monopolar 2, and monopolar 1 + 2 stimulation modes. RESULTS A significant variation was found between CI activation and 6-month follow-up. This difference was found for each of the 22 electrodes. Electrodes 1 to 4 showed higher impedance values compared with all other electrodes in each time interval. Repeated-measures analysis of variance ruled out significant variations in impedance values from 6-month to 5-year follow-up. CONCLUSIONS Impedance values were extremely stable after activation, at least for the first 5 years. In these cases, even minimal impedance variations should be carefully evaluated for their possible implications on hearing performance.
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Affiliation(s)
- Davide Brotto
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Ezio Caserta
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Flavia Sorrentino
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Niccolò Favaretto
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Gino Marioni
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Alessandro Martini
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Roberto Bovo
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Flavia Gheller
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Patrizia Trevisi
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padova, Padova, Italy
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Kocabay AP, Cinar BC, Batuk MO, Yarali M, Sennaroglu G. Pediatric cochlear implant fitting parameters in inner ear malformation: Is it same with normal cochlea? Int J Pediatr Otorhinolaryngol 2022; 155:111084. [PMID: 35217268 DOI: 10.1016/j.ijporl.2022.111084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim was to evaluate the cochlear implant (CI) mapping parameters of CI users with inner ear malformation (IEM) and to reveal the changes in parameters over time. METHODS In total, 118 CI users were included with 127 ears (68-IEM; 59-normal cochlear anatomy) in present retrospective study. The impedance measurements, thresholds levels-THR, most comfortable levels- MCL, pulse width-PW and rate values were analyzed in both IEM and control group at the initial activation, 6th,12th and 24th months postoperatively. RESULTS There were statistically significant differences in impedance measurements in several time points. And also, there was a remarkable difference in THR & MCL and PW values between IEM and control groups in all time points (p < 0.05). THR & MCL levels and PW values increased significantly between all time periods in both groups (p < 0,008) and values of parameters in IEM-group were higher than those of control group. When comparing rates, statistically significant difference was observed only at the initial activation in both within (p < 0.001) and between groups (p = 0.03). CONCLUSION Pediatric CI users with IEM need individual changes in fitting parameters. More frequent map sessions should be planned as they require more PW, THR and MCL increase over time. The increase rate differs between IEM subgroups depending on the deviation of malformation from the normal cochlear anatomy. This study is the first to in its attempt to reveal the mapping characteristics and long-term changes in pediatric CI users with different IEM subgroups.
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Affiliation(s)
| | | | | | - Mehmet Yarali
- Hacettepe University, Department of Audiology, Ankara, Turkey
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12
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Vos TG, Brown KD, Buss E, Bucker AL, Dedmon MM, O'Connell BP, Raymond J, Dillon MT. Influence of Postponed Follow-Up after Cochlear Implant Activation during the COVID-19 Pandemic on Aided Sound Field Detection and Speech Recognition. Audiol Neurootol 2021; 27:227-234. [PMID: 34808626 PMCID: PMC8678240 DOI: 10.1159/000519908] [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: 03/08/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to assess the influence of postponing the first post-activation follow-up due to the COVID-19 pandemic on the aided sound field detection thresholds and speech recognition of cochlear implant (CI) users. METHODS A retrospective review was performed at a tertiary referral center. Two groups of adult CI recipients were evaluated: (1) patients whose first post-activation follow-up was postponed due to COVID-19 closures (postponed group; n = 10) and (2) a control group that attended recommended post-activation follow-ups prior to the COVID-19 pandemic (control group; n = 18). For both groups, electric thresholds were estimated at initial activation based on comfort levels and were measured behaviorally at subsequent post-activation follow-ups. For the control group, behavioral thresholds were measured at the 1-month follow-up. For the postponed group, behavioral thresholds were not measured until 3 months post-activation since the 1-month follow-up was postponed. The aided pure-tone average (PTA) and word recognition results were compared between groups at the 3-month follow-up and at an interim visit 2-9 weeks later. RESULTS At the 3-month follow-up, the postponed group had significantly poorer word recognition (23 vs. 42%, p = 0.027) and aided PTA (42 vs. 37 dB HL, p = 0.041) than the control group. No significant differences were observed between 3-month data from the control group and interim data from the postponed group. CONCLUSIONS The postponed follow-up after CI activation was associated with poorer outcomes, both in terms of speech recognition and aided audibility. However, these detrimental effects were reversed following provision of an individualized map, with behaviorally measured electric threshold and comfort levels. While adult CI recipients demonstrate an improvement in speech recognition with estimated electric thresholds, the present results suggest that behavioral mapping within the initial weeks of device use may support optimal outcomes.
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Affiliation(s)
- Teresa G Vos
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kevin D Brown
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Buss
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea L Bucker
- Department of Audiology, UNC Health Care, Chapel Hill, North Carolina, USA
| | - Matthew M Dedmon
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brendan P O'Connell
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jenna Raymond
- Department of Audiology, UNC Health Care, Chapel Hill, North Carolina, USA
| | - Margaret T Dillon
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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13
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Parreño M, Di Lella FA, Fernandez F, Boccio CM, Ausili SA. Toward Self-Measures in Cochlear Implants: Daily and “Homemade” Impedance Assessment. Front Digit Health 2020; 2:582562. [PMID: 34713054 PMCID: PMC8521944 DOI: 10.3389/fdgth.2020.582562] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/15/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cochlear implant (CI) impedance reflects the status of the electro neural interface, potentially acting as a biomarker for inner ear injury. Most impedance shifts are diagnosed retrospectively because they are only measured in clinical appointments, with unknown behavior between visits. Here we study the application and discuss the benefits of daily and remote impedance measures with software specifically designed for this purpose. Methods: We designed software to perform CI impedance measurements without the intervention of health personnel. Ten patients were recruited to self-measure impedance for 30 days at home, between CI surgery and activation. Data were transferred to a secured online server allowing remote monitoring. Results: Most subjects successfully performed measurements at home without supervision. Only a subset of measurements was missed due to lack of patient engagement. Data were successfully and securely transferred to the online server. No adverse events, pain, or discomfort was reported by participants. Discussion: This work overviews a flexible and highly configurable platform for self-measurement CI impedance. This novel approach simplifies the CI standard of care by reducing the number of clinical visits and by proving useful and constant information to CI clinicians.
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Affiliation(s)
- Matias Parreño
- Department of Otolaryngology, Hospital Italiano, Buenos Aires, Argentina
| | - Federico A. Di Lella
- Department of Otolaryngology, Hospital Italiano, Buenos Aires, Argentina
- *Correspondence: Federico A. Di Lella
| | | | - Carlos M. Boccio
- Department of Otolaryngology, Hospital Italiano, Buenos Aires, Argentina
| | - Sebastian A. Ausili
- Department of Otolaryngology, University of Miami, Coral Gables, FL, United States
- Sebastian A. Ausili
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14
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Saoji AA, Adkins WJ, Olund AP, Graham M, Patel NS, Neff BA, Carlson ML, Driscoll CLW. Increase in cochlear implant electrode impedances with the use of electrical stimulation. Int J Audiol 2020; 59:881-888. [PMID: 32749178 DOI: 10.1080/14992027.2020.1799251] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Electrode impedances play a critical role in cochlear implant programming. It has been previously shown that impedances rise during periods of non-use, such as the post-operative recovery period. Then when the device is activated and use is initiated, impedances fall and are typically stable. In this study, we report a new pattern where electrode impedances increase with device use and decrease with device rest. DESIGN Electrode impedances were measured three to four times every day over a span of 1-3 months for two cochlear implant patients. STUDY SAMPLE Two patients with a Nucleus cochlear implant participated in this study. RESULTS Both subjects in this study show wide fluctuations in electrode impedances. By taking serial electrode impedance measurements throughout a day of use, we observe that electrode impedances consistently increase with device use and decrease with device rest. CONCLUSION In this study, we report two cases of electrode impedances increasing as a function of device use. Numerous management strategies were employed to reduce this effect but none prevailed; a clear pathophysiologic mechanism remains elusive. Further study into the cause of this electrode impedance pattern is warranted to establish a management strategy for these cochlear implant users.
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Affiliation(s)
- Aniket A Saoji
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Weston J Adkins
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Amy P Olund
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Madison Graham
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Neil S Patel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Colin L W Driscoll
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN, USA
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15
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Allam A, Eldegwi A. Efficacy of using NRT thresholds in cochlear implants fitting, in prelingual pediatric patients. J Otol 2020; 14:128-135. [PMID: 32742272 PMCID: PMC7387843 DOI: 10.1016/j.joto.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the efficacy of using neural response telemetry (NRT) thresholds in predicting behavioural thresholds during programming of cochlear implant in prelingual children. Method Prospective study of 28 cochlear implants implanted with Nucleus 24 cochlear implant. We recorded NRT-thresholds on electrode numbers 1, 6, 11, 16 and 22 of the electrode array in each patient, the neural response thresholds were correlated with the behavioural map after six months of programming the device. Results The mean neural response telemetry level was significantly higher than the mean threshold level (T-level) but lower than the comfortable level (C-level) in all the electrodes tested. NRT levels could statistically significantly predict T behavioural levels and comfortable behavioural levels, p < 0.01. There was a strong positive correlation between comfortable thresholds and neural response telemetry level measurements and behavioural threshold level and neural response telemetry threshold measurements. Conclusion There is a useful role for neural response telemetry values in predicting the behavioural threshold and comfortable values in prelingual children. Combining the NRT values with behavioural observations can improve the programming of cochlear implants.
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Affiliation(s)
- Ahmed Allam
- Department of Otolaryngology, Mansoura University, Egypt
| | - Ahmed Eldegwi
- Department of Otolaryngology, Mansoura University, Egypt
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16
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Aebischer P, Meyer S, Caversaccio M, Wimmer W. Intraoperative Impedance-Based Estimation of Cochlear Implant Electrode Array Insertion Depth. IEEE Trans Biomed Eng 2020; 68:545-555. [PMID: 32746052 DOI: 10.1109/tbme.2020.3006934] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Cochlear implant impedances are influenced by the intracochlear position of the electrodes. Herein, we present an intuitive approach to calculate tissue resistances from transimpedance recordings, ultimately enabling to estimate the insertion depth of cochlear implant electrodes. METHODS Electrode positions were measured in computed-tomography images of 20 subjects implanted with the same lateral wall cochlear implant model. The tissue resistances were estimated from intraoperative telemetry data using bivariate spline extrapolation from the transimpedance recordings. Using a phenomenological model, the electrode insertion depths were estimated. RESULTS The proposed method enabled the linear insertion depth of all electrodes to be estimated with an average error of 0.76 ± 0.53 mm. CONCLUSION Intraoperative telemetry recordings correlate with the linear and angular depth of electrode insertion, enabling estimations with an accuracy that can be useful for clinical applications. SIGNIFICANCE The proposed method can be used to objectively assess surgical outcomes during and after cochlear implantation based on non-invasive and readily available telemetry recordings.
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17
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Abstract
OBJECTIVES To assess the effect on impedance levels of intraoperative reinsertion of a cochlear implant (CI) array compared with matched controls. STUDY DESIGN Retrospective patient review. SETTING Cochlear implant center. PATIENTS CI recipients in the Sydney Cochlear Implant Centre (SCIC) database who required intraoperative array reinsertion and matched controls. Exclusion criteria; known preceding meningitis or labyrinthitis ossificans; electrode array buckling; incomplete "final" insertion. INTERVENTION Cochlear implantation. MAIN OUTCOME MEASURES Impedance values measured intraoperatively, at switch on, 3 months, 6 months, and 12 months postoperatively were analyzed. The Generalized Estimating Equation (GEE) Model was used to compare cases with controls for each device, at each time point, and for each channel. RESULTS Thirty-one reinsertion cases identified; six CI 422 arrays; 14 CI 24RE (ST) arrays, and 11 CI 512 arrays. No increase in impedance levels was found in the reinsertion cases when compared with their matched controls. The only statistical difference in impedance was seen in the CI 422 cohort at switch on with the reinsertion cases having lower impedances (p = 0.03). CONCLUSION This is the first study to examine impedance values in patients who underwent intraoperative CI array reinsertion and to compare them with the impedances of matched controls. No significant increase found in impedances between our reinsertion cases and matched controls, suggesting the reinsertion did not result in any additional trauma or inflammation. This has implications for surgery both in routine cases such as a faulty electrode and also for future design of mechanisms for delivery of intracochlear therapies.
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18
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High Electrode Impedance Values in Pediatric Cochlear Implant Recipients May Imply Insufficient Auditory and Language Skills Development. J Clin Med 2020; 9:jcm9020506. [PMID: 32069787 PMCID: PMC7074351 DOI: 10.3390/jcm9020506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 01/22/2020] [Accepted: 02/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Measurements of electrode impedance values are routinely performed after cochlear implantation. The primary objective of the study was to determine if pediatric, prelingually deafened patients with different postoperative performances showed significantly different impedance values one year after implantation. Methods: This study comprised 42 pediatric cochlear implant recipients provided with the device in a single academic tertiary referral center between 1 January 2000, and 31 December 2016. Medical chart analysis was performed in order to assess evolution of impedance values during the first postoperative year on a monthly basis. Electrode impedance values measurements one year postoperatively were compared between children with successful and unsuccessful auditory and language skills development assessed using the EARS protocol (a name of a performance test). Furthermore, values were compared among recipients of different implant types and among different cochlear segments. Results: A gradual rise of average impedance values was found during the first months of implant use (1st month, 7.32 kΩ; 3rd month, 7.86 kΩ) with the peak at the 4th postoperative month (7.96 kΩ), followed by a gradual decrease towards the 12th month (6th month, 7.62 kΩ; 12th month, 6.86 kΩ). Lower values at the 12th postoperative month were observed in recipients with successful development compared to patients presented with unsuccessful development (6.22 kΩ vs. 7.82 kΩ; p = 0.001). Mean impedance values were different when compared among cochlear segments and among different implant types. Conclusion: High electrode impedance values one year after implantation in pediatric patients may imply insufficient auditory and language skills development. Further studies are needed in order to validate our results.
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19
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Fayed EA, Zaghloul HS, Morgan AE. Electrode impedance changes over time in MED El cochlear implant children recipients: Relation to stimulation levels and behavioral measures. Cochlear Implants Int 2020; 21:192-197. [DOI: 10.1080/14670100.2020.1716464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Cutrone A, Micera S. Implantable Neural Interfaces and Wearable Tactile Systems for Bidirectional Neuroprosthetics Systems. Adv Healthc Mater 2019; 8:e1801345. [PMID: 31763784 DOI: 10.1002/adhm.201801345] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/22/2019] [Indexed: 12/12/2022]
Abstract
Neuroprosthetics and neuromodulation represent a promising field for several related applications in the central and peripheral nervous system, such as the treatment of neurological disorders, the control of external robotic devices, and the restoration of lost tactile functions. These actions are allowed by the neural interface, a miniaturized implantable device that most commonly exploits electrical energy to fulfill these operations. A neural interface must be biocompatible, stable over time, low invasive, and highly selective; the challenge is to develop a safe, compact, and reliable tool for clinical applications. In case of anatomical impairments, neuroprosthetics is bound to the need of exploring the surrounding environment by fast-responsive and highly sensitive artificial tactile sensors that mimic the natural sense of touch. Tactile sensors and neural interfaces are closely interconnected since the readouts from the first are required to convey information to the neural implantable apparatus. The role of these devices is pivotal hence technical improvements are essential to ensure a secure system to be eventually adopted in daily life. This review highlights the fundamental criteria for the design and microfabrication of neural interfaces and artificial tactile sensors, their use in clinical applications, and future enhancements for the release of a second generation of devices.
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Affiliation(s)
- Annarita Cutrone
- The Biorobotics Institute, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
| | - Silvestro Micera
- The Biorobotics Institute, Viale Rinaldo Piaggio 34, 56025, Pontedera, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Federale de Lausanne (EPFL), Lausanne, CH-1202, Switzerland
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21
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Batuk M, Yarali M, Cinar B, Kocabay A, Bajin M, Sennaroglu G, Sennaroglu L. Is Early Cochlear Implant Device Activation Safe for All on-the-Ear and off-the-Ear Sound Processors? Audiol Neurootol 2019; 24:279-284. [DOI: 10.1159/000503378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/13/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Cochlear implantation (CI) is an effective treatment option for patients with severe-to-profound hearing loss. When CI first started, it was recommended to wait until at least 4 weeks after the CI surgery for the initial activation because of possible complications. Advances in the surgical techniques and experiences in fitting have made initial activation possible within 24 h. Objectives: To compare the complaints and complications after early activation between behind-the-ear (BTE) and off-the-ear (OTE) sound processors and to show the impact of early activation on the electrode impedance values. Method: CI surgeries performed between March 2013 and July 2018 were retrospectively analyzed from the database. In total, 294 CI users were included in the present study. The impedance measurements were analyzed postoperatively at the initial activation prior to the stimulation, and 4 weeks after the initial activation in the first-month follow-up visit. A customized questionnaire was administered in the first-month follow-up fitting session to caregivers and/or patients who were using CI at least for 6 months. Medical records were also reviewed to identify any postoperative complications. Results: In the early activation group, impedance values were significantly lower than in the control group (p < 0.05) at first fitting. At the first-month follow-up, no significant difference was found between the groups (p > 0.05). The most common side effects were reported to be edema (6.1%) and pain (5.7%) in the early activation group. In patients with OTE sound processors, the rate of side effects such as skin infection, wound swelling, skin hyperemia, and pain was higher than in patients with BTE sound processors; however, a statistical significance was only observed in wound swelling (p = 0.005). Selecting the appropriate magnet was defined as a problem for the OTE sound processors during the initial activation. Conclusion: This study revealed that early activation of CI was clinically safe and feasible in patients with BTE sound processors. When using OTE sound processors, the audiologists should be careful during the activation period and inform patients of possible side effects. The first fitting should be delayed for 4 weeks after CI for OTE sound processors. This current study is the first to report this finding with 5 years of experience in a large cohort.
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22
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Sun CH, Chang CJ, Hsu CJ, Wu HP. Feasibility of early activation after cochlear implantation. Clin Otolaryngol 2019; 44:1004-1010. [PMID: 31487432 DOI: 10.1111/coa.13427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/04/2019] [Accepted: 08/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of the study is to investigate feasibility of early activation after cochlear implantation by evaluating long-term impedance change and speech perception. DESIGN Case-control study SETTING: Between July 2015 and December 2016, we prospectively enrolled 20 subjects for early activation (within 24 hours after cochlear implantation). On the other hand, from November 2013 to July 2015, 20 age- and sex-matched control subjects from the database of cochlear implantees treated with conventional activation schedule (4 weeks after surgery) were retrospectively enrolled. PARTICIPANT Forty patients who underwent cochlear implantation surgeries. MAIN OUTCOME MEASURES The series impedance and speech perception score of both groups were compared. RESULTS No statistical difference in long-term follow-up between the two groups was found using GEEs and multivariate analysis. In the early activation group, impedance reached a steady level by the 2nd postoperative week, and the hearing perception ability significantly improved by the 4th postoperative week. CONCLUSION This comparative study illustrated sequential impedance data during early activation (24 hours) and conventional activation (4 weeks) after CI surgery. There were no major complications in either group, and the safety of early activation with respect to impedance changes, postoperative residual hearing preservation and speech perception scores were non-inferior to that of the conventional group. Therefore, in this study, we established the feasibility of early activation 24 hours after cochlear implantation.
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Affiliation(s)
- Chuan-Hung Sun
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chan-Jung Chang
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Chuan-Jen Hsu
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hung-Pin Wu
- Department of Otolaryngology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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23
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Xu Y, Luo C, Zeng FG, Middlebrooks JC, Lin HW, You Z. Design, Fabrication, and Evaluation of a Parylene Thin-Film Electrode Array for Cochlear Implants. IEEE Trans Biomed Eng 2019; 66:573-583. [PMID: 30004866 PMCID: PMC6328340 DOI: 10.1109/tbme.2018.2850753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To improve the existing manually assembled cochlear implant electrode arrays, a thin-film electrode array (TFEA) was microfabricated having a maximum electrode density of 15 sites along an 8-mm length, with each site having a 75 μm × 1.8 μm (diameter × height) disk electrode. METHODS The microfabrication method adopted photoresist transferring, lift-off, two-step oxygen plasma etching, and fuming nitric acid release to reduce lift-off complexity, protect the metal layer, and increase the release efficiency. RESULTS Systematic in vitro characterization showed that the TFEA's bending stiffness was 6.40 × 10-10 N·m2 near the base and 1.26 × 10-10 N·m2 near the apex. The TFEA electrode produced an average impedance of 16 kΩ and a maximum current limit of 800 μA, measured with 1-kHz sinusoidal current using monopolar stimulation in saline. A TFEA prototype was implanted in a cat cochlea to obtain in vivo measurements of electrically evoked auditory brainstem and inferior colliculus responses to monopolar stimulation with 41-μs/phase biphasic pulses. Both physiological responses produced a threshold of ∼300 μA and a dynamic range of 5-8 dB above the threshold. Compared with existing arrays, the present TFEA had 104 times less bending stiffness, 97% less electrode area, and comparable physiological thresholds. CONCLUSION Using a simplified structure and stable fabrication method, the present TEFA produced physical and physiological performance comparable to existing commercial devices. SIGNIFICANCE The present TFEA represents a step closer toward an automated process replacing the labor-intensive and expensive manual assembly of the cochlear implant electrode arrays.
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24
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Sanderson AP, Rogers ETF, Verschuur CA, Newman TA. Exploiting Routine Clinical Measures to Inform Strategies for Better Hearing Performance in Cochlear Implant Users. Front Neurosci 2019; 12:1048. [PMID: 30697145 PMCID: PMC6340939 DOI: 10.3389/fnins.2018.01048] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/24/2018] [Indexed: 11/21/2022] Open
Abstract
Neuroprostheses designed to interface with the nervous system to replace injured or missing senses can significantly improve a patient's quality of life. The challenge remains to provide implants that operate optimally over several decades. Changes in the implant-tissue interface may precede performance problems. Tools to identify and characterize such changes using existing clinical measures would be highly valuable. Modern cochlear implant (CI) systems allow easy and regular measurements of electrode impedance (EI). This measure is routinely performed as a hardware integrity test, but it also allows a level of insight into the immune-mediated response to the implant, which is associated with performance outcomes. This study is a 5-year retrospective investigation of MED-EL CI users at the University of Southampton Auditory Implant Service including 176 adult ears (18-91) and 74 pediatric ears (1-17). The trend in EI in adults showed a decrease at apical electrodes. An increase was seen at the basal electrodes which are closest to the surgery site. The trend in the pediatric cohort was increasing EI over time for nearly all electrode positions, although this group showed greater variability and had a smaller sample size. We applied an outlier-labeling rule to statistically identify individuals that exhibit raised impedance. This highlighted 14 adult ears (8%) and 3 pediatric ears (5%) with impedance levels that deviated from the group distribution. The slow development of EI suggests intra-cochlear fibrosis and/or osteogenesis as the underlying mechanism. The usual clinical intervention for extreme impedance readings is to deactivate the relevant electrode. Our findings highlight some interesting clinical contradictions: some cases with raised (but not extreme) impedance had not prompted an electrode deactivation; and many cases of electrode deactivation had been informed by subjective patient reports. This emphasizes the need for improved objective evidence to inform electrode deactivations in borderline cases, for which our outlier-labeling approach is a promising candidate. A data extraction and analysis protocol that allows ongoing and automated statistical analysis of routinely collected data could benefit both the CI and wider neuroprosthetics communities. Our approach provides new tools to inform practice and to improve the function and longevity of neuroprosthetic devices.
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Affiliation(s)
- Alan P. Sanderson
- Institute of Sound and Vibration Research, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
| | - Edward T. F. Rogers
- Institute for Life Sciences and Optoelectronics Research Centre, University of Southampton, Southampton, United Kingdom
| | - Carl A. Verschuur
- Auditory Implant Service, Faculty of Engineering and the Environment, University of Southampton, Southampton, United Kingdom
| | - Tracey A. Newman
- Clinical Neurosciences, Institute for Life Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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25
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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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Kim SY, Jeon SK, Oh SH, Lee JH, Suh MW, Lee SY, Lim HJ, Park MK. Electrical dynamic range is only weakly associated with auditory performance and speech recognition in long-term users of cochlear implants. Int J Pediatr Otorhinolaryngol 2018; 111:170-173. [PMID: 29958604 DOI: 10.1016/j.ijporl.2018.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/07/2018] [Accepted: 06/08/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The electrical dynamic range (EDR) has been suggested to be related to auditory performance in cochlear implant (CI) users. However, few reports have evaluated postlingual CI users who have used CIs for long periods in comparison with prelingual CI users. Here, we evaluated auditory perception and speech performance in terms of the EDR in long-term CI users. The EDR, and auditory and speech performances, were compared between pre- and post-lingual CI users. METHODS We enrolled all patients who received CIs from April 2000 to December 2010 at Seoul National University Hospital, and who had ≥5 years of experience with CIs. The EDRs affording subjective responses at the threshold level (T-level) and comfortable level (C-level) were analyzed in terms of their relationships with pure tone audiometry levels, speech evaluation scores, including those on the Phonetically Balanced (PB) Word List test, vowel and consonant tests, a sentence test, and the Korean version of the Central Institute for the Deaf (K-CID) test; we also calculated Category in Auditory Performance (CAP) scores. RESULTS We found no significant difference in the average EDR, CAP, K-CID, PB word, consonant, or vowel scores between pre- and post-lingual CI users. The EDR was weakly associated with the PB word (P = 0.003, r = 0.462) and consonant scores (P = 0.005, r = 0.438). Other speech evaluations, such as the CAP, K-CID, and vowel scores, were not significantly associated with the EDR T-level. We found no association between pure tone thresholds at 0.5, 1, or 2 kHz, and the speech evaluation scores or EDRs of low-, middle-, or high-frequency channels. CONCLUSIONS The EDR was only weakly associated with speech performance, such as scores on consonant and PB word tests in long-term CI users, irrespective of pre- or post-lingual deafness status.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology- Head & Neck Surgery, CHA University College of Medicine, Republic of Korea
| | - Seul-Ki Jeon
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea
| | - Sang-Yub Lee
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea
| | - Hyun-Jung Lim
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology- Head & Neck Surgery, Seoul National University College of Medicine, Republic of Korea.
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Leone CA, Mosca F, Grassia R. Temporal changes in impedance of implanted adults for various cochlear segments. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:312-319. [PMID: 28872161 PMCID: PMC5584104 DOI: 10.14639/0392-100x-1471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/15/2017] [Indexed: 11/23/2022]
Abstract
Electrode impedance (EI) is the first objective assessment carried out during the surgical procedure and follow-up of cochlear implanted patients. This measure provides information on the integrity of electrodes and on the surrounding environment. It is one of the main factors responsible for energy consumption of the cochlear implant (CI). The aim of our study is to investigate changes over time in EI in adult recipients implanted with the perimodiolar array by comparing differences in various cochlear segments. In addition, we explore the relationship between these objective measures and subjective measures such as T-level and C-level. We studied 28 adult patients. Impedance values (IVs) were calculated in "common-ground" (CG) and in monopolar (M1+2) mode for electrode groups in basal middle and apical segments. We found significant decreases in IVs between activation and 1 month. We obtained higher values for basal impedance, whereas lower IVs were found for apical electrodes at all observation times. Statistical pairing over time between impedance and T/C values showed significant correlation for both global impedance (GI) and T-C levels at CG and M1+2 mode up to 6 months. Segregated statistical analysis also showed a significant and prolonged correlation of basal IVs and fitting parameters. The higher basal impedance over time can be explained by the higher proportion of newly formed tissue in this region. The linear correlation of impedances with the fitting parameters become not significant after 3/6 months for the apical and middle segments and remained significant only for the basal region over time. This behaviour underlines the importance of persistence in intra-cochlear factors in influencing fitting parameters in the basal segment.
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Affiliation(s)
- C A Leone
- Ear Nose Throat Department, Monaldi Hospital, Naples, Italy
| | - F Mosca
- Ear Nose Throat Department, Monaldi Hospital, Naples, Italy
| | - R Grassia
- Ear Nose Throat Department, Monaldi Hospital, Naples, Italy
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Investigation of Electrical Stimulation Levels Over 8 to 10 Years Postimplantation for a Large Cohort of Adults Using Cochlear Implants. Ear Hear 2017; 38:736-745. [DOI: 10.1097/aud.0000000000000466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Incerti PV, Ching TYC, Hou S, Van Buynder P, Flynn C, Cowan R. Programming characteristics of cochlear implants in children: effects of aetiology and age at implantation. Int J Audiol 2017; 57:S27-S40. [PMID: 28885072 DOI: 10.1080/14992027.2017.1370139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We investigated effects of aetiology and age at implantation on changes in threshold (T) levels, comfortable (C) levels and dynamic range (DR) for cochlear implants (CIs) in children over the first five years of life. DESIGN Information was collected at 6 months post-activation of CIs, and at 3 and 5 years of age. STUDY SAMPLE One hundred and sixty-one children participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study. RESULTS Children with neural and structural cochlear lesions had higher T-levels and C-levels as compared to those without these conditions. Parameter settings varied from manufacturer's defaults more often in the former than in the latter group. Investigation of the effect of age at implantation for children without neural and structural cochlear lesions showed that those implanted at ≤12 months of age had higher T-levels and narrower DR at 6 months post-activation, as compared to the later-implanted group. For both early- and later-implanted groups, the C-levels at 6 months post-activation were lower than those at age 3 and 5 years. There were no significant differences in T-levels, C-levels, or DR between age 3 and 5 years. CONCLUSIONS Aetiology and age at implantation had significant effects on T-levels and C-levels.
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Affiliation(s)
- Paola V Incerti
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
| | - Teresa Y C Ching
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Sanna Hou
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Patricia Van Buynder
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia.,b The Hearing CRC , Melbourne , Australia ; and
| | - Christopher Flynn
- a National Acoustic Laboratories, Australian Hearing Hub, Macquarie University , Sydney , Australia
| | - Robert Cowan
- b The Hearing CRC , Melbourne , Australia ; and.,c The University of Melbourne , Melbourne , Australia
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The Change in Electrical Stimulation Levels During 24 Months Postimplantation for a Large Cohort of Adults Using the Nucleus® Cochlear Implant. Ear Hear 2017; 38:357-367. [DOI: 10.1097/aud.0000000000000405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stimulation parameters differ between current anti-modiolar and peri-modiolar electrode arrays implanted within the same child. The Journal of Laryngology & Otology 2016; 130:1007-1021. [PMID: 27739380 DOI: 10.1017/s0022215116009026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare stimulation parameters of peri-modiolar and anti-modiolar electrode arrays using two surgical approaches. METHODS Impedance, stimulation thresholds, comfortably loud current levels, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds were compared between 2 arrays implanted in the same child at 5 time points: surgery, activation/day 1, week 1, and months 1 and 3. The peri-modiolar array was implanted via cochleostomy in all children (n = 64), while the anti-modiolar array was inserted via a cochleostomy in 43 children and via the round window in 21 children. RESULTS The anti-modiolar array had significantly lower impedance, but required higher current levels to elicit thresholds, comfort, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds than the peri-modiolar array across all time points, particularly in basal electrodes (p < 0.05). The prevalence of open electrodes was similar in anti-modiolar (n = 5) and peri-modiolar (n = 3) arrays. CONCLUSION Significant but clinically acceptable differences in stimulation parameters between peri-modiolar and anti-modiolar arrays persisted four months after surgery in children using bilateral cochlear implants. The surgical approach used to insert the anti-modiolar array had no overall effect on outcomes.
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Kallioinen P, Olofsson J, Nakeva von Mentzer C, Lindgren M, Ors M, Sahlén BS, Lyxell B, Engström E, Uhlén I. Semantic Processing in Deaf and Hard-of-Hearing Children: Large N400 Mismatch Effects in Brain Responses, Despite Poor Semantic Ability. Front Psychol 2016; 7:1146. [PMID: 27559320 PMCID: PMC4978721 DOI: 10.3389/fpsyg.2016.01146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/18/2016] [Indexed: 11/21/2022] Open
Abstract
Difficulties in auditory and phonological processing affect semantic processing in speech comprehension for deaf and hard-of-hearing (DHH) children. However, little is known about brain responses related to semantic processing in this group. We investigated event-related potentials (ERPs) in DHH children with cochlear implants (CIs) and/or hearing aids (HAs), and in normally hearing controls (NH). We used a semantic priming task with spoken word primes followed by picture targets. In both DHH children and controls, cortical response differences between matching and mismatching targets revealed a typical N400 effect associated with semantic processing. Children with CI had the largest mismatch response despite poor semantic abilities overall; Children with CI also had the largest ERP differentiation between mismatch types, with small effects in within-category mismatch trials (target from same category as prime) and large effects in between-category mismatch trials (where target is from a different category than prime), compared to matching trials. Children with NH and HA had similar responses to both mismatch types. While the large and differentiated ERP responses in the CI group were unexpected and should be interpreted with caution, the results could reflect less precision in semantic processing among children with CI, or a stronger reliance on predictive processing.
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Affiliation(s)
- Petter Kallioinen
- Department of Linguistics, Stockholm UniversityStockholm, Sweden; Lund University Cognitive Science, Lund UniversityLund, Sweden
| | - Jonas Olofsson
- Department of Psychology, Stockholm University Stockholm, Sweden
| | - Cecilia Nakeva von Mentzer
- Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linkoping University Linkoping, Sweden
| | - Magnus Lindgren
- Linneaus Centre, Cognition, Communication and Learning, Lund UniversityLund, Sweden; Department of Psychology, Lund UniversityLund, Sweden
| | - Marianne Ors
- Division of Clinical Neurophysiology, Department of Clinical Neuroscience, Lund UniversityLund, Sweden; Division of Clinical Neurophysiology, Department of Clinical Neuroscience, Skåne University HospitalLund, Sweden
| | - Birgitta S Sahlén
- Linneaus Centre, Cognition, Communication and Learning, Lund UniversityLund, Sweden; Logopedics, Phoniatrics and Audiology, Department of Clinical Sciences Lund UniversityLund, Sweden
| | - Björn Lyxell
- Department of Behavioral Sciences and Learning, Swedish Institute for Disability Research, Linkoping University Linkoping, Sweden
| | - Elisabet Engström
- Department of Hearing and Balance, Karolinska University Hospital and Karolinska Institutet (CLINTEC) Stockholm, Sweden
| | - Inger Uhlén
- Department of Hearing and Balance, Karolinska University Hospital and Karolinska Institutet (CLINTEC) Stockholm, Sweden
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Electrophysiological detection of scalar changing perimodiolar cochlear electrode arrays: a long term follow-up study. Eur Arch Otorhinolaryngol 2016; 273:4251-4256. [DOI: 10.1007/s00405-016-4175-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Telmesani LM, Said NM. Electrically evoked compound action potential (ECAP) in cochlear implant children: Changes in auditory nerve response in first year of cochlear implant use. Int J Pediatr Otorhinolaryngol 2016; 82:28-33. [PMID: 26857311 DOI: 10.1016/j.ijporl.2015.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
Abstract
AIM Recording of the electrically evoked compound action potential (ECAP) of the auditory nerve in cochlear implant (CI) patients represents an option to assess changes in auditory nerve responses and the interaction between the electrode bundle and the neural tissue over time. The aim of the present work is to assess ECAP changes during the first year of cochlear implant for the purpose of predicting thresholds and adjustment of the patients' programs over time. METHOD Data were collected from 25 children using Cochlear Nucleus 24 implants. ECAP thresholds were examined at the time of surgery, at initial stimulation, and 3, 6 and 12 months post-stimulation. Five electrodes located at basal, middle, and apical positions in the cochlea were tested at each time interval and ECAP thresholds were analyzed and compared. RESULTS There was a significant decrease in ECAP thresholds between the intraoperative measure and fitting time at all electrode sites. Mean ECAP thresholds measured at 3, 6 and 12 months post-stimulation remained similar to initial stimulation levels. Although there was no significant difference in ECAP thresholds recorded at fitting time and 12 months follow up session, there was significant increase in behavioral T and C levels from initial stimulation to the 12 months' time point. CONCLUSION Most electrodes undergo non-significant change in ECAP thresholds over time, and therefore thresholds obtained on the day of initial stimulation can be used to estimate the patients' map levels at any time. On the other hand, intraoperative thresholds demonstrated significant change relative to postoperative recording times, limiting the ability to use intraoperatively recorded ECAP thresholds to predict postoperative measurements.
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Affiliation(s)
- Laila M Telmesani
- Otology& Neuro-otology, Otorhinolaryngology Department, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia
| | - Nithreen M Said
- Audiology, Otolaryngology Department, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia; Audiology, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Greisiger R, Shallop JK, Hol PK, Elle OJ, Jablonski GE. Cochlear implantees: Analysis of behavioral and objective measures for a clinical population of various age groups. Cochlear Implants Int 2015; 16 Suppl 4:1-19. [DOI: 10.1080/14670100.2015.1110372] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mittmann P, Todt I, Wesarg T, Arndt S, Ernst A, Hassepass F. Electrophysiological Detection of Scalar-Changing Perimodiolar Cochlear Electrode Arrays: A Six-Month Follow-Up Study. Audiol Neurootol 2015; 20:400-5. [PMID: 26529610 DOI: 10.1159/000441346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/28/2015] [Indexed: 11/19/2022] Open
Abstract
The position of the cochlear electrode array within the scala tympani is essential for optimal hearing benefit. An intraoperative neural response telemetry ratio (NRT ratio; a threshold ratio of pairs of apical and basal electrodes) has been established, which can provide information about the intracochlear electrode array position. Out of a previous collective of 85 patients, the 6-month follow-up electrophysiological NRT data of 37 patients have been included in this study. Comparing the intraoperatively estimated NRT ratio with the 6-month follow-up NRT ratio, it remained unchanged intraindividually in 92% of cases. Within this group the NRT ratio and the intracochlear position of the electrode array matched in all cases. There were two newly occurring mismatches and one new match was observed. After a period of 6 months the NRT ratio remained unchanged in most cases and showed a good correlation with the intracochlear position of the electrode array.
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Affiliation(s)
- Philipp Mittmann
- Department of Otolaryngology, Unfallkrankenhaus Berlin (UKB), Berlin, Germany
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Telmesani LM, Said NM. Effect of cochlear implant electrode array design on auditory nerve and behavioral response in children. Int J Pediatr Otorhinolaryngol 2015; 79:660-5. [PMID: 25746517 DOI: 10.1016/j.ijporl.2015.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/05/2015] [Indexed: 11/28/2022]
Abstract
AIM To study the effect of change in the array design of cochlear implant electrode on electrophysiological, and behavioral functional measures of cochlear implant users. METHOD A total of 33 children using cochlear implants were included in this study. Subjects were implanted with different electrode types including Slim Straight (CI422) and Freedom Contour Advance (CI24RE) electrode arrays. The electrically evoked compound action potential (ECAP) thresholds were evoked by stimulation of basal, mid, and apical electrodes. The behavioral aided responses using the implant were obtained about 6-12 months post fitting of implant. RESULTS ECAP thresholds decreased significantly postoperatively in both electrode arrays. Slim straight electrode (CI422) had higher thresholds than Freedom Contour Advance (CI24RE) electrode at most recording sites, but the differences were only significant at basal site. This is a direct consequence of a perimodiolar electrode versus a lateral wall electrode, i.e., the neurons are further away requiring more current (higher threshold) to record the NRT. CONCLUSION Although the curved electrode array appeared to evoke responses at lower thresholds, effect on patient performance was not obvious.
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Affiliation(s)
- Laila M Telmesani
- Otology & Neuro-Otology, Otorhinolaryngology Department, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia
| | - Nithreen M Said
- Audiology Unit, Otorhinolaryngology Department, Faculty of Medicine, Dammam University, Dammam, Saudi Arabia; Audiology Unit, Otorhinolaryngology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Hagr A, Garadat SN, Al-Momani M, Alsabellha RM, Almuhawas FA. Feasibility of one-day activation in cochlear implant recipients. Int J Audiol 2015; 54:323-8. [DOI: 10.3109/14992027.2014.996824] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zeng FG, Rebscher SJ, Fu QJ, Chen H, Sun X, Yin L, Ping L, Feng H, Yang S, Gong S, Yang B, Kang HY, Gao N, Chi F. Development and evaluation of the Nurotron 26-electrode cochlear implant system. Hear Res 2014; 322:188-99. [PMID: 25281795 DOI: 10.1016/j.heares.2014.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/18/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022]
Abstract
Although the cochlear implant has been widely acknowledged as the most successful neural prosthesis, only a fraction of hearing-impaired people who can potentially benefit from a cochlear implant have actually received one due to its limited awareness, accessibility, and affordability. To help overcome these limitations, a 26-electrode cochlear implant has been developed to receive China's Food and Drug Administration (CFDA) approval in 2011 and Conformité Européenne (CE) Marking in 2012. The present article describes design philosophy, system specification, and technical verification of the Nurotron device, which includes advanced digital signal processing and 4 current sources with multiple amplitude resolutions that not only are compatible with perceptual capability but also allow interleaved or simultaneous stimulation. The article also presents 3-year longitudinal evaluation data from 60 human subjects who have received the Nurotron device. The objective measures show that electrode impedance decreased within the first month of device use, but was stable until a slight increase at the end of two years. The subjective loudness measures show that electric stimulation threshold was stable while the maximal comfort level increased over the 3 years. Mandarin sentence recognition increased from the pre-surgical 0%-correct score to a plateau of about 80% correct with 6-month use of the device. Both indirect and direct comparisons indicate indistinguishable performance differences between the Nurotron system and other commercially available devices. The present 26-electrode cochlear implant has already helped to lower the price of cochlear implantation in China and will likely contribute to increased cochlear implant access and success in the rest of the world. This article is part of a Special Issue entitled <Lasker Award>.
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Affiliation(s)
- Fan-Gang Zeng
- Center for Hearing Research, University of California, Irvine, CA 92697, USA.
| | - Stephen J Rebscher
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, CA 94143, USA
| | - Qian-Jie Fu
- Department of Otolaryngology - Head and Neck Surgery, University of California, Los Angeles, CA 90095, USA
| | - Hongbin Chen
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Xiaoan Sun
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Li Yin
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Lichuan Ping
- Nurotron Biotechnology Inc., Hangzhou, Zhejiang 310011, China
| | - Haihong Feng
- Shanghai Acoustics Laboratory, Institute of Acoustics, Chinese Academy of Sciences, Shanghai 200032, China
| | - Shiming Yang
- Department of Otolaryngology - Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Shusheng Gong
- Department of Otolaryngology - Head and Neck Surgery, Beijing Tongren Hospital of Capital Medical University, Beijing 100730, China
| | - Beibei Yang
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
| | - Hou-Yong Kang
- Department of Otolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Na Gao
- Department of Otolaryngology - Head and Neck Surgery, The Eye and ENT Hospital of Fudan University, Shanghai 200031, China
| | - Fanglu Chi
- Department of Otolaryngology - Head and Neck Surgery, The Eye and ENT Hospital of Fudan University, Shanghai 200031, China.
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Durisin M, Büchner A, Lesinski-Schiedat A, Bartling S, Warnecke A, Lenarz T. Cochlear implantation in children with bacterial meningitic deafness: The influence of the degree of ossification and obliteration on impedance and charge of the implant. Cochlear Implants Int 2014; 16:147-58. [DOI: 10.1179/1754762814y.0000000094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Dixon JF, Shinn JB, Adkins M, Hardin BD, Bush ML. Middle Ear Disease and Cochlear Implant Function: A Case Study. HEARING BALANCE AND COMMUNICATION 2014; 12:155-158. [PMID: 26693101 DOI: 10.3109/21695717.2014.918757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES AND METHODS It has been our clinical observation that active middle ear disease (MED) temporally corresponds to a transient decrease in cochlear implant (CI) function, specifically at the apical electrodes. This is non-intuitive as CI function is thought to be independent of middle ear aeration and inflammation. The purpose of this case study is to demonstrate how active MED negatively affects both subjective hearing complaints and objective impedance measures in a CI patient. RESULTS Subjective hearing decreased and impedances levels increased significantly when the patient was experiencing active MED. No significant changes in these measures occurred when there was no active MED. CONCLUSIONS MED may affect CI function in some patients requiring adjustments in programing at times of involvement.
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Affiliation(s)
- Joshua F Dixon
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Jennifer B Shinn
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Meg Adkins
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Bryan D Hardin
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
| | - Matthew L Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, KY USA
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Chen JKC, Chuang AYC, Sprinzl GM, Tung TH, Li LPH. Impedance and electrically evoked compound action potential (ECAP) drop within 24 hours after cochlear implantation. PLoS One 2013; 8:e71929. [PMID: 23991008 PMCID: PMC3753283 DOI: 10.1371/journal.pone.0071929] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/05/2013] [Indexed: 11/19/2022] Open
Abstract
Previous animal study revealed that post-implantation electrical detection levels significantly declined within days. The impact of cochlear implant (CI) insertion on human auditory pathway in terms of impedance and electrically evoked compound action potential (ECAP) variation within hours after surgery remains unclear, since at this time frequency mapping can only commence weeks after implantation due to factors associated with wound conditions. The study presented our experiences with regards to initial switch-on within 24 hours, and thus the findings about the milieus inside cochlea within the first few hours after cochlear implantation in terms of impedance/ECAP fluctuations. The charts of fifty-four subjects with profound hearing impairment were studied. A minimal invasive approach was used for cochlear implantation, characterized by a small skin incision (≈ 2.5 cm) and soft techniques for cochleostomy. Impedance/ECAP was measured intro-operatively and within 24 hours post-operatively. Initial mapping within 24 hours post-operatively was performed in all patients without major complications. Impedance/ECAP became significantly lower measured within 24 hours post-operatively as compared with intra-operatively (p<0.001). There were no differences between pre-operative and post-operative threshold for air-conduction hearing. A significant drop of impedance/ECAP in one day after cochlear implantation was revealed for the first time in human beings. Mechanisms could be related to the restoration of neuronal sensitivity to the electrical stimulation, and/or the interaction between the matrix enveloping the electrodes and the electrical stimulation of the initial switch-on. Less wound pain/swelling and soft techniques both contributed to the success of immediate initial mapping, which implied a stable micro-environment inside the cochlea despite electrodes insertion. Our research invites further studies to correlate initial impedance/ECAP changes with long-term hearing/speech performance.
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Affiliation(s)
- Joshua Kuang-Chao Chen
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Georg Mathias Sprinzl
- Department of Oto-Rhino-Laryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Lieber Po-Hung Li
- Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Integrated Brain Research Laboratory, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Walravens ELS, Mawman D, O'driscoll M. Changes in psychophysical parameters during the first month of programming the Nucleus Contour and Contour Advance cochlear implants. Cochlear Implants Int 2013; 7:15-32. [DOI: 10.1179/cim.2006.7.1.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Botros A, Banna R, Maruthurkkara S. The next generation of Nucleus(®) fitting: a multiplatform approach towards universal cochlear implant management. Int J Audiol 2013; 52:485-94. [PMID: 23617610 PMCID: PMC3696341 DOI: 10.3109/14992027.2013.781277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This article provides a detailed description and evaluation of the next Nucleus(®) cochlear implant fitting suite. A new fitting methodology is presented that, at its simplest level, requires a single volume adjustment, and at its advanced level, provides access to 22-channel fitting. It is implemented on multiple platforms, including a mobile platform (Remote Assistant Fitting) and an accessible PC application (Nucleus Fitting Software). Additional tools for home care and surgical care are also described. DESIGN Two trials were conducted, comparing the fitting methodology with the existing Custom Sound™ methodology, as fitted by the recipient and by an experienced cochlear implant audiologist. STUDY SAMPLE Thirty-seven subjects participated in the trials. RESULTS No statistically significant differences were observed between the group mean scores, whether fitted by the recipient or by an experienced audiologist. The lower bounds of the 95% confidence intervals of the differences represented clinically insignificant differences. No statistically significant differences were found in the subjective program preferences of the subjects. CONCLUSIONS Equivalent speech perception outcomes were demonstrated when compared to current best practice. As such, the new technology has the potential to expand the capacity of audiological care without compromising efficacy.
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Abstract
Objectives The stimulation levels programmed in cochlear implant systems are affected by an evolution since the first switch-on of the processor. This study was designed to evaluate the changes in stimulation levels over time and the relationship between post-implantation physiological changes and with the hearing experience provided by the continuous use of the cochlear implant. Methods Sixty-two patients, ranging in age from 4 to 68 years at the moment of implantation participated in this study. All subjects were implanted with the 12 channels COMBI 40+ cochlear implant at San Cecilio University Hospital, Granada, Spain. Hearing loss etiology and progression characteristics varied across subjects. Results The analyzed programming maps show that the stimulation levels suffer a fast evolution during the first weeks after the first switch-on of the processor. Then, the evolution becomes slower and the programming parameters tend to be stable at about 6 months after the first switch-on. The evolution of the stimulation levels implies an increment of the electrical dynamic range, which is increased from 15.4 to 20.7 dB and improves the intensity resolution. A significant increment of the sensitivity to acoustic stimuli is also observed. For some patients, we have also observed transitory changes in the electrode impedances associated to secretory otitis media, which cause important changes in the programming maps. Conclusion We have studied the long-term evolution of the stimulation levels in cochlear implant patients. Our results show the importance of systematic measurements of the electrode impedances before the revision of the programming map. This report also highlights that the evolution of the programming maps is an important factor to be considered in order to determine an adequate calendar fitting of the cochlear implant processor.
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Robinson EJ, Davidson LS, Uchanski RM, Brenner CM, Geers AE. A longitudinal study of speech perception skills and device characteristics of adolescent cochlear implant users. J Am Acad Audiol 2012; 23:341-9. [PMID: 22533977 DOI: 10.3766/jaaa.23.5.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND For pediatric cochlear implant (CI) users, CI processor technology, map characteristics, and fitting strategies are known to have a substantial impact on speech perception scores at young ages. It is unknown whether these benefits continue over time as these children reach adolescence. PURPOSE To document changes in CI technology, map characteristics, and speech perception scores in children between elementary grades and high school, and to describe relations between map characteristics and speech perception scores over time. RESEARCH DESIGN A longitudinal design with participants 8-9-yr-old at session 1 and 15-18-yr-old at session 2. STUDY SAMPLE Participants were 82 adolescents with unilateral CIs, who are a subset of a larger longitudinal study. Mean age at implantation was 3.4 yr (range: 1.7-5.4), and mean duration of device use was 5.5 yr (range: 3.8-7.5) at session 1 and 13.3 yr (range: 10.9-15) at session 2. DATA COLLECTION AND ANALYSIS Speech perception tests at sessions 1 and 2 were the Lexical Neighborhood Test (LNT) presented at 70 dB SPL (LNT-70) and Bamford-Kowal-Bench sentences in quiet (BKB-Q) presented at 70 dB SPL. At session 2, the LNT was also administered at 50 dB SPL (LNT-50), and BKB sentences were administered in noise with a +10 dB SNR (BKB-N). CI processor technology type and CI map characteristics (coding strategy, number of electrodes, threshold levels, and comfort levels) were obtained at both sessions. Electrical dynamic range was computed, and descriptive statistics, correlations, and repeated-measures ANOVAs were employed. RESULTS Participants achieved significantly higher LNT and BKB scores, at 70 dB SPL, at ages 15-18 than at ages 8-9 yr. Forty-two participants had 1-3 electrodes either activated or deactivated in their map between test sessions, and 40 had no change in number of active electrodes (mean change: -0.5; range: -3 to +2). After conversion from arbitrary clinical map units to charge-per-phase in nanocoulombs (nC), no significant difference was found for T levels across time. Average comfort levels (C levels) decreased by 19 nC. Seventy-three participants (89%) upgraded their CI processor technology type. At both sessions, significant correlations were found between electrical dynamic range (EDR) and all speech perception measures except LNT-50 (r range: .31 to .47; p < 0.01). Similarly, significant correlations were also found between C levels and all speech perception measures (r range: .29 to .49; p < 0.01). At session 2, a significant correlation was found between processor technology type and the LNT-50 scores (r = .38; p < 0.01). CONCLUSIONS Significant improvement in speech scores was observed between elementary grades and high school for children who had used a CI since preschool. On average, T levels (nC) and electrode function remained stable for these long-term pediatric users. Analyses of maps did not allow for the determination of the exact cause of C level reductions, though power limitations in new processor systems and changes in perceived loudness over time are possible. Larger EDRs and higher C levels were associated with better speech scores. Newer speech processor technology was associated with better speech scores at a softer level.
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Affiliation(s)
- Elizabeth J Robinson
- Program in Audiology and Communication Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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Vlahović S, Šindija B, Aras I, Glunčić M, Trotić R. Differences between electrically evoked compound action potential (ECAP) and behavioral measures in children with cochlear implants operated in the school age vs. operated in the first years of life. Int J Pediatr Otorhinolaryngol 2012; 76:731-9. [PMID: 22398117 DOI: 10.1016/j.ijporl.2012.02.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/09/2012] [Accepted: 02/11/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to identify the differences in the NRT measures, behavioral measures, and their relationship between the group of congenitally deaf children operated in the first years of life and the group of children operated in the school age. METHODS The study included 40 congenitally deaf children with cochlear implants divided into two groups. Group 1 was composed of 20 children (mean age at operation 2.3 years, range 1.4-4.6 years) and Group 2 was composed of 20 children (mean age at operation 11.3 years, range 7.0-17.1 years). The ECAP was recorded using the Nucleus 24 neural response telemetry (NRT) system. In each child, the responses were evoked by the apical, middle and basal electrodes. The analyzed parameters were: the ECAP threshold (T-NRT), N1P2 amplitude, N1 latency, slope of the amplitude growth function, response morphology, threshold (T-) level, maximum comfort (C-) level, dynamic range (DR), T-NRT as a percentage of the map DR, the correlation between the T-NRT and the T- and C-levels. The recordings of parameters were performed two years after implantations. RESULTS The T-NRT, DR, T-NRT as a percentage of the map DR and the correlation between T-NRT and C-levels were significantly different between both groups of children. There were no statistically significant differences between the groups with respect to the amplitude, latency, slope and morphology recorded using the same electrodes. However, intragroup differences regarding NRT measures and behavioral measures with respect to the position of stimulating electrode were more prominent in Group 2 than in the Group 1. CONCLUSIONS Results of this study have also found a great variability of NRT and MAP measures within and across patients in both groups of children, but it was still more pronounced in the group of school children. NRT profile across electrodes follows MAP profiles better in the Group 1 then in the Group 2. Overall findings of NRT and MAP measures are not consistent and unambiguous as we expected, but still suggest potential differences between results in children operated in first years of life, and those operated in school age.
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Affiliation(s)
- Sanja Vlahović
- Polyclinics for Rehabilitation of Hearing and Speech SUVAG, Ljudevita Posavskog 10, HR-10000 Zagreb, Croatia.
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Jia H, Venail F, Piron JP, Batrel C, Pelliccia P, Artières F, Uziel A, Mondain M. Effect of surgical technique on electrode impedance after cochlear implantation. Ann Otol Rhinol Laryngol 2011; 120:529-34. [PMID: 21922977 DOI: 10.1177/000348941112000807] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We compare the evolution of electrode impedance values (IVs) following either conventional cochlear implantation or implantation by the soft surgery (SS) technique. METHODS We performed a retrospective chart review of 20 consecutive adult patients who underwent implantation with the Nucleus CA 24 device between 2004 and 2007. Five patients with preoperative residual hearing at the frequencies 256, 512, and 1,024 Hz underwent implantation by an SS cochlear implantation technique (SS group), and the 15 other patients underwent a conventional implantation technique (conventional cochleostomy [CC] group). The active electrodes were classified as distal (17 to 22), middle (10 to 16), or proximal (3 to 9) according to their position in relation to the tip of the electrode array. Their IVs were collected at 1, 3, 12, 24, and 36 months after implantation. Changes in auditory thresholds at 3 and 24 months were reported for patients in the SS group. RESULTS The postoperative IVs of both the CC and SS groups decreased significantly between 1 and 3 months after implantation (p < 0.05) and then remained stable. The IVs after 12 months were significantly lower (p < 0.05) in the SS group than in the CC group. CONCLUSIONS Patients who underwent the SS technique displayed lower long-term electrode IVs than did their counterparts in the CC group. If electrode IVs are indeed an indirect representation of cochlear fibrosis, the use of the SS technique in lieu of the CC technique could reduce fibrotic development.
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Affiliation(s)
- Huan Jia
- Ear, Nose, and Throat Department and Cochlear Implant Center, Gui de Chauliac, University Hospital, Montpellier, France
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