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Franke-Trieger A, Mattheus W, Seebacher J, Zelger P, Zahnert T, Neudert M. Stapedius reflex thresholds obtained in a free sound field as an indicator for over- and understimulation in cochlear implant listeners. Int J Audiol 2023:1-8. [PMID: 37656611 DOI: 10.1080/14992027.2023.2245141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE The goal of this study was to determine open field stapedius reflex thresholds (oSRTs) in CI patients with fittings based on subjective loudness ratings. A further objective was to compare these oSRTs and those of eSRT-based fittings that are similar to the oSRTs of normal hearing. DESIGN Impedance measurements of the ear drum were taken while subjects were wearing their audio processors. The stapedius reflex was elicited by electrical stimulation transmitted through the activated CI system in response to an acoustic stimulus presented in the free sound field. STUDY SAMPLE Subjects were 50 experienced CI users (n = 57 ears) with CI fittings based on subjective loudness scaling. RESULTS A reference range for the oSRTs was defined that was identified in CI patients with eSRT-based fittings. Sound levels for stapedius reflex detection were inside the reference target range in 70% of the cases, below the reference range (i.e. down to 40 dB HL) in 20% of the cases, and above the reference range in 10% of the cases. CONCLUSION Stapedius reflex detection in a free sound field may help detect fittings with too high or too low stimulation levels that might reduce audiological performance.
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Affiliation(s)
- Annett Franke-Trieger
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Willy Mattheus
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Zelger
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Zahnert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus Neudert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine (and University Hospital) Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Thangaraj M, Arunachalam R, Gore M, AjithKumar U. Prediction of behavioral MCL using electrophysiological responses in children using MED-EL implant. Int J Pediatr Otorhinolaryngol 2023; 172:111696. [PMID: 37563011 DOI: 10.1016/j.ijporl.2023.111696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
The present study aimed to correlate the various electrophysiological tests of ECAP, EABR and ESRT with programming parameters. If there is a correlation between them, fitting formulae to be derived to predict programming parameters. Further this fitting formula was validated on a clinical population. 22 children between age range of 5-12 years using MED-EL implant participated study. Electrophysiological tests of Electrically evoked compound Action Potential (ECAP), Electrical Evoked Stapedial Reflex Threshold (ESRT) and Electrically Evoked Auditory Brain Stem Responses (EABR) were measured on electrodes no 1,4, 8, and 11. Based on Pearson correlation analysis, there was a moderate correlation observed between each of electrophysiological tests with MCL level. Fitting formulae of ECAP with either ESRT or EABR were found to be accurately predict the MCL level. These fitting formulae were clinically validated on 6 children using Sonata implant with OPUS 2 processor. Two new programs with MCL were predicted using combination of ECAP with EABR and ECAP with ESRT as parameters in the fitting formulae. These programs were given to the participants to use for two weeks. Predicted MCLs were found to slightly higher (about 2qu to 5qu) than original MCL level. Reliability analysis indicated that the formulae predicted MCL with good accuracy. Speech perception and sound field thresholds were measured in the participants' Everyday program and two predicted programs. When ECAP & EABR were the parameters, the predicted program had improved audibility as reflected in sound field thresholds as compared to those obtained with other two programs. Based on Freidman test, the results indicated that significantly lower thresholds were found for both ECAP & EABR, or ECAP & ESRT based programs when compared to Everyday program. However, speech perception scores were not significantly different among the program as per Freidman test. Thus, both the fitting models were clinically validated. The findings imply that it is not always advisable to run all three electrophysiological testing to predict the MCL levels in clinical population. It would save lot of time to run just two tests to predict the MCL in difficult to test population.
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Affiliation(s)
- Muthuselvi Thangaraj
- Department of Audiology, Sri Ramachandra Faculty of Audiology & Speech language Pathology, Porur, 600116, Tamil Nadu, India.
| | - Ravikumar Arunachalam
- Medical and Health Sciences, SRM Medical College Hospital & Research Centre, Kattankulathur, India.
| | - Madhuri Gore
- Former Principal & Deputy Director (Technical), Dr. S.R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, 560084, India.
| | - Uppunda AjithKumar
- Department of Audiology, All India Institute of Speech and Hearing, Mysore, India.
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Yiannos JM, Bester CW, Zhao C, Gell B, Jayakody DMP. Speech-in-noise performance in objectively determined cochlear implant maps, including the effect of cognitive state. PLoS One 2023; 18:e0286986. [PMID: 37315077 DOI: 10.1371/journal.pone.0286986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE Cochlear Implant (CI) programming based on subjective psychophysical fine-tuning of loudness scaling involves active participation and cognitive skills and thus may not be appropriate for difficult-to-condition populations. The electrically evoked stapedial reflex threshold (eSRT) is an objective measure that is suggested to provide clinical benefit to CI programming. This study aimed to compare speech reception outcomes between subjective and eSRT objectively determined CI maps for adult MED-EL recipients. The effect of cognitive skills on these skills was further assessed. METHODS Twenty-seven post lingually hearing-impaired MED-EL CI recipients were recruited, 6 with mild cognitive impairment (MCI- 4 male, 79 years ± 5), 21 with normal cognitive function (5 male, 63 years ± 12). Two MAPs were generated: a subjective MAP and an objective MAP in which eSRTs determined maximum comfortable levels (M-Levels). Participants were randomly divided into two groups. Group A trialled the objective MAP for two weeks before returning for outcome assessment. During the following two weeks, Group A trialled the subjective MAP before returning for outcome assessment. Group B trialled MAPs in reverse. Outcome measures included the Hearing Implant Sound Quality Index (HISQUI), Consonant-Nucleus-Consonant (CNC) word test, and Bamford-Kowal-Bench Speech-in-Noise (BKB-SIN) test. RESULTS eSRT based MAPS were obtained in 23 of the participants. A strong relationship was demonstrated between global charge between eSRT-based and psychophysical-based M-Levels (r = 0.89, p < .001). The Montreal Cognitive Assessment for the Hearing Impaired (MoCA-HI) testing identified 6 CI recipients with MCI (MoCA-HI total score ≤23). The MCI group was older (63, 79 years), but were not otherwise different in sex, duration of hearing loss or duration of CI use. For all patients, no significant differences were found for sound quality or speech in quiet scores between eSRT-based and psychophysical-based MAPs. However, psychophysically determined MAPs showed significantly better speech-in-noise reception (6.74 vs 8.20-dB SNR, p = .34). MoCA-HI scores showed a significant, moderate negative correlation with BKB SIN for both MAP approaches (Kendall's Tau B, p = .015 and p = .008), with no effect on the difference between MAP approaches. CONCLUSION Results indicate eSRT-based methods provide poorer outcomes than psychophysical-based method. While speech-in-noise reception is correlated with MoCA-HI score, this affected both behaviourally and objectively determined MAPs. The results suggest fair confidence in the eSRT-based method as a guide for setting M-Level for difficult-to-condition CI populations in simple listening conditions.
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Affiliation(s)
- Jessica M Yiannos
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
| | - Christofer W Bester
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Christopher Zhao
- School of Human Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Barbara Gell
- MED-EL Australasia, Alexandria, New South Wales, Australia
| | - Dona M P Jayakody
- Ear Science Institute Australia, Subiaco, Western Australia, Australia
- Centre for Ear Sciences, Medical School, University of Western Australia, Crawley, Western Australia, Australia
- Western Australian Centre for Health & Ageing, University of Western Australia, Crawley, Western Australia, Australia
- School of Allied Health, Curtin University, Bentley, Western Australia, Australia
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Cortical Auditory Evoked Potentials Recorded Directly Through the Cochlear Implant in Cochlear Implant Recipients: a Feasibility Study. Ear Hear 2022; 43:1426-1436. [DOI: 10.1097/aud.0000000000001212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Callejón-Leblic MA, Barrios-Romero MM, Kontides A, Sánchez-Gómez S, Beynon AJ. Electrically evoked auditory cortical responses elicited from individually fitted stimulation parameters in cochlear implant users. Int J Audiol 2022:1-9. [PMID: 35477333 DOI: 10.1080/14992027.2022.2062578] [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: 11/05/2022]
Abstract
OBJECTIVE To investigate electrically evoked auditory cortical responses (eACR) elicited from the stimulation of intracochlear electrodes based on individually fitted stimulation parameters in cochlear implant (CI) users. DESIGN An eACR setup based on individual fitting parameters is proposed. A 50-ms alternating biphasic pulse train was used to stimulate apical, medial, and basal electrodes and to evoke auditory cortical potentials (N1-P2 complex). STUDY SAMPLE The eACR setup proposed was validated with 14 adult CI users. RESULTS Individual and grand-average eACR waveforms were obtained. The eACR amplitudes were lower in the basal than in the apical and medial regions. Earlier N1 latencies were found in CI users with lower maximum comfortable loudness levels and shorter phase duration in response to apical stimulation, while medial and basal stimulation resulted in earlier N1 latencies and larger N1-P2 amplitudes in users with longer CI experience. CONCLUSIONS eACR could be elicited by direct intracochlear stimulation using individual fitting parameters with a success rate of 71%. The highest cortical peak-to-peak amplitudes were obtained in response to apical stimulation. Unlike the P2, the N1 component appeared to be a consistent cortical potential to determine eACR and gain knowledge of the auditory processing beyond the cochlea in CI users. HighlightseACR can be elicited through direct stimulation of intracochlear electrodes.Stimulation of apical and medial regions yielded the highest N1-P2 amplitudes.CI users with lower maximum comfortable loudness levels had shorter N1 latencies during apical stimulation.The present dataset of mainly well-performing CI users suggests better cortical processing, that is, higher amplitudes and shorter latencies of N1.The N1 potential appears a more consistent and reliable potential than the P2 to determine eACR responses in CI users.
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Affiliation(s)
- María A Callejón-Leblic
- Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain.,Biomedical Engineering Group, University of Seville, Seville, Spain
| | | | - Alejandra Kontides
- MED-EL Headquarters, Innsbruck, Austria; dDonders Centre for Neurosciences, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Serafín Sánchez-Gómez
- Department of Otolaryngology, Head and Neck Surgery, Virgen Macarena University Hospital, Seville, Spain
| | - Andy J Beynon
- Otorhinolaryngology Department, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.,ENT Department, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
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Di Berardino F, Cavicchiolo S, Del Carmen Fuentes M, Kontides A, Lauss K, Zanetti D. Maximum acceptable level for the determination of ECAP and ESRT in a paediatric population. Cochlear Implants Int 2022; 23:214-224. [PMID: 35380097 DOI: 10.1080/14670100.2022.2054097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Two of the most used objective measures are electrically evoked action potentials (ECAPs) and electrically evoked stapedius reflex thresholds (ESRTs). Although stimuli used for these measures differ considerably, both measures are influenced by subjective loudness percept. We focus on the subjective maximum acceptable loudness (MAL) to investigate if loudness sensitivity varied along the electrode array during ECAP recordings. In addition, we explored how the MAL reached during an ECAP recording related to the postoperative ESRT. METHODS Uni- and bilaterally implanted young CI users (n = 15, average age = 9 y, age range 3-18 y) underwent ECAP and ESR recordings using the clinical software MAESTRO (MED-EL, Innsbruck, Austria) and a commercially available immittance instrument (PATH MEDICAL GmbH, Germering, Germany). RESULTS Loudness tolerance during ECAP recordings was lowest at the two apical-most electrode contacts (number 1 and 2). There was a moderate correlation between the MAL achieved during ECAP recordings and ESR maximum stimulation amplitudes. (r: 0.44344). CONCLUSIONS ECAP recordings should commence at basal or medial contacts to increase the users' comfort and loudness tolerance, especially in young CI users. A higher maximum stimulation appears to increase the chance of the automatic determination of ECAP thresholds for all electrode contacts.
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Affiliation(s)
- Federica Di Berardino
- Audiology Unit, Dept of Clinical Sciences and Community Health, State University of Milano and Dept. of Specialistic Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Sara Cavicchiolo
- Audiology Unit, Dept of Clinical Sciences and Community Health, State University of Milano and Dept. of Specialistic Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | - Diego Zanetti
- Audiology Unit, Dept of Clinical Sciences and Community Health, State University of Milano and Dept. of Specialistic Surgical Sciences, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
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Deniz R, Kara E, Deniz B, Kara HÇ, Yener HM, Ataş A. Electrically Evoked Auditory Late Responses as a Novel Method for Cochlear Implant Programming. Otol Neurotol 2022; 43:e414-e420. [PMID: 35085111 DOI: 10.1097/mao.0000000000003485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS Electrically evoked auditory late responses (eALR) are useful as an objective cochlear implant (CI) fitting method. BACKGROUND Different objective and behavioral methods are used for CI fitting. However, there is no objective method that indicates that the electrical signal reaches the auditory cortex. eALR is an indicator that electrical signals reach the auditory cortex, so our aim was to investigate the use of eALR as an objective method for CI programming. METHODS Two different programs were created for 21 unilateral Med-El CI users. In the first program, the most comfortable level (MCL) was adjusted with the electrical stapes reflex threshold (eSRT), and the threshold levels (THR) were behaviorally adjusted according to the user's feedback. In the second program, the MCL level was adjusted to a level where all the components of the eALR were clearly seen, and the user did not feel uncomfortable; the THR levels were adjusted to the lowest level where the eALR P1 wave could be seen. The results of the MCL and THR levels of the two programs and the free field tests conducted with both programs were compared. RESULTS While MCL levels did not differ significantly between the two programs, a significant difference was observed between THR levels. In addition, no significant difference was found between hearing and speech tests with CI in the free field. CONCLUSION The results revealed no significant performance difference between the two programs and that eALR could be preferred as an objective method for MCL determination.
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Affiliation(s)
- Rişvan Deniz
- Department of Otolaryngology, Head and Neck Surgery, Cerrahpaşa Medical Faculty
| | - Eyyup Kara
- Department of Otolaryngology, Head and Neck Surgery, Cerrahpaşa Medical Faculty
- Department of Audiology, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Burcu Deniz
- Department of Otolaryngology, Head and Neck Surgery, Cerrahpaşa Medical Faculty
- Department of Audiology, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, İstanbul, Turkey
| | - Halide Çetin Kara
- Department of Otolaryngology, Head and Neck Surgery, Cerrahpaşa Medical Faculty
| | - Haydar Murat Yener
- Department of Otolaryngology, Head and Neck Surgery, Cerrahpaşa Medical Faculty
| | - Ahmet Ataş
- Department of Otolaryngology, Head and Neck Surgery, Cerrahpaşa Medical Faculty
- Department of Audiology, Faculty of Health Sciences, Istanbul University-Cerrahpaşa, İstanbul, Turkey
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ARTFit—A Quick and Reliable Tool for Performing Initial Fittings in Users of MED-EL Cochlear Implants. Life (Basel) 2022; 12:life12020269. [PMID: 35207556 PMCID: PMC8879980 DOI: 10.3390/life12020269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/06/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
This study assessed the safety and performance of ARTFit, a new tool embedded in MAESTRO, the cochlear implant (CI) system software by MED-EL GmbH (Innsbruck, Austria). ARTFit automatically measures thresholds of the electrically evoked compound action potential (ECAP) to produce initial ‘maps’ (ECAPMAPs), i.e., configuration settings of the audio processor that the audiologist switches to live mode and adjusts for comfortable loudness (LiveECAPMAPs). Twenty-three adult and ten pediatric users of MED-EL CIs participated. The LiveECAPMAPs were compared to behavioral maps (LiveBurstMAPs) and to the participants’ everyday clinical maps (ClinMAPs). Four evaluation measures were considered: average deviations of the maximum comfortable loudness (MCL) levels of the LiveECAPMAPs and the LiveBurstMAPs from the MCLs of the ClinMAPs; correlations between the MCLs of the LiveECAPMAPs (MCLecap) and the LiveBurstMAPs (MCLburst) with the MCLs of the ClinMAPs (MCLclin); fitting durations; and speech reception thresholds (SRTs). All evaluation measures were analyzed separately in the adult and pediatric subgroups. For all evaluation measures, the deviations of the LiveECAPMAPs from the ClinMAPs were not larger than those of the LiveBurstMAPs from the ClinMAPs. The Pearson correlation between the MCLecap and the MCLclin across all channels was r2 = 0.732 (p < 0.001) in the adult and r2 = 0.616 (p < 0.001) in the pediatric subgroups. The mean fitting duration in minutes for the LiveECAPMAPs was significantly shorter than for that of the LiveBurstMAPs in both subgroups: adults took 5.70 (range 1.90–11.98) vs. 9.27 (6.83–14.72) min; children took 3.03 (1.97–4.22) vs. 7.35 (3.95–12.77). SRTs measured with the LiveECAPMAPs were non-inferior to those measured with the ClinMAPs and not statistically different to the SRTs measured with the LiveBurstMAPs. ARTFit is a safe, quick, and reliable tool for audiologists to produce ECAP-based initial fitting maps in adults and young children who are not able to provide subjective feedback.
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Guo H, Lin B, Chen T, Li Y, Guo M. The optimal probe tone frequency for eSRT measurements at individual electrodes in children with cochlear implants. Acta Otolaryngol 2021; 141:1055-1062. [PMID: 34802365 DOI: 10.1080/00016489.2021.1998614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Higher probe tone frequencies have been shown to increase the elicitation rates in electrically evoked stapedius reflex threshold (eSRT) measurements. OBJECTIVES To determine the optimal probe tone frequency for contralateral eSRT measurements at individual electrodes in children with unilateral cochlear implants and to assess the relationship between eSRTs for this frequency and most comfortable levels (M-levels). MATERIALS AND METHODS Contralateral eSRT measurements with three probe tone frequencies (226, 678, and 1000 Hz) at individual electrodes were performed on 26 paediatric Advanced Bionics cochlear implant recipients. RESULTS The elicitation rates of eSRTs for 226, 678, and 1000 Hz probe tones were 73.08% (57/78), 88.46% (69/78), and 88.46% (69/78), respectively. The average eSRT for the 1000 Hz probe tone was significantly lower than those for 226 and 678 Hz probe tones (p<.001 and p=.009, respectively). ESRTs for the 1000 Hz probe tone and M-levels were significantly correlated at all tested electrodes (all p<.001). CONCLUSIONS AND SIGNIFICANCE The optimal probe tone frequency for contralateral eSRT measurement at individual electrodes in children with unilateral cochlear implants is 1000 Hz. ESRTs for the 1000 Hz probe tone are significantly correlated with M-levels and can be used to guide the M-levels setting in these children.
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Affiliation(s)
- Haowei Guo
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Biyu Lin
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Ting Chen
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Yanping Li
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Mingyong Guo
- Department of Otolaryngology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
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Zarowski A, Fuentes MC, Schaudel D, Leblans M, De Coninck L, Theunen T, Vermeiren A, Verschoren L, van Dinther J, Offeciers EF. Intraoperative recordings of electromyogenic responses from the human stapedius muscle. Hear Res 2021; 408:108290. [PMID: 34233241 DOI: 10.1016/j.heares.2021.108290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/16/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
Following surgical implantation of a cochlear implant, the external processor must be programmed individually, which is typically achieved by behavioral measurements, with the user indicating the perceived loudness between the threshold and the maximum comfort levels (MCLs). However, the stapedius reflex measurement could be used instead, as the basis for programming the fitting maps. The electrically evoked stapedius reflex threshold is known to have a high correlation with the MCLs and thus is used as an objective tool to determine the MCL, especially in children and non-cooperative patients. Previous studies demonstrated that the electromyogenic (EMG) activity of the stapedius muscle could be measured to determine stapedius reflex responses. The objective of this study was to demonstrate that intraoperative EMG recordings from the stapedius muscle could be performed with an EMG recording electrode designed for chronical implantation. Ten adult subjects with single sided deafness (SSD) participated in this study. The study was split up into a pre-, intra- and postoperative phase. In the preoperative phase the subjects were screened for the presence of the acoustic stapedius reflex by using a standard tympanometer in the ear to be implanted, while the contralateral ear was stimulated acoustically. During the intraoperative phase an EMG recording electrode was placed in the stapedius muscle and EMG responses were recorded during acoustical and electrical stimulation. The surgical procedure consisted of two interconnected procedures: A classical surgical approach for cochlear implantation with two additional surgical steps, and the temporary placement of an EMG recording electrode in the stapedius muscle made through an opening in the pyramidal eminence, allowing EMG recordings. The postoperative phase was used to evaluate the preservation of the stapedius reflex postoperatively at 1- and 6-months with contralateral acoustic and ipsilateral electrical stimulation. The EMG recording electrode could successfully be placed in the stapedius muscle in all subjects and was able to reliably record EMG signals from the stapedius muscle elicited by acoustic and electrical stimulation. Overall, EMG recordings were obtained intraoperatively in all subjects tested (8 out of 8 subjects). Contralateral acoustic stapedius reflexes were obtained in 6 out of 8 subjects and ipsilateral electrical stapedius reflex in 7 out of 8 subjects. In the postoperative phase, the preservation of the postoperative reflex was observed in 6 out of 10 subjects 1-month after surgery and in 8 out of 10 subjects 6-months after surgery. The study showed that intraoperative EMG recordings from the stapedius muscle can be performed with an EMG recording electrode designed for chronical implantation. The minimally invasive procedure is promising; in particular with regard to the future perspective of measurements in the long-term with an integrated closed-loop self-fitting system.
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Affiliation(s)
- A Zarowski
- European Institute of Otorhinolaryngology, Antwerp, Belgium.
| | - M C Fuentes
- MED-EL Headquarters Innsbruck, Fuerstenweg 77a, 6020 Innsbruck, Austria
| | - D Schaudel
- MED-EL Headquarters Innsbruck, Fuerstenweg 77a, 6020 Innsbruck, Austria
| | - M Leblans
- European Institute of Otorhinolaryngology, Antwerp, Belgium
| | - L De Coninck
- European Institute of Otorhinolaryngology, Antwerp, Belgium
| | - T Theunen
- European Institute of Otorhinolaryngology, Antwerp, Belgium
| | - A Vermeiren
- European Institute of Otorhinolaryngology, Antwerp, Belgium
| | - L Verschoren
- MED-EL BE, Lambroekstraat 5A - BLOOMZ, 1831 Diegem, Belgium
| | - J van Dinther
- European Institute of Otorhinolaryngology, Antwerp, Belgium
| | - E F Offeciers
- European Institute of Otorhinolaryngology, Antwerp, Belgium
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Franke-Trieger A, Mattheus W, Seebacher J, Zahnert T, Neudert M. Stapedius reflex evoked in free sound field in cochlear implant users compared to normal-hearing listeners. Int J Audiol 2021; 60:695-703. [PMID: 33426977 DOI: 10.1080/14992027.2020.1866780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the relation between stapedius reflex thresholds in cochlear implant users evoked once through direct electric stimulation on single channels (ESRT) and once through acoustic stimulation in free sound field. For comparison, stapedius reflex thresholds were obtained in free sound field in a normal-hearing control group. DESIGN For each participant a new ESRT-based fitting was created. Stapedius reflex thresholds were obtained for this new fitting in free sound field for different loudness adjustments. Acoustic stimuli for eliciting the stapedius reflex were narrow band noise signals covering the audiometric frequency range. STUDY SAMPLE N = 29 experienced CI users (34 ears) and N = 10 normal hearing listeners. RESULTS ESRT-based fitting resulted in different stapedius reflex behaviour compared to normal-hearing listeners. A frequency dependence was observed. Stapedius reflex thresholds decreased with increasing centre frequencies of acoustic narrow band noise stimuli. A linear relation between upper stimulation levels on the implant channels and corresponding stapedius reflex thresholds evoked in free sound field was found. CONCLUSION The found correlation may be a guideline for adjusting the electrical dynamic range during cochlear implant fitting. This allows the implant system to mimic the natural reflex behaviour in the best possible way and potentially avoid overstimulation.
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Affiliation(s)
- Annett Franke-Trieger
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Germany
| | - Willy Mattheus
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Germany
| | - Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Zahnert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Germany
| | - Marcus Neudert
- Saxonian Cochlear Implant Centre, Department of Otorhinolaryngology, Head and Neck Surgery, Technische Universität Dresden, Germany
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Dziemba OC, Aristeidou A, Brill S. Slope of electrically evoked compound action potential amplitude growth function is site-dependent. Cochlear Implants Int 2020; 22:136-147. [PMID: 33297870 DOI: 10.1080/14670100.2020.1853956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES In human cochlear implant (CI) recipients, the slope of the electrically evoked compound action potential (ECAP) amplitude growth function (AGF) is not very well investigated, in comparison to the threshold derived from the AGF. This is despite the fact that it was shown in animal experiments that the slope correlates with the number of excitable neurons. The rationale of this study was to establish baseline data of the AGF slope for possible clinical applications, while investigating stability over time and dependence on cochlear site. DESIGN ECAP AGFs of 16 ears implanted with MED-EL CIs were recorded on all electrode contacts during the normal clinical routine at 4 different points in time. RESULTS Due to patient availability, not all 16 ears could be measured at all 4 points in time. A dependence of the slope on the electrode position was visible and statistically significant: At the three electrode contacts at the apical end of the array, the slope is greater compared to the medial and basal region of the cochlea. CONCLUSION The three most apical electrode contacts show greater slopes of ECAP AGF recordings. Our data of the cohort slopes show mild effects between the 4 different points in time.
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Affiliation(s)
- Oliver C Dziemba
- Department of ENT, Head & Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Aristotelis Aristeidou
- Department of ENT, Head & Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Brill
- MED-EL Elektromedizinische Geräte Deutschland GmbH, Starnberg, Germany
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Browning LM, Nie Y, Rout A, Heiner M. Audiologists' preferences in programming cochlear implants: A preliminary report. Cochlear Implants Int 2020; 21:179-191. [PMID: 31900086 DOI: 10.1080/14670100.2019.1708553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: There is little data available addressing how clinical audiologists handle cochlear implant (CI) programming between device manufacturers and make decisions on related services, particularly in the United States. Objectives: This study sought to understand the techniques and settings professionals use with their patients, how they approach bimodal fitting, which tests they use to evaluate patient and device performance, and their overall preferences of (re)habilitative options. Methods: A questionnaire was developed and distributed to CI audiologists throughout the United States electronically. Results: All respondents reported either always or almost always using Cochlear's default signal processing strategy in contrast to the 64% reported for Med-El and 40% for Advanced Bionics. A trend of less use of electrically evoked stapedial reflex threshold (eSRT) than electrically evoked compound action potentials (eCAP) for objective measures was revealed. Higher likelihood of performing speech recognition tests in quiet than in noise was revealed. Preferences for bimodal fitting trend toward using a partner company's hearing aid, although preferences were comparable in adopting four types of hearing aid formulas surveyed in the questionnaire. Conclusions: These data confirm high variability among audiologists' CI programming practices, and documenting these differences is an important step to understanding how to best treat patients.
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Affiliation(s)
- Leanne M Browning
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Yingjiu Nie
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Ayasakanta Rout
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
| | - Meredith Heiner
- Department of Audiology, Virginia Commonwealth University Health System, Richmond, VA, USA
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Gärtner L, Lenarz T, Büchner A. Fine-grain recordings of the electrically evoked compound action potential amplitude growth function in cochlear implant recipients. Biomed Eng Online 2018; 17:140. [PMID: 30340590 PMCID: PMC6195717 DOI: 10.1186/s12938-018-0588-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/10/2018] [Indexed: 11/24/2022] Open
Abstract
Background In cochlear implants (CI) measuring the electrically evoked compound action potential (ECAP) has become an important tool for verifying the electrode-nerve interface as well as establishing a basis for a map to program the speech processor. In a standard clinical setup recordings are averaged over 25–100 repetitions to allow for the detection of ECAPs within the noise floor. To obtain an amplitude growth function, these measurements are normally performed for 5–10 different stimulation levels. We evaluate a recording paradigm where the stimulation intensity is increased in quasi-continuous steps and instead of averaging repeated recordings with identical stimulation parameters, running averages over small intervals of stimulation levels are computed. The first visible nerve response was manually identified by two experts. Results Both recording paradigms were evaluated in 39 cochlear implants, showing an on average lower threshold of the first nerve response for the quasi-continuous measurement paradigm (Wilcoxon signed-rank test, p = 6.2e−08) compared to the clinical standard paradigm. The mean maximal loudness over all implants and stimulation electrodes was 13% lower at the 80 pulses/s quasi-continuous paradigm compared to the 44 pulses/s clinical standard paradigm. Conclusions Beside a more robust determination of the ECAP threshold, the proposed quasi-continuous stimulation paradigm results in a more robust behavioral feedback of the CI user upon the maximal acceptable loudness percept. Furthermore this paradigm can also reveal the fine-structure in the amplitude growth function.
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Affiliation(s)
- Lutz Gärtner
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Thomas Lenarz
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Andreas Büchner
- Department of Otolaryngology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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