Electrocochleography-Guided Pull-Back Technique of Perimodiolar Electrode for Improved Hearing Preservation
Amit WaliaMatthew ShewDavid S. LeeAmanda J. OrtmannJordan VargheseShannon M. LeflerNedim DurakovicCameron C. WickJacques A. HerzogCraig A. Buchman
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Objective To evaluate whether electrocochleography (ECochG)-guided pull-back of the perimodiolar electrode improves perimodiolar proximity, hearing preservation (HP), and cochlear implant performance. Study Design Prospective cohort study Setting Tertiary referral center. Patients 77 adult CI recipients with residual acoustic hearing (low-frequency pure-tone average of 125, 250, 500 Hz; LFPTA ≤80 dB HL) Intervention Unilateral implantation, comparing conventional insertion (N = 31) with ECochG-guided electrode pull-back (N = 46). The guided method uses active ECochG from the apical electrode during adjustment and post-insertion electrode sweep to identify “tonotopic response” (defined as maximum response for 250 Hz at most apical electrode on electrode sweep). Main Outcome Measures Perimodiolar proximity (wrapping factor on postoperative CT); speech-perception testing (CNC, AzBio in noise +10 dB SNR); and HP at 3 and 6 months post-activation (defined as LFPTA ≤80 dB HL). Results Of the subjects undergoing ECochG-guided insertion, 36 required pull-back based on lack of tonotopic responses, whereas the remaining 10 exhibited “optimal responses” post-insertion, needing no adjustment. Improved perimodiolar proximity was achieved with the ECochG-guided method (mean wrapping factor difference, 6.4; 95% CI, 3.0–9.9). The LFPTA shift was smaller using ECochG-guided pull-back when compared with conventional insertion by 17.0 dB HL (95% CI, 8.3–25.7) and 14.8 dB HL (95% CI, 6.5–23.2) at 3 and 6 months, respectively. Forty percent achieved HP using ECochG-guided pull-back versus 27.5% without. There was no difference in CNC scores among both cohorts, but AzBio in noise scores at 6 months was improved in the ECochG-guided pull-back cohort (mean difference, 19.1%; 95% CI, 5.8–32.4). Conclusions ECochG-guided pull-back increased perimodiolar proximity and HP rates. Although there was no difference in speech perception performance in quiet, a significant improvement was noted in noisy conditions, potentially attributable to HP and the utilization of hybrid stimulation.Keywords:
Electrocochleography
Cochlear Implantation
Tonotopy
Recent studies suggest that pitch perceived through cochlear implants (CIs) changes with experience to minimize spectral mismatches between electric and acoustic hearing. This study aimed to test whether perceived spectral mismatches are similarly minimized between two electric inputs.Pitch perception was studied in a subject with a 10-mm CI in one ear and a 24-mm CI in the other ear. Both processors were programmed to allocate information from the same frequency range of 188-7938 Hz, despite the large differences in putative insertion depth and stimulated cochlear locations between the CIs.After 2 and 3 years of experience, pitch-matched electrode pairs between CIs were aligned closer to the processor-provided frequencies than to cochlear position.Pitch perception may have adapted to reduce perceived spectral discrepancies between bilateral CI inputs, despite 2-3 octave differences in tonotopic mapping.
Tonotopy
Pitch perception
Auditory perception
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Electrocochleography (ECochG) is increasingly recognized as a biomarker for assessing inner ear function in cochlear implant patients. This study aimed to objectively determine intraoperative cochlear microphonic (CM) amplitude patterns and correlate them with residual hearing in cochlear implant recipients, addressing the limitations in current ECochG analysis that often depends on subjective visual assessment and overlook the intracochlear measurement location.
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Electrocochleography
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OBJECTIVE The aim of investigations was to compare the perception of the pitch of tonal signals by patients using both the cochlear implant and hearing aid. MATERIAL AND METHOD The subjective evaluation of the pitch of sound presented through classical acoustic amplification and perceived by the residual hearing was compared with the sound perceived as a result of an electric stimulation. The subjects were 6 patients aged 15-63 (mean 38), diagnosed with postlingual deafness. The comparison of the acoustic signal transmitted via the hearing aid (in the acoustic free field) with the electrical signal from stimulated electrode of the cochlear implant enabled to determine subjectively evaluated shift in the frequency domain. The tonotopic distribution according to the Greenwood's model compared with the allocation of frequency determined on the basis of cochlear view was also investigated. RESULTS AND CONCLUSION The study has revealed significant differences in the perception of the pitch of sounds perceived through the acoustic stimulation via the hearing aid and the electric stimulation via the implant.
Tonotopy
Hearing aid
Pitch perception
Auditory perception
Sound perception
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To objectively evaluate whether cochlear implantation surgery made damage to cochlear basal membrane or not through analyzing the change of the threshold of cochlear microphonic (CM) of round window electrocochleography before and after inserting electrode during cochlear implantation surgery.Round window electrocochleography was performed on 40 cases with profound sensorineural deafness under general anesthesia in the standard operating room in order to analyze the change of the threshold of cochlear microphonic (CM) of round window electrocochleography before and after inserting electrode during cochlear implantation surgery.Among the 40 cases, thresholds of cochlear microphonic (CM) before and after inserting electrode during cochlear implantation surgery were similar in 39 cases. The thresholds of cochlear microphonic (CM) after inserting electrode decreased about 5 dB at certain frequency. The thresholds of cochlear microphonic (CM) after inserting electrode increased 20-50 dB in only one case. There was a sense of resistance in implanting the electrodes in this patient.Use of round window electrocochleography may objectively evaluate whether cochlear implantation surgery make damage to cochlear basal membrane or not.
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Round window
Cochlear Implantation
Microphonics
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Introduction In order to preserve residual hearing during cochlear implantation, intraoperative electrocochleography (EcochG) is used promisingly during electrode insertion.This study investigates for the first time if patients lacking tonaudiometrically proven residual hearing can also benefit from direct visualisation of intraoperative EcochG measurements.
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Cochlear implant subjects continue to experience difficulty understanding speech in noise and performing pitch-based musical tasks. Acoustic model studies have suggested that transmitting additional fine structure via multiple stimulation rates is a potential mechanism for addressing these issues [Nie et al., IEEE Trans. Biomed. Eng. 52, 64–73 (2005); Throckmorton et al., Hear. Res. 218, 30–42 (2006)]; however, results from preliminary cochlear implant studies have been less compelling. Multirate speech processing algorithms previously assumed a place-dependent pitch structure in that a basal electrode would always elicit a higher pitch percept than an apical electrode, independent of stimulation rate. Some subjective evidence contradicts this assumption [H. J. McDermott and C. M. McKay, J. Acoust. Soc. Am. 101, 1622–1630 (1997); R. V. Shannon, Hear. Res. 11, 157–189 (1983)]. The purpose of this study is to test the hypothesis that the introduction of multiple rates may invalidate the tonotopic pitch structure resulting from place-pitch alone. The SPEAR3 developmental speech processor was used to collect psychophysical data from five cochlear implant users to assess the tonotopic structure for stimuli presented at two rates on all active electrodes. Pitch ranking data indicated many cases where pitch percepts overlapped across electrodes and rates. Thus, the results from this study suggest that pitch-based tuning across rate and electrode may be necessary to optimize performance of a multirate sound processing strategy in cochlear implant subjects.
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Pitch perception
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In multichannel cochlear implants, low frequency information is delivered to apical cochlear locations while high frequency information is delivered to more basal locations, mimicking the normal acoustic tonotopic organization of the auditory nerves. In clinical practice, little attention has been paid to the distribution of acoustic input across the electrodes of an individual patient that might vary in terms of spacing and absolute tonotopic location. In normal-hearing listeners, Başkent and Shannon (J. Acoust. Soc. Am. 113, 2003) simulated implant signal processing conditions in which the frequency range assigned to the array was systematically made wider or narrower than the simulated stimulation range in the cochlea, resulting in frequency-place compression or expansion, respectively. In general, the best speech recognition was obtained when the input acoustic information was delivered to the matching tonotopic place in the cochlea with least frequency-place distortion. The present study measured phoneme and sentence recognition scores with similar frequency-place manipulations in six Med-El Combi 40+ implant subjects. Stimulation locations were estimated using the Greenwood mapping function based on the estimated electrode insertion depth. Results from frequency-place compression and expansion with implants were similar to simulation results, especially for postlingually deafened subjects, despite the uncertainty in the actual stimulation sites of the auditory nerves. The present study shows that frequency-place mapping is an important factor in implant performance and an individual implant patient’s map could be optimized with functional tests using frequency-place manipulations.
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Deprivation from normal sensory input has been shown to alter tonotopic organization of the human auditory cortex. In this context, cochlear implant subjects provide an interesting model in that profound deafness is made partially reversible by the cochlear implant. In restoring afferent activity, cochlear implantation may also reverse some of the central changes related to deafness. The purpose of the present study was to address whether the auditory cortex of cochlear implant subjects is tonotopically organized. The subjects were thirteen adults with at least 3 months of cochlear implant experience. Auditory event-related potentials were recorded in response to electrical stimulation delivered at different intracochlear electrodes. Topographic analysis of the auditory N1 component (∼85 ms latency) showed that the locations on the scalp and the relative amplitudes of the positive/negative extrema differ according to the stimulated electrode, suggesting that distinct sets of neural sources are activated. Dipole modeling confirmed electrode-dependent orientations of these sources in temporal areas, which can be explained by nearby, but distinct sites of activation in the auditory cortex. Although the cortical organization in cochlear implant users is similar to the tonotopy found in normal-hearing subjects, some differences exist. Nevertheless, a correlation was found between the N1 peak amplitude indexing cortical tonotopy and the values given by the subjects for a pitch scaling task. Hence, the pattern of N1 variation likely reflects how frequencies are coded in the brain.
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Objectives: Modern cochlear implants (CIs) use varying-length electrode arrays inserted at varying insertion angles within variably sized cochleae. Thus, there exists an opportunity to enhance CI performance, particularly in postlinguistic adults, by optimizing the frequency-to-place allocation for electrical stimulation, thereby minimizing the need for central adaptation and plasticity. There has been interest in applying Greenwood or Stakhovskaya et al. function (describing the tonotopic map) to postoperative imaging of electrodes to improve frequency allocation and place coding. Acoustically-evoked electrocochleography (ECochG) allows for electrophysiologic best-frequency (BF) determination of CI electrodes and the potential for creating a personalized frequency allocation function. The objective of this study was to investigate the correlation between early speech-perception performance and frequency-to-place mismatch. Design: This retrospective study included 50 patients who received a slim perimodiolar electrode array. Following electrode insertion, five acoustic pure-tone stimuli ranging from 0.25 to 2 kHz were presented, and electrophysiological measurements were collected across all 22 electrode contacts. Cochlear microphonic tuning curves were subsequently generated for each stimulus frequency to ascertain the BF electrode or the location corresponding to the maximum response amplitude. Subsequently, we calculated the difference between the stimulus frequency and the patient’s CI map’s actual frequency allocation at each BF electrode, reflecting the frequency-to-place mismatch. BF electrocochleography-total response (BF-ECochG-TR), a measure of cochlear health, was also evaluated for each subject to control for the known impact of this measure on performance. Results: Our findings showed a moderate correlation ( r = 0.51; 95% confidence interval: 0.23 to 0.76) between the cumulative frequency-to-place mismatch, as determined using the ECochG-derived BF map (utilizing 500, 1000, and 2000 Hz), and 3-month performance on consonant-nucleus-consonant words (N = 38). Larger positive mismatches, shifted basal from the BF map, led to enhanced speech perception. Incorporating BF-ECochG-TR, total mismatch, and their interaction in a multivariate model explained 62% of the variance in consonant-nucleus-consonant word scores at 3 months. BF-ECochG-TR as a standalone predictor tended to overestimate performance for subjects with larger negative total mismatches and underestimated the performance for those with larger positive total mismatches. Neither cochlear diameter, number of cochlear turns, nor apical insertion angle accounted for the variability in total mismatch. Conclusions: Comparison of ECochG-BF derived tonotopic electrode maps to the frequency allocation tables reveals substantial mismatch, explaining 26.0% of the variability in CI performance in quiet. Closer examination of the mismatch shows that basally shifted maps at high frequencies demonstrate superior performance at 3 months compared with those with apically shifted maps (toward Greenwood and Stakhovskaya et al.). The implications of these results suggest that electrophysiological-based frequency reallocation might lead to enhanced speech-perception performance, especially when compared with conventional manufacturer maps or anatomic-based mapping strategies. Future research, exploring the prospective use of ECochG-based mapping techniques for frequency allocation is underway.
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Electrocochleography
Stimulus (psychology)
Electrode array
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