Evaluation of computed tomography parameters in patients with facial nerve stimulation post-cochlear implantation

Aljazeeri, Isra; Khurayzi, Tawfiq; Al-Amro, Mariam; Alzhrani, Farid; Alsanosi, Abdulrahman

doi:10.1007/s00405-020-06486-7

Cited by 10 publications

(11 citation statements)

References 23 publications

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“…Future studies should therefore investigate whether the EFND can be determined more precisely by considering the three-dimensional anatomy. Recent studies reported that patients with postoperative FNS had signi cantly lower distance and bone density between the upper basal turn of the cochlea and the labyrinthine segment of the facial nerve 32,33 . Therefore, besides the EFND future studies should also include parameters such as bone density, which can in uence the propagation of the electric current.…”

Section: Discussionmentioning

confidence: 99%

“…CIs can in principle stimulate the facial nerve electrically. Postoperative facial nerve stimulation (FNS) is rare but may be facilitated by a number of known conditions, such as otosclerosis 29,30 , cochlear malformations 31 or in cases with a signi cantly reduced thickness of bone separating the upper basal turn of the cochlea and the labyrinthine segment of the facial nerve 32,33 . Unintended FNS can be reduced by using triphasic pulse stimulation 34,35 , electrode repositioning, change of implant type or nally by explantation 36 .…”

Section: Introductionmentioning

confidence: 99%

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Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Herrmann

Müller-Graff

Kaulitz

et al. 2021

Preprint

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Purpose: This proof of concept describes the use of evoked electromyographic (EMG) activation of the facial nerve for intraoperative monitoring of the electrode insertion during cochlear implantation (CI).Methods: Intraoperative EMG measurements from the facial nerve were conducted in nine patients undergoing CI implantation. Electric pulses were emitted from contacts on the CI array during and immediately after electrode insertion. For control, the results of EMG measurements were compared to postoperative flat panel volume computed tomography scans with secondary reconstruction (fpVCTSECO).Results: During insertion, the EMG response evoked by the electrical stimulation from the CI was growing with the stimulating contact approaching the facial nerve and declined with increasing distance. After full insertion, contacts on the apical half of the CI array stimulated higher EMG responses compared with those on the basal half. Comparison with postoperative imaging demonstrated that electrode contacts stimulating high EMG responses had the shortest distances to the facial nerve. Conclusion: It could be demonstrated that electrically evoked EMG activation of the facial nerve can be used to monitor the progress during CI electrode insertion and to control the intracochlear electrode position after full insertion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Herrmann

Müller-Graff

Kaulitz

et al. 2021

Preprint

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“…The stimulation mode was varied both with respect to the electrode configuration (A) and the pulse shape (B), with alternating presentation of the pulse polarity of the assumed spike-eliciting phase (asterisks). C Stimulation modes were 4 different combinations of electrode configuration and pulse shape: (1) We combined the monopolar configuration with both the symmetric biphasic and the pseudo-monophasic (psm) pulse shape, and (2) the two focused configurations were paired with both pulse shapes, which are bipolar-symmetric biphasic and tripolar-psm. The stimulation for each stimulation mode was performed at different, but corresponding CI contacts, i.e., from most basal to most apical stimulation contacts phase in bipolar stimulation was defined as the phase of the more apical contact.…”

Section: Cochlear Implant Stimulationmentioning

confidence: 99%

“…Coincidental facial nerve stimulation (FNS) is an adverse side effect of the therapy of hearing loss using cochlear implants (CI; [1][2][3]). Some FNS remains unobservable and unnoticed by CI users, whereas clinical signs of FNS range from simple awareness, unpleasant twitches or spasms of the facial muscles, to painful sensations, especially during the use of high current levels [4].…”

Section: Introductionmentioning

confidence: 99%

Anodic Polarity Minimizes Facial Nerve Stimulation as a Side Effect of Cochlear Implantation

Konerding

Baumhoff

Kral

2022

JARO

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One severe side effect of the use of cochlear implants (CI) is coincidental facial nerve stimulation (FNS). Clinical methods to alleviate FNS range from the reprogramming of processor settings to revision surgery. We systematically assessed different changes in CI stimulation modes that have been discussed in the literature as “rescue factors” from FNS: electrode configuration (broad to focused), pulse shape (symmetric biphasic to pseudo-monophasic), and pulse polarity (cathodic to anodic). An FNS was assessed, based on electrophysiological thresholds, in 204 electrically evoked compound action potential (eCAP) input/output functions recorded from 33 ears of 26 guinea pigs. The stimulation level difference between auditory nerve eCAP threshold and FNS threshold was expressed as the eCAP-to-FNS offset. Coincidental FNS occurred in all animals and in 45% of all recordings. A change from monopolar to focused (bipolar, tripolar) configurations minimized FNS. The Euclidean distance between the CI contacts and the facial nerve explained no more than 33% of the variance in FNS thresholds. For both the FNS threshold and the eCAP-to-FNS offset, the change from cathodic to anodic pulse polarity significantly reduced FNS and permitted a gain of 14–71% of the dynamic range of the eCAP response. This “anodic rescue effect” was stronger for pseudo-monophasic pulses as compared to the symmetric biphasic pulse shape. These results provide possible mechanisms underlying recent clinical interventions to alleviate FNS. The “anodic-rescue effect” may offer a non-invasive therapeutic option for FNS in human CI users that should be tested clinically, preferably in combination with current-focusing methods.

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“…Плотность (в HU) костной пере городки также была статистически ниже в группе со сти муляцией лицевого нерва (1038 ± 821 против 1409 ± 519; р = 0,029). Таким образом, у пациентов с наблюдаемой после операции стимуляцией лицевого нерва отмечались значительно меньшее расстояние и плотность костной ткани между базальным завитком улитки и лабиринтным сегментом канала лицевого нерва [11].…”

Section: коморбидный пациентunclassified

Etiological factors of facial nerve stimulation in cochlear implant users

et al. 2022

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Cochlear implantation is a high-tech method of rehabilitation of persons with complete deafness. However, cochlear implantation in patients may be accompanied by a number of difficulties due to the peculiarities of the structure of the cochlea, the relative position of anatomical structures relative to it and the nature of the acquired pathology of the inner ear. The reaction of the facial nerve during stimulation of one of the electrodes of the cochlear implant system is a common complication that can lead to a deterioration in the patient’s quality of life due to significant discomfort and restrictions on the use of the cochlear implant system. The debut of twitching of facial muscles in patients after cochlear implantation can occur both at the stage of connecting the speech processor and at the stages of further rehabilitation, which according to world literature can reach an interval of 10 years from the moment of surgery. Anatomical features of the cochlea, its interposition with the facial nerve, changes in the bone labyrinth, further progression of remodeling or ossification of the cochlea play a significant role in the development of symptoms of facial nerve stimulation in patients with sensorineural hearing loss of the IV degree, including at the stage of subsequent settings of the speech processor. The frequency of occurrence of this complication in various literature sources varies from 1 to 14.9 %. The purpose of this work is to review the world literature on the etiology of facial nerve stimulation in users of cochlear implants, highlighting the main theories of the origin of non-auditory sensations in this category of patients, since the data conducted in various studies are variable, and with a certain etiology reaches 38 %.

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Evaluation of computed tomography parameters in patients with facial nerve stimulation post-cochlear implantation

Cited by 10 publications

References 23 publications

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Continuous Facial Nerve Stimulation During Cochlear Implantation – An Electrophysiological Technique to Control the Intracochlear Electrode Contact Position

Anodic Polarity Minimizes Facial Nerve Stimulation as a Side Effect of Cochlear Implantation

Etiological factors of facial nerve stimulation in cochlear implant users

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