Residual Cochlear Function in Adults and Children Receiving Cochlear Implants: Correlations With Speech Perception Outcomes

Fontenot, Tatyana E.; Giardina, Christopher K.; Dillon, Margaret T.; Rooth, Meredith A; Teagle, Holly F. B.; Park, Lisa; Brown, Kevin D.; Adunka, Oliver F.; Buchman, Craig A.; Pillsbury, Harold C.; Fitzpatrick, Douglas C.

doi:10.1097/aud.0000000000000630

Cited by 53 publications

(81 citation statements)

References 96 publications

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“…Once hearing preservation became possible for CI users with the development of less traumatic electrode arrays and the use of the soft surgical techniques, the feasibility of ECoG to measure cochlear function was investigated in this growing population of CI recipients. The ECoG technique has been increasingly used to monitor the status of hearing during cochlear implant surgery [ 18 , 19 , 20 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 47 , 48 ]. In most of these intraoperative monitoring studies, the major focus was monitoring the CM.…”

Section: Discussionmentioning

confidence: 99%

“…ECoG responses were recorded from a monopolar needle electrode placed at the round window before or after an insertion of the CI electrode array into the scala tympani to record changes in response during or after electrode insertion [ 18 , 19 , 20 , 21 , 22 , 35 , 36 , 37 , 38 , 39 , 40 , 44 , 46 ]. In general, ECoG responses after insertion were significantly smaller than the preinsertion response by 3 to 5 dB [ 18 , 28 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic value of intraoperative ECoG to predict postoperative speech outcomes was investigated in a series of studies from the same research group [ 21 , 22 , 38 , 49 ]. The ECoG total response (TR) metric—the sum of first and second harmonics of the Fast Fourier transform (FFT) analysis—was used in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…The ECoG total response (TR) metric—the sum of first and second harmonics of the Fast Fourier transform (FFT) analysis—was used in these studies. Moderate correlations between TR magnitudes and CNC / PB-K word scores were observed both in adults and children [ 21 , 22 , 38 ]. TR accounted for 46% of variability in speech recognition for adults, while 15–36% of variability was accounted for by children.…”

Section: Discussionmentioning

confidence: 99%

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Electrocochleography in Cochlear Implant Users with Residual Acoustic Hearing: A Systematic Review

Kim

2020

IJERPH

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(1) Objectives: This study reviews the use of electrocochleography (ECoG) as a tool for assessing the response of the peripheral auditory system and monitoring hearing preservation in the growing population of cochlear implant (CI) users with preserved hearing in the implanted ear. (2) Methods: A search was conducted in PubMed and CINAHL databases up to August 2020 to locate articles related to the ECoG measured during or after the cochlear implant (CI) surgery for monitoring purposes. Non-English articles, animal studies, literature reviews and editorials, case reports, and conference papers were excluded. The quality of studies was evaluated using the National Institute of Health (NIH) “Study Quality Assessment Tool for Case Series Studies”. (3) Results: A total 30 articles were included for the systematic review. A total of 21 articles were intraoperative ECoG studies, while seven articles were postoperative studies. Two studies were conducted ECoG both during and after the surgery. Intraoperative ECoG studies focused on monitoring changes in ECoG response amplitudes during and/or after electrode insertion and predicting the scalar location of the electrode array. Postoperative ECoG studies focused on using the ECoG measurements to estimate behavioral audiometric thresholds and monitor pathophysiological changes related to delayed onset hearing loss postimplant. (4) Conclusions: ECoG is feasible to provide real-time feedback intraoperatively and has a potential clinical value to monitor the status of hearing preservation postoperatively in this CI population with residual acoustic hearing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Electrocochleography in Cochlear Implant Users with Residual Acoustic Hearing: A Systematic Review

Kim

2020

IJERPH

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“…Thus, using sensory cells as an internal microphone is limited to the extent of remaining hair cell presence in the inner ear. However, previous extra and intra-cochlear ECochG recordings have been carried out by numerous authors in recent years in instances of severe-to-profound SNHL of which many report their ability to record ECochG activity that is thought to predominantly represent the CM 4,6,7,[27][28][29][30] . The challenge then becomes how well the residual sensory cells can represent the incoming speech signal, and what proportion of the acoustic properties (e.g., formant structure) is necessary to be preserved for computer algorithms to accurately identify and differentiate between speech phonemes so that the appropriate signal can be delivered to the stimulating electrode array.…”

Section: Discussionmentioning

confidence: 99%

Utilizing Electrocochleography as a Microphone for Fully Implantable Cochlear Implants

Riggs

Hiss

Skidmore

et al. 2020

Sci Rep

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current cochlear implants (cis) are semi-implantable devices with an externally worn sound processor that hosts the microphone and sound processor. A fully implantable device, however, would ultimately be desirable as it would be of great benefit to recipients. While some prototypes have been designed and used in a few select cases, one main stumbling block is the sound input. Specifically, subdermal implantable microphone technology has been poised with physiologic issues such as sound distortion and signal attenuation under the skin. Here we propose an alternative method that utilizes a physiologic response composed of an electrical field generated by the sensory cells of the inner ear to serve as a sound source microphone for fully implantable hearing technology such as cis. Electrophysiological results obtained from 14 participants (adult and pediatric) document the feasibility of capturing speech properties within the electrocochleography (ecochG) response. Degradation of formant properties of the stimuli /da/ and /ba/ are evaluated across various degrees of hearing loss. preliminary results suggest proof-of-concept of using the ecochG response as a microphone is feasible to capture vital properties of speech. However, further signal processing refinement is needed in addition to utilization of an intracochlear recording location to likely improve signal fidelity.To date, it is estimated that as many as 466 million individuals worldwide have hearing loss as defined as an average hearing level of ≥35 dB HL by pure-tone audiometry 1 . Treatment options for hearing loss typically depend on the severity of the hearing loss. Cochlear implants (CI) have long been a treatment option for individuals with severe-to-profound hearing loss; however, with advancements in technology, candidacy criteria have expanded to include individuals with greater amounts of residual hearing. With this trend, the focus has shifted toward developing techniques and technology to allow for the preservation of residual hearing, as this has been shown to be important in obtaining optimal outcomes through the use of electric-acoustic stimulation. That is, in patients who receive CIs but maintain some useable residual hearing, the implanted ear can be stimulated using the ipsilateral combination of electric (CI) and acoustic (hearing aid) 2,3 .In attempts to achieve preservation of residual hearing, implementation of electrocochleography (ECochG) at the time of CI surgery has recently been described. ECochG is a tool that allows electrophysiological assessment of the peripheral auditory system (i.e., the cochlea and auditory nerve) by using acoustic stimulation. Specifically, ECochG has been used as a monitoring tool during CI surgery in an effort to provide real-time feedback of inner ear physiology that allows for modifying surgical technique in an attempt to avoid trauma caused by the electrode insertion, hence preserving residual hearing 4-6 . The use of ECochG is not new, but its use in CI surgery is novel. Specifically, new technology ...

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For Whom Do Cochlear Implants Work Best?

Shew

Herzog

Buchman

2020

JAMA Otolaryngol Head Neck Surg

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In this issue of JAMA Otolaryngology-Head & Neck Surgery, Zhao and colleagues 1 report a meta-analysis on the association of preoperative patient-related factors with adult cochlear implant (CI) speech perception outcomes. Through pooled analysis, encompassing 13 articles and 1095 patients, the authors demonstrate statistically significant, yet modest at best, association between postoperative CI speech perception measures and commonly used variables: age of implantation (r = −0.31), duration of hearing loss (HL) (r = −0.25), preimplant pure-tone average (r = −0.16), and preoperative aided word recognition scores (WRS) (r = 0.22).Classic studies from Blamey and colleagues, 2 Holden and colleagues, 3 and Lazard and colleagues 4 have demonstrated similar findings. The relatively large-scale study by Blamey and colleagues 2 followed more than 2251 patients across 15 institutions and found that these traditional factors account for approximately 10% of the variance in CI speech perception performance. A separate analysis by Lazard and colleagues 4 of the same data set but using different models demonstrated that the combination of duration of moderate HL, hearing aid (HA) use, pure-tone average and threshold at 500 Hz in the better ear, CI manufacturer, and percentage of active electrodes accounted for only 22% of the variance in CI speech perception performance. Taken together, these findings alongside those of Zhao and colleagues, 1 are enigmatic when one considers the fact that preoperative aided speech perception testing (consonant-nucleus-consonant words and AzBio sentences) is the main candidacy criteria for determining CI eligibility in nearly all centers and among payers. Although these tests do well at identifying individuals with poor hearing, and thus CI candidates, they do not identify the degree to which an individual will gain benefit.In theory, the best performance predictors would be those measures that represent biomarkers of auditory system integrity. CIs attempt to synchronize auditory nerve depolarization within the spectral and temporal domains to activate the central auditory pathways to improve audibility, speech understanding, and music appreciation, among other facets. It stands to reason that the status of the peripheral cochlearneural substrate in conjunction with the central auditory and nonauditory stations play a major role in determining a patient's performance using a CI. 3 Implant recipients typically do very well with their implants, although performance is variable. Holden and colleagues 3 and many others have demonstrated similar mean consonant-nucleus-consonant word scores (approximately 62%) at 6 months of use with modern technology. Thus, the poor correlation between speech perception performance and the common preoperative biographi-

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Residual Cochlear Function in Adults and Children Receiving Cochlear Implants: Correlations With Speech Perception Outcomes

Cited by 53 publications

References 96 publications

Electrocochleography in Cochlear Implant Users with Residual Acoustic Hearing: A Systematic Review

Electrocochleography in Cochlear Implant Users with Residual Acoustic Hearing: A Systematic Review

Utilizing Electrocochleography as a Microphone for Fully Implantable Cochlear Implants

For Whom Do Cochlear Implants Work Best?

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