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Electrode interaction in pediatric cochlear implant subjects.

ABSTRACT: Multielectrode cochlear implants rely on differential stimulation of the cochlear nerve for presenting the brain with the spectral and timing information required to understand speech. In implant patients, the degree of overlap among cochlear nerve fibers stimulated by the different electrodes constitutes the electrode interaction. Electrode interaction degrades the spectral resolution of the implant's stimulus. We sought to define electrode interaction in a cohort of pediatric cochlear implant subjects as a function of both stimulus intensity and electrode location along the array. The 27 pediatric subjects that completed the study were implanted with either the Clarion Hi-Focus array with or without positioner, the Nucleus 24 Contour array, or the Nucleus 24 Straight array. All but two of the patients had congenital hearing loss, and none of the patients had meningitis prior to the onset of deafness. The cochlear nerve response was measured with the electrically evoked compound action potential (ECAP). A forward masking protocol was used such that a probe stimulus electrode remained fixed while a preceding masker was moved across the array. Electrode interaction was estimated by measuring the unmasked probe response minus the masked probe response. Three probe locations and three probe intensities were examined for each subject. At all probe locations, electrode interaction increased as probe intensity increased (p < 0.05). Interaction at the basal probe was less than that at either the middle or apical probe locations (p < 0.05), and significant correlation found between probe distance from the basal end of the array and electrode interaction (p < 0.001). These results demonstrate that in this cohort of pediatric subjects, electrode interaction depended on both stimulus intensity and probe location. Implications of these findings on future implant array design and current implant fitting strategies are discussed. The impact of electrode interaction on implant performance is yet to be elucidated.

SUBMITTER: Eisen MD

PROVIDER: S-EPMC2538331 | biostudies-other | 2005 Jun

REPOSITORIES: biostudies-other

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Project description:Introduction and objectivesAmong cochlear implant candidates, an increasing number of patients are presenting with residual acoustic hearing. To monitor the postoperative course of structural and functional preservation of the cochlea, a reliable objective biomarker would be desirable. Recently, impedance telemetry has gained increasing attention in this field. The aim of this study was to investigate the postoperative course of the residual acoustic hearing and clinical impedance in patients with long electrode arrays and to explore the applicability of impedance telemetry for monitoring residual hearing.MethodsWe retrospectively analyzed records of 42 cochlear implant recipients with residual hearing covering a median postoperative follow-up of 25 months with repeated simultaneous pure tone audiometry and impedance telemetry. We used a linear mixed-effects model to estimate the relation between clinical electrode impedance and residual hearing. Besides the clinical impedance, the follow-up time, side of implantation, gender, and age at implantation were included as fixed effects. An interaction term between impedance and follow-up time, as well as subject-level random intercepts and slopes, were included.ResultsLoss of residual hearing occurred either during surgery or within the first 6 post-operative months. Electrode contacts inserted further apically (i.e., deeper) had higher impedances, independent of residual hearing. The highest impedances were measured 1 month postoperatively and gradually decreased over time. Basal electrodes were more likely to maintain higher impedance. Follow-up time was significantly associated with residual hearing. Regardless of the time, we found that a 1 kΩ increase in clinical impedance was associated with a 4.4 dB deterioration of residual hearing (p < 0.001).ConclusionPure tone audiometry is the current gold standard for monitoring postoperative residual hearing. However, the association of clinical impedances with residual hearing thresholds found in our study could potentially be exploited for objective monitoring using impedance telemetry. Further analysis including near-field related impedance components could be performed for improved specificity to local immune responses.

Project description:ObjectivesReliable determination of cochlear implant electrode positions shows promise for clinical applications, including anatomy-based fitting of audio processors or monitoring of electrode migration during follow-up. Currently, electrode positioning is measured using radiography. The primary objective of this study is to extend and validate an impedance-based method for estimating electrode insertion depths, which could serve as a radiation-free and cost-effective alternative to radiography. The secondary objective is to evaluate the reliability of the estimation method in the postoperative follow-up over several months.DesignThe ground truth insertion depths were measured from postoperative computed tomography scans obtained from the records of 56 cases with an identical lateral wall electrode array. For each of these cases, impedance telemetry records were retrieved starting from the day of implantation up to a maximum observation period of 60 mo. Based on these recordings, the linear and angular electrode insertion depths were estimated using a phenomenological model. The estimates obtained were compared with the ground truth values to calculate the accuracy of the model.ResultsAnalysis of the long-term recordings using a linear mixed-effects model showed that postoperative tissue resistances remained stable throughout the follow-up period, except for the two most basal electrodes, which increased significantly over time (electrode 11: ~10 Ω/year, electrode 12: ~30 Ω/year). Inferred phenomenological models from early and late impedance telemetry recordings were not different. The insertion depth of all electrodes was estimated with an absolute error of 0.9 mm ± 0.6 mm or 22° ± 18° angle (mean ± SD).ConclusionsInsertion depth estimations of the model were reliable over time when comparing two postoperative computed tomography scans of the same ear. Our results confirm that the impedance-based position estimation method can be applied to postoperative impedance telemetry recordings. Future work needs to address extracochlear electrode detection to increase the performance of the method.

Project description:Experimental studies play an important role in establishing the safety and efficacy of cochlear implants and they continue to provide insight into a new generation of electrode arrays and stimulation strategies. One drawback has been the limited depth of insertion of an electrode array in experimental animals. We compared the insertion depth and trauma associated with the insertion of Cochlear Ltd's Hybrid-L (HL) array with a standard 8 ring array in cat cochleae. Both arrays were inserted into cadaver cochleae and an X-ray recorded their anatomical location. The implanted cochlea was serially sectioned and photographed at 300 ?m intervals for evidence of electrode insertion trauma. Subsequently two cats were chronically implanted with HL arrays and electrically-evoked potentials recorded over a three month period. Mean insertion depth for the HL arrays was 334.8° (SD = 21°; n = 4) versus 175.5° (SD = 6°; n = 2) for the standard array. This relates to ?10.5 mm and 6 mm respectively. A similar insertion depth was measured in a chronically implanted animal with an HL array. Histology from each cadaver cochleae showed that the electrode array was always located in the scala tympani; there was no evidence of electrode insertion trauma to the basilar membrane, the osseous spiral lamina or the spiral ligament. Finally, evoked potential data from the chronically implanted animals exhibited significantly lower thresholds compared with animals implanted with a standard 8 ring array, with electrical thresholds remaining stable over a three-month observation period. Cochlear Ltd's HL electrode array can be safely inserted ?50% of the length of the cat scala tympani, placing the tip of the array close to the 4 kHz place. This insertion depth is considerably greater than is routinely achieved using a standard 8-ring electrode array (?12 kHz place). The HL array evokes low thresholds that remain stable over three months of implantation. This electrode array has potential application in a broad area of cochlear implant related research.

Project description:The multichannel design of contemporary cochlear implants (CIs) is predicated on the assumption that each channel activates a relatively restricted and independent sector of the deaf auditory nerve array, just as a sound within a restricted frequency band activates a restricted region of the normal cochlea The independence of CI channels, however, is limited; and the factors that determine their independence, the relative overlap of the activity patterns that they evoke, are poorly understood. In this study, we evaluate the spread of activity evoked by cochlear implant channels by monitoring activity at 16 sites along the tonotopic axis of the guinea pig inferior colliculus (IC). "Spatial tuning curves" (STCs) measured in this way serve as an estimate of activation spread within the cochlea and the ascending auditory pathways. We contrast natural stimulation using acoustic tones with two kinds of electrical stimulation either (1) a loose fitting banded array consisting of a cylindrical silicone elastomer carrier with a linear series of ring contacts; or (2) a space-filling array consisting of a tapered silicone elastomer carrier that is designed to fit snugly into the guinea pig scala tympani with a linear series of ball contacts positioned along it Spatial tuning curves evoked by individual acoustic tones, and by activation of each contact of each array as a monopole, bipole or tripole were recorded. Several channel configurations and a wide range of electrode separations were tested for each array, and their thresholds and selectivity were estimated. The results indicate that the tapered space-filling arrays evoked more restricted activity patterns at lower thresholds than did the banded arrays. Monopolar stimulation (one intracochlear contact activated with an extracochlear return) using either array evoked broad activation patterns that involved the entire recording array at current levels <6dBSL, but at relatively low thresholds. Bi- and tri-polar configurations of both array types evoked more restricted activity patterns, but their thresholds were higher than those of monopolar configurations. Bipolar and tripolar configurations with closely spaced contacts evoked activity patterns that were comparable to those evoked by pure tones. As the spacing of bipolar electrodes was increased (separations >1mm), the activity patterns became broader and evoked patterns with two distinct threshold minima, one associated with each contact.

Project description:Using long Med-El Combi40+ electrode arrays, it is now possible to cover the whole range of the cochlea, up to about two turns. Such insertion depths have received little attention. To evaluate the contribution of deeply inserted electrodes, five Med-El cochlear implant users were tested on vowel and consonant identification tests with fittings with first one, two, and up to five apical electrodes being deactivated. In addition, subjects performed pitch-ranking experiments, using loudness-balanced stimuli, to identify electrodes creating pitch confusions. Radiographs were taken to measure each electrode insertion depth. All subjects used each modified fitting for two periods of about 3 weeks. During the experiment, the same stimulation rate and frequency range were maintained across all the fittings used for each individual subject. After each trial period the subject had to perform three consonant and three vowel identification tests. All subjects showed deep electrode insertions ranging from 605 degrees to 720 degrees. The two subjects with the deepest electrode insertions showed significantly increased vowel- and consonant-identification performances with fittings with the two or three most apical electrodes deactivated compared to their standard fitting with all available electrodes activated. The other three subjects did not show significant improvements in performance when one or two of their most apical electrodes were deactivated. Four out of five subjects preferred to continue use of a fitting with one or more apical electrodes deactivated. The two subjects with the deepest insertions also showed pitch confusions between their most apical electrodes. Two possible reasons for these results are discussed. One is to reduce neural interactions related to electrodes producing pitch confusions. Another is to improve the alignment of the frequency components of sounds coded by the electrical signals delivered to each electrode to the overall pitch of the auditory perception produced by the electrical stimulation of auditory nerve fibers.

Project description:PurposeCochlear implants (CIs) are neural prosthetic devices that provide a sense of sound to people who experience profound hearing loss. Recent research has indicated that there is a significant correlation between hearing outcomes and the intracochlear locations of the electrodes. We have developed an image-guided cochlear implant programming (IGCIP) system based on this correlation to assist audiologists with programming CI devices. One crucial step in our IGCIP system is the localization of CI electrodes in postimplantation CTs. Existing methods for this step are either not fully automated or not robust. When the CI electrodes are closely spaced, it is more difficult to identify individual electrodes because there is no intensity contrast between them in a clinical CT. The goal of this work is to automatically segment the closely spaced CI electrode arrays in postimplantation clinical CTs.MethodsThe proposed method involves firstly identifying a bounding box that contains the cochlea by using a reference CT. Then, the intensity image and the vesselness response of the VOI are used to segment the regions of interest (ROIs) that may contain the electrode arrays. For each ROI, we apply a voxel thinning method to generate the medial axis line. We exhaustively search through all the possible connections of medial axis lines. For each possible connection, we define CI array centerline candidates by selecting two points on the connected medial axis lines as the array endpoints. For each CI array centerline candidate, we use a cost function to evaluate its quality, and the one with the lowest cost is selected as the array centerline. Then, we fit an a priori known geometric model of the array to the centerline to localize the individual electrodes. The method was trained on 28 clinical CTs of CI recipients implanted with three models of closely spaced CI arrays. The localization results are compared with the ground truth localization results manually generated by an expert.ResultsA validation study was conducted on 129 clinical CTs of CI recipients implanted with three models of closely spaced arrays. Ninety-eight percent of the localization results generated by the proposed method had maximum localization errors lower than one voxel diagonal of the CTs. The mean localization error was 0.13 mm, which was close to the rater's consistency error (0.11 mm). The method also outperformed the existing automatic electrode localization methods in our validation study.ConclusionOur validation study shows that our method can localize closely spaced CI arrays with an accuracy close to what is achievable by an expert on clinical CTs. This represents a crucial step toward automating IGCIP and translating it from the laboratory to the clinical workflow.

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Electrode interaction in pediatric cochlear implant subjects.

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