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1.
Trends Hear ; 28: 23312165241252240, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38715410

RESUMO

In recent years, tools for early detection of irreversible trauma to the basilar membrane during hearing preservation cochlear implant (CI) surgery were established in several clinics. A link with the degree of postoperative hearing preservation in patients was investigated, but patient populations were usually small. Therefore, this study's aim was to analyze data from intraoperative extracochlear electrocochleography (ECochG) recordings for a larger group.During hearing preservation CI surgery, extracochlear recordings were made before, during, and after CI electrode insertion using a cotton wick electrode placed at the promontory. Before and after insertion, amplitudes and stimulus response thresholds were recorded at 250, 500, and 1000 Hz. During insertion, response amplitudes were recorded at one frequency and one stimulus level. Data from 121 patient ears were analyzed.The key benefit of extracochlear recordings is that they can be performed before, during, and after CI electrode insertion. However, extracochlear ECochG threshold changes before and after CI insertion were relatively small and did not independently correlate well with hearing preservation, although at 250 Hz they added some significant information. Some tendencies-although no significant relationships-were detected between amplitude behavior and hearing preservation. Rising amplitudes seem favorable and falling amplitudes disadvantageous, but constant amplitudes do not appear to allow stringent predictions.Extracochlear ECochG measurements seem to only partially realize expected benefits. The questions now are: do gains justify the effort, and do other procedures or possible combinations lead to greater benefits for patients?


Assuntos
Audiometria de Resposta Evocada , Limiar Auditivo , Cóclea , Implante Coclear , Implantes Cocleares , Audição , Humanos , Audiometria de Resposta Evocada/métodos , Estudos Retrospectivos , Implante Coclear/instrumentação , Feminino , Pessoa de Meia-Idade , Masculino , Idoso , Adulto , Audição/fisiologia , Cóclea/cirurgia , Cóclea/fisiopatologia , Resultado do Tratamento , Adolescente , Valor Preditivo dos Testes , Adulto Jovem , Criança , Audiometria de Tons Puros , Idoso de 80 Anos ou mais , Pré-Escolar , Perda Auditiva/diagnóstico , Perda Auditiva/fisiopatologia , Perda Auditiva/cirurgia , Perda Auditiva/reabilitação
2.
Trends Hear ; 28: 23312165241248973, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38717441

RESUMO

To preserve residual hearing during cochlear implant (CI) surgery it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring). A promising method is electrocochleography (ECochG). Within this project the relations between intracochlear ECochG recordings, position of the recording contact in the cochlea with respect to anatomy and frequency and preservation of residual hearing were investigated. The aim was to better understand the changes in ECochG signals and whether these are due to the electrode position in the cochlea or to trauma generated during insertion. During and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed using the CI electrode (MED-EL). During insertion, the recordings were performed at discrete insertion steps on electrode contact 1. After insertion as well as postoperatively the recordings were performed at different electrode contacts. The electrode location in the cochlea during insertion was estimated by mathematical models using preoperative clinical imaging, the postoperative location was measured using postoperative clinical imaging. The recordings were analyzed from six adult CI recipients. In the four patients with good residual hearing in the low frequencies the signal amplitude rose with largest amplitudes being recorded closest to the generators of the stimulation frequency, while in both cases with severe pantonal hearing losses the amplitude initially rose and then dropped. This might be due to various reasons as discussed in the following. Our results indicate that this approach can provide valuable information for the interpretation of intracochlearly recorded ECochG signals.


Assuntos
Audiometria de Resposta Evocada , Cóclea , Implante Coclear , Implantes Cocleares , Humanos , Cóclea/cirurgia , Cóclea/fisiologia , Cóclea/fisiopatologia , Implante Coclear/instrumentação , Implante Coclear/métodos , Audiometria de Resposta Evocada/métodos , Pessoa de Meia-Idade , Idoso , Masculino , Feminino , Audição/fisiologia , Adulto , Resultado do Tratamento , Valor Preditivo dos Testes , Estimulação Elétrica , Pessoas com Deficiência Auditiva/reabilitação , Pessoas com Deficiência Auditiva/psicologia , Limiar Auditivo/fisiologia
4.
Hear Res ; 446: 109005, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38598943

RESUMO

Auditory nerve (AN) fibers that innervate inner hair cells in the cochlea degenerate with advancing age. It has been proposed that age-related reductions in brainstem frequency-following responses (FFR) to the carrier of low-frequency, high-intensity pure tones may partially reflect this neural loss in the cochlea (Märcher-Rørsted et al., 2022). If the loss of AN fibers is the primary factor contributing to age-related changes in the brainstem FFR, then the FFR could serve as an indicator of cochlear neural degeneration. In this study, we employed electrocochleography (ECochG) to investigate the effects of age on frequency-following neurophonic potentials, i.e., neural responses phase-locked to the carrier frequency of the tone stimulus. We compared these findings to the brainstem-generated FFRs obtained simultaneously using the same stimulation. We conducted recordings in young and older individuals with normal hearing. Responses to pure tones (250 ms, 516 and 1086 Hz, 85 dB SPL) and clicks were recorded using both ECochG at the tympanic membrane and traditional scalp electroencephalographic (EEG) recordings of the FFR. Distortion product otoacoustic emissions (DPOAE) were also collected. In the ECochG recordings, sustained AN neurophonic (ANN) responses to tonal stimulation, as well as the click-evoked compound action potential (CAP) of the AN, were significantly reduced in the older listeners compared to young controls, despite normal audiometric thresholds. In the EEG recordings, brainstem FFRs to the same tone stimulation were also diminished in the older participants. Unlike the reduced AN CAP response, the transient-evoked wave-V remained unaffected. These findings could indicate that a decreased number of AN fibers contributes to the response in the older participants. The results suggest that the scalp-recorded FFR, as opposed to the clinical standard wave-V of the auditory brainstem response, may serve as a more reliable indicator of age-related cochlear neural degeneration.


Assuntos
Estimulação Acústica , Envelhecimento , Audiometria de Resposta Evocada , Cóclea , Nervo Coclear , Potenciais Evocados Auditivos do Tronco Encefálico , Degeneração Neural , Humanos , Feminino , Cóclea/fisiopatologia , Cóclea/inervação , Adulto , Idoso , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fatores Etários , Nervo Coclear/fisiopatologia , Envelhecimento/fisiologia , Eletroencefalografia , Audiometria de Tons Puros , Limiar Auditivo , Presbiacusia/fisiopatologia , Presbiacusia/diagnóstico , Valor Preditivo dos Testes , Fatores de Tempo
5.
Otol Neurotol ; 45(4): e315-e321, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38478410

RESUMO

INTRODUCTION: Preservation of residual hearing after cochlear implantation allows for electroacoustic stimulation, which leads to better music appreciation, noise localization, and speech comprehension in noisy environments. Real-time intraoperative electrocochleography (rt-ECochG) monitoring has shown promise in improving residual hearing rates. Four-point impedance (4PI) is being explored as a potential biomarker in cochlear implantation that has been associated with fibrotic tissue response, hearing loss, and dizziness. In this study, we explore whether monitoring both rt-ECochG intraoperatively and postoperative 4PI improves predictions of the preservation of residual hearing. METHODS: This was a prospective cohort study. Adults with residual acoustic hearing underwent cochlear implantation with intraoperative intracochlear electrocochleography (ECochG) monitoring. The surgeon responded to a drop in ECochG signal amplitude of greater than 30% by a standardized manipulation of the electrode with the aim of restoring the ECochG. At the end of the procedure, the ECochG signal was categorized as being maintained or having dropped more than 30%. 4PI was measured on 1 day, 1 week, and 1 and 3 months after cochlear implantation. Residual hearing was measured by routine pure-tone audiogram at 3 months postoperatively. The ECochG category and 4PI impedance values were entered as factors in a multiple linear regression predicting the protection of residual hearing. RESULTS: Twenty-six patients were recruited. Rt-ECochG significantly predicted residual hearing at 3 months (t test; mean difference, 37.7%; p = 0.002). Inclusion of both 1-day or 3-month 4PI in a multiple linear regression with rt-ECochG markedly improved upon correlations with residual hearing compared with the rt-ECochG-only model (rt-ECochG and 1-d 4PI model, R2 = 0.67; rt-ECochG and 3-mo 4PI model, R2 = 0.72; rt-ECochG-only model, R2 = 0.33). CONCLUSIONS: Both rt-ECochG and 4PI predict preservation of residual hearing after cochlear implantation. These findings suggest that the biological response of the cochlea to implantation, as reflected in 4PI, is an important determinant of residual hearing, independent of the acute effects on hearing during implant surgery seen with rt-ECochG. We speculate that 4PI relates to inflammation 1 day after implantation and fibrosis at 3 months.


Assuntos
Implante Coclear , Implantes Cocleares , Adulto , Humanos , Implante Coclear/métodos , Estudos Prospectivos , Impedância Elétrica , Cóclea/cirurgia , Audição , Audiometria de Resposta Evocada/métodos , Biomarcadores
6.
PLoS One ; 19(3): e0299911, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38451925

RESUMO

INTRODUCTION: The functional evaluation of auditory-nerve activity in spontaneous conditions has remained elusive in humans. In animals, the frequency analysis of the round-window electrical noise recorded by means of electrocochleography yields a frequency peak at around 900 to 1000 Hz, which has been proposed to reflect auditory-nerve spontaneous activity. Here, we studied the spectral components of the electrical noise obtained from cochlear implant electrocochleography in humans. METHODS: We recruited adult cochlear implant recipients from the Clinical Hospital of the Universidad de Chile, between the years 2021 and 2022. We used the AIM System from Advanced Bionics® to obtain single trial electrocochleography signals from the most apical electrode in cochlear implant users. We performed a protocol to study spontaneous activity and auditory responses to 0.5 and 2 kHz tones. RESULTS: Twenty subjects including 12 females, with a mean age of 57.9 ± 12.6 years (range between 36 and 78 years) were recruited. The electrical noise of the single trial cochlear implant electrocochleography signal yielded a reliable peak at 3.1 kHz in 55% of the cases (11 out of 20 subjects), while an oscillatory pattern that masked the spectrum was observed in seven cases. In the other two cases, the single-trial noise was not classifiable. Auditory stimulation at 0.5 kHz and 2.0 kHz did not change the amplitude of the 3.1 kHz frequency peak. CONCLUSION: We found two main types of noise patterns in the frequency analysis of the single-trial noise from cochlear implant electrocochleography, including a peak at 3.1 kHz that might reflect auditory-nerve spontaneous activity, while the oscillatory pattern probably corresponds to an artifact.


Assuntos
Implante Coclear , Implantes Cocleares , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estimulação Acústica/métodos , Audiometria de Resposta Evocada/métodos , Nervo Coclear/fisiologia , Ruído , Masculino
7.
Eur Arch Otorhinolaryngol ; 281(6): 2913-2920, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38170210

RESUMO

PURPOSE: The study explores the potential of real-time electrocochleographic potentials (ECochG) visualization during electrode insertion using digital microscopes such as RoboticScope (BHS®). Collaborative software development of the MAESTRO Software (MED-EL®) offers continuous ECochG monitoring during implantation and postoperative hearing evaluation, addressing previous time constraints. The study aims to assess software applicability and the impact of real-time visualization on long-term residual hearing preservation. METHODS: Eight patients with residual hearing underwent cochlear implantation with Flex26 or Flex28 electrode according to the Otoplan evaluation. ECochG responses were measured and visualized during electrode insertion, with insertion times recorded. Two randomized display methods (graph and arrows) tracked ECochG potentials. Postoperative behavioral thresholds determined hearing preservation. Successful real-time intraoperative ECochG visualization was achieved in all cases, enabling surgeon adaptation. Mean electrode insertion time was 114 s, with postoperative thresholds comparable to preoperative values. Visualization did not affect surgeon workload. ECochG amplitudes differed between patients with and without residual hearing. CONCLUSION: The study demonstrates effective implementation of advanced ECochG software combined with real-time visualization, enabling residual hearing preservation during CI. Visualization had no apparent effect on surgeon performance or workload. Future investigation involving a larger population will assess the long-term impact of ECochG on hearing threshold and structure preservation.


Assuntos
Audiometria de Resposta Evocada , Implante Coclear , Estudos de Viabilidade , Software , Humanos , Implante Coclear/métodos , Audiometria de Resposta Evocada/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Implantes Cocleares
8.
Otol Neurotol ; 45(2): 143-149, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38206061

RESUMO

OBJECTIVE: To describe the use of robotics-assisted electrode array (EA) insertion combined with intraoperative electrocochleography (ECochG) in hearing preservation cochlear implant surgery. STUDY DESIGN: Prospective, single-arm, open-label study. SETTING: All procedures and data collection were performed at a single tertiary referral center. PATIENTS: Twenty-one postlingually deaf adult subjects meeting Food and Drug Administration indication criteria for cochlear implantation with residual acoustic hearing defined as thresholds no worse than 65 dB at 125, 250, and 500 Hz. INTERVENTION: All patients underwent standard-of-care unilateral cochlear implant surgery using a single-use robotics-assisted EA insertion device and concurrent intraoperative ECochG. MAIN OUTCOME MEASURES: Postoperative pure-tone average over 125, 250, and 500 Hz measured at initial activation and subsequent intervals up to 1 year afterward. RESULTS: Twenty-two EAs were implanted with a single-use robotics-assisted insertion device and simultaneous intraoperative ECochG. Fine control over robotic insertion kinetics could be applied in response to changes in ECochG signal. Patients had stable pure-tone averages after activation with normal impedance and neural telemetry responses. CONCLUSIONS: Combining robotics-assisted EA insertion with intraoperative ECochG is a feasible technique when performing hearing preservation implant surgery. This combined approach may provide the surgeon a means to overcome the limitations of manual insertion and respond to cochlear feedback in real-time.


Assuntos
Acústica , Audiometria de Resposta Evocada , Estados Unidos , Adulto , Humanos , Estudos Prospectivos , Eletrodos Implantados , Cóclea/cirurgia
9.
Eur Arch Otorhinolaryngol ; 281(3): 1175-1183, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37646794

RESUMO

INTRODUCTION: Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data with a focus on residual hearing preservation and speech understanding. MATERIAL AND METHODS: Cochlear implantations were performed in 50 patients (26 female, 24 male) with residual hearing using a digital microscope. Patients were randomized into two groups. Intraoperative ECochG potentials were either displayed directly in the surgeon's field of view (picture-in-picture display, PiP) or not directly in the field of view (without picture-in-picture display, without PiP). Residual hearing preservation and speech comprehension were recorded within a 1-year follow-up period, compared between groups (PiP versus without PiP) and to a control group of 26 patients implanted without ECochG. RESULTS: Mean insertion time was significantly longer in the picture-in-picture group (p = 0.025). Residual hearing preservation after 6 weeks at 250 Hz was significantly better in the picture-in-picture group (p = 0.017). After one year, 76% of patients showed residual hearing in the picture-in-picture group (62% without picture-in-picture technique, p = n.s.). Use of the picture-in-picture technique resulted in better long-term pure tone residual hearing preservation at 250, 500, and 1000 Hz. Speech intelligibility improved by 46% in the picture-in-picture group (38% without picture-in-picture). DISCUSSION: This study is the first to describe long-term results in a large cohort of cochlear implant patients in whom digital visualization of intraoperative ECochG was used. Our results show that visualization of intraoperative ECochG has a positive effect on residual hearing preservation.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Masculino , Feminino , Implante Coclear/métodos , Cóclea/cirurgia , Audiometria de Resposta Evocada/métodos , Inteligibilidade da Fala
11.
Otolaryngol Head Neck Surg ; 170(4): 1124-1132, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38018567

RESUMO

OBJECTIVE: To evaluate the predictive value of intracochlear electrocochleography (ECochG) for identifying tip fold-over during cochlear implantation (CI) using the slim modiolar electrode (SME) array. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral center. METHODS: From July 2022 to June 2023, 142 patients, including adults and children, underwent intracochlear ECochG monitoring during and after SME placement. Tone-bursts were presented from 250 Hz to 2 kHz at 108 to 114 dB HL. A fast Fourier transform (FFT) allowed for frequency-specific evaluation of ECochG response. ECochG patterns during insertion and postinsertion were evaluated using sensitivity and specificity analysis to predict tip fold-over. Intraoperative plain radiographs served as a reference standard. RESULTS: Fifteen tip fold-over cases occurred (10.6%) with significant ECochG response (>2 µV). Sixty-one cases without tip fold-over occurred (43.0%) with significant ECochG response. All tip fold-overs had both a nontonotopic postinsertion sweep and nonrobust active insertion pattern. No patients with robust insertion or tonotopic sweep patterns had tip fold-over. Sensitivity of detecting tip fold-over when having both nonrobust insertion and nontonotopic sweep patterns was 100% (95% confidence inteval [CI] 78.2%-100%), specificity was 68.9% (95% CI 55.7%-80.1%), and the overall accuracy was 72.0% (95% CI 60.5%-81.7%). CONCLUSION: Intracochlear ECochG monitoring during cochlear implantation with the SME can be a valuable tool for identifying properly positioned electrode arrays. In cases where ECochG patterns are nonrobust on insertion and nontonotopic for electrode sweeps, there may be a concern for tip fold-over, and intraoperative imaging is necessary to confirm proper insertion.


Assuntos
Implante Coclear , Implantes Cocleares , Adulto , Criança , Humanos , Audiometria de Resposta Evocada/métodos , Estudos Prospectivos , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Implante Coclear/métodos
12.
Int J Oral Maxillofac Surg ; 53(5): 376-381, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38061954

RESUMO

Brainstem evoked response audiometry (BERA) is the most established and recommended objective audiometric method for the clinical diagnosis of hearing impairment in high-risk infants. It is unclear whether infants with orofacial clefts meet the criteria for the high-risk group. This retrospective cohort study evaluated the need for diagnostic BERA in infants with cleft palate with or without cleft lip by assessing the predisposition to and diagnosis of congenital hearing impairment. Data from 122 patients treated at a single cleft centre were evaluated. BERA was conducted at the time of palate repair at 4-6 months of age. Clinical follow-up was analysed up to 4 years. The presence of a syndrome was examined as a risk factor for congenital hearing impairment. Among the 122 patients, four had congenital sensorineural or mixed hearing loss requiring hearing aids. All affected patients had syndromes in addition to the cleft. Most patients with elevated hearing thresholds had transient conductive hearing loss. Most suspected sensorineural hearing loss initially diagnosed was refuted. However, a higher incidence of sensorineural hearing loss was found in patients with syndromic clefts, supporting the diagnostic use of BERA with initial surgery only in patients with syndromic clefts.


Assuntos
Fenda Labial , Fissura Palatina , Perda Auditiva Neurossensorial , Perda Auditiva , Lactente , Humanos , Fenda Labial/cirurgia , Fissura Palatina/complicações , Fissura Palatina/cirurgia , Audiometria de Resposta Evocada , Estudos Retrospectivos , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva/epidemiologia , Tronco Encefálico
13.
Otol Neurotol ; 45(1): 36-45, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38085760

RESUMO

HYPOTHESIS: Gross electrode movements detected with intraoperative, real-time X-ray fluoroscopy will correlate with fluctuations in cochlear output, as measured with intraoperative electrocochleography (ECochG). BACKGROUND: Indications for cochlear implantation (CI) are expanding to include patients with residual hearing; however, implant recipients often lose residual hearing after CI. The objective of this study was to identify probable traumatic events during implantation by combining electrophysiological monitoring of cochlear function with simultaneous X-ray monitoring. The surgical timing of these apparently traumatic events was then investigated. METHODS: For 19 adult patients (21 surgeries, 2 bilateral), the ECochG responses were measured during implantation of a cochlear nucleus slim modiolar electrode (CI532/CI632, Cochlear Ltd Australia Nucleus slim modiolar). Simultaneous fluoroscopy was performed, as well as a postoperative cone-beam computed tomography (CT) scan. For all patients, pre- and postoperative audiograms were recorded up to 1 year after surgery to record the loss of residual hearing. RESULTS: Electrode insertions for 21 surgeries were successfully monitored. A drop in ECochG response was significantly correlated with reduced hearing preservation compared with patients with preserved responses throughout. Drops in the ECochG response were measured to occur during insertion, because of movement of the array after insertion was complete, including while sealing of the electrode array at the round window or coiling of the array lead within the mastoid cavity. In some patients, a reduction in cochlear output, resulting in poor ECochG response, was inferred to occur before the beginning of implantation. CONCLUSION: The combination of perioperative ECochG measurements, microscope video, fluoroscopy, and postoperative CT scan may inform on what causes the loss of residual hearing after implantation. These findings will be used to improve the surgical procedure in future.


Assuntos
Implante Coclear , Implantes Cocleares , Adulto , Humanos , Audiometria de Resposta Evocada/métodos , Cóclea/diagnóstico por imagem , Cóclea/cirurgia , Cóclea/lesões , Implante Coclear/métodos , Fluoroscopia
14.
Trends Hear ; 27: 23312165231220997, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38105510

RESUMO

The objective to preserve residual hearing during cochlear implantation has recently led to the use of intracochlear electrocochleography (ECochG) as an intraoperative monitoring tool. Currently, a decrease in the amplitude of the difference between responses to alternating-polarity stimuli (DIF response), predominantly reflecting the hair cell response, is used for providing feedback. Including other ECochG response components, such as phase changes and harmonic distortions, could improve the accuracy of surgical feedback. The objectives of the present study were (1) to compare simultaneously recorded stepwise intracochlear and extracochlear ECochG responses to 500 Hz tone bursts, (2) to explore patterns in features extracted from the intracochlear ECochG recordings relating to hearing preservation or hearing loss, and (3) to design support vector machine (SVM) and random forest (RF) classifiers of acoustic hearing preservation that treat each subject as a sample and use all intracochlear ECochG recordings made during electrode array insertion for classification. Forty subjects undergoing cochlear implant (CI) surgery at the Oslo University Hospital, St. Thomas' Hearing Implant Centre, or the University Hospital of Zurich were prospectively enrolled. In this cohort, DIF response amplitude decreases did not relate to postoperative acoustic hearing preservation. Exploratory analysis of the feature set extracted from the ECochG responses and preoperative audiogram showed that the features were not discriminative between outcome classes. The SVM and RF classifiers that were trained on these features could not distinguish cases with hearing loss and hearing preservation. These findings suggest that hearing loss following CI surgery is not always reflected in intraoperative ECochG recordings.


Assuntos
Implante Coclear , Implantes Cocleares , Surdez , Perda Auditiva , Humanos , Cóclea/cirurgia , Audiometria de Resposta Evocada , Audição , Perda Auditiva/diagnóstico , Perda Auditiva/cirurgia , Surdez/reabilitação
15.
JAMA Otolaryngol Head Neck Surg ; 149(12): 1120-1129, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37856099

RESUMO

Importance: Cochlear implantation produces remarkable results in postlingual deafness, although auditory outcomes vary. Electrocochleography (ECochG) has emerged as a valuable tool for assessing the cochlear-neural substrate and evaluating patient prognosis. Objective: To assess whether ECochG-total response (ECochG-TR) recorded at the best-frequency electrode (BF-ECochG-TR) correlates more strongly with speech perception performance than ECochG-TR measured at the round window (RW-ECochG-TR). Design, Setting, and Participants: This single-center cross-sectional study recruited 142 patients from July 1, 2021, to April 30, 2022, with 1-year follow-up. Exclusions included perilymph suctioning, crimped sound delivery tubes, non-native English speakers, inner ear malformations, nonpatent external auditory canals, or cochlear implantation revision surgery. Exposures: Cochlear implantation. Main Outcomes and Measures: Speech perception testing, including the consonant-nucleus-consonant (CNC) words test, AzBio sentences in quiet, and AzBio sentences in noise plus 10-dB signal to noise ratio (with low scores indicating poor performance and high scores indicating excellent performance on all tests), at 6 months postoperatively; and RW-ECochG-TR and BF-ECochG-TR (measured for 250, 500, 1000, and 2000 Hz). Results: A total of 109 of the 142 eligible postlingual adults (mean [SD] age, 68.7 [15.8] years; 67 [61.5%] male) were included in the study. Both BF-ECochG-TR and RW-ECochG-TR were correlated with 6-month CNC scores (BF-ECochG-TR: r = 0.74; 95% CI, 0.62-0.82; RW-ECochG-TR: r = 0.67; 95% CI, 0.54-0.76). A multivariate model incorporating age, duration of hearing loss, and angular insertion depth did not outperform BF-ECochG-TR or RW-ECochG-TR alone. The BF-ECochG-TR correlation with CNC scores was significantly stronger than the RW-ECochG-TR correlation (r difference = -0.18; 95% CI, -0.31 to -0.01; z = -2.02). More moderate correlations existed between 6-month AzBio scores in noise, Montreal Cognitive Assessment (MoCA) scores (r = 0.46; 95% CI, 0.29-0.60), and BF-ECochG-TR (r = 0.42; 95% CI, 0.22-0.58). MoCA and the interaction between BF-ECochG-TR and MoCA accounted for a substantial proportion of variability in AzBio scores in noise at 6 months (R2 = 0.50; 95% CI, 0.36-0.61). Conclusions and Relevance: In this case series, BF-ECochG-TR was identified as having a stronger correlation with cochlear implantation performance than RW-ECochG-TR, although both measures highlight the critical role of the cochlear-neural substrate on outcomes. Demographic, audiologic, and surgical factors demonstrated weak correlations with cochlear implantation performance, and performance in noise was found to require a robust cochlear-neural substrate (BF-ECochG-TR) as well as sufficient cognitive capacity (MoCA). Future cochlear implantation studies should consider these variables when assessing performance and related interventions.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva , Percepção da Fala , Adulto , Humanos , Masculino , Idoso , Feminino , Implante Coclear/métodos , Audiometria de Resposta Evocada/métodos , Estudos Transversais , Percepção da Fala/fisiologia , Resultado do Tratamento
16.
Otol Neurotol ; 44(7): 718-724, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37400265

RESUMO

OBJECTIVES: To evaluate the diagnostic role of combined electrocochleography and pure-tone audiometry monitoring during dehydrating test in Ménière's disease and consider its suitability as a diagnostic tool to differentiate those patients with unclear differential diagnosis and therefore identify those with clear endolymphatic hydrops responsive to dehydrating test. To study the efficacy of dehydrating therapy on vertiginous symptoms and hearing loss in patients with Ménière's disease. STUDY DESIGN: Prospective case series. SETTINGS: University hospital, secondary referral center. PATIENTS: Thirty patients, 20 women and 10 men, age range of 25 to 75 years, matching the criteria for definite Ménière's disease according to the Barany Society classification. INTERVENTION: Diagnostic. During an active phase of the disease, electrocochleography and pure-tone audiometry were performed, and repeated at 30th, 45th, and 60th minutes after intramuscular injection of 40 mg furosemide and 40 mg methylprednisolone. MAIN OUTCOME MEASURE: Data related to symptoms, electrocochleography, and pure-tone audiometry during the dehydrating test were collected at different times and statistically analyzed. RESULTS: After the administration of dehydrating therapy, we observed that both summating potential and action potential ratio and summating potential and action potential area ratio were normalized in 21 of 30 subjects. Furthermore, pure-tone audiometry thresholds improved significantly. An improvement of ear fullness was also observed, whereas tinnitus unchangeably persisted. CONCLUSIONS: The monitoring of the electrocochleography and pure-tone audiometry thresholds during dehydrating tests with furosemide and methylprednisolone could allow to detect an improvement of instrumental features and clinical symptoms related to endolymphatic hydrops, and therefore, it could be used as a diagnostic tool in the identification of those patients affected by Ménière's disease with unclear differential diagnosis.


Assuntos
Hidropisia Endolinfática , Doença de Meniere , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doença de Meniere/diagnóstico , Doença de Meniere/complicações , Audiometria de Resposta Evocada , Audiometria de Tons Puros , Furosemida/uso terapêutico , Hidropisia Endolinfática/diagnóstico , Hidropisia Endolinfática/complicações
17.
Int J Pediatr Otorhinolaryngol ; 170: 111596, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37267660

RESUMO

OBJECTIVES: This study aimed to compare intracochlear electrocochleography (ECochG) findings in a group of cochlear implant (CI) recipients with auditory neuropathy spectrum disorder (ANSD) with a group of CI recipients with sensorineural hearing loss (SNHL). Auditory outcome and spectral resolution findings were also compared among CI recipients with and without cochlear microphonic (CM) responses. METHODS: This single-center, prospective cohort study was undertaken at a tertiary referral center. CM responses by the intracochlear ECochG test were recorded in CI recipients at 0.25-2 kHz. Speech, spatial, and hearing quality (SSQ) outcomes and spectral resolution measured with the spectral-temporally modulated ripple test were obtained for each recipient. The study included 62 implanted ears in 46 recipients, of which 59% (n = 27) were male and 41% (n = 19) were female. Twenty-nine ears with ANSD and 33 ears with SNHL were included. The mean age of the participants was 11 years. The results compared the intracochlear ECochG findings of the ANSD group with those of the SNHL group. RESULTS: Participants were divided into two groups with and without obtainable CM responses. CM responses were obtained in 13 of 29 ears in the ANSD group and 14 of 33 ears in the SNHL group. CM thresholds obtained were better according to behavioral audiometric responses in some frequencies in the ANSD group. No significant difference was found in the auditory outcome and spectral resolution among CI recipients with and without CM responses. CONCLUSIONS: Intracochlear ECochG has a limited potential clinical value for monitoring ANSD. CM thresholds obtained using ECochG may not reflect behavioral hearing thresholds.


Assuntos
Implante Coclear , Implantes Cocleares , Perda Auditiva Central , Perda Auditiva Neurossensorial , Masculino , Feminino , Humanos , Criança , Audiometria de Resposta Evocada/métodos , Estudos Prospectivos , Perda Auditiva Central/diagnóstico , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/cirurgia , Perda Auditiva Neurossensorial/reabilitação
18.
JASA Express Lett ; 3(2): 024401, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36858988

RESUMO

In search of biomarkers for cochlear neural degeneration (CND) in electrocochleography from humans with normal thresholds, we high-pass and low-pass filtered the responses to separate contributions of auditory-nerve action potentials (N1) from hair-cell summating potentials (SP). The new N1 measure is better correlated with performance on difficult word-recognition tasks used as a proxy for CND. Furthermore, the paradoxical correlation between larger SPs and worse word scores, observed with classic electrocochleographic analysis, disappears with the new metric. Classic SP is simultaneous with and opposite in phase to an early neural contribution, and filtering separates the sources to eliminate this interference.


Assuntos
Degeneração Neural , Doenças do Nervo Vestibulococlear , Humanos , Audiometria de Resposta Evocada , Biomarcadores , Nervo Coclear
19.
Ear Hear ; 44(5): 1088-1106, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36935398

RESUMO

OBJECTIVES: The underlying state of cochlear and neural tissue function is known to affect postoperative speech perception following cochlear implantation. The ability to assess these tissues in patients can be performed using intracochlear electrocochleography (IC ECochG). One component of ECochG is the summating potential (SP) that appears to be generated by multiple cochlear tissues. Its qualities may be able to detect the presence of functional inner hair cells, but evidence for this is limited in human cochleae. This study aimed to examine the IC SP characteristics in cochlear implantation recipients, its relationship to preoperative speech perception and audiometric thresholds, and to other IC ECochG components. DESIGN: This is a retrospective analysis of 113 patients' IC ECochG recordings across the array in response to a 500 Hz tone burst stimulus. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the cochlear microphonic and added to one another to emphasize the SP, auditory nerve neurophonic, and compound action potential. Patients were grouped based on their maximum SP deflection being large and positive (+SP), large and negative (-SP), or minimal (0 SP) to further investigate these relationships. RESULTS: Patients in the +SP group had better preoperative speech perception (mean consonant-vowel-consonant phoneme score 46%) compared to the -SP and 0 SP groups (consonant-vowel-consonant phoneme scores 34% and 36%, respectively, difference to +SP: p < 0.05). Audiometric thresholds were lowest for +SP (mean pure-tone average 50 dB HL), then -SP (65 dB HL), and highest for 0 SP patients (70 dB HL), but there was not a statistical significance between +SP and -SP groups ( p > 0.1). There were also distinct differences between SP groups in the qualities of their other ECochG components. These included the +SP patients having larger cochlear microphonic maximum amplitude, more apical SP peak electrode locations, and a more spatially specific SP magnitude growth pattern across the array. CONCLUSIONS: Patients with large positive SP deflection in IC ECochG have preoperatively better speech perception and lower audiometric thresholds than those without. Patterns in other ECochG components suggest its positive deflection may be an indicator of cochlear function.


Assuntos
Implante Coclear , Implantes Cocleares , Humanos , Estudos Retrospectivos , Cóclea , Nervo Coclear , Audiometria de Resposta Evocada
20.
Sci Data ; 10(1): 157, 2023 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-36949075

RESUMO

Electrocochleography (ECochG) measures electrophysiological inner ear potentials in response to acoustic stimulation. These potentials reflect the state of the inner ear and provide important information about its residual function. For cochlear implant (CI) recipients, we can measure ECochG signals directly within the cochlea using the implant electrode. We are able to perform these recordings during and at any point after implantation. However, the analysis and interpretation of ECochG signals are not trivial. To assist the scientific community, we provide our intracochlear ECochG data set, which consists of 4,924 signals recorded from 46 ears with a cochlear implant. We collected data either immediately after electrode insertion or postoperatively in subjects with residual acoustic hearing. This data descriptor aims to provide the research community access to our comprehensive electrophysiological data set and algorithms. It includes all steps from raw data acquisition to signal processing and objective analysis using Deep Learning. In addition, we collected subject demographic data, hearing thresholds, subjective loudness levels, impedance telemetry, radiographic findings, and classification of ECochG signals.


Assuntos
Audiometria de Resposta Evocada , Cóclea , Implantes Cocleares , Humanos , Cóclea/fisiologia , Implante Coclear , Aprendizado Profundo
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