Clinical experiences with intraoperative electrocochleography in cochlear implant recipients and its potential to reduce insertion trauma and improve postoperative hearing preservation.

Access to low-frequency acoustic information in cochlear implant patients leads to better speech understanding in noise. Electrocochleography (ECochG) can provide real-time feedback about the health of the cochlea during the insertion process with the potential to reduce insertion trauma. We describe our experiences of using this technique. Data from 47 adult subjects with measurable residual hearing and an Advanced Bionics (Valencia, CA) SlimJ (46) or MidScala (1) electrode array were analyzed. ECochGs were recorded intraoperatively via the implant. The surgeon adjusted the course of the electrode insertion based on drops in the ECochG. The final array position was assessed using postoperative imaging and pure tone thresholds were measured before and after surgery. Three different patterns of ECochG response amplitude were observed: Growth, Fluctuating and Total Loss. Subjects in the growth group showed the smallest postoperative hearing loss. However, the group with fluctuating amplitudes showed no meaningful correlation between the ECochG responses and the postoperative hearing loss, indicating that amplitude alone is insufficient for detecting damage. Considering the phase of the signal additionally to the amplitude and reclassifying the data by both the phase and amplitude of the response into three groups Type I-Type III produced statistically significant correlations between postoperative hearing loss and the grouping based on amplitude and phase respectively. We showed significantly better hearing preservation for Type I (no drop in amplitude) and Type II (drop with a concurrent phase shift), while Type III (drop without concurrent phase shift) had more surgery induced hearing loss. ECochG potentials measured through the implant could provide valuable feedback during the electrode insertion. Both the amplitude and phase of the ECochG response are important to consider. More data needs to be evaluated to better understand the impact of the different signal components to design an automated system to alert the surgeon ahead of damaging the cochlea.

Electric acoustic stimulation (EAS) with the Naída CI Q90 sound processor in experienced cochlear implant users.

Objectives: The benefit of using the electroacoustic functionality was tested compared to electric stimulation alone. Two different cut-off frequencies between acoustic and electric stimulation were tried. Methods: Performance and subjective preference in 10 subjects was measured with electric only and electroacoustic stimulation with two settings: a cut-off for acoustic amplification at the frequency where thresholds exceeded 70 dB and 85 dB. An overlapping setting was also tried in five participants. Results: There was a non-significant trend with a median improvement in SRT of 1.3 dB (70 dB cut-off) and 0.8 dB (85 dB cut-off) compared to the electric only condition. From nine subjects who completed the study, one preferred the 85 dB cut-off frequency, with the others preferred either a 70 dB cut-off or an overlapping setting. Discussion: Nine subjects continued to use the EAS processor after study termination because of subjective benefits. The variability in speech outcomes and subjective preference is underlining the importance of being able to manually change acoustic and electric cut-off frequencies. Conclusion: There were non-significant median group benefits from use of the acoustic component for these existing CI users. A hearing loss of 70 dB HL is an appropriate default cut-off frequency in the fitting software.

Speech reception threshold benefits in cochlear implant users with an adaptive beamformer in real life situations.

OBJECTIVES: To compare the Naida CI UltraZoom adaptive beamformer and T-Mic settings in a real life environment. METHODS: Speech reception thresholds (SRTs) were measured in a moderately reverberant room, using the German Oldenburger sentence test. The speech signal was always presented from the front loudspeaker at 0° azimuth and fixed masking noise was presented either simultaneously from all eight loudspeakers around the subject at 0°, ±45°, ±90°, ±135°, and 180° azimuth or from five loudspeakers positioned at ±70°, ±135°, and 180° azimuth. In the third test setup, an additional roving noise was added to the six loudspeaker arrangement. RESULTS: There was a significant difference in mean SRTs between the Naida CI T-Mic and UltraZoom in each of the three test setups. The largest improvements were seen in the six speaker roving and fixed noise conditions. Adding ClearVoice to the Naida CI T-Mic setting significantly improved the SRT in both fixed noise conditions, but not in the roving noise condition. In each setup, the lowest SRTs were obtained with the UltraZoom plus ClearVoice setting. DISCUSSION: The degree of improvement was consistent with previous beamforming studies. In the most challenging listening situation, with noise from eight speakers and speech and noise presented coincidentally from the front, UltraZoom still provided a significant benefit. When a moving noise source was added, the improvement in SRT provided by UltraZoom was maintained. CONCLUSION: When tested in challenging and realistic noise environments, the Naida CI UltraZoom adaptive beamformer resulted in significantly lower mean SRTs than when the T-Mic alone was used.