实现双侧听神经平衡刺激的方法研究：同时接受匹配和不匹配双侧人工耳蜗植入的儿童证据。

Toward a method of achieving balanced stimulation of bilateral auditory nerves: Evidence from children receiving matched and unmatched bilateral cochlear implants simultaneously.

机构信息

Archie's Cochlear Implant Laboratory, Rm 6D08, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.

Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada; Archie's Cochlear Implant Laboratory, Rm 6D08, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Otolaryngology, The Hospital for Sick Children, Toronto, ON, Canada.

出版信息

Hear Res. 2022 Mar 15;416:108445. doi: 10.1016/j.heares.2022.108445. Epub 2022 Jan 21.

DOI:10.1016/j.heares.2022.108445

PMID:35104716

Abstract

OBJECTIVES

To identify whether mismatched bilateral cochlear implants compromise balanced stimulation of the two auditory nerves and establish asymmetric hearing in children.

METHODS

Behavioural and electrophysiological measures were completed in 47 children receiving bilateral CIs in the same surgery (simultaneously): 27 children received a peri‑modiolar N24RE array in one ear and a 422 anti-modiolar array in the other (experimental group) and 20 children received 2 peri‑modiolar arrays (control group). Differences in current levels between the two devices were measured by electrically evoked compound action potentials (ECAPs) at the time of surgery. These data were compared with minimum and maximum comfortably loud levels programmed in each speech processor (T-levels, C-levels, respectively) after 12 months of bilateral CI use. Asymmetries in functional hearing between arrays were measured in open set speech perception testing between 3 to 5 years of CI use.

RESULTS

Higher current levels were required from the anti-modiolar than peri‑modiolar array to evoke balanced interaural ECAP amplitudes (mismatched group: mean ± SD difference: -9.9 ± 22.6; matched group: -0.8 ± 26.5). This difference was larger in the experimental group than control group (t = -2.51; p = 0.016) and remained constant with increases in current level from ECAP threshold to maximum amplitudes (dynamic range) in many but not all children in both groups. T and C-levels were poorly predictive of levels needed to evoke balanced ECAP amplitudes in children with mismatched devices (F(1, 312) = 1.3, p = 0.263). Speech perception scores were more asymmetric between ears in children using bilateral mismatched arrays (mean ± SD: 73.8 ± 16.4 at the peri‑modiolar array; 57.7 ± 26.4 at the anti-modiolar array), compared to children with bilateral matched arrays (right ear: 78.0 ± 10.4; left ear: 74.9 ± 13.5).

CONCLUSION

Higher current level requirements at the anti-modiolar array compared to the peri‑modiolar array in children with bilateral mismatched CIs are not fully accounted for in device programming. Mismatched electrodes in children receiving bilateral cochlear implants increases the risk of asymmetric hearing.

摘要

目的

确定双侧耳蜗植入物不匹配是否会影响对两条听神经的平衡刺激，并确定儿童的听力不对称。

方法

在同一次手术中（同时）为 47 名接受双侧 CI 的儿童完成了行为和电生理测量：27 名儿童在一只耳朵中接受了 peri-modiolar N24RE 阵列，而在另一只耳朵中接受了 422 反 modiolar 阵列（实验组），而 20 名儿童接受了 2 个 peri-modiolar 阵列（对照组）。在手术时通过电诱发复合动作电位 (ECAP) 测量两个设备之间的电流水平差异。在使用双侧 CI 12 个月后，将这些数据与每个语音处理器中编程的最小和最大舒适响度（T 级、C 级）进行比较。在使用 CI 3 至 5 年后，在开放式语音感知测试中测量了数组之间的功能听力不对称性。

结果

与 peri-modiolar 阵列相比，anti-modiolar 阵列需要更高的电流水平才能引起平衡的耳间 ECAP 幅度（不匹配组：平均 ± SD 差异：-9.9 ± 22.6；匹配组：-0.8 ± 26.5）。实验组与对照组之间的差异更大（t=-2.51；p=0.016），并且在两组中许多但不是所有儿童的 ECAP 阈值到最大幅度（动态范围）的电流水平增加时保持不变。在有不匹配设备的儿童中，T 和 C 级对引起平衡 ECAP 幅度所需的水平预测不佳（F(1,312)=1.3，p=0.263）。与使用双侧匹配数组的儿童相比，使用双侧不匹配数组的儿童的听力更不对称（peri-modiolar 数组：平均 ± SD：73.8 ± 16.4；anti-modiolar 数组：57.7 ± 26.4），与双侧匹配数组的儿童相比（右耳：78.0 ± 10.4；左耳：74.9 ± 13.5）。