Mushtaq Faizah, Soulby Andrew, Boyle Patrick, Nunn Terry, Hartley Douglas E H
National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, United Kingdom.
Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Front Neurol. 2022 Nov 16;13:1042408. doi: 10.3389/fneur.2022.1042408. eCollection 2022.
Recent technological advances in cochlear implant (CI) telemetry have enabled, for the first time, CI users to perform cochlear health (CH) measurements through self-assessment for prolonged periods of time. This is important to better understand the influence of CH on CI outcomes, and to assess the safety and efficacy of future novel treatments for deafness that will be administered as adjunctive therapies to cochlear implantation. We evaluated the feasibility of using a CI to assess CH and examined patterns of electrode impedances, electrically-evoked compound action potentials (eCAPs) and electrocochleography (ECochGs), over time, in a group of adult CI recipients. Fifteen subjects were trained to use the Active Insertion Monitoring tablet by Advanced Bionics, at home for 12 weeks to independently record impedances twice daily, eCAPs once weekly and ECochGs daily in the first week, and weekly thereafter. Participants also completed behavioral hearing and speech assessments. Group level measurement compliance was 98.9% for impedances, 100% for eCAPs and 99.6% for ECochGs. Electrode impedances remained stable over time, with only minimal variation observed. Morning impedances were significantly higher than evening measurements, and impedances increased toward the base of the cochlea. eCAP thresholds were also highly repeatable, with all subjects showing 100% measurement consistency at, at least one electrode. Just over half of all subjects showed consistently absent thresholds at one or more electrodes, potentially suggesting the existence of cochlear dead regions. All subjects met UK NICE guidelines for cochlear implantation, so were expected to have little residual hearing. ECochG thresholds were, unsurprisingly, highly erratic and did not correlate with audiometric thresholds, though lower ECochG thresholds showed more repeatability over time than higher thresholds. We conclude that it is feasible for CI users to independently record CH measurements using their CI, and electrode impedances and eCAPs are promising measurements for objectively assessing CH.
近年来，人工耳蜗（CI）遥测技术的进步首次使CI使用者能够通过自我评估长时间进行耳蜗健康（CH）测量。这对于更好地理解CH对CI效果的影响，以及评估未来作为CI辅助治疗的新型耳聋治疗方法的安全性和有效性非常重要。我们评估了使用CI评估CH的可行性，并研究了一组成年CI接受者随时间变化的电极阻抗、电诱发复合动作电位（eCAP）和耳蜗电图（ECochG）模式。15名受试者在家中接受了12周的培训，使用Advanced Bionics的主动插入监测平板电脑，每天独立记录两次阻抗，每周记录一次eCAP，第一周每天记录ECochG，此后每周记录一次。参与者还完成了行为听力和言语评估。组水平上，阻抗测量的依从性为98.9%，eCAP为100%，ECochG为99.6%。电极阻抗随时间保持稳定，仅观察到极小的变化。早晨的阻抗明显高于晚上的测量值，且阻抗向耳蜗底部增加。eCAP阈值也具有高度可重复性，所有受试者在至少一个电极上的测量一致性为100%。超过一半的受试者在一个或多个电极上始终显示阈值缺失，这可能表明存在耳蜗死区。所有受试者均符合英国国家卫生与临床优化研究所（NICE）的人工耳蜗植入指南，因此预计几乎没有残余听力。不出所料，ECochG阈值非常不稳定，与听力阈值无关，尽管较低的ECochG阈值随时间的重复性比较高的阈值更好。我们得出结论，CI使用者使用其CI独立记录CH测量是可行的，电极阻抗和eCAP是客观评估CH的有前景的测量方法。
