Electrical Compound Action Potential Research Articles

Liquid Metal‐Based High‐Density Interconnect Technology for Stretchable Printed Circuits

AbstractHigh‐density interconnect (HDI) technology for liquid metal (LM)‐based stretchable printed circuit boards is crucial for expanding their applicability. HDI technology provides high‐resolution multilayer circuits with a high density of components, as required for next generation of neuroprobes and ultrasonic and sensor arrays. This study presents a HDI technique utilizing laser engraved micro grooves in silicone with a protective lift‐off mask of polyvinyl alcohol (PVA) and subsequent microscale LM particle spray deposition. This approach achieves high‐resolution LM patterns and enables multilayer connectivity and high‐density integration of components simultaneously, that is, realizing HDI technology. It is demonstrated using a stretchable 0201 LED display with a density of six leads per mm2 and a cochlear implant (CI) electrode array. The demonstrated manufacturing of the CI has the potential to enable fully automated printed circuit board manufacturing of such implants with increased precision and throughput. Implants in guinea pigs show that the CI is capable of activating the auditory neuron with electrical auditory brainstem response (eABR) and electrical compound action potential (eCAP) of high quality. Moreover, the U‐shaped cross section of the LM interconnects provides a higher mechanical shock resistance of the circuit than that of normal rectangular cross sections.

Plasticity after pediatric cochlear implantation: Implication from changes in peripheral plasma level of BDNF and auditory nerve responses

IntroductionSensory neural hearing loss could lead to some structural and physiological changes in the auditory pathways, such as alteration in the expression of neurotrophins. These factors, especially Brain-Derived Neurotrophic Factor (BDNF), play an important role in synaptic functions and experience-related plasticity. Restoring cochlear function after hearing loss is possible through cochlear implantation (CI). Evaluation of the blood concentration changes of neurotrophins as prerequisites of plasticity could help scientists to determine the prognosis of CI as in the candidacy procedure or enhancing prosthesis function by adding the exact needed amount of BDNF to the electrode array. MethodsHere we have studied the plasma BDNF concentration before CI surgery and 6 months after using CI device in 15 pediatric CI recipients and compared this level with changes of BDNF concentration in 10 children who were using hearing aid (H.A). In addition, we searched for a possible correlation between post-surgery plasma BDNF concentration and electrical compound action potential (ECAP) and comfort-level (C-level) thresholds. ResultsPlasma BDNF concentration in children with CI increased significantly after CI surgery, while this difference in H.A group was not significant. Analysis of repeated measures of ECAP and C-level thresholds in CI group showed that there were some kinds of steadiness during follow- up sessions for ECAP thresholds in basal and E16 of middle electrodes, whereas C-level thresholds for all selected electrodes increased significantly up to six months follow-up. Interestingly, we did not find any significant correlation between post-surgery plasma BDNF concentration and ECAP or C-level threshold changes. ConclusionIt is concluded that changes in C-level threshold and steady state of ECAP thresholds and significant changes in BDNF concentration could be regarded as an indicator of experienced-related plasticity after CI stimulation.

Audiological Outcomes and Map Characteristics in Children With Perimodiolar and Slim Straight Array Cochlear Implants in Opposite Ears.

To identify differences in outcomes and map characteristics in pediatric bilateral cochlear implants with modiolar conforming and lateral wall arrays in opposite ears. Retrospective case series. Tertiary care pediatric referral center. Fourteen children who received a perimodiolar array in one ear and a slim straight array in the opposite ear in sequential surgeries. None. Consonant-nucleus-consonant test (CNC) word recognition score, battery life, power levels, electrical compound action potential (ECAP) thresholds, and electrical threshold and comfort charge levels. Speech perception outcomes were poorer in the lateral wall ears than the perimodiolar ears, and scores in the bilateral condition were better than with the lateral wall device alone. Sequential placement was a factor with differences in preoperative candidacy time correlating with greater difference in speech perception. There was no difference in charge levels between ears, in spite of higher ECAP threshold values for the lateral wall devices. While bilateral speech perception was good, speech perception with the lateral wall device alone was poorer. This cannot be explained solely by the device, as differences in preoperative candidacy time were a significant factor. ECAP thresholds are significantly higher for lateral wall electrodes, but that did not translate in to higher psychophysical measurements.

Maps created using a new objective procedure (C-NRT) correlate with behavioral, loudness-balanced maps: a study in adult cochlear implant users.

In uncooperative patients, electrical compound action potential (ECAP) thresholds are reliable in predicting T-levels, but are not in determining the C-level profile. The present study aims to assess if the C-level profile can be predicted by a new objective procedure (C-NRT) which uses the amplitude growth function (AGF) and is based on the assumption that equal ECAP amplitudes elicit equal loudness percepts. This is a correlational study conducted in five tertiary care referral hospitals with 21 post-lingually deaf adult cochlear implant users. Two maps were created: a behavioral, bitonal balanced (BB) map and an objective map, in which T-levels were the same as in the BB map, and C-levels were obtained with C-NRT. C-NRT consisted of performing the AGF of nine electrodes, and of setting the current level eliciting a 100μV ECAP amplitude as C-level in the map. AutoNRT was also measured. Main outcome measures were correlation between behavioral C-profile level, objective C-profile level, behavioral T-profile level and objective T-profile (AutoNRT) level; disyllabic word recognition scores in quiet and in noise conditions (SNR=+10 and 0) with both maps. A strong correlation was found between behavioral and C-NRT-derived C-levels (mean per electrode correlation: R=0.862, p<0.001). C-NRT could predict behavioral C-levels with a greater accuracy than AutoNRT. Word recognition was significantly better with BB maps only in the quiet condition (p=0.002). C-NRT is more accurate than AutoNRT in predicting the C-level profile in adult cochlear implant users. This finding encourages future application in uncooperative patients, especially in very young children.

Improved outcomes in auditory brainstem implantation with the use of near-field electrical compound action potentials.

To compare the outcomes (auditory threshold and open-set speech perception at 48-month follow-up) of a new near-field monitoring procedure, electrical compound action potential, on positioning the auditory brainstem implant electrode array on the surface of the cochlear nuclei versus the traditional far-field electrical auditory brainstem response. Retrospective study. Tertiary referral center. Among the 202 patients with auditory brainstem implants fitted and monitored with electrical auditory brainstem response during implant fitting, 9 also underwent electrical compound action potential recording. These subjects were matched retrospectively with a control group of 9 patients in whom only the electrical auditory brainstem response was recorded. Electrical compound action potentials were obtained using a cotton-wick recording electrode located near the surface of the cochlear nuclei and on several cranial nerves. Significantly lower potential thresholds were observed with the recording electrode located on the cochlear nuclei surface compared with the electrical auditory brainstem response (104.4 ± 32.5 vs 158.9 ± 24.2, P = .0030). Electrical brainstem response and compound action potentials identified effects on the neighboring cranial nerves on 3.2 ± 2.4 and 7.8 ± 3.2 electrodes, respectively (P = .0034). Open-set speech perception outcomes at 48-month follow-up had improved significantly in the near- versus far-field recording groups (78.9% versus 56.7%; P = .0051). Electrical compound action potentials during auditory brainstem implantation significantly improved the definition of the potential threshold and the number of auditory and extra-auditory waves generated. It led to the best coupling between the electrode array and cochlear nuclei, significantly improving the overall open-set speech perception.

Neural Adaptation and Behavioral Measures of Temporal Processing and Speech Perception in Cochlear Implant Recipients

The objective was to determine if one of the neural temporal features, neural adaptation, can account for the across-subject variability in behavioral measures of temporal processing and speech perception performance in cochlear implant (CI) recipients. Neural adaptation is the phenomenon in which neural responses are the strongest at the beginning of the stimulus and decline following stimulus repetition (e.g., stimulus trains). It is unclear how this temporal property of neural responses relates to psychophysical measures of temporal processing (e.g., gap detection) or speech perception. The adaptation of the electrical compound action potential (ECAP) was obtained using 1000 pulses per second (pps) biphasic pulse trains presented directly to the electrode. The adaptation of the late auditory evoked potential (LAEP) was obtained using a sequence of 1-kHz tone bursts presented acoustically, through the cochlear implant. Behavioral temporal processing was measured using the Random Gap Detection Test at the most comfortable listening level. Consonant nucleus consonant (CNC) word and AzBio sentences were also tested. The results showed that both ECAP and LAEP display adaptive patterns, with a substantial across-subject variability in the amount of adaptation. No correlations between the amount of neural adaptation and gap detection thresholds (GDTs) or speech perception scores were found. The correlations between the degree of neural adaptation and demographic factors showed that CI users having more LAEP adaptation were likely to be those implanted at a younger age than CI users with less LAEP adaptation. The results suggested that neural adaptation, at least this feature alone, cannot account for the across-subject variability in temporal processing ability in the CI users. However, the finding that the LAEP adaptive pattern was less prominent in the CI group compared to the normal hearing group may suggest the important role of normal adaptation pattern at the cortical level in speech perception.

Effects of electrical pulse polarity shape on intra cochlear neural responses in humans: Triphasic pulses with cathodic second phase

Charge balanced pulses are used in modern cochlear implants to avoid direct current (DC) stimulation that may damage neural tissues. In this context the effect of electrical pulse shape and polarity is still a matter of debate and the most effective pulse shape needs to be determined (Bahmer et al., 2010a; Undurraga et al., 2010; Wieringen et al., 2008; Macherey et al., 2008). Therefore, we conducted electrophysiological measurements, namely electrical compound action potentials (ECAPs) to assess response strength elicited by various pulse shapes and polarities in five cochlear implant recipients (SonataTI100/PulsarCI100 devices, MED-EL Innsbruck). ECAP response strength depending on pulse shape was compared with individual psychophysical thresholds. Results indicated the weakest response amplitude and highest thresholds for symmetric triphasic pulse shapes (with cathodic second phase), and the strongest response amplitude and lowest thresholds for biphasic pulses with anodic first phase. Biphasic pulses with cathodic first phase generated intermediate response amplitude and thresholds.

Direct Monitoring of ABIs Evoked Potentials on the Cochlear Nuclei and Neighboring Cranial Nerves

Objectives: The potentials evoked with Auditory Brainstem Implant (ABI) on the cochlear nuclei (CN) and on the neighboring cranial nerves are traditionally evaluated with Electrical Auditory Brainstem Response (E-ABR) and electromyography (EMG). To obtain a more precise evaluation of ABI insertion, a near field monitoring procedure that records electrical compound action potentials (E-CNAPs) directly from the CN and from each individual cranial nerve is presented. Methods: Between January 1997 and September 2012, 184 patients were fitted with ABI by the Verona team, 155 in Verona and 29 (13 children and 16 adults) elsewhere. The E-CNAPs utilizes a cotton-wick recording electrode locate on different anatomical structures: CN, root entry zone of the cranial nerve VII, IX, X, XI, and V. All subjects were monitored with E-ABR and 18 of them underwent also E-CNAPs recording. Results: Systematic significant lower E-CNAPs thresholds were observed compared with E-ABRs. The evaluation of the threshold for inducing extra-auditory effects with E-CNAPs on the neighboring cranial nerves allowed a more precise selection of the active electrodes to be used in the fitting. For the same electrical intensity value utilized for obtaining ABI responses, E-ABRs and E-CNAPs showed potentials of neighboring cranial nerves respectively on 4 and 10 electrodes. Conclusions: The adoption of near-field recordings offered the chance to improve the correct placement of the array and post-operative outcomes. E-CNAPs recorded on neighboring cranial nerves can replace EMG giving an on line demonstration of the effects on nerves on which electrodes induce myogenic responses.

Auditory neuropathy spectrum disorder: predictive value of radiologic studies and electrophysiologic tests on cochlear implant outcomes and its radiologic classification

Conclusion: The width of the bony cochlear nerve canal (BCNC) and the size of the cochlear nerve are reliable predictors of long-term speech perception abilities for children with auditory neuropathy spectrum disorder (ANSD) after cochlear implantation (CI). In addition, electrical stapedial reflex (ESR) and electrical compound action potential (ECAP) also have considerable value in predicting postoperative speech perception abilities in these children. Objectives: To assess whether speech perception abilities after CI in children with ANSD can be predicted from the results of radiologic studies and electrophysiologic tests. Methods: Fifteen children with ANSD underwent CI. The width of the BCNC and the size of the cochlear nerve were measured using preoperative CT and MRI. The results of early postoperative ESR, ECAP, and implant evoked electrical auditory brainstem response were reviewed. The latest speech perception test scores were also reviewed. Results: Radiologic findings of normal BCNC and normal cochlear nerve correlated with excellent speech perception abilities after CI. A narrow or obliterated BCNC and a deficient cochlear nerve correlated with poor speech perception abilities. Children with good speech perception abilities showed robust responses on ESR and ECAP, but there were no responses from any of the children with poor speech perception abilities.

Cochlear implantation in children with cochlear aplasia

Conclusion: Children with cochlear aplasia can achieve favorable speech perception abilities from cochlear implantation (CI) by inserting an electrode array into the vestibule if an audiological response is reliably demonstrated before surgery by behavioral audiometry and objective measures. Objectives: The purpose of this study was to evaluate the surgical outcome of CI in children with cochlear aplasia. Methods: The medical records of 454 children who underwent CI at the Dong-A University Hospital between January 1994 and September 2011 were reviewed. The prevalence of cochlear aplasia and the preoperative evaluations, operative findings, and postoperative speech perception abilities of implanted children with cochlear aplasia were evaluated. Results: The implanted children with cochlear aplasia accounted for 2% of those with inner ear malformations and 0.4% of all pediatric cochlear implantees. They showed audiological responses in preoperative electrophysiologic tests, and the eighth nerve was present in magnetic resonance imaging. The electrode array was inserted into the vestibule through an oval window after removing the stapes or through a transmastoid labyrinthotomy site. Electrical compound action potential and electrical auditory brainstem response tests showed clear neural responses after implantation. The hearing thresholds of the implanted ear improved to 25 dB HL and the children achieved significant open set speech perception abilities.

Programming peculiarities in two cochlear implant users with superficial siderosis of the central nervous system

To report the audiological outcomes of cochlear implantation in two patients with severe to profound sensorineural hearing loss secondary to superficial siderosis of the CNS and discuss some programming peculiarities that were found in these cases. Retrospective review. Data concerning clinical presentation, diagnosis and audiological assessment pre- and post-implantation were collected of two patients with superficial siderosis of the CNS. Both patients showed good hearing thresholds but variable speech perception outcomes. One patient did not achieve open-set speech recognition, but the other achieved 70% speech recognition in quiet. Electrical compound action potentials could not be elicited in either patient. Map parameters showed the need for increased charge. Electrode impedances showed high longitudinal variability. The implants were fairly beneficial in restoring hearing and improving communication abilities although many reprogramming sessions have been required. The hurdle in programming was the need of frequent adjustments due to the physiologic variations in electrical discharges and neural conduction, besides the changes in the impedances. Patients diagnosed with superficial siderosis may achieve limited results in speech perception scores due to both cochlear and retrocochlear reasons. Careful counseling about the results must be given to the patients and their families before the cochlear implantation indication.

Electrical Compound Action Potentials Recorded With Automated Neural Response Telemetry: Threshold Changes as a Function of Time and Electrode Position

Since the introduction of neural response telemetry (NRT) for the Nucleus 24 cochlear implant (CI24), researchers and clinicians have investigated the feasibility of using the electrically evoked compound action potential (ECAP) threshold to objectively predict psychophysical measurements that are used in the programming of the speech processor. The ability to substitute objective for behavioral measurements, particularly measurements made at the time of surgery, would greatly facilitate programming the MAP for young children and other individuals who are not able to provide reliable behavioral data required for MAP programming. There have been a number of studies that have examined characteristics of the ECAP measured at the time of surgery and postoperatively; however, all the available published data are based on the CI24. With the introduction of the Nucleus Freedom device, an automated NRT (AutoNRT) program became available, which was capable of measuring ECAP thresholds at lower levels than was previously possible with NRT software associated with the CI24 device. It was hypothesized that the enhancements to the NRT program may improve the predictability of postoperative measurements from intraoperatively recorded ECAP thresholds. The purpose of this study was to track ECAP thresholds obtained using AutoNRT as a function of time and electrode position. ECAP thresholds were recorded from 71 children and adults implanted with the Nucleus Freedom device using the AutoNRT test protocol. ECAP thresholds were obtained at the time of surgery, at initial stimulation, and 3 mos poststimulation. Five electrodes located at basal, middle, and apical positions in the cochlea were tested at each time interval and thresholds were compared. Significant differences were found in ECAP thresholds measured with AutoNRT as a function of both time and electrode position. Basal electrodes had higher ECAP thresholds than apical electrodes and that relationship was consistent for each time period. Thresholds for all electrodes decreased between surgery and initial stimulation and remained relatively stable at 3 mos poststimulation. ECAP thresholds were consistently lower for children compared with adults at each time point. Mid-array electrodes (11 and 16) showed the least amount of change over time. AutoNRT thresholds demonstrated significant change over time, limiting the ability to use intraoperatively recorded ECAP thresholds to predict postoperative measurements. In this study, electrodes 11 and 16 showed the least amount of change in ECAP threshold over time and therefore would be the best choices for estimating postoperative ECAP thresholds. Although not an ideal solution, mid-array ECAP thresholds obtained intraoperatively may prove to be helpful in creating a first MAP when no other behavioral or electrophysiological data are available.

Audiological performance after cochlear implantation: a 2-year follow-up in children with inner ear malformations

Conclusions: Open-set speech perception in children with an inner ear malformation is equal to that of other congenitally deaf children after an average of 2 years follow-up. Objective: To analyze audiological performance after cochlear implantation in a sample of children with radiographically detectable malformations of the inner ear compared to performance in prelingually deafened children at large. Materials and methods: Nine children with osseous inner ear malformations were compared to 22 congenitally deaf children, all of whom underwent cochlear implantation. All subjects were tested on their electrical evoked compound action potential. Speech perception tests were performed using the monosyllabic trochee polysyllabic test without visual support and the open-set monosyllabic wordlist. Results: In all, 20% of the congenitally deaf children in our center study have inner ear abnormalities. Inner ear malformations were limited to incomplete partition of the cochlea; none of the subjects had common cavity malformations. Electrical compound action potentials were successfully recorded in both groups intraoperatively. Speech perception tests on open-set speech yielded an average of 48.8% (SD 21.2%) in the group of children with inner ear malformations vs 54.5% (SD 21.1%) in congenitally deaf children. In four of nine cases with an inner ear malformation we encountered a minor CSF leak.

Eight-nerve electrophysiology after electrocautery in cochlear implant patients

Problem: To date, there have been over 50,000 cochlear implant recipients; however, there have been no data in the literature regarding safety or complications from the use of monopolar electrocautery in patients with cochlear implants. We address the use of monopolar electrocautery in patients with cochlear implants and the effects of the cautery on the function of the implant and the primary afferent neurons with which this auditory prosthesis interfaces. Methods: The electrically evoked whole nerve action potential of the auditory nerve was measured using neural response telemetry obtained using typical stimulation parameters. Recording electrodes were 2 electrodes away in the apical direction. Results: Neural response telemetry demonstrated auditory nerve activity via electrical stimulation and confirmed proper functioning of the cochlear implant before and after monopolar electrocautery use. Electrical compound action potential (ECAP) thresholds obtained following exposure to monopolar electrocautery were within 5 current level steps of the initial results. Increases in stimulus level resulted in expected increase in response amplitude and response morphology remained consistent. Behavioral reports indicated sound perception as expected for these types of measures. Finally, electrode voltage impedances were within the normal range, within compliance, and similar between sessions. Conclusion: Neural response telemetry demonstrated a fully functional cochlear implant after being exposed to monopolar electrocautery. We feel that the use of monopolar electrocautery at a site distant from the cochlear implant poses little risk to the proper functioning of the cochlear implant. Significance: To date, there is an absence in the literature regarding the use of electrocautery, either monopolar or bipolar in patients with cochlear implants. Given the current practice of implanting young children, the likelihood of those patients needing future surgeries is very high. It is important to establish the safe parameters for the use of electrocautery for these and all patients who have been implanted. Support: None reported.