Neural Response Telemetry System Research Articles

A DSP Architecture for Distortion-Free Evoked Compound Action Potential Recovery in Neural Response Telemetry System.

This paper presents a digital signal processing (DSP) architecture for real-time and distortion-free recovery of electrically-evoked compound action potentials (ECAPs) from stimulus artifacts and periodic noises in bidirectional neural response telemetry (NRT) system. In this DSP architecture, a low computation-cost bidirectional-filtered coherent averaging (BFCA) method is proposed for programmable linear-phase filtering of ECAPs, which can be easily combined with the alternating-polarity (AP) stimulation method to reject stimulus artifacts overlapped with ECAP responses. Design techniques including the configurable folded infinite-impulse response (IIR) filter and division-free averaging are also presented for efficient hardware implementation. Implemented in 180-nm CMOS process, the proposed DSP architecture consumes 10.03-mm2 area and 2.35-mW post-layout simulated power. The efficacy of the DSP architecture in recovering ECAPs from recorded neural data contaminated by overlapped stimulus artifacts and periodic noises is validated in in-vivo electrical nerve stimulations. Experiment results show that compared with the previous coherent averaging technique, the proposed DSP architecture improves the signal-to-noise ratio (SNR) of ECAP responses by 11 dB and achieves a 3.1% waveform distortion that is 17.1× lower.

Using Neural Response Telemetry to Monitor Physiological Responses to Acoustic Stimulation in Hybrid Cochlear Implant Users.

This report describes the results of a series of experiments where we use the neural response telemetry (NRT) system of the Nucleus cochlear implant (CI) to measure the response of the peripheral auditory system to acoustic stimulation in Nucleus Hybrid CI users. The objectives of this study were to determine whether they could separate responses from hair cells and neurons and to evaluate the stability of these measures over time. Forty-four CI users participated. They all had residual acoustic hearing and used a Nucleus Hybrid S8, S12, or L24 CI or the standard lateral wall CI422 implant. The NRT system of the CI was used to trigger an acoustic stimulus (500-Hz tone burst or click), which was presented at a low stimulation rate (10, 15, or 50 per second) to the implanted ear via an insert earphone and to record the cochlear microphonic, the auditory nerve neurophonic and the compound action potential (CAP) from an apical intracochlear electrode. To record acoustically evoked responses, a longer time window than is available with the commercial NRT software is required. This limitation was circumvented by making multiple recordings for each stimulus using different time delays between the onset of stimulation and the onset of averaging. These recordings were then concatenated off-line. Matched recordings elicited using positive and negative polarity stimuli were added off-line to emphasize neural potentials (SUM) and subtracted off-line to emphasize potentials primarily generated by cochlear hair cells (DIF). These assumptions regarding the origin of the SUM and DIF components were tested by comparing the magnitude of these derived responses recorded using various stimulation rates. Magnitudes of the SUM and DIF components were compared with each other and with behavioral thresholds. SUM and DIF components were identified for most subjects, consistent with both hair cell and neural responses to acoustic stimulation. For a subset of the study participants, the DIF components grew as stimulus level was increased, but little or no SUM components were identified. Latency of the CAPs in response to click stimuli was long relative to reports in the literature of recordings obtained using extracochlear electrodes. This difference in response latency and general morphology of the CAPs recorded was likely due to differences across subjects in hearing loss configuration. The use of high stimulation rates tended to decrease SUM and CAP components more than DIF components. We suggest this effect reflects neural adaptation. In some individuals, repeated measures were made over intervals as long as 9 months. Changes over time in DIF, SUM, and CAP thresholds mirrored changes in audiometric threshold for the subjects who experienced loss of acoustic hearing in the implanted ear. The Nucleus NRT software can be used to record peripheral responses to acoustic stimulation at threshold and suprathreshold levels, providing a window into the status of the auditory hair cells and the primary afferent nerve fibers. These acoustically evoked responses are sensitive to changes in hearing status and consequently could be useful in characterizing the specific pathophysiology of the hearing loss experienced by this population of CI users.

Cochlear response telemetry: intracochlear electrocochleography via cochlear implant neural response telemetry pilot study results.

To record cochlear responses to acoustic stimulation (electrocochleography) directly from a cochlear implant (CI) in awake recipients with residual hearing, using an adaptation of Neural Response Telemetry (NRT) that achieves a 10-ms recording window. Modern cochlear implants contain circuitry for recording neural responses to electrical stimulation, which is known in Cochlear Ltd systems as NRT. We adapted NRT to achieve an extended recording window long enough to record an acoustic electrocochleogram. This paper reports recordings made with this system in recipients with residual hearing. Subjects were adults with CI422 CIs who retained audiometric thresholds between 75 and 90 dB HL at 500 Hz in their implanted ear. The CI was interfaced to a laptop via a Freedom speech processor connected by USB. Calibrated acoustic stimuli (clicks and tone bursts between 500 and 1,500 Hz) were presented via insert tube phones to the implanted ear. Responses were acquired through the adapted NRT system. Recordings were made from apical, mid-array, and basal electrodes. Electrocochleography responses were compared with audiometric thresholds. Electrocochleography could be recorded from all five subjects. The compound action potential, cochlear microphonic, and summating potentials were identified. Good quality recordings were most reliably attained from apical electrodes using 40 to 100 repetitions. Audiometric thresholds were similar to compound action potential thresholds. Intracochlear responses to acoustic stimulation can be recorded directly from the CI in awake recipients with residual hearing. This may prove useful for monitoring postoperative hearing and for device fitting.

Neural response telemetry measures in patients implanted with Nucleus 24®

SummaryCochlear implantation has been recommended for children under 24 months of age. The use of objective measures is needed to help speech processor programming. The electrically evoked compound potential (EAP), which can be assessed by neural response telemetry (NRT), is one of those objective measures. Aim: to determine how often the EAP can be recorded by NRT system during surgery and to describe the responses. Study design: clinical with transversal cohort. Material and Method: the impedances and NRT were measured in a group of 17 Nucleus 24® implant users. The responses were analyzed and compared to the etiology, hearing loss duration and electrode array position. Results: The EAP was easily recorded in the apical electrodes and, in otosclerosis and meningitis cases the EAP threshold was higher than in the other etiology cases. Conclusions: The NRT can be found in 82% of the cases during surgery. The responses obtained may vary according to etiology and the position of electrodes along the cochlea.

Channel Interaction in Cochlear Implant Users Evaluated Using the Electrically Evoked Compound Action Potential

One likely determinant of performance with a cochlear implant is the degree of interaction that occurs when overlapping subsets of nerve fibers are stimulated by various electrodes of a multielectrode array. The electrically evoked compound action potential (ECAP) can be used to assess physiological channel interaction. This paper describes results from two different methods of analysis of ECAP channel interaction measures made by the Nucleus neural response telemetry system. Using a forward-masking stimulus paradigm, masker and probe pulses are delivered through different electrodes. The response to the probe is then dependent on the extent of overlap in the stimulated neural populations. The amplitude of response to the probe as a function of masker electrode position then reflects the degree of overlap between the population of neurons responding to the masker and those stimulated by the probe. Results demonstrate large variations across individual implant users as well as across electrodes within an individual. In general, the degree of interaction is shown to be dependent on stimulus level.

Relationship between NRT measurements and behavioral levels in children with the Nucleus 24 cochlear implant may change over time: preliminary report

Objective: Response from spiral ganglion cells to electrical stimulation via the Nucleus 24 cochlear implant can be measured using the neural response telemetry system. The purpose of this study was to assess, in children, the correlation between the neural response threshold and the behavioral levels used for cochlear implant programming process. Methods: The neural response telemetry test was administered to 23 children (mean age at implantation: 4 years) with the Nucleus 24 cochlear implant. Four intra-cochlear electrodes (electrodes 5, 10, 15 and 20) were tested. The neural response threshold at 3, 6, 9 and 12 months post-implantation was compared with the behavioral threshold and the maximum comfort level estimated during the same periods: a Pearson's correlation test was performed for each tested electrode. Results: On apical electrodes, the correlation with the behavioral threshold remained significant from 3 to 12 months post-implantation ( r ranging from 0.696 to 0.909, P<0.05), and the correlation with the maximum comfort level was also significant throughout the study period, except on electrode 15 at 9 months (tendency to significance). On basal and intermediate electrodes, statistical correlations were found only at some points of time; nonetheless, at 12 months post-implantation, a significant correlation with behavioral levels could be clearly demonstrated both on electrode 15 ( r=0.914–0.778, P<0.05) and on electrode 10 ( r=0.845–0.720, P<0.05). Conclusions: This preliminary study suggests that the correlation between the neural response threshold and behavioral levels may improve from the base towards the apex of the cochlea. However, a significant correlation can be demonstrated for all tested electrodes at 12 months post-implantation. During the first months post-implantation care must be exercised when interpreting neural response telemetry measurements: a positive test does not necessarily mean that the stimulus delivered to the acoustic nerve will be centrally processed with the result of an auditory perception.

An Improved Method of Reducing Stimulus Artifact in the Electrically Evoked Whole-Nerve Potential

Recording a compound action potential in response to electrical stimulation requires attention to minimize contamination due to electrical stimulus artifact. In patients implanted with the Nucleus 24 device, the electrically evoked whole-nerve potential (EAP) is recorded using a neural response telemetry (NRT) system. This system employs a forward-masking technique that greatly reduces stimulus artifact. However, theoretical considerations and experimental animal data suggest that the technique may distort the acquired EAP waveform under some situations. We proposed and evaluated a modification to the forward-masking technique that addresses this concern, particularly during collection of refractory recovery data. We first examined neural responses of the electrically stimulated auditory nerve using cat preparations. Through single-fiber recordings from cats, we demonstrated underlying physiological limitations likely encountered with the "standard" forward masking technique. We then recorded feline EAP waveforms using both the standard technique and our proposed, modified, technique. Finally, we collected EAP data from human cochlear implant patients using both artifact reduction methods. These comparisons allowed us to evaluate the effectiveness of our modification. The cat EAP data demonstrated that the standard forward-masking technique currently in use in the Nucleus NRT system can distort the EAP waveform when the nerve is partially refractory. In the cat, this distortion resulted in forward-masking recovery curves with artifactually prolonged recovery times and inaccurate latency trends. Similar effects were observed in the comparison of human recovery curves obtained using both the standard and modified techniques. In some cases, the modified technique produced EAP waveforms with more clearly defined peaks than were obtainable with the standard method. Consideration should be given to implementing our modified forward-masking artifact reduction scheme, because it introduces less distortion of the EAP waveform and accordingly provides for more accurate assessment of the refractory properties of the electrically stimulated nerve.

The relationship between EAP and EABR thresholds and levels used to program the nucleus 24 speech processor: data from adults.

The objective of this study was to determine the relationship between electrically evoked whole nerve action potential (EAP) and electrical auditory brain stem response (EABR) thresholds and MAP threshold (T-level) and maximum comfort level (C-level) for subjects who use the Nucleus 24 cochlear implant system. Forty-four adult Nucleus 24 cochlear implant users participated in this study. EAP thresholds were recorded using the Neural Response Telemetry System developed by Cochlear Corporation. EABR thresholds were measured for a subset of 14 subjects using standard evoked potential techniques. These physiologic thresholds were collected on a set of five electrodes spaced across the cochlea, and were then compared with behavioral measures of T-level and C-level used to program the speech processor. EAP thresholds were correlated with MAP T- and C-levels; however, the correlation was not strong. A technique for improving the correlation by combining measures of T- and C-levels made on one electrode with the EAP thresholds was presented. Correlations between predicted and measured T- and C-levels using this technique were 0.83 and 0.77, respectively. Similar results were obtained using the EABR thresholds for a smaller set of subjects. In general, EABR thresholds were recorded at levels that were approximately 4.7 programming units lower than EAP thresholds. Either EAP or EABR thresholds can be used in combination with a limited amount of behavioral information to predict MAP T- and C-levels with reasonable accuracy.

Summary of results using the nucleus CI24M implant to record the electrically evoked compound action potential.

This study outlines a series of experiments using the neural response telemetry (NRT) system of the Nucleus CI24M cochlear implant to measure the electrically evoked compound action potential (EAP). The goal of this investigation was to develop a protocol that allows successful recording of the EAP in a majority of CI24M cochlear implant users. Twenty-six postlingually deafened adults participated in this study. A series of experiments were conducted that allowed us to examine how manipulation of stimulation and recording parameters may affect the morphology of the EAP recorded using the Nucleus NRT system. Results of this study show consistent responses on at least some electrodes from all subjects. Cross-subject and cross electrode variations in both the growth of the response and the temporal refractory properties of the response were observed. The range of stimulus and recording parameters that can be used to record the EAP with the Nucleus NRT system is described. Using the protocol outlined in this study, it is possible to reliably record EAP responses from most subjects and for most electrodes in Nucleus CI24M cochlear implant users. These responses are robust and recording these responses does not require that the subject sleep or remain still. Based on these results, a specific protocol is proposed for measurement of the EAP using the NRT system of the CI24M cochlear implant. Potential clinical implications of these results are discussed.