Hostname: page-component-6766d58669-mzsfj Total loading time: 0 Render date: 2026-05-20T15:55:25.644Z Has data issue: false hasContentIssue false
  • English
  • Français

Stimulation parameters differ between current anti-modiolar and peri-modiolar electrode arrays implanted within the same child

Published online by Cambridge University Press:  14 October 2016

M J Polonenko ,
S L Cushing ,
K A Gordon ,
B Allemang ,
S Jewell  and
B C Papsin
M J Polonenko*
Affiliation:
Archie's Cochlear Implant Laboratory, Department of Otolaryngology, Hospital for Sick Children, Toronto, Canada Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Canada
S L Cushing
Affiliation:
Archie's Cochlear Implant Laboratory, Department of Otolaryngology, Hospital for Sick Children, Toronto, Canada Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Toronto, Canada
K A Gordon
Affiliation:
Archie's Cochlear Implant Laboratory, Department of Otolaryngology, Hospital for Sick Children, Toronto, Canada Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Canada Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Toronto, Canada
B Allemang
Affiliation:
Archie's Cochlear Implant Laboratory, Department of Otolaryngology, Hospital for Sick Children, Toronto, Canada
S Jewell
Affiliation:
Archie's Cochlear Implant Laboratory, Department of Otolaryngology, Hospital for Sick Children, Toronto, Canada
B C Papsin
Affiliation:
Archie's Cochlear Implant Laboratory, Department of Otolaryngology, Hospital for Sick Children, Toronto, Canada Department of Otolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Toronto, Canada
*
Address for correspondence: Melissa J Polonenko, Archie's Cochlear Implant Laboratory, Department of Otolaryngology, 6th Floor Elm Wing, Room 6D08, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 Fax: +1 416 813 5036 Phone: +1 416 813 6683 E-mail: melissa.polonenko@mail.utoronto.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To compare stimulation parameters of peri-modiolar and anti-modiolar electrode arrays using two surgical approaches.

Methods:

Impedance, stimulation thresholds, comfortably loud current levels, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds were compared between 2 arrays implanted in the same child at 5 time points: surgery, activation/day 1, week 1, and months 1 and 3. The peri-modiolar array was implanted via cochleostomy in all children (n = 64), while the anti-modiolar array was inserted via a cochleostomy in 43 children and via the round window in 21 children.

Results:

The anti-modiolar array had significantly lower impedance, but required higher current levels to elicit thresholds, comfort, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds than the peri-modiolar array across all time points, particularly in basal electrodes (p < 0.05). The prevalence of open electrodes was similar in anti-modiolar (n = 5) and peri-modiolar (n = 3) arrays.

Conclusion:

Significant but clinically acceptable differences in stimulation parameters between peri-modiolar and anti-modiolar arrays persisted four months after surgery in children using bilateral cochlear implants. The surgical approach used to insert the anti-modiolar array had no overall effect on outcomes.

Keywords

Cochlear ImplantElectrodeElectric StimulationProsthesis Fitting

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 11 , November 2016 , pp. 1007 - 1021
Copyright
Copyright © JLO (1984) Limited 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Portions of this article were presented at: the Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum annual conference, 28–31 August 2016, Bordeaux, France; the 14th Symposium on Cochlear Implants in Children, 12–13 December 2014, Nashville, Tennessee, USA; and the Society for Ear, Nose and Throat Advances in Children annual meetings, 5 December 2014, St Louis, Missouri, USA, and 6 December 2013, Long Beach, California.

Dr B C Papsin is The Journal of Laryngology & Otology 2016 Visiting Professor.

References

1 Zilberman, Y, Santogrossi, T. Back-telemetry and the Clarion cochlear prosthesis. Ann Otol Rhinol Laryngol Suppl 1995;166:146–7Google ScholarPubMed
2 Gordin, A, Papsin, B, James, A, Gordon, K. Evolution of cochlear implant arrays result in changes in behavioral and physiological responses in children. Otol Neurotol 2009;30:908–15CrossRefGoogle ScholarPubMed
3 Shepherd, RK, Hatsushika, S, Clark, GM. Electrical stimulation of the auditory nerve: the effect of electrode position on neural excitation. Hear Res 1993;66:108–20CrossRefGoogle ScholarPubMed
4 Saunders, E, Cohen, L, Aschendorff, A, Shapiro, W, Knight, M, Stecker, M et al. Threshold, comfortable level and impedance changes as a function of electrode-modiolar distance. Ear Hear 2002;23:28–40S CrossRefGoogle ScholarPubMed
5 Busby, PA, Plant, KL, Whitford, LA. Electrode impedance in adults and children using the Nucleus 24 cochlear implant system. Cochlear Implants Int 2002;3:87–103 CrossRefGoogle ScholarPubMed
6 van Wermeskerken, GK, van Olphen, AF, Smoorenburg, GF. Intra- and postoperative electrode impedance of the straight and Contour arrays of the Nucleus 24 cochlear implant: relation to T and C levels. Int J Audiol 2006;45:537–44CrossRefGoogle Scholar
7 Bacciu, A, Pasanisi, E, Vincenti, V, Guida, M, Barbot, A, Berghenti, M et al. Comparison of speech perception performance between the Nucleus 24 and Nucleus 24 Contour cochlear implant systems. Acta Otolaryngol 2004;124:1155–8CrossRefGoogle ScholarPubMed
8 Davis, TJ, Zhang, D, Gifford, RH, Dawant, BM, Labadie, RF, Noble, JH. Relationship between electrode-to-modiolus distance and current levels for adults with cochlear implants. Otol Neurotol 2016;37:31–7CrossRefGoogle ScholarPubMed
9 Dietz, A, Wennström, M, Lehtimäki, A, Löppönen, H, Valtonen, H. Electrode migration after cochlear implant surgery: more common than expected? Eur Arch Otorhinolaryngol 2016;273:1411–18CrossRefGoogle ScholarPubMed
10 Briggs, RJ, Tykocinski, M, Saunders, E, Hellier, W, Dahm, M, Pyman, B et al. Surgical implications of perimodiolar cochlear implant electrode design: avoiding intracochlear damage and scala vestibuli insertion. Cochlear Implants Int 2001;2:135–49CrossRefGoogle ScholarPubMed
11 Adunka, O, Gstoettner, W, Hambek, M, Unkelbach, MH, Radeloff, A, Kiefer, J. Preservation of basal inner ear structures in cochlear implantation. ORL J Otorhinolaryngol Relat Spec 2004;66:306–12CrossRefGoogle ScholarPubMed
12 Adunka, O, Unkelbach, MH, Mack, M, Hambek, M, Gstoettner, W, Kiefer, J. Cochlear implantation via the round window membrane minimizes trauma to cochlear structures: a histologically controlled insertion study. Acta Otolaryngol 2004;124:807–12CrossRefGoogle ScholarPubMed
13 Briggs, RJ, Tykocinski, M, Xu, J, Risi, F, Svehla, M, Cowan, R et al. Comparison of round window and cochleostomy approaches with a prototype hearing preservation electrode. Audiol Neurootol 2006;11:42–8CrossRefGoogle ScholarPubMed
14 Briggs, RJ, Tykocinski, M, Stidham, K, Roberson, JB. Cochleostomy site: implications for electrode placement and hearing preservation. Acta Otolaryngol 2005;125:870–6CrossRefGoogle ScholarPubMed
15 Doshi, J, Johnson, P, Mawman, D, Green, K, Bruce, IA, Freeman, S et al. Straight versus modiolar hugging electrodes: does one perform better than the other? Otol Neurotol 2015;36:223–7CrossRefGoogle ScholarPubMed
16 Telmesani, LM, Said, NM. Effect of cochlear implant electrode array design on auditory nerve and behavioral response in children. Int J Pediatr Otorhinolaryngol 2015;79:660–5CrossRefGoogle ScholarPubMed
17 Hassepass, F, Aschendorff, A, Bulla, S, Arndt, S, Maier, W, Laszig, R et al. Radiologic results and hearing preservation with a straight narrow electrode via round window versus cochleostomy approach at initial activation. Otol Neurotol 2015;36:993–1000 CrossRefGoogle ScholarPubMed
18 Daya, H, Figueirido, JC, Gordon, KA, Twitchell, K, Gysin, C, Papsin, BC. The role of a graded profile analysis in determining candidacy and outcome for cochlear implantation in children. Int J Pediatr Otorhinolaryngol 1999;49:135–42CrossRefGoogle ScholarPubMed
19 MacDonald, L, Sohn, G, Papsin, BC, Gordon, KA. Use of a Graded Profile Analysis to assess cochlear implant candidacy: recent findings. Cochlear Implants. Proceedings of the VIII International Cochlear Implant Conference 2004;1273:215–18Google Scholar
20 Swanson, B, Seligman, P, Carter, P. Impedance measurement of the Nucleus 22-electrode array in patients. Ann Otol Rhinol Laryngol Suppl 1995;166:141–4Google ScholarPubMed
21 Tykocinski, M, Duan, Y, Tabor, B, Cowan, RS. Chronic electrical stimulation of the auditory nerve using high surface area (HiQ) platinum electrodes. Hear Res 2001;159:53–68 CrossRefGoogle ScholarPubMed
22 Charlet de Sauvage, R, Lima da Costa, D, Erre, JP, Aran, JM. Electrical and physiological changes during short-term and chronic electrical stimulation of the normal cochlea. Hear Res 1997;110:119–34CrossRefGoogle ScholarPubMed
23 Hughes, ML, Vander Werff, KR, Brown, CJ, Abbas, PJ, Kelsay, DM, Teagle, HF et al. A longitudinal study of electrode impedance, the electrically evoked compound action potential, and behavioral measures in nucleus 24 cochlear implant users. Ear Hear 2001;22:471–86CrossRefGoogle ScholarPubMed
24 Newbold, C, Richardson, R, Huang, CQ, Milojevic, D, Cowan, R, Shepherd, R. An in vitro model for investigating impedance changes with cell growth and electrical stimulation: implications for cochlear implants. J Neural Eng 2004;1:218–27CrossRefGoogle Scholar
25 Dorman, MF, Smith, LM, Dankowski, K, McCandless, G, Parkin, JL. Long-term measures of electrode impedance and auditory thresholds for the Ineraid cochlear implant. J Speech Hear Res 1992;35:1126–30CrossRefGoogle ScholarPubMed
26 Henkin, Y, Kaplan-Neeman, R, Muchnik, C, Kronenberg, J, Hildesheimer, M. Changes over time in electrical stimulation levels and electrode impedance values in children using the Nucleus 24M cochlear implant. Int J Pediatr Otorhinolaryngol 2003;67:873–80CrossRefGoogle ScholarPubMed
27 Henkin, Y, Kaplan-Neeman, R, Kronenberg, J, Migirov, L, Hildesheimer, M, Muchnik, C. Electrical stimulation levels and electrode impedance values in children using the Med-El Combi 40+ cochlear implant: a one year follow-up. J Basic Clin Physiol Pharmacol 2005;16:127–37CrossRefGoogle ScholarPubMed
28 Henkin, Y, Kaplan-Neeman, R, Kronenberg, J, Migirov, L, Hildesheimer, M, Muchnik, C. A longitudinal study of electrical stimulation levels and electrode impedance in children using the Clarion cochlear implant. Acta Otolaryngol 2006;126:581–6CrossRefGoogle ScholarPubMed
29 Paasche, G, Bockel, F, Tasche, C, Lesinski-Schiedat, A, Lenarz, T. Changes of postoperative impedances in cochlear implant patients: the short-term effects of modified electrode surfaces and intracochlear corticosteroids. Otol Neurotol 2006;27:639–47CrossRefGoogle Scholar
30 Gordon, KA, Papsin, BC, Harrison, RV. Toward a battery of behavioral and objective measures to achieve optimal cochlear implant stimulation levels in children. Ear Hear 2004;25:447–63CrossRefGoogle Scholar
31 Gordin, A, Papsin, B, Gordon, K. Packing of the cochleostomy site affects auditory nerve response thresholds in precurved off-stylet cochlear implants. Otol Neurotol 2010;31:204–9CrossRefGoogle ScholarPubMed
32 Shapiro, W, Waltzman, S. Changes in electrical thresholds over time in young children implanted with the Nucleus cochlear prosthesis. Ann Otol Rhinol Laryngol Suppl 1995;166:177–8Google ScholarPubMed
33 Raghunandhan, S, Ravikumar, A, Kameswaran, M, Mandke, K, Ranjith, R. A clinical study of electrophysiological correlates of behavioural comfort levels in cochlear implantees. Cochlear Implants Int 2014;15:145–60CrossRefGoogle ScholarPubMed
34 Huang, TC, Reitzen, SD, Marrinan, MS, Waltzman, SB, Roland, JT. Modiolar coiling, electrical thresholds, and speech perception after cochlear implantation using the nucleus contour advance electrode with the advance off stylet technique. Otol Neurotol 2006;27:159–66CrossRefGoogle ScholarPubMed
35 Gordon, KA, Chaikof, MH, Salloum, C, Goulding, G, Papsin, B. Toward a method for programming balanced bilateral cochlear implant stimulation levels in children. Cochlear Implants Int 2012;13:220–7CrossRefGoogle Scholar
36 Polak, M, Hodges, AV, King, JE, Balkany, TJ. Further prospective findings with compound action potentials from Nucleus 24 cochlear implants. Hear Res 2004;188:104–16CrossRefGoogle ScholarPubMed
37 Polak, M, Hodges, A, Balkany, T. ECAP, ESR and subjective levels for two different Nucleus 24 electrode arrays. Otol Neurotol 2005;26:639–45CrossRefGoogle ScholarPubMed
38 Propst, EJ, Papsin, BC, Stockley, TL, Harrison, RV, Gordon, KA. Auditory responses in cochlear implant users with and without GJB2 deafness. Laryngoscope 2006;116:317–27CrossRefGoogle ScholarPubMed
39 Rattay, F, Leao, RN, Felix, H. A model of the electrically excited human cochlear neuron. II. Influence of the three-dimensional cochlear structure on neural excitability. Hear Res 2001;153:64–79 CrossRefGoogle Scholar
40 Cohen, LT, Saunders, E, Knight, MR, Cowan, RS. Psychophysical measures in patients fitted with Contour and straight Nucleus electrode arrays. Hear Res 2006;212:160–75CrossRefGoogle ScholarPubMed
41 Franck, KH. A model of a Nucleus 24 cochlear implant fitting protocol based on the electrically evoked whole nerve action potential. Ear Hear 2002;23:67–71S CrossRefGoogle Scholar
42 Han, D-M, Chen, X-Q, Zhao, X-T, Kong, Y, Li, Y-X, Liu, S et al. Comparisons between neural response imaging thresholds, electrically evoked auditory reflex thresholds and most comfortable loudness levels in CII bionic ear users with HiResolution sound processing strategies. Acta Otolaryngol 2005;125:732–5CrossRefGoogle ScholarPubMed
43 Hughes, ML, Stille, LJ. Effect of stimulus and recording parameters on spatial spread of excitation and masking patterns obtained with the electrically evoked compound action potential in cochlear implants. Ear Hear 2010;31:679–92CrossRefGoogle ScholarPubMed
44 Potts, LG, Skinner, MW, Gotter, BD, Strube, MJ, Brenner, CA. Relation between neural response telemetry thresholds, T- and C-levels, and loudness judgments in 12 adult Nucleus 24 cochlear implant recipients. Ear Hear 2007;28:495–511 CrossRefGoogle ScholarPubMed
45 Holstad, BA, Sonneveldt, VG, Fears, BT, Davidson, LS, Aaron, RJ, Richter, M et al. Relation of electrically evoked compound action potential thresholds to behavioral T- and C-levels in children with cochlear implants. Ear Hear 2009;30:115–27CrossRefGoogle ScholarPubMed
46 Fitzgerald, MB, Shapiro, WH, McDonald, PD, Neuburger, HS, Ashburn-Reed, S, Immerman, S et al. The effect of perimodiolar placement on speech perception and frequency discrimination by cochlear implant users. Acta Otolaryngol 2007;127:378–83CrossRefGoogle ScholarPubMed
47 Gordon, KA, Deighton, MR, Abbasalipour, P, Papsin, BC. Perception of binaural cues develops in children who are deaf through bilateral cochlear implantation. PLoS One 2014;9:e114841 CrossRefGoogle ScholarPubMed
48 Gordon, KA, Wong, DD, Papsin, BC. Bilateral input protects the cortex from unilaterally-driven reorganization in children who are deaf. Brain 2013;136:1609–25CrossRefGoogle ScholarPubMed
49 Gordon, KA, Valero, J, Papsin, BC. Auditory brainstem activity in children with 9–30 months of bilateral cochlear implant use. Hear Res 2007;233:97–107 CrossRefGoogle ScholarPubMed