Objectives: The upper loudness limit of electrical stimulation in cochlear implant patients is sometimes set using electrically elicited stapedius reflex thresholds (eSRTs), especially in children for whom reporting skills may be limited. In unilateral cochlear implant patients, eSRT levels are measured typically in the contralateral unimplanted ear because the ability to measure eSRTs in the implanted ear is likely to be limited due to the cochlear implant surgery and consequential changes in middle ear dynamics. This practice is particularly limiting in the case of fitting bilaterally implanted pediatric cases because there is no unimplanted ear option to choose for eSRT measurement. The goal of this study was to identify an improved measurement protocol to increase the success of eSRT measurement in ipsilateral or contralateral or both implanted ears of pediatric cochlear implant recipients. This work hypothesizes that use of a higher probe frequency (e.g., 1000 Hz compared with the 226 Hz standard), which is closer to the mechanical middle ear resonant frequency, may be more effective in measuring middle ear muscle contraction in either ear. Design: In the present study, eSRTs were measured using multiple probe frequencies (226, 678, and 1000 Hz) in the ipsilateral and contralateral ears of 19 children with unilateral Advanced Bionics (AB) cochlear implants (mean age = 8.6 years, SD = 2.29). An integrated middle ear analyzer designed by AB was used to elicit and detect stapedius reflexes and assign eSRT levels. In the integrated middle ear analyzer system, an Interacoustics Titan middle ear analyzer was used to perform middle ear measurements in synchrony with research software running on an AB Neptune speech processor, which controlled the delivery of electrical pulse trains at varying levels to the test subject. Changes in middle ear acoustic admittance following an electrical pulse train stimulus indicated the occurrence of an electrically elicited stapedius reflex. Results: Of the 19 ears tested, ipsilateral eSRTs were successfully measured in 3 (16%), 4 (21%), and 7 (37%) ears using probe tones of 226, 678, and 1000 Hz, respectively. Contralateral eSRT levels were measured in 11 (58%), 13 (68%), and 13 (68%) ears using the three different probe frequencies, respectively. A significant difference was found in the incidence of successful eSRT measurement as a function of probe frequency in the ipsilateral ears with the greatest pair-wise difference between the 226 and 1000 Hz probe. A significant increase in contralateral eSRT measurement success as a function of probe frequency was not found. These findings are consistent with the idea that changes in middle ear mechanics, secondary to cochlear implant surgery, may interfere with the detection of stapedius muscle contraction in the ipsilateral middle ear. The best logistic, mixed-effects model of the occurrence of successful eSRT measures included ear of measurement and probe frequency as significant fixed effects. No significant differences in average eSRT levels were observed across ipsilateral and contralateral measurements or as a function of probe frequency. Conclusion: Typically, measurement of stapedius reflexes is less successful in the implanted ears of cochlear implant recipients compared with measurements in the contralateral, unimplanted ear. The ability to measure eSRT levels ipsilaterally can be improved by using a higher probe frequency. ACKNOWLEDGMENTS: All authors listed in the article contributed toward the work reported in this submission. Lizette Carranco Hernandez, Lisette Cristerna Sánchez, Miriam Camacho Olivares, Carina Rodríguez, and Aniket A. Saoji were involved in data collection and interpretation of the data. Aniket A. Saoji and Charles C. Finley were involved in experimental software and hardware set up, statistical analysis, and preparation of the article. Author Carina Rodriguez is an Advanced Bionics employee (a cochlear implant manufacturer). Authors Charles C. Finley and Aniket A. Saoji were employed with Advanced Bionics when this study was completed. Address for correspondence: Aniket Saoji, PhD, CCC-A, Dept. of Otolaryngology, Mayo Clinic, 200 1st St SW, Rochester, MN 55902 E-mail: aniket.saoji@gmail.com Received August 9, 2017; accepted July 11, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
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