期刊
EAR AND HEARING
卷 42, 期 4, 页码 941-948出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/AUD.0000000000000985
关键词
Angular insertion depth; Cochlear implant; Electrocochleography; Peripheral auditory physiology; Precurved array; Speech perception; Straight array
资金
- NIH through NIDCD [T32 DC005360, F30 DC015168]
- MED-EL Corporation
- Advanced Bionics
Electrocochleography (ECochG) obtained before CI insertion provides important information for predicting speech perception outcomes in adults, with variables such as angular insertion depth (AID) and array design also playing significant roles. The combination of ECochG, AID, and array design accounts for approximately 72% of the variability in speech perception outcomes, suggesting that peripheral factors are crucial for speech perception with CIs.
Objectives: Electrocochleography (ECochG), obtained before the insertion of a cochlear implant (CI) array, provides a measure of residual cochlear function that accounts for a substantial portion of variability in postoperative speech perception outcomes in adults. It is postulated that subsequent surgical factors represent independent sources of variance in outcomes. Prior work has demonstrated a positive correlation between angular insertion depth (AID) of straight arrays and speech perception under the CI-alone condition, with an inverse relationship observed for precurved arrays. The purpose of the present study was to determine the combined effects of ECochG, AID, and array design on speech perception outcomes. Design: Participants were 50 postlingually deafened adult CI recipients who received one of three straight arrays (MED-EL Flex24, MED-EL Flex28, and MED-EL Standard) and two precurved arrays (Cochlear Contour Advance and Advanced Bionics HiFocus Mid-Scala). Residual cochlear function was determined by the intraoperative ECochG total response (TR) measured before array insertion, which is the sum of magnitudes of spectral components in response to tones of different stimulus frequencies across the speech spectrum. The AID was then determined with postoperative imaging. Multiple linear regression was used to predict consonant-nucleus-consonant (CNC) word recognition in the CI-alone condition at 6 months postactivation based on AID, TR, and array design. Results: Forty-one participants received a straight array and nine received a precurved array. The AID of the most apical electrode contact ranged from 341 degrees to 696 degrees. The TR measured by ECochG accounted for 43% of variance in speech perception outcomes (p < 0.001). A regression model predicting CNC word scores with the TR tended to underestimate the performance for precurved arrays and deeply inserted straight arrays, and to overestimate the performance for straight arrays with shallower insertions. When combined in a multivariate linear regression, the TR, AID, and array design accounted for 72% of variability in speech perception outcomes (p < 0.001). Conclusions: A model of speech perception outcomes that incorporates TR, AID, and array design represents an improvement over a model based on TR alone. The success of this model shows that peripheral factors including cochlear health and electrode placement may play a predominant role in speech perception with CIs.
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