Stimulating the cochlear apex without longer electrodes

无需较长电极即可刺激耳蜗尖部

• 批准号: 10461862
• 负责人: David M Landsberger
• 金额: $ 21.19万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-04 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10461862
• 关键词: Acoustics; Address; Affect; Apical; Caliber; Clinical; Cochlea; Cochlear Implants; Cochlear duct; Code; Computer software; Devices; Disadvantaged; Discrimination; Ear; Electric Stimulation; Electrodes; FDA approved; Felis catus; Frequencies; Human; Implant; Implanted Electrodes; Inferior Colliculus; Intervention; Intervention Studies; Lead; Left; Length; Maps; Measures; Methods; Modification; Operative Surgical Procedures; Outcome; Patients; Perception; Performance; Phase; Probability; Reporting; Residual state; Scala Tympani; Site; Speech; Speech Perception; Structure; Tissues; design; electric field; experimental study; helicotrema; implantable device; implantation; improved; normal hearing; novel; novel strategies; relating to nervous system; signal processing; sound; temporalis muscle

PROJECT SUMMARY Cochlear implant (CI) electrode arrays are only partially inserted into the cochlea, in most cases leaving more than half of the cochlea unstimulated. In the normal hearing ear, the cochlear region left unstimulated by most CIs represents frequencies below approximately 800Hz. Providing electrical stimulation to a broader region of the cochlea with a CI has the potential to enhance performance. For example, increasing apical coverage has been shown to improve speech perception and accelerate CI patients’ adaptation to their device. These benefits may be due to representation of low-frequency information closer to the normal cochlear place. Furthermore, stimulation deeper than one cochlear turn may provide better perception of temporal information and better sound quality. However, using longer electrode arrays to access deep apical regions has several disadvantages. First, because the scala tympani diameter decreases with increasing cochlear depth, the likelihood of an incomplete insertion increases with electrode array length. Second, if deeper insertion is achieved, the probability of damage to cochlear structures increases as the walls of the cochlear duct become closer to the electrode. Third, even the longest electrodes only stimulate ~70% of the cochlear length. To address these shortcomings, we developed a novel approach to stimulate the cochlear apex without increasing the electrode array length. Moreover, our approach uses existing FDA-approved CIs, speech processors, and commercial fitting software without modification. In Cochlear CI devices, two extra-cochlear electrodes (ECEs) are used for grounds: ECE1 (usually placed under the temporalis muscle) and ECE2 (located on the implant case). In the novel approach, ECE1 is placed into the cochlear helicotrema via an apical cochleostomy and the electrode array is inserted from the basal end of the cochlea through a traditional cochleostomy. When an electrode from the array is grounded to ECE1 in the cochlear helicotrema, the electric field is driven towards the cochlear apex, stimulating residual neural tissue at sites deeper than available with the standard configuration of electrode arrays and ground electrodes. Using ECE2 as the ground provides monopolar stimulation, which is the clinical standard. Thus far, we have successfully implanted three patients using this novel surgical approach and implemented novel signal processing using the ECE1 electrode. All reported a lower pitch when using ECE1 instead of ECE2 as a ground. This new approach provides a unique opportunity to answer important scientific questions and to evaluate a new clinical intervention. It provides the first opportunity to directly stimulate the cochlear helicotrema (apex) in humans. We can now study if such stimulation improves temporal coding (Aim 1) and extends the tonotopic pitch range (Aim 2). Additionally, we can study if the intervention improves clinical outcomes (Aim 3). We propose to implant 15 patients with this new approach to address the three aims.

项目摘要 耳蜗植入物（CI）电极阵列仅部分插入耳蜗，在大多数情况下 超过一半的耳蜗未刺激。在正常的听力耳朵中，耳蜗区域未刺激 大多数CI表示大约低于800Hz的频率。提供电刺激到更广泛的 CI的耳蜗区域具有提高性能的潜力。例如，增加顶端 覆盖范围已显示可改善语音感知，并加速CI患者对设备的适应性。 这些好处可能是由于代表了靠近正常人工耳蜗的低频信息。 此外，刺激比一个耳蜗更深的刺激可能会更好地感知临时信息 以及更好的音质。但是，使用较长的电极阵列访问深根部有几个 缺点。首先，因为Scala鼓膜直径随着耳蜗深度的增加而降低，所以 不完全插入的可能性随电极阵列长度而增加。第二，如果更深的插入是 达到的，随着耳蜗壁的壁变为 靠近电极。第三，即使是最长的电极，也只能刺激约70％的人工耳蜗长度。 为了解决这些缺点，我们开发了一种新的方法来刺激人工耳蜗 不增加电极阵列长度。此外，我们的方法使用现有的FDA批准 顺式，语音处理器和商业拟合软件而无需修改。在耳蜗CI设备中， 两个用于地面：ECE1（通常位于临时性下方） 肌肉）和ECE2（位于植入物情况下）。在新方法中，ECE1被放入人工耳蜗中 通过顶端骨髓造口术和电极阵列从耳蜗的基本端插入helicotrema 通过传统的耳蜗术。当阵列中的电极接地到人工耳蜗的ECE1 Helicotrema，电场被驱动到耳蜗顶端，刺激位点的残留神经组织 比电极阵列和接地电极的标准配置更深。使用ECE2 由于地面提供了单极刺激，这是临床标准。那远，我们已经成功 使用这种新型手术方法植入三名患者并实施了新的信号处理 使用ECE1电极。所有人都报告使用ECE1而不是ECE2作为地面。 这种新方法为回答重要的科学问题提供了独特的机会和 评估新的临床干预措施。它提供了直接刺激人工耳蜗的第一个机会 人类中的Helicotrema（Apex）。现在，我们可以研究这种刺激是否改善了临时编码（AIM 1）和 扩展了Tonotopic音高范围（AIM 2）。此外，我们可以研究干预措施是否改善临床 结果（目标3）。我们建议使用这种新方法植入15名患者，以解决这三个目标。

项目成果

Stimulating the Cochlear Apex Without Longer Electrodes: Preliminary Results With a New Approach.

• DOI: 10.1097/mao.0000000000003529
• 发表时间: 2022-06-01
• 期刊: OTOLOGY & NEUROTOLOGY
• 影响因子: 2.1
• 作者: Landsberger, David M.;Stupak, Natalia;Spitzer, Emily R.;Entwisle, Lavin;Mahoney, Laurel;Waltzman, Susan B.;McMenomey, Sean;Friedmann, David R.;Svirsky, Mario A.;Shapiro, William;Roland, J. Thomas, Jr.
• 通讯作者: Roland, J. Thomas, Jr.