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）电极阵列在大多数Casses中都插入了耳蜗中 一半以上的耳蜗未刺激。 大多数CI代表低于800Hz的自由定量。 CI的耳蜗区域具有增强性能的潜力。 覆盖范围已被证明可以改善语音感知，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，刺激比转弯更深入，可能会更好地感知时间信息 但是，更好的声音质量。 缺点。 如果更深的插入是，则不满的可能性随着电极阵列的长度而增加。 达到的，人工耳蜗对人工耳蜗结构的损害的可能性如耳蜗变为 靠近电极，即使是最长的电极也只能刺激人工耳蜗的70％。 为了解决缺点，我们开发了一种新的方法来刺激人工耳蜗 不增加电极阵列的长度。 CI，语音处理器和具有修改的商业拟合软件。 两个用于地面：ECE1（通常放置在颞下面） 肌肉）和ECE2（位于植入物中）。 通过顶端骨髓造口术和电极阵列从耳蜗的基部插入电力阵列阵列的Helicotrema 通过传统的耳塞术。 Helicotrema，电场被驱动到耳蜗顶点，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。 由于地面提供了单极刺激，这是临床标准。 使用THEL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。所有使用ECE1而不是ECE2作为地面时都报告了较低的音高。 这种新方法提供了一个独特的机会，可以回答重要的科学问题和 评估新的临床干预措施。 Helicotrema（Apex）在人类中。 扩展了Tonotopic音高范围（AIM 2）。 结果（目标3）。

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.