Neural Encoding and Auditory Processing of Electrical Stimulation in Pediatric Cochlear Implant Users

儿童人工耳蜗用户电刺激的神经编码和听觉处理

• 批准号: 10378134
• 负责人: Shuman He
• 金额: $ 39.43万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10378134
• 关键词: Action Potentials; Affect; Age; Apical; Auditory; Auditory system; Biological Markers; Child; Childhood; Clinical; Clinical Practice Guideline; Clinical Research; Cochlea; Cochlear Implants; Cochlear Nerve; Cochlear implant procedure; Cues; Data; Detection; Deterioration; Discrimination; Effectiveness; Electric Stimulation; Electrodes; Event-Related Potentials; Foundations; Goals; Hearing; Hearing problem; High Prevalence; Implant; Implanted Electrodes; Individual; Interphase; Knowledge; Labyrinth; Language Development; Length; Location; Magnetic Resonance Imaging; Maps; Measurable; Measures; Mission; Modiolus; Nature; Nerve Fibers; Patients; Pattern; Peripheral; Phase; Physiologic pulse; Practice Management; Predisposition; Process; Public Health; Pulse Rates; Recovery; Resolution; Sensorineural Hearing Loss; Signal Transduction; Site; Speech; Speech Development; Stimulus; Testing; United States National Institutes of Health; Variant; Work; auditory discrimination; auditory processing; base; behavioral response; clinical care; clinical practice; clinically significant; comorbidity; disability; evidence base; functional status; improved; malformation; patient population; patient variability; programs; relating to nervous system; research study; response; tool

PROJECT SUMMARY/ABSTRACT Cochlear nerve deficiency (CND) refers to a small or absent cochlear nerve (CN) as revealed by high- resolution magnetic resonance imaging. Cochlear implantation has been used as a treatment option for children with CND for nearly two decades. Due to the lack of understanding of how electrical stimulation is encoded and processed in their auditory system, there is still no evidenced-based clinical practice for managing this unique patient population. To further complicate matters, more than half of children with CND cannot provide reliable behavioral responses despite their age due to severe comorbidities. As a result, clinicians often use a combined “one-size-fits-all” and “try-and-see” approach to program cochlear implant (CI) speech processors for children with CND. This practice typically results in stimulating all intra-cochlear CI electrodes with similar programming parameters. However, recent work from our lab showed that the likelihood of measuring CN neural responses in children with CND reduced as the stimulating CI electrode site moved from the base to the apex of the cochlea. This unique response-deterioration pattern is not observed in children with normal-sized CNs. In addition, our compiling preliminary data show that information transmitted by CI electrodes with no measurable CN response is only adequate for auditory detection but not sufficient for auditory discrimination, which explains why the majority of children with CND do not make satisfactory progress in speech and language development despite good auditory detection thresholds with their CIs. These new findings suggest that the current clinical practice is unlikely to provide appropriate CI programming settings for this unique patient population. Therefore, there is an urgent need to develop objective clinical tools for optimizing CI settings for individual children with CND. As the first step toward developing such objective clinical tools, this study aims to better understand neural encoding and processing of electrical stimulation in both the CN and the central auditory system in implanted children with CND. Aim 1 will compare effects of changing pulse-phase duration, inter-phase gap and pulse rate on neural representation of electrical stimulation in the CN between children with CND and children with normal-sized CNs. Aim 2 will determine effects of variation in CN neural survival on cortical sensitivity to amplitude modulation and electrode discrimination in children with CND and children with normal-sized CNs. Results of this study have high scientific significance because they will establish how variations in neural survival of CN fibers affect neural encoding of electrical stimulation in the CN, as well as how variations in the peripheral input affect cortical neural encoding and processing of electrical stimulation. Results of this study also have high clinical significance because they will 1) provide scientific evidence for identifying and excluding the nonfunctional intra-cochlear CI electrodes from programming maps, 2) establish the importance of selecting pulse-phase durations, inter-phase gaps and pulse rates based on CN neural survival for individual CI electrodes, and 3) lay the knowledge foundation for developing evidence-based clinical practice guidelines for managing children with CND.

项目摘要/摘要 人工耳蜗神经缺乏症（CND）是指高层或缺失的人耳神神经（CN） 分辨率磁共振成像。人工耳蜗植入已被用作儿童的治疗选择 与CND一起使用了将近二十年。由于缺乏对电刺激的编码方式的了解 在他们的听觉系统中处理，仍然没有基于证据的临床实践来管理这种独特的 患者人数。为了进一步复杂化，有一半以上的CND儿童无法提供可靠的 行为反应由于严重的合并症而导致其年龄。结果，临床医生经常使用合并 为儿童的编程人工耳蜗（CI）演讲处理器的“单身型”和“尝试观看”方法 与CND。这种做法通常会导致刺激所有具有类似编程的结构内CI电子 参数。但是，我们实验室的最新工作表明，测量CN神经反应的可能性 在CND的儿童中，随着刺激的CI电极位点从基部移到耳蜗的顶点，降低了。 在正常大小的中枢神经系统的儿童中未观察到这种独特的响应更方向。另外，我们的 编译初步数据显示，CI电子传输的信息无可测量的CN响应 仅足以进行听觉检测，但不足以进行听觉歧视，这解释了为什么 大多数有CND的儿童不会使言语和语言发展目的地的满意 良好的听觉检测阈值与他们的顺式阈值。这些新发现表明当前的临床实践是 不太可能为这个独特的患者人群提供适当的CI编程设置。因此，有一个 迫切需要开发客观的临床工具，以优化CND个体儿童的CI设置。作为 迈向开发此类客观临床工具的第一步，本研究旨在更好地了解神经编码 以及在植入儿童中的CN和中央听觉系统中电气模拟的处理 CND。 AIM 1将比较不断变化的脉冲持续时间，相间间隙和脉搏率对中性的影响 CND儿童和正常大小CNS儿童的CN中电刺激的表示。 AIM 2将确定CN神经存活率变异对放大器调制的皮质敏感性和 CND儿童和患有正常大小CNS的儿童的电极区分。这项研究的结果有 高科学意义，因为它们将确定CN纤维神经存活的变化如何影响神经元 CN中电刺激的编码，以及外周输入的变化如何影响皮层中性 电气模拟的编码和处理。这项研究的结果也具有很高的临床意义 因为他们将1）提供科学证据以识别和排除非功能性的内部CI 编程图的电子，2）确定选择脉冲持续时间，相之间的重要性 基于单个CI电极的CN神经存活率的间隙和脉搏率，3）铺设知识 制定基于证据的临床实践指南的基金会，以管理患有CND的儿童。