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.

项目概要/摘要 耳蜗神经缺陷（CND）是指耳蜗神经（CN）较小或缺失，表现为高 高分辨率磁共振成像已被用作儿童的治疗选择。 由于缺乏对电刺激的编码和编码方式的了解，我对 CND 进行了近二十年的研究。 在他们的听觉系统中进行处理，仍然没有基于证据的临床实践来管理这种独特的 使问题变得更加复杂的是，超过一半的 CND 儿童无法提供可靠的信息。 尽管年龄很大，但由于严重的合并症而导致行为反应，因此经常使用组合疗法。 对儿童人工耳蜗 (CI) 语音处理器进行编程的“一刀切”和“试看”方法 这种做法通常会通过类似的编程刺激所有耳蜗内 CI 电极。 然而，我们实验室最近的工作表明测量 CN 神经反应的可能性。 随着刺激 CI 电极部位从耳蜗基部移至耳蜗顶端，患有 CND 的儿童的症状减少。 在具有正常大小的 CN 的儿童中没有观察到这种独特的反应恶化模式。 汇编初步数据表明 CI 电极传输的信息没有可测量的 CN 响应 仅足以用于听觉检测，但不足以用于听觉辨别，这解释了为什么 大多数患有 CND 的儿童在言语和语言发展方面并未取得令人满意的进展，尽管 这些新发现表明，当前的临床实践是通过 CI 实现良好的听觉检测阈值。 不太可能为这种独特的患者群体提供适当的 CI 编程设置。 迫切需要开发客观的临床工具来优化个别 CND 儿童的 CI 设置。 开发此类客观临床工具的第一步，本研究旨在更好地理解神经编码 植入儿童中枢神经系统和中枢听觉系统的电刺激和处理 CND。目标 1 将比较改变脉冲相位持续时间、相间间隙和脉冲频率对神经的影响。 患有 CND 的儿童和具有正常大小 CN 的儿童之间 CN 的电刺激表现。 目标 2 将确定 CN 神经存活变化对皮层对幅度调制的敏感性的影响 患有 CND 的儿童和具有正常大小 CN 的儿童的电极歧视。 具有很高的科学意义，因为他们将确定 CN 纤维的神经存活变化如何影响神经 CN 中电刺激的编码，以及外周输入的变化如何影响皮质神经 这项研究的结果也具有很高的临床意义。 因为他们将 1) 提供科学证据来识别和排除非功能性耳蜗内 CI 编程图中的电极，2) 确定选择脉冲相持续时间、相间的重要性 基于单个 CI 电极 CN 神经存活的间隙和脉冲率，以及 3) 奠定知识 为制定治疗 CND 儿童的循证临床实践指南奠定了基础。