导致人工耳蜗使用者前庭电共振的刺激条件

IF 1.6 4区医学 Q2 OTORHINOLARYNGOLOGY Laryngoscope Investigative Otolaryngology Pub Date : 2024-09-09 DOI:10.1002/lio2.70011

Laura Fröhlich PhD, Stefan K. Plontke MD, Lea B. Löffler, Antonia Manthey, Torsten Rahne PhD

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引用次数: 0

摘要

研究目的研究电刺激特性对人工耳蜗电刺激颈部和眼部前庭诱发肌源性电位（e-cVEMPs、e-oVEMPs）的影响。方法使用电脉冲列车（4 个双相脉冲，频率为 1000 Hz）记录成年 Nucleus 人工耳蜗（CI）患者的电子前庭诱发电位。接地路径和刺激电极在基底电极接触点 E3 的单极刺激（MP1 + 2 E3）、顶端电极接触点 E20 的单极刺激（MP1 + 2 E20）和 E3 与 E14 之间的双极跨膜刺激（BP E3-E14）之间变化。在出现电子-VEMP 反应的患者中，电脉冲序列进一步变化为 1000 赫兹的 2 个脉冲、500 赫兹的 2 个脉冲和单脉冲。所有参与者都记录了骨传导振动（BCV）的 VEMPs 作为参考。结果对 27 名参与者（平均年龄 49.3 岁，标准差 12.7 岁）的 30 只耳朵进行了测量。13只耳朵（43%）出现了E-VEMPs。13 个病例中有 5 个病例出现了 e-VEMPs 但没有 BCV 诱发的 VEMPs。随着刺激水平的增加，反应数也随之增加。MP1 + 2 E3 刺激的反应率最高，为 40%。刺激的变化不影响反应数。E-VEMP 振幅与 BCV 刺激的 VEMPs 相当。电刺激的延迟时间最多可缩短 3.1 毫秒。一些患者的电子 VEMP 阈值接近或低于电刺激听阈水平。结论 e-VEMP 的发生取决于电流路径和刺激水平。高刺激水平和单极刺激基底电极触点的患者更有可能受到 CI 的前庭共刺激。证据等级 4。

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Stimulation conditions leading to electrical vestibular co-stimulation in cochlear implant users

Objectives

The study objective was to investigate the influence of electrical stimulus properties on cervical and ocular vestibular-evoked myogenic potentials to electrical stimulation by cochlear implants (e-cVEMPs, e-oVEMPs).

Methods

E-VEMPs were recorded in adult Nucleus cochlear implant (CI) patients using electric pulse trains (4 biphasic pulses at 1000 Hz burst rate). Ground path and stimulation electrodes were varied between monopolar stimulation at basal electrode contact E3 (MP1 + 2 E3), monopolar stimulation at apical electrode contact E20 (MP1 + 2 E20), and bipolar transmodiolar stimulation between E3 and E14 (BP E3-E14). The electric pulse train was further varied to 2 pulses at 1000 Hz, 2 pulses at 500 Hz, and a single pulse, in patients with present e-VEMP responses. VEMPs to bone-conducted vibration (BCV) were recorded as reference in all participants.

Results

Measurements were conducted in 30 ears of 27 participants (mean age 49.3 years, SD 12.7 years). E-VEMPs were present in 13 ears (43%). 5 of the 13 cases showed e-VEMPs but no BCV evoked VEMPs. Response numbers increased with increasing stimulation levels. The highest response rate of 40% was obtained for MP1 + 2 E3 stimulation. Stimulus variation did not affect response numbers. E-VEMP amplitudes were comparable to BCV-stimulated VEMPs. Latencies were up to 3.1 ms shorter for electric stimulation. Some patients showed e-VEMP thresholds close to or below the electric hearing threshold level.

Conclusion

The occurrence of e-VEMPs is dependent on current path and stimulation level. Vestibular co-stimulation by the CI is more likely in patients with high stimulation levels and for monopolar stimulation of basal electrode contacts.