Abstract：
OBJECTIVE: To assess the clinical utility of spread of excitation (SOE) functions obtained via electrically evoked compound action potentials (eCAP) to 1) identify electrode array tip fold-over, 2) predict electrode placement factors confirmed via postoperative computed tomography (CT) imaging, and 3) predict postoperative speech recognition through the first year post-activation in a large clinical sample.
METHODS: Retrospective case review.
METHODS: Cochlear implant (CI) program at a tertiary medical center.
METHODS: Two hundred seventy-two ears (238 patients) with Cochlear Ltd. CIs (mean age = 46 yr, range = 9 mo-93 yr, 50% female) implanted between August 2014 and December 2022 were included.
METHODS: eCAP SOE widths (mm) (probe electrodes 5, 11, and 17), incidence of electrode tip fold-over, CT imaging data (electrode-to-modiolus distance, angular insertion depth, scalar location), and speech recognition outcomes (consonant-nucleus-consonant [CNC], AzBio quiet, and +5 dB SNR) through the first year after CI activation.
RESULTS: 1) eCAP SOE demonstrated a sensitivity of 85.7% for identifying tip fold-over instances that were confirmed by CT imaging. In the current dataset, the tip fold-over incidence rate was 3.1% (7 patients), with all instances involving a precurved electrode array. 2) There was a significant positive relationship between eCAP SOE and mean electrode-to-modiolus distance for precurved arrays, and a significant positive relationship between eCAP SOE and angular insertion depth for straight arrays. No relationships between eCAP SOE and scalar location or cochlea diameter were found in this sample. 3) There were no significant relationships between eCAP SOE and speech recognition outcomes for any measure or time point, except for a weak negative correlation between average eCAP SOE widths and CNC word scores at 6 months post-activation for precurved arrays.
CONCLUSIONS: In the absence of intraoperative CT or fluoroscopic imaging, eCAP SOE is a reasonable alternative method for identifying electrode array tip fold-over and should be routinely measured intraoperatively, especially for precurved electrode arrays with a sheath.
METHODS: Retrospective case review.
METHODS: Cochlear implant (CI) program at a tertiary medical center.
METHODS: Two hundred seventy-two ears (238 patients) with Cochlear Ltd. CIs (mean age = 46 yr, range = 9 mo-93 yr, 50% female) implanted between August 2014 and December 2022 were included.
METHODS: eCAP SOE widths (mm) (probe electrodes 5, 11, and 17), incidence of electrode tip fold-over, CT imaging data (electrode-to-modiolus distance, angular insertion depth, scalar location), and speech recognition outcomes (consonant-nucleus-consonant [CNC], AzBio quiet, and +5 dB SNR) through the first year after CI activation.
RESULTS: 1) eCAP SOE demonstrated a sensitivity of 85.7% for identifying tip fold-over instances that were confirmed by CT imaging. In the current dataset, the tip fold-over incidence rate was 3.1% (7 patients), with all instances involving a precurved electrode array. 2) There was a significant positive relationship between eCAP SOE and mean electrode-to-modiolus distance for precurved arrays, and a significant positive relationship between eCAP SOE and angular insertion depth for straight arrays. No relationships between eCAP SOE and scalar location or cochlea diameter were found in this sample. 3) There were no significant relationships between eCAP SOE and speech recognition outcomes for any measure or time point, except for a weak negative correlation between average eCAP SOE widths and CNC word scores at 6 months post-activation for precurved arrays.
CONCLUSIONS: In the absence of intraoperative CT or fluoroscopic imaging, eCAP SOE is a reasonable alternative method for identifying electrode array tip fold-over and should be routinely measured intraoperatively, especially for precurved electrode arrays with a sheath.
摘要：
目的：评估通过电诱发复合动作电位（eCAP）获得的兴奋扩散（SOE）功能的临床实用性，以1）识别电极阵列尖端折叠，2）预测通过术后计算机断层扫描（CT）成像确认的电极放置因素，和3）在大临床样本中通过激活后的第一年预测术后语音识别。
方法：回顾性病例回顾。
方法：三级医疗中心的人工耳蜗植入（CI）项目。
方法：患有耳蜗Ltd.CI的两百72只耳朵（238例患者）（平均年龄=46岁，范围=9个月-93年，包括2014年8月至2022年12月期间植入的50％女性）。
方法：eCAPSOE宽度（mm）（探针电极5、11和17），电极尖端折叠的发生率，CT成像数据(电极到modiolus距离，角度插入深度,标量位置)，和语音识别结果(辅音-核-辅音[CNC]，AzBio安静，和+5dBSNR)通过CI激活后的第一年。
结果：1）eCAPSOE对识别CT成像证实的尖端折叠实例的敏感性为85.7％。在当前数据集中，尖端折叠发生率为3.1%(7例)，所有实例都涉及预固化电极阵列。2）对于预固化阵列，eCAPSOE与平均电极到modiolus距离之间存在显着的正相关关系，eCAPSOE与直线阵列的角度插入深度之间存在显着的正相关关系。在该样本中没有发现eCAPSOE与标量位置或耳蜗直径之间的关系。3)在任何度量或时间点，eCAPSOE和语音识别结果之间都没有显著关系，除了平均eCAPSOE宽度和CNC单词分数之间的弱负相关在6个月后激活的阵列。
结论：在没有术中CT或荧光成像的情况下，eCAPSOE是识别电极阵列尖端折叠的合理替代方法，应在术中常规测量，特别是对于带护套的预固化电极阵列。
方法：回顾性病例回顾。
方法：三级医疗中心的人工耳蜗植入（CI）项目。
方法：患有耳蜗Ltd.CI的两百72只耳朵（238例患者）（平均年龄=46岁，范围=9个月-93年，包括2014年8月至2022年12月期间植入的50％女性）。
方法：eCAPSOE宽度（mm）（探针电极5、11和17），电极尖端折叠的发生率，CT成像数据(电极到modiolus距离，角度插入深度,标量位置)，和语音识别结果(辅音-核-辅音[CNC]，AzBio安静，和+5dBSNR)通过CI激活后的第一年。
结果：1）eCAPSOE对识别CT成像证实的尖端折叠实例的敏感性为85.7％。在当前数据集中，尖端折叠发生率为3.1%(7例)，所有实例都涉及预固化电极阵列。2）对于预固化阵列，eCAPSOE与平均电极到modiolus距离之间存在显着的正相关关系，eCAPSOE与直线阵列的角度插入深度之间存在显着的正相关关系。在该样本中没有发现eCAPSOE与标量位置或耳蜗直径之间的关系。3)在任何度量或时间点，eCAPSOE和语音识别结果之间都没有显著关系，除了平均eCAPSOE宽度和CNC单词分数之间的弱负相关在6个月后激活的阵列。
结论：在没有术中CT或荧光成像的情况下，eCAPSOE是识别电极阵列尖端折叠的合理替代方法，应在术中常规测量，特别是对于带护套的预固化电极阵列。
