HYPOTHESIS:Perimodiolar intracochlear electrodes with contacts facing towards the modiolus have limited current flow towards the outer wall of the cochlea and therefore, may reduce the occurrence of facial nerve stimulation (FN) in cochlear implant subjects. BACKGROUND:Facial nerve stimulation is a well-known complication in cochlear implant treatment especially in the group of subjects with otosclerosis. The possible explanation of this side effect is a change of the electrical properties of the otosclerotic bone leading to leakage current and resulting in facial nerve stimulation. METHODS:Four CI subjects who had been implanted with a Nucleus Mini22 device with a Nucleus Straight electrode between 9 to 12 years ago suffered from severe FN stimulation. Electrode contacts had to be switched off so that they could only use 4, 11, 13, and 15 electrodes of their usual set of 22. The switch off resulted in deteriorating speech understanding over time. Therefore, all subjects were reimplanted with a Nucleus 24R device with a Contour electrode. Preoperatively, the threshold of FN stimulation was obtained on all electrodes subjectively. Intraoperatively, FN stimulation thresholds were measured objectively with both, the old and the new device and were compared. NRT and SRT thresholds were also obtained with the reimplanted device to assure effective electrical stimulation of the auditory nerve. RESULTS:In all four cases the postoperative fitting demonstrated no FN stimulation on all electrodes up to maximum comfortable level. The insertion of the Contour electrode array was complete in three cases, in one case the array could only be inserted partially similarly to the situation before the reimplantation. Speech perception tests showed a significant improvement in all subjects with the new device. CONCLUSION:Electrodes with modiolar facing contacts and perimodiolar position like the Nucleus Contour electrode reduce the possibility of facial nerve stimulation significantly due to more focused electrical stimulation.

译文

假设:耳蜗周围的耳蜗内电极面向耳蜗,电流流向耳蜗外壁的电流有限,因此可以减少人工耳蜗植入对象面部神经刺激(FN)的发生。
背景:面神经刺激是耳蜗植入治疗中众所周知的并发症,尤其是在耳硬化症患者群体中。这种副作用的可能解释是耳硬化骨的电特性发生变化,导致漏电流并导致面神经刺激。
方法:4名在9至12年前之间植入带有Nucleus直电极的Nucleus Mini22装置的CI受试者遭受了严重的FN刺激。必须关闭电极触点,以便它们只能使用其通常的22组电极中的4、11、13和15个电极。断开会导致语音理解随着时间的流逝而变差。因此,所有受试者均被植入带有轮廓电极的Nucleus 24R装置。术前,主观地在所有电极上获得FN刺激的阈值。术中用新旧设备客观测量FN刺激阈值,并进行比较。 NRT和SRT阈值也可以通过重新植入的设备获得,以确保对听神经进行有效的电刺激。
结果:在所有四种情况下,术后佩戴均未显示在最大舒适度下所有电极上均未受到FN刺激。在三种情况下,轮廓电极阵列的插入均已完成,在一种情况下,只能与再植入前的情况部分相似地插入阵列。语音感知测试显示,使用新设备后,所有受试者的感觉都有明显改善。
结论:具有模块化的面对面接触和电极周围位置的电极(如Nucleus Contour电极)可通过更加集中的电刺激显着降低面部神经刺激的可能性。

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