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Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation

A percentage (i.e., 5.6%) of Cochlear Implant (CI) users reportedly experience unwanted facial nerve stimulation (FNS). For some, the effort to control this problem results in changing stimulation parameters, thereby reducing their hearing performance. For others, the only viable solution is to deac...

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Autores principales: Gärtner, Lutz, Backus, Bradford C., Le Goff, Nicolas, Morgenstern, Anika, Lenarz, Thomas, Büchner, Andreas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573649/
https://www.ncbi.nlm.nih.gov/pubmed/37834838
http://dx.doi.org/10.3390/jcm12196194
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author Gärtner, Lutz
Backus, Bradford C.
Le Goff, Nicolas
Morgenstern, Anika
Lenarz, Thomas
Büchner, Andreas
author_facet Gärtner, Lutz
Backus, Bradford C.
Le Goff, Nicolas
Morgenstern, Anika
Lenarz, Thomas
Büchner, Andreas
author_sort Gärtner, Lutz
collection PubMed
description A percentage (i.e., 5.6%) of Cochlear Implant (CI) users reportedly experience unwanted facial nerve stimulation (FNS). For some, the effort to control this problem results in changing stimulation parameters, thereby reducing their hearing performance. For others, the only viable solution is to deactivate the CI completely. A growing body of evidence in the form of case reports suggests that undesired FNS can be effectively addressed through re-implantation with an Oticon Medical (OM) Neuro-Zti implant. However, the root of this benefit is still unknown: is it due to surgical adjustments, such as varied array geometries and/or positioning, or does it stem from differences in stimulation parameters and/or grounding? The OM device exhibits two distinct features: (1) unique stimulation parameters, including anodic leading pulses and loudness controlled by pulse duration—not current—resulting in lower overall current amplitudes; and (2) unconventional grounding, including both passive (capacitive) discharge, which creates a pseudo-monophasic pulse shape, and a ‘distributed-all-polar’ (DAP) grounding scheme, which is thought to reduce current spread. Unfortunately, case reports alone cannot distinguish between surgical factors and these implant-related ones. In this paper, we present a novel follow-up study of two CI subjects who previously experienced FNS before re-implantation with Neuro-Zti implants. We used the Oticon Medical Research Platform (OMRP) to stimulate a single electrode in each subject in two ways: (1) with traditional monopolar biphasic cathodic-first pulses, and (2) with distinct OM clinical stimulation. We progressively increased the stimulation intensity until FNS occurred or the sound became excessively loud. Non-auditory/FNS sensations were observed with the traditional stimulation but not with the OM clinical one. This provides the first direct evidence demonstrating that stimulation parameters and/or grounding—not surgical factors—play a key role in mitigating FNS.
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spelling pubmed-105736492023-10-14 Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation Gärtner, Lutz Backus, Bradford C. Le Goff, Nicolas Morgenstern, Anika Lenarz, Thomas Büchner, Andreas J Clin Med Article A percentage (i.e., 5.6%) of Cochlear Implant (CI) users reportedly experience unwanted facial nerve stimulation (FNS). For some, the effort to control this problem results in changing stimulation parameters, thereby reducing their hearing performance. For others, the only viable solution is to deactivate the CI completely. A growing body of evidence in the form of case reports suggests that undesired FNS can be effectively addressed through re-implantation with an Oticon Medical (OM) Neuro-Zti implant. However, the root of this benefit is still unknown: is it due to surgical adjustments, such as varied array geometries and/or positioning, or does it stem from differences in stimulation parameters and/or grounding? The OM device exhibits two distinct features: (1) unique stimulation parameters, including anodic leading pulses and loudness controlled by pulse duration—not current—resulting in lower overall current amplitudes; and (2) unconventional grounding, including both passive (capacitive) discharge, which creates a pseudo-monophasic pulse shape, and a ‘distributed-all-polar’ (DAP) grounding scheme, which is thought to reduce current spread. Unfortunately, case reports alone cannot distinguish between surgical factors and these implant-related ones. In this paper, we present a novel follow-up study of two CI subjects who previously experienced FNS before re-implantation with Neuro-Zti implants. We used the Oticon Medical Research Platform (OMRP) to stimulate a single electrode in each subject in two ways: (1) with traditional monopolar biphasic cathodic-first pulses, and (2) with distinct OM clinical stimulation. We progressively increased the stimulation intensity until FNS occurred or the sound became excessively loud. Non-auditory/FNS sensations were observed with the traditional stimulation but not with the OM clinical one. This provides the first direct evidence demonstrating that stimulation parameters and/or grounding—not surgical factors—play a key role in mitigating FNS. MDPI 2023-09-25 /pmc/articles/PMC10573649/ /pubmed/37834838 http://dx.doi.org/10.3390/jcm12196194 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Gärtner, Lutz
Backus, Bradford C.
Le Goff, Nicolas
Morgenstern, Anika
Lenarz, Thomas
Büchner, Andreas
Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation
title Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation
title_full Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation
title_fullStr Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation
title_full_unstemmed Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation
title_short Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation
title_sort cochlear implant stimulation parameters play a key role in reducing facial nerve stimulation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573649/
https://www.ncbi.nlm.nih.gov/pubmed/37834838
http://dx.doi.org/10.3390/jcm12196194
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