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Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series
To investigate the combined effect of changing pulse shape and grounding configuration to manage facial nerve stimulation (FNS) in cochlear implant (CI) recipients. PATIENTS: Three adult CI recipients with severe FNS were offered a replacement implant when standard stimulation strategies and program...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915992/ https://www.ncbi.nlm.nih.gov/pubmed/35085112 http://dx.doi.org/10.1097/MAO.0000000000003493 |
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author | Eitutis, Susan T. Carlyon, Robert P. Tam, Yu Chuen Salorio-Corbetto, Marina Vanat, Zebunnisa Tebbutt, Karen Bardsley, Rhian Powell, Harry R. F. Chowdhury, Shibasis Tysome, James R. Bance, Manohar L. |
author_facet | Eitutis, Susan T. Carlyon, Robert P. Tam, Yu Chuen Salorio-Corbetto, Marina Vanat, Zebunnisa Tebbutt, Karen Bardsley, Rhian Powell, Harry R. F. Chowdhury, Shibasis Tysome, James R. Bance, Manohar L. |
author_sort | Eitutis, Susan T. |
collection | PubMed |
description | To investigate the combined effect of changing pulse shape and grounding configuration to manage facial nerve stimulation (FNS) in cochlear implant (CI) recipients. PATIENTS: Three adult CI recipients with severe FNS were offered a replacement implant when standard stimulation strategies and programming adjustments did not resolve symptoms. Our hypothesis was that the facial nerve was less likely to be activated when using anodic pulses with “mixed-mode” intra-cochlear and extra-cochlear current return. INTERVENTION: All patients were reimplanted with an implant that uses a pseudo-monophasic anodic pulse shape, with mixed-mode grounding (stimulus mixed-mode anodic)—the Neuro Zti CI (Oticon Medical). This device also allows measurements of neural function and loudness with monopolar, symmetric biphasic pulses (stimulus MB), the clinical standard used by most CIs as a comparison. MAIN OUTCOME MEASURES: The combined effect of pulse shape and grounding configuration on FNS was monitored during surgery. Following CI activation, FNS symptoms and performance with the Neuro Zti implant were compared with outcomes before reimplantation. RESULTS: FNS could only be recorded using stimulus MB for all patients. In clinical use, all patients reported reduced FNS and showed an improvement in Bamford-Kowal-Bench sentences recognition compared with immediately before reimplantation. Bamford-Kowal-Bench scores with a male speaker were lower compared with measurements taken before the onset of severe FNS for patients 1 and 2. CONCLUSIONS: In patients where CI auditory performance was severely limited by FNS, charge-balanced pseudo-monophasic stimulation mode with a mixed-mode grounding configuration limited FNS and improved loudness percept compared with standard biphasic stimulation with monopolar grounding. |
format | Online Article Text |
id | pubmed-8915992 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-89159922022-03-18 Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series Eitutis, Susan T. Carlyon, Robert P. Tam, Yu Chuen Salorio-Corbetto, Marina Vanat, Zebunnisa Tebbutt, Karen Bardsley, Rhian Powell, Harry R. F. Chowdhury, Shibasis Tysome, James R. Bance, Manohar L. Otol Neurotol Cochlear Implants To investigate the combined effect of changing pulse shape and grounding configuration to manage facial nerve stimulation (FNS) in cochlear implant (CI) recipients. PATIENTS: Three adult CI recipients with severe FNS were offered a replacement implant when standard stimulation strategies and programming adjustments did not resolve symptoms. Our hypothesis was that the facial nerve was less likely to be activated when using anodic pulses with “mixed-mode” intra-cochlear and extra-cochlear current return. INTERVENTION: All patients were reimplanted with an implant that uses a pseudo-monophasic anodic pulse shape, with mixed-mode grounding (stimulus mixed-mode anodic)—the Neuro Zti CI (Oticon Medical). This device also allows measurements of neural function and loudness with monopolar, symmetric biphasic pulses (stimulus MB), the clinical standard used by most CIs as a comparison. MAIN OUTCOME MEASURES: The combined effect of pulse shape and grounding configuration on FNS was monitored during surgery. Following CI activation, FNS symptoms and performance with the Neuro Zti implant were compared with outcomes before reimplantation. RESULTS: FNS could only be recorded using stimulus MB for all patients. In clinical use, all patients reported reduced FNS and showed an improvement in Bamford-Kowal-Bench sentences recognition compared with immediately before reimplantation. Bamford-Kowal-Bench scores with a male speaker were lower compared with measurements taken before the onset of severe FNS for patients 1 and 2. CONCLUSIONS: In patients where CI auditory performance was severely limited by FNS, charge-balanced pseudo-monophasic stimulation mode with a mixed-mode grounding configuration limited FNS and improved loudness percept compared with standard biphasic stimulation with monopolar grounding. Lippincott Williams & Wilkins 2022-04 2022-01-27 /pmc/articles/PMC8915992/ /pubmed/35085112 http://dx.doi.org/10.1097/MAO.0000000000003493 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0 (https://creativecommons.org/licenses/by/4.0/) |
spellingShingle | Cochlear Implants Eitutis, Susan T. Carlyon, Robert P. Tam, Yu Chuen Salorio-Corbetto, Marina Vanat, Zebunnisa Tebbutt, Karen Bardsley, Rhian Powell, Harry R. F. Chowdhury, Shibasis Tysome, James R. Bance, Manohar L. Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series |
title | Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series |
title_full | Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series |
title_fullStr | Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series |
title_full_unstemmed | Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series |
title_short | Management of Severe Facial Nerve Cross Stimulation by Cochlear Implant Replacement to Change Pulse Shape and Grounding Configuration: A Case-series |
title_sort | management of severe facial nerve cross stimulation by cochlear implant replacement to change pulse shape and grounding configuration: a case-series |
topic | Cochlear Implants |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915992/ https://www.ncbi.nlm.nih.gov/pubmed/35085112 http://dx.doi.org/10.1097/MAO.0000000000003493 |
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