scholarly journals Intraoperative Monitoring of the Cochlear Nerve during Neurofibromatosis Type-2 Vestibular Schwannoma Surgery and Description of a “Test Intracochlear Electrode”

2019 ◽  
Vol 80 (01) ◽  
pp. e1-e9 ◽  
Author(s):  
Anand Kasbekar ◽  
Yu Chuen Tam ◽  
Robert Carlyon ◽  
John Deeks ◽  
Neil Donnelly ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Vestibular Schwannoma ◽  
Intraoperative Monitoring ◽  
Neurofibromatosis Type ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Auditory Brainstem Responses ◽  
Tertiary Referral Center ◽  
Objective Evidence ◽  
Brainstem Response

Objectives A decision on whether to insert a cochlear implant can be made in neurofibromatosis 2 (NF2) if there is objective evidence of cochlear nerve (CN) function post vestibular schwannoma (VS) excision. We aimed to develop intraoperative CN monitoring to help in this decision. Design We describe the intraoperative monitoring of a patient with NF2 and our stimulating and recording set up. A novel test electrode is used to stimulate the CN electrically. Setting This study was set at a tertiary referral center for skull base pathology. Main outcome measure Preserved auditory brainstem responses leading to cochlear implantation. Results Electrical auditory brainstem response (EABR) waveforms will be displayed from different stages of the operation. A cochlear implant was inserted at the same sitting based on the EABR. Conclusion Electrically evoked CN monitoring can provide objective evidence of CN function after VS excision and aid in the decision-making process of hearing rehabilitation in patients who will be rendered deaf.

scholarly journals Peran implanted electrically evoked auditory brainstem responses(Imp-eABR) pada pasien tuli kongenital

2019 ◽  
Vol 49 (20) ◽  
Author(s):  
Fikri Mirza Putranto ◽  
Jenny Bashiruddin ◽  
Semiramis Zizlavsky ◽  
Irawan Mangunatmadja ◽  
Jacub Pandelaki ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Cochlear Implant ◽  
Hearing Aids ◽  
Auditory Pathway ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Auditory Brainstem Responses ◽  
Auditory Pathways ◽  
Internal Factors ◽  
Brainstem Response

Latar belakang: Variasi performa pasca implan koklea menunjukkan adanya variasi patologi yang belum dapat dijelaskan melalui pemeriksaan standar pra-operasi. Untuk itu dibutuhkan pemeriksaan yang dapat menunjukkan variasi integritas jaras auditori sebagai petunjuk variasi potensi internal tiap individu. Tujuan: Mendapatkan variasi respons jaras auditori terhadap stimulus listrik pasca implan berdasarkan pemeriksaan Implanted Electrically evoked Auditory Brainstem Respons (Imp-eABR), serta korelasinya dengan faktor internal pra-implan lain berupa usia, luas area n. koklearis dan kemampuan komunikasi pra-operasi. Metode: Kriteria subjek penelitian adalah pasien operasi implan koklea berusia kurang dari 10 tahun, memiliki koklea dan n. koklearis normal, dan pada pasien berusia lebih dari 4 tahun sudah memakai alat bantu dengar minimal 1 tahun. Pemeriksaan Imp-eABR dilakukan terhadap 5 elektrode yang mewakili area apikal, medial dan basal koklea. Dicari hubungan respons dari stimulasi terhadap ketiga faktor internal.Hasil:Pemeriksaan Imp-eABR dilakukan terhadap 28 telinga dari 19 pasien yang dilakukan operasi secara unilateral dan bilateral. Rerata skor total respons Imp-eABR adalah 6,3 + 2,63; dengan 60,7% telinga memiliki skor total kurang dari 8. Uji regresi linear menunjukkan faktor usia, luas area n. koklearis dan kemampuan komunikasi berkorelasi secara bermakna dan dapat memprediksi variasi skor Imp-eABR sebanyak 49,2%. Kesimpulan:Variasi skor total Imp-eABR pada pasien dengan faktor internal pra-operasi menunjukkan adanya patogenesis lain yang mendasari kemampuan transmisi jaras pendengaran retrokoklea terhadap stimulasi listrik dari implan koklea. Faktor internal pra-operasi dapat menjelaskan kurang dari 50% variasi respons Imp-eABR. Kata kunci: Imp-eABR, luas area n. koklearis, implant koklea, integritas jaras auditori ABSTRACT Background:Variations in performance after cochlear implant indicates pathology variations that cannot be explained through standard preoperative examination. Therefore, an examination is needed to show variations in the integrity of auditory pathways as a guide to internal potential variations of each individual. Objectives: To show variations of auditory pathways responses to electrical stimulation from cochlear implant by performing Implanted Electrically evoked Auditory Brainstem Response (Imp-eABR) examination and to find its correlation to age, cochlear nerve area and preoperative communication skills. Methods: Subjects were cochlear implant patients with age less than 10 years, had normal cochlear and cochlear nerve,and patients over 4 years old with history of wearing hearing aids for at least 1 year. The Imp-eABR examination was performed to 5 electrodes representing the apical, medial and basal areas of the cochlea. Results:Imp-eABR examination was performed on 28 ears from 19 patients who underwent unilateral and bilateral surgery. The average total score of Imp-eABR responses was 6.3 + 2.63; with 60.7% of the ears having a total score of less than 8. Linear regression tests showed age,cochlear nerve area,andcommunicationabilitysignificantlycorrelate,it canexplain49.2%ofthevariationinthetotal Imp-eABR score. Conclusion: The variation in the total Imp-eABR score in patients with preoperative internal factors indicated that another pathogenesis also underlines the ability of transmission of the retrocochlear auditory pathway to electrical stimulation from the cochlear implant. Preoperative internal factors can only explain less than 50% of the variation of the Imp-eABR response.   

scholarly journals Translabyrinthine resection of NF2 associated vestibular schwannoma with cochlear implant insertion

2021 ◽  
Vol 5 (2) ◽  
pp. V14
Author(s):  
Cathal John Hannan ◽  
Priya Sharma ◽  
Matthew Edward Smith ◽  
Laurence Johann Glancz ◽  
Martin O’Driscoll ◽  
...  
Keyword(s):  
Cochlear Implant ◽  
Vestibular Schwannoma ◽  
Neurofibromatosis Type ◽  
Cochlear Nerve ◽  
Csf Leak ◽  
Tumor Control ◽  
Nerve Preservation ◽  
A Minor ◽  
Facial Function

The authors present the case of a 24-year-old female with neurofibromatosis type 2. Growth of the left vestibular schwannoma and progressive hearing loss prompted the decision to proceed to translabyrinthine resection with cochlear nerve preservation and cochlear implant insertion. Complete resection with preservation of the facial and cochlear nerves was achieved. The patient had grade 1 facial function and was discharged on postoperative day 4 following suturing of a minor CSF leak. This case highlights the feasibility of cochlear nerve preservation and cochlear implant insertion in appropriately selected patients, offering a combination of effective tumor control and hearing rehabilitation. The video can be found here: https://stream.cadmore.media/r10.3171/2021.7.FOCVID21122

Temporal bone pathology of acoustic neuroma correlating with presence of electrocochleography and absence of auditory brainstem response

1997 ◽  
Vol 111 (10) ◽  
pp. 967-972 ◽  
Author(s):  
Kimitaka Kaga ◽  
Shinichi Iwasaki ◽  
Akira Tamura ◽  
Jun-Ichi Suzuki ◽  
Hideyuki Haebara
Keyword(s):  
Temporal Bone ◽  
Vestibular Schwannoma ◽  
Auditory Brainstem Response ◽  
Action Potentials ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Bone Pathology ◽  
Compound Action Potentials ◽  
Brainstem Response ◽  
Compound Action

AbstractThe temporal bone pathology of a 74-year-old female affected by vestibular schwannoma was compared with findings of auditory brainstem response and electrocochleography. At age 71, she complained of hearing loss in the left ear in which pure tone audiometry revealed threshold elevation in the middle- and high-frequency range. Temporal bone CT scanning revealed a medium-sized cerebellopontine angle tumour in the left ear. ABR showed no response in the left ear, but the electrocochleography showed clear compound action potentials. Three years later, at age 74, she died of metastatic lung cancer and sepsis. The left temporal bone pathology consisted primarily of a large vestibular schwannoma occupying the internal auditory meatus. The organ of Corti was well preserved in each turn. In the modiolus, the numbers of spiral ganglion cells and cochlear nerve fibres in each turn were decreased. These histological findings suggest that clear compound action potentials were recorded from the distal portion of the cochlear nerve in spite of the presence of the vestibular schwannoma, but ABR could not be detected because of the blockade of the proximal portion of the cochlear nerve by the vestibular schwannoma.

Performance with an Auditory Brainstem Implant and Contralateral Cochlear Implant in Pediatric Patients

2018 ◽  
Vol 23 (4) ◽  
pp. 216-221 ◽  
Author(s):  
David R. Friedmann ◽  
Leena Asfour ◽  
William H. Shapiro ◽  
J. Thomas Roland Jr. ◽  
Susan B. Waltzman
Keyword(s):  
Cochlear Implant ◽  
Auditory Brainstem ◽  
Preliminary Evidence ◽  
Cochlear Nerve ◽  
Case Review ◽  
Retrospective Case ◽  
Tertiary Referral Center ◽  
Auditory Brainstem Implant ◽  
Adaptive Ability ◽  
Cochlear Nerve Deficiency

Objective: To assess bimodal auditory performance in children with a cochlear implant (CI) and contralateral auditory brainstem implant (ABI). Methods: This is a retrospective case review performed at a tertiary referral center. Four patients with cochlear nerve deficiency initially underwent cochlear implantation but were not benefiting from their devices and underwent ABI in the contralateral ear. The main outcome measures included age-appropriate speech perception and production assessments. Results: Three subjects performed better on their auditory perception assessments using both of their devices than with either device alone. One subject had only preliminary outcomes, but subjectively performed best with both devices. Conclusions: We observed continued improvement in CI performance over time, even if no benefit was evident before the decision for ABI. This could suggest that ABI and CI have a synergistic effect, or it could simply be the adaptive ability of the developing brain to utilize the signals coming from these devices. There is preliminary evidence to support choosing the ear contralateral to the CI for an ABI in a pediatric patient with bilateral cochlear nerve deficiency.

Auditory Brainstem Implant (ABI): New Frontiers in Adults and Children

2005 ◽  
Vol 133 (1) ◽  
pp. 126-138 ◽  
Author(s):  
Vittorio Colletti ◽  
Marco Carner ◽  
Veronica Miorelli ◽  
Maurizio Guida ◽  
Liliana Colletti ◽  
...  
Keyword(s):  
Electrode Array ◽  
Neurofibromatosis Type ◽  
Auditory Brainstem ◽  
Cochlear Nerve ◽  
Auditory Brainstem Responses ◽  
Closed Set ◽  
Sentence Recognition ◽  
Auditory Brainstem Implant ◽  
Open Set ◽  
Cochlear Nerve Aplasia

Previous studies have considered only patients with neurofibromatosis type 2 (NF2) older than 12 years as candidates for an auditory brainstem implant (ABI). Our study expands the potential criteria to include both children and adult subjects with other cochlear or cochlear nerve malfunctions who either would not benefit at all from a cochlear implant (eg, cochlear nerve aplasia or avulsion) or whose benefit was or would be severely compromised (eg, cochlear ossification, cochlear fracture). STUDY DESIGN: In our department, over the period from April 1997 to September 2002, 29 patients, 20 adults and 9 children, were fitted with ABIs. Their ages ranged from 14 months to 70 years. Thirteen subjects had tumors, 10 NF2 and 3 solitary vestibular schwannoma, and 16 patients had a variety of nontumor (NT) cochlear or cochlear nerve diseases. A retrosigmoid-transmeatal approach was used in T and a retrosigmoid approach in NT patients. The electrode array was inserted into the lateral recess of the fourth ventricle and correct electrode positioning was monitored with the aid of electrically evoked auditory brainstem responses (EABRs). RESULTS: Correct implantation was achieved in all patients. No complications were observed due to implantation surgery or related to ABI activation or long-term use. Auditory sensations were induced in all patients with various numbers of electrodes (from 5 to 15). Different pitch sensations were identifiable with different electrode stimulation. Closed-set word recognition, open-set sentence recognition, and speech tracking scores achieved by the patients are reported in detail. The auditory performance of the patients showed significantly better outcomes than controls (Multicentric European clinical investigations on ABI with NF2). CONCLUSION: We have shown that the indications for the ABI can be extended to include NT patients with severe cochlear and/or cochlear nerve abnormalities. The degree of auditory benefit varies as a function of the underlying pathological conditions, with NT subjects exhibiting significantly better outcomes than the T patients.

Intraoperative Cochlear Nerve Monitoring for Vestibular Schwannoma Resection and Simultaneous Cochlear Implantation in Neurofibromatosis Type 2: A Case Series

2021 ◽  
Author(s):  
Margaret J Butler ◽  
Cameron C Wick ◽  
Matthew A Shew ◽  
Michael R Chicoine ◽  
Amanda J Ortmann ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Cochlear Implantation ◽  
Case Series ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Cochlear Nerve ◽  
Tumor Removal ◽  
Nerve Monitoring ◽  
Brainstem Response

Abstract BACKGROUND Neurofibromatosis type 2 (NF2) often results in profound hearing loss and cochlear implantation is an emerging hearing rehabilitation option. However, cochlear implant (CI) outcomes in this population vary, and intraoperative monitoring to predict cochlear nerve viability and subsequent outcomes is not well-established. OBJECTIVE To review the use of intraoperative electrically evoked cochlear nerve monitoring in patients with NF2 simultaneous translabyrinthine (TL) vestibular schwannoma (VS) resection and cochlear implantation. METHODS A retrospective review was performed of 3 patients with NF2 that underwent simultaneous TL VS resection and cochlear implantation with electrical auditory brainstem response (eABR) measured throughout tumor resection. Patient demographics, preoperative assessments, surgical procedures, and outcomes were reviewed. RESULTS Patients 1 and 3 had a reliable eABR throughout tumor removal. Patient 2 had eABR pretumor removal, but post-tumor removal eABR presence could not be reliably determined because of electrical artifact interference. All patients achieved auditory percepts upon CI activation. Patients 1 and 2 experienced a decline in CI performance after 1 yr and after 3 mo, respectively. Patient 3 continues to perform well at 9 mo. Patients 2 and 3 are daily users of their CI. CONCLUSION Cochlear implantation is attainable in cases of NF2-associated VS resection. Intraoperative eABR may facilitate cochlear nerve preservation during tumor removal, though more data and long-term outcomes are needed to refine eABR methodology and predictive value for this population.

The Effect of Kalman-Weighted Averaging and Artifact Rejection on Residual Noise During Auditory Brainstem Response Testing

2019 ◽  
Vol 28 (1) ◽  
pp. 114-124
Author(s):  
Linda W. Norrix ◽  
Julie Thein ◽  
David Velenovsky
Keyword(s):  
Repeated Measures ◽  
Auditory Brainstem ◽  
Weighted Averaging ◽  
Auditory Brainstem Responses ◽  
Residual Noise ◽  
Electrophysiological Recordings ◽  
Artifact Rejection ◽  
Brainstem Response ◽  
Active Motor ◽  
Averaging Time

Purpose Low residual noise (RN) levels are critically important when obtaining electrophysiological recordings of threshold auditory brainstem responses. In this study, we examine the effectiveness and efficiency of Kalman-weighted averaging (KWA) implemented on the Vivosonic Integrity System and artifact rejection (AR) implemented on the Intelligent Hearing Systems SmartEP system for obtaining low RN levels. Method Sixteen adults participated. Electrophysiological measures were obtained using simultaneous recordings by the Vivosonic and Intelligent Hearing Systems for subjects in 2 relaxed conditions and 4 active motor conditions. Three averaging times were used for the relaxed states (1, 1.5, and 3 min) and for the active states (1.5, 3, and 6 min). Repeated-measures analyses of variance were used to examine RN levels as a function of noise reduction strategy (i.e., KWA, AR) and averaging time. Results Lower RN levels were obtained using KWA than AR in both the relaxed and active motor states. Thus, KWA was more effective than was AR under the conditions examined in this study. Using KWA, approximately 3 min of averaging was needed in the relaxed condition to obtain an average RN level of 0.025 μV. In contrast, in the active motor conditions, approximately 6 min of averaging was required using KWA. Mean RN levels of 0.025 μV were not attained using AR. Conclusions When patients are not physiologically quiet, low RN levels are more likely to be obtained and more efficiently obtained using KWA than AR. However, even when using KWA, in active motor states, 6 min of averaging or more may be required to obtain threshold responses. Averaging time needed and whether a low RN level can be attained will depend on the level of motor activity exhibited by the patient.

Comparisons of Auditory Brainstem Responses Between a Laboratory and Simulated Home Environment

2020 ◽  
Vol 63 (11) ◽  
pp. 3877-3892
Author(s):  
Ashley Parker ◽  
Candace Slack ◽  
Erika Skoe
Keyword(s):  
Home Environment ◽  
Signal To Noise Ratio ◽  
Auditory Brainstem ◽  
Auditory Brainstem Responses ◽  
Single Family ◽  
Adult Participants ◽  
Simulated Home Environment ◽  
Brainstem Response ◽  
Research Populations ◽  
Response Consistency

Purpose Miniaturization of digital technologies has created new opportunities for remote health care and neuroscientific fieldwork. The current study assesses comparisons between in-home auditory brainstem response (ABR) recordings and recordings obtained in a traditional lab setting. Method Click-evoked and speech-evoked ABRs were recorded in 12 normal-hearing, young adult participants over three test sessions in (a) a shielded sound booth within a research lab, (b) a simulated home environment, and (c) the research lab once more. The same single-family house was used for all home testing. Results Analyses of ABR latencies, a common clinical metric, showed high repeatability between the home and lab environments across both the click-evoked and speech-evoked ABRs. Like ABR latencies, response consistency and signal-to-noise ratio (SNR) were robust both in the lab and in the home and did not show significant differences between locations, although variability between the home and lab was higher than latencies, with two participants influencing this lower repeatability between locations. Response consistency and SNR also patterned together, with a trend for higher SNRs to pair with more consistent responses in both the home and lab environments. Conclusions Our findings demonstrate the feasibility of obtaining high-quality ABR recordings within a simulated home environment that closely approximate those recorded in a more traditional recording environment. This line of work may open doors to greater accessibility to underserved clinical and research populations.

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