Can intracochlear electrocochleography (ECochG) be used to es8mate residual acous8c hearing following cochlear implanta8on?

Transcription

1 Can intracochlear electrocochleography (ECochG) be used to es8mate residual acous8c hearing following cochlear implanta8on? Jourdan Holder, AuD July 27, 2017

2 Disclosures No personal disclosures This study u<lizes equipment supported by Advanced Bionics. Co-author disclosures: René Gifford is on the audiology advisory board for Advanced Bionics and Cochlear Americas and the clinical advisory board for Frequency Therapeu<cs. Robert Labadie is a consultant for Advanced Bionics, Cochlear Americas, and Ototronix. David Haynes is on the surgical advisory boards for Cochlear, MED-EL, AB, Stryker, Anspach, and O<con Medical. Marc BenneU is on the surgical advisory board for MED-EL and is a consultant for O<con Medical. Alejandro Rivas is on the surgical advisory boards for Cochlear, MED-EL, AB, Stryker, Olympus, and Grace Medical. George Wanna is on the surgical advisory board for O<con Medical and is a consultant for AB, Cochlear, and MED-EL.

3 Acknowledgements ECochG Research Team: Robert Dwyer, AuD CI Surgeons: David Haynes, MD Alejandro Rivas, MD George Wanna, MD Marc BenneU, MD Robert Labadie, MD, PhD Brendan O Connell, MD Jack Noble, PhD Sta<s<cs: Mary Dietrich, PhD Advanced Bionics: Kanthaiah Koka, PhD René Gifford, PhD Robert Labadie, MD, PhD Research supported by: Vanderbilt University School of Medicine Na<onal Ins<tute of Health (NIH, R01DC008408, R01DC009404, and R01DC014037) Vanderbilt IRB

4 ECochG Recorded at Round Window Predicts Speech Percep<on Outcomes with CI What else can it predict? More on this topic at Poster #162! Can we use ECochG to predict residual hearing?

5 Why is es<ma<ng residual hearing important? Growing popula<on of pa<ents with residual hearing (including children!) 73/287 (25.4%) of adult clinical popula<on qualified for a Hybrid implant (Holder & Gifford et al., Under Review) Limited appointment <me and/or child s auen<on span Currently unable to quan<fy hearing preserva<on un<l ac<va<on Can this be es<mated with a quick ECochG measurement?

6 Methods Prospec<ve study 18 adult pa<ents with 250-Hz thresholds 80 db HL undergoing CI with a mid-scala device were studied Pre-Op Pure-tone thresholds CT imaging Intra-Op ECochG Post-Op ECochG Pure-tone thresholds CT imaging to determine scalar loca<on

7 Hypotheses Intra-op ECochG will predict post-op audiometric hearing thresholds Post-op ECochG will predict post-op audiometric hearing thresholds Intra-op ECochG will not correlate with pre-op audiometric hearing thresholds

8 Setup for Data Collec<on Koka et al, 2016

9 Frequency Scan Es<ma<ng Postopera<ve Thresholds

10 Postopera<ve CT Scalar Loca<on Scala Tympani Scala Ves<buli 38%

11 Results

12 Results: LFPTA Shiq & Scalar Loca<on O Connell et al., 2017

13 Scalar Loca<on Impacts Hearing Preserva<on Low-Frequency PTA Shift at Activation Postoperative Audiometric Threshold (db HL) Preoperative Audiometric Threshold (db HL) * ST Insertion SV Insertion Scala Unknown Average LFPTA Shiq ST: 16 db HL SV: 38 db HL Low-Frequency PTA Shift (db) ST p=0.02 SV Electrode Location O Connell et al., 2017

14 INTRAOPERATIVE ECochG Es<ma<on of Thresholds

15 Intra-op ECochG thresholds correlated with pre-op audiometric thresholds O Connell et al., 2017

16 No significant correla<on between intra-op EcochG thresholds and post-op residual hearing Postoperative Behavioral Threshold (db HL) Entire Cohort 125 Hz (r=0.12, p=0.64) 250 Hz (r=0.08, p=0.77) 500 Hz (r=0.46, p=0.07) Intraoperative ECochG Threshold O Connell et al., 2017

17 Intra-op ECochG thresolds and post-op residual hearing by scalar loca<on Postoperative Behavioral Threshold (db HL) ST Insertions 125 Hz (r=0.64, p=0.06) 250 Hz (r=0.50, p=0.16) 500 Hz (r=0.31, p=0.41) Postoperative Behavioral Threshold (db HL) SV Insertions 125 Hz (r=-0.55, p=0.33) 250 Hz (r=-0.50, p=0.39) 500 Hz (r=0.24, p=0.69) Intraoperative ECochG Threshold O Connell et al., Intraoperative ECochG Threshold

18 Intraopera<ve ECochG Summary Preopera<ve audiogram correlated with intra-op ECochG, but intra-op ECochG did not significantly correlate with post-op residual hearing Sugges<ng that changes in cochlear physiology con<nue between end of inser<on and ac<va<on Or, middle ear effusion at ac<va<on is eleva<ng audiometric thresholds at ac<va<on Case study

19 POSTOPERATIVE ECochG Es<ma<on of Thresholds

20 Post-op ECochG thresholds strongly correlated with post-op residual hearing Postoperative Behavioral Threshold (db HL) Entire Cohort 125 Hz (r=0.83, p<0.0001) 250 Hz (r=0.88, p<0.0001) 500 Hz (r=0.88, p<0.0001) Postoperative ECochG Threshold O Connell et al., 2017

21 Impact of scalar loca<on v Correla<on is stronger for ST inser<ons Postoperative Behavioral Threshold (db HL) ST Insertions 125 Hz (r=0.93, p=0.001) 250 Hz (r=0.90, p=0.006) 500 Hz (r=0.86, p=0.006) Postoperative Behavioral Threshold (db HL) SV Insertions 125 Hz (r=0.82, p=0.07) 250 Hz (r=0.88, p=0.05) 500 Hz (r=0.88, p=0.05) Postoperative ECochG Threshold Postoperative ECochG Threshold O Connell et al, 2017

22 Postpera<ve EcochG Summary Post-op ECochG correlated with post-op residual hearing thresholds This correla<on is stronger in ST electrodes May be used as a way to quickly es<mate residual hearing in difficult to test pa<ent popula<ons or clinics in which appointment <mes are limited Future direc<ons may include determining EAS cutoff frequency and programming of acous<c component.

23 Conclusions ST inser<ons lead to beuer hearing preserva<on Correla<ons: Pre-op audio vs. Intra-op ECochG þ Post-op audio vs. Intra-op ECochG ý Post-op audio vs. Post-op ECochG þ BeUer correla<ons for ST inser<on Factors subsequent to electrode inser<on impact residual hearing outcomes, and they likely differ according to scalar loca<on of array.

24 Thank you More informa<on and inser<on data here: