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2015 ; 36
(3
): 368-76
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Auditory brainstem implant: electrophysiologic responses and subject perception
#MMPMID25437141
Herrmann BS
; Brown MC
; Eddington DK
; Hancock KE
; Lee DJ
Ear Hear
2015[May]; 36
(3
): 368-76
PMID25437141
show ga
OBJECTIVES: The primary aim of this study was to compare the perceptual sensation
produced by bipolar electrical stimulation of auditory brainstem implant (ABI)
electrodes with the morphology of electrically evoked responses elicited by the
same bipolar stimulus in the same unanesthetized, postsurgical state. Secondary
aims were to (1) examine the relationships between sensations elicited by the
bipolar stimulation used for evoked potential recording and the sensations
elicited by the monopolar pulse-train stimulation used by the implant processor,
and (2) examine the relationships between evoked potential morphology (elicited
by bipolar stimulation) to the sensations elicited by monopolar stimulation.
DESIGN: Electrically evoked early-latency and middle-latency responses to
bipolar, biphasic low-rate pulses were recorded postoperatively in four adults
with ABIs. Before recording, the perceptual sensations elicited by these bipolar
stimuli were obtained and categorized as (1) auditory sensations only, (2) mixed
sensations (both auditory and nonauditory), (3) side effect (nonauditory
sensations), or (4) no sensation. In addition, the sensations elicited by
monopolar higher-rate pulse-train stimuli similar to that used in processor
programming were measured for all electrodes in the ABI array and classified
using the same categories. Comparisons were made between evoked response
morphology, bipolar stimulation sensation, and monopolar stimulation sensation.
RESULTS: Sensations were classified for 33 bipolar pairs as follows: 21 pairs
were auditory, 6 were mixed, 5 were side effect, and 1 was no sensation. When
these sensations were compared with the electrically evoked response morphology
for these signals, P3 of the electrically evoked auditory brainstem response
(eABR) and the presence of a middle-latency positive wave, usually between 15 and
25 msec (electrical early middle-latency response [eMLR]), were only present when
the perceptual sensation had an auditory component (either auditory or mixed
pairs). The presence of other waves in the early-latency response such as N1 or
P2 or a positive wave after 4 msec did not distinguish between only auditory or
only nonauditory sensations. For monopolar stimulation, 42 were classified as
auditory, 16 were mixed, and 26 were classified as side effect or no sensation.
When bipolar sensations were compared with monopolar sensations for the 21
bipolar pairs categorized as auditory, 7 pairs had monopolar sensations of
auditory for both electrodes, 9 pairs had only one electrode with a monopolar
sensation of auditory, with the remainder having neither electrode as auditory.
Of 6 bipolar pairs categorized as mixed, 3 had monopolar auditory sensations for
one of the electrodes. When monopolar stimulation was compared with evoked
potential morphology elicited by bipolar stimulation, P3 and the eMLR were more
likely to be present when one or both of the electrodes in the bipolar pair
elicited an auditory or mixed sensation with monopolar stimulation and were less
likely to occur when neither of the electrodes had an auditory monopolar
sensation. Again, other eABR waves did not distinguish between auditory and
nonauditory sensations. CONCLUSIONS: ABI electrodes that are associated with
auditory sensations elicited by bipolar stimulation are more likely to elicit
evoked responses with a P3 wave or a middle-latency wave. P3 of the eABR and
M15-25 of the eMLR are less likely to be present if neither electrode of the
bipolar pair evoked an auditory sensation with monopolar stimulation.