Clinical Evaluation of an Image-Guided Cochlear Implant Programming Strategy

TLDR

The cochlear implant is the most successful neural prosthesis, yet many recipients still experience poor speech understanding and normal auditory fidelity remains rare despite two decades of limited improvement. This study presents results of an image‑guided, patient‑customized stimulation strategy that uses CT‑derived electrode position information. The strategy identifies electrodes that produce overlapping stimulation patterns and deactivates them from the patient’s map. In 68 adult CI recipients, the individualized mapping significantly improved speech understanding in quiet and noise and spectral resolution, demonstrating that image guidance can enhance outcomes without additional surgery or experimental hardware. Published by S.

Abstract

The cochlear implant (CI) has been labeled the most successful neural prosthesis. Despite this success, a significant number of CI recipients experience poor speech understanding, and, even among the best performers, restoration to normal auditory fidelity is rare. While significant research efforts have been devoted to improving stimulation strategies, few developments have led to significant hearing improvement over the past two decades. We have recently introduced image processing techniques that open a new direction for advancement in this field by making it possible, for the first time, to determine the position of implanted CI electrodes relative to the nerves they stimulate using computed tomography images. In this article, we present results of an image-guided, patient-customized approach to stimulation that utilizes the electrode position information our image processing techniques provide. This approach allows us to identify electrodes that cause overlapping stimulation patterns and to deactivate them from a patient's map. This individualized mapping strategy yields significant improvement in speech understanding in both quiet and noise as well as improved spectral resolution in the 68 adult CI recipients studied to date. Our results indicate that image guidance can improve hearing outcomes for many existing CI recipients without requiring additional surgery or the use of ‘experimental' stimulation strategies, hardware or software. i 2014 S. Karger AG, Basel