Wideband Acoustic Immittance in Cochlear Implant Recipients: Reflectance and Stapedial Reflexes.
Wideband Acoustic Immittance in Cochlear Implant Recipients: Reflectance and Stapedial Reflexes.
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DOI：
10.1097/aud.0000000000000810
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Hajicek JJ
中科院分区：
文献类型：
--
作者：
Scheperle RA;Hajicek JJ
目的：研究植入人工耳蜗者与不植入人工耳蜗者的宽带功率反射特性的差异，描述电诱发腓骨肌反射(ESR)引起的反射特性变化，并评价宽带探头在确定CI患者反射阈值中的作用。假设CI患者耳朵的反射模式与中耳硬度的增加是一致的，宽带探头测量的反射阈值比单频探头测量的阈值低。11名CI受试者参加了宽带反射和血沉测试。用三个探头测量同侧反射：宽带啁啾(从200至8000赫兹)、226赫兹的音调和678赫兹的音调。以28例中耳功能正常、无顺应性的成年人的宽带反射率测量结果作为标准数据集进行比较。考虑到群体数据，CI在250-891赫兹和4238-4490赫兹之间的个体的平均反射率显著高于标准数据组，尽管个体的反射率曲线是不同的。考虑到对照组的临床设计导纳正常，一些CI患者的226赫兹导纳也很低，这也是该组发现的原因之一。电诱发的14耳中有9耳(64.3%)可测到腓骨反射，在46个电极中有24耳(52.5%)可测到。反射引起的反射模式的变化是参与者/耳朵独有的，但在给定耳朵内的激活器(电极)上类似。此外，即使在临床正常的226赫兹导纳的耳朵中，激活腓骨反射对1000赫兹或以上的反射值的影响也是最大的。这是一个比已报道的由声诱发反射引起的反射变化的频率范围更高的频率范围，并且与增加的中耳休息时的僵硬一致。与226赫兹的探针音相比，使用678或宽带探头可以更频繁地测量电诱发反射。尽管在24种情况中有16种情况下，宽带探头的反射阈值低于678HZ探头，但这并不是一个有统计学意义的发现(Wilcoxon符号等级检验；p=0.072)。对于有CI的耳朵，也应考虑应用宽带声导抗测量(反射比和反射)。还需要进一步的工作来描述CI患者耳朵随时间的变化，以更全面地了解表明中耳僵硬增加的反射模式，并优化使用宽带探头测量ESRS。
To characterize differences in wideband power reflectance for ears with and without cochlear implants (CI), to describe electrically evoked stapedial reflex (eSR) -induced changes in reflectance, and to evaluate the benefit of a broadband probe for reflex threshold determination for CI recipients. It was hypothesized that reflectance patterns in ears with CI would be consistent with increased middle ear stiffness and that reflex thresholds measured with a broadband probe would be lower compared to thresholds obtained with single-frequency probe. Eleven CI recipients participated in both wideband reflectance and eSR testing. Ipsilateral reflexes were measured with three probes: a broadband chirp (swept from 200 to 8000 Hz), a 226 Hz tone, and a 678 Hz tone. Wideband reflectance measures acquired from 28 adults without CIs and with normal middle ear function served as a normative data set for comparison. Considering the group data, average reflectance was significantly higher for individuals with CI across 250–891 Hz and 4238–4490 Hz compared to the normative data set, though individual reflectance curves were variable. Some CI recipients also had low 226 Hz admittance, which contributed to the group finding, considering the control group had clinically normal 226 Hz admittance by design. Electrically evoked stapedial reflexes were measurable in 9 of 14 ears (64.3%), and in 24 of 46 electrodes (52.5%) tested. Reflex-induced changes in reflectance patterns were unique to the participant/ear, but similar across activator (electrode) within a given ear. Additionally, reflectance values at or above 1000 Hz were affected most by activating the stapedial reflex, even in ears with clinically normal 226 Hz admittance. This is a higher frequency range than has been reported for acoustically evoked reflex induced reflectance changes, and is consistent with increased middle ear stiffness at rest. Electrically evoked reflexes could be measured more often with 678 or the broadband probe compared to the 226 Hz probe tone. Although reflex thresholds were lower with the broadband probe compared to the 678 Hz probe in 16 of 24 conditions, this was not a statistically significant finding (Wilcoxon signed-rank test; p = 0.072). The applications of wideband acoustic immittance measurements (reflectance and reflexes) should also be considered for ears with CI. Further work is needed to describe changes across time in ears with CI to more fully understand the reflectance pattern indicating increased middle ear stiffness, and to optimize measuring eSRs with a broadband probe.