Computed-Tomography Estimates of Interaural Mismatch in Insertion Depth and Scalar Location in Bilateral Cochlear-Implant Users.
Computed-Tomography Estimates of Interaural Mismatch in Insertion Depth and Scalar Location in Bilateral Cochlear-Implant Users.
复制标题
双侧耳蜗植入者耳蜗插入深度和标量位置的耳间不匹配的计算机断层扫描估计。
DOI：
10.1097/mao.0000000000003538
复制
发表时间：
2022-07-01
影响因子：
2.1
通讯作者：
Bernstein, Joshua G. W.
中科院分区：
文献类型：
--
作者：
Goupell, Matthew J.;Noble, Jack H.;Phatak, Sandeep A.;Kolberg, Elizabeth;Cleary, Miranda;Stakhovskaya, Olga A.;Jensen, Kenneth K.;Hoa, Michael;Kim, Hung Jeffrey;Bernstein, Joshua G. W.
由于阵列放置或特征不同，双侧耳蜗植入体（BI-CI）用户将存在一系列耳间插入深度不匹配。对于位于顶点附近或鼓阶外部的电极，或者对于预弯曲和直类型的混合的阵列，失配将更大。脑干上级橄榄复合体神经元对声音定位的耳间差异线索非常敏感。由于这些神经元依赖于耳间刺激位置匹配的输入，因此BI-CI用户的耳间插入深度或标量位置差异可能导致耳间刺激位置不匹配，从而损害双耳能力。根据107名BI-CI用户的颞骨计算机断层扫描计算插入深度和标量位置（27名Advanced Bionics，62名Cosmosar，18名MED-EL）。中位耳间插入深度不匹配为23.4°或1.3 mm。总体上，13-19%的电极对发生了预期会损害双耳处理的估计临床相关范围内的不匹配（>75°或3 mm），23-37%的受试者发生了至少3个电极对。插入深度、标量位置和阵列类型之间存在显著的三向相互作用。耳间插入深度不匹配是最大的顶端电极，电极对在两个不同的阶，和阵列都是预弯曲。平均BI-CI耳间插入深度不匹配是小的，然而，大的耳间插入深度不匹配的潜力，降低空间听力发生频繁，足以值得注意。对于新的BI-CI用户，建议改进手术技术，以避免耳间插入深度和标量不匹配。对于耳间插入深度不匹配的现有BI-CI用户，临床频率表的耳间对齐可能会减少负面的空间听力后果。
Bilateral cochlear-implant (BI-CI) users will have a range of interaural insertion-depth mismatch because of different array placement or characteristics. Mismatch will be larger for electrodes located near the apex or outside scala tympani, or for arrays that are a mix of pre-curved and straight types. Brainstem superior olivary-complex neurons are exquisitely sensitive to interaural-difference cues for sound localization. Because these neurons rely on interaurally place-of-stimulation-matched inputs, interaural insertion-depth or scalar-location differences for BI-CI users could cause interaural place-of-stimulation mismatch that impairs binaural abilities. Insertion depths and scalar locations were calculated from temporal-bone computed-tomography scans for 107 BI-CI users (27 Advanced Bionics, 62 Cochlear, 18 MED-EL). Median interaural insertion-depth mismatch was 23.4° or 1.3 mm. Mismatch in the estimated clinically relevant range expected to impair binaural processing (>75° or 3 mm) occurred for 13–19% of electrode pairs overall, and for at least three electrode pairs for 23–37% of subjects. There was a significant three-way interaction between insertion depth, scalar location, and array type. Interaural insertion-depth mismatch was largest for apical electrodes, for electrode pairs in two different scala, and for arrays that were both pre-curved. Average BI-CI interaural insertion-depth mismatch was small; however, large interaural insertion-depth mismatch—with the potential to degrade spatial hearing—occurred frequently enough to warrant attention. For new BI-CI users, improved surgical techniques to avoid interaural insertion-depth and scalar mismatch are recommended. For existing BI-CI users with interaural insertion-depth mismatch, interaural alignment of clinical frequency tables might reduce negative spatial-hearing consequences.