Functional MRI during electrical auditory stimulation as an objective evaluation of the retrocochlear auditory pathway in profoundly deaf patients

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Electrical promontory stimulation test has been used for preoperative functional evaluation of the retrocochlear auditory pathway in cochlear implant candidates. However, due to the lack of an objective information on cortical integration, results of this test do not seem to predict what extent the cochlear implant will be successful.In order to employ functional magnetic resonance imaging (fMRI) to assess the cortical activation during electrical auditory stimulation, safe stimulation devices allowing to use inside the gauss field of an MR system was developed. We performed fMRI by using these electrical stimulation devices in 4 deaf adult patients before cochlear implantation. All 4 patients showed activation of the auditory cortex and good postoperative performance with a cochlear implant. Demonstration of the cortical activation in one patient with mitochondrial diseases also helped to encourage both patients and surgeons for cochlear implantation.This method can thus provide an objective test of the integrity of the retrocochlear auditory pathway and help the surgeon in decision making before cochlear implantation.