Neural Encoding and Auditory Processing of Electrical Stimulation in Pediatric Cochlear Implant Users

儿童人工耳蜗用户电刺激的神经编码和听觉处理

• 批准号: 9882977
• 负责人: Shuman He
• 金额: $ 39.43万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9882977
• 关键词: Action Potentials; Affect; Age; Apical; Auditory; Auditory system; Biological Markers; Child; Childhood; Clinical; Clinical Practice Guideline; Clinical Research; Cochlea; Cochlear Implants; Cochlear Nerve; Cochlear implant procedure; Cues; Data; Detection; Deterioration; Discrimination; Effectiveness; Electric Stimulation; Electrodes; Event-Related Potentials; Foundations; Goals; Hearing; Hearing problem; High Prevalence; Implant; Implanted Electrodes; Individual; Interphase; Knowledge; Labyrinth; Language Development; Length; Location; Magnetic Resonance Imaging; Maps; Measurable; Measures; Mission; Modiolus; Nature; Nerve Fibers; Patients; Pattern; Peripheral; Phase; Physiologic pulse; Practice Management; Predisposition; Process; Public Health; Pulse Rates; Recovery; Resolution; Sensorineural Hearing Loss; Signal Transduction; Site; Speech; Speech Development; Stimulus; Testing; United States National Institutes of Health; Variant; Work; auditory discrimination; auditory processing; base; behavioral response; clinical care; clinical practice; clinically significant; comorbidity; disability; evidence base; functional status; improved; malformation; patient population; patient variability; programs; relating to nervous system; research study; response; tool

PROJECT SUMMARY/ABSTRACT Cochlear nerve deficiency (CND) refers to a small or absent cochlear nerve (CN) as revealed by high- resolution magnetic resonance imaging. Cochlear implantation has been used as a treatment option for children with CND for nearly two decades. Due to the lack of understanding of how electrical stimulation is encoded and processed in their auditory system, there is still no evidenced-based clinical practice for managing this unique patient population. To further complicate matters, more than half of children with CND cannot provide reliable behavioral responses despite their age due to severe comorbidities. As a result, clinicians often use a combined “one-size-fits-all” and “try-and-see” approach to program cochlear implant (CI) speech processors for children with CND. This practice typically results in stimulating all intra-cochlear CI electrodes with similar programming parameters. However, recent work from our lab showed that the likelihood of measuring CN neural responses in children with CND reduced as the stimulating CI electrode site moved from the base to the apex of the cochlea. This unique response-deterioration pattern is not observed in children with normal-sized CNs. In addition, our compiling preliminary data show that information transmitted by CI electrodes with no measurable CN response is only adequate for auditory detection but not sufficient for auditory discrimination, which explains why the majority of children with CND do not make satisfactory progress in speech and language development despite good auditory detection thresholds with their CIs. These new findings suggest that the current clinical practice is unlikely to provide appropriate CI programming settings for this unique patient population. Therefore, there is an urgent need to develop objective clinical tools for optimizing CI settings for individual children with CND. As the first step toward developing such objective clinical tools, this study aims to better understand neural encoding and processing of electrical stimulation in both the CN and the central auditory system in implanted children with CND. Aim 1 will compare effects of changing pulse-phase duration, inter-phase gap and pulse rate on neural representation of electrical stimulation in the CN between children with CND and children with normal-sized CNs. Aim 2 will determine effects of variation in CN neural survival on cortical sensitivity to amplitude modulation and electrode discrimination in children with CND and children with normal-sized CNs. Results of this study have high scientific significance because they will establish how variations in neural survival of CN fibers affect neural encoding of electrical stimulation in the CN, as well as how variations in the peripheral input affect cortical neural encoding and processing of electrical stimulation. Results of this study also have high clinical significance because they will 1) provide scientific evidence for identifying and excluding the nonfunctional intra-cochlear CI electrodes from programming maps, 2) establish the importance of selecting pulse-phase durations, inter-phase gaps and pulse rates based on CN neural survival for individual CI electrodes, and 3) lay the knowledge foundation for developing evidence-based clinical practice guidelines for managing children with CND.

项目摘要/摘要 耳蜗神经缺乏症(CND)是指耳蜗神经(CN)体积较小或缺失，表现为耳蜗神经高度萎缩。 分辨率磁共振成像。人工耳蜗植入已被用作儿童的一种治疗选择 与CND合作了近20年。由于缺乏对电刺激如何编码和编码的理解 在他们的听觉系统中进行处理，仍然没有以证据为基础的临床实践来管理这种独特的 病人群体。更复杂的是，超过一半的CND儿童无法提供可靠的 尽管他们年龄大了，但由于严重的合并症，行为反应。因此，临床医生经常使用联合 “一刀切”和“试试看”方法在儿童人工耳蜗术中的应用 与CND。这种做法通常导致用类似的编程刺激所有的耳蜗内CI电极 参数。然而，我们实验室最近的工作表明，测量中枢神经反应的可能性 在CND儿童中，随着刺激CI电极位置从耳蜗底向顶端移动而减少。 这种独特的反应-恶化模式在正常大小的中枢神经系统儿童中没有观察到。此外，我们的 初步数据汇编表明，CI电极传输的信息没有可测量的CN响应 仅适用于听觉检测，但不足以用于听觉辨别，这就解释了为什么 大多数患有CND的儿童在言语和语言发展方面没有取得令人满意的进步，尽管 良好的听觉检测阈值及其顺应性。这些新的发现表明，目前的临床实践是 不太可能为这一独特的患者群体提供适当的CI编程设置。因此，有一个 迫切需要开发客观的临床工具，以优化CND儿童个体的CI设置。作为 开发这种客观的临床工具的第一步，这项研究旨在更好地理解神经编码 移植儿童中枢神经系统和中枢听觉系统的电刺激加工 CND.目标1将比较改变脉冲相位持续时间、相位间隙和脉冲频率对神经的影响 CND儿童与正常大小CNS儿童CN的电刺激表现。 目的2将确定CN神经存活的变化对皮层对幅度调制和 CND儿童与正常大小CNS儿童的电极辨别这项研究的结果是 具有很高的科学意义，因为他们将确定CN纤维神经存活的差异是如何影响神经的 CN中电刺激的编码，以及外周输入的变化如何影响皮质神经 电刺激的编码和处理。本研究结果也具有较高的临床意义。 因为它们将1)为识别和排除无功能的耳蜗内CI提供科学依据 从编程图中选择电极，2)确定选择脉冲相位持续时间、相间的重要性 基于单个CI电极CN神经元存活率的间隙和脉率，以及3)奠定了知识 为管理患有CND的儿童制定循证临床实践指南的基础。