Intraoperative determination of coupling efficiency of Carina^® middle ear implant by means of auditory evoked potentials

Abstract

Objective

The Carina^® implant system is a fully implantable active middle ear implant, which can be coupled to various structures in the middle ear, depending on the nature of the hearing loss and the middle ear anatomy. Currently, there is only one method for determining the coupling efficiency of the actuator of this implant system, and this is limited to incus coupling.

Design

The proposed method is based on the intraoperative recording and evaluation of auditory brainstem responses (ABRs) while directly stimulating the hearing system via the actuator. The acoustic stimulation was achieved using an optimised broadband chirp stimulus (CE-Chirp^®).

Study samples

This study included 10 subjects having moderate to severe sensorineural or mixed hearing loss.

Results

The intraoperative ABR measurements show, that it is possible to derive reliable AEP thresholds via the actuator of the implant. The ABR thresholds correlate well with preoperative BC PTA4 thresholds (r = 0.87) while the postoperative OC-direct thresholds (in situ audiogram via the implant) correlate with r = 0.77.

Conclusion

The results demonstrated that the direct actuator stimulation allow for reliable intraoperative ABR measurements and that the proposed method can be used to estimate the coupling efficiency of the actuator and facilitate its positioning.

Keywords:

• Active middle ear implant
• auditory brainstem responses
• chirp stimulation
• intraoperative monitoring

Acknowledgments

The authors want to thank Bernd Waldmann, Manager Cochlear Research Hannover, for his valuable comments and suggestions. This study was supported in part by Cochlear GmbH (Germany) and Pro Akustik (Germany).

Disclosure statement

No potential conflict of interest was reported by the author(s).