Optimizing ECAP recording parameters in pediatric cochlear implantation: a clinical perspective
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252778Keywords:
Artifact suppression, Cochlear implant, ECAP, Neural telemetry, PediatricAbstract
Background: Intraoperative ECAP (electrically evoked compound action potential) monitoring provides critical objective data during pediatric cochlear implantation, where behavioral feedback is often unavailable. Despite its clinical importance, there is considerable variability in ECAP recording protocols, leading to inconsistent waveform quality and limited inter-institutional reproducibility. This study aimed to identify and validate optimal ECAP recording parameters that enhance signal fidelity and suppress artifacts, thereby improving intraoperative assessment and programming consistency.
Methods: Fifty-six pediatric patients undergoing cochlear implantation with Cochlear Nucleus devices were prospectively included. ECAPs were recorded using AutoNRT software while systematically varying four parameters: pulse width (25, 37, 50 μs/phase), stimulation rate (50, 80, 120 Hz), recording electrode separation (0, 1, 2, 3 contacts) and recording delay (0.2, 0.4, 0.6 ms). Recordings were assessed for waveform clarity, N1 latency, peak-to-peak amplitude, signal-to-noise ratio and residual artifact.
Results: The combination of 25 μs/phase pulse width, 80 Hz stimulation rate, 1–2 electrode separation and 0.4 ms recording delay produced the most reliable ECAP waveforms. These settings resulted in clearly defined N1-P2 peaks, higher amplitude consistency across the electrode array, superior signal-to-noise ratios and effective artifact suppression compared to other configurations.
Conclusions: The adoption of standardized ECAP recording settings significantly enhances intraoperative telemetry quality in pediatric CI recipients. These parameters facilitate more accurate assessment of neural responses, support consistent device programming and may ultimately contribute to improved auditory outcomes.
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References
Entwisle LK, Warren SE, Messersmith JJ. Cochlear Implantation for Children and Adults with Severe-to-Profound Hearing Loss. Semin Hear. 2018;39(4):390-404. DOI: https://doi.org/10.1055/s-0038-1670705
Pfingst BE, Zhou N, Colesa DJ. Importance of cochlear health for implant function. Hear Res. 2015;322:77-88. DOI: https://doi.org/10.1016/j.heares.2014.09.009
Nassiri AM, Yawn RJ, Gifford RH. Intraoperative Electrically Evoked Compound Action Potential (ECAP) Measurements in Traditional and Hearing Preservation Cochlear Implantation. J Am Acad Audiol. 2019;30(10):918-26. DOI: https://doi.org/10.3766/jaaa.18052
Tavartkiladeze, GA, Bakhshinyan, VV. Objective Measures at Different Stages of Cochlear Implantation: A Data Analysis. Med Res Arch. 2022;13(1):457. DOI: https://doi.org/10.18103/mra.v13i1.6171
Callejón-Leblic, MA, Barrios-Romero MM, Kontides A. Electrically evoked auditory cortical responses elicited from individually fitted stimulation parameters in cochlear implant users. Int J Audiol. 2022;62(7):650–8. DOI: https://doi.org/10.1080/14992027.2022.2062578
Skidmore J, Yuan Y, He S. A new method for removing artifacts from recordings of the electrically evoked compound action potential: Single-pulse stimulation. Preprint. medRxiv. 2024;1:17. DOI: https://doi.org/10.1101/2024.01.17.24301435
Garg S, Suneela G, Chadha BS, Malhotra S, Agarwal AK. Hearing impairment: Prevalent, preventive and controllable in India. Indian J Med Sci. 2008;22:79-81.
MA Pourhoseingholi, M Vahedi, M Rahimzadeh. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14-7.
Schrank L, Nachtigäller P, Müller J. ART and AutoART ECAP measurements and cochlear nerve anatomy as predictors in adult cochlear implant recipients. Eur Arch Otorhinolaryngol. 2024;281(7):3461-73. DOI: https://doi.org/10.1007/s00405-023-08444-5
McLaughlin M, Lopez Valdes A, Reilly RB, Zeng FG. Cochlear implant artifact attenuation in late auditory evoked potentials: a single channel approach. Hear Res. 2013;302:84-95. DOI: https://doi.org/10.1016/j.heares.2013.05.006
Zhang B, Hu Y, Du H. Tissue engineering strategies for spiral ganglion neuron protection and regeneration. J Nanobiotechnol. 2024;22(1):458. DOI: https://doi.org/10.1186/s12951-024-02742-8
Graham CE, Basappa J, Turcan S, Vetter DE. The cochlear CRF signaling systems and their mechanisms of action in modulating cochlear sensitivity and protection against trauma. Mol Neurobiol. 2011;44(3):383-406. DOI: https://doi.org/10.1007/s12035-011-8203-3
Marin N, Cerna FL, Barral J. Signatures of cochlear processing in neuronal coding of auditory information. Mol Cell Neurosci. 2022;120:103732. DOI: https://doi.org/10.1016/j.mcn.2022.103732
Canfarotta MW, Dillon MT, Buchman CA. Long-term influence of electrode array length on speech recognition in cochlear implant users. Laryngoscope. 2021;131(4):892-7. DOI: https://doi.org/10.1002/lary.28949
Kwon BJ. Effects of electrode separation between speech and noise signals on consonant identification in cochlear implants. J Acoust Soc Am. 2009;126(6):3258-67. DOI: https://doi.org/10.1121/1.3257200
Bahmer A, Pieper S, Baumann U. Evaluation of an artifact reduction strategy for electrically evoked auditory steady-state responses: Simulations and measurements. J Neurosci Methods. 2018;296:57-68. DOI: https://doi.org/10.1016/j.jneumeth.2017.12.025
Winchester A, Kay-Rivest E, Bruno M, Hagiwara M, Moonis G, Jethanamest D. Image Quality and Artifact Reduction of a Cochlear Implant With Rotatable Magnets. Otol Neurotol. 2023;44(4):223-9. DOI: https://doi.org/10.1097/MAO.0000000000003840
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