Abstract
Acoustic hearing can be preserved after cochlear implant (CI) surgery, allowing for combined electric-acoustic stimulation (EAS) and superior speech understanding compared to electric-only hearing. Among patients who initially retain useful acoustic hearing, 30–40 % experience a delayed hearing loss that occurs 3 or more months after CI activation. Increases in electrode impedances have been associated with delayed loss of residual acoustic hearing, suggesting a possible role of intracochlear inflammation/fibrosis as reported by Scheperle et al. (Hear Res 350:45–57, 2017) and Shaul et al. (Otol Neurotol 40(5):e518–e526, 2019). These studies measured only total impedance. Total impedance consists of a composite of access resistance, which reflects resistance of the intracochlear environment, and polarization impedance, which reflects resistive and capacitive properties of the electrode–electrolyte interface as described by Dymond (IEEE Trans Biomed Eng 23(4):274–280, 1976) and Tykocinski et al. (Otol Neurotol 26(5):948–956, 2005). To explore the role of access and polarization impedance components in loss of residual acoustic hearing, these measures were collected from Nucleus EAS CI users with stable acoustic hearing and subsequent precipitous loss of hearing. For the hearing loss group, total impedance and access resistance increased over time while polarization impedance remained stable. For the stable hearing group, total impedance and access resistance were stable while polarization impedance declined. Increased access resistance rather than polarization impedance appears to drive the increase in total impedances seen with loss of hearing. Moreover, access resistance has been correlated with intracochlear fibrosis/inflammation in animal studies as observed by Xu et al. (Hear Res 105(1–2):1–29, 1997) and Tykocinski et al. (Hear Res 159(1–2):53–68, 2001). These findings thus support intracochlear inflammation as one contributor to loss of acoustic hearing in our EAS CI population.
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Acknowledgements
Electrode Voltage Telemetry research software was provided by Cochlear Ltd. Linjie Shu, Alexandra Watts, and Sushun (Albert) Zhang assisted in compiling the dataset. Audiologists on the University of Iowa Cochlear Implant team contributed audiometric and clinical impedance datasets, provided expert care for our cochlear implant patients, and shared valuable insights regarding impedance fluctuations and relevant clinical pathologies in our EAS population.
Funding
This study was funded by National Institutes of Health/National Institute on Deafness and Other Communicative Disorders P50 DC 00242 (PI: Gantz).
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BJG is a consultant for Cochlear Ltd. MRH is co-founder and Chief Medical Officer for iotaMotion, Inc. VDT is a consultant for iotaMotion, Inc. All other authors declare that they have no conflict of interest.
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Tejani, V.D., Yang, H., Kim, JS. et al. Access and Polarization Electrode Impedance Changes in Electric-Acoustic Stimulation Cochlear Implant Users with Delayed Loss of Acoustic Hearing. JARO 23, 95–118 (2022). https://doi.org/10.1007/s10162-021-00809-z
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DOI: https://doi.org/10.1007/s10162-021-00809-z