Re-evaluation of local anesthesia transtympanic electrical auditory brainstem response in cochlear implant candidacy

Abstract

Introduction: The trans-tympanic electrically evoked auditory brainstem response measurement in local anesthesia (= LA-TT-EABR) has been shown as a useful tool in doubtful CI candidacy to objectively evaluate the excitability of the auditory pathway up to the brainstem. Previous studies in this matter were of relatively low subjects number. To update the knowledge of the reliability of LA-TTEABR, we re-evaluated the latest results from a bigger subjects dataset from our clinic and follow up regarding hearing sensation post-operatively. Methods: LA-TT-EABR was performed, as described in previous publications, with a trans-tympanic golf-club electrode in the round window niche for pre-operative stimulation in local anesthesia and with an evoked potential device for EABR recording. Hearing sensations were monitored in the implanted CI subjects. Results: 39 of 40 planned subjects were included in this study. In 22 subjects, a positive LA-TT-EABR was recorded. In 11 subjects, the response was insecure. In 6 subjects, no response was recorded. One subject was excluded because of pain during the paracentesis. Among them, 19 were implanted with a CI, and 18 had hearing sensations with a hearing prosthesis post-operative. The sensitivity and specificity of LA-TTEABR in estimating the excitability of the auditory nerve preoperatively are both 100%. Conclusion: LA-TT-EABR was shown as a reliable pre-operative test to objectively evaluate the auditory brainstem response. In addition to LA-TT-EABR, an analysis of the auditory cortex using LA-TT-EALR may provide correlation and confirmation of LA-TT-EABR results and additional information about cortical reorganization after long deafness.

Keywords

• promontory stimulation
• electrical stimulation
• electrical auditory brainstem response
• trans-tympanic
• cochlear implant
• auditory nerve