RU-2861678-C1 - METHOD FOR INTRAOPERATIVE ASSESSMENT OF FUNCTIONALITY OF COCHLEAR IMPLANT WHEN PERFORMING SURGERY UNDER LOCAL ANAESTHESIA

Abstract

FIELD: medicine. SUBSTANCE: invention relates to otorhinolaryngology, and can be used for intraoperative assessment of the functionality of a cochlear implant. The patient is placed on an operating table with the face open towards the audiologist. The audiologist selects the 'Electrically evoked stapedial reflex' mode and applies electrical stimuli of increasing strength channel by channel, starting from 10 qu. When the patient experiences auditory sensations in response to electrical stimulation, the patient responds verbally that they hear the sound. The audiologist assesses the functionality of the cochlear implant according to the patient's responses. The appearance of auditory sensations in the patient during stimulation of more than half of the electrode array nodes, with the mandatory inclusion of the most proximal and distal ones, indicates adequate operation of the installed implant and its correct position. The absence of auditory sensations during stimulation of the most distal and proximal nodes of the electrode array, while sensations are preserved up to the middle ones, indicates an incorrect position inside the spiral canal. The absence of auditory sensations in more than 90% of the electrode array nodes indicates poor performance of the cochlear implant and low prospects for hearing prosthetics with its help. EFFECT: increasing the effectiveness of assessing the functionality of a cochlear implant intraoperatively under local anaesthesia. 1 cl, 1 ex

Inventors

• Kuzovkov Vladislav Evgenevich
• SUGAROVA SERAFIMA BORISOVNA
• Kliachko Dmitrii Semenovich
• Lilenko Andrei Sergeevich
• Kaliapin Denis Dmitrievich

Dates

Publication Date

20260507

Application Date

20250529

Claims (1)

1. A method for intraoperative evaluation of the performance of a cochlear implant during surgery under local anesthesia, during which electrical stimulation is performed, characterized in that the patient is positioned on the operating table with an open face towards the audiologist. During the surgery, after the surgeon has fixed the implant body in the formed bed and inserted the electrode array into the spiral canal of the cochlea, the audiologist selects the "Electrically evoked stapedial reflex" mode and applies electrical stimuli of increasing strength channel by channel, starting with 10 qu. When the patient experiences auditory sensations in response to electrical stimulation, the patient responds with a voice that he hears a sound. The audiologist evaluates the performance of the cochlear implant in accordance with the patient's responses: the appearance of auditory sensations in the patient during stimulation of more than half of the nodes of the electrode array with the obligatory inclusion of the most proximal and distal of them indicates the adequate functioning of the installed implant and its correct position; The absence of auditory sensations during stimulation of the most distal and proximal nodes of the electrode array, while maintaining sensations up to the middle ones, indicates its incorrect position within the spiral canal; the absence of auditory sensations at more than 90% of the nodes of the electrode array indicates poor performance of the cochlear implant and low prospects for hearing aids using it.

Description

The invention relates to the field of medicine, namely to otolaryngology, and can be used to effectively assess the performance of a cochlear implant during cochlear implantation surgery under local anesthesia. A known method for tuning speech processors in implanted patients is by recording intraoperative stapedius reflex thresholds (Lorens A., Anderson I. ESRT and MCL correlations in experienced pediatric cochlear implant users // Cochlear Implants international, 2004, vol. 5, no. 1, pp. 28-37). This method involves recording contractions of the stapedius muscle of the opposite ear in response to electrical stimulation of the implant. The reflex threshold levels recorded on individual electrodes are used to tune the speech processor. The closest method is (Method for recording the stapedial reflex: patent RU 2469690, Russian Federation, application RU 2011127376, filed 06/28/2011, published 12/20/2012), carried out during cochlear implantation surgery, including the delivery of stimuli to the electrodes of the cochlear implant and recording of the response in the form of contraction of the stapedius muscle. Registration is carried out using an impedance meter on the non-operated side, contralaterally, initially tympanometry is performed to determine the gas pressure in the middle ear, and if the pressure is detected to be more than 350 daPa, the pressure in the external auditory canal is increased using an additional volume of air introduced into the impedance meter circuit until the pressure in the outer and middle ear is equalized, after which the stapedial reflex is recorded. The disadvantages of the above methods include the low efficiency of intraoperative assessment of the performance of the cochlear implant, due to the low preservation of the stapedial reflex during surgery due to the influence of muscle relaxants on neuromuscular transmission, as well as in the case of the influence of many relevant concomitant diseases, such as otosclerosis, tympanosclerosis, developmental anomalies of the middle and inner ear, damage to the motor nuclei of the facial nerve, in which the stapedial reflex cannot be recorded by any of the methods. The technical problem is the need to develop an effective method for intraoperative assessment of the performance of a cochlear implant during surgery under local anesthesia, devoid of the above-mentioned disadvantages. The technical result consists in increasing the efficiency of assessing the performance of a cochlear implant. The technical result is achieved by the fact thatAccording to the invention, the method for intraoperative assessment of the performance of a cochlear implant during an operation in which electrical stimulation is performed is used, wherein the operation is performed under local anesthesia and the presence of auditory sensations in the patient in response to electrical stimulation is recorded using verbal communication. The proposed invention improves the efficiency of cochlear implant performance assessment by utilizing not only automated measurement technologies but also the patient's subjective assessment of their sensations, which ultimately determines the quality of their rehabilitation. Thus, we complement the conventional objective diagnostic battery, consisting of implant telemetry and neural response telemetry, which evaluate automatically calculated electrophysiological parameters, with a new subjective method that enables the patient to assess their perceptions in real time. The claimed method is carried out as follows. During cochlear implantation under local anesthesia, the patient is positioned on the operating table, facing the audiologist. Before and during the procedure, the audiologist or their assistant communicates with the patient using specially prepared instructions printed on A4 paper in large font (over 30 pt). During the surgery, after the surgeon secures the implant body in the formed socket and inserts the electrode array into the cochlear canal, the audiologist connects the implanted cochlear implant via a diagnostic coil to the programmer, which is in turn connected to a PC and controlled by specialized software for configuring the cochlear implant system. The audiologist performs cochlear implant telemetry and neural response telemetry according to general guidelines. Next, the standard diagnostic test suite is supplemented by the following procedure: the "Electrically Evoked Stapedial Reflex" mode is selected in the program. The audiologist delivers electrical stimuli of increasing strength, channel by channel, starting with 10 qubits. When the patient experiences hearing in response to the electrical stimulation, they vocalize their hearing using any convenient method. Based on the patient's responses, the audiologist evaluates the performance of the cochlear implant system at each node of the electrode array, as well as the threshold for hearing. The resulting data is stored in the computer program for subsequent