Brain Stem Responses Evoked by Stimulation of the Mature Cochlear Nucleus With an Auditory Brain Stem Implant

Objectives: The Nucleus auditory brain stem implant (ABI) has been used in the hearing rehabilitation of totally deaf individuals for whom a cochlear implant is not an option such as in the case of neurofibromatosis type 2 (NF2). Intraoperative electrically evoked auditory brain stem responses (EABRs) are recorded to assist in the placement of the electrode array over the dorsal and ventral cochlear nuclei in the lateral recess of the IVth ventricle of the brain stem. This study had four objectives: (1) to characterize EABRs evoked by stimulation with an ABI in adolescents and adults with NF2, (2) to evaluate how the EABR morphology relates to auditory sensations elicited from stimulation by an ABI, (3) to establish whether there is evidence of morphology changes in the EABR with site of stimulation by the ABI, and (4) to investigate how the threshold of the EABR relates to behavioral threshold and comfortably loud sensations measured at initial device activation. Design: Intraoperative EABRs were recorded from 34 subjects with ABIs: 19 male and 15 female, mean age 27 yrs (range 12 to 52 yrs). ABI stimulation was applied at seven different sites using either wide bipolar stimulation across the array or in subsections of the array from medial to lateral and inferior to superior. The EABRs were analyzed with respect to morphology, peak latency, and changes in these characteristics with the site of stimulation. In a subset of eight subjects, additional narrow bipolar sites were stimulated to compare the intraoperative EABR threshold levels with the behavioral threshold (T) and comfortably loud (C) levels of stimulation required at initial device activation. Results: EABRs were elicited from 91% of subjects. Morphology varied from one to four vertex-positive peaks with mean latencies of 0.76, 1.53, 2.51, and 3.64 msecs, respectively. The presence of an EABR from stimulation by electrodes across the whole array had a high predictive value for the presence of auditory electrodes at initial device activation. When examining subsections of the array, the absence of an EABR was a poor predictor for the absence of auditory electrodes. The morphology of the EABRs varied with site of stimulation in 16 cases, but there was no consistent pattern of change with stimulation site. There was a trend for more auditory electrodes to be present in stimulation sites that evoked EABRs with a higher number of peaks in the waveform. The EABR threshold was closer to the behavioral C level than the T level, but there was no overall correlation between the intraoperative EABR threshold level and the behavioral T and C levels. Conclusions: The presence of an intraoperative EABR corresponded well to the presence of auditory electrodes. The absence of an EABR from stimulating subsections of the array was not; however, a good indicator for the absence of auditory electrodes and the EABR from such stimulation would not be of assistance in identifying the nonauditory sections of the array to exclude in behavioral fitting of the device. The morphology of the EABR did not relate to site of stimulation. More peaks in the EABR was associated with a greater number of electrodes with auditory sensations, suggesting that correct positioning of the ABI activated more auditory subsystems within the cochlear nucleus. The intraoperative EABR thresholds did not correlate with the behavioral T and C levels and could not be used to assist in device fitting.