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Biomedical subjects

R D Battmer

Publications and source records attributed to R D Battmer.

At least 19 recordsLinked to original sources
PubMed1992

Experience with the cochlear miniature speech processor in adults and children together with a comparison of unipolar and bipolar modes.

Following the experience with nearly 150 patients with the Nucleus cochlear implant, a more sophisticated and lighter speech processor was tested successfully in terms of better speech understanding. In order to prepare further miniaturization, the standard bipolar stimulation mode was compared with an unipolar mode. It was found that unipolar stimulation needs less energy, without decreasing speech understanding. Preconditions for supplying very young children with a cochlear implant were the use of electrically elicited stapedius reflex thresholds, obtained intraoperatively, for the fitting of the speech processor and the setup of a special rehabilitation center, where children together with their mothers could be trained in hearing and understanding by special teachers and engineers for 12 weeks, distributed over the 1st postoperative year.

Adult↗
PubMed1992

[Correlation between electrically-induced stapedius reflex and discomfort threshold in cochlear implant patients].

Electrically elicited stapedius reflex thresholds are an objective criteria for the fitting of speech processors in very young children. Reflex thresholds generally fit well within the upper third of a subject's individual dynamic range, the difference between electrical threshold of hearing, (T) and maximum comfort (C) levels and can be used to predict ultimate behavioral maximum comfort levels. In acoustically elicited stapedius reflexes a saturation of impedance amplitude can be registered at approximately 110 dB, which is 90% of the dynamic range. Assuming a similar relationship for the electrically elicited stapedius reflex there would be two values within the dynamic range which could be used for extrapolation of the threshold level. In the present study, the electrically elicited stapedius reflex was examined in 16 deaf patients who had received 22-channel Clark/NUCLEUS cochlear implants. Using an apical, a medial and a basal electrode pair, different stimulation positions within the cochlea were tested. The contralateral reflexes could be elicited in 11 patients (69%). A saturation of the reflex amplitude was recordable in 10 subjects, at least in one of the electrode pairs. The reflex saturation in all cases was located close to the uncomfortable loudness level within the subjects' dynamic ranges (at 95% dynamic). This finding is comparable to acoustic matter. As a result, these data together with reflex threshold data suggest a means for predicting to predict the threshold levels.

Acoustic Impedance Tests↗
PubMed1991

Comparative speech recognition results in eight subjects using two different coding strategies with the Nucleus 22 channel cochlear implant.

This study was designed to compare the results of several speech tests administered to eight subjects who used two types of speech-coding strategies with the Nucleus 22 channel cochlear implant. The subjects had an average experience of 40 months with the F0F1F2 coding strategy implemented in their previous wearable speech processor. Three subjects were good performers (showing significant open-set understanding without lip-reading) and five were moderate performers (not able to do speech-tracking by auditory means alone). All subjects were evaluated again after 1 month and 6 months of experience with the MULTIPEAK coding strategy of the miniature speech processor. The test materials included vowel and consonant identification, monosyllabic words, everyday sentences and numbers in noise. All eight subjects showed an improvement on more than three of five measures. The group of moderate performers showed a larger improvement in vowel (+16%) and consonant (+17%) identification scores than the group of good performers. For the open-set sentence test, the better patients were able to increase their score from 52% to 80% correct; two of the moderate performers did not improve. Six subjects achieved significantly higher scores at moderate signal-to-noise ratios (up to 10 dB S/N) in the (Freiburger) number test. Results of information transmission analysis are also discussed.

Acoustic Stimulation↗
PubMed1990

Electrically elicited stapedius reflex in cochlear implant patients.

Electrically elicited stapedius reflexes were examined in 25 deaf patients who had received a 22-channel Clark/NUCLEUS cochlear implant. Using an apical, a medial and a basal electrode pair, different stimulation positions within the cochlea and different stimulation modes were examined. For threshold determination, 10 reflexes were averaged with reflexes recorded on the nonoperated side. Reflexes were elicited in 19 of the 25 patients (76%); a saturation of reflex amplitude could be recorded in 14 (56%) subjects. In two additional cases, a reflex could be obtained by increasing the bipolar stimulation width (changing the stimulation mode). In comparison with different stimulation positions within the cochlea, the stimulation of apical electrodes produced more distinctive reflexes and required lower current levels. An increase in the bipolar stimulation width also decreased the intensity required for stapedius reflex threshold. Our data suggest that stapedius reflex evaluation may be a useful tool for speech processor fitting.

Adult↗
PubMed1989

[Suppression of tinnitus by electric stimulation in cochlear implant patients].

The use of electrical stimulation for the treatment of tinnitus was evaluated on 38 cochlear implant patients suffering from chronic tinnitus. In answer to a questionnaire 29 (76%) of the subjects reported a reduction of the tinnitus while using their speech processor; 15 even noted complete suppression. Sixteen patients used a processor delivering subthreshold current for 2 weeks. A placebo trial followed. Reduction of tinnitus was found in only 3 (19%) of the patients; however, 13 (81%) mentioned a substantial decrease of tinnitus when using their own device with above-threshold stimulation. The fact that tinnitus was also reduced on the contralateral side suggests that the acoustic masking effect must be the main determining factor rather than electrical stimulation. Therefore, the best therapy for the deaf seems to be the improvement of their hearing ability.

Adult↗
PubMed1988

[Psychophysical data and speech comprehension after 2 years with the Clark/Nucleus prosthesis].

Psychophysical data such as threshold and comfort levels indicate an extensive preservation of auditory nerve fibers. Changes of these data can point to increasing damage of nerve fibres due to long-term electrical stimulation or to obliteration of the cochlea when an intracochlear system is used. Unfavourable levels indicate negative influence on speech comprehension. The psychophysical data and the speech comprehension of 10 patients fitted with a Clark/NUCLEUS cochlear implant in the last 2 years have been analysed. During this period of time the threshold and comfort levels remained almost stable, whereas speech comprehension is still increasing, though to a lesser extent, after 2 years with the implant. These results indicate that the patients suffer neither an increasing destruction of auditory nerve fibres nor severe intracochlear changes.

Auditory Threshold↗
PubMed1988

[Changes in the hearing and discomfort thresholds in patients with the Clark/nucleus inner ear prosthesis].

The Nucleus 22-electrode cochlear implant should be fitted individually for both pitch and loudness. Loudness is related to the charge delivered, and is usually controlled by current amplitude. In special cases the loudness may be influenced by stimulation mode and pulse width. 3 examples demonstrate optimal fitting with low current intensities, using these possibilities. In addition the threshold level and comfortable level date were analysed over a 2-year period. No significant changes were found, indicating that electrical stimulation caused no damage to the remaining auditory nerve fibres.

Adult↗
PubMed1988

Magnetic resonance imaging (MRI) and high resolution computertomography (HRCT) in cochlear implant candidates.

Cochlear implant candidates must be thoroughly tested for their suitability pre-operatively. Electrical and electrophysiological tests as well as a psychological assessment are of fundamental importance in the selection process. The implantation of an intracochlear electrode requires specific information about the anatomy of the petrous bone and the endocochlear space. Such information can be obtained by using high resolution computed tomography (HRCT) or magnetic resonance imaging (MRI) using a surface coil. Over three years 438 patients were evaluated in our clinic as possible implant candidates. Out of these candidates 251 were evaluated using HRCT and 123 using MRI. In 39 (15.5%) cases we found bony abnormalities of the petrous bone using HRCT scans. 17 (13.8%) of the cases evaluated with MRI had no complete fluid filled spaces in the cochlea. Three patients who where identified as having ossified cochleas were subsequently implanted with an extracochlear device. MRI and HRCT have proved to be fundamental tools in determining patients suitable for implantation of an intracochlear electrode array.

Cochlea↗
PubMed1986

[The promontory test and electrocochleography in deafness caused by mumps].

Contradictory histological findings in patients with deafness following mumps led us to conduct electrophysiological investigations. Promontory testing (PT) and measurement of cochlear microphonics (CM) enabled us to distinguish between neural and sensory deafness. On the basis of a careful history and serological tests in 19 cases of unilateral deafness we found that the hearing loss was probably caused by mumps. In all patients except one auditory sensations could be obtained by electric stimulation of the acoustic nerve whereas no CM were detectable even with strong stimuli of 100 dB tonepips. In view of the electrophysiological findings, doubt is cast on the neural genesis of deafness following mumps as assumed by Lehnhardt (1962).

Audiometry, Evoked Response↗
PubMed1986

[The promontory test and electrocochleography with reference to indications for cochlear implant].

A successful cochlear implant demands a functioning auditory nerve. A subjective and qualitative recording can be obtained by promontory testing (PT) whereas cochlear microphonics (CM) give information about the status of the hair-cells in the inner ear. The results of both tests together show different patterns: in sensory deafness in which a cochlear implant is indicated, no CM and no compound action potentials (CAP) can be obtained, whereas the patient reports hearing sensations (PT positive) in response to promontory testing. Deafness caused by lesions close to the second neurone of the auditory pathways can be localized by preserved CM and CAP, but there is no response to promontory testing. A ganglionic deafness ie. of the first neurone can be distinguished by preserved CM, absent CAP and a negative PT. The combined results of electrocochleography and promontory testing help in deciding whether a cochlear implant is indicated, and in localising the origin of the deafness, eg. neural or sensorineural. The possible results are illustrated by examples.

Adult↗
PubMed1986

[Cochlear implants].

Since the middle of 1984, the HNO-Klinik der Medizinischen Hochschule Hannover has provided deaf adults with a 22-channel cochlear implant (CI) device of Clark-NUCLEUS. The digital working system consists of an implantable stimulator/receiver and an externally worn speech processor. Energy and signals are transmitted transcutaneously via a transmitter coil. During the prevailing 26 operations (April 1986) the electrode array could be inserted at least 17 mm into the cochlea. The threshold and comfort levels of all patients were adjusted very quickly; the dynamic range usually grows during the first postoperative weeks. The individual rehabilitation results vary greatly, but all patients show a significant increase of vowel and consonant comprehension while using the speech processor and an improvement of words understood per minute in speech tracking from lip-reading alone to lip-reading with speech processor. Four months after surgery seven of 17 patients (group I) are able to understand on average 42.7 words per minute by speech tracking without lip-reading. Six patients (group II) recognise 69.2% of vowels and 42.5% of consonants by speech processor alone. Four patients (group III) can correctly repeat only vowels (52.3%) without lip-reading, but using the speech processor together with lip reading they have an improvement in consonant understanding of 37.9% and under freefield conditions they are able to understand up to 17.8% numbers of the Freiburg speech test.

Cochlear Implants↗
PubMed1986

[High-resolution computerized tomography as a supplementary examination prior to cochlear implants].

Patients must be thoroughly tested for their suitability for a cochlear implant. Promontory testing and electrocochleography are of fundamental importance. It is possible to distinguish sensory deafness from other forms by combining the results of both tests. The implantation of intracochlear electrodes requires exact information of the anatomy of the cochlea, the tympanic wall of the cochlea and the endocochlear space. This can be assessed by axial high resolution computed tomographic scans. 8 of 70 patients were inoperable because of cochlea lesions (fractures or malformations). The advantage of computer tomography compared to conventional tomography is the fact that radiation exposure is less while the resolution is nearly the same. If computer tomography and conventional tomography do not reveal any fractures an exploratory tympanotomy should precede the cochlear implant operation in patients with a history of cranio-cerebral trauma.

Audiometry, Evoked Response↗
PubMed1979

Simultaneous recording of fast and slow auditory evoked potentials (slow-fast-simultaneous-ERA, SFS-ERA).

In order to reduce measurement time we have used part of the interstimulus interval of the slow cortical responses to record fast brain stem responses. For this purpose we reconstructed a programmable audiometer and preamplifier which are controlled by a computer. These, with 1/4 ms-click and tone-burst stimulation simultaneously gained fast and slow responses, not only give a frequency-related view of the threshold and the kind of hearing loss--because of amplitude and latency--, but also in some cases--because of differences between both responses--give ideas of the possible location of the hearing impairment through the auditory pathways. The audiological value of this new method is discussed and explained by giving examples of two interesting cases, one central-neural hearing loss and one questionable aggravation.

Acoustic Stimulation↗
PubMed1979

[Behaviour of the fast brain stem response P6 under noise influence, an "objective noise audiometry" (author's transl)].

The fast brain stem response can be recorded even at the threshold; it informs on hearing in the high frequency range of greater than or equal to 2000 cps. Especially in those frequencies often the differentiation between sensorial and neural hearing impairment is of interest--f. e. controlling the pure tone threshold in noise: at sensorial hearing loss tones remain heard within noise of equal loudness unaltered, at neural hearing loss the tone vanishes in noise, e. g. the tone-intensity must be increased to make the tone arise again. This phenomenon known from subjective audiometry mentally can be transferred to the recording of acoustic evoked potentials and can be proved by the behaviour of latency of P6: at sensorial hearing loss the latency is prolonged (corresponding to minus 20 dB) but the response furthermore is recorded in the noise as well as at the click masked threshold; at neural hearing loss, however, the response can be recorded again with a click-intensity, which exceeds that of the noise clearly.

Audiometry↗