Addressing facial nerve stimulation in cochlear implants using model-based diagnostics

Abstract

Post-implantation facial nerve stimulation is a common side-effect of cochlear electrical stimulation. Facial nerve stimulation can often be resolved through adjustments in speech processor fitting but, in some instances, exhibit limited benefit or may have a detrimental effect on speech perception. In this study, the apical reference stimulation mode was investigated as a potential intervention to facial nerve stimulation. Firstly, a model refinement software tool was developed to improve the accuracy of models created by an automated workflow. Secondly, the refined model of the human cochlea, facial nerve and electrode array, coupled with a neural model, was used to predict excitations of auditory and facial nerve fibres. Finally, psychoacoustic tests were used to determine auditory comfort and threshold levels for the apical reference stimulation mode while simultaneously capturing electromyography data. The refinement tool illustrated an improved accuracy compared to measured data. Models predicted a desirable outcome for apical reference stimulation, as facial nerve fibre thresholds were higher and auditory thresholds were lower, in direct comparison to conventional monopolar stimulation. Psychoacoustic tests illustrated decreased auditory thresholds and increased dynamic range during apical reference stimulation. Furthermore, apical reference stimulation resulted in lower electromyography energy levels, compared to conventional monopolar stimulation, which suggests a reduction in facial nerve stimulation. Subjective feedback corroborated that apical reference stimulation alleviated facial nerve stimulation. This suggests that apical reference stimulation may be a viable strategy to alleviate facial nerve stimulation considering the improvements in dynamic range and auditory thresholds, complemented with a reduction in facial nerve stimulation