Direct Elicitation of Cortical Auditory Evoked Potentials by Electrical Stimulation and Their Use to Verify the Most Comfortable Level of Stimulation in Cochlear Implant Users

Introduction: This study was designed to investigate the use of electrically evoked cortical auditory evoked potentials (eCAEPs) as a tool for cochlear implant (CI) verification, the relationships between the site and intensity of stimulation and the detection rates and morphologies of eCAEPs as well as investigate whether correlations exist between the morphologies of eCAEPs and speech perception in quiet and in noise, duration of hearing loss, age at implantation, whether the hearing loss bilateral or single-sided and the electrode current level required to elicit MCL stimulation. Methods: 32 adult unilateral CI users with postlingual hearing loss were enrolled. The stimuli were 1 kHz biphasic alternating pulses and were presented at either the behaviorally measured MCL or 50% of this value (MCL0.5) via the CI fitting software. Pulses were directed to apical, medial, or basal electrodes. CAEPs were recorded from a scalp electrode placed at the vertex, low forehead, and contralateral mastoid and were evaluated by two electrophysiologists. Results: Overall, eCAEPs could be detected in 31/32 users when stimulating at MCL, and in 29/32 users when stimulating at MCL0.5. The detection rates were 31, 31, and 28/32 for apical, medial, and basal stimulation at MCL, and 29, 29, and 26/32 at MCL0.5. Significant differences in eCAEP amplitudes and latencies were observed across electrodes and stimulation levels. No significant correlations were found between eCAEP latencies and amplitudes and user age, duration of deafness prior to CI surgery, or with bilateral versus single-sided hearing loss, nor with the charge level required to elicit MCL, or with speech perception scores in quiet. Peak latencies correlated with speech perception scores in some configurations of speech-in-noise. Conclusion: eCAEPs can readily be elicited in the majority of adult CI users and show normal waveform characteristics at stimulation levels corresponding to MCL, as well as at basal, medial, and apical electrode stimulation sites. Neither the latencies nor amplitudes of eCAEPs are confounded by variables of age, duration of deafness prior to CI surgery, or the laterality of hearing loss. eCAEPs are a useful, objective method evaluate sound perception in CI users.