Anodic Polarity Minimizes Facial Nerve Stimulation as a Side Effect of Cochlear Implantation

Abstract

One severe side effect of the use of cochlear implants (CI) is coincidental facial nerve stimulation (FNS). Clinical methods to alleviate FNS range from the reprogramming of processor settings to revision surgery. We systematically assessed different changes in CI stimulation modes that have been discussed in the literature as “rescue factors” from FNS: electrode configuration (broad to focused), pulse shape (symmetric biphasic to pseudo-monophasic), and pulse polarity (cathodic to anodic). An FNS was assessed, based on electrophysiological thresholds, in 204 electrically evoked compound action potential (eCAP) input/output functions recorded from 33 ears of 26 guinea pigs. The stimulation level difference between auditory nerve eCAP threshold and FNS threshold was expressed as the eCAP-to-FNS offset. Coincidental FNS occurred in all animals and in 45% of all recordings. A change from monopolar to focused (bipolar, tripolar) configurations minimized FNS. The Euclidean distance between the CI contacts and the facial nerve explained no more than 33% of the variance in FNS thresholds. For both the FNS threshold and the eCAP-to-FNS offset, the change from cathodic to anodic pulse polarity significantly reduced FNS and permitted a gain of 14–71% of the dynamic range of the eCAP response. This “anodic rescue effect” was stronger for pseudo-monophasic pulses as compared to the symmetric biphasic pulse shape. These results provide possible mechanisms underlying recent clinical interventions to alleviate FNS. The “anodic-rescue effect” may offer a non-invasive therapeutic option for FNS in human CI users that should be tested clinically, preferably in combination with current-focusing methods.

Hearing Performance in Cochlear Implant Users Who Have Facial Nerve Stimulation

“… 16 Meanwhile, at Cochlear Corporation, a change in the stimulation mode was observed, changing the mode from monopolar to bipolar, allowing a more restricted electric field, dispersing the electric current less, and being able to avoid and/or decrease FNS. 17 …”

“…16 Meanwhile, at Cochlear Corporation, a change in the stimulation mode was observed, changing the mode from monopolar to bipolar, allowing a more restricted electric field, dispersing the electric current less, and being able to avoid and/or decrease FNS. 17 In our study, data regarding the recognition of sentences in different conditions were collected. The average of speech recognition in open presentation before the identification of the FNS was 57,5% of correct answers; however, after the identification of the FNS and adjustments had been made to avoid extra hearing aid stimulation, the average speech recognition was 83,7% correct.…”

Cochlear Implant Stimulation Parameters Play a Key Role in Reducing Facial Nerve Stimulation

“…Both return current via intracochlear electrodes. A study investigating the effects of different grounding strategies on FNS efficacy, conducted using 204 electrically evoked compound action potential (eCAP) input/output functions recorded from 33 ears of 26 guinea pigs, revealed that-for biphasic pulses-the broad-MP grounding was associated with a high occurrence of FNS (65%), while bipolar and an experimental tripolar configuration (expected to be the most focused) generated only 20% and 2% of FNS occurrences, respectively [15].…”