Intraoperative recordings of electromyogenic responses from the human stapedius muscle

Zarowski, Andrzej; Fuentes, M.C.; Schaudel, D.; Leblans, Marc; Coninck, L. De; Theunen, Tinne; Vermeiren, A.; Verschoren, L.; Dinther, Joost van; Offeciers, Erwin

doi:10.1016/j.heares.2021.108290

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…The alternative anterior access to the SM—via drilling of the PE and through the stapedial tendon to record the electromyographic activity of the SM have been previously documented [ 33 – 35 ]. This anterior type surgical approach might decrease the success rate regarding access to the muscle fibers.…”

Section: Discussionmentioning

confidence: 99%

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

et al. 2022

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Human stapedius muscle (SM) can be directly and safely accessed via retrofacial approach, opening new approaches to directly measure the electrically evoked stapedius reflex threshold (eSRT). The measurement of the SM activity via direct surgical access represents a potential tool for objective eSRT fitting of cochlear implants (CI), increasing the benefit experienced by the CI users and leading to new perspectives in the development of smart implantable neurostimulators. 3D middle-ear reconstructions created after manual segmentation and related SM accessibility metrics were evaluated before the CI surgery for 16 candidates with assessed stapedius reflex. Retrofacial approach to access the SM was performed after facial recess exposure. In cases of poor exposition of SM, the access was performed anteriorly to the FN via drilling of the pyramidal eminence (PE). The total access rate of the SM via both the retrofacial and anterior approach of the FN was 100%. In 81.2% of cases (13/16), the retrofacial approach allowed to access the SM on previously categorized well exposed (8/8), partially exposed (4/5), and wholly concealed (1/3) SM with respect to FN. Following intraoperative evaluation in the remaining 18.8% (3/16), the SM was accessed anteriorly via drilling of the PE. Exposure of SM with respect to the FN and the sigmoid sinus’s prominence was a predictor for the suitable surgical approach. The retrofacial approach offers feasible and reproducible access to the SM belly, opening direct access to electromyographic sensing of the eSRT. Surgical planner tools can quantitatively assist pre-surgical assessment.

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Section: Discussionmentioning

confidence: 99%

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

et al. 2022

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“…The stapedial reflex is a normal autonomic reflex that protects the ear from loud noise and requires an intact auditory nerve (afferent limb), central auditory brainstem, and facial nerve (efferent limb) (6). The electrically evoked stapedial reflex (eSR) test is an objective measure of stapedial muscle contraction in response to electrical stimulation through the cochlear nerve and requires an intact reflex pathway through the brainstem (7). The eSR is an important tool in the CI programming battery and has been used in this field for decades (8,9).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Use of Electrical Stapedius Reflex Testing for Cochlear Nerve Monitoring During Simultaneous Translabyrinthine Resection of Vestibular Schwannoma and Cochlear Implantation

Kocharyan

Daher

Nassiri

et al. 2022

Otology &Amp; Neurotology

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Objective: To report the novel use of intraoperative electrically evoked stapedial reflex (eSR) for cochlear nerve monitoring during simultaneous translabyrinthine resection of vestibular schwannoma (VS) and cochlear implantation. Study Design: Clinical capsule report with video demonstration. Setting: Tertiary academic referral center. Patient: A 58-year-old female presented with a small right intracanalicular VS with associated asymmetrical right moderate to severe sensorineural hearing loss, poor word recognition, tinnitus, and disequilibrium. Based on patient symptomatology and goals, simultaneous CI with translabyrinthine resection of the VS was performed. Intervention: Cochlear implantation before the tumor was resected facilitated intraoperative eSRs by delivering repeated single-electrode stimulations through the cochlear implant (CI) electrode during tumor resection. A pulse duration of 50-us and a current amplitude of 200-CL or 648-us was used to elicit eSRs visible through the facial recess. Intraoperative eSR was monitored in conjunction with electrically evoked compound action potentials via neural response telemetry and electrical auditory brainstem response. Results: Despite the transient evoked compound action potentials amplitude and electrical auditory brainstem response latency changes, the visually observed eSR was preserved and remained robust throughout tumor dissection, indicating an intact cochlear nerve. Four weeks postoperatively, the patient exhibited open-set speech capacity (14% CNC and 36% AzBio in quiet). Conclusion:The current study demonstrates the feasibility of using intraoperative eSR via a CI electrode to monitor cochlear nerve integrity during VS resection, which may indicate successful CI outcomes. These preliminary findings require further substantiation in a larger study.

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Diagnosis and Management of Cochlear Implant Malfunctions

Zwolan,

Stach

2024

Pediatric Cochlear Implantation

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Intraoperative recordings of electromyogenic responses from the human stapedius muscle

Cited by 3 publications

References 29 publications

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

Intraoperative Use of Electrical Stapedius Reflex Testing for Cochlear Nerve Monitoring During Simultaneous Translabyrinthine Resection of Vestibular Schwannoma and Cochlear Implantation

Diagnosis and Management of Cochlear Implant Malfunctions

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