New protocol for auditory brainstem implant positioning

Background: Surgery for applying the auditory brainstem implant is an otoneurosurgery that requires careful intraoperative monitoring to optimize the placement of the electrode paddle. This study aimed to validate a new method capable of increasing the accuracy of electrode array placement, reducing channel interaction, electrical artefacts, and saturation effects, and providing the largest number of electrodes that can be activated with the lowest possible electric charge. Materials and methods: Thirty-six subjects aged between 1.42 and 69.92 years were tested during surgery for auditory brainstem implantation. We recorded auditory electrical responses of the brainstem using the implant supplier's suggested stimulation protocol and the new protocol. Results: Saturations effects and electric artefacts were noticed respectively in 81.85% and 53.25% of recordings using implant supplier's method, while in 70.34% and 24.75% of recordings using the new method, with a percentage variation of 11.51% and 28.50%. Considering the amount of charge required to activate the electrodes, with the implant supplier's method an average charge of 14 nC was needed, while with the new protocol an average charge of 8 nC was necessary. Conclusions: The new method improves the coupling between the auditory brainstem implant and the surface of the cochlear nucleus.