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Multi-mode grounding stimulation with anodic monophasic pulses to treat/prevent anomalous facial nerve stimulation in cochlear implant: case report

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Titel: Multi-mode grounding stimulation with anodic monophasic pulses to treat/prevent anomalous facial nerve stimulation in cochlear implant: case report
Autoren: Leonardo Elías Ordóñez Ordóñez, Paola Medina Bravo, Jogeiri Núñez Rivera, Estefany Catherine Hernández, Fabiana Danieli, Esther Sofía Angulo Martínez
Quelle: The Egyptian Journal of Otolaryngology, Vol 41, Iss 1, Pp 1-7 (2025)
Verlagsinformationen: SpringerOpen, 2025.
Publikationsjahr: 2025
Bestand: LCC:Otorhinolaryngology
Schlagwörter: Cochlear implant, Facial nerve, Facial nerve stimulation, Facial nerve stimulation cochlear implant, Case report, Otorhinolaryngology, RF1-547
Beschreibung: Abstract Background A notable complication in cochlear implant (CI) users is Anomalous Facial Nerve Stimulation (AFNS), an unintended stimulation of the facial nerve causing sound-triggered involuntary facial movements. Reported in about 5.6% of users (range 0.68–43%), AFNS risk factors include otologic conditions like otosclerosis or cochlear malformations and device factors such as high stimulation levels. Initial management involves conservative programming adjustments to minimize current spread. If unsuccessful, deactivating offending electrodes is necessary. While often effective, these interventions can occasionally lead to a decline in auditory performance, sometimes resulting in device discontinuation or even explantation. This requires careful clinical consideration to balance optimal hearing outcomes with patient comfort. Case presentation Two clinical cases of CI users with severe-to-profound sensorineural hearing loss are described. The first case, a 57-year-old woman suffering chronic otitis media since childhood, required explantation because of severe AFNS and reimplantation with a device delivering using multi-mode grounding (MMG) stimulation with anodic monophasic pulses (AMP). The AFNS was controlled, and she returned to using CI with acceptable functional gain. The second case, a 27-year-old woman with bilateral otospongiosis, exhibited intraoperative facial nerve stimulation during bipolar monophasic testing, but this was prevented postoperatively using MMG-AMP. Conclusions CI reimplantation with MMG-AMP was effective in managing severe AFNS when conservative measures failed to resolve it. This electrical stimulation pattern should be a viable option for CI candidates with AFNS risk factors (otosclerosis, inner ear malformations, FN dehiscence, cochlear obliteration/ossification) or for those who have an indication for cochlear reimplantation due to severe AFNS. Further studies are required to better explore the use of MMG-AMP in a larger number of subjects.
Publikationsart: article
Dateibeschreibung: electronic resource
Sprache: English
ISSN: 2090-8539
Relation: https://doaj.org/toc/2090-8539
DOI: 10.1186/s43163-025-00940-1
Zugangs-URL: https://doaj.org/article/9bc1a3337b71477a9e1de31f16a24ef0
Dokumentencode: edsdoj.9bc1a3337b71477a9e1de31f16a24ef0
Datenbank: Directory of Open Access Journals
Beschreibung
Abstract:Abstract Background A notable complication in cochlear implant (CI) users is Anomalous Facial Nerve Stimulation (AFNS), an unintended stimulation of the facial nerve causing sound-triggered involuntary facial movements. Reported in about 5.6% of users (range 0.68–43%), AFNS risk factors include otologic conditions like otosclerosis or cochlear malformations and device factors such as high stimulation levels. Initial management involves conservative programming adjustments to minimize current spread. If unsuccessful, deactivating offending electrodes is necessary. While often effective, these interventions can occasionally lead to a decline in auditory performance, sometimes resulting in device discontinuation or even explantation. This requires careful clinical consideration to balance optimal hearing outcomes with patient comfort. Case presentation Two clinical cases of CI users with severe-to-profound sensorineural hearing loss are described. The first case, a 57-year-old woman suffering chronic otitis media since childhood, required explantation because of severe AFNS and reimplantation with a device delivering using multi-mode grounding (MMG) stimulation with anodic monophasic pulses (AMP). The AFNS was controlled, and she returned to using CI with acceptable functional gain. The second case, a 27-year-old woman with bilateral otospongiosis, exhibited intraoperative facial nerve stimulation during bipolar monophasic testing, but this was prevented postoperatively using MMG-AMP. Conclusions CI reimplantation with MMG-AMP was effective in managing severe AFNS when conservative measures failed to resolve it. This electrical stimulation pattern should be a viable option for CI candidates with AFNS risk factors (otosclerosis, inner ear malformations, FN dehiscence, cochlear obliteration/ossification) or for those who have an indication for cochlear reimplantation due to severe AFNS. Further studies are required to better explore the use of MMG-AMP in a larger number of subjects.
ISSN:20908539
DOI:10.1186/s43163-025-00940-1