Functional MR imaging of the auditory cortex with electrical stimulation of the promontory in 35 deaf patients before cochlea implantation.
OBJECTIVE
Promontory testing is used for preoperative assessment of the auditory pathway before cochlear implantation. This method depends on patient cooperation and cannot be used in children or disabled persons. Promontory stimulation during functional MR imaging (fMRI) provides a new and objective method to test the integrity of the auditory pathway. To evaluate the method, we performed this prospective study in deaf adult patients.


METHODS
fMRI of the auditory pathway with electrical stimulation of the promontory was performed in 35 profoundly deaf patients, bilaterally in seven. For safe stimulation inside the MR environment, a specially designed nerve stimulator was used. We acquired nine sections parallel to the sylvian fissure by using an echo-planar pulse sequence (1.5 T). To evaluate the number of pixels in the auditory cortex, areas were counted and the minimum confidence level (p(st) value) was determined. The auditory pathway was called intact when the minimal p(st) value was 10(-5) or when the minimal p(st) value was 10(-4) in at least five activated pixels.


RESULTS
Images in 85% of patients reporting an auditory sensation showed activation of the contralateral auditory cortex. In the group of patients reporting no hearing sensation, images in 75% did not show activation.


CONCLUSIONS
This method can prove the intactness of the auditory pathway and help the surgeon in decision making before cochlear implantation. However, a negative finding should not be interpreted as indicating a nonfunctioning auditory pathway. Additional technical refinements and experience are needed to further improve this method.
Schmidt
Anja M
AM
Department of Neuroradiology, Medical School Hannover, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Weber
Benno P
BP
Vahid
Mehdi
M
Zacharias
Rene
R
Neuburger
Jürgen
J
Witt
Myriam
M
Lenarz
Thomas
T
Becker
Hartmut
H
D000328:Adult; D000368:Aged; D001303:Auditory Cortex / Q000503:physiopathology*; D001306:Auditory Pathways / Q000503:physiopathology; D001931:Brain Mapping; D019929:Cochlear Implantation; D003056:Cochlear Nerve / Q000503:physiopathology*; D003638:Deafness / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D004292:Dominance, Cerebral / Q000502:physiology; D004558:Electric Stimulation / Q000295:instrumentation*; D004567:Electrodes, Implanted; D005260:Female; D006309:Hearing / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome