Preliminary evaluation of the FastCAP for users of the Nurotron cochlear implant

Background: Electrically evoked compound action potential (ECAP) can be used to measure the auditory nerve's response to electrical stimulation in cochlear implant (CI) users. In the Nurotron CI system, extracting the ECAP waveform from the stimulus artifact is time-consuming.

Method: We developed a new paradigm ("FastCAP") for use with Nurotron CI devices. In electrically evoked compound action potential in fast mode (FastCAP), N recordings are averaged directly on the CI hardware before data transmission, significantly reducing data transmission time. FastCAPs and ECAPs were measured across five electrodes and four stimulation levels per electrode. The FastCAP stimulation rate (33.3 Hz) is also faster than the ECAP rate (2.5 Hz).

Results: Results showed strong correlations between ECAPs and FastCAPs for N1 latency (r = 0.84, p < 0.001) and N1 amplitude (r = 0.97, p < 0.001). Test-retest reliability for FastCAPs was also high, with intraclass correlation coefficients of r = 0.87 for N1 latency (p < 0.001) and r = 0.96 for N1 amplitude (p < 0.001). The mean test time was 46.9 ± 1.4 s for the FastCAP and 340.3 ± 6.3 s for the ECAP. The FastCAP measurement time was significantly shorter than the ECAP measurement time (W = -210.0, p < 0.001). FastCAP thresholds were significantly correlated with behavioral thresholds in 7/20 participants and with comfortable loudness levels in 11/20 participants. The time required to measure FastCAPs was significantly lower than that for ECAPs. The FastCAP paradigm maintained the accuracy and reliability the ECAP measurements while offering a significant reduction in time requirements.

Conclusion: This preliminary evaluation suggests that the FastCAP could be an effective clinical tool to optimize CI processor settings (e.g., threshold stimulation levels) in users of the Nurotron CI device.