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Using Cortical Auditory Evoked Potentials in Active Middle Ear and Bone Conduction Implant Users: An Objective Method

Marcus Voola, Lorenzo Vignali¹, Hamidreza Mojallal¹

¹MED-EL GmbH, Innsbruck.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology

|August 5, 2025

Summary

Cortical auditory evoked potential (CAEP) measurements effectively optimized active middle ear implant (aMEI) and bone conduction implant (BCI) fittings in adults. This optimization led to significant improvements in speech-in-noise hearing performance.

Keywords:

Active middle ear implants Bone conduction implants Cortical auditory evoked potentials Fitting

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Area of Science:

Audiology
Neuroscience
Medical Devices

Background:

Hearing loss affects millions, necessitating advanced implantable solutions like active middle ear implants (aMEIs) and bone conduction implants (BCIs).
Optimizing the fitting of these devices is crucial for maximizing patient benefit and hearing outcomes.
Current fitting protocols may not always achieve optimal device performance for all users.

Purpose of the Study:

To evaluate the efficacy of cortical auditory evoked potential (CAEP) measures for optimizing aMEI and BCI device fitting in adult patients.
To determine if CAEP-guided optimization improves objective and subjective hearing performance.

Main Methods:

Cortical auditory evoked potentials (CAEPs) were recorded in response to LING sounds (/OO/, /AH/, /SH/) in sound field.
Device fitting maps were adjusted based on CAEP responses, aiming to elicit responses for all tested sounds.
Functional outcomes were assessed using pre- and post-optimization adaptive speech-in-noise tests, supplemented by subjective feedback.

Main Results:

CAEP measurements successfully guided optimization in a majority of participants (9 out of 12 requiring adjustment).
Significant differences in CAEP morphology were observed for middle- and high-frequency sounds post-optimization.
Adaptive speech-in-noise test results showed significant improvements after CAEP-guided fitting, with generally positive subjective feedback.

Conclusions:

Cortical auditory evoked potential (CAEP) measurements are a viable tool for optimizing the fitting of active middle ear implants (aMEIs) and bone conduction implants (BCIs) in adults.
CAEP-guided optimization leads to measurable improvements in hearing performance, particularly for middle- and high-frequency sounds.
The findings support the clinical use of CAEPs to enhance fitting protocols for implantable hearing devices.