AutoART & MAESTRO 7.0: Fast, Intuitive, Reliable ECAP Measurement

When you’re fitting cochlear implant recipients, objective measures can be a very useful tool. For example, objective measures can quickly confirm implant function. They can also provide valuable insight into the physiological health of the auditory system.¹

On the other hand, time is valuable, especially during a fitting session. That’s why objective measures should be simple and practical, so that you can routinely perform them for your patients without losing time or focus.

One widely used objective measure is electrically evoked compound action potentials (ECAPs). This method stimulates the cochlear implant electrode array to measure the response of the auditory nerve. This makes ECAPs a simple and effective measurement of how the auditory nerve responds to stimulation.

Generally, ECAPs can be used to explore the auditory nerve response at each electrode contact on the cochlear implant array. This allows you to quickly verify electrode-nerve interface intraoperatively. ECAPs can also offer helpful guidance in establishing fitting levels, and may be especially useful where behavioral responses are limited or uncertain.

We’re excited to introduce AutoART, a quick and completely automatic ECAP measurement tool in our MAESTRO 7.0 system software.

There are three key benefits we’ve incorporated into AutoART:

• Simple & intuitive to use
• Accurate, reliable data
• Fastest automatic ECAP recording system^2,3,4,5,6,7

Today, we’re going to look at how AutoART’s fast, intuitive, and reliable objective measure tool let you focus your time and energy on your patients.

Ease of Use

Let’s start with how easy it is to use AutoART in MAESTRO 7.0. This simplicity is a key part of an overall intuitive workflow design that makes MAESTRO 7.0 our most user-friendly software ever. Even if you’ve never used our MAESTRO software before, you can quickly become comfortable with MAESTRO 7.0 and AutoART.

Previously, MED-EL fitting software offered manual measurement and analysis of Auditory Nerve Response Telemetry (ART) on each electrode channel. This method is still available in MAESTRO 7, but based on extensive clinical feedback, we have created a robust automatic process for measuring auditory nerve responses.

AutoART is simple to use—you just click one button to automatically measure and analyze all electrode channels. You can also easily pause or skip electrodes during the measurement.

AutoART automatically analyzes all the data, so you can get clearly defined ECAP thresholds without the need for time-consuming manual analysis.

The intuitive design also makes it simple to quickly and easily perform intraoperative AutoART to confirm implant function and auditory nerve response.

FineGrain Precision

AutoART isn’t just simple to use—it’s also an exceptionally accurate and reliable means of measuring ECAP thresholds.

In other ECAP tools, such as NRT™ & NRI, the stimulation on an electrode is generally repeated at a certain charge. Then the charge is increased by relatively large steps and repeated again until a nerve response is detected.  The threshold then has to be refined with an up and down stimulation pattern.

Unique to AutoART, the stimulation intensity is continuously increased in very small steps. This FineGrain method enables a very precise calculation of the ECAP threshold for each electrode. This also offers a predictable and relatively smooth loudness increase, making it easier for patients to anticipate loudness growth.

Once ECAP threshold is determined, the next electrode is stimulated. The electrodes are scheduled in a pre-defined sequence that automatically switches between middle, apical, and basal channels. AutoART measures all channels by default, but if testing is stopped, this order ensures measurements are well-distributed across the cochlea.

The algorithm also gathers response data from more than one recording electrode. The recording electrode with minimum artifact is automatically selected—removing the need to manually vary recording electrode to reduce artifact.

Advantages of AutoART:

• Precise FineGrain calculation of auditory nerve ECAP threshold and slope
• Predictable loudness growth for greater patient comfort
• Measurements across all electrodes or an automatically prioritized subset
• Multiple recording electrodes with automatic selection for minimum artifact

Automatic Analysis

So, after you click a single button, AutoART begins automatically measuring each electrode channel with FineGrain precision. Then what happens?

While recording each channel, AutoART automatically analyzes ECAP results. With advanced artifact reduction and a robust algorithm that accounts for a wide range of physiological properties, AutoART is able to provide a reliable and robust analysis of ECAP thresholds and auditory nerve function.

In testing, AutoART was able to correctly identify ECAP thresholds as reliably as experienced human experts.

AutoART uses an intuitive interface that displays ECAP thresholds for each available channel. A more detailed view of the measured responses and amplitude growth function is also available for each measured channel.