**The Effects of Multi-Mode Monophasic Stimulation with Capacitive Discharge on the Facial Nerve Stimulation Reduction in Young Children with Cochlear Implants: Intraoperative Recordings**

**Fabiana Danieli 1,2,\*, Miguel Angelo Hyppolito 3, Raabid Hussain 4, Michel Hoen 5, Chadlia Karoui <sup>5</sup> and Ana Cláudia Mirândola Barbosa Reis <sup>6</sup>**


**Abstract:** Facial nerve stimulation (FNS) is a potential complication which may affect the auditory performance of children with cochlear implants (CIs). We carried out an exploratory prospective observational study to investigate the effects of the electrical stimulation pattern on FNS reduction in young children with CI. Ten ears of seven prelingually deafened children with ages up to 6 years old who undergone a unilateral or bilateral CI surgery were included in this study. Electromyographic (EMG) action potentials from orbicularis oculi muscle were recorded using monopolar biphasic stimulation (ST1) and multi-mode monophasic stimulation with capacitive discharge (ST2). Presence of EMG responses, facial nerve stimulation thresholds (T-FNS) and EMG amplitudes were compared between ST1 and ST2. Intra-cochlear electrodes placement, cochlear-nerve and electrode-nerve distances were also estimated to investigate their effects on EMG responses. The use of ST2 significantly reduced the presence of intraoperative EMG responses compared to ST1. Higher stimulation levels were required to elicit FNS with ST2, with smaller amplitudes, compared to ST1. No and weak correlation was observed between cochlea-nerve and electrode-nerve distances and EMG responses, respectively. ST2 may reduce FNS in young children with CI. Differently from the electrical stimulation pattern, the cochlea-nerve and electrode-nerve distances seem to have limited effects on FNS in this population.

**Keywords:** facial nerve stimulation; cochlear implant; electromyography; stimulation strategy; image analysis; computed tomography; image segmentation; 3D model
