Cochlear implants (CI) provide deaf or severely hearingimpaired people with speech perception. A microphone and sound processor behind the ear capture sound and transmit it, via a radiofrequency link and magnets, to an implant below the scalp. The implant delivers the transformed acoustic signal as electric pulses onto the auditory nerve fibres through intracochlear electrodes [1]. Importantly, hearing loss increases the risk of dementia, depression, psychosis, and schizophrenia. Electroconvulsive therapy is a highly effective treatment for severe and psychotic depression and other psychiatric conditions, and ECT is often the last resort in medically treatment-resistant patients. ECT relies on the induction of seizures by electrical stimulation (Fig. 1). Transcranial magnetic stimulation (TMS), on the other hand, uses electromagnetic induction fields in different brain regions to treat neurological and psychiatric disorders [2]. Both methods space a range of doses that determines the strength of the current or the electromagnetic field generated in the body. The dose is defined by parameters that affect the spatial distribution (including properties of the stimulating electrodes or coil) and temporal characteristics (including parameters of the current or voltage waveform of the stimulating electrodes or coil) of the electromagnetic field [3]. The number of CI-users is increasing [1], and so is the number of CI-users that may need psychiatric treatment with ECT or TMS. However, ECT and TMS are not advised by CI manufacturers and contraindicated in ECT and TMS guidelines [2,4]. Thus, CI-patients are prevented from an effective and, in some cases, life-saving treatment [5,6]. Potential problems with electrical or magnetic stimulation in CI patients have been argued to include heating of the device and heat-induced injury to adjacent tissue, induction of current, damage to the implant, and magnetic displacement [2].

中文翻译：

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人工耳蜗不应成为电休克疗法和经颅磁刺激疗法的绝对禁忌症

人工耳蜗 (CI) 为耳聋或重度听力障碍人士提供言语感知能力。耳朵后面的麦克风和声音处理器捕捉声音，并通过射频链路和磁铁将其传输到头皮下方的植入物。植入物通过耳蜗内电极将转换后的声学信号作为电脉冲传递到听觉神经纤维上 [1]。重要的是，听力损失会增加患痴呆症、抑郁症、精神病和精神分裂症的风险。电休克疗法是治疗重度和精神病性抑郁症和其他精神疾病的高效疗法，而 ECT 通常是对药物治疗抵抗的患者的最后手段。ECT 依赖于电刺激诱发癫痫发作（图 1）。另一方面，经颅磁刺激 (TMS) 利用不同大脑区域的电磁感应场来治疗神经和精神疾病 [2]。这两种方法都将一定范围的剂量隔开，这些剂量决定了体内产生的电流或电磁场的强度。剂量由影响电磁场的空间分布（包括刺激电极或线圈的特性）和时间特性（包括刺激电极或线圈的电流或电压波形的参数）的参数定义[3]。CI 用户的数量正在增加 [1]，因此可能需要使用 ECT 或 TMS 进行精神治疗的 CI 用户的数量也在增加。但是，CI 制造商不建议使用 ECT 和 TMS，并且在 ECT 和 TMS 指南中禁用 ECT 和 TMS [2,4]。因此，CI 患者无法获得有效的治疗，并且在某些情况下，挽救生命的治疗 [5,6]。CI 患者的电或磁刺激的潜在问题被认为包括设备加热和相邻组织的热损伤、电流感应、植入物损坏和磁位移 [2]。