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Geys M, Sijgers L, Dobrev I, Dalbert A, Röösli C, Pfiffner F, Huber A. ZH-ECochG Bode Plot: A Novel Approach to Visualize Electrocochleographic Data in Cochlear Implant Users. J Clin Med 2024; 13:3470. [PMID: 38929998 PMCID: PMC11205027 DOI: 10.3390/jcm13123470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/08/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Various representations exist in the literature to visualize electrocochleography (ECochG) recordings along the basilar membrane (BM). This lack of generalization complicates comparisons within and between cochlear implant (CI) users, as well as between publications. This study synthesized the visual representations available in the literature via a systematic review and provides a novel approach to visualize ECochG data in CI users. Methods: A systematic review was conducted within PubMed and EMBASE to evaluate studies investigating ECochG and CI. Figures that visualized ECochG responses were selected and analyzed. A novel visualization of individual ECochG data, the ZH-ECochG Bode plot (ZH = Zurich), was devised, and the recordings from three CI recipients were used to demonstrate and assess the new framework. Results: Within the database search, 74 articles with a total of 115 figures met the inclusion criteria. Analysis revealed various types of representations using different axes; their advantages were incorporated into the novel visualization framework. The ZH-ECochG Bode plot visualizes the amplitude and phase of the ECochG recordings along the different tonotopic regions and angular insertion depths of the recording sites. The graph includes the pre- and postoperative audiograms to enable a comparison of ECochG responses with the audiometric profile, and allows different measurements to be shown in the same graph. Conclusions: The ZH-ECochG Bode plot provides a generalized visual representation of ECochG data, using well-defined axes. This will facilitate the investigation of the complex ECochG potentials generated along the BM and allows for better comparisons of ECochG recordings within and among CI users and publications. The scripts used to construct the ZH-ECochG Bode plot are provided by the authors.
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Affiliation(s)
- Marlies Geys
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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Haggerty RA, Hutson KA, Riggs WJ, Brown KD, Pillsbury HC, Adunka OF, Buchman CA, Fitzpatrick DC. Assessment of cochlear synaptopathy by electrocochleography to low frequencies in a preclinical model and human subjects. Front Neurol 2023; 14:1104574. [PMID: 37483448 PMCID: PMC10361575 DOI: 10.3389/fneur.2023.1104574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Cochlear synaptopathy is the loss of synapses between the inner hair cells and the auditory nerve despite survival of sensory hair cells. The findings of extensive cochlear synaptopathy in animals after moderate noise exposures challenged the long-held view that hair cells are the cochlear elements most sensitive to insults that lead to hearing loss. However, cochlear synaptopathy has been difficult to identify in humans. We applied novel algorithms to determine hair cell and neural contributions to electrocochleographic (ECochG) recordings from the round window of animal and human subjects. Gerbils with normal hearing provided training and test sets for a deep learning algorithm to detect the presence of neural responses to low frequency sounds, and an analytic model was used to quantify the proportion of neural and hair cell contributions to the ECochG response. The capacity to detect cochlear synaptopathy was validated in normal hearing and noise-exposed animals by using neurotoxins to reduce or eliminate the neural contributions. When the analytical methods were applied to human surgical subjects with access to the round window, the neural contribution resembled the partial cochlear synaptopathy present after neurotoxin application in animals. This result demonstrates the presence of viable hair cells not connected to auditory nerve fibers in human subjects with substantial hearing loss and indicates that efforts to regenerate nerve fibers may find a ready cochlear substrate for innervation and resumption of function.
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Affiliation(s)
- Raymond A. Haggerty
- Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kendall A. Hutson
- Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - William J. Riggs
- Department of Otolaryngology, The Ohio State University, Columbus, OH, United States
| | - Kevin D. Brown
- Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Harold C. Pillsbury
- Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Oliver F. Adunka
- Department of Otolaryngology, The Ohio State University, Columbus, OH, United States
| | - Craig A. Buchman
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, United States
| | - Douglas C. Fitzpatrick
- Department of Otolaryngology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Bayri Ulukan M, Ciprut A. Intracochlear electrocochleography findings in cochlear implant recipients with auditory neuropathy spectrum disorder. Int J Pediatr Otorhinolaryngol 2023; 170:111596. [PMID: 37267660 DOI: 10.1016/j.ijporl.2023.111596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This study aimed to compare intracochlear electrocochleography (ECochG) findings in a group of cochlear implant (CI) recipients with auditory neuropathy spectrum disorder (ANSD) with a group of CI recipients with sensorineural hearing loss (SNHL). Auditory outcome and spectral resolution findings were also compared among CI recipients with and without cochlear microphonic (CM) responses. METHODS This single-center, prospective cohort study was undertaken at a tertiary referral center. CM responses by the intracochlear ECochG test were recorded in CI recipients at 0.25-2 kHz. Speech, spatial, and hearing quality (SSQ) outcomes and spectral resolution measured with the spectral-temporally modulated ripple test were obtained for each recipient. The study included 62 implanted ears in 46 recipients, of which 59% (n = 27) were male and 41% (n = 19) were female. Twenty-nine ears with ANSD and 33 ears with SNHL were included. The mean age of the participants was 11 years. The results compared the intracochlear ECochG findings of the ANSD group with those of the SNHL group. RESULTS Participants were divided into two groups with and without obtainable CM responses. CM responses were obtained in 13 of 29 ears in the ANSD group and 14 of 33 ears in the SNHL group. CM thresholds obtained were better according to behavioral audiometric responses in some frequencies in the ANSD group. No significant difference was found in the auditory outcome and spectral resolution among CI recipients with and without CM responses. CONCLUSIONS Intracochlear ECochG has a limited potential clinical value for monitoring ANSD. CM thresholds obtained using ECochG may not reflect behavioral hearing thresholds.
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Affiliation(s)
- Merve Bayri Ulukan
- Marmara University, Health Sciences Institute, Istanbul, Turkey; Cochlear, Turkey.
| | - Ayca Ciprut
- Marmara University, Medical School, Audiology Department, Istanbul, Turkey
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Schvartz-Leyzac KC, Colesa DJ, Swiderski DL, Raphael Y, Pfingst BE. Cochlear Health and Cochlear-implant Function. J Assoc Res Otolaryngol 2023; 24:5-29. [PMID: 36600147 PMCID: PMC9971430 DOI: 10.1007/s10162-022-00882-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/24/2022] [Indexed: 01/06/2023] Open
Abstract
The cochlear implant (CI) is widely considered to be one of the most innovative and successful neuroprosthetic treatments developed to date. Although outcomes vary, CIs are able to effectively improve hearing in nearly all recipients and can substantially improve speech understanding and quality of life for patients with significant hearing loss. A wealth of research has focused on underlying factors that contribute to success with a CI, and recent evidence suggests that the overall health of the cochlea could potentially play a larger role than previously recognized. This article defines and reviews attributes of cochlear health and describes procedures to evaluate cochlear health in humans and animal models in order to examine the effects of cochlear health on performance with a CI. Lastly, we describe how future biologic approaches can be used to preserve and/or enhance cochlear health in order to maximize performance for individual CI recipients.
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Affiliation(s)
- Kara C Schvartz-Leyzac
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Ave, Charleston, SC, 29425, USA
| | - Deborah J Colesa
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Donald L Swiderski
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Yehoash Raphael
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA
| | - Bryan E Pfingst
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Kresge Hearing Research Institute, University of Michigan, 1150 Medical Center Drive, Ann Arbor, MI, 48109-5616, USA.
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Relationship Between Intraoperative Electrocochleography Responses and Immediate Postoperative Bone Conduction Thresholds in Cochlear Implantation. Otol Neurotol 2022; 43:e880-e887. [PMID: 35970166 DOI: 10.1097/mao.0000000000003620] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the relationship between intraoperative electrocochleography (ECochG) measurements and residual hearing preservation after cochlear implant (CI) surgery by comparing differences between preoperative and immediate postoperative bone conduction thresholds. STUDY DESIGN Prospective cohort study. SETTING Tertiary academic referral center. PATIENTS Sixteen patients with preoperative residual hearing and measurable (no-vibrotactile) bone conduction thresholds at 250 and/or 500 Hz who underwent cochlear implantation. MAIN OUTCOME MEASURE Intraoperative ECochG and air and bone conduction thresholds. RESULTS Nine patients showed no significant drop (<30%) in ECochG amplitude during CI surgery with an average preoperative and immediate postoperative BC threshold of 46 and 39 dB HL, respectively, at 500 Hz. Seven patients with a decrease in ECochG amplitude of 30% or greater showed an average preoperative 500 Hz BC threshold of 32 dB HL and immediate postoperative threshold of 55 dB HL. Air and bone conduction thresholds measured approximately 1 month after CI surgery show delayed-onset of hearing loss across our study patients. CONCLUSIONS A small decrease (<30%) in difference response or cochlear microphonics amplitude correlates with no significant changes in immediate postoperative residual hearing, whereas patients who show larger changes (≥30%) in difference response or cochlear microphonics amplitude during intraoperative ECochG measurements show significant deterioration in BC thresholds. This study reveals the necessity of prompt postoperative bone conduction measurement to isolate the intraoperative cochlear trauma that may be detected during intraoperative ECochG measurements. Although delayed postoperative audiometrics represent longer-term functional hearing, it includes the sum of all postoperative changes during the recovery period, including subacute changes after implantation that may occur days or weeks later. Measuring air and bone conduction thresholds immediately postoperatively will better isolate factors influencing intraoperative, early postoperative, and delayed postoperative hearing loss. This will ultimately help refine surgical technique, device design, and highlight the use of intraoperative ECochG in monitoring cochlear trauma during CI surgery.
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Agrawal S, Coulthurst S, Nachman A, Koka K, Murray M. Acoustic component programming in children with cochlear implants using electrocochleography. Int J Audiol 2021; 61:736-743. [PMID: 34355617 DOI: 10.1080/14992027.2021.1917779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Objective measurements improve reliability and effectiveness of hearing assessment and cochlear implant (CI) programming in young children. In CI recipients with acoustic hearing in the implanted ear, electrocochleography (ECochG) can be conducted using intracochlear electrodes. The cochlear microphonic (CM) portion of ECochG has been shown to correlate with pure-tone audiometric thresholds in adult and paediatric CI recipients. Our goal was to determine if ECochG thresholds can be used to appropriately fit the acoustic component to the implanted ear in children. DESIGN Prospective. STUDY SAMPLE Eight children (aged 3.5-15.5 years, 10 ears) implanted with Advanced Bionics HiFocus Mid-Scala electrode array were recruited. CI ear acoustic thresholds were measured behaviourally and via ECochG. Two acoustic component enabled CI programs were created using the two sets of thresholds. Age and language appropriate speech outcomes and subjective feedback were obtained. RESULTS Speech scores were equivalent with the behavioural and ECochG thresholds programs. Subjectively, the ECochG thresholds program was preferred by 7/8 subjects. One subject preferred to use an electric only program. CONCLUSION Our data suggest that ECochG thresholds can be used to supplement the behavioural clinical methods and aid the reliable fitting of the acoustic component in paediatric CI recipients.
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Valenzuela CV, Lichtenhan JT, Lefler SM, Koka K, Buchman CA, Ortmann AJ. Intracochlear Electrocochleography and Speech Perception Scores in Cochlear Implant Recipients. Laryngoscope 2021; 131:E2681-E2688. [PMID: 34019310 DOI: 10.1002/lary.29629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Previous studies have demonstrated that electrocochleography (ECochG) measurements made at the round window prior to cochlear implant (CI) electrode insertion can account for 47% of the variability in 6-month speech perception scores. Recent advances have made it possible to use the apical CI electrode to record intracochlear responses to acoustic stimuli. Study objectives were to determine 1) the relationship between intracochlear ECochG response amplitudes and 6-month speech perception scores and 2) to determine the relationship between behavioral auditory thresholds and ECochG threshold estimates. The hypothesis was that intracochlear ECochG response amplitudes made immediately after electrode insertion would be larger than historical controls (at the extracochlear site) and explain more variability in speech perception scores. STUDY DESIGN Prospective case series. METHODS Twenty-two adult CI recipients with varying degrees of low-frequency hearing had intracochlear ECochG measurements made immediately after CI electrode insertion using 110 dB SPL tone bursts. Tone bursts were centered at five octave-spaced frequencies between 125 and 2,000 Hz. RESULTS There was no association between intracochlear ECochG response amplitudes and speech perception scores. But, the data suggest a mild to moderate relationship between preoperative behavioral audiometric testing and intraoperative ECochG threshold estimates. CONCLUSION Performing intracochlear ECochG is highly feasible and results in larger response amplitudes, but performing ECochG before, rather than after, CI insertion may provide a more accurate assessment of a patient's speech perception potential. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Carla V Valenzuela
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Jeffery T Lichtenhan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Shannon M Lefler
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Kanthaiah Koka
- Department of Research and Technology, Advanced Bionics Corporation, Valencia, California, U.S.A
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Amanda J Ortmann
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Kim JS. Electrocochleography in Cochlear Implant Users with Residual Acoustic Hearing: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7043. [PMID: 32993065 PMCID: PMC7579537 DOI: 10.3390/ijerph17197043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022]
Abstract
(1) Objectives: This study reviews the use of electrocochleography (ECoG) as a tool for assessing the response of the peripheral auditory system and monitoring hearing preservation in the growing population of cochlear implant (CI) users with preserved hearing in the implanted ear. (2) Methods: A search was conducted in PubMed and CINAHL databases up to August 2020 to locate articles related to the ECoG measured during or after the cochlear implant (CI) surgery for monitoring purposes. Non-English articles, animal studies, literature reviews and editorials, case reports, and conference papers were excluded. The quality of studies was evaluated using the National Institute of Health (NIH) "Study Quality Assessment Tool for Case Series Studies". (3) Results: A total 30 articles were included for the systematic review. A total of 21 articles were intraoperative ECoG studies, while seven articles were postoperative studies. Two studies were conducted ECoG both during and after the surgery. Intraoperative ECoG studies focused on monitoring changes in ECoG response amplitudes during and/or after electrode insertion and predicting the scalar location of the electrode array. Postoperative ECoG studies focused on using the ECoG measurements to estimate behavioral audiometric thresholds and monitor pathophysiological changes related to delayed onset hearing loss postimplant. (4) Conclusions: ECoG is feasible to provide real-time feedback intraoperatively and has a potential clinical value to monitor the status of hearing preservation postoperatively in this CI population with residual acoustic hearing.
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Affiliation(s)
- Jeong-Seo Kim
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA 52242, USA
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