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Walia A, Ortmann AJ, Lefler S, Holden TA, Puram SV, Herzog JA, Buchman CA. Electrocochleography-Based Tonotopic Map: I. Place Coding of the Human Cochlea With Hearing Loss. Ear Hear 2024:00003446-990000000-00336. [PMID: 39233326 DOI: 10.1097/aud.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
OBJECTIVES Due to the challenges of direct in vivo measurements in humans, previous studies of cochlear tonotopy primarily utilized human cadavers and animal models. This study uses cochlear implant electrodes as a tool for intracochlear recordings of acoustically evoked responses to achieve two primary goals: (1) to map the in vivo tonotopy of the human cochlea, and (2) to assess the impact of sound intensity and the creation of an artificial "third window" on this tonotopic map. DESIGN Fifty patients with hearing loss received cochlear implant electrode arrays. Postimplantation, pure-tone acoustic stimuli (0.25 to 4 kHz) were delivered, and electrophysiological responses were recorded from all 22 electrode contacts. The analysis included fast Fourier transformation to determine the amplitude of the first harmonic, indicative of predominantly outer hair cell activity, and tuning curves to identify the best frequency (BF) electrode. These measures, coupled with postoperative imaging for precise electrode localization, facilitated the construction of an in vivo frequency-position function. The study included a specific examination of 2 patients with auditory neuropathy spectrum disorder (ANSD), with preserved cochlear function as assessed by present distortion-product otoacoustic emissions, to determine the impact of sound intensity on the frequency-position map. In addition, the electrophysiological map was recorded in a patient undergoing a translabyrinthine craniotomy for vestibular schwannoma removal, before and after creating an artificial third window, to explore whether an experimental artifact conducted in cadaveric experiments, as was performed in von Békésy landmark experiments, would produce a shift in the frequency-position map. RESULTS A significant deviation from the Greenwood model was observed in the electrophysiological frequency-position function, particularly at high-intensity stimulations. In subjects with hearing loss, frequency tuning, and BF location remained consistent across sound intensities. In contrast, ANSD patients exhibited Greenwood-like place coding at low intensities (~40 dB SPL) and a basal shift in BF location at higher intensities (~70 dB SPL or greater). Notably, creating an artificial "third-window" did not alter the frequency-position map. CONCLUSIONS This study successfully maps in vivo tonotopy of human cochleae with hearing loss, demonstrating a near-octave shift from traditional frequency-position maps. In patients with ANSD, representing more typical cochlear function, intermediate intensity levels (~70 to 80 dB SPL) produced results similar to high-intensity stimulation. These findings highlight the influence of stimulus intensity on the cochlear operational point in subjects with hearing loss. This knowledge could enhance cochlear implant programming and improve auditory rehabilitation by more accurately aligning electrode stimulation with natural cochlear responses.
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Affiliation(s)
- Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri, USA
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Kommentar zu „Direktes Feedback während der Insertion der Elektrode des Cochlea-Implantats“. Laryngorhinootologie 2024; 103:630. [PMID: 39222629 DOI: 10.1055/a-2331-4482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
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Harris MS, Koka K, Thompson-Harvey A, Harvey E, Riggs WJ, Saleh S, Holder JT, Dwyer RT, Prentiss SM, Lefler SM, Kozlowski K, Hiss MM, Ortmann AJ, Nelson-Bakkum ER, Büchner A, Salcher R, Harvey SA, Hoffer ME, Bohorquez JE, Alzhrani F, Alshihri R, Almuhawas F, Danner CJ, Friedland DR, Seidman MD, Lenarz T, Telischi FF, Labadie RF, Buchman CA, Adunka OF. Amplitude Parameters Are Predictive of Hearing Preservation in a Randomized Controlled Trial of Intracochlear Electrocochleography During Cochlear Implant Surgery. Otol Neurotol 2024; 45:887-894. [PMID: 39052893 DOI: 10.1097/mao.0000000000004286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE To prospectively evaluate the association between hearing preservation after cochlear implantation (CI) and intracochlear electrocochleography (ECochG) amplitude parameters. STUDY DESIGN Multi-institutional, prospective randomized clinical trial. SETTING Ten high-volume, tertiary care CI centers. PATIENTS Adults (n = 87) with sensorineural hearing loss meeting CI criteria (2018-2021) with audiometric thresholds of ≤80 dB HL at 500 Hz. METHODS Participants were randomized to CI surgery with or without audible ECochG monitoring. Electrode arrays were inserted to the full-depth marker. Hearing preservation was determined by comparing pre-CI, unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to LF-PTA at CI activation. Three ECochG amplitude parameters were analyzed: 1) insertion track patterns, 2) magnitude of ECochG amplitude change, and 3) total number of ECochG amplitude drops. RESULTS The Type CC insertion track pattern, representing corrected drops in ECochG amplitude, was seen in 76% of cases with ECochG "on," compared with 24% of cases with ECochG "off" ( p = 0.003). The magnitude of ECochG signal drop was significantly correlated with the amount of LF-PTA change pre-CI and post-CI ( p < 0.05). The mean number of amplitude drops during electrode insertion was significantly correlated with change in LF-PTA at activation and 3 months post-CI ( p ≤ 0.01). CONCLUSIONS ECochG amplitude parameters during CI surgery have important prognostic utility. Higher incidence of Type CC in ECochG "on" suggests that monitoring may be useful for surgeons in order to recover the ECochG signal and preventing potentially traumatic electrode-cochlear interactions.
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Affiliation(s)
- Michael S Harris
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kanth Koka
- Advanced Bionics, LLC Valencia, California
| | - Adam Thompson-Harvey
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Erin Harvey
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William J Riggs
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Shaza Saleh
- King Saud University, College of Medicine, King Abdullah Ear Specialist Center (KAESC), Riyadh, Saudi Arabia
| | - Jordan T Holder
- Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sandra M Prentiss
- Department of Otolaryngology-Head & Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Shannon M Lefler
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kristin Kozlowski
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Meghan M Hiss
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Amanda J Ortmann
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Rolf Salcher
- Medizinische Hochschule Hannover, Hannover, Germany
| | - Steven A Harvey
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael E Hoffer
- Department of Otolaryngology-Head & Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Jorge E Bohorquez
- Department of Biomedical Engineering, University of Miami, Miami, Florida
| | - Farid Alzhrani
- King Saud University, College of Medicine, King Abdullah Ear Specialist Center (KAESC), Riyadh, Saudi Arabia
| | - Rana Alshihri
- King Saud University, College of Medicine, King Abdullah Ear Specialist Center (KAESC), Riyadh, Saudi Arabia
| | - Fida Almuhawas
- King Saud University, College of Medicine, King Abdullah Ear Specialist Center (KAESC), Riyadh, Saudi Arabia
| | | | - David R Friedland
- Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Fred F Telischi
- Department of Otolaryngology-Head & Neck Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Robert F Labadie
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Craig A Buchman
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Oliver F Adunka
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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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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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Eichler T, Lakomek A, Waschkies L, Meyer M, Sadok N, Lang S, Arweiler-Harbeck D. Two different methods to digitally visualize continuous electrocochleography potentials during cochlear implantation: a first description of feasibility. Eur Arch Otorhinolaryngol 2024; 281:2913-2920. [PMID: 38170210 PMCID: PMC11065901 DOI: 10.1007/s00405-023-08400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE The study explores the potential of real-time electrocochleographic potentials (ECochG) visualization during electrode insertion using digital microscopes such as RoboticScope (BHS®). Collaborative software development of the MAESTRO Software (MED-EL®) offers continuous ECochG monitoring during implantation and postoperative hearing evaluation, addressing previous time constraints. The study aims to assess software applicability and the impact of real-time visualization on long-term residual hearing preservation. METHODS Eight patients with residual hearing underwent cochlear implantation with Flex26 or Flex28 electrode according to the Otoplan evaluation. ECochG responses were measured and visualized during electrode insertion, with insertion times recorded. Two randomized display methods (graph and arrows) tracked ECochG potentials. Postoperative behavioral thresholds determined hearing preservation. Successful real-time intraoperative ECochG visualization was achieved in all cases, enabling surgeon adaptation. Mean electrode insertion time was 114 s, with postoperative thresholds comparable to preoperative values. Visualization did not affect surgeon workload. ECochG amplitudes differed between patients with and without residual hearing. CONCLUSION The study demonstrates effective implementation of advanced ECochG software combined with real-time visualization, enabling residual hearing preservation during CI. Visualization had no apparent effect on surgeon performance or workload. Future investigation involving a larger population will assess the long-term impact of ECochG on hearing threshold and structure preservation.
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Affiliation(s)
- Theda Eichler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany.
| | - Antonia Lakomek
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Laura Waschkies
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Moritz Meyer
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Nadia Sadok
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Stephan Lang
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital Essen, Essen, Germany
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Dalbert A, Weder S. [Application of extra- and intracochlear electrocochleography during and after cochlear implantation]. HNO 2024:10.1007/s00106-024-01481-4. [PMID: 38761228 DOI: 10.1007/s00106-024-01481-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 05/20/2024]
Abstract
Electrocochleography (ECochG) represents a promising approach for monitoring cochlear function during cochlear implantation and for investigating the causes of residual cochlear function loss after implantation. This paper provides an overview of the current research and application status of ECochG, both during and after cochlear implantation. Intraoperative ECochG can be conducted either via the implant itself or an extracochlear measuring electrode. Postoperative ECochG recordings are also feasible via the implant. Various studies have demonstrated that a significant decrease in ECochG amplitude during electrode insertion correlates with an increased risk of losing residual cochlear function, with critical cochlear events occurring primarily towards the end of the insertion. Postoperative data suggest that the loss of cochlear function mainly occurs in the early postoperative phase. Future research directions include the automation and objectification of signal analysis, as well as a more in-depth investigation into the underlying mechanisms of these signal changes.
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Affiliation(s)
- Adrian Dalbert
- Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Stefan Weder
- Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, Kopf- und Halschirurgie Inselspital, Universitätsspital Bern, Freiburgstrasse 20, 3012, Bern, Schweiz.
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Rau TS, Böttcher-Rebmann G, Schell V, Cramer J, Artukarslan E, Baier C, Lenarz T, Salcher R. First clinical implementation of insertion force measurement in cochlear implantation surgery. Front Neurol 2024; 15:1400455. [PMID: 38711559 PMCID: PMC11070539 DOI: 10.3389/fneur.2024.1400455] [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: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Purpose The significance of atraumatic electrode array (EA) insertion in cochlear implant (CI) surgery is widely acknowledged, with consensus that forces due to EA insertion are directly correlated with insertion trauma. Unfortunately, the manual perception of these forces through haptic feedback is inherently limited, and techniques for in vivo force measurements to monitor the insertion are not yet available. Addressing this gap, we developed of a force-sensitive insertion tool capable of capturing real-time insertion forces during standard CI surgery. Methods This paper describes the tool and its pioneering application in a clinical setting and reports initial findings from an ongoing clinical study. Data and experiences from five patients have been evaluated so far, including force profiles of four patients. Results The initial intraoperative experiences are promising, with successful integration into the conventional workflow. Feasibility of in vivo insertion force measurement and practicability of the tool's intraoperative use could be demonstrated. The recorded in vivo insertion forces show the expected rise with increasing insertion depth. Forces at the end of insertion range from 17.2 mN to 43.6 mN, while maximal peak forces were observed in the range from 44.8 mN to 102.4 mN. Conclusion We hypothesize that this novel method holds the potential to assist surgeons in monitoring the insertion forces and, thus, minimizing insertion trauma and ensuring better preservation of residual hearing. Future data recording with this tool can form the basis of ongoing research into the causes of insertion trauma, paving the way for new and improved prevention strategies.
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Affiliation(s)
- Thomas S. Rau
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Georg Böttcher-Rebmann
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Viktor Schell
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Jakob Cramer
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Eralp Artukarslan
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Thomas Lenarz
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
| | - Rolf Salcher
- Department of Otolaryngology and Cluster of Excellence EXC 2177/1 “Hearing4all”, Hannover Medical School, Hannover, Germany
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Herrada J, Medel V, Dragicevic C, Maass JC, Stott CE, Delano PH. A frequency peak at 3.1 kHz obtained from the spectral analysis of the cochlear implant electrocochleography noise. PLoS One 2024; 19:e0299911. [PMID: 38451925 PMCID: PMC10919660 DOI: 10.1371/journal.pone.0299911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION The functional evaluation of auditory-nerve activity in spontaneous conditions has remained elusive in humans. In animals, the frequency analysis of the round-window electrical noise recorded by means of electrocochleography yields a frequency peak at around 900 to 1000 Hz, which has been proposed to reflect auditory-nerve spontaneous activity. Here, we studied the spectral components of the electrical noise obtained from cochlear implant electrocochleography in humans. METHODS We recruited adult cochlear implant recipients from the Clinical Hospital of the Universidad de Chile, between the years 2021 and 2022. We used the AIM System from Advanced Bionics® to obtain single trial electrocochleography signals from the most apical electrode in cochlear implant users. We performed a protocol to study spontaneous activity and auditory responses to 0.5 and 2 kHz tones. RESULTS Twenty subjects including 12 females, with a mean age of 57.9 ± 12.6 years (range between 36 and 78 years) were recruited. The electrical noise of the single trial cochlear implant electrocochleography signal yielded a reliable peak at 3.1 kHz in 55% of the cases (11 out of 20 subjects), while an oscillatory pattern that masked the spectrum was observed in seven cases. In the other two cases, the single-trial noise was not classifiable. Auditory stimulation at 0.5 kHz and 2.0 kHz did not change the amplitude of the 3.1 kHz frequency peak. CONCLUSION We found two main types of noise patterns in the frequency analysis of the single-trial noise from cochlear implant electrocochleography, including a peak at 3.1 kHz that might reflect auditory-nerve spontaneous activity, while the oscillatory pattern probably corresponds to an artifact.
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Affiliation(s)
- Javiera Herrada
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Vicente Medel
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Constantino Dragicevic
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Juan C. Maass
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Carlos E. Stott
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Paul H. Delano
- Servicio Otorrinolaringología, Hospital Clínico de la Universidad de Chile, Santiago, Chile
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Centro Avanzado de Ingeniería Eléctrica y Electrónica, AC3E, Universidad Técnica Federico Santa María, Valparaíso, Chile
- Biomedical Neuroscience Institute, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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Höing B, Eichler T, Juelly V, Meyer M, Jung L, Waschkies L, Lang S, Arweiler-Harbeck D. Digital live imaging of intraoperative electrocochleography during cochlear implantation: the first 50 patients. Eur Arch Otorhinolaryngol 2024; 281:1175-1183. [PMID: 37646794 PMCID: PMC10858150 DOI: 10.1007/s00405-023-08197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Real-time visualization of intraoperative electrocochleography (ECochG) potentials via a digital microscope during cochlear implantation can provide direct feedback during electrode insertion. The aim of this prospective, randomized study of 50 patients was to obtain long-term data with a focus on residual hearing preservation and speech understanding. MATERIAL AND METHODS Cochlear implantations were performed in 50 patients (26 female, 24 male) with residual hearing using a digital microscope. Patients were randomized into two groups. Intraoperative ECochG potentials were either displayed directly in the surgeon's field of view (picture-in-picture display, PiP) or not directly in the field of view (without picture-in-picture display, without PiP). Residual hearing preservation and speech comprehension were recorded within a 1-year follow-up period, compared between groups (PiP versus without PiP) and to a control group of 26 patients implanted without ECochG. RESULTS Mean insertion time was significantly longer in the picture-in-picture group (p = 0.025). Residual hearing preservation after 6 weeks at 250 Hz was significantly better in the picture-in-picture group (p = 0.017). After one year, 76% of patients showed residual hearing in the picture-in-picture group (62% without picture-in-picture technique, p = n.s.). Use of the picture-in-picture technique resulted in better long-term pure tone residual hearing preservation at 250, 500, and 1000 Hz. Speech intelligibility improved by 46% in the picture-in-picture group (38% without picture-in-picture). DISCUSSION This study is the first to describe long-term results in a large cohort of cochlear implant patients in whom digital visualization of intraoperative ECochG was used. Our results show that visualization of intraoperative ECochG has a positive effect on residual hearing preservation.
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Affiliation(s)
- Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.
| | - Theda Eichler
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Viktoria Juelly
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Moritz Meyer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Lea Jung
- Cochlear Implant Rehabilitation Centre Ruhr (CIC), Essen, Germany
| | - Laura Waschkies
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Diana Arweiler-Harbeck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
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Greisiger R, Bester C, Sørensen T, Korslund H, Bunne M, O'Leary S, Jablonski GE. Intraoperative Measured Electrocochleography and Fluoroscopy Video to Detect Cochlea Trauma. Otol Neurotol 2024; 45:36-45. [PMID: 38085760 DOI: 10.1097/mao.0000000000004055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
HYPOTHESIS Gross electrode movements detected with intraoperative, real-time X-ray fluoroscopy will correlate with fluctuations in cochlear output, as measured with intraoperative electrocochleography (ECochG). BACKGROUND Indications for cochlear implantation (CI) are expanding to include patients with residual hearing; however, implant recipients often lose residual hearing after CI. The objective of this study was to identify probable traumatic events during implantation by combining electrophysiological monitoring of cochlear function with simultaneous X-ray monitoring. The surgical timing of these apparently traumatic events was then investigated. METHODS For 19 adult patients (21 surgeries, 2 bilateral), the ECochG responses were measured during implantation of a cochlear nucleus slim modiolar electrode (CI532/CI632, Cochlear Ltd Australia Nucleus slim modiolar). Simultaneous fluoroscopy was performed, as well as a postoperative cone-beam computed tomography (CT) scan. For all patients, pre- and postoperative audiograms were recorded up to 1 year after surgery to record the loss of residual hearing. RESULTS Electrode insertions for 21 surgeries were successfully monitored. A drop in ECochG response was significantly correlated with reduced hearing preservation compared with patients with preserved responses throughout. Drops in the ECochG response were measured to occur during insertion, because of movement of the array after insertion was complete, including while sealing of the electrode array at the round window or coiling of the array lead within the mastoid cavity. In some patients, a reduction in cochlear output, resulting in poor ECochG response, was inferred to occur before the beginning of implantation. CONCLUSION The combination of perioperative ECochG measurements, microscope video, fluoroscopy, and postoperative CT scan may inform on what causes the loss of residual hearing after implantation. These findings will be used to improve the surgical procedure in future.
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Affiliation(s)
- Ralf Greisiger
- Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Christofer Bester
- Department of Surgery-Otolaryngology, University of Melbourne, Melbourne, Australia
| | - Torquil Sørensen
- Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Marie Bunne
- Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Stephen O'Leary
- Department of Surgery-Otolaryngology, University of Melbourne, Melbourne, Australia
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Scheperle R, Etler C, Oleson J, Dunn C, Kashani R, Claussen A, Gantz BJ, Hansen MR. Evaluation of Real-Time Intracochlear Electrocochleography for Guiding Cochlear Implant Electrode Array Position. J Clin Med 2023; 12:7409. [PMID: 38068461 PMCID: PMC10707171 DOI: 10.3390/jcm12237409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/12/2023] [Accepted: 11/24/2023] [Indexed: 02/12/2024] Open
Abstract
This study evaluates intracochlear electrocochleography (ECochG) for real-time monitoring during cochlear implantation. One aim tested whether adjusting the recording electrode site would help differentiate between atraumatic and traumatic ECochG amplitude decrements. A second aim assessed whether associations between ECochG amplitude decrements and post-operative hearing loss were weaker when considering hearing sensitivity at the ECochG stimulus frequency compared to a broader frequency range. Eleven adult cochlear implant recipients who were candidates for electro-acoustic stimulation participated. Single-frequency (500-Hz) ECochG was performed during cochlear implantation; the amplitude of the first harmonic of the difference waveform was considered. Post-operative hearing preservation at 500 Hz ranged from 0 to 94%. The expected relationship between ECochG amplitude decrements and hearing preservation was observed, though the trend was not statistically significant, and predictions were grossly inaccurate for two participants. Associations did not improve when considering alternative recording sites or hearing sensitivity two octaves above the ECochG stimulus frequency. Intracochlear location of a moving recording electrode is a known confound to real-time interpretation of ECochG amplitude fluctuations, which was illustrated by the strength of the correlation with ECochG amplitude decrements. Multiple factors contribute to ECochG amplitude patterns and to hearing preservation; these results highlight the confounding influence of intracochlear recording electrode location on the ECochG.
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Affiliation(s)
- Rachel Scheperle
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Christine Etler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Jacob Oleson
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA
| | - Camille Dunn
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
| | - Rustin Kashani
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Alexander Claussen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Bruce J. Gantz
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | - Marlan R. Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA; (C.E.); (C.D.); (R.K.); (A.C.); (B.J.G.); (M.R.H.)
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Department of Molecular Physiology and Biophysics, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Schuerch K, Wimmer W, Rummel C, Caversaccio MD, Weder S. Objective evaluation of intracochlear electrocochleography: repeatability, thresholds, and tonotopic patterns. Front Neurol 2023; 14:1181539. [PMID: 37621854 PMCID: PMC10446839 DOI: 10.3389/fneur.2023.1181539] [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: 03/07/2023] [Accepted: 06/26/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Intracochlear electrocochleography (ECochG) is increasingly being used to measure residual inner ear function in cochlear implant (CI) recipients. ECochG signals reflect the state of the inner ear and can be measured during implantation and post-operatively. The aim of our study was to apply an objective deep learning (DL)-based algorithm to assess the reproducibility of longitudinally recorded ECochG signals, compare them with audiometric hearing thresholds, and identify signal patterns and tonotopic behavior. Methods We used a previously published objective DL-based algorithm to evaluate post-operative intracochlear ECochG signals collected from 21 ears. The same measurement protocol was repeated three times over 3 months. Additionally, we measured the pure-tone thresholds and subjective loudness estimates for correlation with the objectively detected ECochG signals. Recordings were made on at least four electrodes at three intensity levels. We extracted the electrode positions from computed tomography (CT) scans and used this information to evaluate the tonotopic characteristics of the ECochG responses. Results The objectively detected ECochG signals exhibited substantial repeatability over a 3-month period (bias-adjusted kappa, 0.68; accuracy 83.8%). Additionally, we observed a moderate-to-strong dependence of the ECochG thresholds on audiometric and subjective hearing levels. Using radiographically determined tonotopic measurement positions, we observed a tendency for tonotopic allocation with a large variance. Furthermore, maximum ECochG amplitudes exhibited a substantial basal shift. Regarding maximal amplitude patterns, most subjects exhibited a flat pattern with amplitudes evenly distributed over the electrode carrier. At higher stimulation frequencies, we observed a shift in the maximum amplitudes toward the basal turn of the cochlea. Conclusions We successfully implemented an objective DL-based algorithm for evaluating post-operative intracochlear ECochG recordings. We can only evaluate and compare ECochG recordings systematically and independently from experts with an objective analysis. Our results help to identify signal patterns and create a better understanding of the inner ear function with the electrode in place. In the next step, the algorithm can be applied to intra-operative measurements.
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Affiliation(s)
- Klaus Schuerch
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, TUM School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Rummel
- Support Center for Advanced Neuroimaging (SCAN), University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stefan Weder
- Department of ENT, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Sijgers L, Sorensen T, Soulby A, Boyle P, Dalbert A, Röösli C, Jablonski GE, Hamacher V, Greisiger R, Jiang D, Huber A, Pfiffner F. Classification of Acoustic Hearing Preservation After Cochlear Implantation Using Electrocochleography. Trends Hear 2023; 27:23312165231220997. [PMID: 38105510 PMCID: PMC10729624 DOI: 10.1177/23312165231220997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
The objective to preserve residual hearing during cochlear implantation has recently led to the use of intracochlear electrocochleography (ECochG) as an intraoperative monitoring tool. Currently, a decrease in the amplitude of the difference between responses to alternating-polarity stimuli (DIF response), predominantly reflecting the hair cell response, is used for providing feedback. Including other ECochG response components, such as phase changes and harmonic distortions, could improve the accuracy of surgical feedback. The objectives of the present study were (1) to compare simultaneously recorded stepwise intracochlear and extracochlear ECochG responses to 500 Hz tone bursts, (2) to explore patterns in features extracted from the intracochlear ECochG recordings relating to hearing preservation or hearing loss, and (3) to design support vector machine (SVM) and random forest (RF) classifiers of acoustic hearing preservation that treat each subject as a sample and use all intracochlear ECochG recordings made during electrode array insertion for classification. Forty subjects undergoing cochlear implant (CI) surgery at the Oslo University Hospital, St. Thomas' Hearing Implant Centre, or the University Hospital of Zurich were prospectively enrolled. In this cohort, DIF response amplitude decreases did not relate to postoperative acoustic hearing preservation. Exploratory analysis of the feature set extracted from the ECochG responses and preoperative audiogram showed that the features were not discriminative between outcome classes. The SVM and RF classifiers that were trained on these features could not distinguish cases with hearing loss and hearing preservation. These findings suggest that hearing loss following CI surgery is not always reflected in intraoperative ECochG recordings.
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Affiliation(s)
- Leanne Sijgers
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Torquil Sorensen
- Department of Otorhinolaryngology, Oslo University Hospital, Oslo, Norway
| | - Andrew Soulby
- Hearing Implant Centre, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
| | - Patrick Boyle
- European Research Center, Advanced Bionics GmbH, Hannover, Germany
| | - Adrian Dalbert
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christof Röösli
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Greg Eigner Jablonski
- Department of Otorhinolaryngology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Volkmar Hamacher
- European Research Center, Advanced Bionics GmbH, Hannover, Germany
| | - Ralf Greisiger
- Department of Otorhinolaryngology, Oslo University Hospital, Oslo, Norway
| | - Dan Jiang
- Hearing Implant Centre, Guy's and St. Thomas’ NHS Foundation Trust, London, UK
- Centre for Craniofacial and Regenerative Biology, King's College London, London, UK
| | - Alexander Huber
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Flurin Pfiffner
- Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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