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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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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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Lee C, Hartsock JJ, Salt AN, Lichtenhan JT. A Guinea Pig Model Suggests That Objective Assessment of Acoustic Hearing Preservation in Human Ears With Cochlear Implants Is Confounded by Shifts in the Spatial Origin of Acoustically Evoked Potential Measurements Along the Cochlear Length. Ear Hear 2024; 45:666-678. [PMID: 38178312 DOI: 10.1097/aud.0000000000001457] [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: 01/06/2024]
Abstract
OBJECTIVES Our recent empirical findings have shown that the auditory nerve compound action potential (CAP) evoked by a low-level tone burst originates from a narrow cochlear region tuned to the tone burst frequency. At moderate to high sound levels, the origins shift to the most sensitive audiometric regions rather than the extended high-frequency regions of the cochlear base. This means that measurements evoked from extended high-frequency sound stimuli can shift toward the apex with increasing level. Here we translate this study to understand the spatial origin of acoustically evoked responses from ears that receive cochlear implants, an emerging area of research and clinical practice that is not completely understood. An essential step is to first understand the influence of the cochlear implant in otherwise naive ears. Our objective was to understand how function of the high-frequency cochlear base, which can be excited by the intense low-frequency sounds that are frequently used for objective intra- and postoperative monitoring, can be influenced by the presence of the cochlear implant. DESIGN We acoustically evoked responses and made measurements with an electrode placed near the guinea pig round window. The cochlear implant was not utilized for either electrical stimulation or recording purposes. With the cochlear implant in situ, CAPs were acoustically evoked from 2 to 16 kHz tone bursts of various levels while utilizing the slow perfusion of a kainic acid solution from the cochlear apex to the cochlear aqueduct in the base, which sequentially reduced neural responses from finely spaced cochlear frequency regions. This cochlear perfusion technique reveals the spatial origin of evoked potential measurements and provides insight on what influence the presence of an implant has on acoustical hearing. RESULTS Threshold measurements at 3 to 11 kHz were elevated by implantation. In an individual ear, thresholds were elevated and lowered as cochlear implant was respectively inserted and removed, indicative of "conductive hearing loss" induced by the implant. The maximum threshold elevation occurred at most sensitive region of the naive guinea pig ear (33.66 dB at 8 kHz), making 11 kHz the most sensitive region to acoustic sounds for guinea pig ears with cochlear implants. Conversely, the acute implantation did not affect the low-frequency, 500 Hz thresholds and suprathreshold function, as shown by the auditory nerve overlapped waveform. As the sound pressure level of the tone bursts increased, mean data show that the spatial origin of CAPs along the cochlear length shifted toward the most sensitive cochlear region of implanted ears, not the extended high-frequency cochlear regions. However, data from individual ears showed that after implantation, measurements from moderate to high sound pressure levels originate in places that are unique to each ear. CONCLUSIONS Alterations to function of the cochlear base from the in situ cochlear implant may influence objective measurements of implanted ears that are frequently made with intense low-frequency sound stimuli. Our results from guinea pigs advance the interpretation of measurements used to understand how and when residual acoustic hearing is lost in human ears receiving a cochlear implant.
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Affiliation(s)
- Choongheon Lee
- Department of Otolaryngology, University of Rochester, Rochester, New York, USA
| | - Jared J Hartsock
- Department of Cochlear Surgery, Turner Scientific, Inc., Jacksonville, Illinois, USA
| | - Alec N Salt
- Department of Pharmacokinetics, Turner Scientific, Inc., Jacksonville, Illinois, USA
| | - Jeffery T Lichtenhan
- Department of Otolaryngology, University of South Florida Morsani School of Medicine, Tampa, Florida, USA
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Kelly SM, Kim AH, Lalwani AK. Does Intraoperative Electrocochleography Improve Hearing Preservation in Cochlear Implantation? Laryngoscope 2024; 134:1496-1497. [PMID: 37962241 DOI: 10.1002/lary.31165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/11/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Scott M Kelly
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - Ana H Kim
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - Anil K Lalwani
- Department of Otolaryngology-Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
- Department of Mechanical Engineering, Columbia University, New York, New York, U.S.A
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Kim JS. Clinical Applications of Intracochlear Electrocochleography in Cochlear Implant Users With Residual Acoustic Hearing. J Audiol Otol 2024; 28:100-106. [PMID: 38695055 PMCID: PMC11065546 DOI: 10.7874/jao.2024.00129] [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: 02/12/2024] [Accepted: 03/20/2024] [Indexed: 05/05/2024] Open
Abstract
We herein review the use of electrocochleography (ECoG) to assess peripheral auditory system responsiveness in a growing population of cochlear implant (CI) users with preserved hearing in ears with implants. Twenty-eight recently published intracochlear ECoG articles were thoroughly reviewed to investigate the prognostic utility of intraoperative ECoG monitoring to assess hearing preservation, and the clinical applicability of postoperative ECoG for estimating audiometric thresholds and monitoring longitudinal changes in residual acoustic hearing in patients with EAS. Intraoperative ECoG studies have focused on monitoring the changes in the cochlear microphonics (CM) amplitudes during and after electrode insertion. Mixed results have been reported regarding the relationship between changes in CM amplitude in the operating room and changes in hearing thresholds after surgery. Postoperative ECoG studies have shown that CM and auditory nerve neurophonics thresholds correlate significantly with behavioral thresholds. ECoG thresholds sensitively detect changes as residual acoustic hearing decreases over time in some CI users. This indicates its potential clinical value for monitoring the post-implantation status of the peripheral auditory system. Intracochlear ECoG can provide real-time intraoperative feedback and monitor postoperative hearing preservation in a growing population of CI users.
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Affiliation(s)
- Jeong-Seo Kim
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
- Medical Research Institute, Sungkyunkwan University, Suwon, Korea
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Kashani RG, Kocharyan A, Bennion DM, Scheperle RA, Etler C, Oleson J, Dunn CC, Claussen AD, Gantz BJ, Hansen MR. Combining Intraoperative Electrocochleography with Robotics-Assisted Electrode Array Insertion. Otol Neurotol 2024; 45:143-149. [PMID: 38206061 PMCID: PMC10786337 DOI: 10.1097/mao.0000000000004094] [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] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To describe the use of robotics-assisted electrode array (EA) insertion combined with intraoperative electrocochleography (ECochG) in hearing preservation cochlear implant surgery. STUDY DESIGN Prospective, single-arm, open-label study. SETTING All procedures and data collection were performed at a single tertiary referral center. PATIENTS Twenty-one postlingually deaf adult subjects meeting Food and Drug Administration indication criteria for cochlear implantation with residual acoustic hearing defined as thresholds no worse than 65 dB at 125, 250, and 500 Hz. INTERVENTION All patients underwent standard-of-care unilateral cochlear implant surgery using a single-use robotics-assisted EA insertion device and concurrent intraoperative ECochG. MAIN OUTCOME MEASURES Postoperative pure-tone average over 125, 250, and 500 Hz measured at initial activation and subsequent intervals up to 1 year afterward. RESULTS Twenty-two EAs were implanted with a single-use robotics-assisted insertion device and simultaneous intraoperative ECochG. Fine control over robotic insertion kinetics could be applied in response to changes in ECochG signal. Patients had stable pure-tone averages after activation with normal impedance and neural telemetry responses. CONCLUSIONS Combining robotics-assisted EA insertion with intraoperative ECochG is a feasible technique when performing hearing preservation implant surgery. This combined approach may provide the surgeon a means to overcome the limitations of manual insertion and respond to cochlear feedback in real-time.
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Affiliation(s)
- Rustin G. Kashani
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Armine Kocharyan
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Douglas M. Bennion
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Rachel A. Scheperle
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christine Etler
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jacob Oleson
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Camille C. Dunn
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Alexander D. Claussen
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bruce J. Gantz
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Marlan R. Hansen
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Eitutis ST, Vickers DA, Tebbutt K, Thomas T, Jiang D, de Klerk A, Clemesha J, Chung M, Bance ML. A Multicenter Comparison of 1-yr Functional Outcomes and Programming Differences Between the Advanced Bionics Mid-Scala and SlimJ Electrode Arrays. Otol Neurotol 2023; 44:e730-e738. [PMID: 37889939 PMCID: PMC10662583 DOI: 10.1097/mao.0000000000004048] [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] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To determine if there is a difference in hearing outcomes or stimulation levels between Advanced Bionics straight and precurved arrays. STUDY DESIGN Retrospective chart review across three implant centers. SETTING Tertiary centers for cochlear and auditory brainstem implantation. PATIENTS One hundred fifteen pediatric and 205 adult cochlear implants (CIs) were reviewed. All patients were implanted under the National Institute for Health and Care Excellence 2009 guidelines with a HiRes Ultra SlimJ or Mid-Scala electrode array. MAIN OUTCOME MEASURES Hearing preservation after implantation, as well as CI-only listening scores for Bamford-Kowal-Bench sentences were compared 1 year after implantation. Stimulation levels for threshold and comfort levels were also compared 1 year after implantation. RESULTS Hearing preservation was significantly better with the SlimJ compared with the Mid-Scala electrode array. Bamford-Kowal-Bench outcomes were not significantly different between the two arrays in any listening condition. Stimulation levels were not different between arrays but did vary across electrode contacts. At least one electrode was deactivated in 33% of implants but was more common for the SlimJ device. CONCLUSION Modern straight and precurved arrays from Advanced Bionics did not differ in hearing performance or current requirements. Although hearing preservation was possible with both devices, the SlimJ array would still be the preferred electrode in cases where hearing preservation was a priority. Unfortunately, the SlimJ device was also prone to poor sound perception on basal electrodes. Further investigation is needed to determine if deactivated electrodes are associated with electrode position/migration, and if programming changes are needed to optimize the use of these high-frequency channels.
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Affiliation(s)
- Susan T. Eitutis
- Emmeline Centre, Cambridge University Hospitals NHS Foundation Trust
- Cambridge Hearing Group, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge
| | - Deborah A. Vickers
- Sound Laboratory, Cambridge Hearing Group, Clinical Neurosciences, University of Cambridge, Cambridge
| | | | | | - Dan Jiang
- Guy's and St. Thomas' NHS Foundation Trust
| | | | - Jennifer Clemesha
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Mark Chung
- Auditory Implant Department, Royal National ENT & Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Manohar L. Bance
- Cambridge Hearing Group, Department of Clinical Neurosciences, Cambridge Biomedical Campus, University of Cambridge
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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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10
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Saoji AA, Graham MK, Adkins WJ, Koka K, Carlson ML, Neff BA, Driscoll CLW, Fitzpatrick DC. Multi-Frequency Electrocochleography and Electrode Scan to Identify Electrode Insertion Trauma during Cochlear Implantation. Brain Sci 2023; 13:brainsci13020330. [PMID: 36831873 PMCID: PMC9954676 DOI: 10.3390/brainsci13020330] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Intraoperative electrocochleography (ECOG) is performed using a single low-frequency acoustic stimulus (e.g., 500 Hz) to monitor cochlear microphonics (CM) during cochlear implant (CI) electrode insertion. A decrease in CM amplitude is commonly associated with cochlear trauma and is used to guide electrode placement. However, advancement of the recording electrode beyond the sites of CM generation can also lead to a decrease in CM amplitude and is sometimes interpreted as cochlear trauma, resulting in unnecessary electrode manipulation and increased risk of cochlear trauma during CI electrode placement. In the present study, multi-frequency ECOG was used to monitor CM during CI electrode placement. The intraoperative CM tracings were compared with electrode scan measurements, where CM was measured for each of the intracochlear electrodes. Comparison between the peak CM amplitude measured during electrode placement and electrode scan measurements was used to differentiate between different mechanisms for decrease in CM amplitude during CI electrode insertion. Analysis of the data shows that both multi-frequency electrocochleography and electrode scan could potentially be used to differentiate between different mechanisms for decreasing CM amplitude and providing appropriate feedback to the surgeon during CI electrode placement.
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Affiliation(s)
- Aniket A. Saoji
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence:
| | - Madison K. Graham
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Weston J. Adkins
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kanthaiah Koka
- Department of Research and Technology, Advanced Bionics, Valencia, CA 91355, USA
| | - Matthew L. Carlson
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Brian A. Neff
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Colin L. W. Driscoll
- Department of Otolaryngology Head and Neck Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Douglas C. Fitzpatrick
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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