1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
2
|
Temboury-Gutierrez M, Märcher-Rørsted J, Bille M, Yde J, Encina-Llamas G, Hjortkjær J, Dau T. Electrocochleographic frequency-following responses as a potential marker of age-related cochlear neural degeneration. Hear Res 2024; 446:109005. [PMID: 38598943 DOI: 10.1016/j.heares.2024.109005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/19/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
Auditory nerve (AN) fibers that innervate inner hair cells in the cochlea degenerate with advancing age. It has been proposed that age-related reductions in brainstem frequency-following responses (FFR) to the carrier of low-frequency, high-intensity pure tones may partially reflect this neural loss in the cochlea (Märcher-Rørsted et al., 2022). If the loss of AN fibers is the primary factor contributing to age-related changes in the brainstem FFR, then the FFR could serve as an indicator of cochlear neural degeneration. In this study, we employed electrocochleography (ECochG) to investigate the effects of age on frequency-following neurophonic potentials, i.e., neural responses phase-locked to the carrier frequency of the tone stimulus. We compared these findings to the brainstem-generated FFRs obtained simultaneously using the same stimulation. We conducted recordings in young and older individuals with normal hearing. Responses to pure tones (250 ms, 516 and 1086 Hz, 85 dB SPL) and clicks were recorded using both ECochG at the tympanic membrane and traditional scalp electroencephalographic (EEG) recordings of the FFR. Distortion product otoacoustic emissions (DPOAE) were also collected. In the ECochG recordings, sustained AN neurophonic (ANN) responses to tonal stimulation, as well as the click-evoked compound action potential (CAP) of the AN, were significantly reduced in the older listeners compared to young controls, despite normal audiometric thresholds. In the EEG recordings, brainstem FFRs to the same tone stimulation were also diminished in the older participants. Unlike the reduced AN CAP response, the transient-evoked wave-V remained unaffected. These findings could indicate that a decreased number of AN fibers contributes to the response in the older participants. The results suggest that the scalp-recorded FFR, as opposed to the clinical standard wave-V of the auditory brainstem response, may serve as a more reliable indicator of age-related cochlear neural degeneration.
Collapse
Affiliation(s)
- Miguel Temboury-Gutierrez
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 352, DK-2800 Kgs. Lyngby, Denmark.
| | - Jonatan Märcher-Rørsted
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 352, DK-2800 Kgs. Lyngby, Denmark
| | - Michael Bille
- Copenhagen Hearing and Balance Center, Ear, Nose and Throat (ENT) and Audiology Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark, Inge Lehmanns Vej 8, DK-2100 København Ø, Denmark
| | - Jesper Yde
- Copenhagen Hearing and Balance Center, Ear, Nose and Throat (ENT) and Audiology Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark, Inge Lehmanns Vej 8, DK-2100 København Ø, Denmark
| | - Gerard Encina-Llamas
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 352, DK-2800 Kgs. Lyngby, Denmark; Copenhagen Hearing and Balance Center, Ear, Nose and Throat (ENT) and Audiology Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark, Inge Lehmanns Vej 8, DK-2100 København Ø, Denmark; Faculty of Medicine. University of Vic - Central University of Catalonia (UVic-UCC), Vic, 08500, Catalonia - Spain
| | - Jens Hjortkjær
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 352, DK-2800 Kgs. Lyngby, Denmark; Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, DK-2650 Hvidovre, Denmark
| | - Torsten Dau
- Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Ørsteds Plads, Building 352, DK-2800 Kgs. Lyngby, Denmark
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Jeong-Seo Kim
- Hearing Research Laboratory, Samsung Medical Center, Seoul, Korea
- Medical Research Institute, Sungkyunkwan University, Suwon, Korea
| |
Collapse
|
4
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- Merve Bayri Ulukan
- Marmara University, Health Sciences Institute, Istanbul, Turkey; Cochlear, Turkey.
| | - Ayca Ciprut
- Marmara University, Medical School, Audiology Department, Istanbul, Turkey
| |
Collapse
|
5
|
Goodman SS, Lichtenhan JT, Jennings SG. Minimum Detectable Differences in Electrocochleography Measurements: Bayesian-Based Predictions. J Assoc Res Otolaryngol 2023; 24:217-237. [PMID: 36795197 PMCID: PMC10121985 DOI: 10.1007/s10162-023-00888-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/10/2023] [Indexed: 02/17/2023] Open
Abstract
Physiology of the cochlea and auditory nerve can be assessed with electrocochleography (ECochG), a technique that involves measuring auditory evoked potentials from an electrode placed near or within the cochlea. Research, clinical, and operating room applications of ECochG have in part centered on measuring the auditory nerve compound action potential (AP) amplitude, the summating potential (SP) amplitude, and the ratio of the two (SP/AP). Despite the common use of ECochG, the variability of repeated amplitude measurements for individuals and groups is not well understood. We analyzed ECochG measurements made with a tympanic membrane electrode in a group of younger normal-hearing participants to characterize the within-participant and group-level variability for the AP amplitude, SP amplitude, and SP/AP amplitude ratio. Results show that the measurements have substantial variability and that, especially with smaller sample sizes, significant reduction in variability can be obtained by averaging measurements across repeated electrode placements within subjects. Using a Bayesian-based model of the data, we generated simulated data to predict minimum detectable differences in AP and SP amplitudes for experiments with a given number of participants and repeated measurements. Our findings provide evidence-based recommendations for the design and sample size determination of future experiments using ECochG amplitude measurements, and the evaluation of previous publications in terms of sensitivity to detecting experimental effects on ECochG amplitude measurements. Accounting for the variability of ECochG measurements should result in more consistent results in the clinical and basic assessments of hearing and hearing loss, either hidden or overt.
Collapse
Affiliation(s)
- Shawn S Goodman
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Jeffery T Lichtenhan
- Department of Otolaryngology - Head and Neck Surgery, University of South Florida, Tampa, FL, USA
| | - Skyler G Jennings
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
6
|
Zhan KY, Wick CC. Intraoperative Cochlear Nerve Monitoring in Vestibular Schwannoma Microsurgery. Otolaryngol Clin North Am 2023; 56:471-482. [PMID: 36964094 DOI: 10.1016/j.otc.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Monitoring the cochlear nerve during vestibular schwannoma (VS) microsurgery depends on the hearing status and surgical approach. Traditional hearing preservation VS microsurgery relies on acoustically driven auditory brainstem response (ABR) and cochlear nerve action potential. Both modalities have advantages and disadvantages that need to be understood for proper implementation. When hearing is lost or the approach violates the otic capsule, electrically evoked monitoring methods may be used. Evoked ABR (eABR) is feasible and safe but may be limited by artifact. Combining eABR with near-field measures such as electrocochleography or neural telemetry shows promise.
Collapse
Affiliation(s)
- Kevin Y Zhan
- Department of Otolaryngology-Head & Neck Surgery, Washington University, St Louis, MO, USA
| | - Cameron C Wick
- Department of Otolaryngology-Head & Neck Surgery, Washington University, St Louis, MO, USA.
| |
Collapse
|
7
|
Orimoto KY, Vartanyan M, O’Leary SJ. Systematic review of the diagnostic value of hydrops MRI in relation to audiovestibular function tests ( electrocochleography, cervical vestibular evoked myogenic potential and caloric test). Eur Arch Otorhinolaryngol 2023; 280:947-962. [PMID: 36301356 PMCID: PMC9899732 DOI: 10.1007/s00405-022-07702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
The objective of this systematic review is to compare the diagnostic value of endolymphatic hydrops (EH) magnetic resonance imaging (MRI) with audiovestibular function tests, including electro cochleography (ECochG), cervical vestibular evoked myogenic potential (cVEMP) and caloric tests for the diagnosis of definite Meniere's disease (DMD). An electronic search was performed in the PubMed, Embase and Cochrane databases in August 2022. Original studies which reported the efficacy of gadolinium MRI for diagnosis of DMD were compared with ECochG, cVEMP and caloric tests from 2007 to 2022 published in English. Two reviewers extracted the methodology and results of MRI and functional tests, assessing them independently. A modified version of the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used for the assessment of the quality and the risk of bias of each study. The proportion of DMD cases diagnosed by MRI hydrops vs corresponding functional tests were calculated and the relationship between MRI and functional tests were evaluated using the Cohen's Kappa test. Concerning the MRI, the proportion diagnostic of DMD was 0.67 by cochlear EH and 0.80-0.82 by vestibular EH. Regarding the functional test, the propotiojn diagnostic of DMD was 0.48 by ECochG, 0.76 by cVEMP and 0.65 by caloric test. The findings of this systematic review were that the vestibular EH on imaging most effectively assisted in diagnosing DMD. Among the functional tests, cVEMP was the second most effective test. The agreement between imaging and cVEMP was moderate (0.44), indicating a gap between the patients identified by the imaging and functional tests based on the relatively small number of patients.
Collapse
Affiliation(s)
- Kumiko Yukawa Orimoto
- The University of Melbourne, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002 Australia
| | - Maria Vartanyan
- The Royal Victorian Eye and Ear Hospital, East Melbourne, 3002 Australia
| | - Stephen J. O’Leary
- The University of Melbourne, The Royal Victorian Eye and Ear Hospital, 32 Gisborne St, East Melbourne, VIC 3002 Australia
| |
Collapse
|
8
|
Chen J, Jennings SG. Temporal Envelope Coding of the Human Auditory Nerve Inferred from Electrocochleography: Comparison with Envelope Following Responses. J Assoc Res Otolaryngol 2022; 23:803-814. [PMID: 35948693 PMCID: PMC9789235 DOI: 10.1007/s10162-022-00865-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/12/2022] [Indexed: 01/06/2023] Open
Abstract
Neural coding of the slow amplitude fluctuations of sound (i.e., temporal envelope) is thought to be essential for speech understanding; however, such coding by the human auditory nerve is poorly understood. Here, neural coding of the temporal envelope by the human auditory nerve is inferred from measurements of the compound action potential in response to an amplitude modulated carrier (CAPENV) for modulation frequencies ranging from 20 to 1000 Hz. The envelope following response (EFR) was measured simultaneously with CAPENV from active electrodes placed on the high forehead and tympanic membrane, respectively. Results support the hypothesis that phase locking to higher modulation frequencies (> 80 Hz) will be stronger for CAPENV, compared to EFR, consistent with the upper-frequency limits of phase locking for auditory nerve fibers compared to auditory brainstem/cortex neurons. Future work is needed to determine the extent to which (1) CAPENV is a useful tool for studying how temporal processing of the auditory nerve is affected by aging, hearing loss, and noise-induced cochlear synaptopathy and (2) CAPENV reveals the relationship between auditory nerve temporal processing and perception of the temporal envelope.
Collapse
Affiliation(s)
- Jessica Chen
- Department of Communication Sciences and Disorders, The University of Utah, 390 South BEHS 1201, Salt Lake City, UT, USA
| | - Skyler G Jennings
- Department of Communication Sciences and Disorders, The University of Utah, 390 South BEHS 1201, Salt Lake City, UT, USA.
| |
Collapse
|
9
|
Lutz BT, Hutson KA, Trecca EMC, Hamby M, Fitzpatrick DC. Neural Contributions to the Cochlear Summating Potential: Spiking and Dendritic Components. J Assoc Res Otolaryngol 2022; 23:351-363. [PMID: 35254541 DOI: 10.1007/s10162-022-00842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
Using electrocochleography, the summating potential (SP) is a deflection from baseline to tones and an early rise in the response to clicks. Here, we use normal hearing gerbils and gerbils with outer hair cells removed with a combination of furosemide and kanamycin to investigate cellular origins of the SP. Round window electrocochleography to tones and clicks was performed before and after application of tetrodotoxin to prevent action potentials, and then again after kainic acid to prevent generation of an EPSP. With appropriate subtractions of the response curves from the different conditions, the contributions to the SP from outer hair cells, inner hair cell, and neural "spiking" and "dendritic" responses were isolated. Like hair cells, the spiking and dendritic components had opposite polarities to tones - the dendritic component had negative polarity and the spiking component had positive polarity. The magnitude of the spiking component was larger than the dendritic across frequencies and intensities. The onset to tones and to clicks followed a similar sequence; the outer hair cells responded first, then inner hair cells, then the dendritic component, and then the compound action potential of the spiking response. These results show the sources of the SP include at least the four components studied, and that these have a mixture of polarities and magnitudes that vary across frequency and intensity. Thus, multiple possible interactions must be considered when interpreting the SP for clinical uses.
Collapse
Affiliation(s)
- Brendan T Lutz
- The University of North Carolina at Chapel Hill, Department of Otolaryngology - Head & Neck Surgery, 101 Mason Farm Rd, CB#7546, Chapel Hill, NC, USA
| | - Kendall A Hutson
- The University of North Carolina at Chapel Hill, Department of Otolaryngology - Head & Neck Surgery, 101 Mason Farm Rd, CB#7546, Chapel Hill, NC, USA
| | - Eleonora M C Trecca
- IRCCS Casa Sollievo Della Sofferenza, Department of Maxillofacial Surgery and Otolaryngology, San Giovanni Rotondo (Foggia), Italy.,University Hospital of Foggia, Department of Otolaryngology- Head and Neck Surgery, Foggia, Italy
| | - Meredith Hamby
- The University of North Carolina at Chapel Hill, Department of Otolaryngology - Head & Neck Surgery, 101 Mason Farm Rd, CB#7546, Chapel Hill, NC, USA
| | - Douglas C Fitzpatrick
- The University of North Carolina at Chapel Hill, Department of Otolaryngology - Head & Neck Surgery, 101 Mason Farm Rd, CB#7546, Chapel Hill, NC, USA.
| |
Collapse
|
10
|
Jwair S, Boerboom RA, Versnel H, Stokroos RJ, Thomeer HGXM. Evaluating cochlear insertion trauma and hearing preservation after cochlear implantation (CIPRES): a study protocol for a randomized single-blind controlled trial. Trials 2021; 22:895. [PMID: 34886884 PMCID: PMC8656003 DOI: 10.1186/s13063-021-05878-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/25/2021] [Indexed: 12/26/2022] Open
Abstract
Background In order to preserve residual hearing in patients with sensorineural hearing loss (SNHL) who receive a cochlear implant (CI), insertion trauma to the delicate structures of the cochlea needs to be minimized. The surgical approach comprises the conventional mastoidectomy-posterior tympanotomy (MPT) to arrive at the middle ear, followed by either a cochleostomy (CO) or the round window (RW) approach. Both techniques have their benefits and disadvantages. Another important aspect in structure preservation is the design of the electrode array. Two different designs are used: a “straight” lateral wall lying electrode array (LW) or a “pre-curved” perimodiolar lying electrode array (PM). Interestingly, until now, the best surgical approach and design of the implant is uncertain. Our hypothesis is that there is a difference in hearing preservation outcomes between the four possible treatment options. Methods We designed a monocenter, multi-arm, randomized controlled trial to compare insertion trauma between four groups of patients, with each group having a unique combination of an electrode array type (LW or PM) and surgical approach (RW or CO). In total, 48 patients will be randomized into one of these four intervention groups. Our primary objective is the comparison of postoperative hearing preservation between these four groups. Secondly, we aim to assess structure preservation (i.e., scalar translocation, with basilar membrane disruption or tip fold-over of array) for each group. Thirdly, we will compare objective outcomes of hearing and structure preservation by way of electrocochleography (ECochG). Discussion Cochlear implantation by way of a cochleostomy or round window approach, using different electrode array types, is the standard medical care for patients with severe to profound bilateral sensorineural hearing loss, as it is a relatively simple and low-risk procedure that greatly benefits patients. However, loss of residual hearing remains a problem. This trial is the first randomized controlled trial that evaluates the effect of cochlear insertion trauma of several CI treatment options on hearing preservation. Trial registration Netherlands Trial Register (NTR) NL8586. Registered on 4 May 2020. Retrospectively registered; 3/48 participants were included before registration. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05878-2.
Collapse
Affiliation(s)
- Saad Jwair
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands. .,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands.
| | - Ralf A Boerboom
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Huib Versnel
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Robert J Stokroos
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| | - Hans G X M Thomeer
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508, GA, Utrecht, the Netherlands.,UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
11
|
Veeranna SA, Allan C, Allen P. Assessment of cochlear electrophysiology in typically developing children and children with auditory processing disorder. Int J Pediatr Otorhinolaryngol 2021; 151:110962. [PMID: 34736007 DOI: 10.1016/j.ijporl.2021.110962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children with auditory processing disorder (APD) are reported to have abnormal auditory brainstem responses (ABR) but little is understood about their cochlear integrity. Poor cochlear integrity can affect neural responses. In this study, cochlear and auditory brainstem integrity was investigated in children with APD. METHOD Twenty children with APD, sixteen typically developing children and twenty adults participated in this study. Click evoked electrocochleography (ECochG) and ABRs were recorded from all the participants. Cochlear responses were analyzed using a) latency and amplitude of summating potential; action potential, b) transmission time between summating potential and action potential, c) summating potential/action potential amplitude ratio and d) action potential latency difference to condensation and rarefaction polarity. Amplitude in the ABR components was examined. RESULTS Children with APD showed similar cochlear function to the typically developing children. There were no significant differences in wave I amplitude between children with APD and typically developing children. However, wave V amplitude was significantly reduced in children with APD compared to typically developing children. CONCLUSION In the absence of any functional differences in the cochlea, children with APD can show poor amplitude in the later components of the ABR. The ABR anomalies observed in children with APD arise due to poor neural processing, possibly after the first auditory synapse.
Collapse
Affiliation(s)
| | - Chris Allan
- National Centre for Audiology, Western University, London, Canada; School of Communication Science and Disorder, Western University, London, Canada
| | - Prudence Allen
- National Centre for Audiology, Western University, London, Canada; School of Communication Science and Disorder, Western University, London, Canada
| |
Collapse
|
12
|
Bilińska M, Wojciechowski T, Sokołowski J, Niemczyk K. Analysis of tympanic sinus shape for purposes of intraoperative hearing monitoring: a microCT study. Surg Radiol Anat 2021; 44:323-331. [PMID: 34817623 PMCID: PMC8831278 DOI: 10.1007/s00276-021-02859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Sinus tympani is the space in the retrotympanum, with variable morphology. Computed tomography is a common tool to investigate sinus tympani anatomy. During cochlear implantation or tympanoplasty, electrocochleography can be used for hearing monitoring. In such a surgical strategy the electrode is placed in the round window's region throughout posterior tympanotomy. Common accessible needle-shaped electrodes using is difficult in achieving intraoperative stabilization. The aim of the study is to assess the dimensions and shape of sinus tympani, basing on the micro computed tomography scans for purposes of establishing the possible new electrocochleography electrode shape. MATERIALS AND METHODS Sixteen fresh frozen cadaveric temporal bones were dissected. MicroCT measurements included the depth and the width of sinus tympani, width of facial canal with stapedius muscle chamber. Obtained data were analyzed statistically with the use of RStudio 1.3.959 software. RESULTS The highest average width of sinus tympani amounted for 2.68 mm, depth measured at the round window plane for 3.19 mm. Width of facial canal with stapedius muscle chamber highest average values at the round window plane- 3.32 mm. The lowest average minimum and maximum values were calculated at the 1 mm above the round window plane. The highest average posterior tympanotomy width was 2.91 mm. CONCLUSIONS The shape of the tympanic sinus is like a trough with the narrowest and deepest dimensions in the middle part. The ST shape and dimensions should be taken into account in constructing the ECochG electrode, designed for optimal placement through posterior tympanotomy approach.
Collapse
Affiliation(s)
- Małgorzata Bilińska
- Department of Dentistry and Oral Health, Aarhus University, Midtjylland, Aarhus, Denmark
| | - Tomasz Wojciechowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Banacha 1a Street, 02-202, Warsaw, Poland.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chałubińskiego 5, 02-004, Warsaw, Poland
| | - Jacek Sokołowski
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Banacha 1a Street, 02-202, Warsaw, Poland.
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Warsaw, Banacha 1a Street, 02-202, Warsaw, Poland
| |
Collapse
|
13
|
Abstract
BACKGROUND The non-invasive tympanic electrocochleography (TM-ECochG) is useful for clinical diagnoses. Nevertheless, the influence of the electrode location on tympanic membrane (TM) on ECochG results needs to be studied. OBJECTIVE The aim of the present study was to compare the TM-ECochG results obtained when the electrode was placed on the superior region versus the inferior region of TM. MATERIALS AND METHODS Forty healthy adults (aged 29 to 50 years) participated in this comparative study. The TM-ECochG testing was conducted with the electrode placed on the superior and inferior regions of TM. RESULTS SP and AP amplitudes were statistically higher for the inferior region of TM (p < .05). In contrast, SP/AP ratios were comparable between the two regions of TM (p = .417). CONCLUSIONS AND SIGNIFICANCE In TM-ECochG recording, when the electrode was placed on the inferior region of TM, SP and AP amplitudes were greater than when the electrode was placed on the superior region of TM. On the other hand, SP/AP amplitude ratio was not affected by the location of electrode on TM. The findings from the present study could be useful to guide clinicians in optimizing TM-ECochG recording when testing their respective patients.
Collapse
Affiliation(s)
- Mohd Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nik Adilah Nik Othman
- Department of Otorhinolaryngology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Zalilah Musa
- Department of Otorhinolaryngology, Kemaman Hospital, Kemaman, Malaysia
| |
Collapse
|
14
|
Abstract
Audiological tests in patients with Menière's disease reveal abnormal patterns relevant for diagnostic purposes with some success. Electrocochleography, otoacoustic emissions and immittance measurements share a moderate sensitivity but a good specificity. Their potential for monitoring the patients suggests means to understand the characteristic time course of Menière's disease and the pathophysiology behind its attacks. Besides, magnetic resonance imaging now allows direct evaluation of endolymphatic hydrops. One issue is now to understand the links between volume inflation of endolymphatic spaces, which sometimes remains asymptomatic, and the functional signs, in the hope that a better understanding of what triggers the attacks may guide future treatments. This article provides a short review of the possible biophysical significance of audiological tests of Menière's disease, and of the attempts to make sense of functional and imaging data and of the patterns they form when combined.
Collapse
Affiliation(s)
- Paul Avan
- Neurosensory Biophysics, INSERM, University Clermont Auvergne, Clermont-Ferrand, France.,Centre Jean Perrin, Clermont-Ferrand, France.,Institut de l'Audition, Centre Institut Pasteur, Paris, France
| | - Idir Djennaoui
- Neurosensory Biophysics, INSERM, University Clermont Auvergne, Clermont-Ferrand, France.,University Hospital, ENT Department, Strasbourg, France
| |
Collapse
|
15
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
16
|
Alsarhan H. Identification of early-stage Meniere's disease as a cause of unilateral tinnitus. J Otol 2021; 16:85-88. [PMID: 33777120 PMCID: PMC7984994 DOI: 10.1016/j.joto.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Meniere's disease (MD) is characterized by episodic symptoms, including vertigo, hearing loss, and tinnitus. Objectives in this study, cases of unilateral tinnitus were investigated for MD. Method Twenty-two patients who presented with chronic unilateral tinnitus on puretone audiograms showing an average threshold better than 25 dB HL and thresholds in the lower frequencies worse than those in the higher frequencies by more than 10 dB were suspected to have early-stage MD and underwent electrocochleography (ECochG). Patients showing ECochG findings conclusive for MD were compared to a control group of patients presenting with chronic unilateral tinnitus on pure-tone audiograms showing an average threshold better than 25 dB and thresholds in the higher frequencies worse than those in the lower frequencies by more than 10 dB. Results Eighteen of the 22 patients included in this study showed elevated summating potential amplitude to action potential amplitude ratios in ECochG (suggestive of endolymphatic hydrops due to MD) and were followed up for 2 months; 14 of them experienced at least two attacks of vertigo or unsteadiness. In contrast, only one patient in the control group reported two or more attacks of vertigo or unsteadiness in the 2 month observation period. The incidence of this finding in the two groups was significantly different. Conclusion Patients with early-stage MD can present with only unilateral tinnitus. Thus, the addition of "pure-tone audiograms showing lower-frequency thresholds worse than higher-frequency thresholds" to the probable MD category in the globally.agreed diagnostic criteria for MD, may be useful.
Collapse
|
17
|
Yazdani N, Rahmaty B, Mousavi M, Aghazadeh K, Dabiri S, Erfanian R, Jafari N, Rezazadeh N, Tajdini A, Givzadeh H. Evaluation of Patients with Delayed Endolymphatic Hydrops by Videonystagmography, Vestibular-Evoked Myogenic Potentials, and Electrocochleography. ORL J Otorhinolaryngol Relat Spec 2021; 83:242-251. [PMID: 33730714 DOI: 10.1159/000513628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 12/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The categorization of delayed endolymphatic hydrops (DEH) based on the ear which produces vertigo may sometimes cause misdiagnosis. OBJECTIVES The aim of this study was investigating the vestibular-evoked myogenic potentials (VEMPs), electrocochleography (ECoG), and videonystagmography (VNG) in cases with DEH to determine the ear that originates symptoms. METHODS In this cross-sectional study, 34 patients - 20 males and 14 females - with profound unilateral sensorineural deafness and vertigo attacks were recruited and evaluated by the ECoG, VNG, and VEMPs tests. RESULTS The average age was around 43; the summating potential/action potential was abnormal in 29.4% of patients in their normal auditive ear. In 32.4, 17.6, and 50% of cases with a deaf ear, absent, normal, and abnormal VEMPs results were sequentially observed, respectively. In normal-hearing ears, absent, normal, and abnormal VEMPs were observed in 23.5, 50, and 26.5%, respectively. In the normal-hearing ear, the distribution of abnormal VEMPs was 26.5%, and in the deaf ear, this parameter was abnormal in 50% of the opposite ear (p value = 0.00021). In the VNG test, among patients with a normal-hearing ear, results in 27 and 7 patients were sequentially normal and hypofunction. CONCLUSION AND SIGNIFICANCE The probability of a hypofunction VNG test in a normal-hearing ear might be greater when the VEMPs results of the contralateral deaf ear are normal. In patients with a normal-hearing ear, the distribution of abnormal VEMPs in the contralateral deaf ear is greater, although the intact side may also manifest abnormality in VEMPs tests. The initial evaluation should begin in a deaf ear as well as for the normal-hearing ear ere utilizing ablation surgery.
Collapse
Affiliation(s)
- Nasrin Yazdani
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Rahmaty
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran,
| | - Meead Mousavi
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kayvan Aghazadeh
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Dabiri
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Erfanian
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Jafari
- Radiology Department, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezazadeh
- Audiology Department, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardavan Tajdini
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Givzadeh
- Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Bester C, Weder S, Collins A, Dragovic A, Brody K, Hampson A, O'Leary S. Cochlear microphonic latency predicts outer hair cell function in animal models and clinical populations. Hear Res 2020; 398:108094. [PMID: 33099252 DOI: 10.1016/j.heares.2020.108094] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
As recently reported, electrocochleography recorded in cochlear implant recipients showed reduced amplitude and shorter latency in patients with more severe high-frequency hearing loss compared with those with some residual hearing. As the response is generated primarily by receptor currents in outer hair cells, these variations in amplitude and latency may indicate outer hair cell function after cochlear implantation. We propose that an absence of latency shift when the cochlear microphonic is measured on two adjacent electrodes indicates an absence or dysfunction of outer hair cells between these electrodes. We test this preclinically in noise deafened guinea pigs (2 h of a 124 dB HL, 16-24 kHz narrow-band noise), and clinically, in electrocochleographic recordings made in cochlear implant recipients immediately after implantation. We found that normal hearing guinea pigs showed a progressive increase in latency from basal to apical electrodes. In contrast, guinea pigs with significantly elevated high-frequency hearing thresholds showed no change in cochlear microphonic latency measured on basal electrodes (located approximately at the 16-24 kHz location in the cochlea).. In the clinical cohort, a significant negative correlation existed between cochlear microphonic latency shifts and hearing thresholds at 1-, 2-, & 4 kHz when tested on electrodes located at the relevant cochlear tonotopic place. This reduction in latency shift was such that patients with no measurable hearing also had no detectable latency shift (place assessed by CT scan, r's of -.70 to -.83). These findings suggest that electrocochleography can be used as a diagnostic tool to detect cochlear regions with functioning hair cells, which may be important for defining cross-over point for electro-acoustic stimulation.
Collapse
|
19
|
Abstract
OBJECTIVES Hearing-in-noise (HIN) is a primary complaint of both the hearing impaired and the hearing aid user. Both auditory nerve (AN) function and outer hair cell (OHC) function are thought to contribute to HIN, but their relative contributions are still being elucidated. OHCs play a critical role in HIN by fine tuning the motion of the basilar membrane. Further, animal studies suggest that cochlear (auditory) synaptopathy, which is the loss of synaptic contact between hair cells and the AN, may be another cause of HIN difficulty. While there is evidence that cochlear synaptopathy occurs in animal models, there is debate as to whether cochlear synaptopathy is clinically significant in humans, which may be due to disparate methods of measuring noise exposure in humans and our high variability in susceptibility to noise damage. Rather than use self-reported noise exposure to define synaptopathic groups, this paper assumes that the general population exhibits a range of noise exposures and resulting otopathologies and defines cochlear synaptopathy "operationally" as low CAP amplitude accompanied by normal DPOAE levels in persons with low pure tone averages. The first question is whether the standard audiogram detects AN dysfunction and OHC dysfunction? The second question is whether HIN performance is primarily dependent on AN function, OHC function, or both functions? DESIGN Adult subjects have been recruited to participate in an ongoing study and variables such as age, self-reported gender, pure tone audiometry (0.25-20 kHz), subjective perception of HIN difficulty, Quick Speech-in Noise (QuickSIN) test, 45% time compressed word recognition (WR) in 10% reverberation and WR in the presence of ipsilateral speech-weighted noise have been collected. These variables were correlated with OHC function measured by distortion-product otoacoustic emission (DPOAE) signal to-noise-ratio (SNR), and AN function measured by compound action potential (CAP) peak amplitude and ratio to summating potential measured using electrocochleography. RESULTS Synaptopathy, by this operational definition, may be present in as many as 30% of individuals with normal hearing. Persons hearing within normal limits may exhibit HIN difficulties, and persons with hearing within normal limits may exhibit two distinct types of otopathologies undetected by the standard audiogram (a.k.a. hidden hearing loss) namely operational cochlear synaptopathy and OHC dysfunction. AN untuning secondary to OHC dysfunction is a third otopathology that occurs in subjects with a Mild-Moderate sensorineural hearing loss (SNHL). Clinical norms for each of these otopathologies are presented. Finally, the data show that operational cochlear synaptopathy does not correlate with HIN dysfunction. Rather, HIN performance is primarily governed by OHC function, while AN untuning also plays a lesser but statistically significant role. CONCLUSIONS The results of this study suggest the following: (1) persons hearing within normal limits may exhibit HIN difficulties; (2) persons hearing within normal limits may exhibit undetected otopathologies, namely AN dysfunction and OHC dysfunction; (3) AN untuning secondary to OHC dysfunction occurs in subjects with Mild-Moderate SNHL; (4) HIN performance is primarily governed by OHC function rather than AN function.
Collapse
Affiliation(s)
- Mark A Parker
- Department of Otolaryngology-Head and Neck Surgery, Steward St. Elizabeth's Medical Center, 736 Cambridge St., SMC-8, Brighton, MA 02135, United States; Tufts University School of Medicine, Boston MA, United States.
| |
Collapse
|
20
|
Riggs WJ, Hiss MM, Varadarajan VV, Mattingly JK, Adunka OF. Enlarged vestibular aqueduct: Intraoperative electrocochleography findings during cochlear implantation. Int J Pediatr Otorhinolaryngol 2020; 134:110065. [PMID: 32361253 DOI: 10.1016/j.ijporl.2020.110065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
Enlarged vestibular aqueduct (EVA) is the most frequent inner ear abnormality found on computed tomography in children with sensorineural hearing loss. The effects EVA abnormalities have on electrocochleography (ECochG) are unknown. Positive deflections in summation potential evoked by tone bursts were observed in 3/5 subjects, while a large negative deflection, similar to endolymphatic hydrops (EH), was observed for 2/5 subjects. The presence of an enlarged summation potential, with and without a compound action potential, was observed in response to a broadband click stimulus. Results suggest likely effects of a third window on ECochG responses and presence of EH in EVA.
Collapse
Affiliation(s)
- William J Riggs
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA; Nationwide Children's Hospital, Department of Audiology, Columbus, OH, USA.
| | - Meghan M Hiss
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA
| | - Varun V Varadarajan
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA
| | - Jameson K Mattingly
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA
| | - Oliver F Adunka
- The Ohio State University, College of Medicine, Department of Otolaryngology- Head and Neck Surgery, Columbus, OH, USA; Nationwide Children's Hospital, Department of Otolaryngology-Head and Neck Surgery, Columbus, OH, USA
| |
Collapse
|
21
|
Barnes JH, Yin LX, Saoji AA, Carlson ML. Electrocochleography in cochlear implantation: Development, applications, and future directions. World J Otorhinolaryngol Head Neck Surg 2020; 7:94-100. [PMID: 33997718 PMCID: PMC8103527 DOI: 10.1016/j.wjorl.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/02/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jason H Barnes
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aniket A Saoji
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
22
|
Tejani VD, Abbas PJ, Brown CJ, Woo J. An improved method of obtaining electrocochleography recordings from Nucleus Hybrid cochlear implant users. Hear Res 2019; 373:113-120. [PMID: 30665078 DOI: 10.1016/j.heares.2019.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 11/16/2022]
Abstract
Interest in electrocochleography (ECoG) has recently resurged as a potential tool to assess peripheral auditory function in cochlear implant (CI) users. ECoG recordings can be evoked using acoustic stimulation and recorded from an extra- or intra-cochlear electrode in CI users. Recordings reflect contributions from cochlear hair cells and the auditory nerve. We recently demonstrated the feasibility of using Custom Sound EP (clinically available software) to record ECoG responses in Nucleus Hybrid CI users with preserved acoustic hearing in the implanted ear (Abbas et al, 2017). While successful, the recording procedures were time intensive, limiting clinical applications. The current report describes how we improved data collection efficiency by writing custom software using Python programming language. The software interfaced with Nucleus Implant Communicator (NIC) routines to record responses from an intracochlear electrode. ECoG responses were recorded in eight CI users with preserved acoustic hearing using Custom Sound EP and the Python-based software. Responses were similar across both recording systems, but the recording time decreased significantly using the Python-based software. Seven additional CI users underwent repeated testing using the Python-based software and showed high test-retest reliability. The improved efficiency and high reliability increases the likelihood of translating intracochlear ECoG to clinical practice.
Collapse
Affiliation(s)
- Viral D Tejani
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paul J Abbas
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Carolyn J Brown
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jihwan Woo
- Department of Biomedical Engineering, University of Ulsan, Ulsan, Republic of Korea.
| |
Collapse
|
23
|
Abstract
The transduction process in the cochlea requires patent hair cells. Population responses that reflect this patency are the cochlear microphonic (CM) and summating potential (SP). They can be measured using electrocochleography (ECochG). The CM reflects the sound waveform in the form of outer hair cell (OHC) depolarization and hyperpolarization, and the SP reflects the average voltage difference of the OHC membrane potential for depolarization and hyperpolarization. The CM can be measured using ECochG or via the so-called otoacoustic emissions, using a sensitive microphone in the ear canal. Neural population responses are called the compound action potentials (CAPs), which by frequency selective masking can be decomposed into narrow-band action potentials (NAPs) reflecting CAPs evoked by activity from small cochlear regions. Presence of CM and absence of CAPs are the diagnostic hallmarks of auditory neuropathy. Increased and prolonged SPs are often found in Ménière's disease but are too often in the normal range to be diagnostic. When including NAP waveforms, Ménière's disease can be differentiated from vestibular schwannomas, which often feature overlapping symptoms such as dizziness, hearing loss, and tinnitus. The patency of the efferent system, particularly the olivocochlear bundle, can be tested using the suppressive effect of contralateral stimulation on the otoacoustic emission amplitude.
Collapse
|
24
|
Higashi-Shingai K, Imai T, Okumura T, Uno A, Kitahara T, Horii A, Ohta Y, Osaki Y, Sato T, Okazaki S, Kamakura T, Takimoto Y, Ozono Y, Watanabe Y, Imai R, Hanada Y, Ohata K, Oya R, Inohara H. Change in endolymphatic hydrops 2 years after endolymphatic sac surgery evaluated by MRI. Auris Nasus Larynx 2018; 46:335-345. [PMID: 30502065 DOI: 10.1016/j.anl.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/16/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was performed to determine whether endolymphatic sac surgery improves vestibular and cochlear endolymphatic hydrops 2 years after sac surgery and to elucidate the relationship between the degree of improvement of endolymphatic hydrops and the changes in vertigo symptoms, the hearing level, and the summating potential/action potential ratio (-SP/AP ratio) by electrocochleography (ECochG) in patients with Ménière's disease (MD). METHODS Twenty-one patients with unilateral MD who underwent sac surgery were included in this study. All patients underwent gadolinium-enhanced magnetic resonance imaging (Gd-MRI) before and 2 years after sac surgery. We evaluated the difference in vestibular and cochlear endolymphatic hydrops between before and after surgery in both ears and compared these findings with the frequency of vertigo attacks, hearing level, and ECochG findings. RESULTS In affected ears, the presence of vestibular endolymphatic hydrops and the frequency of vertigo attacks significantly decreased after surgery. However, affected ears showed no significant improvement in the presence of cochlear endolymphatic hydrops or the -SP/AP ratio by ECochG; there was also no significant improvement or deterioration in the hearing level. CONCLUSION The present findings suggest that sac surgery reduces vestibular endolymphatic hydrops and prevents aggravation of cochlear endolymphatic hydrops, and these changes lead to a reduction of vertigo attacks and suppress the progression of hearing impairment associated with vertigo attacks.
Collapse
Affiliation(s)
| | - Takao Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Tomoko Okumura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
| | - Tadashi Kitahara
- Department of Otorhinolaryngology - Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Arata Horii
- Department of Otorhinolaryngology - Head and Neck Surgery, Niigata University Graduate School of Medicine and Dentistry, Niigata, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Osaki
- Department of Otolaryngology, Kinki University Faculty of Medicine, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Suzuyo Okazaki
- Department of Otolaryngology, Osaka City General Hospital, Osaka, Japan
| | | | | | - Yoshiyuki Ozono
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiyuki Watanabe
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryusuke Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yukiko Hanada
- Department of Otolaryngology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kazuya Ohata
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryohei Oya
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
25
|
Kim JS, Tejani VD, Abbas PJ, Brown CJ. Postoperative Electrocochleography from Hybrid Cochlear Implant users: An Alternative Analysis Procedure. Hear Res 2018; 370:304-315. [PMID: 30393003 DOI: 10.1016/j.heares.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/18/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Shorter electrode arrays and soft surgical techniques allow for preservation of acoustic hearing in many cochlear implant (CI) users. Recently, we developed a method of using the Neural Response Telemetry (NRT) system built in Custom Sound EP clinical software to record acoustically evoked electrocochleography (ECoG) responses from an intracochlear electrode in Nucleus Hybrid CI users (Abbas et al., 2017). We recorded responses dominated by the hair cells (cochlear microphonic, CM/DIF) and the auditory nerve (auditory nerve neurophonic, ANN/SUM). Unfortunately, the recording procedure was time consuming, limiting potential clinical applications. This report describes a modified method to record the ECoG response more efficiently. We refer to this modified technique as the "short window" method, while our previous technique (Abbas et al., 2017) is referred as the "long window" method. In this report, our goal was to 1) evaluate the feasibility of the short window method to record the CM/DIF and ANN/SUM responses, 2) characterize the reliability and sensitivity of the measures recorded using the short window method, and 3) evaluate the relationship between the CM/DIF and ANN/SUM measures recorded using the modified method and audiometric thresholds. METHOD Thirty-four postlingually deafened adult Hybrid CI users participated in this study. Acoustic tone bursts were presented at four frequencies (250, 500, 750, and 1000 Hz) at various stimulation levels via an insert earphone in both condensation and rarefaction polarities. Acoustically evoked ECoG responses were recorded from the most apical electrode in the intracochlear array. These two responses were subtracted to emphasize the CM/DIF responses and added to emphasize the ANN/SUM responses. Response thresholds were determined based on visual inspection of time waveforms, and trough-to-peak analysis technique was used to quantify response amplitudes. Within-subject comparison of responses measured using both short and long window methods were obtained from seven subjects. We also assessed the reliability and sensitivity of the short window method by comparing repeated measures from 19 subjects at different times. Correlations between CM/DIF and ANN/SUM measures using the short window recording method and audiometric thresholds were also assessed. RESULTS Regardless of the recording method, CM/DIF responses were larger than ANN/SUM responses. Responses obtained using the short window method were positively correlated to those obtained using the conventional long window method. Subjects who had stable acoustic hearing at two different time points had similar ECoG responses at those points, confirming high test-retest reliability of the short window method. Subjects who lost hearing between two different time points showed increases in ECoG thresholds, suggesting that physiologic ECoG responses are sensitive to audiometric changes. Correlations between CM/DIF and ANN/SUM thresholds and audiometric thresholds at all tested frequencies were significant. CONCLUSION This study compares two different recording methods. Intracochlear ECoG measures recorded using the short window technique were efficient, reliable, and repeatable. We were able to collect more frequency specific data with the short window method, and observed similar results between the long window and short window methods. Correlations between physiological thresholds and audiometric thresholds were similar to those reported previously using the long window method (Abbas et al., 2017). This is an important finding because it demonstrates that clinically-available software can be used to measure frequency-specific ECoG responses with enhanced efficiency, increasing the odds that this technique might move from the laboratory into clinical practice.
Collapse
Affiliation(s)
- Jeong-Seo Kim
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| | - Viral D Tejani
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Paul J Abbas
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Carolyn J Brown
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA; Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| |
Collapse
|
26
|
Favier V, Vincent C, Bizaguet É, Bouccara D, Dauman R, Frachet B, Le Her F, Meyer-Bisch C, Tronche S, Sterkers-Artières F, Venail F. French Society of ENT (SFORL) guidelines (short version): Audiometry in adults and children. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:341-347. [PMID: 29929777 DOI: 10.1016/j.anorl.2018.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION French Society of ENT (SFORL) good practice guidelines for audiometric examination in adults and children. METHODS A multidisciplinary working group performed a review of the scientific literature. Guidelines were drawn up, reviewed by an independent reading group, and finalized in a consensus meeting. RESULTS Audiometry should be performed in an acoustically controlled environment (<30dBA); audiometer calibration should be regularly checked; and patient-specific masking rules should be systematically applied. It should be ensured that masking is not overmasking. Adult pure-tone audiometry data should be interpreted taking account of clinical data, speech audiometry and impedancemetry. In case of discrepancies between clinical and pure-tone and speech audiometry data, objective auditory tests should be perform. In children aged 2 years or younger, subjective audiometry should be associated to behavioral audiometry adapted to the child's age. In suspected hearing impairment, behavioral audiometry should be systematically supplemented by objective hearing tests to determine and confirm the level and type of hearing impairment.
Collapse
Affiliation(s)
- V Favier
- ORL et chirurgie cervico-faciale, CHU de Montpellier, 34090 Montpellier, France.
| | - C Vincent
- Service d'otologie et otoneurologie, CHU de Lille, 59037 Lille cedex, France
| | - É Bizaguet
- Laboratoire de correction auditive, 75001 Paris, France
| | - D Bouccara
- Groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - R Dauman
- Unité d'audiologie, université et CHU de Bordeaux, 33000 Bordeaux, France
| | - B Frachet
- Hôpital Rothschild, centre de réglage des implants cochléaires, Association agir pour l'audition/association France Presbyacousie, AP-HP, 75012 Paris, France
| | - F Le Her
- 41, rue de la Tour-de-Beurre, 76000 Rouen, France
| | | | | | - F Sterkers-Artières
- Service d'audiophologie, d'otologie et otoneurologie, institut Saint-Pierre, Palavas, CHU de Montpellier, 34090 Montpellier, France
| | - F Venail
- Inserm 1051, service otologie-otoneurologie, plateforme d'audiologie I-PaudioM, CHU de Montpellier, 34090 Montpellier, France
| |
Collapse
|
27
|
Heidari Phd F, Pourbakht A, Kamrava SK, Kamali M, Yousefi A. Comparison of Cochlear Microphonics Magnitude with Broad and Narrow Band Stimuli in Healthy Adult Wistar Rats. Iran J Child Neurol 2018; 12:58-65. [PMID: 29696047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/04/2017] [Accepted: 01/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cochlear microphonic (CM) is a cochlear AC electric field, recorded within, around, and remote from its sources. Nowadays it can contribute to the differential diagnosis of different auditory pathologies such as auditory neuropathy spectrum disorder (ANSD). This study compared CM waveforms (CMWs) and amplitudes with broad and narrow band stimuli in 25 healthy male young adults Wistar rats. MATERIALS & METHODS This experimental study was accomplished in the School of Rehabilitation Sciences of Iran University of Medical Sciences, Tehran, Iran (April, 2016). Using an extratympanic technique in ECochG (Electrocochleography) recording, CMWs in response to click and tonal stimuli with different octave frequencies were recorded at a high intensity level in subjects. The CMW amplitudes were calculated by a graphical user interface (GUI) designed in MATLAB. RESULTS The CMW magnitude increased upon an increase in bandwidth stimulation. CM amplitude with click stimulation was larger than tonal stimuli. Across tonal stimuli, the CMW amplitudes at lower frequency tones were larger than those at higher frequency tones. Those findings were statistically significant (P<0.001). CONCLUSION CMW amplitude with click as broadband stimulus was larger than those with tone bursts as narrowband stimulation. Click stimulation due to the width of spectral involves greater regions of cochlear partition. Therefore, CMW most likely is a reflection of spatial summation of voltage drops generated by hair cell groups in response to acoustic stimulation. In order to production nature of CM potentials as well as their very small magnitudes especially with tonal stimuli, thus, we recommend using click stimulation for CM potential recording.
Collapse
|
28
|
Campbell L, Bester C, Iseli C, Sly D, Dragovic A, Gummer AW, O'Leary S. Electrophysiological Evidence of the Basilar-Membrane Travelling Wave and Frequency Place Coding of Sound in Cochlear Implant Recipients. Audiol Neurootol 2017; 22:180-189. [PMID: 29084395 DOI: 10.1159/000478692] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/13/2017] [Indexed: 11/19/2022] Open
Abstract
AIM To obtain direct evidence for the cochlear travelling wave in humans by performing electrocochleography from within the cochlea in subjects implanted with an auditory prosthesis. BACKGROUND Sound induces a travelling wave that propagates along the basilar membrane, exhibiting cochleotopic tuning with a frequency-dependent phase delay. To date, evoked potentials and psychophysical experiments have supported the presence of the travelling wave in humans, but direct measurements have not been made. METHODS Electrical potentials in response to rarefaction and condensation acoustic tone bursts were recorded from multiple sites along the human cochlea, directly from a cochlear implant electrode during, and immediately after, its insertion. These recordings were made from individuals with residual hearing. RESULTS Electrocochleography was recorded from 11 intracochlear electrodes in 7 ears from 6 subjects, with detectable responses on all electrodes in 5 ears. Cochleotopic tuning and frequency-dependent phase delay of the cochlear microphonic were demonstrated. The response latencies were slightly shorter than those anticipated which we attribute to the subjects' hearing loss. CONCLUSIONS Direct evidence for the travelling wave was observed. Electrocochleography from cochlear implant electrodes provides site-specific information on hair cell and neural function of the cochlea with potential diagnostic value.
Collapse
Affiliation(s)
- Luke Campbell
- Department of Surgery - Otolaryngology, University of Melbourne, RVEEH, East Melbourne, VIC, Australia
| | | | | | | | | | | | | |
Collapse
|
29
|
Imai T, Uno A, Kitahara T, Okumura T, Horii A, Ohta Y, Sato T, Okazaki S, Kamakura T, Ozono Y, Watanabe Y, Hanada Y, Imai R, Ohata K, Inohara H. Evaluation of endolymphatic hydrops using 3-T MRI after intravenous gadolinium injection. Eur Arch Otorhinolaryngol 2017; 274:4103-11. [PMID: 28948373 DOI: 10.1007/s00405-017-4739-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
Aim of this work is to establish evaluation criteria for identifying endolymphatic hydrops in the vestibule and cochlea using a magnetic resonance imaging (MRI) scanner. This is a retrospective diagnostic study. We evaluated 70 ears of 35 unilateral Ménière's disease patients. We performed 3-T MRI 4 h after intravenous gadolinium injection. Otologists manually traced the outline of vestibule, cochlea, and endolymphatic space of the vestibule and cochlea on two-dimensional fluid-attenuated inversion-recovery (2D-FLAIR) images. The traced area was measured, and rates of endolymphatic space to the vestibule and cochlea were calculated. The same otologists judged whether the low signal intensity area of the cochlea was at the edge of the cochlea. For measuring the rate of endolymphatic space to the vestibule, when the cut-off value was 30%, the presence of endolymphatic hydrops was determined with sensitivity of 87.1% and specificity of 94.3%. In contrast, the rate of endolymphatic space to the cochlea produced low accuracy. Therefore, when the presence of endolymphatic hydrops in the cochlea was judged by whether the low signal intensity area in the cochlea was at the edge of cochlea, endolymphatic hydrops could be detected with sensitivity of 91.4% and specificity of 94.3%. We were able to identify endolymphatic hydrops in the vestibule when the rate of endolymphatic space to the vestibule was greater than 30%, and could detect endolymphatic hydrops in the cochlea when a low signal intensity area was located at the edge of the cochlea in 2D-FLAIR images. Level of evidence 4.
Collapse
|
30
|
Montazeri K, Mahmoudian S, Razaghi Z, Farhadi M. Alterations in Auditory Electrophysiological Responses Associated With Temporary Suppression of Tinnitus Induced by Low-Level Laser Therapy: A Before-After Case Series. J Lasers Med Sci 2017; 8:S38-S45. [PMID: 29071034 DOI: 10.15171/jlms.2017.s8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Tinnitus is the phantom auditory perception of sound in the absence of an external or internal acoustic stimulus. The treatment is difficult due to multiple etiologies and great psychological influence. The purpose of this study was to determine alterations in auditory physiological and electrophysiological responses associated with temporary suppression of tinnitus induced by low-level laser (LLL) irradiation. Methods: This study was conducted on 20 subjects with subjective tinnitus. All subjects signed the informed consent form and satisfied all the study eligibility criteria. Visual analog scale (VAS) for loudness, loudness matching of tinnitus (LMT), pitch matching of tinnitus (PMT), Persian-tinnitus questionnaire (P-TQ) and Persian-tinnitus handicap inventory (P-THI) were conducted pre- and post-low level laser therapy (LLLT) for all the subjects. Electrocochleography (ECochG) and distortion product otoacoustic emissions (DPOAEs) were recorded in 11 subjects. Continuous wave diode lasers, including red (630 nm) and infra-red (808 nm) were applied, and were both designed by the Canadian Optic and Laser (COL) Center. Twelve sessions of laser therapy were performed, 2 sessions per week for each subject. Total dose was 120 Joule/ ear/session. Results: LLL irradiation could cause a significant decrease in subjective tests scores consisting of VAS for loudness, PMT, P-TQ, P-THI, but did not result in a significant improvement of objective evaluating parameters except for compound action potential (CAP) amplitude. Conclusion: LLLT might be a subjectively effective treatment for short-term improvement of tinnitus. Defining a new protocol for optimizing LLLT parameters may be an option to improve parameters of objective tests.
Collapse
Affiliation(s)
- Katayoon Montazeri
- Laboratory for Auditory Neuroscience, ENT and Head & Neck Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Mahmoudian
- Laboratory for Auditory Neuroscience, ENT and Head & Neck Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Razaghi
- Laser Application in Medical Sciences Research Center (LAMSRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- Laboratory for Auditory Neuroscience, ENT and Head & Neck Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
31
|
Fontenot TE, Giardina CK, Teagle HF, Park LR, Adunka OF, Buchman CA, Brown KD, Fitzpatrick DC. Clinical role of electrocochleography in children with auditory neuropathy spectrum disorder. Int J Pediatr Otorhinolaryngol 2017; 99:120-127. [PMID: 28688553 PMCID: PMC5538887 DOI: 10.1016/j.ijporl.2017.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To assess electrocochleography (ECochG) to tones as an instrument to account for CI speech perception outcomes in children with auditory neuropathy spectrum disorder (ANSD). MATERIALS & METHODS Children (<18 years) receiving CIs for ANSD (n = 30) and non-ANSD (n = 74) etiologies of hearing loss were evaluated with ECochG using tone bursts (0.25-4 kHz). The total response (TR) is the sum of spectral peaks of responses across frequencies. The compound action potential (CAP) and the auditory nerve neurophonic (ANN) in ECochG waveforms were used to estimate nerve activity and calculate nerve score. Performance on open-set monosyllabic word tests was the outcome measure. Standard statistical methods were applied. RESULTS On average, TR was larger in ANSD than in non-ANSD subjects. Most ANSD (73.3%) and non-ANSD (87.8%) subjects achieved open-set speech perception; TR accounted for 33% and 20% of variability in the outcomes, respectively. In the ANSD group, the PTA accounted for 69.3% of the variability, but there was no relationship with outcomes in the non-ANSD group. In both populations, nerve score was sensitive in identifying subjects at risk for not acquiring open-set speech perception, while the CAP and the ANN were more specific. CONCLUSION In both subject groups, the TRs correlated with outcomes but these measures were notably larger in the ANSD group. There was also strong correlation between PTA and speech perception outcome in ANSD group. In both subject populations, weaker evidence of neural activity was related to failure to achieve open-set speech perception.
Collapse
Affiliation(s)
- Tatyana E Fontenot
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, NC, United States.
| | - Christopher K Giardina
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, NC, United States; University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Holly F Teagle
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, NC, United States
| | - Lisa R Park
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, NC, United States
| | - Oliver F Adunka
- The Ohio State University, Department of Otolaryngology, Columbus, OH, United States
| | - Craig A Buchman
- Washington University in St. Louis, Department of Otolaryngology, St. Louis, MO, United States
| | - Kevin D Brown
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, NC, United States
| | - Douglas C Fitzpatrick
- University of North Carolina at Chapel Hill, Department of Otolaryngology, Chapel Hill, NC, United States; University of North Carolina School of Medicine, Chapel Hill, NC, United States
| |
Collapse
|
32
|
Mammarella F, Zelli M, Varakliotis T, Eibenstein A, Pianura CM, Bellocchi G. Is Electrocochleography Still Helpful in Early Diagnosis of Meniere Disease? J Audiol Otol 2017; 21:72-76. [PMID: 28704892 PMCID: PMC5516694 DOI: 10.7874/jao.2017.21.2.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/05/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives Despite the extensive research for the Meniere’s disease (MD), it’s pathophysiology still remains uncertain and questionable among scientists. Clinical symptoms and audiometric tests form the basis for the diagnosis. Nevertheless the differential diagnosis can be extremely challenging, due to subjective and not specific results. Incorrect diagnosis is most likely and for this reason there is a great demand for objective and reliable tests. Subjects and Methods The presence of endolymphatic hydrops is necessary condition but non enough for the diagnosis. In this study we analyze retrospectively the summating potentials (SP)/action protentials (AP) ratio from peritympanic electrocochleography in 34 patients,divided in two groups (13 patients classified as defined MD and 21 patients classified as probable MD). The purpose was to identify the utility of the exam so to be able to achieve an early defined diagnosis. Furthermore our intention was to obtain an objective test, besides the clinical criteria currently in use for the diagnosis and the classification of the MD. Results The analysis of the SP/AP results shows high predictability for the MD (positive in six out of seven cases with a sensitivity greater than 80%). Conclusions Our study demonstrates a satisfactory sensibility percentage in recurrent defined MD presentation (>80%). Early identification of MD can lead to an early treatment and control of the progression of the disease. Furthermore it could be a valuable instrument for the follow up and evaluation of the patients classified as probable MD in accordance with the criteria of the American Academy of Otolaryngology-Head and Neck Surgery (1995).
Collapse
Affiliation(s)
| | - Melissa Zelli
- ENT Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Theodoros Varakliotis
- ENT Department, San Camillo Forlanini Hospital, Rome, Italy.,Department of Applied Clinical Sciences and Biotechnology (DISCAB), L'Aquila University, L'Aquila, Italy
| | - Alberto Eibenstein
- Department of Applied Clinical Sciences and Biotechnology (DISCAB), L'Aquila University, L'Aquila, Italy
| | | | | |
Collapse
|
33
|
Ward BK, Wenzel A, Ritzl EK, Carey JP. Electrocochleography summating potential seen on auditory brainstem response in a case of superior semicircular canal dehiscence. Surg Neurol Int 2017; 8:90. [PMID: 28607824 PMCID: PMC5461570 DOI: 10.4103/sni.sni_442_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Superior canal dehiscence syndrome (SCDS) is a condition in which an abnormal communication between the superior semicircular canal and the middle cranial fossa causes patients to hear internal noises transmitted loudly to their affected ear as well as to experience vertigo with pressure changes or loud sounds. Patients with SCDS can have an elevated ratio of summating potential (SP) to action potential (AP) as measured by electrocochleography (ECochG). Changes in this ratio have been observed during surgical intervention to correct this abnormal communication. Case Description: We present a case of SCDS along with history, physical examination, vestibular function testing, and computed tomography imaging. Due to the disabling symptoms, the patient elected to undergo surgery for plugging of the superior semicircular canal by middle cranial fossa approach. Simultaneous intraoperative ECochG and auditory brainstem response (ABR) were performed. Changes in SP/AP ratio, SP amplitude, and ABR wave I latency were observed during surgery, with a large ECochG SP amplitude generating a new wave, identifiable on the ABR and preceding the traditional wave I. The patient's symptoms resolved after surgery, and no long-term detriment to hearing was observed. Conclusions: This case demonstrates the intraoperative changes in ECochG during surgery for repair of a SCDS. The substantial intraoperative changes in the summating potential can create a novel wave on intraoperative ABR.
Collapse
Affiliation(s)
- Bryan K Ward
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Angela Wenzel
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Eva K Ritzl
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - John P Carey
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
34
|
Grasel SS, Beck RMDO, Loureiro RSC, Rossi AC, de Almeida ER, Ferraro J. Normative data for TM electrocochleography measures. J Otol 2017; 12:68-73. [PMID: 29937840 PMCID: PMC5963457 DOI: 10.1016/j.joto.2017.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 12/27/2022] Open
Abstract
Objective Establish normative data for tympanic electrocochleography (TM ECochG) parameters in normal hearing adults without Ménière's disease's (MD) symptoms. Describe TM ECochG variables that help to distinguish normal from MD ears. Material and methods We enrolled 100 subjects (N = 200 ears), 59 females, aged between 19 and 71 years from 09/2010 to 04/2014. Inclusion criteria: normal otomicroscopy, hearing thresholds ≤25 dB nHL from 250 to 4000 Hz, normal tympanogram, no symptoms of MD according to the AAO-HNS 1995 criteria and Gibson's score <7. We excluded subjects with dizziness, aural fullness or other symptoms of endolymphatic hydrops. The following parameters were analyzed: SP/AP amplitude ratio, SP/AP area ratio and the difference between AP latency with rarefaction and condensation stimuli. Results There was no significant difference between right and left ears (Intraclass correlation coefficient < 0.6). SP/AP amplitude ratio varied between 0.084 and 0.356 and SP/AP area ratio between 0.837 and 1.671 (percentiles 5 and 95). The AP latency difference to rarefaction and condensation clicks was between 0.0 and 0.333 ms. Conclusion Normative data for TM ECochG parameters were established in 100 normal hearing subjects without MD. These data can be used to distinguish normal from pathological findings and in follow-up of MD patients.
Collapse
Affiliation(s)
- Signe Schuster Grasel
- University of Sao Paulo School of Medicine, Dr. Eneas de Carvalho Aguiar, 255, sala 6173, Cerqueira César, Sao Paulo, SP CEP 05403-000, Brazil
| | - Roberto Miquelino de Oliveira Beck
- University of Sao Paulo School of Medicine, Dr. Eneas de Carvalho Aguiar, 255, sala 6173, Cerqueira César, Sao Paulo, SP CEP 05403-000, Brazil
| | - Ricardo Silva Chiabai Loureiro
- University of Sao Paulo School of Medicine, Dr. Eneas de Carvalho Aguiar, 255, sala 6173, Cerqueira César, Sao Paulo, SP CEP 05403-000, Brazil
| | - Amanda Costa Rossi
- University of Sao Paulo School of Medicine, Dr. Eneas de Carvalho Aguiar, 255, sala 6173, Cerqueira César, Sao Paulo, SP CEP 05403-000, Brazil
| | - Edigar Rezende de Almeida
- University of Sao Paulo School of Medicine, Dr. Eneas de Carvalho Aguiar, 255, sala 6173, Cerqueira César, Sao Paulo, SP CEP 05403-000, Brazil
| | - John Ferraro
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| |
Collapse
|
35
|
Abstract
Electrophysiologic hearing tests have been developed since the 1960s to determine hearing thresholds objectively. They are now implemented in newborn hearing screening. While they determine thresholds, interpretation requires subjective pure-tone and speech audiometry to determine the type of hearing loss. Each examination tests a different anatomic region, enabling the auditory system to be explored from the organ of Corti to the auditory cortex. Thus, the various objective audiometric examinations are complementary.
Collapse
Affiliation(s)
- D Bakhos
- ENT department, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Équipe 1, CNRS ERL 3106, UMRS imagerie et cerveau, Inserm U930, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France.
| | - M Marx
- Service d'otologie-otoneurologie, CHU de Toulouse, hôpital Purpan, place du Docteur-Baylac, 31059 Toulouse, France; Laboratoire CerCo, université Paul-Sabatier, 31059 Toulouse, France
| | - A Villeneuve
- ENT department, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - E Lescanne
- ENT department, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Équipe 1, CNRS ERL 3106, UMRS imagerie et cerveau, Inserm U930, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - S Kim
- ENT department, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; Équipe 1, CNRS ERL 3106, UMRS imagerie et cerveau, Inserm U930, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| | - A Robier
- ENT department, université François-Rabelais de Tours, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France
| |
Collapse
|
36
|
Zakaria MN, Nik Othman NA, Musa Z. Electrocochleographic recording in Asian adults: Preliminary normative data and demographic analyses. J Otol 2017; 12:29-33. [PMID: 29937834 PMCID: PMC6011801 DOI: 10.1016/j.joto.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 01/29/2017] [Accepted: 02/06/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Electrocochleography (ECochG) is valuable to diagnose Meniere's disease objectively. The aim of the present study was to provide preliminary normative data for ECochG among Asian adults. The influences of ethnicity (Malay versus Chinese) and gender on ECochG results were also studied. METHODS Twenty-two Malay adults (10 men and 12 women) and twenty Chinese participants (10 men and 10 women) aged between 20 and 49 years participated in this study. Extratympanic ECochG (ET-ECochG) was recorded according to standard non-invasive procedure. Summating potential (SP) amplitude, action potential (AP) amplitude and SP/AP ratio were analyzed accordingly. RESULTS ET-ECochG results were found to be comparable between left and right ears (p > 0.05). No notable differences in ET-ECochG results were found between Malay and Chinese groups (p > 0.05). No significant influence of gender on ET-ECochG outcomes was also noted (p > 0.05). The derived normative data for Asian adults (84 ears) are consistent with previous reports. CONCLUSION The present study provides preliminary normative data for ET-ECochG among Asian adults. The ECochG components do not appear to be influenced by either ethnicity or gender. The derived normative data can be used for clinical applications and as the reference for future studies involving Asian population.
Collapse
Affiliation(s)
- Mohd Normani Zakaria
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
- Corresponding author. Fax: +60 9 7677515.
| | - Nik Adilah Nik Othman
- Audiology Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Zalilah Musa
- Department of Otorhinolaryngology (ORL), School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
37
|
Lee JD, Kim HJ, Jung J, Kim SH, Kim BG, Kim KS. Is dehydration test using isosorbide useful in Meniere's disease? Acta Otolaryngol 2016; 136:1107-1109. [PMID: 27348133 DOI: 10.1080/00016489.2016.1195917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION The dehydration test using isosorbide is well tolerated when used to detect endolymphatic hydrops and may also be used to improve the sensitivity of ECoG performed on patients with MD, especially in poor hearing at low-frequency. OBJECTIVE This prospective study was to explore the diagnostic utility of a dehydration test, administering oral isosorbide, which has been used to treat Meniere's disease (MD). METHOD Electrocochleography (ECoG) and the dehydration test with isosorbide were performed on 32 patients diagnosed with definite diagnosed MD. Isosorbide (120 mL) was orally administered after baseline audiometric testing, and the testing was repeated 3 h later. The dehydration test was considered positive when improvements in hearing thresholds of 10 dB or more were evident at two or more frequencies, or the speech discrimination score increased by 12% or more. An abnormal ECoG finding was defined as an SP/AP (summating potential/action potential) ratio ≥0.4. RESULTS The dehydration test using isosorbide was positive in 10 of 32 patients (31.3%). The test was not associated with development of any serious side-effect. Abnormal ECoG findings were noted in 14 of 32 patients (43.8%). When endolymphatic hydrops was defined as an abnormal ECoG or a positive dehydration test, the condition was detected in 21 of 32 patients (65.6%). The positive result in dehydration test was significantly higher in patients with above moderate hearing loss at low-frequency.
Collapse
|
38
|
Lamounier P, de Souza TSA, Gobbo DA, Bahmad F. Evaluation of vestibular evoked myogenic potentials (VEMP) and electrocochleography for the diagnosis of Ménière's disease. Braz J Otorhinolaryngol 2016; 83:394-403. [PMID: 27397722 PMCID: PMC9442737 DOI: 10.1016/j.bjorl.2016.04.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/03/2016] [Accepted: 04/14/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction Ménière's disease (MD) is an inner ear disorder characterized by episodic vertigo, tinnitus, ear fullness, and fluctuating hearing. Its diagnosis can be especially difficult in cases where vestibular symptoms are present in isolation (vestibular MD). The definitive diagnosis is made histologically and can only be performed post-mortem, after analysis of the temporal bone. Endolymphatic hydrops is a histopathological finding of the disease and occurs more often in the cochlea and saccule, followed by the utricle and semicircular canals. Vestibular evoked myogenic potentials (VEMP) emerged as the method of assessment of vestibular function in 1994. Until then, there was no unique way of assessing saccular function and the inferior vestibular nerve. Given that the saccule is responsible for most cases of severe hydrops, VEMP appears as a new tool to assist in the diagnosis of MD. Objective To evaluate the sensitivity and specificity of VEMP and electrocochleography (EcochG) in the diagnosis of definite MD compared with clinical diagnosis. Methods The study includes 12 patients (24 ears) diagnosed with definite MD defined according to the clinical criteria proposed by the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) in 1995, as well as 12 healthy volunteers allocated to the control group (24 ears). A clinical diagnosis by the AAO-HNS criteria was considered as the gold standard. All patients underwent an otoneurological examination, including pure tone and speech audiometry, VEMP, and extratympanic EcochG. The sensitivity and specificity to detect the presence or absence of disease were calculated, as well as their 95% confidence intervals. The reliability of VEMP and EcochG in both ears was assessed using the kappa index. Results In both tests and in both ears, the ability to diagnose healthy cases was high, with specificity ranging from 84.6% to 100%. Moreover, the ability of the tests to diagnose the disease varied from low to moderate sensitivity, with values ranging from 37.5% to 63.6%. The agreement of both tests in the right ear, measured by the kappa coefficient, was equal to 0.54 (95% CI: 0.20–0.89), indicating a moderate agreement. In the left ear, that agreement was equal to 0.07 (95% CI: −0.33 to 0.46), indicating a weak correlation between the tests. The sensitivity of the VEMP for the right ear was 63.6% and for the left ear, 62.5%. The sensitivity of EcochG for the right ear was 63.6% and 37.5% for the left ear. Conclusion The specificity of both tests was high, and the sensitivity of VEMP was higher than that of EcochG.
Collapse
Affiliation(s)
- Pauliana Lamounier
- Universidade de Brasília (UNB), Ciências da Saúde, Brasília, DF, Brazil; Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER-GO), Goiânia, GO, Brazil
| | | | - Debora Aparecida Gobbo
- Centro de Reabilitação e Readaptação Dr. Henrique Santillo (CRER-GO), Goiânia, GO, Brazil
| | - Fayez Bahmad
- Universidade de Brasília (UNB), Ciências da Saúde, Brasília, DF, Brazil; Instituto Brasiliense de Otorrinolaringologia, Brasília, DF, Brazil.
| |
Collapse
|
39
|
Redondo-Martínez J, Morant-Ventura A, Robledo-Aguayo D, Ayas-Montero A, Mencheta-Benet E, Marco-Algarra J. Extra-tympanic electrocochleography in a normal population. A descriptive study. Acta Otorrinolaringol Esp 2016; 67:254-60. [PMID: 26968947 DOI: 10.1016/j.otorri.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVES Extra-tympanic electrocochleography is an electrophysiological register obtained after stimulating the cochlea with an audible stimulus. This stimulus is applied using an earphone over the external auditory canal, while the electrical activity is registered by surface electrodes. There are few studies that analyse normal electrocochleography in our environment. Thus, the main objective of our study was to regularize the values obtained with electrocochleography in ears without any otoneurological diseases. We explain in detail the process of obtaining the register. METHODS Sixty healthy ears were studied by extratympanic electrocochleography. Statistical results were analysed. While 30 ears were studied with a stimulus at 90dB, another 30 ears were studied with a stimulus at 80dB. RESULTS Summating potential and action potential latencies and amplitudes were measured. Summating potential/action potential ratios were calculated. Wave I and wave II latencies were also determined. These results were analysed in function of stimulus intensity, patient gender, patient age group and ear side studied. CONCLUSIONS This study collected extra-tympanic electrocochleography data in a normal population and the results were in the range of other international studies obtained in other countries. These data can be used as a reference to evaluate illnesses that affect cochlear structure or functions.
Collapse
Affiliation(s)
- Jaume Redondo-Martínez
- Servicio de ORL, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Cirugía, Universitat de València, Valencia, España.
| | - Antonio Morant-Ventura
- Servicio de ORL, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Cirugía, Universitat de València, Valencia, España
| | | | | | | | - Jaime Marco-Algarra
- Servicio de ORL, Hospital Clínico Universitario de Valencia, Valencia, España; Departamento de Cirugía, Universitat de València, Valencia, España
| |
Collapse
|
40
|
Adunka OF, Giardina CK, Formeister EJ, Choudhury B, Buchman CA, Fitzpatrick DC. Round window electrocochleography before and after cochlear implant electrode insertion. Laryngoscope 2015; 126:1193-200. [PMID: 26360623 DOI: 10.1002/lary.25602] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE/HYPOTHESIS Previous reports have documented the feasibility of utilizing electrocochleographic (ECoG) responses to acoustic signals to assess trauma caused during cochlear implantation. The hypothesis is that intraoperative round window ECoG before and after electrode insertion will help predict postoperative hearing preservation outcomes in cochlear implant recipients. STUDY DESIGN Prospective cohort study. METHODS Intraoperative round window ECoG responses were collected from 31 cochlear implant recipients (14 children and 17 adults) immediately prior to and just after electrode insertion. Hearing preservation was determined by postoperative changes in behavioral thresholds. RESULTS On average, the postinsertion response was smaller than the preinsertion response by an average of 4 dB across frequencies. However, in some cases (12 of 31) the response increased after insertion. The subsequent hearing loss was greater than the acute loss in the ECoG, averaging 22 dB across the same frequency range (250-1,000 Hz). There was no correlation between the change in the ECoG response and the corresponding change in audiometric threshold. CONCLUSIONS Intraoperative ECoG is a sensitive method for detecting electrophysiologic changes during implantation but had limited prognostic value regarding hearing preservation in the current conventional cochlear implant patient population where hearing preservation was not intended. LEVEL OF EVIDENCE 2b Laryngoscope, 126:1193-1200, 2016.
Collapse
Affiliation(s)
- Oliver F Adunka
- Department of Otolaryngology-Head & Neck Surgery, the Ohio State University, Columbus, Ohio, U.S.A.,Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Christopher K Giardina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Eric J Formeister
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Baishakhi Choudhury
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Craig A Buchman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Douglas C Fitzpatrick
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| |
Collapse
|
41
|
Gerenton G, Giraudet F, Djennaoui I, Pavier Y, Gilain L, Mom T, Avan P. Abnormal fast fluctuations of electrocochleography and otoacoustic emissions in Menière's disease. Hear Res 2015; 327:199-208. [PMID: 26232527 DOI: 10.1016/j.heares.2015.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/10/2015] [Accepted: 07/23/2015] [Indexed: 12/25/2022]
Abstract
The responses of cochlear hair cells to sound stimuli depend on the resting position of their stereocilia bundles, which is sensitive to the chemical and mechanical environment. Cochlear hydrops, a hallmark of Menière's disease (MD), which is likely to come with disruption of this environment, results in hearing symptoms and electrophysiological signs, such as excessive changes in the cochlear summating potential (SP) and in the postural shifts of distortion-product otoacoustic emissions (DPOAEs). Here, SP from the basal part of the cochlea and DPOAEs from the apical part of the cochlea were recorded concomitantly in 73 patients with a definite MD, near an attack (n = 40) or between attacks with no clinical symptoms (n = 33), to compare their sensitivities to posture and evaluate their stability. The phase of the 2f1-f2 DPOAEs was monitored during body tilt, with stimuli f1 = 1 kHz and f2 = 1.2 kHz at 72 dB SPL. Extratympanic electrocochleography was performed in response to 95-dBnHL clicks. The normal limits of the DPOAE phase shift with body tilt, [-18°, +38°], and of the SP to action-potential (AP) ratio, <0.40, were exceeded in 75% and 60% of patients, respectively, near an attack. In these patients, but not in the asymptomatic ones, both tests reveal fluctuating cochlear responses from one data sample to the next. They emphasize how hydrops hinders normal hair-cell operation and may generate fast fluctuations in inner-ear functioning. If these fluctuations also occur on shorter time scales, it might explain the imperfect diagnostic sensitivity of SP and DPOAE tests, as averaging procedures would tend to level out transient fluctuations characteristic of hydrops.
Collapse
|
42
|
Santarelli R, del Castillo I, Cama E, Scimemi P, Starr A. Audibility, speech perception and processing of temporal cues in ribbon synaptic disorders due to OTOF mutations. Hear Res 2015; 330:200-12. [PMID: 26188103 DOI: 10.1016/j.heares.2015.07.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 06/21/2015] [Accepted: 07/12/2015] [Indexed: 11/26/2022]
Abstract
Mutations in the OTOF gene encoding otoferlin result in a disrupted function of the ribbon synapses with impairment of the multivesicular glutamate release. Most affected subjects present with congenital hearing loss and abnormal auditory brainstem potentials associated with preserved cochlear hair cell activities (otoacoustic emissions, cochlear microphonics [CMs]). Transtympanic electrocochleography (ECochG) has recently been proposed for defining the details of potentials arising in both the cochlea and auditory nerve in this disorder, and with a view to shedding light on the pathophysiological mechanisms underlying auditory dysfunction. We review the audiological and electrophysiological findings in children with congenital profound deafness carrying two mutant alleles of the OTOF gene. We show that cochlear microphonic (CM) amplitude and summating potential (SP) amplitude and latency are normal, consistently with a preserved outer and inner hair cell function. In the majority of OTOF children, the SP component is followed by a markedly prolonged low-amplitude negative potential replacing the compound action potential (CAP) recorded in normally-hearing children. This potential is identified at intensities as low as 90 dB below the behavioral threshold. In some ears, a synchronized CAP is superimposed on the prolonged responses at high intensity. Stimulation at high rates reduces the amplitude and duration of the prolonged potentials, consistently with their neural generation. In some children, however, the ECochG response only consists of the SP, with no prolonged potential. Cochlear implants restore hearing sensitivity, speech perception and neural CAP by electrically stimulating the auditory nerve fibers. These findings indicate that an impaired multivesicular glutamate release in OTOF-related disorders leads to abnormal auditory nerve fiber activation and a consequent impairment of spike generation. The magnitude of these effects seems to vary, ranging from no auditory nerve fiber activation to an abnormal generation of EPSPs that occasionally trigger a synchronized electrical activity, resulting in high-threshold CAPs.
Collapse
Affiliation(s)
- Rosamaria Santarelli
- Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Audiology and Phoniatrics Service, Treviso Regional Hospital, Piazza Ospedale 1, 31100 Treviso, Italy.
| | - Ignacio del Castillo
- Servicio de Genética, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28034 Madrid, Spain
| | - Elona Cama
- Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Audiology and Phoniatrics Service, Treviso Regional Hospital, Piazza Ospedale 1, 31100 Treviso, Italy
| | - Pietro Scimemi
- Department of Neurosciences, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; Audiology and Phoniatrics Service, Treviso Regional Hospital, Piazza Ospedale 1, 31100 Treviso, Italy
| | - Arnold Starr
- Department of Neurology, University of California, Irvine, CA 92697, USA
| |
Collapse
|
43
|
Stuermer KJ, Beutner D, Foerst A, Hahn M, Lang-Roth R, Walger M. Electrocochleography in children with auditory synaptopathy/neuropathy: diagnostic findings and characteristic parameters. Int J Pediatr Otorhinolaryngol 2015; 79:139-45. [PMID: 25530534 DOI: 10.1016/j.ijporl.2014.11.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The early diagnosis of AS/AN in children remains challenging because it exclusively relies on the detection of OAE and/or CM, while ABR are pathologically changed or missing. The aim of our study was to ensure the diagnosis of AS/AN, demarcate it to an outer hair cell damage and possibly differentiate between pre- and postsynaptic pathologies. METHODS We retrospectively evaluated the transtympanic ECochG results of ten children with AS/AN and compared them to a matched group with SNHL and without any signs of AS/AN. We analyzed the thresholds, latencies and - as a new parameter - the amplitude ratio between CAP and SP. RESULTS CM and SP thresholds were significantly lower than CAP thresholds in AS/AN patients and significantly lower than SP and CM thresholds in SNHL patients with comparable CAP thresholds. The CAP/SP ratio of amplitudes in SNHL children was more than three times (significantly) higher than in AS/AN children. The cutoff value was set at 1.0 in order to differentiate between both groups with a 80-90% sensitivity and specificity. It was not possible to differentiate between a pre- and postsynaptic type of AS/AN in our collective. SUMMARY AND CONCLUSION The ECochG can add valuable information for a precise differential diagnosis of AS/AN, especially in babyhood. We identified the CAP/SP ratio as a new parameter for differentiation between AS/AN and SNHL. When the CAP/SP ratio falls below 1.0, patients can be diagnosed AS/AN with high specificity and sensitivity. Significantly smaller SPL are needed to evoke SP and CM in the AS/AN group, thus showing the preserved hair cell function.
Collapse
Affiliation(s)
| | - Dirk Beutner
- Department of Otorhinolaryngology, University of Cologne, Germany
| | - Astrid Foerst
- Department of Otorhinolaryngology, University of Cologne, Germany
| | - Moritz Hahn
- Institute of Medical Statistics, Informatics and Epidemiology (IMSIE), University of Cologne, Germany
| | - Ruth Lang-Roth
- Department of Otorhinolaryngology, University of Cologne, Germany
| | - Martin Walger
- Department of Otorhinolaryngology, University of Cologne, Germany
| |
Collapse
|
44
|
Abstract
Animal models of endolymphatic hydrops (ELH) provide critical insight into the pathophysiology of Meniere's disease (MD). A new genetic murine model, called the Phex mouse, circumvents prior need for a time and cost-intensive surgical procedure to create ELH. The Phex mouse model of ELH, which also has X-linked hypophosphatemic rickets, creates a postnatal, spontaneous, and progressive ELH whose phenotype has a predictable decline of vestibular and hearing function reminiscent of human MD. The Phex mouse enables real-time histopathologic analysis to assess diagnostic and therapeutic interventions as well as further our understanding of ELH's adverse effects. Already the model has validated electrocochleography and cervical vestibular evoked myogenic potential as useful diagnostic tools. New data on caspase activity in apoptosis of the spiral ganglion neurons may help target future therapeutic interventions. This paper highlights the development of the Phex mouse model and highlights its role in characterizing ELH.
Collapse
Affiliation(s)
- Cameron C Wick
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Maroun T Semaan
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Qing Yin Zheng
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Cliff A Megerian
- Ear, Nose, and Throat Institute, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| |
Collapse
|