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Estimating Performance Using Tonotopic Measurements of Intracochlear Electrocochleography: Comparison of Lateral Wall and Perimodiolar Arrays.

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Related Experiment Video

Updated: Jun 20, 2026

Performing Intracochlear Electrocochleography During Cochlear Implantation
09:10

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Identifying Slim Modiolar Electrode Tip Fold-Over With Intracochlear Electrocochleography.

Jordan J Varghese1, Amit Walia1, Shannon M Lefler1

  • 1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|November 29, 2023
PubMed
Summary

Intracochlear electrocochleography (ECochG) can predict tip fold-over during cochlear implantation (CI) with slim modiolar electrodes (SME). Nonrobust insertion and nontonotopic sweep patterns indicate potential fold-over, necessitating imaging.

Keywords:
CI632ECochGcochlear implantationcochlear implantsintracochlear electrocochleographyslim modiolar electrodetip fold‐over

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Biomedical Engineering

Background:

  • Cochlear implantation (CI) with slim modiolar electrode (SME) arrays aims for optimal hearing restoration.
  • Accurate electrode placement is crucial for CI efficacy, but complications like tip fold-over can occur.
  • Identifying intraoperative complications like tip fold-over is essential for successful CI outcomes.

Purpose of the Study:

  • To assess the predictive capability of intracochlear electrocochleography (ECochG) for detecting tip fold-over during CI using SME arrays.
  • To determine the sensitivity and specificity of ECochG patterns in identifying SME tip fold-over.
  • To establish ECochG as a potential tool for real-time monitoring of electrode array position during CI.

Main Methods:

  • A prospective cohort study was conducted at a tertiary referral center involving 142 patients undergoing CI with SME arrays.
  • Intracochlear ECochG was monitored during and after electrode insertion, with tone-bursts presented at varying frequencies and intensities.
  • ECochG responses were analyzed using Fast Fourier Transform (FFT) for frequency-specific evaluation, correlating patterns with intraoperative radiographs to identify tip fold-over.

Main Results:

  • Fifteen cases (10.6%) of tip fold-over were identified, all associated with significant ECochG responses (>2 µV).
  • Tip fold-over cases exhibited a nontonotopic postinsertion sweep and a nonrobust active insertion pattern.
  • The combination of nonrobust insertion and nontonotopic sweep patterns demonstrated 100% sensitivity and 68.9% specificity for detecting tip fold-over.

Conclusions:

  • Intracochlear ECochG monitoring during CI with SME arrays is a valuable tool for assessing electrode array position.
  • Nonrobust ECochG patterns during insertion and nontonotopic sweeps suggest potential tip fold-over, warranting further investigation.
  • Intraoperative imaging is recommended to confirm electrode placement when concerning ECochG patterns are observed, ensuring optimal CI outcomes.