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09:10
Performing Intracochlear Electrocochleography During Cochlear Implantation
Published on: March 8, 2022
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Electrocochleography-Guided Pull-Back Technique of Perimodiolar Electrode for Improved Hearing Preservation
Amit Walia1, Matthew A Shew, David S Lee
1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, St Louis, Missouri.
Summary
Electrocochleography (ECochG)-guided pull-back of cochlear implant electrodes improved proximity and hearing preservation. This technique enhanced speech understanding in noise, offering better outcomes for patients with residual hearing.
Area of Science:
- Otolaryngology
- Neuroscience
- Biomedical Engineering
Background:
- Maintaining proximity of cochlear implant electrodes to the modiolus is crucial for optimal device performance.
- Hearing preservation (HP) is a key goal in cochlear implantation, especially for patients with residual acoustic hearing.
- Conventional electrode insertion may not always achieve optimal perimodiolar positioning or preserve hearing.
Purpose of the Study:
- To assess if electrocochleography (ECochG)-guided pull-back of perimodiolar electrodes enhances perimodiolar proximity.
- To determine the impact of ECochG-guided pull-back on hearing preservation (HP) in cochlear implant (CI) recipients.
- To evaluate the effect of this technique on cochlear implant performance, including speech perception.
Main Methods:
- A prospective cohort study involving 77 adult CI recipients with residual low-frequency hearing.
- Comparison between conventional electrode insertion (N=31) and ECochG-guided pull-back (N=46).
- ECochG guidance involved identifying tonotopic responses during electrode insertion and adjustment.
Main Results:
- ECochG-guided pull-back significantly improved perimodiolar proximity (mean wrapping factor difference: 6.4).
- Smaller low-frequency pure-tone average (LFPTA) shifts were observed with ECochG-guided pull-back at 3 and 6 months post-activation.
- Hearing preservation rates were higher in the ECochG-guided group (40%) compared to conventional insertion (27.5%).
- Improved AzBio in noise scores were noted in the ECochG-guided group at 6 months (mean difference: 19.1%).
Conclusions:
- ECochG-guided pull-back is an effective method for improving perimodiolar proximity and hearing preservation rates in cochlear implant surgery.
- While speech perception in quiet remained similar, significant improvements in noisy conditions were observed with the ECochG-guided approach.
- The enhanced hearing preservation and potential benefits of hybrid stimulation may contribute to improved speech understanding in challenging listening environments.
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