使用外淋巴电图记录在耳蜗植入过程中的反应变化。
Response Changes During Insertion of a Cochlear Implant Using Extracochlear Electrocochleography.
机构信息
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.
Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, North Carolina, USA.
出版信息
Ear Hear. 2018 Nov/Dec;39(6):1146-1156. doi: 10.1097/AUD.0000000000000571.
OBJECTIVES
Electrocochleography is increasingly being utilized as an intraoperative monitor of cochlear function during cochlear implantation (CI). Intracochlear recordings from the advancing electrode can be obtained through the device by on-board capabilities. However, such recordings may not be ideal as a monitor because the recording electrode moves in relation to the neural and hair cell generators producing the responses. The purposes of this study were to compare two extracochlear recording locations in terms of signal strength and feasibility as intraoperative monitoring sites and to characterize changes in cochlear physiology during CI insertion.
DESIGN
In 83 human subjects, responses to 90 dB nHL tone bursts were recorded both at the round window (RW) and then at an extracochlear position-either adjacent to the stapes or on the promontory just superior to the RW. Recording from the fixed, extracochlear position continued during insertion of the CI in 63 cases.
RESULTS
Before CI insertion, responses to low-frequency tones at the RW were roughly 6 dB larger than when recording at either extracochlear site, but the two extracochlear sites did not differ from one another. During CI insertion, response losses from the promontory or adjacent to the stapes stayed within 5 dB in ≈61% (38/63) of cases, presumably indicating atraumatic insertions. Among responses which dropped more than 5 dB at any time during CI insertion, 12 subjects showed no response recovery, while in 13, the drop was followed by partial or complete response recovery by the end of CI insertion. In cases with recovery, the drop in response occurred relatively early (<15 mm insertion) compared to those where there was no recovery. Changes in response phase during the insertion occurred in some cases; these may indicate a change in the distributions of generators contributing to the response.
CONCLUSIONS
Monitoring the electrocochleography during CI insertion from an extracochlear site reveals insertions that are potentially atraumatic, show interaction with cochlear structures followed by response recovery, or show interactions such that response losses persist to the end of recording.
目的
电 Cochleography 越来越多地被用作耳蜗植入（CI）过程中耳蜗功能的术中监测。通过板载功能，可以从推进中的电极通过设备获得 Cochlear 内记录。然而，由于记录电极相对于产生反应的神经和毛细胞发生器移动，因此此类记录可能不是理想的监测器。本研究的目的是比较两种 Cochlear 外记录位置在信号强度和作为术中监测部位的可行性方面，并描述在 CI 插入过程中 Cochlear 生理学的变化。
设计
在 83 名人类受试者中，在圆窗（RW）和 Cochlear 外位置（靠近镫骨或 RW 上方的 promontory）记录 90 dB nHL 短音爆发的反应。在 63 例中，在 CI 插入期间继续从固定的 Cochlear 外位置进行记录。
结果
在 CI 插入之前，RW 处低频音的反应大约比在任何 Cochlear 外部位记录时大 6 dB，但两个 Cochlear 外部位彼此之间没有差异。在 CI 插入过程中，来自 promontory 或靠近镫骨的响应损失在 ≈61%（38/63）的情况下保持在 5 dB 以内，这可能表明插入无创伤。在 CI 插入过程中，任何时间的响应下降超过 5 dB 的响应中，有 12 个受试者没有响应恢复，而在 13 个受试者中，响应下降后，在 CI 插入结束时部分或完全恢复了响应。在有恢复的情况下，响应下降发生得相对较早（<15 mm 插入），而在没有恢复的情况下则相对较晚。在某些情况下，插入过程中响应相位发生变化；这些可能表明反应的发生器分布发生了变化。
结论
从 Cochlear 外部位监测 CI 插入过程中的电 Cochleography 可以揭示潜在的无创伤插入、显示与 Cochlear 结构相互作用后响应恢复，或显示相互作用，导致响应损失持续到记录结束。
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