Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Otolaryngology - Head and Neck Surgery, University Hospital of Foggia, Foggia, Italy.
Otol Neurotol. 2021 Apr 1;42(4):e433-e437. doi: 10.1097/MAO.0000000000003008.
Tip fold-over is a rare but serious complication of cochlear implant (CI) surgery. The purpose of this study was to present intraoperative electrocochleography (ECochG) observations in a series of CI electrode tip fold-overs.
Five pediatric subjects undergoing CI surgery through a round window (RW) approach with a perimodiolar electrode array, who were diagnosed with either auditory neuropathy spectrum disorder or enlarged vestibular aqueduct.
Intraoperative RW ECochG during CI surgery: tone burst stimuli were presented from 95 to 110 dB SPL.
Magnitude and phase characteristics of ECochG responses obtained intraoperatively before and immediately after electrode insertion were examined for patients with and without tip fold-over.
Three subjects presented with tip fold-over and two formed the control group. Among fold-over cases, one participant exhibited an inversion in the starting phase of the cochlear microphonic response and a decrease in spectral magnitude from pre- to postinsertion. Both subjects who did not exhibit a change in phase had an increase in the ECochG-total response (ECochG-TR) magnitude. No case in the control group exhibited a change in starting phase. In regard to the ECochG-TR, all controls showed a decrease in the magnitude.
Despite the small number of patients, heterogeneous ECochG response patterns were observed within the fold-over group. Though these results are not conclusive, they can serve as a framework to begin to understand ECochG's utility in detecting intraoperative tip fold-over.
电极顶端折叠是耳蜗植入（CI）手术中一种罕见但严重的并发症。本研究旨在展示一系列 CI 电极顶端折叠手术中的术中电 Cochleography（ECochG）观察结果。
五名接受经圆窗（RW）入路和中周电极阵列的 CI 手术的儿科患者，这些患者被诊断为听觉神经病谱系障碍或扩大的前庭水管。
CI 手术期间的 RW 术中 ECochG：从 95 到 110 dB SPL 呈现短音刺激。
对有和无顶端折叠的患者，在电极插入前后的术中获得的 ECochG 反应的幅度和相位特征进行检查。
三名患者出现顶端折叠，两名患者形成对照组。在折叠病例中，一名参与者表现出耳蜗微音反应起始相位的反转和插入前后谱幅度的降低。没有表现出相位变化的两个受试者的 ECochG-总反应（ECochG-TR）幅度增加。对照组中没有一个病例表现出起始相位的变化。关于 ECochG-TR，所有对照组的幅度都减小。
尽管患者数量较少，但折叠组内观察到了不同的 ECochG 反应模式。尽管这些结果尚不确定，但它们可以作为一个框架，开始理解 ECochG 在检测术中顶端折叠中的作用。
