Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin.
Advanced Bionics, Valencia, California.
Otol Neurotol. 2022 Aug 1;43(7):789-796. doi: 10.1097/MAO.0000000000003588. Epub 2022 Jul 19.
To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation.
Prospective, randomized clinical trial.
Ten high-volume, tertiary care CI centers.
Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI.
Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation.
Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was "good" (i.e., LF-PTA change 0-15 dB) in 34.5%, "fair" (i.e., LF-PTA change >15-29 dB) in 22.5%, and "poor" (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG "on," mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG "off" ( p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli.
Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG "on" compared with ECochG "off."
评估耳蜗内电 CochG 监测在人工耳蜗植入 (CI) 手术中对术后听力保留的作用。
前瞻性、随机临床试验。
10 家高容量、三级护理 CI 中心。
符合 CI 标准并选择先进仿生学 CI 的感音神经性听力损失成年患者。
患者随机分为 CI 手术组，术中电极插入时术者可获得可听的 ECochG 监测或无 ECochG 监测。听力保护通过比较术前未助听低频 (125、250 和 500Hz) 纯音平均 (LF-PTA) 与 CI 激活后的术后 LF-PTA 来确定。术前和术后 CT 用于确定电极标度位置和电极移位。
85 名成年 CI 候选者入组。整个样本的平均 (标准差 [SD]) 未助听术前 LF-PTA 为 54 (17) dB HL。对于整个样本，听力保护“良好”(即 LF-PTA 变化 0-15dB)占 34.5%，“尚可”(即 LF-PTA 变化>15-29dB)占 22.5%，“差”(即 LF-PTA 变化≥30dB)占 43%。对于随机分配到 ECochG“开”的患者，平均 (SD) LF-PTA 变化为 27 (20) dB，而随机分配到 ECochG“关”的患者为 27 (23) dB (p=0.89)。7%的患者，所有患者均随机分配到 ECochG 关闭组，显示电极从鼓阶移到前庭阶。
尽管耳蜗内 ECochG 在 CI 手术中有重要的预后作用，但我们的数据并未显示随机分配到 ECochG“开”的患者听力保护明显优于 ECochG“关”的患者。
