Gawliczek Tom, Mantokoudis Georgios, Anschuetz Lukas, Caversaccio Marco D, Weder Stefan
Department of ENT, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.
Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
Front Neurol. 2023 Sep 6;14:1231403. doi: 10.3389/fneur.2023.1231403. eCollection 2023.
This study aimed to compare the effectiveness of auditory brainstem response (ABR) and extracochlear electrocochleography (ECochG) in objectively evaluating the coupling efficiency of floating mass transducer (FMT) placement during active middle ear implant (AMEI) surgery.
We enrolled 15 patients (mean age 58.5 ± 19.4 years) with mixed hearing loss who underwent AMEI implantation (seven ossicular chain and eight round window couplings). Before the surgical procedure, an audiogram was performed. We utilized a clinical measurement system to stimulate and record intraoperative ABR and ECochG recordings. The coupling efficiency of the VSB was evaluated through ECochG and ABR threshold measurements. Postoperatively, we conducted an audiogram and a vibrogram.
In all 15 patients, ABR threshold testing successfully determined intraoperative coupling efficiency, while ECochG was successful in only eight patients. In our cohort, ABR measurements were more practical, consistent, and robust than ECochG measurements. Coupling efficiency, calculated as the difference between vibrogram thresholds and postoperative bone conduction thresholds, was found to be more accurately predicted by ABR measurements ( = 0.016, = 0.37) than ECochG measurements ( = 0.761, = 0.02). We also found a non-significant trend toward better results with ossicular chain coupling compared to round window coupling.
Our findings suggest that ABR measurements are more practical, robust, and consistent than ECochG measurements for determining coupling efficiency during FMT placement surgery. The use of ABR measurements can help to identify the optimal FMT placement, especially with round window coupling. Finally, we offer normative data for both techniques, which can aid other clinical centers in using intraoperative monitoring for AMEI placement.
本研究旨在比较听性脑干反应（ABR）和鼓室外电耳蜗图（ECochG）在客观评估主动式中耳植入（AMEI）手术中浮动质量传感器（FMT）放置耦合效率方面的有效性。
我们纳入了15例混合性听力损失患者（平均年龄58.5±19.4岁），他们接受了AMEI植入手术（7例听骨链耦合和8例圆窗耦合）。在手术前进行了听力图检查。我们使用临床测量系统来刺激并记录术中ABR和ECochG记录。通过ECochG和ABR阈值测量评估VSB的耦合效率。术后，我们进行了听力图和振动图检查。
在所有15例患者中，ABR阈值测试成功确定了术中耦合效率，而ECochG仅在8例患者中成功。在我们的队列中，ABR测量比ECochG测量更实用、更一致且更可靠。通过ABR测量（r = 0.016，p = 0.37）比ECochG测量（r = 0.761，p = 0.02）能更准确地预测以振动图阈值与术后骨导阈值之差计算的耦合效率。我们还发现与圆窗耦合相比，听骨链耦合有取得更好结果的非显著趋势。
我们的研究结果表明，在FMT放置手术中确定耦合效率时，ABR测量比ECochG测量更实用、更可靠且更一致。使用ABR测量有助于确定最佳的FMT放置，尤其是在圆窗耦合时。最后，我们提供了这两种技术的规范数据，可帮助其他临床中心在AMEI放置术中使用术中监测。
