Intra-Cochlear Electrocochleography During Cochear Implant Electrode Insertion Is Predictive of Final Scalar Location

Kanthaiah Koka, William Jason Riggs, Robert Dwyer, Jourdan Taylor Holder, Jack H Noble, Benoit M Dawant, Amanda Ortmann, Carla V Valenzuela, Jameson K Mattingly, Michael M Harris, Brendan P O'Connell, Leonid M Litvak, Oliver F Adunka, Craig Alan Buchman, Robert F Labadie, Kanthaiah Koka, William Jason Riggs, Robert Dwyer, Jourdan Taylor Holder, Jack H Noble, Benoit M Dawant, Amanda Ortmann, Carla V Valenzuela, Jameson K Mattingly, Michael M Harris, Brendan P O'Connell, Leonid M Litvak, Oliver F Adunka, Craig Alan Buchman, Robert F Labadie

Abstract

Hypothesis: Electrocochleography (ECochG) patterns observed during cochlear implant (CI) electrode insertion may provide information about scalar location of the electrode array.

Background: Conventional CI surgery is performed without actively monitoring auditory function and potential damage to intracochlear structures. The central hypothesis of this study was that ECochG obtained directly through the CI may be used to estimate intracochlear electrode position and, ultimately, residual hearing preservation.

Methods: Intracochlear ECochG was performed on 32 patients across 3 different implant centers. During electrode insertion, a 50-ms tone burst stimulus (500 Hz) was delivered at 110 dB SPL. The ECochG response was monitored from the apical-most electrode. The amplitude and phase changes of the first harmonic were imported into an algorithm in an attempt to predict the intracochlear electrode location (scala tympani [ST], translocation from ST to scala vestibuli [SV], or interaction with basilar membrane). Anatomic electrode position was verified using postoperative computed tomography (CT) with image processing.

Results: CT analysis confirmed 25 electrodes with ST position and 7 electrode arrays translocating from ST into SV. The ECochG algorithm correctly estimated electrode position in 26 (82%) of 32 subjects while 6 (18%) electrodes were wrongly identified as translocated (sensitivity = 100%, specificity = 77%, positive predictive value = 54%, and a negative predictive value = 100%). Greater hearing loss was observed postoperatively in participants with translocated electrode arrays (36 ± 15 dB) when compared with isolated ST insertions (28 ± 20 dB HL). This result, however, was not significant (p = 0.789).

Conclusion: Intracochlear ECochG may provide information about CI electrode location and hearing preservation.

Figures

Figure 1:
Figure 1:
Simulated patterns observed during insertion for amplitude and phase.
Figure 2:
Figure 2:
Two representative insertions for each non-translocation and translocation. Panels A and B show two different views of a reconstructed CT image showing insertion completely in ST. Panel C shows the ECochG amplitude and phase changes during insertion. EcochG amplitudes show increase during insertion and minor decrease in amplitude during insertion. Panels D and E show two different views of reconstructed CT image showing electrode translocation from ST to SV. Panel F shows the ECochG amplitude and phase changes during insertion. ECochG amplitude shows an increase in amplitude followed by a dramatic drop and no recovery.

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