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Increasing the reliability of real-time electrocochleography during cochlear implantation: a standardized guideline

  • Otology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Electrocochleography (ECochG) measures electrical potentials generated by the inner ear in response to acoustic stimulation. Real-time (rt) recordings are increasingly used during cochlear implant (CI) surgeries to monitor the inner ear function. However, the performance of rt-ECochG is a delicate measurement procedure involving several pitfalls, which lead to inaccurate or invalid signal recordings in up to 20%. In order to use the technique routinely in CI candidates, an improvement in measurement reliability must be achieved.

Methods

In our prospective study, we systematically investigated potential pitfalls and error sources during rt-ECochG recordings. We performed experiments (i) on a head and torso simulator, (ii) on a whole-head cadaver specimen, (iii) as well as in vivo during rt-ECochG recordings in CI recipients. After analyzing experiments i–iii, a standardized measurement procedure was developed. We followed this guideline in 10 CI recipients to test the measurement reliability.

Results

Besides improper installation, surgical and patient-specific factors influenced the measured signal. In particular, the unattenuated presentation of the acoustic stimulus was of importance. We summarized our findings in a standardized guideline. Following this guideline, we measured successful intraoperative ECochG recordings in 9/10 patients.

Conclusions

Our error analysis improved the understanding of successful rt-ECochG measurements. When following our proposed guideline, we achieved more reliable intraoperative ECochG recordings.

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Availability of data and material

Is made available on request.

Code availability

Not applicable.

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Acknowledgements

The authors would like to thank Marek Polak and his team from MED-EL, Austria, for their support.

Funding

This study was partly funded by the Department of Otorhinolaryngology, Head and Neck Surgery at the Inselspital Bern, the Clinical trials unit (CTU) research grant, and the MED-EL company. Georgios Mantokoudis was supported by the Swiss National Science Foundation #320030_173081.

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Author notes

  1. K. Schuerch and M. Waser contributed equally to this work.

Authors and Affiliations

  1. Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland

    K. Schuerch, M. Caversaccio & W. Wimmer

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland

    K. Schuerch, M. Waser, G. Mantokoudis, L. Anschuetz, M. Caversaccio, W. Wimmer & S. Weder

Authors
  1. K. Schuerch
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  2. M. Waser
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  3. G. Mantokoudis
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  4. L. Anschuetz
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  5. M. Caversaccio
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  6. W. Wimmer
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  7. S. Weder
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Contributions

All authors contributed to this work. KS performed the experiments, wrote the software and paper. MW performed the experiments and wrote the paper. GM, LA, and MC provided interpretive analysis and critical revision. WW analyzed the data and provided interpretive analysis and critical revision. SW designed the experiment, analyzed the data, and provided interpretive analysis and critical revision.

Corresponding author

Correspondence to S. Weder.

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Conflict of interest

There are no conflicts of interest, financial, or otherwise.

Ethics approval

This experimental study was conducted in accordance with the Declaration of Helsinki and was approved by the local institutional review board (KEK-BE 2016–00887 and 2019–01578).

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All participants gave written informed consent before participating in the study.

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Schuerch, K., Waser, M., Mantokoudis, G. et al. Increasing the reliability of real-time electrocochleography during cochlear implantation: a standardized guideline. Eur Arch Otorhinolaryngol 279, 4655–4665 (2022). https://doi.org/10.1007/s00405-021-07204-7

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  • DOI: https://doi.org/10.1007/s00405-021-07204-7

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