A clinical study of electrocochleography monitoring for residual hearing retention during minimally invasive cochlear implant
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摘要: 目的 探讨微创人工耳蜗植入(cochlear implant，CI)术中耳蜗电图(electrocochleography，ECochG)实时监测技术指导电极植入的应用价值，分析术中波形变化及植入方式与患者术后残余听力(residual hearing，RH)保留效果的相关性。方法 本研究纳入2022年6月至2024年7月进行CI手术的31例患者(共35耳)。术中均采用动态植入监测(active insertion monitoring，AIM)系统进行电极植入过程中的ECochG实时监测。记录术中耳蜗微音电位(cochlear microphonic，CM)波形变化，分析其与患者术后RH保留的相关性。结果 ① 所有35耳中成功记录到术中CM反应的有34耳(97.1%)。②根据Harris分型，A型(上升型)有7耳(20.6%)、C型(下降型)7耳(20.6%)、CC型(波动型)8耳(23.5%)、D型(无反应型)12耳(35.3%)。③CM幅值下降总量与术后低中频听力下降呈显著中度正相关(r=0.67，P=0.017)与术后低频听力下降呈显著中度正相关(r=0.65，P=0.023)。④平均幅值变化中，Amax为30.70 μV、Amin为8.64 μV、Aend为18.27 μV。⑤其中16耳进行了术后短期听力随访，低中频(125~1 000 Hz)听力损失为15.25 dB HL，RH保留率为87.5%。结论 微创CI植入术中ECochG实时监测技术可有效指导手术医生进行微创电极植入，术中CM波形变化可预估术后短期内的听力变化，ECochG术中监测有助于提高患者的RH保留效果。Abstract: Objective To investigate the application value of intraoperative electrocochleography(ECochG) monitoring technique and insertion techniques in cochlear implant(CI) and analyze its relationship with postoperative residual hearing(RH) preservation.Methods Thirty-one patients(35 ears) who received CI in our hospital from June 2022 to July 2024 were enrolled. The Advanced Bionics Active Insertion Monitoring(AIM) system was used for real-time ECochG monitoring during surgery. Intraoperative cochlear microphonics (CM) waveform changes were recorded and analyzed in relation to postoperative RH preservation.Results ① ECochG recordings were successfully obtained in 34 of 35 ears (97.1%). ②According to Harris classification, there were 7 ears(20.6%) of Type A(rising), 7 ears(20.6%) of Type C(declining), 8 ears(23.5%) of Type CC(fluctuating), and 12 ears(35.3%) of Type D(no response). ③The total CM amplitude decrease was significantly moderately correlated with postoperative low-mid frequency hearing loss(r=0.67, P=0.017). The total CM amplitude decrease was significantly moderately correlated with postoperative low frequency hearing loss(r=0.65, P=0.023). ④For the mean amplitude variation, the Amax was 30.70 μV, the Amin was 8.64 μV, and the Aend was 18.27 μV. ⑤Sixteen cases completed postoperative follow-up, with an average low-mid frequency(125-1 000 Hz) residual hearing loss of 15.25 dB HL and a RH preservation rate of 87.5%.Conclusion Intraoperative ECochG monitoring can effectively predict postoperative residual hearing changes, effectively guide surgical manipulation, and improve residual hearing preservation rate.
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Key words:
- cochlear implantation /
- electrocochleography /
- residual hearing
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表 1 31例(35耳)受试者基本信息
序号 性别 植入年龄/岁 病因 影像学 植入侧别 手术入路 植入电极 1 F 4 先天性 M，E L 圆窗 Advantage MS 2 F 4 先天性 M，E R 扩大圆窗 Advantage MS 3 M 42 不明原因 正常 L 圆窗 Advantage MS 4 F 50 不明原因 M，E R 圆窗 Ultra MS 5 F 15 不明原因 正常 L 圆窗 Ultra MS 6 F 31 先天性 M，E L 圆窗 Ultra SlimJ 7 F 23 先天性 M，E R 圆窗 Ultra SlimJ 8 F 43 突发性 正常 R 圆窗 Ultra MS 9 F 35 不明原因 正常 L 圆窗 Ultra MS 10 F 48 不明原因 正常 R 圆窗 Ultra MS 11 M 41 不明原因 正常 L 圆窗 Ultra SlimJ 12 M 64 外伤 正常 R 圆窗 Ultra SlimJ 13 M 36 先天性 正常 L 圆窗 Ultra MS 14 M 34 药物性 正常 L 圆窗 Ultra MS 15 M 7 先天性 M，E L 圆窗 Ultra SlimJ 16 F 23 不明原因 正常 R 圆窗 Ultra SlimJ 17 F 8 先天性 M，E L 圆窗 Ultra MS 18 M 23 先天性 正常 L 圆窗 Ultra SlimJ 19 M 23 先天性 正常 R 圆窗 Ultra SlimJ 20 M 60 不明原因 正常 R 圆窗 Ultra SlimJ 21 M 25 先天性 正常 L 圆窗 Ultra SlimJ 22 M 27 不明原因 正常 L 圆窗 Ultra SlimJ 23 F 45 药物性 正常 R 圆窗 Ultra MS 24 F 63 不明原因 正常 L 圆窗 Ultra MS 25 M 46 发热 正常 L 圆窗 Ultra MS 26 F 7 中耳炎 M，E L 圆窗 Ultra MS 27 F 30 不明原因 正常 L 扩大圆窗 Ultra MS 28 F 30 不明原因 正常 R 扩大圆窗 Ultra MS 29 M 7 先天性 M，E L 扩大圆窗 Ultra SlimJ 30 M 5 先天性 M，E R 扩大圆窗 Ultra MS 31 F 1 先天性 M，E L 扩大圆窗 Ultra MS 32 F 1 先天性 M，E R 扩大圆窗 Ultra MS 33 M 10 不明原因 正常 L 圆窗 Ultra MS 34 M 40 先天性 正常 R 扩大圆窗 Ultra MS 35 M 44 不明原因 正常 R 扩大圆窗 Ultra MS M：男，F：女；L：左侧，R：右侧；M：Mondini畸形，E：前庭导水管扩大。 
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