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  • Title: Intraoperative Real-time Cochlear Response Telemetry Predicts Hearing Preservation in Cochlear Implantation.
    Author: Campbell L, Kaicer A, Sly D, Iseli C, Wei B, Briggs R, O'Leary S.
    Journal: Otol Neurotol; 2016 Apr; 37(4):332-8. PubMed ID: 26859542.
    Abstract:
    AIM: To monitor cochlear function during cochlear implantation and determine correlations with postoperative acoustic hearing. BACKGROUND: Cochlear response telemetry measures cochlear function directly from cochlear implant electrodes. We have adapted this system to provide real-time cochlear response telemetry (RT-CRT) monitoring of a patient's acoustic hearing as the cochlear implant electrode array is inserted. METHODS: Eighteen subjects (1 child and 17 adults) with sloping high frequency hearing loss were implanted with Cochlear Ltd slim straight arrays (CI422/CI522). Tone bursts (500 Hz, 100-110 dB) were presented at 14 Hz continuously during the array insertion. RT-CRT amplitudes were correlated with surgical manoeuvres recorded on the video from the operating microscope and with postoperative pure tone audiograms. RESULTS: Despite an excellent overall rate of complete or partial hearing preservation (79%), RT-CRT identified that in 47% of these implantations there was transient or permanent reduction in the amplitude of the cochlear microphonic (CM). Patients with a preserved CM at the end of insertion had on average 15 dB better low-frequency hearing preservation. The CM amplitude was most vulnerable during the last few millimeters of insertion or when inadvertent movement of the array occurred after full insertion. Physical contact/elevation of the basilar membrane is hypothesized as a likely mechanism of hearing loss rather than overt physical trauma. CONCLUSION: RT-CRT can be used to predict early postoperative hearing loss and to potentially refine surgical technique. In the future, feedback of RT-CRT may prove to be a valuable tool for maximizing preservation of residual hearing or providing feedback on electrode contact with the basilar membrane.
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