{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:38:58Z","timestamp":1785253138206,"version":"3.55.0"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Advanced Bionics"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Access to low-frequency acoustic information in cochlear implant patients leads to better speech understanding in noise. Electrocochleography (ECochG) can provide real-time feedback about the health of the cochlea during the insertion process with the potential to reduce insertion trauma. We describe our experiences of using this technique. Data from 47 adult subjects with measurable residual hearing and an Advanced Bionics (Valencia, CA) SlimJ (46) or MidScala (1) electrode array were analyzed. ECochGs were recorded intraoperatively via the implant. The surgeon adjusted the course of the electrode insertion based on drops in the ECochG. The final array position was assessed using postoperative imaging and pure tone thresholds were measured before and after surgery. Three different patterns of ECochG response amplitude were observed: Growth, Fluctuating and Total Loss. Subjects in the growth group showed the smallest postoperative hearing loss. However, the group with fluctuating amplitudes showed no meaningful correlation between the ECochG responses and the postoperative hearing loss, indicating that amplitude alone is insufficient for detecting damage. Considering the phase of the signal additionally to the amplitude and reclassifying the data by both the phase and amplitude of the response into three groups Type I\u2013Type III produced statistically significant correlations between postoperative hearing loss and the grouping based on amplitude and phase respectively. We showed significantly better hearing preservation for Type I (no drop in amplitude) and Type II (drop with a concurrent phase shift), while Type III (drop without concurrent phase shift) had more surgery induced hearing loss. ECochG potentials measured through the implant could provide valuable feedback during the electrode insertion. Both the amplitude and phase of the ECochG response are important to consider. More data needs to be evaluated to better understand the impact of the different signal components to design an automated system to alert the surgeon ahead of damaging the cochlea.<\/jats:p>","DOI":"10.1371\/journal.pone.0266077","type":"journal-article","created":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T17:23:49Z","timestamp":1650648229000},"page":"e0266077","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":32,"title":["Clinical experiences with intraoperative electrocochleography in cochlear implant recipients and its potential to reduce insertion trauma and improve postoperative hearing preservation"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6788-3985","authenticated-orcid":true,"given":"Andreas","family":"Buechner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Bardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9138-0277","authenticated-orcid":true,"given":"Sabine","family":"Haumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Geissler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Salcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lenarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,22]]},"reference":[{"key":"pone.0266077.ref001","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1159\/000027695","article-title":"Electric-acoustic stimulation of the auditory system. New technology for severe hearing loss","volume":"61","author":"C Von Ilberg","year":"1999","journal-title":"ORL"},{"key":"pone.0266077.ref002","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1159\/000095616","article-title":"Acoustic plus Electric Speech Processing: Preliminary Results of a Multicenter Clinical Trial of the Iowa\/Nucleus Hybrid Implant","volume":"11","author":"BJ Gantz","year":"2006","journal-title":"Audiol Neurotol"},{"key":"pone.0266077.ref003","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1159\/000206490","article-title":"Impact of low-frequency hearing. Audiology and Neurotology","author":"A B\u00fcchner","year":"2009","journal-title":"Audiol Neurootol"},{"key":"pone.0266077.ref004","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1159\/000206492","article-title":"Hearing conservation surgery using the hybrid-L electrode: Results from the first clinical trial at the Medical University of Hannover","author":"T Lenarz","year":"2009","journal-title":"Audiology and Neurotology"},{"key":"pone.0266077.ref005","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.wjorl.2016.08.002","article-title":"Electrode selection for hearing preservation in cochlear implantation: A review of the evidence","volume":"2","author":"JA Brant","year":"2016","journal-title":"World J Otorhinolaryngol\u2014Head Neck Surg"},{"key":"pone.0266077.ref006","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/MOO.0000000000000089","article-title":"Toward hearing preservation in cochlear implant surgery","volume":"22","author":"RM Huarte","year":"2014","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"key":"pone.0266077.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/468515","article-title":"Hearing Preservation in Cochlear Implant Surgery","volume":"2014","author":"PC Miranda","year":"2014","journal-title":"Int J Otolaryngol"},{"key":"pone.0266077.ref008","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1159\/000360601","article-title":"Hearing preservation outcomes with different cochlear implant electrodes: Nucleus\u00ae hybridTM-L24 and nucleus freedomTM CI422","volume":"19","author":"MC Jurawitz","year":"2014","journal-title":"Audiol Neurotol"},{"key":"pone.0266077.ref009","first-page":"506","article-title":"Source, au niveau de la membrane basilaire, du potentiel microphonique cochl\u00e9aire enregistr\u00e9 par \u00e9lectrodes de surface chez l\u2019homme","volume":"49","author":"H Sohmer","year":"1980","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"pone.0266077.ref010","doi-asserted-by":"crossref","DOI":"10.1152\/jn.00006.2019","article-title":"Hair cell and neural contributions to the cochlear summating potential","volume":"121","author":"AK Pappa","year":"2019","journal-title":"Journal of Neurophysiology"},{"key":"pone.0266077.ref011","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0378-5955(97)00127-5","article-title":"Evidence that inner hair cells are the major source of cochlear summating potentials","volume":"113","author":"XY Zheng","year":"1997","journal-title":"Hear Res"},{"key":"pone.0266077.ref012","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/0378-5955(84)90033-9","article-title":"The auditory neurophonic: Basic properties","volume":"15","author":"RL Snyder","year":"1984","journal-title":"Hear Res"},{"key":"pone.0266077.ref013","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/000348946006900214","article-title":"XL Human cochlea responses to sound stimuli","volume":"69","author":"RJ Ruben","year":"1960","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"pone.0266077.ref014","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1037\/h0075820","article-title":"The nature of acoustic response","volume":"13","author":"EG Wever","year":"1930","journal-title":"J Exp Psychol"},{"key":"pone.0266077.ref015","doi-asserted-by":"crossref","first-page":"274","DOI":"10.3389\/fnins.2017.00274","article-title":"The Clinical Uses of Electrocochleography","volume":"11","author":"WP Gibson","year":"2017","journal-title":"Front Neurosci"},{"key":"pone.0266077.ref016","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1097\/01.mlg.0000217224.94804.bb","article-title":"Monitoring of Cochlear Function During Cochlear Implantation","volume":"116","author":"O Adunka","year":"2006","journal-title":"Laryngoscope"},{"key":"pone.0266077.ref017","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1159\/000438742","article-title":"Extra- and Intracochlear Electrocochleography in Cochlear Implant Recipients","volume":"20","author":"A Dalbert","year":"2015","journal-title":"Audiol Neurotol"},{"key":"pone.0266077.ref018","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1177\/0194599811435895","article-title":"Electrocochleography during cochlear implantation for hearing preservation","volume":"146","author":"M Mandal\u00e0","year":"2012","journal-title":"Otolaryngol\u2014Head Neck Surg (United States)"},{"key":"pone.0266077.ref019","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/MAO.0b013e318248ea86","article-title":"Intraoperative Monitoring Using Cochlear Microphonics in Cochlear Implant Patients With Residual Hearing","volume":"33","author":"A Radeloff","year":"2012","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref020","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1179\/146701011X12950038111657","article-title":"Preliminary results and technique for electrophysiological intra-operative monitoring of residual hearing during cochlear implantation","volume":"12","author":"R Harris","year":"2011","journal-title":"Cochlear Implants Int"},{"key":"pone.0266077.ref021","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/MAO.0000000000000972","article-title":"Intraoperative Real-time Cochlear Response Telemetry Predicts Hearing Preservation in Cochlear Implantation","volume":"37","author":"L Campbell","year":"2016","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref022","doi-asserted-by":"crossref","first-page":"233121651983356","DOI":"10.1177\/2331216519833567","article-title":"Monitoring of the Inner Ear Function During and After Cochlear Implant Insertion Using Electrocochleography","volume":"23","author":"S Haumann","year":"2019","journal-title":"Trends Hear"},{"key":"pone.0266077.ref023","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1097\/AUD.0000000000000659","article-title":"Intracochlear electrocochleography: Response patterns during cochlear implantation and hearing preservation","volume":"40","author":"CK Giardina","year":"2019","journal-title":"Ear Hear"},{"key":"pone.0266077.ref024","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1097\/MAO.0000000000000219","article-title":"Round window electrocochleography just before cochlear implantation: Relationship to word recognition outcomes in adults","volume":"35","author":"DC Fitzpatrick","year":"2014","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref025","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1097\/AUD.0000000000000106","article-title":"Intraoperative Round Window Electrocochleography and Speech Perception Outcomes in Pediatric Cochlear Implant Recipients","volume":"36","author":"EJ Formeister","year":"2015","journal-title":"Ear Hear"},{"key":"pone.0266077.ref026","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1097\/MAO.0000000000001224","article-title":"The compound action potential in subjects receiving a cochlear implant","volume":"37","author":"WC Scott","year":"2016","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref027","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1097\/MAO.0000000000000998","article-title":"Assessment of Cochlear Trauma During Cochlear Implantation Using Electrocochleography and Cone Beam Computed Tomography","volume":"37","author":"A Dalbert","year":"2016","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref028","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3389\/fnins.2018.00018","article-title":"Assessment of Cochlear Function during Cochlear Implantation by Extra- and Intracochlear Electrocochleography","volume":"12","author":"A Dalbert","year":"2018","journal-title":"Front Neurosci"},{"key":"pone.0266077.ref029","doi-asserted-by":"crossref","first-page":"e654","DOI":"10.1097\/MAO.0000000000001906","article-title":"Intra-Cochlear Electrocochleography During Cochear Implant Electrode Insertion Is Predictive of Final Scalar Location","volume":"39","author":"K Koka","year":"2018","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref030","doi-asserted-by":"crossref","first-page":"291","DOI":"10.3389\/fnins.2017.00291","article-title":"Intra- and Postoperative Electrocochleography May Be Predictive of Final Electrode Position and Postoperative Hearing Preservation","volume":"11","author":"BP O\u2019Connell","year":"2017","journal-title":"Front Neurosci"},{"key":"pone.0266077.ref031","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1002\/lary.25602","article-title":"Round window electrocochleography before and after cochlear implant electrode insertion","volume":"126","author":"OF Adunka","year":"2016","journal-title":"Laryngoscope"},{"key":"pone.0266077.ref032","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.1097\/AUD.0000000000000385","article-title":"Electrocochleography in Cochlear Implant Recipients With Residual Hearing","volume":"38","author":"K Koka","year":"2017","journal-title":"Ear Hear"},{"key":"pone.0266077.ref033","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.heares.2018.10.016","article-title":"Postoperative Electrocochleography from Hybrid Cochlear Implant users: An Alternative Analysis Procedure","volume":"370","author":"JS Kim","year":"2018","journal-title":"Hear Res"},{"key":"pone.0266077.ref034","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1097\/MAO.0b013e3181d279e0","article-title":"Consensus panel on a cochlear coordinate system applicable in histologic, physiologic, and radiologic studies of the human cochlea","volume":"31","author":"BM Verbist","year":"2010","journal-title":"Otol Neurotol"},{"key":"pone.0266077.ref035","first-page":"3","article-title":"A Proposed Method for Accurate 3D Analysis of Cochlear Implant Migration Using Fusion of Cone Beam CT","author":"G Dees","year":"2016","journal-title":"Front Surg"},{"key":"pone.0266077.ref036","doi-asserted-by":"crossref","first-page":"4135","DOI":"10.1007\/s00405-016-4099-x","article-title":"Insertion characteristics and placement of the Mid-Scala electrode array in human temporal bones using detailed cone beam computed tomography","volume":"273","author":"A Dietz","year":"2016","journal-title":"Eur Arch Oto-Rhino-Laryngology"},{"key":"pone.0266077.ref037","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s10162-007-0076-9","article-title":"Frequency map for the human cochlear spiral ganglion: Implications for cochlear implants","volume":"8","author":"O Stakhovskaya","year":"2007","journal-title":"JARO\u2014J Assoc Res Otolaryngol"},{"issue":"6","key":"pone.0266077.ref038","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1097\/AUD.0000000000000871","article-title":"Toward a Better Understanding of Electrocochleography: Analysis of Real-Time Recordings","volume":"41","author":"S Weder","year":"2020","journal-title":"Ear Hear"},{"key":"pone.0266077.ref039","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/S0022-460X(70)80036-0","article-title":"Longitudinal amplitude and phase distribution of the cochlear microphonic (guinea pig) and spatial filtering","volume":"11","author":"LUE Kohll\u00f6ffel","year":"1970","journal-title":"J Sound Vib"},{"key":"pone.0266077.ref040","doi-asserted-by":"crossref","first-page":"108094","DOI":"10.1016\/j.heares.2020.108094","article-title":"Cochlear microphonic latency predicts outer hair cell function in animal models and clinical populations","volume":"398","author":"C Bester","year":"2020","journal-title":"Hear Res"},{"key":"pone.0266077.ref041","doi-asserted-by":"crossref","first-page":"3245","DOI":"10.1002\/cne.23594","article-title":"Variations in microanatomy of the human cochlea","volume":"522","author":"E Avci","year":"2014","journal-title":"J. Comp. Neurol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T17:24:34Z","timestamp":1650648274000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266077"}},"subtitle":[],"editor":[{"given":"Qian-Jie","family":"Fu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,22]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0266077","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,22]]}}}