Staff View: Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial

Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial

Background: Preservation of natural hearing during cochlear implantation is associated with improved speech outcomes, however more than half of implant recipients lose this hearing. Real-time electrophysiological monitoring of cochlear output during implantation, made possible by recording electroco...

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Main Authors:	Bester, Christofer, Collins, Aaron, Razmovski, Tayla, Weder, Stefan, Briggs, Robert J., Wei, Benjamin, Zakaria, Atiqah Farah, Gerard, Jean-Marc, Mitchell-Innes, Alistair, Tykocinski, Michael, Kennedy, Richard, Iseli, Claire, Dahm, Markus, Ellul, Simon, O'Leary, Stephen
Format:	Article
Published:	Elsevier 2021
Online Access:	http://psasir.upm.edu.my/id/eprint/97054/ https://www.sciencedirect.com/science/article/pii/S0378595521001878
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spelling	my.upm.eprints.970542023-04-19T04:06:28Z http://psasir.upm.edu.my/id/eprint/97054/ Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial Bester, Christofer Collins, Aaron Razmovski, Tayla Weder, Stefan Briggs, Robert J. Wei, Benjamin Zakaria, Atiqah Farah Gerard, Jean-Marc Mitchell-Innes, Alistair Tykocinski, Michael Kennedy, Richard Iseli, Claire Dahm, Markus Ellul, Simon O'Leary, Stephen Background: Preservation of natural hearing during cochlear implantation is associated with improved speech outcomes, however more than half of implant recipients lose this hearing. Real-time electrophysiological monitoring of cochlear output during implantation, made possible by recording electrocochleography using the electrodes on the cochlear implant, has shown promise in predicting hearing preservation. Sudden drops in the amplitude of the cochlear microphonic (CM) have been shown to predict more severe hearing losses. Here, we report on a randomized clinical trial investigating whether immediate surgical intervention triggered by these drops can save residual hearing. Methods: A single-blinded placebo-controlled trial of surgical intervention triggered when CM amplitude dropped by at least 30% of a prior maximum amplitude during cochlear implantation. Intraoperative electrocochleography was recorded in 60 adults implanted with Cochlear Ltd's Thin Straight Electrode, half randomly assigned to a control group and half to an interventional group. The surgical intervention was to withdraw the electrode in ½-mm steps to recover CM amplitude. The primary outcome was hearing preservation 3 months following implantation, with secondary outcomes of speech-in-noise reception thresholds by group or CM outcome, and depth of implantation. Results: Sixty patients were recruited; neither pre-operative audiometry nor speech reception thresholds were significantly different between groups. Post-operatively, hearing preservation was significantly better in the interventional group. This was the case in absolute difference (median of 30 dB for control, 20 dB for interventional, χ² = 6.2, p = .013), as well as for relative difference (medians of 66% for the control, 31% for the interventional, χ² = 5.9, p = .015). Speech-in-noise reception thresholds were significantly better in patients with no CM drop at any point during insertion compared with patients with a CM drop; however, those with successfully recovered CMs after an initial drop were not significantly different (median gain required for speech reception score of 50% above noise of 6.9 dB for no drop, 8.6 for recovered CM, and 9.8 for CM drop, χ² = 6.8, p = .032). Angular insertion depth was not significantly different between control and interventional groups. Conclusions: This is the first demonstration that surgical intervention in response to intraoperative hearing monitoring can save residual hearing during cochlear implantation. Elsevier 2021 Article PeerReviewed Bester, Christofer and Collins, Aaron and Razmovski, Tayla and Weder, Stefan and Briggs, Robert J. and Wei, Benjamin and Zakaria, Atiqah Farah and Gerard, Jean-Marc and Mitchell-Innes, Alistair and Tykocinski, Michael and Kennedy, Richard and Iseli, Claire and Dahm, Markus and Ellul, Simon and O'Leary, Stephen (2021) Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial. Hearing Research, 426. art. no. 108353. pp. 1-11. ISSN 0378-5955 https://www.sciencedirect.com/science/article/pii/S0378595521001878 10.1016/j.heares.2021.108353
institution	Universiti Putra Malaysia
building	UPM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Putra Malaysia
content_source	UPM Institutional Repository
url_provider	http://psasir.upm.edu.my/
description	Background: Preservation of natural hearing during cochlear implantation is associated with improved speech outcomes, however more than half of implant recipients lose this hearing. Real-time electrophysiological monitoring of cochlear output during implantation, made possible by recording electrocochleography using the electrodes on the cochlear implant, has shown promise in predicting hearing preservation. Sudden drops in the amplitude of the cochlear microphonic (CM) have been shown to predict more severe hearing losses. Here, we report on a randomized clinical trial investigating whether immediate surgical intervention triggered by these drops can save residual hearing. Methods: A single-blinded placebo-controlled trial of surgical intervention triggered when CM amplitude dropped by at least 30% of a prior maximum amplitude during cochlear implantation. Intraoperative electrocochleography was recorded in 60 adults implanted with Cochlear Ltd's Thin Straight Electrode, half randomly assigned to a control group and half to an interventional group. The surgical intervention was to withdraw the electrode in ½-mm steps to recover CM amplitude. The primary outcome was hearing preservation 3 months following implantation, with secondary outcomes of speech-in-noise reception thresholds by group or CM outcome, and depth of implantation. Results: Sixty patients were recruited; neither pre-operative audiometry nor speech reception thresholds were significantly different between groups. Post-operatively, hearing preservation was significantly better in the interventional group. This was the case in absolute difference (median of 30 dB for control, 20 dB for interventional, χ² = 6.2, p = .013), as well as for relative difference (medians of 66% for the control, 31% for the interventional, χ² = 5.9, p = .015). Speech-in-noise reception thresholds were significantly better in patients with no CM drop at any point during insertion compared with patients with a CM drop; however, those with successfully recovered CMs after an initial drop were not significantly different (median gain required for speech reception score of 50% above noise of 6.9 dB for no drop, 8.6 for recovered CM, and 9.8 for CM drop, χ² = 6.8, p = .032). Angular insertion depth was not significantly different between control and interventional groups. Conclusions: This is the first demonstration that surgical intervention in response to intraoperative hearing monitoring can save residual hearing during cochlear implantation.
format	Article
author	Bester, Christofer Collins, Aaron Razmovski, Tayla Weder, Stefan Briggs, Robert J. Wei, Benjamin Zakaria, Atiqah Farah Gerard, Jean-Marc Mitchell-Innes, Alistair Tykocinski, Michael Kennedy, Richard Iseli, Claire Dahm, Markus Ellul, Simon O'Leary, Stephen
spellingShingle	Bester, Christofer Collins, Aaron Razmovski, Tayla Weder, Stefan Briggs, Robert J. Wei, Benjamin Zakaria, Atiqah Farah Gerard, Jean-Marc Mitchell-Innes, Alistair Tykocinski, Michael Kennedy, Richard Iseli, Claire Dahm, Markus Ellul, Simon O'Leary, Stephen Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
author_facet	Bester, Christofer Collins, Aaron Razmovski, Tayla Weder, Stefan Briggs, Robert J. Wei, Benjamin Zakaria, Atiqah Farah Gerard, Jean-Marc Mitchell-Innes, Alistair Tykocinski, Michael Kennedy, Richard Iseli, Claire Dahm, Markus Ellul, Simon O'Leary, Stephen
author_sort	Bester, Christofer
title	Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
title_short	Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
title_full	Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
title_fullStr	Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
title_full_unstemmed	Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
title_sort	electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial
publisher	Elsevier
publishDate	2021
url	http://psasir.upm.edu.my/id/eprint/97054/ https://www.sciencedirect.com/science/article/pii/S0378595521001878
_version_	1765298663240761344
score	13.211869

Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of randomised clinical trial

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