人工耳蜗术中一体式蜗内耳蜗电图应用及标准化流程探讨OA

Objective To analyze the clinical utility of intraoperative integrated intracochlear electrocochleography(ECochG)system during cochlear implant(CI)surgery,discuss its advantages and limitations,and propose a standardized monitoring protocol.Methods Consecutive CI recipients who underwent intraoperative integrated intracochlear ECochG monitoring in our team between March 2023 and August 2025 were enrolled.Clinical data and real-time ECochG recordings were collected.Monitoring success rate,waveform characteristics,and amplitude trends were analyzed.A three-phase intraoperative pattern classification(Early,Mid,and Late Insertion;Type I,Type D,Type S,Type F)was established.Results Included were 45 ears(44 patients;mean age 27.3±19.2 years;mean preoperative low-frequency pure-tone average[LF-PTA]86.6±21.1 dB HL)without radiological cochlear malformation.Full electrode insertion was achieved in all ears.Cochlear microphonic(CM)was successfully obtained intraoperatively in 15 ears;9 additional ears showed CM at wound closure or on postoperative day(POD)2;21 ears remained non-responsive(9 due to electrical interference,2 due to displaced earphone).After excluding the 9 ears with electrical interference and the 2 ears with displaced earphone,intraoperative CM acquisition rates were not significantly associated with preoperative LF-PTA≤80 dB HL(n=34,χ2=1.145,P=0.451),and intraoperative CM amplitudes did not correlate with preoperative LF-PTA(n=34,r=-0.015,P=0.931;n=15,r=0.237,P=0.395).Among the 15 ears with acquired intraoperative CM,Type F pattern predominated in the early phase(7 ears,46.7%).Of these,optimized intervention based on waveform changes was applied in 4 ears.Type S and Type F patterns both predominated in the mid phase(each accounting for 5 ears,33.3%).In the late phase,the distribution of pattern types was similar across categories,and declining waveforms showed no response to intervention.Postoperative follow-up was completed in 12 ears.Complete hearing preservation(HP)was observed in 75%,and partial HP in 25%.The ratio of wound closure to intraoperative maximum CM amplitude correlated significantly and inversely with postoperative LF threshold shift(r=-0.707,P=0.01).Conclusion Intraoperative application of ECochG monitoring provides real-time feedback on trauma during electrode insertion and allows for minimally invasive adjustment during the reversible phase,thereby facilitating postoperative residual hearing preservation.Implementing a standardized intraoperative protocol contributes to improving the intraoperative CM acquisition rate.The three-phase intraoperative pattern classification facilitates the analysis of the mechanisms underlying insertion-related trauma.The relationship between intraoperative CM acquisition rate or amplitude and preoperative LF-PTA remains to be further investigated.