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
Integrated Intracochlear Electrocochleography during Cochlear Implantation: Clinical Application and Proposal for a Standardized Protocol
- 中国听力语言康复科学杂志 2026年24卷第1期 页码：12-19
- 作者机构：
1.上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科 上海 200011
2.上海交通大学医学院 上海 200025
3.上海交通大学医学院耳科学研究所/上海市耳鼻疾病转化医学重点实验室 上海 200125
4.兰州大学第二医院耳鼻咽喉头颈外科 兰州 730000
5.中国科学技术大学附属第一医院（安徽省立医院）耳鼻咽喉头颈外科 合肥 230001
6.上海交通大学医学院医学技术学院 上海 200025
- 作者简介：
何妍荻 硕士；研究方向：人工听觉重建及耳科新技术
徐百成，E-mail： xbsuc@126.com
孙家强，E-mail： sunjq0606@163.com
贾欢，E-mail： huan.jia.orl@shsmu.edu.cn
- 基金信息：上海申康三年行动计划-临床“五新”创新研发项目(SHDC2020CR3010A);2022年九院优秀研究型医师培育项目(2022yxyjxys-jh);上海市耳鼻疾病转化医学重点实验室(14DZ2260300)
DOI：10.3969/j.issn.1672-4933.2026.01.003
中图分类号： R764.35收稿：2025-09-09，
纸质出版：2026-01-15
- 稿件说明：
移动端阅览
何妍荻,任艾蓉,李蕴等.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[J].中国听力语言康复科学杂志,2026,24(01):12-19.
HE Yan-di,REN Ai-rong,LI Yun,et al.Integrated Intracochlear Electrocochleography during Cochlear Implantation: Clinical Application and Proposal for a Standardized Protocol[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2026,24(01):12-19.
何妍荻,任艾蓉,李蕴等.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[J].中国听力语言康复科学杂志,2026,24(01):12-19. DOI： 10.3969/j.issn.1672-4933.2026.01.003.
HE Yan-di,REN Ai-rong,LI Yun,et al.Integrated Intracochlear Electrocochleography during Cochlear Implantation: Clinical Application and Proposal for a Standardized Protocol[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2026,24(01):12-19. DOI： 10.3969/j.issn.1672-4933.2026.01.003.
摘要
目的
2
分析一体式蜗内耳蜗电图在人工耳蜗植入（CI）术中的应用情况，讨论其优势及局限，总结该技术的标准化流程。
方法
2
收集2023年3月～2025年8月于本团队实施人工耳蜗术中一体式蜗内耳蜗电图的全部临床资料及术中监测数据，对监测成功率、监测指标变化规律等进行分析，建立术中监测三阶段分型（植入早期、中期和晚期；上升型、下降型、稳定型、波动型）。
结果
2
共有44例（45耳）患者应用该技术（男24，女20），平均年龄27.
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3.38666677
2.03200006
19.2岁，术前低频平均听力为86.6±2
1.1 dB HL，无明显的耳蜗畸形，均完成全部电极植入。15耳成功在术中引出CM波形，9耳于术毕或术后第2天引出波形，21耳未引出波形（其中9耳术中干扰严重，2耳术中耳机脱落）。在去除术中干扰严重的9耳和术中耳机脱落的2耳后，34耳的术中CM波形引出率与术前低频平均听力之间无统计学意义（n=34，
χ
2
=1.145，
P
=0.451），且该34耳以及术中成功引出15耳耳蜗微音电位（cochlear microphonics， CM）波形最大幅值与术前低频平均听力无明显相关（n=34，
r
=-0.015，
P
=0.931；n=15，
r
=0.237，
P
=0.395）。15耳中，植入早期最常见为波动型［7耳（46.7%）］，其中4耳依据波形变化采用优化植入干预方案；在中期为稳定型和波动型居多［均为5耳（33.3%）］；在晚期，各类型比例相近，且波形下降趋势难以通过干预方案得到恢复。在本院完成术后开机随访且具有术前可测听力的12例（12耳）患者，术后低频听力完全保留率为75%，部分保留率为25%。术毕/术中最高幅值比与术后低频听力阈移呈显著负相关（
r
=-0.707，
P
=0.01）。
结论
2
术中应用ECochG 技术可实时反馈电极植入对内耳的创伤，及时在损伤可逆期内进行微创化调整，有助于术后残余听力的保留。术中标准化流程的建立有助于提升该技术的术中引出率。术中监测三阶段分型的建立有助于电极植入对内耳创伤的机制分析。术中CM 波形引出率、引出幅值与术前低频平均听力的关系仍待进一步探讨分析。
Abstract
Objective
2
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
2
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
2
Included were 45 ears (44 patients; mean age 27.
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https://html.publish.founderss.cn/rc-pub/api/common/picture?pictureId=99797454&type=
3.38666677
2.03200006
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
χ
2
=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
2
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.
关键词
Keywords
references
Buchman CA , Gifford RH , Haynes DS , et al . Unilateral cochlear implants for severe, profound, or moderate sloping to profound bilateral sensorineural hearing loss: A systematic review and consensus statements [J ] . JAMA otolaryngology-- head & neck surgery , 2020 , 146 ( 10 ): 942 - 953 .
Gantz BJ , Hansen M , Dunn CC . Clinical perspective on hearing preservation in cochlear implantation, the university of iowa experience [J ] . Hearing Research , 2022 , 426 : 108487 .
Bleckly F , Lo CY , Rapport F , et al . Music perception, appreciation, and participation in postlingually deafened adults and cochlear implant users: A systematic literature review [J ] . Trends in Hearing , 2024 , 28 : 23312165241287391 .
Panario J , Bester C , O'Leary S . Predicting postoperative speech perception and audiometric thresholds using intracochlear electrocochleography in cochlear implant recipients [J ] . Ear and Hearing , 2024 , 45 ( 5 ): 1173 - 1190 .
Trecca EMC , Riggs WJ , Mattingly JK , et al . Electrocochleography and cochlear implantation: A systematic review [J ] . Otology & Neurotology , 2020 , 41 ( 7 ): 864 - 878 .
Lenarz T , Buechner A , Gantz B , et al . Relationship between intraoperative electrocochleography and hearing preservation [J ] . Otology & Neurotology , 2022 , 43 ( 1 ): e72 - e78 .
Giardina CK , Brown KD , Adunka OF , et al . Intracochlear electrocochleography: Response patterns during cochlear implantation and hearing preservation [J ] . Ear and Hearing , 2019 , 40 ( 4 ): 833 - 848 .
Buechner A , Bardt M , Haumann S , et al . Clinical experiences with intraoperative electrocochleography in cochlear implant recipients and its potential to reduce insertion trauma and improve postoperative hearing preservation [J ] . PloS One , 2022 , 17 ( 4 ): e0266077 .
O'Leary S , Briggs R , Gerard JM , et al . Intraoperative observational real-time electrocochleography as a predictor of hearing loss after cochlear implantation: 3 and 12 month outcomes [J ] . Otology & Neurotology , 2020 , 41 ( 9 ): 1222 - 1229 .
O'Leary S , Mylanus E , Venail F , et al . Monitoring cochlear health with intracochlear electrocochleography during cochlear implantation: Findings from an international clinical investigation [J ] . Ear and Hearing , 2023 , 44 ( 2 ): 358 - 370 .
Cooper J , Mittal J , Zalta M , et al . Bridging the gap: A systematic review of intraoperative electrocochleography during cochlear implantation and preservation of residual hearing [J ] . PloS One , 2025 , 20 ( 5 ): e0323493 .
Kim JS . Clinical applications of intracochlear electrocochleography in cochlear implant users with residual acoustic hearing [J ] . Journal of Audiology & Otology , 2024 , 28 ( 2 ): 100 - 106 .
王睿婕 , 罗建芬 , 戴清蕾 , 等 . 微创人工耳蜗术中耳蜗电图监测用于残余听力保留的临床研究 [J ] . 临床耳鼻咽喉头颈外科杂志 , 2025 , 39 ( 5 ): 425 - 432 .
Weder S , Bester C , Collins A , et al . Toward a better understanding of electrocochleography: Analysis of real-time recordings [J ] . Ear and Hearing , 2020 , 41 ( 6 ): 1560 - 1567 .
Harris MS , Koka K , Thompson-Harvey A , et al . Amplitude parameters are predictive of hearing preservation in a randomized controlled trial of intracochlear electrocochleography during cochlear implant surgery [J ] . Otology & Neurotology , 2024 , 45 ( 8 ): 887 - 894 .
Torres R , Daoudi H , Gu W , et al . Exploring trauma patterns and contributing factors with slim straight electrode array after cochlear implantation [J ] . Otolaryngology--Head and Neck Surgery , 2024 , 171 ( 2 ): 521 - 529 .
Skarzynski H , van de Heyning P , Agrawal S , et al . Towards a consensus on a hearing preservation classification system [J ] . Acta Oto-Laryngologica. Supplementum , 2013 ( 564 ): 3 - 13 .
Scheperle R , Etler C , Oleson J , et al . Evaluation of real-time intracochlear electrocochleography for guiding cochlear implant electrode array position [J ] . Journal of Clinical Medicine , 2023 , 12 ( 23 ): 7409 .
Schuerch K , Waser M , Mantokoudis G , et al . Increasing the reliability of real-time electrocochleography during cochlear implantation: A standardized guideline [J ] . European archives of oto-rhino-laryngology , 2022 , 279 ( 10 ): 4655 - 4665 .
Yin LX , Barnes JH , Saoji AA , et al . Clinical utility of intraoperative electrocochleography (ECochG) during cochlear implantation: A systematic review and quantitative analysis [J ] . Otology & Neurotology , 2021 , 42 ( 3 ): 363 - 371 .
Torres R , Drouillard M , De Seta D , et al . Cochlear Implant Insertion Axis Into the Basal Turn: A Critical Factor in Electrode Array Translocation . [J ] . Otology & Neurotology , 2018 ; 39 ( 2 ): 168 - 176 .
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