Integrated Intracochlear Electrocochleography during Cochlear Implantation: Clinical Application and Proposal for a Standardized Protocol

HE Yan-di; REN Ai-rong; LI Yun; JI Yan; YANG Lu; XU Bai-cheng; SUN Jia-qiang; JIA Huan

doi:10.3969/j.issn.1672-4933.2026.01.003

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Integrated Intracochlear Electrocochleography during Cochlear Implantation: Clinical Application and Proposal for a Standardized Protocol

The Application of Auditory Evoked Potentials in Cochlear Implantation | 更新时间：2026-07-30

- Integrated Intracochlear Electrocochleography during Cochlear Implantation: Clinical Application and Proposal for a Standardized Protocol
- Chinese Scientific Journal of Hearing and Speech Rehabilitation Vol. 24, Issue 1, Pages: 12-19(2026)
- 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：
- 基金信息：
- DOI：10.3969/j.issn.1672-4933.2026.01.003
  CLC： R764.35
- Received：09 September 2025，
  
  Online First：09 January 2026，
  
  Published：15 January 2026
- 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

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

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

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±21.1 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，

=1.145，

=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，

=-0.015，

=0.931；n=15，

=0.237，

=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（

=-0.707，

=0.01）。

结论

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

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 patient

s; mean age 27.

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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

=1.145

=0.451)

and intraoperative CM amplitudes did not correlate with preoperative LF-PTA (n=34

r=-0.015

=0.931;n=15

r=0.237

=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 C

M amplitude correlated significantly and inversely with postoperative LF threshold shift (r=-0.707

=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.

关键词

Keywords

references

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