Cochlear microphonic audiometry: a new hearing test for objective diagnosis of deafness.
ABSTRACT Objective audiometric tests could constitute a valuable tool for detection of deafness. This could be especially useful in children (universal newborn hearing screening) and non-collaborative patients, who are especially difficult candidates for classic audiometry. The cochlear microphonic audiometry (CMA) technique offers the possibility of obtaining objective audiometric profiles, highly correlated with those obtained by pure tone audiometry (PTA). Therefore, CMA could be used as an alternative test to obtain the audiometric profile of these patients.
The main purpose of the present study was to demonstrate that CMA provides objective audiometric profiles by avoiding active participation by the patient. Subjects and methods. CMA specific equipment, improved for non-invasive recording of cochlear microphonic potentials, was used. This tool plots the recordings obtained as the classic audiogram. Verification of the method was carried out in adult patients by comparing the PTA with the CMA audiometric profiles obtained for each patient.
Our findings showed that audiometric profiles obtained from CMA are highly correlated, without statistical differences, to those obtained with PTA. More than 81% of patients explored (91.67% at 250 Hz) exhibited differences below 10 dB(HL) between tests at all exploration frequencies, while a low number of cases showed differences over 20 dB(HL).
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ABSTRACT: To report the authors' experience with transtympanic electrocochleography during the past 10 years. Retrospective case review. Otology/neurotology referral center. Transtympanic electrocochleography was performed on 2,421 ears of 2,140 patients from May 1990 to April 2000. Clicks and tonebursts were used in electrocochleography testing. Summating potential/action potential ratio was calculated. Action potential latency shift by rarefaction and condensation clicks was measured. Cochlear microphonic was recorded. An enlarged summating potential/action potential ratio (>0.40), broadened action potential waveform (>3 msec) or prolonged action potential latency shift (>0.2 msec) was considered to be indicative of endolymphatic hydrops. The presence of cochlear microphonic indicated hair cell survival. In response to clicks, an enlarged summating potential/action potential ratio was found in 76.1% of ears and a broadened action potential waveform in 70%. Either an enlarged summating potential/action potential ratio or a broadened action potential waveform was observed in 78.4% of ears. In response to tonebursts, an enlarged summating potential/action potential ratio was found in 64.8%. The combined use of clicks and tonebursts yielded an enlarged summating potential/action potential ratio in 81.7%. Electrocochleography using tonebursts had the advantage of frequency selectivity. A prolonged action potential latency shift was found in 62.2% of ears with Ménière's disease. A significant association between an enlarged summating potential/action potential ratio and an action potential latency shift was noted (chi = 5.357, p = 0.021). An enlarged summating potential/action potential ratio was found 71% in Stage 1 of Ménière's disease, 82% in Stage 2, 85% in Stage 3, and 90% in Stage 4 (chi = 19.442, p = 0.000). An enlarged summating potential/action potential ratio was associated with the duration of the disease, 43% in the under 1-year group, and 100% in the more than 30-years group (chi = 33.555, p = 0.000). A large cochlear microphonic was present in 69% of ears with hearing levels greater than 40 dB. Transtympanic electrocochleography using clicks and tonebursts is a reliable test to detect the presence of endolymphatic hydrops in Ménière's disease. A prolonged action potential latency shift evoked by rarefaction and condensation clicks is a useful addition to the application of electrocochleography in the diagnosis of Ménière's disease.Ontology & Neurotology 10/2002; 23(5):799-805. · 2.01 Impact Factor
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ABSTRACT: To determine whether cochlear function is beneficial in decision-making concerning the selection of hearing preservation surgery for vestibular schwannoma. Retrospective review of 44 patients undergoing tumor resection with a middle fossa approach. Cochlear microphonics in electrocochleography together with tumor size, pure-tone average (PTA), speech discrimination score (SDS), auditory brainstem response (ABR), and compound action potentials were examined. As acoustic stimuli, short tone-bursts with frequencies of 0.5, 1, and 2 kHz were employed to measure cochlear microphonics and a click was used to obtain compound action potentials. We determined detection thresholds of cochlear microphonics and action potentials. The overall rate of preservation of serviceable hearing was 59.1% (26/44). There were significant differences between patients with and without serviceable postoperative hearing in PTA, SDS, finding of ABR, compound action potential detection threshold, and mean cochlear microphonic detection threshold (at 0.5, 1, and 2 kHz). However, tumor size was unrelated to hearing outcome. Serviceable hearing was preserved in 23 (76.7%) of 30 patients, with a mean cochlear microphonic detection threshold of 40 dB nHL or less, suggesting normal or slightly impaired cochlear function. Hearing recovery was recognized in three patients, who also had a mean cochlear microphonic detection threshold of 40 dB nHL or less. Of the three patients, two had lower cochlear microphonic detection thresholds than audiometric thresholds, demonstrating the existence of a retrocochlear component in their hearing loss. The cochlear microphonic detection threshold predicts not only hearing preservation but also hearing improvement in patients with vestibular schwannomas.The Laryngoscope 01/2000; 109(12):1982-7. · 1.98 Impact Factor
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ABSTRACT: Electrocochleography (ECochG) has evolved as an important tool in the diagnosis/assessment/monitoring of Ménière's disease/endolymphatic hydrops (MD/ELH). This manuscript provides an update on the use of ECochG for these purposes. The material presented includes descriptions of the components of the electrocochleogram; ECochG recording approaches and parameters; how to prepare for an exam, including subject/patient considerations; construction and placement of a tympanic membrane recording electrode; and interpretation the electrocochleogram. Various approaches aimed at improving ECochG's sensitivity and specificity to MD/ELH also are described. These approaches go beyond simple measurement of the now-conventional summating potential (SP)/action potential (AP) magnitude ratio to include the SP magnitude to tonebursts, the SP/AP area ratio, and the AP latency difference to clicks of opposing polarity.Journal of the American Academy of Audiology 02/2006; 17(1):45-68. · 1.63 Impact Factor