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Intraoperative round window electrocochleography is correlated with speech perception outcomes in
pediatric cochlear implant recipients
Formeister E.J. , McClellan J.H. , Merwin III W.H. , Iseli C.E. , Teagle H.F.B. , Buchman C.A. , Fitzpatrick D.C. ,
Adunka O.F.
University of North Carolina School of Medicine, Otolaryngology/Head and Neck Surgery, Chapel Hill, United States
Introduction: Speech perception performance following cochlear implantation (CI) varies substantially in
children. The use of round window (RW) electrocochleography (ECoG) at the time of implantation was shown to
account for over 40% of the variance in word score outcomes in adults (Fitzpatrick et al., Otol Neurotol 2014;
35(1): 64-71. The hypothesis for this study was that the ECoG measurements would also correlate with speech
perception outcomes in children.
Methods: ECoG recordings were obtained from 72 children (82 ears) during cochlear implantation. A total
response metric was derived from the summed magnitudes of significant ECoG responses over a frequency
series of acoustic stimuli presented at 90 dB nHL in the ipsilateral ear. Implanted children were followed
prospectively, and at 9-12 months postoperatively, children were evaluated with the phonetically balanced
kindergarten (PB-k) open set speech perception test, if age- and developmentally appropriate (n=22). PB-k
scores were compared to ECoG total response and other clinical and bioaudiometric variables using multiple
linear regression analysis to construct a parsimonious model for predicting speech outcomes in implanted
Results: Postoperative PB-k scores were significantly correlated with ECoG total response (r =0.34, p=0.004)
and to a lesser extent, with preoperative PTA (r =0.19, p=0.02). ECoG total response was weakly and inversely
correlated with preoperative audiometric pure tone averages (PTA) (r =0.11, p=0.007, n=78). Other significant
predictors of speech perception performance in univariate analyses included duration of CI use and age at
testing. When all four of these predictors were combined in a multiple linear regression, only the ECoG total
response remained significant. Hierarchical multiple linear regression identified a model for speech perception
performance that included pre-operative PTA, duration of CI use, and ECoG total response that was able to
predict about half of the variance in PB-k scores (adjusted r =0.49, p=0.002).
Discussion: Intraoperative ECoG recordings can account for a greater proportion of variance in pediatric
speech perception outcomes than traditionally recognized bioaudiometric influences. The relatively weak
correlation between total power and PTA and PTA and speech outcomes suggests that the ECoG recordings
contain additional information about residual cochlear function than cannot be determined through behavioral
audiometric testing.
Conclusion: RW ECoG is a useful perioperative measurement for predicting pediatric speech perception
performance following CI.
Learning outcome: Despite the variability inherent in assessing pediatric speech perception performance, as a
direct measure of cochlear function, the ECoG total response can provide important insight into postoperative
prognosis in implanted children.