Multi-Frequency Electrocochleography Results in Fewer Drop Alarms During Cochlear Implant Insertion.

Publication Title

The Laryngoscope

Authors

• Mana Espahbodi
• Ali Syed
• Alex Tu
• Michael D Seidman
• Christopher J Danner
• Kyle P Allen
• Loren J Bartels
• Syed F Ahsan
• Courtney C J Voelker, Otology/Neurotology-Lateral Skull Base Surgery, Pacific Neuroscience Institute, Los Angeles, California, USA.Follow
• Nicholas L Deep
• Jacob B Hunter
• Rebecca C Chiffer
• Elias M Michaelides
• Mohamed Elrakhawy
• Matthew W Miller
• Harrison W Lin
• Hamid R Djalilian
• Esther X Vivas
• Simon I Angeli
• Michael Hoa
• H Jeffrey Kim
• Mark H Widick
• Katrina R Stidham
• Neil S Patel
• Richard K Gurgel
• Karl W Doerfer
• Kanthaiah Koka
• Michael S Harris

Document Type

Article

Publication Date

5-5-2026

Keywords

ECochG; cochlear implantation; multi‐frequency electrocochleography.; california; pni; los angeles

Abstract

OBJECTIVE: To evaluate intracochlear electrocochleography (ECochG) amplitude parameters during cochlear implantation (CI) using a novel multi-frequency ECochG algorithm.

METHODS: A multi-institutional, prospective cohort study was performed at 18 high-volume CI centers. The inclusion criteria were adults with sensorineural hearing loss and audiometric thresholds of ≤ 90 dB hearing level at 500 Hz undergoing CI with Advanced Bionics (Valencia, CA) Ultra 3D devices between 2024 and 2025. ECochG recordings were performed with simultaneous multi-frequency stimulation of four frequencies between 125 and 4000 Hz during cochlear implant insertion. Concurrent multi-frequency recording allowed extraction of amplitude and phase of each frequency individually. Post hoc analysis was performed to determine the difference in the number of drop alarms between single- and multi-frequency ECochG. An ECochG amplitude drop of 6 dB was defined as a drop alarm. Insertion track patterns were compared between single- and multi-frequency ECochG.

RESULTS: One hundred ninety-five ears were included. Mean number of drop alarms for the single-frequency algorithm was 1.72 (95% CI: 1.52, 1.92; median 1) compared to 0.42 (95% CI: 0.31, 0.53; median 0) for multi-frequency; p <  0.001. The number of Type C patterns (rise in amplitude during insertion followed by a drop) decreased with the multi-frequency ECochG algorithm compared to the single-frequency ECochG algorithm. The number of Type D patterns (no-response) decreased, indicating that multi-frequency ECochG generated more responses across the cochlea than single-frequency ECochG.

CONCLUSIONS: A novel multi-frequency ECochG algorithm during CI is associated with fewer drop alarms and altered insertion track patterns, which may provide a more accurate assessment of the cochlear microenvironment.

Specialty/Research Institute

Otolaryngology

Specialty/Research Institute

Internal Medicine

Specialty/Research Institute

Surgery

DOI

10.1002/lary.70592