Introduction: Preserving residual hearing during cochlear implant surgery requires insertion to be as atraumatic as possible. Real-time visualization of intraoperative electrocochleography (EcochG) potentials via picture-in-picture (PIP) mode in digital microscopes such as e.g. RoboticScope or Arriscope provides direct feedback to the surgeon during cochlear implant electrode insertion. The aim of this prospective study was to assess the influence of two different intraoperative real-time visualization modes (graph vs arrows) on the preservation of residual hearing.

Methods: The EcochG potentials is visualized in a PiP mode (direct HDMI transmission from Maestro into the different digital microscopes) using either arrows or graphs. This allows the surgeon to fine-tune insertion-speed and –force during implantation. Subsequently, residual hearing is directly audiometrically recorded intraoperatively. For follow-up, the development of residual hearing of 65 included adults is monitored both subjectively and objectively at 1st day, 6 and 12 weeks postoperatively.

Results: Initial results show a good preservation of residual hearing and confirm results of a former graph based Ecochg study (N>100). The individual workload of the surgeon varies depending on the visualization method. Both Arrow and graph visualization show equal results in hearing performance and preservation as well as in insertion time.

Conclusion: EcochG via PiP is a crucial tool to monitor the insertion of the cochlear implant and maintain residual hearing. The new arrow-display represents a simple and very suitable EcochG montoring method and doesn"t seem to have an influence on hearing outcome and insertion quality. The choice of method (graph or arrow) is up to individual requirements of the surgeon.

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