Electrocochleography (abbreviated ECochG or ECOG) is a technique of recording

electrical potential The electric potential (also called the ''electric field potential'', potential drop, the electrostatic potential) is defined as the amount of work energy needed to move a unit of electric charge from a reference point to the specific point in ...

s generated in the

inner ear The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In vertebrates, the inner ear is mainly responsible for sound detection and balance. In mammals, it consists of the bony labyrinth, a hollow cavity in the ...

and

auditory nerve The cochlear nerve (also auditory nerve or acoustic nerve) is one of two parts of the vestibulocochlear nerve, a cranial nerve present in amniotes, the other part being the vestibular nerve. The cochlear nerve carries auditory sensory information ...

in response to sound stimulation, using an electrode placed in the ear canal or

tympanic membrane In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the air ...

. The test is performed by an

otologist Otology is a branch of medicine which studies normal and pathological anatomy and physiology of the ear (hearing and vestibular sensory systems and related structures and functions) as well as their diseases, diagnosis and treatment. Otologic ...

audiologist Audiology (from Latin , "to hear"; and from Greek , ''-logia'') is a branch of science that studies hearing, balance, and related disorders. Audiologists treat those with hearing loss and proactively prevent related damage. By employing vario ...

with specialized training, and is used for detection of elevated inner ear pressure (

endolymphatic hydrops Endolymphatic hydrops is a disorder of the inner ear. It consists of an excessive build-up of the endolymph fluid, which fills the hearing and balance structures of the inner ear. Endolymph fluid, which is partly regulated by the endolymph sac, ...

) or for the testing and monitoring of inner ear and auditory nerve function during surgery.

Clinical applications

The most common clinical applications of electrocochleography include: * Objective identification and monitoring of

Ménière's disease Ménière's disease (MD) is a disease of the inner ear that is characterized by potentially severe and incapacitating episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Typically, only one ear is affected initial ...

and endolymphatic hydrops (EH) *

Intraoperative monitoring Intraoperative neurophysiological monitoring (IONM) or intraoperative neuromonitoring is the use of electrophysiological methods such as electroencephalography (EEG), electromyography (EMG), and evoked potentials to monitor the functional integ ...

of auditory system function during surgery on the brainstem or cerebellum * Enhancement of Wave I of the

auditory brainstem response The auditory brainstem response (ABR), also called brainstem evoked response audiometry (BERA), is an auditory evoked potential extracted from ongoing electrical activity in the brain and recorded via electrodes placed on the scalp. The measured r ...

, particularly in patients who are hard of hearing * Diagnosis of

auditory neuropathy Auditory neuropathy (AN) is a hearing disorder in which the outer hair cells of the cochlea are present and functional, but sound information is not transmitted sufficiently by the auditory nerve to the brain. Hearing loss with AN can range from nor ...

Cochlear physiology

The

basilar membrane The basilar membrane is a stiff structural element within the cochlea of the inner ear which separates two liquid-filled tubes that run along the coil of the cochlea, the scala media and the scala tympani. The basilar membrane moves up and down in ...

and the hair cells of the cochlea function as a sharply tuned frequency analyzer. Sound is transmitted to the inner ear via vibration of the

, leading to movement of the middle ear bones (malleus, incus, and stapes). Movement of the stapes on the

oval window The oval window (or ''fenestra vestibuli'' or ''fenestra ovalis'') is a membrane-covered opening from the middle ear to the cochlea of the inner ear. Vibrations that contact the tympanic membrane travel through the three ossicles and into the in ...

generates a pressure wave in the

perilymph Perilymph is an extracellular fluid located within the inner ear. It is found within the scala tympani and scala vestibuli of the cochlea. The ionic composition of perilymph is comparable to that of plasma and cerebrospinal fluid. The major ca ...

within the cochlea, causing the basilar membrane to vibrate. Sounds of different frequencies vibrate different parts of the basilar membrane, and the point of maximal vibration amplitude depends on the sound frequency. As the basilar membrane vibrates, the

hair cells Hair cells are the sensory receptors of both the auditory system and the vestibular system in the ears of all vertebrates, and in the lateral line organ of fishes. Through mechanotransduction, hair cells detect movement in their environment. ...

attached to this membrane are rhythmically pushed up against the

tectorial membrane The tectoria membrane (TM) is one of two acellular membranes in the cochlea of the inner ear, the other being the basilar membrane (BM). "Tectorial" in anatomy means forming a cover. The TM is located above the spiral limbus and the spiral organ ...

, bending the hair cell

stereocilia Stereocilia (or stereovilli or villi) are non-motile apical cell modifications. They are distinct from cilia and microvilli, but are closely related to microvilli. They form single "finger-like" projections that may be branched, with normal cel ...

. This opens mechanically gated ion channels on the hair cell, allowing influx of potassium (K⁺) and calcium (Ca²⁺) ions. The flow of ions generates an AC current through the hair cell surface, at the same frequency as the acoustic stimulus. This measurable AC voltage is called the cochlear microphonic (CM), which mimics the stimulus. The hair cells function as a transducer, converting the mechanical movement of the basilar membrane into electrical voltage, in a process requiring ATP from the stria vascularis as an energy source. The depolarized hair cell releases neurotransmitters across a synapse to primary auditory neurons of the

spiral ganglion The spiral (cochlear) ganglion is a group of neuron cell bodies in the modiolus, the conical central axis of the cochlea. These bipolar neurons innervate the hair cells of the organ of Corti. They project their axons to the ventral and dorsal co ...

. Upon reaching receptors on the postsynaptic spiral ganglion neurons, the neurotransmitters induce a

postsynaptic potential Postsynaptic potentials are changes in the membrane potential of the postsynaptic terminal of a chemical synapse. Postsynaptic potentials are graded potentials, and should not be confused with action potentials although their function is to ini ...

or generator potential in the neuronal projections. When a certain threshold potential is reached, the spiral ganglion neuron fires an action potential, which enters the auditory processing pathway of the brain.

Cochlear potentials

A resting endolymphatic potential of a normal cochlea is + 80 mV. There are at least 3 other potentials generated upon cochlear stimulation: *Cochlear microphonic (CM) *Summating potential (SP) *

Action potential An action potential occurs when the membrane potential of a specific cell location rapidly rises and falls. This depolarization then causes adjacent locations to similarly depolarize. Action potentials occur in several types of animal cells, ...

(AP) As described above, the cochlear microphonic (CM) is an

alternating current Alternating current (AC) is an electric current which periodically reverses direction and changes its magnitude continuously with time in contrast to direct current (DC) which flows only in one direction. Alternating current is the form in whic ...

(AC) voltage that mirrors the waveform of the acoustic stimulus. It is dominated by the outer hair cells of the organ of Corti. The magnitude of the recording is dependent on the proximity of the recording electrodes to the hair cells. The CM is proportional to the displacement of the basilar membrane. A fourth potential, the auditory nerve neurophonic, is sometimes dissociated from the CM. The neurophonic represents the neural part (auditory nerve spikes) phased-locked to the stimulus and is similar to the

Frequency following response The frequency following response (FFR), also referred to as frequency following potential (FFP) or envelope following response (EFR), is an evoked potential generated by periodic or nearly-periodic auditory stimuli.Burkard, R., Don, M., & Eggermon ...

. The summating potential (SP), first described by Tasaki et al. in 1954, represents the

direct current Direct current (DC) is one-directional flow of electric charge. An electrochemical cell is a prime example of DC power. Direct current may flow through a conductor such as a wire, but can also flow through semiconductors, insulators, or even ...

(DC) response of the hair cells as they move in conjunction with the basilar membrane, as well as the DC response from dendritic and axonal potentials of the auditory nerve. The SP is the stimulus-related potential of the cochlea. Although historically it has been the least studied, renewed interest has surfaced due to changes in the SP reported in cases of endolymphatic hydrops or Ménière's disease. The auditory nerve action potential, also called the compound action potential (CAP), is the most widely studied component in ECochG. The AP represents the summed response of the synchronous firing of the nerve fibers. It also appears as an AC voltage. The first and largest wave (N1) is identical to wave I of

(ABR). Following this is N2, which is identical to wave II of the ABR. The magnitude of the action potential reflects the number of fibers that are firing. The latency of the AP is measured as the time between the onset and the peak of the N1 wave.

Procedure and recording parameters

ECochG can be performed with either invasive or non-invasive electrodes. Invasive electrodes, such as transtympanic (TT) needles, give clearer, more robust electrical responses (with larger amplitudes) since the electrodes are very close to the voltage generators. The needle is placed on the promontory wall of the middle ear and the round window. Non-invasive, or extratympanic (ET), electrodes have the advantage of not causing pain or discomfort to the patient. Unlike with invasive electrodes, there is no need for sedation, anesthesia, or medical supervision. The responses, however, are smaller in magnitude. Auditory stimuli in the form of broadband clicks 100 microseconds in duration are used. The stimulus polarity can be rarefaction polarity, condensation polarity, or alternating polarity. Signals are recorded from a primary recording (non-inverted) electrode located in the ear canal, tympanic membrane, or promontory (depending on type of electrode used). Reference (inverting) electrodes can be placed on the contralateral earlobe, mastoid, or ear canal. The signal is processed, including signal amplification (by as much as a factor 100000 for extratympanic electrode recordings), noise filtration, and signal averaging. A band-pass filter from 10 Hz to 1.5 kHz is often used.

Interpretation of results

The CM, SP, and AP are all used in the diagnosis of endolymphatic hydrops and Ménière's disease. In particular, abnormally high SP and a high SP:AP ratio are signs of Ménière's disease. An SP:AP ratio of 0.45 or greater is considered abnormal.

History

The CM was first discovered in 1930 by Ernest Wever and Charles Bray in cats. Wever and Bray mistakenly concluded that this recording was generated by the auditory nerve. They named the discovery the "Wever-Bray effect".

Hallowell Davis Hallowell Davis (August 31, 1896 – August 22, 1992) was an American physiologist, otolaryngologist and researcher who did pioneering work on the physiology of hearing and the inner ear. He served as director of research at the Central Institut ...

and A.J. Derbyshire from Harvard replicated the study and concluded that the waves were in fact cochlear origin and not from the auditory nerve. Fromm et al. were the first investigators to employ the ECochG technique in humans by inserting a wire electrode through the tympanic membrane and recording the CM from the niche of the round window and cochlear promontory. Their first measurement of the CM in humans was in 1935. They also discovered the N1, N2, and N3 waves following the CM, but it was Tasaki who identified these waves as

action potentials. Fisch and Ruben were the first to record the compound action potentials from both the round window and the eighth cranial nerve (CN VIII) in cats and mice. Ruben was also the first person to use CM and AP clinically. The summating potential, a stimulus-related hair cell potential, was first described by Tasaki and colleagues in 1954. Ernest J. Moore was the first investigator to record the CM from surface electrodes. In 1971, Moore conducted five experiments in which he recorded CM and AP from 38 human subjects using surface electrodes. The purpose of the experiment was to establish the validity of the responses and to develop an artifact-free earphone system. Unfortunately, bulk of his work was never published.

References

{{reflist, refs= {{cite web, last1=Ferraro, first1=John A., title=Clinical Electrocochleography: Overview of Theories, Techniques and Applications, url=http://www.audiologyonline.com/articles/clinical-electrocochleography-overview-theories-techniques-1275-1275, website=Audiology Online, access-date=15 September 2014, date=November 15, 2000 {{cite journal , author= Kohlloffel LUE , year = 1972 , title = A study of basilar membrane vibrations III: The basilar membrane frequency response curve in the living guinea pig , journal = Acustica , volume = 27 , pages = 82 {{cite journal , author= Wever EG, Bray CW , year = 1930 , title = Auditory Nerve Impulses , journal = Science , volume = 71 , issue =1834, pages = 215 , pmid = 17818230, doi= 10.1126/science.71.1834.215 {{Cite book, title= Bases of auditory brain-stem evoked responses , author= Moore EJ , year= 1983 , publisher= Grune & Stratton, Inc. {{cite journal , author= Fromm B , year = 1934–1935 , title = Studies in the mechanism of the Wever-Bray effect , journal = Acta Oto-Laryngologica , volume = 22 , pages = 477–486 , name-list-style=vanc , display-authors= 1 , author2= , issue = 3 , doi=10.3109/00016483509118125 {{cite journal , author= Fisch UP, Ruben RJ , year = 1962 , title = Electrical acoustical response to click stimulation after section of the eighth nerve , journal = Acta Oto-Laryngologica , volume = 54 , issue =1–6, pages = 532–42 , pmid =13893094 , doi= 10.3109/00016486209126971 {{cite journal , author= Tasaki I , year = 1954 , title = Exploration of cochlear potentials in guinea pigs with a micro-electrode , journal =

Journal of the Acoustical Society of America The ''Journal of the Acoustical Society of America'' is a monthly peer-reviewed scientific journal covering all aspects of acoustics. It is published by the Acoustical Society of America and the editor-in-chief is James F. Lynch (Woods Hole Oceanog ...

, volume = 26 , issue =5, pages = 765 , name-list-style=vanc , display-authors= 1 , doi= 10.1121/1.1907415 , author2= , bibcode = 1954ASAJ...26..765T {{Cite book, title= Human cochlear microphonics and auditory nerve action potentials from surface electrodes , author= Moore EJ , year= 1971, publisher= Unpublished Ph.D. dissertation, University of Wisconsin. Madison, Wisconsin Ear procedures Medical tests