ECochG Atlas · References
Full references
Every clinical claim in the atlas is anchored against this typed registry of 93 peer-reviewed references, with DOI or PMID links where available and Oxford CEBM evidence levels where the source stated one. Search by author, year, title, journal, or the atlas note for each entry. Return to the Tools module or jump to the introduction for the atlas roadmap.
- 2025Optimizing staging of Meniere's disease: integrating electrocochleography with vestibular testsFrontiers in Neuroscience; 19:1600665
Multimodal staging — ECochG positivity ~55%, complemented by VEMP and vHIT.
- 2025Electrocochleography for monitoring hearing preservation during cochlear implantationJAMA Otolaryngology–Head & Neck Surgery; Published online Nov 20, 2025:e254044
Multicentre cohort (112 patients across Melbourne, Bern, Zurich): automated CM-event detection with ≥30% drop threshold; additional features (ANN:CM ratio, CM phase) improve prediction; four event paradigms (naive/deep/persistent/combined).
- 2025Bridging the gap: a systematic review of intraoperative electrocochleography during cochlear implantation and preservation of residual hearingPLOS One; 20(5):e0323493
Recent systematic review of intraop ECochG during CI surgery.
- 2024ElectrocochleographyStatPearls
Open-access reference summarising clinical ECochG technique.
- 2024Click SP/AP area ratio versus tone burst SP amplitude to diagnose Ménière's disease using electrocochleographyOtolaryngology–Head and Neck Surgery; 170(5):1338–1346
Modern head-to-head: TT click area ratio 88.5% sens / 70% spec.
- 2024Electrocochleography in the diagnosis of third window conditionsFrontiers in Neurology; 14:1263513
Recent cohort: all confirmed SSCD ears showed abnormal SP/AP.
- 2024Intraoperative hearing monitoring using ABR and TT-ECochG and hearing preservation during vestibular schwannoma resectionJournal of Clinical Medicine; 13(14):4230
75-patient series showing combined TT-ECochG and ABR monitoring during schwannoma surgery improves prognostic information for hearing preservation.
- 2023Vestibular migraine versus Ménière's disease: diagnostic utility of electrocochleographyAudiology Research; 13(1):12–22
Retrospective cohort: ECochG predicts response to anti-migraine therapy in VM (94%) better than clinical criteria alone (83%); a normal ECochG with VM criteria gave 100% symptom improvement on anti-migraine treatment.
- 2023ASNM Position Statement: Intraoperative Monitoring of Auditory Evoked PotentialsASNM Position Statement
Society guidance on intraoperative auditory monitoring — recommends combined ECochG-CAP, AN-CAP, and ABR for CPA tumour surgery when hearing preservation is the goal.
- 2022Neural contributions to the cochlear summating potential: spiking and dendritic componentsJournal of the Association for Research in Otolaryngology; 23:351–363
Further dissection of SP into dendritic and spiking neural contributions.
- 2022Extratympanic electrocochleography in the diagnosis of auditory neuropathy/auditory dyssynchronyBrazilian Journal of Otorhinolaryngology; 88(suppl 3):S133–S140
Modern ET technique for diagnosing ANSD with polarity reversal.
- 2022Electrocochleography triggered intervention successfully preserves residual hearing during cochlear implantation: results of a randomised clinical trialHearing Research; 426:108353
First randomised controlled trial: 60 adults, single-blinded, surgical intervention triggered by ≥30% CM amplitude drop preserved residual hearing significantly vs control.
- 2022Clinical experiences with intraoperative electrocochleography in cochlear implant recipients and its potential to reduce insertion trauma and improve postoperative hearing preservationPLOS ONE; 17(4):e0266077
Identified three response patterns during electrode insertion — Growth, Fluctuating, Total Loss — with Growth associated with the smallest postoperative hearing loss.
- 2022Is characteristic frequency limiting real-time electrocochleography during cochlear implantation?Frontiers in Neuroscience; 16:915302
250 Hz CM amplitude drops more predictive of hearing preservation than 500 Hz; multifrequency optimal.
- 2021Use of an extra-tympanic membrane electrode to record cochlear microphonics with click, tone burst and chirp stimuliJournal of Clinical Medicine; 10(4):786
Modern ET technique paper; click vs tone burst vs chirp success rates.
- 2021Primary neural degeneration in noise-exposed human cochleas: correlations with outer hair cell loss and word-discrimination scoresJournal of Neuroscience; 41(20):4439–4447
Temporal bone evidence of noise-induced primary neural degeneration in humans, correlated with reduced word-discrimination scores.
- 2021Assessment of cochlear function during cochlear implantation by extra- and intracochlear electrocochleographyFrontiers in Neuroscience; 15:686629
Demonstrated that intracochlear recording yields substantially larger amplitudes than extracochlear, but recording site moves with array advancement.
- 2021Monitoring cochlear health with intracochlear electrocochleography during cochlear implantation: findings from an international clinical investigationEar and Hearing; 42(2):358–370
International multi-centre evidence base for intraop ECochG monitoring.
- 2020Techniques for obtaining high-quality recordings in electrocochleographyFrontiers in Systems Neuroscience; 14:18
Practical technique paper — TM electrode placement, artifact suppression.
- 2019Hair cell and neural contributions to the cochlear summating potentialJournal of Neurophysiology; 121(6):2163–2180
Pharmacological dissection of SP into OHC, IHC, and neural components.
- 2019A systematic review and meta-analysis of extratympanic electrocochleography in Ménière's disease diagnosisInternational Journal of Audiology; 58(9):518–528
Meta-analysis showing combination measures outperform SP/AP amplitude alone.
- 2019The value of four-stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Ménière's disease on MRINeuroradiology; 61:421–429
MRI grading of endolymphatic hydrops; correlates with SP/AP area ratio on ECochG.
- 2019Auditory synaptopathy, auditory neuropathy, and cochlear implantationLaryngoscope Investigative Otolaryngology; 4(4):429–440
Modern review linking ANSD genetics (OTOF, OPA1, others) to CI outcomes — presynaptic responds well, postsynaptic less reliably.
- 2019Primary neural degeneration in the human cochlea: evidence for hidden hearing loss in the aging earNeuroscience; 407:8–20
Human temporal bone evidence — age-related cochlear synapse loss with intact hair cells; direct anatomical evidence for hidden hearing loss in humans.
- 2019Clinical practice guideline: sudden hearing loss (update)Otolaryngology–Head and Neck Surgery; 161(1_suppl):S1–S45
2019 AAO-HNSF SSNHL guideline update — MRI or ABR for retrocochlear workup, no role for routine ECochG in SSNHL.
- 2019Third window syndrome: surgical management of cochlea-facial nerve dehiscenceFrontiers in Neurology; 10:1281
Newer third-window entities beyond SSCD — overlapping ECochG findings.
- 2017Ups and downs in 75 years of electrocochleographyFrontiers in Systems Neuroscience; 11:2
Historical and physiological overview of ECochG.
- 2017Editorial: New advances in electrocochleography for clinical and basic investigationFrontiers in Neuroscience; 11:445
Modern overview of generators, methods, and applications; canonical for technique section.
- 2017Normative data for TM electrocochleography measuresJournal of Otology; 12(2):68–73
Modern normative SP/AP amplitude ratio, area ratio, and rarefaction–condensation latency difference in 200 normal-hearing ears.
- 2017Tone burst electrocochleography for the diagnosis of clinically certain Ménière's diseaseFrontiers in Neuroscience; 11:301
Demonstrates higher sensitivity/specificity of tone-burst SP vs click SP/AP ratio.
- 2017The clinical uses of electrocochleographyFrontiers in Neuroscience; 11:274
Gibson's perspective on why click SP/AP underperforms; tone-burst SP more reliable for hydrops.
- 2017Spectrum of third-window abnormalities: semicircular canal dehiscence and beyondAmerican Journal of Neuroradiology; 38(1):2–9
Imaging and clinical spectrum of third-window conditions beyond SCD.
- 2017Intraoperative electrocochleographic characteristics of auditory neuropathy spectrum disorder in cochlear implant subjectsFrontiers in Neuroscience; 11:416
Intraoperative ECochG-TR characterises residual cochlear function in ANSD CI candidates.
- 2017Noise-induced cochlear synaptopathy in rhesus monkeys (Macaca mulatta)Hearing Research; 353:213–223
Macaque model — synapse loss observed but required higher noise levels than rodent models; species comparison important for translation.
- 2017Tinnitus with a normal audiogram: relation to noise exposure but no evidence for cochlear synaptopathyHearing Research; 344:265–274
Notable failure to replicate — found no SP/AP or ABR wave I evidence for synaptopathy in tinnitus + noise exposure cohort.
- 2017Effects of noise exposure on young adults with normal audiograms I: electrophysiologyHearing Research; 344:68–81
Manchester cohort — no significant ABR wave I, SP/AP, or EFR differences attributable to noise exposure in young adults with normal audiograms.
- 2016Fast click rate electrocochleography and auditory brainstem response in normal-hearing adults using continuous loop averaging deconvolutionEar and Hearing; 37(6):e361–e369
Rate-effect normative data: AP/wave-I amplitude decreases and latency increases from 7.1 to ~500 clicks/s.
- 2016Intraoperative neuromonitoring for superior semicircular canal dehiscence and hearing outcomesOtology & Neurotology; 37(1):e22–e30
76.5% of SCD patients have elevated SP/AP; median 0.62 (matching Adams). Interpretation: shunt reduces perilymph pressure rather than raising endolymph pressure ('hydrops ex vacuo').
- 2016Toward a differential diagnosis of hidden hearing loss in humansPLOS One; 11(9):e0162726
SP/AP ratio elevated in human cochlear synaptopathy — first human evidence.
- 2015Diagnostic criteria for Ménière's diseaseJournal of Vestibular Research; 25(1):1–7
2015 Bárány Society consensus diagnostic criteria for Ménière's disease.
- 2015Electrocochleographic findings in superior canal dehiscence syndromeOtology & Neurotology; 36(1):126–134
92.3% sens, 94% spec at SP/AP cutoff of 0.34 for SCD diagnosis.
- 2015Electrocochleographic findings in superior canal dehiscence syndromeHearing Research; 323:61–67
Korean cohort confirming Adams 2015 cutoff (0.34) with 92.3% sens, 94% spec; 5/13 surgical patients showed SP/AP normalisation after plugging.
- 2015Auditory function in normal-hearing, noise-exposed human earsEar and Hearing; 36(2):172–184
Suprathreshold ABR/ECochG changes in noise-exposed normal-audiogram adults.
- 2015Cochlear response telemetry: intracochlear electrocochleography via cochlear implant neural response telemetry pilot study resultsOtology & Neurotology; 36(3):399–405
Demonstrated feasibility of recording ECochG via the CI's own back-telemetry amplifier — the enabling technology for modern intraoperative monitoring.
- 2014Integrating the active process of hair cells with cochlear functionNature Reviews Neuroscience; 15(9):600–614
Modern review of hair-cell mechanoelectrical transduction and the cochlear amplifier.
- 2014Cochlear neuropathy and the coding of supra-threshold soundFrontiers in Systems Neuroscience; 8:26
Theoretical framework — synaptopathy hypothesized to selectively impair suprathreshold and in-noise listening.
- 2014Intracochlear electrocochleography during cochlear implantationOtology & Neurotology; 35(8):1451–1457
Early intracochlear ECochG during CI surgery.
- 2014Electrophysiologic auditory testsHandbook of Clinical Neurology; 129:289–311
Comprehensive handbook chapter on ABR/ECochG generators, clinical applications, and intraoperative monitoring; covers ECochG persistence after auditory nerve section showing the distal AP generator anatomy.
- 2013A systematic review of electrocochleography in Ménière's disease diagnosisOtolaryngology–Head and Neck Surgery; 149(2_suppl):P116
Systematic review establishing 53–70% sensitivity, 80–90% specificity for click SP/AP ratio.
- 2013Near-dehiscence: clinical findings in patients with thin bone over the superior semicircular canalOtology & Neurotology; 34(8):1421–1428
Near-dehiscence — thin bone produces SCD-like ECochG even without overt defect.
- 2013Noise-induced cochlear neuropathy is selective for fibers with low spontaneous ratesJournal of Neurophysiology; 110(3):577–586
Demonstrated that synapse loss preferentially affects low- and medium-spontaneous-rate fibres — the ones crucial for suprathreshold and in-noise coding.
- 2012Electrocochleography during cochlear implantation for hearing preservationOtolaryngology–Head and Neck Surgery; 146(5):774–781
Surgical modification triggered by intraop CAP changes improved hearing preservation.
- 2012Perilymph fistula: fifty years of controversyISRN Otolaryngology; 2012:281248
Comprehensive review of PLF: definitions, history, diagnostic controversy, ECochG and other testing limitations.
- 2012Clinical practice guideline: sudden hearing lossOtolaryngology–Head and Neck Surgery; 146(3 suppl):S1–S35
AAO-HNSF guideline for SSNHL — contextualises ECochG use.
- 2010Click- and chirp-evoked human compound action potentialsJournal of the Acoustical Society of America; 127(5):2992–2996
Spectral and temporal comparison of clicks vs chirps for CAP recording.
- 2010Clinical utility of electrocochleography in the diagnosis and management of Ménière's disease: AOS and ANS membership survey dataOtology & Neurotology; 31(3):455–459
Survey of US otologists/neurotologists on real-world ECochG use in MD.
- 2010Endolymphatic hydrops: pathophysiology and experimental modelsOtolaryngologic Clinics of North America; 43(5):971–983
Definitive review of hydrops biology — Reissner membrane distension, compliance variation, basilar membrane operating point.
- 2010Electrocochleography: a review of recording approaches, clinical applications, and new findings in adults and childrenJournal of the American Academy of Audiology; 21(3):145–152
Comprehensive Ferraro review — useful for cross-cutting clinical sections.
- 2009Input and output compensation for the cochlear traveling wave delay in wide-band ABR recordings: implications for small acoustic tumor detectionJournal of the American Academy of Audiology; 20(2):99–108
Stacked ABR (output) vs chirp (input) compensation for cochlear traveling-wave delay.
- 2009Reversible electrocochleographic abnormalities in superior canal dehiscenceOtology & Neurotology; 30(1):79–86
First demonstration of elevated SP/AP ratio in SCD and its reversal after plugging.
- 2009Adding insult to injury: cochlear nerve degeneration after 'temporary' noise-induced hearing lossJournal of Neuroscience; 29(45):14077–14085
Animal foundation of cochlear synaptopathy — synaptic loss without threshold shift.
- 2009Cochlin-tomoprotein: a novel perilymph-specific protein and a potential marker for the diagnosis of perilymphatic fistulaAudiology and Neurotology; 14(5):338–344
Cochlin-tomoprotein (CTP) detection in middle ear lavage — modern biochemical alternative to functional PLF testing.
- 2009The role of magnetic resonance imaging in the identification of suspected acoustic neuroma: a systematic review of clinical and cost effectiveness and natural historyHealth Technology Assessment; 13(18):1–154
Systematic review establishing gadolinium-enhanced MRI as the diagnostic gold standard for vestibular schwannoma.
- 2008Cochlear outer hair cell motilityPhysiological Reviews; 88(1):173–210
OHC electromotility / prestin — the basis for the cochlear microphonic.
- 2008The endocochlear potential depends on two K+ diffusion potentials and an electrical barrier in the stria vascularis of the inner earPNAS; 105(4):1351–1356
Biophysical mechanism of the +80 mV endocochlear potential.
- 2008Frequency-specific electrocochleography indicates that presynaptic and postsynaptic mechanisms of auditory neuropathy existEar and Hearing; 29(3):314–325
ECochG can distinguish presynaptic from postsynaptic ANSD — major teaching point.
- 2008Auditory neuropathy (handbook chapter)Handbook of Clinical Neurology; 129:495–508
Starr's later synthesis — recommends 'presynaptic AN' vs 'postsynaptic AN' as the most informative subdivision; etiologies span IHC ribbon synapse, dendrites, demyelination, and axonal loss.
- 2007Auditory steady-state responses to chirp stimuli based on cochlear traveling wave delayJournal of the Acoustical Society of America; 122(5):2772–2785
Origin of the CE-Chirp — compensates cochlear traveling-wave dispersion at the stimulus input.
- 2006Supporting sensory transduction: cochlear fluid homeostasis and the endocochlear potentialJournal of Physiology; 576(1):11–21
Stria vascularis, K+ recycling, +80 mV endocochlear potential — driver of MET.
- 2006OTOF mutations revealed by genetic analysis of hearing loss families including a potential temperature-sensitive auditory neuropathy alleleJournal of Medical Genetics; 43(7):576–581
OTOF/otoferlin mutations as the prototypical presynaptic ANSD — IHC ribbon synapse failure with preserved hair cell function.
- 2003Utility of area curve ratio electrocochleography in early Ménière diseaseArchives of Otolaryngology–Head & Neck Surgery; 129(5):547–551
Area ratio improves sensitivity in early/possible MD vs amplitude ratio.
- 2003Subspecialty review: electrocochleography in the retrocochlear assessmentClinical Otolaryngology; 28(3):187–193
Background on ECochG vs ABR in retrocochlear pathology.
- 2002Electrocochleography in auditory neuropathyHearing Research; 170(1-2):32–47
ECochG in ANSD: present CM/SP, abnormal CAP.
- 2000Clinical electrocochleography: overview of theories, techniques and applicationsAudiologyOnline (Article 1275)
Practical click vs tone burst protocols, including 2 kHz toneburst 2 ms rise/fall 10 ms plateau alternating polarity at 80–90 dB HL.
- 1999SP/AP area ratio in the diagnosis of Ménière's diseaseAmerican Journal of Audiology; 8(1):21–28
Foundational paper introducing the SP/AP area ratio.
- 1998Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canalArchives of Otolaryngology–Head & Neck Surgery; 124(3):249–258
First clinical description of SCD syndrome.
- 1998Reversing click polarity may uncover auditory neuropathy in infantsEar and Hearing; 19(1):37–47
Polarity-reversal protocol for diagnosing ANSD — the foundation of CM authenticity testing.
- 1997Cochlear potentials in clinical audiologyAudiology and Neurotology; 2(5):241–256
Classic review of clinical ECochG technique and interpretation.
- 1996Auditory neuropathyBrain; 119(3):741–753
Original description of auditory neuropathy as a clinical entity.
- 1995Guidelines for the diagnosis and evaluation of therapy in Menière's diseaseOtolaryngology–Head and Neck Surgery; 113(3):181–185
Pre-Bárány AAO-HNS diagnostic criteria — still cited frequently for the 4-stage hearing-loss classification.
- 1993Atypical hearing loss in acoustic neuroma patientsLaryngoscope; 103(4 Pt 1):437–441
Diverse audiometric presentations of vestibular schwannoma — pure-tone loss may be minimal even with substantial tumour.
- 1992Electrocochleography with postural changes in perilymphatic fistulaOtolaryngology–Head and Neck Surgery; 106(2):152–159
Classical use of ECochG with postural manoeuvres for fistula.
- 1992Electrocochleography in the diagnosis of perilymphatic fistula: intraoperative observations and assessment of a new diagnostic office procedureAmerican Journal of Otology; 13(2):146–151
Gibson's pressure-change ECochG technique for perilymph fistula.
- 1989Comparison of tympanic membrane to promontory electrode recordings of electrocochleographic responses in patients with Meniere's diseaseOtolaryngology–Head and Neck Surgery; 100(6):546–552
Classical comparison of TT vs TM electrode placements.
- 1989A comparative study of primary electrodes used in extratympanic electrocochleographySeminars in Hearing; 10(1):71–82
Foundational comparison of TM, TT, and tiptrode electrodes and their effect on wave-I detectability — relevant to combined ECochG-ABR protocols.
- 1981Auditory evoked potentials from the human cochlea and brainstemJournal of Otolaryngology Supplement; 9:1–41
Canonical normative latency–intensity function for click ABR wave I / ECochG N1.
- 1981Brain-stem auditory-evoked potentials recorded directly from human brain-stem and thalamusBrain; 104(4):841–859
Direct brainstem recording confirming N1/wave-I origin in the distal auditory nerve.
- 1969Innervation patterns in the organ of Corti of the catActa Oto-Laryngologica; 67(2):239–254
Type I (95%) vs Type II (5%) afferent innervation pattern in mammalian cochlea.
- 1967Experimental blockage of the endolymphatic duct and sac and its effect on the inner ear of the guinea pigAnnals of Otology, Rhinology & Laryngology; 76(3):664–687
Classic guinea-pig model of endolymphatic hydrops via duct ablation; experimental basis for most subsequent work.
- 1965A model for transducer action in the cochleaCold Spring Harbor Symposia on Quantitative Biology; 30:181–190
Davis battery model — endocochlear potential as the bias supply for hair-cell transduction.
- 1960Experiments in hearingMcGraw-Hill (New York)
Classic — traveling wave on the basilar membrane, tonotopic organisation.
- 1954Exploration of cochlear potentials in guinea pig with a microelectrodeJournal of the Acoustical Society of America; 26:765–773
First description of the summating potential.
- 1935Studies in the mechanism of the Wever and Bray effectActa Oto-Laryngologica; 22:477–486
First human ECochG-style recording — cochlear microphonic from the promontory.