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Intraoperative facial nerve monitoring has been accepted as a valuable adjunctive modality to be employed in a variety of neurotologic and skull base surgical procedures. However, the role that electrical or mechanical stimulation assessment plays in chronic ear surgery is less well defined, especially in a residency training program. In this study, 250 consecutive operative cases of chronic otitis media, with and without cholesteatoma were monitored with the Xomed-Treace Nerve Integrity Monitor, NIM-2 system. Data regarding electrophysiologic monitoring parameters; electromechanical artifact, including system failure; and surgical outcome were analyzed. Although not a substitute for anatomic identification of the facial nerve, intraoperative monitoring provides an additional technique to optimize resident surgical education.

A patient with "far-advanced" otosclerosis with a profound bilateral hearing loss was evaluated for cochlear reserve using transtympanic electrocochleography (ECoG) and promontory stimulation. Results indicated that both ECoG and promontory responses were present, indicating that cochlear function was present bilaterally. A stapedectomy resulted in closure of the air-bone gap. Postoperative hearing yielded excellent aided responses compared to no measurable preoperative hearing aid benefit. This case serves to demonstrate the value of evaluating cochlear function using these electrophysiologic techniques.