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Radomska K, Mielnik M, Gostyński M, Dzięciołowska-Baran E. Objective evaluation, using computed tomography, of round window access for cochlear implantation. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08873-w. [PMID: 39098956 DOI: 10.1007/s00405-024-08873-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The aim of this study was to determine optimal radiological parameters for assessment of the round window approach in cochlear implantation surgery. MATERIALS AND METHODS Patients undergoing cochlear implantation at the Department of Otolaryngology in Szczecin, between 2015 and 2022 inclusive, were eligible for the study. Radiological assessments were performed according to eight parameters (seven proposed in the literature) and visibility clinical assessments were made intra-operatively on a scale of 1 to 5 (1 - not visible, 5 - fully visible). Visibility assessments of the round window niche (RWN) and round window membrane (RWM) allowed the difference (RWN minus RWM) to be used as a clinical assessment of the size of the overhang over the round window. RESULTS Computed tomography images of 57 ears from 52 patients were analyzed in terms of round window access. The study group included 26 females and 26 males, ranging in age from 1 year to 80 years, with a median age of 41 years. In clinical assessment, round window visibility was rated as 5, after removal of the bone overhang, in 69% of patients. Cochlear access through the round window was achieved in 39 (68%) cases, extended access through the round window in 13 (23%) cases and cochleostomy was performed in 5 (9%) cases. Statistically significant ordinal correlations with round-window access were found using one parameter from the literature (Chen_Angle) and from our proposal (RWM_prediction). From parameters describing the bone overhang of the round window, positive correlations (using Kendall rank tests) were found using parameters from the literature (Sarafraz_OH and Mehanna_OH). CONCLUSIONS Radiological measurements describing access to the round window which determine the angle based on the anatomy of the posterior wall of the auditory canal and the position of the facial nerve were found to be of the highest value. CLINICAL RELEVANCE STATEMENT In the future, the use of algorithms for computed tomography evaluation and robot-assisted surgery will require parameters for assessing round window access, for surgery planning and choice of electrode. The parameters proposed by various authors are summarized, allowing researchers to assess their usefulness in further clinical practice.
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Affiliation(s)
- Katarzyna Radomska
- Department of Otolaryngology, Pomeranian University of Medicine, Unii Lubelskiej 1, Szczecin, 71-252, Poland
| | - Michał Mielnik
- Department of Otolaryngology, Pomeranian University of Medicine, Unii Lubelskiej 1, Szczecin, 71-252, Poland.
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Reynard P, Ortega-Solís J, Tronche S, Darrouzet V, Thai-Van H. Guidelines of the French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) for vestibular rehabilitation in children with vestibular dysfunction. A systematic review. Arch Pediatr 2024; 31:217-223. [PMID: 38697883 DOI: 10.1016/j.arcped.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue, particularly during tasks requiring postural control. The aim of these recommendations is to establish guidelines for vestibular rehabilitation (VR) in children with vestibular impairment. MATERIAL AND METHODS The guidelines were developed based on a systematic review of the international literature, validated by a multidisciplinary group of French-speaking otorhinolaryngologists, scientists, and physiotherapists. They are classified as grade A, B, C, or expert opinion according to a decreasing level of scientific evidence. RESULTS A PubMed search of studies published between January 1990 and December 2021 was carried out using the keywords "vestibular," "rehabilitation," and "children". After filtering and reviewing the articles, a total of 10 publications were included to establish the recommendations. CONCLUSION It is recommended that a vestibular assessment be carried out before VR, including a study of vestibulo-ocular reflex, otolithic function, and postural control. In cases of vestibular dysfunction, physiotherapy treatment is recommended from an early age to train different aspects of postural control, including anticipatory and reactive postural adjustments. VR adapted to the pediatric population is recommended for children whose vestibular dysfunction leads to functional disorders or symptoms of vertigo for those who have suffered head trauma. It is recommended that children with bilateral vestibular impairment be treated using gaze stabilization exercises for adaptation and substitution. Optokinetic stimulation and virtual reality are not recommended for children and young adolescents.
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Affiliation(s)
- Pierre Reynard
- Department of Audiology and Otoneurological Evaluation, Hôpital Édouard Herriot & Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69003 Lyon, France; Center for Research and Innovation in Human Audiology (CERIAH), Institut de l'Audition, Institut Pasteur, Inserm, Paris, France; French Society of Vestibular Physiotherapy (SFKV), 31000 Toulouse, France.
| | - José Ortega-Solís
- Department of Audiology and Otoneurological Evaluation, Hôpital Édouard Herriot & Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69003 Lyon, France; French Society of Vestibular Physiotherapy (SFKV), 31000 Toulouse, France
| | - Sophie Tronche
- French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), 75116 Paris, France
| | - Vincent Darrouzet
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Hôpital Édouard Herriot & Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69003 Lyon, France; Center for Research and Innovation in Human Audiology (CERIAH), Institut de l'Audition, Institut Pasteur, Inserm, Paris, France; Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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Weiss N. [Cochlear implantation - Adverse effects on the cochlea and the vestibular organ]. Laryngorhinootologie 2023; 102:381-389. [PMID: 37141880 DOI: 10.1055/a-1961-5815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cochlear implantation is the treatment of choice for patients with profound hearing loss and deafness. At the same time, inserting a cochlear implant (CI) leaves damage to the inner ear. The preservation of inner ear structure and function has become a central issue in CI surgery. The reasons for this are i) electroacoustic stimulation (EAS), i.e., the option of joint stimulation by a hearing aid and a CI; ii) an improved audiologic outcome in electric-only stimulation; iii) the preservation of structures and residual hearing for potential future therapy options; and iv) the avoidance of side effects, such as vertigo. The exact mechanisms that determine the extent of damage to the inner ear and which factors contribute to preservation of residual hearing are not yet fully understood. In addition to the surgical technique, electrode selection may play a role. This article provides an overview of what is known about the direct and indirect adverse effects of cochlear implantation on the inner ear, of the methods available to monitor inner ear function during cochlear implantation, and of the focus of future research on preservation of inner ear structure and function.
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Wu Q, Zhang Q, Xiao Q, Zhang Y, Chen Z, Liu S, Wang X, Xu Y, Xu XD, Lv J, Jin Y, Yang J, Zhang Q. Vestibular dysfunction in pediatric patients with cochlear implantation: A systematic review and meta-analysis. Front Neurol 2022; 13:996580. [PMID: 36324374 PMCID: PMC9618669 DOI: 10.3389/fneur.2022.996580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Vestibular dysfunction may delay the achievement of balance and perception milestones in pediatric patients after cochlear implantation (CIM). Methods A strategic literature search was done following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed, Medline, Embase, Web of Science, and Cochrane Library databases from inception to July 2022. Studies were included on the otoliths, semicircular canals, and balance function changes in children after CIM. Two reviewers independently assessed the level of evidence, methodological limitations, risk of bias, and characteristics of the cases. Matched pre- and postoperative vestibular functional test data, including ocular and cervical vestibular-evoked myogenic potential (oVEMP and cVEMP), caloric test, video head impulse test (vHIT), and Bruininks-Oseretsky Test 2 (BOT-2), were used to calculate the relative risk of vestibular disorders. Subgroup analyses were performed according to surgical approach, CIM device status, and etiology. Results Twenty studies that met the inclusion criteria were selected for the meta-analysis. We observed significant vestibular dysfunction in pediatric patients with CIM. The results showed a statistically significant increase in abnormal cVEMP response (RR = 2.20, 95% CI = 1.87, 2.58, P < 0.0001), abnormal oVEMP response (RR = 2.10, 95% CI = 1.50, 2.94, P < 0.0001), and abnormal caloric test results (RR = 1.62, 95% CI = 1.20, 2.19, P = 0.0018) after implantation. Statistically significant differences were not found in the vHIT test results of all three semicircular canals before and after the operation (P > 0.05). Regarding static and dynamic balance, we found significantly poorer BOT-2 scores in children with CIM than in the normal group (mean difference = −7.26, 95% CI = −10.82, −3.70, P < 0.0001). Conclusion The results showed that vestibular dysfunction might occur after CIM in pediatric patients. Some children experience difficulties with postural control and balance. Our results suggest that a comprehensive evaluation of vestibular function should be performed before and after CIM.
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Affiliation(s)
- Qiong Wu
- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
| | - Qin Zhang
- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
| | - Qianwen Xiao
- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
| | - Yuzhong Zhang
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Zichen Chen
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Shuyun Liu
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Xueyan Wang
- Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Yanbian University, Yanji, Jilin, China
| | - Yong Xu
- Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Xin-Da Xu
- Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Jingrong Lv
- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
| | - Yulian Jin
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
- Diagnosis and Treatment Center of Hearing Impairment and Vertigo, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Yulian Jin
| | - Jun Yang
- Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
- Jun Yang
| | - Qing Zhang
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China
- Diagnosis and Treatment Center of Hearing Impairment and Vertigo, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Qing Zhang
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Kunelskaya NL, Baybakova EV, Garov EV, Chugunova MA, Butaev FF. [Effects of cochlear implantation on vestibular function]. Vestn Otorinolaringol 2021; 86:92-98. [PMID: 34964337 DOI: 10.17116/otorino20218606192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The literature review is devoted to the effects arising from the effect of a cochlear implant on the vestibular system. Due to the pronounced anatomical proximity and physiological interaction of vestibular receptors with the cochlea, the installation of a cochlear implant and its electrical activity are associated with an effect on the vestibular system. The analysis of the works of foreign and domestic researchers who carried out monitoring of vestibular function in patients after cochlear implantation using modern objective methods was carried out.
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Affiliation(s)
- N L Kunelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Baybakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - F F Butaev
- Pirogov Russian National Research Medical University, Moscow, Russia
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Merchant GR, Schulz KM, Patterson JN, Fitzpatrick D, Janky KL. Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance. Ear Hear 2021; 41:1111-1124. [PMID: 32032225 PMCID: PMC7392788 DOI: 10.1097/aud.0000000000000831] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. DESIGN Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. RESULTS All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. CONCLUSIONS Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.
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Affiliation(s)
| | - Kyli M. Schulz
- Boys Town National Research Hospital, Omaha, NE 68131
- The University of Texas at Austin, TX 78712
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Riemann C, Sudhoff H, Todt I. Influence of Intracochlear Air on Experimental Pressure Measurements. Audiol Neurootol 2021; 27:34-39. [PMID: 34130281 DOI: 10.1159/000516142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Intracochlear pressure changes have been assumed to play a central role in hearing preservation during cochlear implantation. The pressure in different settings has been evaluated (temporal bones vs. cochlea models) and was found to have advantages and disadvantages. Experimentally, problems have been discussed to influence the results substantially. OBJECTIVE The aim of the present study was to evaluate the effect of intracochlear air on the measurements in a cochlea model by using a fiber optic pressure sensor. MATERIALS AND METHODS The experiments were performed in an uncurled 3D printed full cochlea model. A microfiber-optic pressure sensor was inserted, and intracochlear pressures were evaluated under 3 conditions: (1) cochlea model filled to 100% with fluid, (2) cochlea model filled with air, and (3) cochlea model filled to approximately 50% with fluid. Since the cochlea model is transparent, a direct visualization of air under the microscope was possible when performing the insertions. RESULTS In the first condition, the mean intracochlear pressure at the end of the insertion was 0.044 psi (SD 0.012, 95% CI). In the second setting, the results were similar. In the last scenario, with 50% filling, the mean intracochlear pressure was statistically significantly different with a mean value of 0.074 psi (SD 0.013, 95% CI) (p < 0.0044, ANOVA). Besides this, in the last condition with 50% fluid, a plateau was formed when the fiber optic reached the air portion. CONCLUSION The results obtained in a 3D printed full cochlea model show the importance of a direct evaluation of air inside the experimental setting. The exclusion of intracochlear air should be an important factor for the choice of the model for intracochlear pressure measurement (temporal bone vs. cochlea model).
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Affiliation(s)
- Conrad Riemann
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Campus Mitte, Klinikum Bielefeld, Bielefeld, Germany
| | - Holger Sudhoff
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Campus Mitte, Klinikum Bielefeld, Bielefeld, Germany
| | - Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Campus Mitte, Klinikum Bielefeld, Bielefeld, Germany
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Weinmann C, Baumann U, Leinung M, Stöver T, Helbig S. Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle. Front Neurol 2021; 12:663386. [PMID: 34177768 PMCID: PMC8226011 DOI: 10.3389/fneur.2021.663386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Vertigo is a common side effect of cochlear implant (CI) treatment. This prospective study examines the incidence of postoperative vertigo over time and aims to analyze influencing factors such as electrode design and insertion angle (IA). Study Design and Setting: This is a prospective study which has been conducted at a tertiary referral center (academic hospital). Patients: A total of 29 adults were enrolled and received a unilateral CI using one of six different electrode carriers, which were categorized into "structure-preserving" (I), "potentially structure-preserving" (II), and "not structure-preserving" (III). Intervention: Subjective vertigo was assessed by questionnaires at five different time-points before up to 6 months after surgery. The participants were divided into four groups depending on the time of the presence of vertigo before and after surgery. Preoperatively and at 6 months postoperatively, a comprehensive vertigo diagnosis consisting of Romberg test, Unterberger test, subjective visual vertical, optokinetic test, video head impulse test, and caloric irrigation test was performed. In addition, the IA was determined, and the patients were divided in two groups (<430°; ≥430°). Main Outcome Measures: The incidence of vertigo after CI surgery (group 1) was reported, as well as the correlation of subjective vertigo with electrode array categories (I-III) and IA. Results: Among the participants, 45.8% experienced new vertigo after implantation. Based on the questionnaire data, a vestibular origin was suspected in 72.7%. The results did not show a significant correlation with subjective vertigo for any of the performed tests. In group 1 with postoperative vertigo, 18% of patients showed conspicuous results in a quantitative analysis of caloric irrigation test despite the fact that the category I or II electrodes were implanted, which are suitable for structure preservation. Average IA was 404° for the overall group and 409° for group 1. There was no statistically significant correlation between IA and perceived vertigo. Conclusions: Though vertigo after CI surgery seems to be a common complication, the test battery used here could not objectify the symptoms. Further studies should clarify whether this is due to the multifactorial cause of vertigo or to the lack of sensitivity of the tests currently in use. The proof of reduced probability for vertigo when using atraumatic electrode carrier was not successful, nor was the proof of a negative influence of the insertion depth.
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Affiliation(s)
- Charlotte Weinmann
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Uwe Baumann
- Department of Audiological Acoustics, Goethe-University Frankfurt, Frankfurt, Germany
| | - Martin Leinung
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Timo Stöver
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
| | - Silke Helbig
- Department of Otorhinolaryngology, Goethe-University Frankfurt, Frankfurt, Germany
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Koyama H, Kashio A, Fujimoto C, Uranaka T, Matsumoto Y, Kamogashira T, Kinoshita M, Iwasaki S, Yamasoba T. Alteration of Vestibular Function in Pediatric Cochlear Implant Recipients. Front Neurol 2021; 12:661302. [PMID: 34122305 PMCID: PMC8193854 DOI: 10.3389/fneur.2021.661302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Vestibular dysfunction is a complication of cochlear implantation (CI). Reports on the evaluation of vestibular function before and after CI are limited, especially in children. We investigated the effect of CI on vestibular function in pediatric patients. Patients and Methods: We routinely evaluated vestibular function before but not immediately after CI. Therefore, patients who underwent sequential bilateral CI were enrolled in this study. Seventy-three children who underwent sequential CI from 2003 to 2020 at our hospital were included. Since the vestibular function of the first implanted ear was evaluated before the second surgery for the contralateral ear, post-CI evaluation timing differed among the cases. The evaluation included a caloric test, a cervical vestibular-evoked myogenic potential (cVEMP) test, and a damped rotation test. The objective variables included the results of these tests, and the explanatory variables included the age at surgery, cause of hearing loss, electrode type, and surgical approach used. The associations of these tests were analyzed. Results: cVEMP was the most affected after CI (36.1%), followed by the caloric test (23.6%), and damped rotation test (7.8%). Cochleostomy was significantly more harmful than a round window (RW) approach or an extended RW approach based on the results of the caloric test (p = 0.035) and damped rotation test (p = 0.029). Perimodiolar electrodes affected the caloric test results greater than straight electrodes (p = 0.041). There were no significant associations among these tests' results. Conclusions: Minimally invasive surgery in children using a round window approach or an extended round window approach with straight electrodes is desirable to preserve vestibular function after CI.
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Affiliation(s)
- Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Kashio
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Uranaka
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sosna-Duranowska M, Tacikowska G, Gos E, Krupa A, Skarzynski PH, Skarzynski H. Vestibular Function After Cochlear Implantation in Partial Deafness Treatment. Front Neurol 2021; 12:667055. [PMID: 34093414 PMCID: PMC8175845 DOI: 10.3389/fneur.2021.667055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Cochlear implantation is a fully accepted method of treating individuals with profound hearing loss. Since the indications for cochlear implantation have broadened and include patients with low-frequency residual hearing, single-sided deafness, or an already implanted ear (meaning bilateral cochlear implantation), the emphasis now needs to be on vestibular protection. Materials and Methods: The research group was made up of 107 patients operated on in the otorhinolaryngosurgery department: 59 females and 48 males, aged 10.4–80.2 years (M = 44.4; SD = 18.4) with hearing loss lasting from 1.4 to 56 years (M = 22.7; SD = 13.5). The patients underwent cVEMP, oVEMP, a caloric test, and vHIT assessment preoperatively, and, postoperatively, cVEMP and oVEMP at 1–3 months and a caloric test and vHIT at 4–6 months. Results: After cochlear implantation, there was postoperative loss of cVEMP in 19.2% of the patients, oVEMP in 17.4%, reduction of caloric response in 11.6%, and postoperative destruction of the lateral, anterior, and posterior semicircular canal as measured with vHIT in 7.1, 3.9, and 4% respectively. Conclusions: Hearing preservation techniques in cochlear implantation are connected with vestibular protection, but the risk of vestibular damage in never totally eliminated. The vestibular preservation is associated with hearing preservation and the relation is statistically significant. Informed consent for cochlear implantation must include information about possible vestibular damage. Since the risk of vestibular damage is appreciable, preoperative otoneurological diagnostics need to be conducted in the following situations: qualification for a second implant, after otosurgery (especially if the opposite ear is to be implanted), having a history of vestibular complaints, and when there are no strict audiological or anatomical indications on which side to operate.
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Affiliation(s)
| | | | - Elzbieta Gos
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Anna Krupa
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland.,Medical University of Warsaw, Warsaw, Poland
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11
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Guan R, Wang Y, Wu S, Zhang B, Sun J, Guo X, Sun J. Vestibular Function in Children and Adults Before and After Unilateral or Sequential Bilateral Cochlear Implantation. Front Neurol 2021; 12:675502. [PMID: 33995266 PMCID: PMC8116579 DOI: 10.3389/fneur.2021.675502] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Cochlear implantation (CI) helps patients with severe or profound sensorineural hearing loss (SNHL) restore hearing and speech abilities. However, some patients exhibit abnormal vestibular functions with symptoms such as dizziness or balance disorders, after CI. Whether age at CI and CI approach (unilateral or sequential bilateral) affect vestibular functions in users with cochlear implants remains unclear. Objectives: To investigate the vestibular functions in children and adults before and after unilateral or sequential bilateral CI. Materials and Methods: Thirty-seven patients with severe or profound SNHL who were candidates for a first- or second-side CI were divided into three groups: first-side CI-implanted adults (≥18 years), first-side CI-implanted children (6–17 years), and second-side CI-implanted children (6–17 years). All cases were implanted with the round window approach to minimize damage to the intra-cochlear structures. The caloric test, vestibular evoked myogenic potential (VEMP) test, video head impulse test (vHIT), Dizziness Handicap Inventory (DHI), Pediatric Vestibular Symptom Questionnaire (PVSQ), and audiometric tests were performed before and 1 month after CI. Results: The abnormal rates of caloric test and VEMP test after CI in the first-side CI-implanted adults and children significantly increased compared with those before CI. The pre-implantation VEMP test showed significantly higher abnormal rates between first- and second-side CI-implanted children. No other significant differences of abnormal rates between first- and second-side CI-implanted children or between first-side CI-implanted adults and children were found. In second-side CI-implanted children, PVSQ scores significantly increased at day 3 post-implantation but decreased at day 30. Conclusion: CI has a negative effect on the results of caloric and VEMP tests, but not on vHIT, indicating that the otolith and low-frequency semicircular canal (SCC) are more vulnerable to damage from CI. The alterations of vestibular functions resulting from CI surgery may be independent of age at CI and CI approach (unilateral or sequential bilateral). Long-term impacts on the vestibular function from CI surgery, as well as the chronic electrical stimulation to the cochlea, are still to be investigated.
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Affiliation(s)
- Ruirui Guan
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yanqi Wang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Sasa Wu
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bo Zhang
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jingwu Sun
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiaotao Guo
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jiaqiang Sun
- Department of Otolaryngology Head and Neck Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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12
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Tsukada K, Usami SI. Vestibular Preservation After Cochlear Implantation Using the Round Window Approach. Front Neurol 2021; 12:656592. [PMID: 33986720 PMCID: PMC8110830 DOI: 10.3389/fneur.2021.656592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique. Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria). Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA. Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.
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Affiliation(s)
- Keita Tsukada
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Usami
- Department of Otolaryngology, Shinshu University School of Medicine, Matsumoto, Japan.,Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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13
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Wang R, Zhang D, Luo J, Chao X, Xu J, Liu X, Fan Z, Wang H, Xu L. Influence of Cochlear Implantation on Vestibular Function in Children With an Enlarged Vestibular Aqueduct. Front Neurol 2021; 12:663123. [PMID: 33967946 PMCID: PMC8099028 DOI: 10.3389/fneur.2021.663123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cochlear implantation (CI) is becoming increasingly used in the rehabilitation of hearing-impaired patients. Children with an enlarged vestibular aqueduct (EVA) need CI for severe or profound hearing loss, with excellent outcomes in hearing rehabilitation. However, vestibular function influenced by CI in children with EVA has not been clarified. We compared the characteristics of vestibular function in implanted children with EVA and those with a normal cochlea. Methods: In this retrospective case-control study, 16 children with large vestibular aqueduct syndrome (LVAS) and 16 children with a normal cochlea were recruited as the Study and Control Group, respectively. All children (mean age, 10.3 ± 4.4 years) had bilateral profound sensorineural hearing loss (SNHL) and normal pre-operative vestibular functions and underwent unilateral CI. Otolith and canal functions were assessed before CI and 12 months thereafter. Cervical vestibular-evoked myogenic potential (cVEMP), ocular vestibular-evoked myogenic potential (oVEMP), and video head impulse test (vHIT) were evaluated. Results: Full insertion of the electrode array was achieved in all the cases. Preoperatively, no significant differences in parameters in cVEMP between the Study and Control Group were revealed (p > 0.05). In pre-operative oVEMP, shorter N1 latencies (p = 0.012), shorter P1 latencies (p = 0.01), and higher amplitudes (p = 0.001) were found in the Study than in the Control Group. The Study Group had shorter P1 latency in cVEMP (p = 0.033), and had lower amplitude in oVEMP after implantation (p = 0.03). Statistically significant differences were not found in VOR gains of all three semicircular canals before and after surgery (p > 0.05). VEMP results revealed that the Control Group had significantly lower deterioration rates after CI (p < 0.05). The surgical approach and electrode array had no statistically significant influence on the VEMP results (p > 0.05). Conclusion: oVEMP parameters differed between children with EVA and children with a normal cochlea before surgery. Systematic evaluations before and after CI showed that otolith function was affected, but all three semicircular canals functions were essentially undamaged after implantation. In contrast to subjects with a normal cochlea, children with EVA are more likely to preserve their saccular and utricular functions after CI surgery. Possible mechanisms include less pressure-related damage, a reduced effect in terms of the air-bone gap (ABG), or more sensitivity to acoustic stimulation.
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Affiliation(s)
- Ruijie Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Daogong Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianfen Luo
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiuhua Chao
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiliang Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xianfeng Liu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhaomin Fan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Haibo Wang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Xu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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14
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Vestibular impairment in cochlear implanted children presenting enlarged vestibular aqueduct and enlarged endolymphatic sac. Int J Pediatr Otorhinolaryngol 2021; 141:110557. [PMID: 33341717 DOI: 10.1016/j.ijporl.2020.110557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/11/2020] [Accepted: 12/11/2020] [Indexed: 11/22/2022]
Abstract
UNLABELLED Enlarged vestibular aqueduct (EVA) is a common finding in tomodensitometry. When cranial MRI is performed, enlarged endolymphatic sac (EES) can also be found. Profound hearing loss is a common finding in these patients but a few studies have investigated vestibular function after cochlear implantation (CI) in EVA and EES patients. Our main objective was to find out whether in EVA children candidates to CI, a higher endolymphatic sac (ES) volume was predictive for higher rates of postsurgical vestibular complications. METHODS We retrospectively included EVA children who benefited from CI, during the last 2 years. Two groups were constituted according to the presence or not of a vestibular impairment (decrease in the VOR gain on the VHIT test on one of the semicircular canals and/or a loss of cVEMPs) 6 months after CI. Endolymphatic volume of both VA and ES was measured for each patient. RESULTS Fifteen patients were included. The mean endolymph volume was significantly higher in the impaired group (0.40 cm3 ± 0.23, range 0.08-0.70) than in the non-impaired group (0.11 cm3 ± 0.07, range 0.04-0.29; p = 0.029). Four children of the impaired group were followed during one year. At the end of vestibular rehabilitation, all children recovered a lateral canal function and a saccular function. CONCLUSION In EVA children, a combined EES appears to increase the risk of severe post CI vestibular impairment. To minimize this risk prior CI surgery, besides tomodensitometry, MRI measurement of the ES volume should be systematically performed.
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15
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Long-Term Lateral Semicircular Canal Function in Children with Cochlear Implants: Results of Video Head Impulse Test. Eur J Investig Health Psychol Educ 2021; 11:12-19. [PMID: 34542446 PMCID: PMC8314328 DOI: 10.3390/ejihpe11010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 11/22/2022] Open
Abstract
In children with profound deafness, bilateral cochlear implant (CI) is an effective, established procedure. However, its safety on vestibular function has recently been debated. The goal of this study is to evaluate the long-term lateral semicircular canal high-frequency vestibulo-oculomotor reflex (LSC HF VOR) in children with CI by video head impulse testing (vHIT). This is a cross-sectional study assessing a cohort of children who received either a unilateral (12) or a bilateral (12) cochlear implant (CI), compared with a control group of 12 normal-hearing children. No significant LSC HF VOR gain difference was found between CI users and controls. In the unilaterally implanted group, the LSC HF VOR gain measured in the “CI-ON” condition was significantly higher than in the “CI-OFF” condition, both in the implanted and in the non-implanted ear. In the bilaterally implanted group, the difference between the two conditions was not significant. Our results do not show any impairment of LSC HF VOR function in children with CI compared to normal-hearing children in the long-term period. This suggests that both unilateral and simultaneous/sequential bilateral CI are procedures that do not impair HF LSC long-term function when analyzed by vHIT.
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16
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Yıldırım Gökay N, Yücel E. Bilateral cochlear implantation: an assessment of language sub-skills and phoneme recognition in school-aged children. Eur Arch Otorhinolaryngol 2020; 278:2093-2100. [PMID: 33231756 DOI: 10.1007/s00405-020-06493-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSES The main purpose of this study is to investigate whether there is a difference in phoneme recognition and school-age language skills in children with bilateral and unilateral cochlear implants (CI). The second aim of the study is to examine language-based skills in bilateral cochlear implanted children with the first implant, second implant and in the bilateral listening situations. METHOD 60 to 108-month-old children with similar demographic and audiological features were included. Of the 64 participants in total, 30 are bilateral cochlear implant users and 34 of them use unilateral cochlear implants. Turkish version of "Test of Language Development-Primary: Fourth edition (TOLD-P:4)" and "Phoneme Recognition Test (PRT)" were implemented for the evaluation of the language sub-components skills and auditory perception. In addition, the PRT test audio file was presented directly to the implant with connection cables via the fitting program methodologically. RESULTS Children with bilateral cochlear implants were more successful in all language-based skills than children with unilateral cochlear implants (p < 0.05). In the PRT test, the most successful scores were obtained in the bilateral listening conditions, the second with the experienced implant side, and the most unsuccessful scores in the listening conditions with second implant. CONCLUSION Bilateral cochlear implants are very useful in terms of language-based skills in children with severe/profound hearing loss. This can positively affect even the future academic and social skills of children.
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Affiliation(s)
- Nuriye Yıldırım Gökay
- Department of Audiology, Gazi University, Faculty of Health Sciences, 06745, Ankara, Turkey.
| | - Esra Yücel
- Department of Audiology, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
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17
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Veroul E, Sabban D, Blexmann L, Frachet B, Poncet-Wallet C, Mamelle E. Predictive factors of vertigo following cochlear implantation in adults. Eur Arch Otorhinolaryngol 2020; 278:3731-3741. [PMID: 33146776 DOI: 10.1007/s00405-020-06449-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/20/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The occurrence of vertigo after cochlear implantation surgery is one of the most common complications, and often transient. The purpose of this study was to evaluate the occurrence of vertigo after unilateral or bilateral cochlear implantation as well as to identify potential predictive factors. MATERIALS AND METHODS Patients who have undergone cochlear implantation and vestibular assessment pre- and postoperatively were included retrospectively. The presence of vertigo before and after surgery was noted. Postoperative vertigo duration was divided into 3 categories: immediate postoperative (less than 2 months), transient postoperative (between 2 months and 1 year), and persistent postoperative (greater than 1 year). Pre- and postoperative vestibular assessment results (caloric irrigation and VEMP tests) as well as patients' age, operated side, surgical technique for round window access, and characteristics of the electrode array were all analyzed as potential predictive factors of postoperative vertigo. RESULTS A total of 166 cochlear implants (137 patients) were included in the study, with a mean age of 57.5 ± 16.4 years. Of these, 36% developed postoperative vertigo, of which 19.3% was immediately postoperative. At 1 year postoperatively, 6 cases (3.6%) had persistent disabling vertigo, with 2 cases (1.2%) having no history of vertigo prior to cochlear implantation. Regarding caloric irrigation, 21% of the patients had a vestibular deficiency before surgery, and the same percentage had decreased vestibular responses. At 2 months after cochlear implantation, 31% of the patients exhibited an alteration in their vestibular test results, and 23.5% had experienced immediate postoperative vertigo. None of the factors studied (age, operated side, surgical technique, electrode array characteristics, and vestibular test alteration) correlated with the occurrence of short-term or long-term postoperative vertigo. CONCLUSION The occurrence of vertigo after cochlear implantation is difficult to predict by the healthcare team and may develop into an invalidating condition. Each vestibular examination performed routinely only evaluates a specific vestibular organ dysfunction. Therefore, combining several vestibular assessments tests before and after cochlear implantation can increase their sensitivity of predicting the occurrence and eventual persistence of this symptom.
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Affiliation(s)
- E Veroul
- Department of Otolaryngology, Otology, AP-HP, Sorbonne Université, Hôpital Rothschild, Auditory Implants, 5 rue Santerre, 75012, Paris, France
| | - D Sabban
- Department of Otolaryngology, Otology, AP-HP, Sorbonne Université, Hôpital Rothschild, Auditory Implants, 5 rue Santerre, 75012, Paris, France
| | - L Blexmann
- Department of Otolaryngology, Otology, AP-HP, Sorbonne Université, Hôpital Rothschild, Auditory Implants, 5 rue Santerre, 75012, Paris, France
| | - B Frachet
- Department of Otolaryngology, Otology, AP-HP, Sorbonne Université, Hôpital Rothschild, Auditory Implants, 5 rue Santerre, 75012, Paris, France
| | - C Poncet-Wallet
- Department of Otolaryngology, Otology, AP-HP, Sorbonne Université, Hôpital Rothschild, Auditory Implants, 5 rue Santerre, 75012, Paris, France
| | - E Mamelle
- Department of Otolaryngology, Otology, AP-HP, Sorbonne Université, Hôpital Rothschild, Auditory Implants, 5 rue Santerre, 75012, Paris, France.
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18
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The role of high-resolution Computer Tomography in prediction of the round window membrane visibility and the feasibility of the round window electrode insertion. Eur Arch Otorhinolaryngol 2020; 278:3283-3290. [PMID: 33058011 DOI: 10.1007/s00405-020-06417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this work is to assess the role of pre-operative high-resolution computerized tomography (HRCT) in prediction of the round window membrane (RWM) visibility and the feasibility of round window electrode insertion. MATERIALS AND METHODS Retrospective study on a series of 97 cases of cochlear implant (CI) who were implanted in tertiary referral centers. We reviewed HRCT of all cases, and we implicated two radiological measurements on HRCT which are membrano-facial angle (MFA) and length of the bony overhang of the round window niche (RWN). We reviewed the intra-operative surgical video recordings of all cases for detection of the type of RWM visibility, according to The St Thomas' Hospital classification. RESULTS The MFA was 21.9 ± 14.5. The length of the bony overhang of the RWN was 2.4 ± 0.33 mm. About 37% of the studied patients needed cochleostomy. The best cut-off of MFA in the prediction of the RW (type 2B and 3) was ≥ 15.1o with sensitivity 100%, and specificity 82%. CONCLUSION HRCT offers highly reliable and reproducible measurements for the prediction of RWM visibility and, therefore, prediction of the utility of the RW approach for electrode insertion. Membrano-facial angle (MFA) is a new measurement that can be used for this purpose.
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Obeidat FS, Bell SL, Julie E. An exploration of vestibular function pre and post unilateral cochlear implantation. Cochlear Implants Int 2020; 21:281-291. [PMID: 32567980 DOI: 10.1080/14670100.2020.1774716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: To examine the effects of unilateral cochlear implantation on the balance system for adult patients with bilateral severe to profound sensory neural hearing loss. Methods: 7 CI candidates. The function of the sacculus, utricle, and three semi-circular canals (SCCs) was assessed separately using air conduction cervical vestibular evoked myogenic potentials (VEMP), vibration ocular VEMP and the video head impulse test (vHIT) respectively on each side, pre- and post-operatively. Results: The Otoliths appear more affected by implantation than SCCs. In 3 of 7 cases VEMP was affected by implantation. In 2 cases this was associated with short-term dizziness. Discussion: Differential assessment of vestibular end organ function may elucidate how cochlear implantation affects the vestibular system. As many CI candidates have some vestibular function, pre-implant vestibular assessment may help to inform which side of implantation may best preserve that function if other audiology and surgical considerations are equal. Post-implant assessment with VEMP may help to predict short-term dizziness. More work with a larger sample will be needed to make the case for routine clinical assessment. Conclusions: There is potential benefit of conducting multimodal vestibularassessment pre and post cochlear implantation. The otoliths appear more affected by implantation than the SCC.
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Affiliation(s)
- F S Obeidat
- Hearing and Speech Sciences, Faculty of Rehabilitation Sciences, University of Jordan, Amman, Jordan.,Institute of Sound and Vibration Research, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - S L Bell
- Institute of Sound and Vibration Research, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - Eyles Julie
- Institute of Sound and Vibration Research, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
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20
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Preservation of Vestibular Function and Residual Hearing After Round Window Cochlear Implantation. Otol Neurotol 2020; 40:878-882. [PMID: 31219963 DOI: 10.1097/mao.0000000000002257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the possible correlation between the loss of short-term residual hearing and vestibular function after cochlear implantation (CI). STUDY DESIGN Retrospective patient review. SETTING Academic tertiary referral center. PATIENTS One hundred twenty patients with normal vestibular function (VF) in the caloric testing and residual hearing (RH) at the frequencies 250, 500, and 1000 Hz on the surgery side between 2008 and 2016 were included in the study. INTERVENTION Primary CI on the first side via round window with a conventional full-length electrode. MAIN OUTCOME MEASURES Changes of RH and VF 7 weeks after surgery were analyzed. Preservation of RH was defined as measurable postoperative thresholds at the frequencies 250, 500, and 1000 Hz in the pure-tone audiogram. Preservation of the VF after CI was assessed both by an absolute and relative threshold in the caloric testing. RESULTS Seven weeks after implantation, the preservation of RH was achieved in 52 (43.3 %) patients and the preservation of VF in 95 (79.2 %) patients on the operated side. There was no significant statistical correlation between these two parameters. CONCLUSION The loss of RH was more than twice as frequent as the loss of VF. However, no statistical correlation between the failure of the two inner ear functions was found. The exact causes are still unknown, but our data could give an indication that there may be different underlying pathomechanisms.
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21
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Pascual-Rubio V, Domènech-Vadillo E, Cárdenas-Escalante P, Avilés-Jurado FX, Pellisé-Guinjoan A, Figuerola-Massana E. Uncovered p1 and p2 waves preceding the N3 vestibular evoked neurogenic potential in profound sensorineural hearing loss. Physiol Rep 2020; 8:e14392. [PMID: 32170855 PMCID: PMC7070157 DOI: 10.14814/phy2.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background The N3 wave is a vestibular evoked neurogenic potential detected in some patients with profound sensorineural hearing loss (PSNHL) during brainstem auditory evoked potential (BAEP) analysis. In 1998, Kato et al. mentioned two electropositive waves preceding N3, which we named p1‐p2, but no further description was given. Objective We sought to demonstrate the reproducibility of these waves and hypothesize on their anatomic origin. Methods We used two cohorts of patients with PSNHL. The first cohort comprised 10 patients with N3, allowing us to establish a new test with adequate electrophysiological conditions headed to detect p1‐p2 waves (PN3EP). The second cohort consisted of two groups: group A comprised 10 patients in whom N3 was not detected; and group B comprised 20 patients presenting N3. PN3EP was performed in both groups, of which 50% had cervical myogenic vestibular evoked potentials (cVEMPs). Results Only group B presented p1‐p2. The PN3EP facilitated the identification of p1‐p2 over BAEP analysis, and their presence correlated well with cVEMPs. Conclusions P1‐p2 may be covered due to inadequate BAEP setting conditions, and could be generated in the distal neural path that generates the N3 wave.
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Affiliation(s)
- Vicenç Pascual-Rubio
- Department of Neurology and Clinical Neurophysiology, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain.,HJ23 Otorhinolaryngology Diseases Research Group-IISPV, Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Esther Domènech-Vadillo
- HJ23 Otorhinolaryngology Diseases Research Group-IISPV, Universitat Rovira i Virgili (URV), Tarragona, Spain.,Department of Otorhinolaryngology Head-Neck Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Paulina Cárdenas-Escalante
- HJ23 Otorhinolaryngology Diseases Research Group-IISPV, Universitat Rovira i Virgili (URV), Tarragona, Spain.,Department of Otorhinolaryngology Head-Neck Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Francesc X Avilés-Jurado
- HJ23 Otorhinolaryngology Diseases Research Group-IISPV, Universitat Rovira i Virgili (URV), Tarragona, Spain.,Department of Otorhinolaryngology Head-Neck Surgery, Hospital Clínic de Barcelona, Tarragona, Spain
| | - Anna Pellisé-Guinjoan
- Department of Neurology and Clinical Neurophysiology, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Enric Figuerola-Massana
- HJ23 Otorhinolaryngology Diseases Research Group-IISPV, Universitat Rovira i Virgili (URV), Tarragona, Spain.,Department of Otorhinolaryngology Head-Neck Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
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Li X, Gong S. The Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potential in Children. Laryngoscope 2020; 130:E918-E925. [PMID: 32031698 PMCID: PMC7754474 DOI: 10.1002/lary.28520] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/18/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022]
Abstract
Objectives/Hypothesis We conducted this study to assess the effects of unilateral cochlear implantation (CI) on otolith function by observing the changes in ocular vestibular evoked myogenic potential (oVEMP) and cervical vestibular evoked myogenic potential (cVEMP) in children. Study Design: Prospective case series. Methods The oVEMP and cVEMP elicited by air‐conducted sound in 35 children were analyzed preoperatively and at 5 days, 1 month, and 2 months after surgery. Results Before CI, the response rates of oVEMPs and cVEMPs were 81.4% and 91.4%, respectively. In the implanted side, oVEMPs and cVEMPs were reduced by 37.1% and 68.6%, respectively, 5 days after CI. One month after CI, oVEMPs and cVEMPs were 34.6% and 72%, respectively, with the device switched off, and 50% and 73.1%, respectively, with the device switched on. Two months after CI, the oVEMPs and cVEMPs were 36% and 80%, respectively, when the implant was turned off, and 70.8% and 75%, respectively, when the implant was turned on. Conclusions The study confirmed the value of VEMP testing in the clinical setting and that absent VEMPs could indicate impairment of otolith function after CI. Level of Evidence 4 Laryngoscope, 2020
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Affiliation(s)
- Xin Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Otorhinolaryngology-Head and Neck Surgery, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Shusheng Gong
- Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Lateral Semicircular Canal Pressures During Cochlear Implant Electrode Insertion: a Possible Mechanism for Postoperative Vestibular Loss. Otol Neurotol 2019; 39:755-764. [PMID: 29889786 DOI: 10.1097/mao.0000000000001807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS Insertion of cochlear implant electrodes generates transient pressure spikes within the vestibular labyrinth equivalent to high-intensity acoustic stimuli. BACKGROUND Though cochlear implant (CI) surgery is regarded as having low risk of impacting the vestibular system, several studies have documented changes in vestibular function after implantation. The mechanism of these changes is not understood. We have previously established that large, potentially damaging pressure transients can be generated in the cochlea during electrode insertion, but whether pressure transients occur within the vestibular labyrinth has yet to be determined. Here, we quantify the exposure of the vestibular system to potentially damaging pressure transients during CI surgery. METHODS Five human cadaveric heads were prepared with an extended facial recess and implanted sequentially with eight different CI electrode styles via a round window approach. Fiber-optic sensors measured intralabyrinthine pressures in scala vestibuli, scala tympani, and the lateral semicircular canal during insertions. RESULTS Electrode insertion produced a range of high-intensity pressure spikes simultaneously in the cochlea and lateral semicircular canal with all electrodes tested. Pressure transients recorded were found to be significantly higher in the vestibular labyrinth than the cochlea and occurred at peak levels known to cause acoustic trauma. CONCLUSION Insertion of CI electrodes can produce transients in intralabyrinthine fluid pressure levels equivalent to high-intensity, impulsive acoustic stimuli. Results from this investigation affirm the importance of atraumatic surgical techniques and suggest that in addition to the cochlea, the vestibular system is potentially exposed to damaging fluid pressure waves during cochlear implantation.
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Shute WG, McOwan B, O'Leary SJ, Szmulewicz D. The Early Postoperative Effects of Cochlear Implantation on Horizontal Semicircular Canal Function. Otol Neurotol 2019; 39:e524-e531. [PMID: 29995005 DOI: 10.1097/mao.0000000000001840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To use video head impulse testing to examine the effect of cochlear implantation (CI) on horizontal SCC vestibulo-ocular reflex (VOR) gain early after surgery, and to relate outcomes to subjective imbalance. STUDY DESIGN Prospective cohort study. SETTING Academic tertiary referral center. PATIENTS Thirty-seven (23F:14M) adult cochlear implant recipients (mean age, 55; age range, 20-80). INTERVENTION Cochlear implantation. MAIN OUTCOME MEASURE The VOR of the horizontal semicircular canal of both the operated and non-operated ears was examined using video head impulse testing before surgery and at days 1, 7, and 28 following surgery. VOR gain, VOR gain asymmetry, and the change in VOR gain from preoperative baseline where the primary outcome measures. Subjective imbalance was assessed using a structured questionnaire. RESULTS VOR gain value for the operated ear was 0.88 ± 0.21. Mean VOR gain on day 1 postoperatively was 0.86 ± 0.19; on day 7, 0.87 ± 0.17, and on day 30, 0.91 ± 0.21. Before surgery median asymmery was -5.50%, on day 1 it was -5.30%, at day 7, -6.44%, and at day 30 it was -2.61%. There was no significant difference between these measures for the cohort across the four time points. Thirteen of 37 (35%) of patients experienced imbalance in the follow-up period, but this was not correlated to changes in VOR gain. CONCLUSION Horizontal semicircular canal function is preserved in the immediate and early postoperative period. This suggests that horizontal semicircular canal impairment is not likely to be responsible for postoperative imbalance.
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Affiliation(s)
| | - Benjamin McOwan
- Department of Surgery (Otolaryngology) University of Melbourne
| | - Stephen John O'Leary
- Department of Surgery (Otolaryngology) University of Melbourne.,Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - David Szmulewicz
- Department of Surgery (Otolaryngology) University of Melbourne.,Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Qiao XF, Li X, Wang WX, Zheng W, Li TL. Cervical vestibular evoked myogenic potential testing for assessment of vestibular functions in cochlear implant patients. Artif Organs 2019; 44:428-434. [PMID: 31660615 DOI: 10.1111/aor.13589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/07/2019] [Accepted: 10/23/2019] [Indexed: 11/28/2022]
Abstract
This study aims to investigate the vestibular function status of cochlear implant patients using cervical vestibular evoked myogenic potential (cVEMP) testing and estimate the effects of cochlear implants on vestibular function. The cVEMPs of 50 cochlear implant patients were measured preoperatively, and at one and six months postoperatively. Then, implanted ears and non-implanted ears were compared in terms of p13/n23 wave response rates, latency, amplitude and threshold. Preoperatively, the binaural cVEMP response rate was 92%, while the cVEMP response rates of implanted ears vs. non-implanted ears at postoperative one and six months were 24% vs. 80% and 52% vs. 82%, respectively. No significant difference between implanted and non-implanted ears was found preoperatively, in terms of latent period, amplitude, or threshold. However, significant changes were found in amplitude and threshold for implanted ears after the operation, but not in latency. No significant postoperative change was found in amplitude, latent period, or threshold for non-implanted ears. Significant differences between implanted and non-implanted ears were found in both amplitude and threshold. Cochlear implants affect vestibular function, especially saccular function, and reduce the cVEMP amplitude and threshold of implanted ears.
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Affiliation(s)
- Xiao-Feng Qiao
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Xin Li
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Wei-Xing Wang
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Wei Zheng
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Tong-Li Li
- Department of Otorhinolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
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Papathanasiou E, Straumann D. Why and when to refer patients for vestibular evoked myogenic potentials: A critical review. Clin Neurophysiol 2019; 130:1539-1556. [DOI: 10.1016/j.clinph.2019.04.719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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Sosna M, Tacikowska G, Pietrasik K, Skarżyński H, Lorens A, Skarżyński PH. Effect on vestibular function of cochlear implantation by partial deafness treatment-electro acoustic stimulation (PDT-EAS). Eur Arch Otorhinolaryngol 2019; 276:1951-1959. [PMID: 31053967 PMCID: PMC6581932 DOI: 10.1007/s00405-019-05425-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 11/26/2022]
Abstract
Purpose Although the cochlear implantation procedure does not interfere with vestibular structures directly, both the vestibulum and the cochlea share the same inner ear fluid space, and this fluid may be responsible for transferring possibly damaging forces from one to the other. The purpose of the study is to assess postoperative vestibular function after partial deafness treatment–electro-acoustic stimulation (PDT–EAS) cochlear implantation. Methods Fifty-five patients were included in the study (30 females, 25 males, age 11–80, mean 41.8 ± 19.35). cVEMP and oVEMP were performed preoperatively and 1–3 months after cochlear implantation. Caloric and vHIT tests were conducted preoperatively and 4–6 months after cochlear implantation. Results Our study shows that, based on a wide range of electrodes, use of PDT–EAS is protective in terms of preserving vestibular function. It gives a rate of saccular damage of 15.79%, utricular damage of 19.04%, and a horizontal semicircular canal response reduction of 15.79%. Conclusions PDT–EAS is protective in terms of preserving vestibular function. Nevertheless, it should be emphasized that the risk of vestibular damage cannot be totally eliminated even when hearing preservation techniques are adopted.
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Affiliation(s)
- Magdalena Sosna
- Otorhinolaryngosurgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- Department of Otoneurology, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Grażyna Tacikowska
- Department of Otoneurology, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Katarzyna Pietrasik
- Department of Otoneurology, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Henryk Skarżyński
- Otorhinolaryngosurgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Artur Lorens
- Department of Auditory Implant and Perception, Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland
| | - Piotr H Skarżyński
- Otorhinolaryngosurgery Clinic, Institute of Physiology and Pathology of Hearing, Warsaw, Poland.
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Mokra 17 Street, 05-830, Kajetany, Poland.
- Institute of Sensory Organs, Kajetany, Poland.
- Heart Failure and Cardiac Rehabilitation Department, Medical University of Warsaw, Warsaw, Poland.
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Assessing Gait Stability before and after Cochlear Implantation. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2474273. [PMID: 30733957 PMCID: PMC6348847 DOI: 10.1155/2019/2474273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/05/2018] [Accepted: 01/01/2019] [Indexed: 12/26/2022]
Abstract
Background It is known that cochlear implantation may alter the inner ear and induce vestibular disorders. Research Question How does cochlear implantation influence gait stability? Material and Methods. An experimental group of twenty-one subjects scheduled for cochlear implantation underwent gait testing twice, on the day before cochlear implantation (BCI) and three months after cochlear implantation (ACI), using a motion capture system. A control group of 30 age-matched healthy individuals were also tested. Results In the experimental group, the gait stability ratio (GSR) was found to improve in 17 subjects after implantation, by an average of 6%. Certain other parameters also showed statistically significant improvement between the two experimental group tests: step time (p<0.001), single-support phase walking speed (p<0.05), and center of mass (CoM) (p<0.05). Using the CoM results of the control group, we devised a stability classification system and applied it to the pre- and postimplantation subjects. After implantation, increases were seen in the number of subjects classified in interval II (strong stability) and III (weak stability). The number of subjects in interval I (perfect stability) decreased by 1 and in interval IV (no stability) by 4. Significance (1) Although cochlear implantation intervenes in the vestibular area, we found evidence that gait stability improves in most subjects after the surgery, reducing the risk of falls. (2) We found statistically significant improvements in individual parameters (such as single-support phase time), in GSR, and in CoM. (3) Based on CoM results, we proposed a new rule-of-thumb way of classifying patients into gait stability intervals, for use in rehabilitation planning and monitoring.
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Colin V, Bertholon P, Roy S, Karkas A. Impact of cochlear implantation on peripheral vestibular function in adults. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:417-420. [PMID: 30431000 DOI: 10.1016/j.anorl.2018.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Cochlear implantation may have a detrimental effect on vestibular function and residual hearing. Our goal was to investigate the impact of cochlear implantation on peripheral vestibular function and the symptomatology that ensues. MATERIAL AND METHODS A prospective observational study included all adults undergoing cochlear implantation by the same operator between July 2014 and December 2015, with pre- and postoperative (4 months) neurovestibular balance examination comprising a questionnaire and clinical tests [head impulse test (HIT), head-shaking test (HST), skull vibration test (SVT)] and instrumental tests [caloric test of the lateral semicircular canal and cervical vestibular-evoked myogenic potentials (cVEMP)]. RESULTS Twenty-two patients were included, with a mean age of 62 years and sex-ratio of 1.2. Before implantation, 50% of subjects (n=11) reported at least one episode of vertigo associated with balance disorder during their life. After implantation, there were 11 cases of vertigo but only one patient described persistent discomfort related to vertigo 4 months after surgery. Patients with impaired vestibular function after 4 months, taking all symptoms together, were all aged more than 75 years. HIT was abnormal in 18% of cases before implantation and in 59% after (P=NS). HST showed nystagmus in one patient both before and after surgery. Only 18% of patients showed nystagmus induced by SVT before surgery, increasing to one-third after surgery (P=NS). Caloric test of the lateral canal showed hypofunction in 50% of cases before surgery, including 10% of cases with areflexia. This rate increased after surgery to 58%, with 18% areflexia (P=NS). cVEMPs were not detected in 68% of cases before implantation and this rate increased to 86% after surgery (P=NS). There were no significant associations (P>0.05) between test results and symptoms. CONCLUSIONS In the medium term, although older subjects more frequently presented vestibular disorder, cochlear implantation induced little vertigo or balance disorder, sometimes even improving vestibular function. However, vestibular disorders were frequent preoperatively and increased postoperatively. We tested vestibular function on different stimulation frequencies and yet found no correlation between postoperative test results and postoperative vertigo.
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Affiliation(s)
- V Colin
- Service ORL, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France.
| | - P Bertholon
- Service ORL, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
| | - S Roy
- Service ORL, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
| | - A Karkas
- Service ORL, CHU de Saint-Étienne, 42270 Saint-Priest-en-Jarez, France
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Dagkiran M, Tuncer U, Surmelioglu O, Tarkan O, Ozdemir S, Cetik F, Kiroglu M. How does cochlear implantation affect five vestibular end-organ functions and dizziness? Auris Nasus Larynx 2018; 46:178-185. [PMID: 30100248 DOI: 10.1016/j.anl.2018.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 07/04/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate all five vestibular end-organ functions (lateral, anterior, posterior semicircular canal, utricule, and saccule) and to investigate the relationship between Dizziness Handicap Inventory (DHI) and vestibular functions prior to CI (cochlear implantation) and at postoperative day 3 and month 3. METHODS A total of 42 patients (age 16-70years) with normal vestibular functions preoperatively and undergoing unilateral CI were included in this prospective descriptive study. Video head impulse test (vHIT) for three semicircular canal (SSC) functions, ocular vestibular-evoked myogenic potential (oVEMP) for utricule function, cervical vestibular-evoked myogenic potential (cVEMP) for saccule function and DHI for subjective vertigo symptoms were performed prior to CI and at postoperative day 3 and month 3. RESULTS There was a significant impairment of vestibular function in 12 patients (28.5%) on the implantation side and significant DHI increase was observed in 13 of 42 (30.9%) patients at postoperative day 3 after CI (p<0.05). We found SSC dysfunction in 7 patients (16,6%) who underwent observation with vHIT, saccule dysfunction in 8 patients (19%) with cVEMP and utricule dysfunction in 5 patients (11.9%) with oVEMP on the operated side 3days after surgery (p<0.05). Posterior SSC functions (5 patients) were more affected than lateral SSC functions (3 patients). At postoperative month 3, six patients (14.2%) still had deteriorating results in the objective tests and significant DHI increase was continued in 4 (9.5%) patients (p<0.05). The deterioration in vHIT continued in only 1 (2.3%) patient (p>0.05). The deterioration in cVEMP continued in 5 (11.9%) patients (p<0.05). The deterioration in oVEMP continued in 2 (4.7%) patients (p>0.05). There was a significant correlation between DHI and objective vestibular tests both in the early and late postoperative period (r=0.795; p<0.05). CONCLUSION Our study showed that both canal and otolith functions can be damaged after CI especially in the early postoperative period. Surprisingly, posterior SSC functions were more affected than lateral SSC. Therefore, a gold standard vestibular test battery that can evaluate each of three SSC canals and two otoliths functions is essential. Since a single vestibular test for this purpose is not available, we recommend the use of the three available vestibular tests together. This test battery, which is capable of evaluating five vestibular end-organ functions in preoperative and postoperative vestibular evaluations, can provide more accurate results not only for CI but also for most otologic surgeries.
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Affiliation(s)
- Muhammed Dagkiran
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey.
| | - Ulku Tuncer
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Ozgur Surmelioglu
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Ozgur Tarkan
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Suleyman Ozdemir
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Fikret Cetik
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
| | - Mete Kiroglu
- Cukurova University, Faculty of Medicine, Department of Otorhinolaryngology, Turkey
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Melo JJ, Gibrin PCD, Marchiori LLDM. Vestibular dysfunction and postural balance in cochlear implant users: a narrative literature review. REVISTA CEFAC 2018. [DOI: 10.1590/1982-021620182019016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Cochlear implants directly stimulate nerve fibers and ganglion cells of the auditory nerve, which transform sound energy into low levels of electrical current, stimulating the remaining fibers of the auditory nerve in patients with severe to profound hearing loss, in order to provide the significant range of auditory sensation and speech comprehension. Due to the close relationship between cochlea and vestibular receptors, some patients may present vestibular and postural balance changes concomitantly after surgery. This study aimed to perform a narrative review of the main studies that relate vestibular symptoms in patients implanted in the last six years. The research was performed through the databases: SciELO, LILACS and PubMed, using associated descriptors for "cochlear implant", "vestibular dysfunction", "vertigo" and "balance", totalizing 21 studies that fitted the inclusion criteria. The results were described in a chronological order of publication, showing the main conclusions. Of the total studies analyzed, 18 related vestibular function to cochlear implant and only 3 studies did not find such a relationship. The literature characterize the effects of the cochlear implant on the vestibular system, however, the results are contradictory.
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Ibrahim I, da Silva SD, Segal B, Zeitouni A. Effect of cochlear implant surgery on vestibular function: meta-analysis study. J Otolaryngol Head Neck Surg 2017; 46:44. [PMID: 28595652 PMCID: PMC5465585 DOI: 10.1186/s40463-017-0224-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
Importance Vestibular disorders have been reported following cochlear implant (CI) surgery, but the literature shows a wide discrepancy in the reported clinical impact. The aim of this meta-analysis is to quantify the effect of CI before and after surgery on the outcomes of vestibular tests, postural stability, and subjective perception of dizziness. Objective To evaluate the effects of CI surgery on vestibular function in adult patients (≥18 years) with sensorineural hearing loss who underwent unilateral or bilateral implantation. Data sources MEDLINE, PubMed, Web of Science and Cochrane Library from January 1, 1995, through July 12, 2016. Study selection Published studies of adult patients who received unilateral or bilateral CIs and whose vestibular function or postural stability was assessed before and after surgery. Data extraction From each study, test results before and after surgery were compared, for the following five tests: clinical head impulse test (HIT); bi-thermal caloric irrigation of the horizontal semicircular canal; vestibular evoked myogenic potential (VEMP); dizziness handicap inventory (DHI); and computerized dynamic posturography (CDP). Results Twenty-seven studies met all inclusion criteria. Most studies performed either bi-thermal caloric irrigation and/or VEMP, with fewer studies investigating changes in HIT, posturography or DHI. CI surgery significantly affected the results of caloric and VEMP testing. However, HIT results, posturography, and DHI, scores were not significantly affected after CI surgery. Conclusions and relevance CI surgery has a significant negative effect on the results of caloric as well as VEMP tests. No significant effect of CI surgery was detected in HIT, posturography, or DHI scores. Overall, the clinical effect of CI surgery on the vestibular function was found to be insignificant. Nonetheless, the potential effects of surgery on the vestibular system should be discussed with CI candidates before surgery.
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Affiliation(s)
- Iman Ibrahim
- Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, McGill University, Montréal, Canada
| | - Sabrina Daniela da Silva
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montréal, Canada
| | - Bernard Segal
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montréal, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, McGill University, Montréal, Canada.
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The effects of cochlear implantation on vestibular function in 1-4 years old children. Int J Pediatr Otorhinolaryngol 2017; 94:100-103. [PMID: 28166997 DOI: 10.1016/j.ijporl.2017.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although cochlear implants offer an effective hearing restoration option in children with severe to profound hearing loss, concern continues to exist regarding the possible effects of cochlear implantation on the vestibular system and balance. METHODS In a prospective cohort study, 27 children with bilateral profound hearing loss (all candidates for cochlear implantation) were evaluated for their vestibular function before and after cochlear implantation. Vestibular evaluations consisted of Vestibular Evoked Myogenic Potentials, caloric testing and the Head-Impulse Test. RESULTS Mean age at the time of cochlear implantation was 27.19 months. Without considering vestibular evaluation results, one of the ears was selected for surgery. Vestibular tests after surgery were not indicative of any statistically significant change in vestibular system or balance. CONCLUSION This limited data shows that cochlear implantation did not impair the vestibular system of these patients. By the results of our study we may conclude that round window implantation does not have any disturbing impact on vestibular function in children. The generalization of this result needs further research.
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Chiesa Estomba CM, Rivera Schmitz T, Betances Reinoso FA, Dominguez Collado L, Estevez Garcia M, Lorenzo Lorenzo AI. Complications after cochlear implantation in adult patients. 10-Year retrospective analysis of a tertiary academic centre. Auris Nasus Larynx 2017; 44:40-45. [DOI: 10.1016/j.anl.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/17/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
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le Nobel GJ, Hwang E, Wu A, Cushing S, Lin VY. Vestibular function following unilateral cochlear implantation for profound sensorineural hearing loss. J Otolaryngol Head Neck Surg 2016; 45:38. [PMID: 27301263 PMCID: PMC4908777 DOI: 10.1186/s40463-016-0150-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 06/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many Canadians are affected by sensorineural hearing loss (SNHL) and those with severe or profound hearing loss may have poor hearing function despite optimized hearing aids. Cochlear implants (CI) offer effective hearing rehabilitation for these patients, however, concern continues to exist regarding possible effects of CI on the vestibular system and balance. The objective of this study was to conduct a pilot study assessing the effects of unilateral cochlear implantation (CI) on balance and the vestibular system in post-lingually deafened adults. METHODS Twelve patients were included in this pilot study and were assessed pre-operatively and at immediate, 1 week, and 1 month post-operative intervals. Assessments consisted of the dizziness handicap inventory (DHI), subjective visual vertical (SVV), and timed up-and-go testing (TUG). When applicable, testing was repeated with the CI on and off. RESULTS Many patients were found to have deviated SVV at pre-operative and post-operative assessments. However, statistically significant changes were not seen when comparing pre-operative and post-operative SVV or when comparing SVV with the CI on and with the CI off. DHI was found to improve in five patients and worsen in two patients, however, no statistically significant change was found in DHI scores or with TUG testing. CONCLUSIONS This current pilot study does not indicate that CI surgery or implant activity influence vestibular or balance function, however, this pilot study is underpowered and greater numbers of patients would need be assessed to confirm these findings.
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Affiliation(s)
- Gavin J le Nobel
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Rm 3S438, RFE building, Toronto, ON, M5G2N2, Canada. .,University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Center, Toronto, ON, Canada.
| | - Euna Hwang
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Rm 3S438, RFE building, Toronto, ON, M5G2N2, Canada.,University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Adrian Wu
- Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Sharon Cushing
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Rm 3S438, RFE building, Toronto, ON, M5G2N2, Canada.,University of Toronto, Toronto, ON, Canada.,Hospital for Sick Children, Toronto, ON, Canada
| | - Vincent Y Lin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, 190 Elizabeth Street, Rm 3S438, RFE building, Toronto, ON, M5G2N2, Canada.,University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Center, Toronto, ON, Canada
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Cho HS, Lee KY, Choi H, Jang JH, Lee SH. Dexamethasone Is One of the Factors Minimizing the Inner Ear Damage from Electrode Insertion in Cochlear Implantation. Audiol Neurootol 2016; 21:178-86. [PMID: 27229744 DOI: 10.1159/000445099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 02/29/2016] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate the efficacy of preoperative and intraoperative steroid administration for inner ear protection in cochlear implantation (CI). Nineteen subjects who underwent CI were included in the study, and 10 subjects were enrolled as controls (steroid-administered group, n = 19; control group, n = 10). Dexamethasone (dexamethasone sodium phosphate, 5 mg/ml) was systemically administered preoperatively (1 ml) and topically applied during CI (0.5 ml). The extent of hearing preservation (HP) after CI and the change in the bithermal caloric response were evaluated. Hearing level was calculated using mean thresholds [(250 Hz + 500 Hz + 1,000 Hz + 2,000 Hz)/4]. Preoperative hearing thresholds were similar in the steroid-administered and control groups (100.92 ± 12.60 vs. 103.29 ± 14.39 dB, p = 0.650). The mean thresholds significantly increased in both groups after surgery (108.46 ± 14.08 dB, p = 0.006, for the steroid-administered group; 117.50 ± 6.34 dB, p = 0.027, for the control group), and the difference between the groups was also significant (p = 0.027). The postoperative shift in the hearing thresholds at frequencies of 500 and 1,000 Hz was significant in the steroid-administered group and that at the frequencies of 500, 1,000 and 2,000 Hz was significant in the control group. However, the extent of the shift in hearing threshold levels at each frequency was not significantly different between the groups. Preservation of hearing thresholds was compared between the groups, and there were significantly more subjects with complete and partial HP in the steroid-administered group than in the control group (p = 0.008). The preoperative caloric response was maintained after CI in the steroid-administered group. This study suggests that the perioperative use of a steroid could minimize the inner ear damage after CI.
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Affiliation(s)
- Hyun Soo Cho
- Department of Otorhinolaryngology, Head and Neck Surgery, Kyungpook National University College of Medicine, Daegu, South Korea
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Dizziness and vestibular function before and after cochlear implantation. Eur Arch Otorhinolaryngol 2016; 273:3615-3621. [DOI: 10.1007/s00405-016-3988-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/14/2016] [Indexed: 11/26/2022]
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Compensation of Vestibular Function and Plasticity of Vestibular Nucleus after Unilateral Cochleostomy. Neural Plast 2016; 2016:7287180. [PMID: 26881130 PMCID: PMC4737456 DOI: 10.1155/2016/7287180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/20/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022] Open
Abstract
Dizziness and vertigo frequently occur after cochlear implantation (CI) surgery, particularly during the early stages. It could recover over time but some of the patients suffered from delayed or sustained vestibular symptoms after CI. This study used rat animal models to investigate the effect of unilateral cochleostomy on the vestibular organs over time. Twenty-seven Sprague Dawley rats underwent cochleostomy to evaluate the postoperative changes in hearing threshold, gain and symmetry of the vestibular ocular response, overall balance function, number of hair cells in the crista, and the c-Fos activity in the brainstem vestibular nucleus. Loss of vestibular function was observed during the early stages, but function recovered partially over time. Histopathological findings demonstrated a mild decrease in vestibular hair cells numbers. Increased c-Fos immunoreactivity in the vestibular nucleus, observed in the early stages after cochleostomy, decreased over time. Cochleostomy is a risk factor for peripheral vestibular organ damage that can cause functional impairment in the peripheral vestibular organs. Altered vestibular nucleus activity may be associated with vestibular compensation and plasticity after unilateral cochleostomy.
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Effects of Unilateral Cochlear Implantation on Balance Control and Sensory Organization in Adult Patients with Profound Hearing Loss. BIOMED RESEARCH INTERNATIONAL 2015; 2015:621845. [PMID: 26583121 PMCID: PMC4637149 DOI: 10.1155/2015/621845] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/30/2015] [Accepted: 07/09/2015] [Indexed: 11/17/2022]
Abstract
Many studies were interested in the consequence of vestibular dysfunction related to cochlear implantation on balance control. This pilot study aimed to assess the effects of unilateral cochlear implantation on the modalities of balance control and sensorimotor strategies. Posturographic and vestibular evaluations were performed in 10 patients (55 ± 20 years) with profound hearing loss who were candidates to undergo unilateral multichannel cochlear implantation. The evaluation was carried out shortly before and one year after surgery. Posturographic tests were also performed in 10 age-matched healthy participants (63 ± 16 years). Vestibular compensation was observed within one year. In addition, postural performances of the patients increased within one year after cochlear implantation, especially in the more complex situations, in which sensory information is either unavailable or conflicting. Before surgery, postural performances were higher in the control group compared to the patients' group. One year after cochlear implantation, postural control was close to normalize. The improvement of postural performance could be explained by a mechanism of vestibular compensation. In addition, the recovery of auditory information which is the consequence of cochlear implantation could lead to an extended exploration of the environment possibly favoring the development of new balance strategies.
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Ocular and cervical vestibular-evoked myogenic potentials in children with cochlear implant. Clin Neurophysiol 2015; 126:1624-31. [DOI: 10.1016/j.clinph.2014.10.216] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/24/2022]
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Kuang H, Haversat HH, Michaelides EM. Impairment of Caloric Function After Cochlear Implantation. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:1387-1395. [PMID: 26088799 DOI: 10.1044/2015_jslhr-h-15-0010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/03/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE This article seeks to review current literature on caloric function following cochlear implantation while analyzing any correlations of caloric function changes with vestibular symptoms. METHOD This article is a systematic review of evidence-based literature. English language articles published between 1980 and 2014 that presented some form of caloric data from cochlear implant (CI) patients and that did not solely analyze overlapping data from a previous study were reviewed. Twenty-five articles met these criteria. RESULTS Of the 439 individuals tested, 37% of patients demonstrated reduced maximum slow-phase velocity, and 34% had onset of caloric asymmetry post-CI. CONCLUSIONS This review article found that cochlear implantation can affect caloric responses but is variable. When counseling patients preoperatively, possible effects of CI on labyrinthine function should be discussed.
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González-Navarro M, Manrique-Huarte R, Manrique-Rodríguez M, Huarte-Irujo A, Pérez-Fernández N. Long-term follow-up of late onset vestibular complaints in patients with cochlear implant. Acta Otolaryngol 2015. [PMID: 26224013 DOI: 10.3109/00016489.2015.1072874] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Patients with cochlear implants should be treated no differently than non-implanted patients with similar symptomatology. OBJECTIVES To describe the spectrum of symptomatology, treatment, and long-term follow-up of patients with cochlear implant and vestibular complaints. METHODS This retrospective study included 25 patients with late onset vestibular complaints (more than 1 month post-implantation). Each patient underwent an extensive interrogatory and physical exam with ancillary test to complete a diagnosis. Treatment was given according to this and all patients followed a vestibular rehabilitation program. RESULTS The total population was 72% male and 28% female, median age was 58 years; minimal follow-up was 9 months (mean = 51, median = 34). Cochleostomy was performed in eight cases and round window insertion was performed in 19 (two patients were removed from each group in the analysis due to their bilateral implantation under a different approach). The mean time from implant to vestibular symptoms was 53 months, median = 32; a Kaplan Meier graphic showed the round window approach has faster onset of symptoms with statistical significance (p = 0.020). The most common complaint was instability in all patients and after both surgical approaches. No difference in symptoms was found with a Kruskall Wallis test except for vertigo spells (more common in the round window approach). In 12 patients the symptomatology was attributed to the implanted side. In the long-term follow-up a relatively high number of patients (20/25) recovered with standard treatment, suggesting the presence of the implant is not associated with poor recovery prognosis.
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Affiliation(s)
- Mauricio González-Navarro
- a 1 Subdivision of Otolaryngology Head and Neck Surgery, Instituto Nacional de Rehabilitacion , Distrito Federal, Mexico
| | | | | | - Alicia Huarte-Irujo
- b 2 Department of Otorhinolaryngology, Clínica Universidad de Navarra , Pamplona, Spain
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Batuecas‐Caletrio A, Klumpp M, Santacruz‐Ruiz S, Gonzalez FB, Sánchez EG, Arriaga M. Vestibular function in cochlear implantation: Correlating objectiveness and subjectiveness. Laryngoscope 2015; 125:2371-5. [DOI: 10.1002/lary.25299] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/07/2015] [Accepted: 03/09/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Angel Batuecas‐Caletrio
- Department of OtorhinolaryngologyOtoneurology UnitUniversity Hospital of Salamanca, University of SalamancaSalamanca Spain
| | - Micah Klumpp
- Department of Otolaryngology and NeurosurgeryLouisiana State University Health Sciences–New Orleans, Division of Otology and Neurotology–Hearing and Balance Center, Our Lady of the Lake Regional Medical CenterBaton Rouge Louisiana U.S.A
| | - Santiago Santacruz‐Ruiz
- Department of OtorhinolaryngologyOtoneurology UnitUniversity Hospital of Salamanca, University of SalamancaSalamanca Spain
| | - Fernando Benito Gonzalez
- Department of OtorhinolaryngologyOtoneurology UnitUniversity Hospital of Salamanca, University of SalamancaSalamanca Spain
| | - Enrique Gonzalez Sánchez
- Department of OtorhinolaryngologyOtoneurology UnitUniversity Hospital of Salamanca, University of SalamancaSalamanca Spain
| | - Moises Arriaga
- Department of Otolaryngology and NeurosurgeryLouisiana State University Health Sciences–New Orleans, Division of Otology and Neurotology–Hearing and Balance Center, Our Lady of the Lake Regional Medical CenterBaton Rouge Louisiana U.S.A
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Louza J, Mertes L, Braun T, Gürkov R, Krause E. Influence of insertion depth in cochlear implantation on vertigo symptoms and vestibular function. Am J Otolaryngol 2015; 36:254-8. [PMID: 25516142 DOI: 10.1016/j.amjoto.2014.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/17/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the present study was to investigate the effect of the electrode insertion depth in vestibular function after cochlear implantation. MATERIAL AND METHODS In a retrospective observational study design, 41 adult patients who had undergone cochlear implantation between 2006 and 2012 at a tertiary referral university hospital were included. The postoperative performed radiograph images of the petrous bone were acquired according to the Stenvers method. These were analyzed to determine electrode insertion depth. Pre- and postoperative subjective vertigo symptoms were assessed by a questionnaire. The function of the horizontal semi-circular canal was evaluated by caloric irrigation and the function of the sacculus was tested by using cervical vestibular evoked myogenic potentials pre- and postoperatively. RESULTS The average electrode insertion depth was 464°. A certain variability of insertion depth existed among the different electrodes according to their designs. No statistical difference of the insertion depth was found between patients with or without vertigo. There was also no correlation between electrode insertion depth and alterations of the measurable vestibular function. CONCLUSION In our study the variability of insertion depth didn't have a significant influence on subjective vertigo, horizontal semi-circular canal function or saccular function. Plain radiography is a rapid, simple and cost-effective method to determine electrode insertion depth after implantation. However the scalar position of the electrode cannot be analyzed in plain radiography, so that an interscalar dislocation as a possible influence in vestibular function remains undetected.
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Affiliation(s)
- Julia Louza
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich.
| | - Lynn Mertes
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
| | - Thomas Braun
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
| | - Robert Gürkov
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
| | - Eike Krause
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich
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Stevens MN, Baudhuin JE, Hullar TE. Short-term risk of falling after cochlear implantation. Audiol Neurootol 2014; 19:370-7. [PMID: 25402502 DOI: 10.1159/000363214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 04/25/2014] [Indexed: 11/19/2022] Open
Abstract
Cochlear implantation is a highly effective intervention for hearing loss, but insertion of an implant into the cochlea is often accompanied by loss of residual hearing function. Sometimes, postoperative testing also shows loss of function in the semicircular canals or otolith organs. The effect of this loss on equilibrium, particularly in the short term following surgery, and the risk of falling due to this loss is unknown. We prospectively measured balance in 16 consecutive adult cochlear implant patients before and 2 weeks after surgery. Subjects stood on a foam pad with eyes closed, feet together and arms at the side. The length of time over which this posture could be maintained was recorded up to a maximum value of 30 s indicating normal performance. Ten of 16 subjects reached a maximal time on preoperative testing. Nine of 16 subjects lost balance function after surgery. Four of the 10 subjects with normal preoperative balance function lost function. Subjects older than the age of 60 were more likely to lose balance function than younger subjects. We used previously published values relating balance performance on foam to risk of falling to calculate the fall risk among our subjects. The relative risk of falling increased after surgery by more than threefold in some patients. Imbalance after cochlear implantation may be much more common, particularly in the short term, than previously appreciated. This imbalance is accompanied by an increased risk of falling in many patients. Careful preoperative counseling before implantation and postoperative therapeutic intervention to improve comfort and reduce the chance of falling may be warranted, particularly in patients at a risk for injuries from falls (level of evidence: 2b).
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Affiliation(s)
- Madelyn N Stevens
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Mo., USA
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Rumalla K, Karim AM, Hullar TE. The effect of hearing aids on postural stability. Laryngoscope 2014; 125:720-3. [DOI: 10.1002/lary.24974] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/22/2014] [Accepted: 09/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Kavelin Rumalla
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri U.S.A
| | - Adham M. Karim
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri U.S.A
| | - Timothy E. Hullar
- Department of Otolaryngology-Head and Neck Surgery; Washington University in St. Louis; St. Louis Missouri U.S.A
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Vestibular function and cochlear implant. Eur Arch Otorhinolaryngol 2014; 272:523-30. [PMID: 24737055 DOI: 10.1007/s00405-014-3040-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/29/2014] [Indexed: 10/25/2022]
Abstract
Vestibular lesions are found after cochlear implantation in 23-100 % of cases. The objectives of this study were to evaluate the vestibular function before and after implantation while focusing its feasibility. This prospective study included 35 patients, mean age 49 years. Each patient enjoyed a vestibular balance before and after implantation in a median period of 5 months compared to surgery. Vestibular evaluations were performed using vestibular-evoked myogenic potentials (VEMP) and videonystagmography. Before implantation, the VEMPs were bilateral in 73 % of cases. They are modified after implantation for 13 patients, including 12 missing or reduced potentials on implanted side (p = 0.0015). Caloric tests found themselves a significant decrease in the reflectivity of the ear implanted (p < 0.0001). Vestibular symptoms were independent of changes on vestibular tests. No relation was found between the occurrence of post-operative vestibular symptoms and the results of the vestibular investigations. However, the achievement of these exams is not easy especially for children and only part of the vestibule is tested. In conclusion, the vestibular assessments help to choose the side of implantation, assess the pre-operative vestibular condition and assess and locate vestibular lesions induced. Further tests should enable a complete vestibular assessment.
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Schick B, Dlugaiczyk J. Surgery of the ear and the lateral skull base: pitfalls and complications. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2013; 12:Doc05. [PMID: 24403973 PMCID: PMC3884540 DOI: 10.3205/cto000097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surgery of the ear and the lateral skull base is a fascinating, yet challenging field in otorhinolaryngology. A thorough knowledge of the associated complications and pitfalls is indispensable for the surgeon, not only to provide the best possible care to his patients, but also to further improve his surgical skills. Following a summary about general aspects in pre-, intra-and postoperative care of patients with disorders of the ear/lateral skull base, this article covers the most common pitfalls and complications in stapes surgery, cochlear implantation and surgery of vestibular schwannomas and jugulotympanal paragangliomas. Based on these exemplary procedures, basic "dos and don'ts" of skull base surgery are explained, which the reader can easily transfer to other disorders. Special emphasis is laid on functional aspects, such as hearing, balance and facial nerve function. Furthermore, the topics of infection, bleeding, skull base defects, quality of life and indication for revision surgery are discussed. An open communication about complications and pitfalls in ear/lateral skull base surgery among surgeons is a prerequisite for the further advancement of this fascinating field in ENT surgery. This article is meant to be a contribution to this process.
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Affiliation(s)
- Bernhard Schick
- Dept. of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Julia Dlugaiczyk
- Dept. of Otorhinolaryngology, Saarland University Medical Center, Homburg/Saar, Germany
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