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Mosnier I, Belmin J, Cuda D, Manrique Huarte R, Marx M, Ramos Macias A, Khnifes R, Hilly O, Bovo R, James CJ, Graham PL, Greenham P. Cognitive processing speed improvement after cochlear implantation. Front Aging Neurosci 2024; 16:1444330. [PMID: 39355541 PMCID: PMC11442269 DOI: 10.3389/fnagi.2024.1444330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/27/2024] [Indexed: 10/03/2024] Open
Abstract
Background Untreated hearing loss has an effect on cognition. It is hypothesized that the additional processing required to compensate for the sensory loss affects the cognitive resources available for other tasks and that this could be mitigated by a hearing device. Methods The impact on cognition of cochlear implants (CIs) was tested in 100 subjects, ≥60 years old, with bilateral moderately-severe to profound post linguistic deafness using hearing aids. Data was compared pre and 12 and 18 months after cochlear implantation for the speech spatial qualities questionnaire, Mini Mental State Examination (MMSE), Trail making test B (TMTB) and digit symbol coding (DSC) from the Wechsler Adult Intelligence Scale version IV and finally the timed up and go test (TUG). Subjects were divided into young old (60-64), middle old (65-75) and old old (75+) groups. Cognitive test scores and times were standardized according to available normative data. Results Hearing significantly improved pre- to post-operatively across all age groups. There was no change post-implant in outcomes for TMTB, TUG or MMSE tests. Age-corrected values were within normal expectations for all age groups for the TUG and MMSE. However, DSC scores and TMTB times were worse than normal. There was a significant increase in DSC scores between baseline and 12-months for 60- to 64-year-olds (t[153] = 2.608, p = 0.027), which remained at 18 months (t[153] = 2.663, p = 0.023). Discussion The improved attention and processing speed in the youngest age group may be a consequence of reallocation of cognitive resources away from auditory processing due to greatly improved hearing. The oldest age group of participants had cognition scores closest to normal values, suggesting that only the most able older seniors tend to come forward for a CI. Severe to profoundly deaf individuals with hearing aids or cochlear implants were still poorer than age-equivalent normally hearing individuals with respect to cognitive flexibility, attention, working memory, processing speed and visuoperceptual functions. Due to a lack of data for the TUG, TMTB and DSC in the literature for hearing impaired individuals, the results reported here provide an important set of reference data for use in future research.
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Affiliation(s)
- Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs, ORL, GH Pitié-Salpêtrière, AP-HP Sorbonne Université and Université Paris Cité, Institut Pasteur, AP-HP, Inserm, Fondation Pour l’Audition, Institut de l’Audition, Paris, France
| | - Joël Belmin
- Sorbonne Université and Hôpital Charles Foix, Paris, France
| | - Domenico Cuda
- Ospedale Guglielmo da Saliceto, University of Parma, Piacenza, Italy
| | | | | | - Angel Ramos Macias
- Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | | | - Ohad Hilly
- Rabin Medical Center, Petah Tikva, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Petra L. Graham
- School of Mathematical and Physical Sciences, Macquarie University, Sydney, NSW, Australia
| | - Paula Greenham
- Greenham Research Consulting Ltd., Ashbury, United Kingdom
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Licameli GR, Wang A, Zhou G, Faller D, Kenna M, Poe D, Shearer E, Oster L, Brodsky JR. Vestibular Preservation in Pediatric Cochlear Implantation. Laryngoscope 2024; 134:1913-1918. [PMID: 37584403 DOI: 10.1002/lary.30978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Evaluate the rate of preserved vestibular function in pediatric cochlear implant surgery. STUDY DESIGN Retrospective case review. METHODS Pre- and post-operative vestibular tests were compared in children who underwent cochlear implantation at a tertiary level pediatric hospital over a 4-year period. RESULTS Data from 59 implanted ears in 44 children was included. Median age was 2.8 years at initial testing (range 7 months - 21 years) with 1:1 male/female ratio. Implant surgeries were 26 unilateral, 13 bilateral simultaneous, and 5 bilateral sequential. The majority were implanted with slim, non-styletted electrodes (86.4%) via a round window approach (91.5%). Normal pre-operative results were preserved post-operatively on rotary chair testing in 75% (21/28) of patients, cervical vestibular evoked myogenic potential testing in (75%) 30/40 of ears tested, ocular vestibular evoked myogenic potential testing in 85.7% (6/7) of ears tested, video head impulse testing in 100% (9/9) of ears tested, and computerized dynamic posturography in 100% (5/5) of patients tested. Overall, 62.5% of patients had no new deficits on any vestibular test performed post-operatively. CONCLUSIONS Preservation rates of vestibular function following cochlear implant surgery were higher in this cohort than what has been reported in many earlier studies. Contemporary, less traumatic electrodes and insertion techniques may be a significant factor. The risk of causing a new, severe bilateral vestibular loss with long-term functional impacts appears to be low. Further study is warranted on the impacts of different cochlear implant electrode designs and insertion approaches on post-operative vestibular preservation. LEVEL OF EVIDENCE 4, Case Series Laryngoscope, 134:1913-1918, 2024.
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Affiliation(s)
- Greg R Licameli
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David Faller
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Margaret Kenna
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Dennis Poe
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eliot Shearer
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Linda Oster
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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3
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Čakrt O, Slabý K, Kučerová K, Balatková Z, Jeřábek J, Bouček J. Subjective visual vertical and postural control in patients following cochlear implantation. J Vestib Res 2023; 33:403-409. [PMID: 37574747 DOI: 10.3233/ves-220136] [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] [Indexed: 08/15/2023]
Abstract
BACKGROUND Cochlear implantation (CI) is associated with changes in the histopathology of the inner ear and impairment of vestibular function. OBJECTIVE The objectives of our study were to evaluate patients for clinical manifestations of space perception and balance changes before surgery, compare them with asymptomatic subjects (controls), and report changes in posturography and subjective visual vertical (SVV) during the acute post-surgery period in patients. METHODS Examination was performed using static posturography and the SVV measurement. We examined 46 control subjects and 39 CI patients. Patients were examined pre-surgery (Pre), 2nd day (D2) and then 14th day (D14) after implantation. RESULTS Baseline SVV was not different between patients and control group. There was a statistically significant difference (p < 0.001) in SVV between subgroups of right- and left-implanted patients at D2 (-1.36±3.02° and 2.71±2.36°, right and left side implanted respectively) but not Pre (0.76±1.07° and 0.31±1.82°) or D14 (0.72±1.83° and 1.29±1.60°). Baseline posturography parameters between patients and control group were statistically significantly different during stance on foam with eyes closed (p < 0.05). There was no statistically significant difference in posturography among Pre, D2 and D14. CONCLUSIONS CI candidates have impaired postural control before surgery. CI surgery influences perception of subjective visual vertical in acute post-surgery period with SVV deviation contralateral to side of cochlear implantation, but not after two weeks.
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Affiliation(s)
- Ondřej Čakrt
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Kryštof Slabý
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Klára Kučerová
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Zuzana Balatková
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
| | - Jaroslav Jeřábek
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Jan Bouček
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Postgraduate Medical School, Prague, Czech Republic
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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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Truong M, Bester C, Orimoto K, Vartanyan M, Phyland D, MacDougall H, Tari S, Rousset A, Curthoys I, O'Leary S. Cochlear implant surgery and perioperative dizziness is associated with utricular hyperfunction. J Vestib Res 2021; 32:295-304. [PMID: 34459428 DOI: 10.3233/ves-210053] [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: 11/15/2022]
Abstract
BACKGROUND Dizziness is a common perioperative complication after cochlear implantation (CI). To date, the exact cause behind this phenomenon remains unclear. There is recent evidence to suggest that otolith function, specifically utricular, may be affected shortly after CI surgery, however whether these changes are related to patient symptoms has not yet been investigated. OBJECTIVE To determine whether CI surgery and perioperative dizziness is associated with changes on utricular function. METHODS We performed an observational study on patients undergoing routine CI surgery. Utricular function was assessed using the Subjective Visual Vertical (SVV), and perioperative dizziness was determined using a questionnaire. The study followed patients before surgery and then again 1-day, 1-week and 6-weeks after implantation. RESULTS Forty-one adult CI recipients participated in the study. The SVV deviated away from the operated ear by an average of 2.17° a day after implantation, 0.889° 1 week and -0.25° 6 weeks after surgery. Dizziness contributed to a tilt of 0.5° away from the implanted ear. These deviations were statistically significant. CONCLUSIONS CI surgery causes utricular hyperfunction in the operated ear that resolves over 6 weeks. SVV tilts were greater in participants experiencing dizziness, suggesting that utricular hyperfunction may contribute to the dizziness.
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Affiliation(s)
- Michelle Truong
- Department of Surgery, Otolaryngology, University of Melbourne.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Christo Bester
- Department of Surgery, Otolaryngology, University of Melbourne
| | - Kumiko Orimoto
- Department of Surgery, Otolaryngology, University of Melbourne.,Royal Victorian Eye and Ear Hospital, Melbourne
| | | | - Debra Phyland
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | | | - Sylvia Tari
- Royal Victorian Eye and Ear Hospital, Melbourne
| | | | | | - Stephen O'Leary
- Department of Surgery, Otolaryngology, University of Melbourne.,Royal Victorian Eye and Ear Hospital, Melbourne
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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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8
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Fabre-Adinolfi D, Ceyte H, Hoffmann CP, Frère J, Parietti-Winkler C. Postural disorders induced by cochlear implantation in normo-reflexic patients: A potential origin of a transient geocentric perception disorder. Gait Posture 2020; 81:225-229. [PMID: 32810698 DOI: 10.1016/j.gaitpost.2020.08.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 07/16/2020] [Accepted: 08/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Profound hearing loss is a public health problem with serious consequences for patient's quality of life. Some of them, submitted to cochlear implantation, revealed various postural disorders such as balance and spatial perception disorders without detail on their vestibular status. RESEARCH QUESTION The purpose of this preliminary study was to analyze the evolution of the balance control and geocentric perception after cochlear implantation procedure in normo-reflexic patients before the implant activation. METHODS We assessed balance control of five patients with profound hearing loss and five healthy participants by means of computerized dynamic posturography and their geocentric perception by the subjective visual vertical test before surgery, three days and forty-five days after surgery (prior to implant activation). RESULTS Before surgery, the patients showed some difficulties to control their balance in challenged postural context without geocentric perception disorder. Patients presented an improvement in their postural accuracy, but their balance control remained inappropriate in challenging environment. Moreover, their geocentric perception was deviated towards their healthy ear immediately after cochlear implantation. This misperception naturally fades before the implant activation. SIGNIFICANCE This transient spatial perception alteration might probably cause the perceived postural discomforts and the daily difficulties often reported by these patients in their clinical records early after cochlear implantation. This preliminary study allows for the first time the distinction between the both components of posture: balance control and geocentric perception. Therefore, a specific therapeutic care targeting the rehabilitation of spatial cognition could be proposed to these patients in order to reduce their transient postural disorders.
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Affiliation(s)
- Dimitri Fabre-Adinolfi
- Université de Lorraine, CHRU-Nancy, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, F-54000, France; Université de Lorraine, DevAH, F-54000, Nancy, France
| | - Hadrien Ceyte
- Université de Lorraine, DevAH, F-54000, Nancy, France
| | - Charles P Hoffmann
- Université de Lorraine, CHRU-Nancy, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, F-54000, France
| | - Julien Frère
- Université de Lorraine, DevAH, F-54000, Nancy, France.
| | - Cécile Parietti-Winkler
- Université de Lorraine, CHRU-Nancy, Department of Oto-Rhino-Laryngology, Head and Neck Surgery, F-54000, France; Université de Lorraine, DevAH, F-54000, Nancy, France
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9
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Marx M, Mosnier I, Belmin J, Wyss J, Coudert-Koall C, Ramos A, Manrique Huarte R, Khnifes R, Hilly O, Martini A, Cuda D. Healthy aging in elderly cochlear implant recipients: a multinational observational study. BMC Geriatr 2020; 20:252. [PMID: 32703167 PMCID: PMC7376635 DOI: 10.1186/s12877-020-01628-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Given an increase in the aging population and its impact on healthcare systems, policy makers for provision of health and social services are aiming to keep older adults in good health for longer, in other words towards ‘healthy aging’. Our study objective is to show that rehabilitation with cochlear implant treatment in the elderly with hearing impairment improves the overall health-related quality of life and general well-being that translate into healthy aging. Methods The multicentre, prospective, repeated measures, single-subject, clinical observational study will accrue 100 elderly, first-time, unilateral CI recipients (≥ 60 years) and analyze changes on specific measurement tools over ca. 20 months from preimplant to postimplant. Evaluations will consist of details collected through case history and interview questionnaires by clinicians, data logging, self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in overall quality of life will be the HUI-3. Discussion The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare effects of CI rehabilitation in adults immediately before their implantation, (pre-implant) and after gaining 1–1.5 years of experience (post-implant). The broad approach will lead to a greater understanding of how useful hearing impacts the quality of life in elderly individuals, and thus improves potentials for healthy aging. Outcomes will be described and analyzed in detail. Trial registration This research has been registered in ClinicalTrials.gov (http://www.clinicaltrials.gov/), 7 March 2017 under the n° NCT03072862.
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Affiliation(s)
- M Marx
- Otology and Neurotology Department, ENT Department, Bâtiment Pierre Paul Riquet - Hôpital Purpan, Place du Dr Baylac, 31059, Toulouse Cedex 9, France.
| | - I Mosnier
- Groupe Hospitalier de la Pitié-Salpétrière, Paris, France
| | - J Belmin
- Université Pierre and Marie Curie and Hôpital Charles Foix, Paris, France
| | - J Wyss
- Cochlear Ltd., Sydney, Australia
| | | | - A Ramos
- Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | | | - R Khnifes
- Bnai Zion Medical Center, Haifa, Israel
| | - O Hilly
- ENT Department at Rabin Medical Center (Beilinson), Petah Tikva, Israel
| | - A Martini
- ENT Otosurgery Department at Azienda Ospedaliera di Padova, Padova, Italy
| | - D Cuda
- ENT Department of Ospedale Guglielmo da Saliceto, Piacenza, Italy
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Stultiens JJA, Kieft HW, Mylanus EAM, Pennings RJE, Terwoert L, Beynon AJ. Impact of cochlear implantation on the function of the three semicircular canals. Int J Audiol 2020; 59:843-849. [DOI: 10.1080/14992027.2020.1768310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joost J. A. Stultiens
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hieke W. Kieft
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emmanuel A. M. Mylanus
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald J. E. Pennings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lotte Terwoert
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andy J. Beynon
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Vestibular Outcome After Cochlear Implantation Is Not Related to Surgical Technique: A Double Blinded, Randomized Clinical Trial of Round Window Approach Versus Cochleostomy. Otol Neurotol 2019; 39:306-312. [PMID: 29283913 PMCID: PMC5821484 DOI: 10.1097/mao.0000000000001695] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To establish whether the round window approach (RWA) leads to less vestibular dysfunction and dizziness than the standard cochleostomy approach (SCA) during cochlear implant (CI) surgery, as assessed using the video head impulse test (vHIT). Additionally, objective findings were compared with the subjective dizziness perceived by the patient.
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12
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Sluydts M, Curthoys I, Vanspauwen R, Papsin BC, Cushing SL, Ramos A, Ramos de Miguel A, Borkoski Barreiro S, Barbara M, Manrique M, Zarowski A. Electrical Vestibular Stimulation in Humans: A Narrative Review. Audiol Neurootol 2019; 25:6-24. [PMID: 31533097 DOI: 10.1159/000502407] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. SUMMARY Vestibular co-stimulation with a CI is based on "spread of excitation," which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.
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Affiliation(s)
- Morgana Sluydts
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium,
| | - Ian Curthoys
- Vestibular Research Laboratory, University of Sydney, Sydney, New South Wales, Australia
| | - Robby Vanspauwen
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
| | - Blake Croll Papsin
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Lynn Cushing
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angel Ramos
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | - Angel Ramos de Miguel
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | - Silvia Borkoski Barreiro
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | | | - Manuel Manrique
- Otorhinolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Andrzej Zarowski
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
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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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14
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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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15
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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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16
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Hänsel T, Gauger U, Bernhard N, Behzadi N, Romo Ventura ME, Hofmann V, Olze H, Knopke S, Todt I, Coordes A. Meta-analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation. Laryngoscope 2018; 128:2110-2123. [PMID: 29314057 DOI: 10.1002/lary.27071] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates. DATA SOURCES We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Cochrane Register, and EMBASE. REVIEW METHODS We presented 116 eligible studies investigating subjective complaints of vertigo after cochlear implantation and/or related vestibular diagnostic tests. We conducted three meta-analyses of 46 eligible studies with matched pre- and postoperative data to calculate the odds ratio of new vertigo onset, as well as the impairment of vestibular receptors measured by nystagmography and cervical vestibular evoked myogenic potentials (cVEMP). Postoperative vertigo was calculated from 95 studies and further subdivided by mean age with pooled data. RESULTS We observed a significant increase in postoperative vertigo and significant impairment of nystagmography and cVEMP detection. Vertigo after cochlear implantation was reported in 9.3% of the patients with a continuous increase in patient age at surgery. In a subgroup of studies, new onset of vertigo was found in 17.4% of the patients. In addition, 7.2% of the patients had persisting vertigo complaints, whereas 11.6% described an altered vertigo quality and 7.7% had their preoperative complaints resolved. A comparison of round window approach and cochleostomy revealed significantly increased vertigo after cochleostomy. Both insertion methods showed similar effects in nystagmography and cVEMP testing. CONCLUSION Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018.
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Affiliation(s)
- Toni Hänsel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | | | - Nikolai Bernhard
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Nina Behzadi
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | | | - Veit Hofmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Steffen Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Virchow-Klinikum, Berlin, Germany
| | - Ingo Todt
- Department of Otorhinolaryngology, Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - Annekatrin Coordes
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany
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17
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Strojan P, Hutcheson KA, Eisbruch A, Beitler JJ, Langendijk JA, Lee AWM, Corry J, Mendenhall WM, Smee R, Rinaldo A, Ferlito A. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev 2017; 59:79-92. [PMID: 28759822 PMCID: PMC5902026 DOI: 10.1016/j.ctrv.2017.07.003] [Citation(s) in RCA: 170] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/05/2017] [Accepted: 07/09/2017] [Indexed: 12/21/2022]
Abstract
Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, MD Anderson Cancer Center, Houston, TX, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne W M Lee
- Center of Clinical Oncology, University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - June Corry
- Radiation Oncology, GenesisCare, St. Vincents's Hospital, Melbourne, Victoria, Australia
| | | | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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