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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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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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Jang JH, Kim H, Choo OS, Park HY, Choung YH. Changes in Vestibular Symptoms and Function After Cochlear Implantation: Relevant Factors and Correlations With Residual Hearing. Clin Exp Otorhinolaryngol 2020; 14:69-75. [PMID: 32526819 PMCID: PMC7904426 DOI: 10.21053/ceo.2019.01851] [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: 11/12/2019] [Accepted: 03/05/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives The aim of this study was to evaluate vestibular function loss after cochlear implantation (CI) and the relationship between vestibular function and hearing changes. Methods Seventy-five patients with CI were enrolled and divided into those with normal preoperative caloric function (group I) and those with a normal preoperative waveform in cervical vestibular evoked myogenic potential (c-VEMP) testing (group II). The relationship between hearing and changes in the vestibular system was analyzed preoperatively and at 3 and 6 months postoperatively. Results In group I, unilateral weakness on the implanted side was detected in five (7.7%) and eight (12.3%) patients at 3 and 6 months post-CI, respectively. By 3 months post-CI, the total slow-phase velocity (SPV; warm and cold stimulations) was significantly different between the implanted and non-implanted sides (P=0.011), and the shift in total SPV from pre- to post-CI was significantly correlated with the average hearing threshold at 6 months post-CI. In group II, an abnormal c-VEMP was detected on the implanted side in six patients (16.2%) at 3 months post-CI, and in six patients (16.2%) at 6 months post-CI. Significant changes were noticed in the P1 and N1 amplitude at 3 months postCI (P=0.027 and P=0.019, respectively). Conclusion Vestibular function and residual hearing function should be afforded equal and simultaneous consideration in terms of preservation.
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Affiliation(s)
- Jeong Hun Jang
- Department of Otorhinolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hantai Kim
- Department of Otorhinolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Oak-Sung Choo
- Department of Otorhinolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Hun Yi Park
- Department of Otorhinolaryngology, Ajou University School of Medicine, Suwon, Korea
| | - Yun-Hoon Choung
- Department of Otorhinolaryngology, Ajou University School of Medicine, Suwon, Korea.,BK21 Plus Research Center for Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
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Abstract
Sensorineural hearing loss (SNHL) in children occurs in 1 to 3% of live births and acquired hearing loss can additionally occur. This sensory deficit has far reaching consequences that have been shown to extend beyond speech and language development. Thankfully there are many therapeutic options that exist for these children with the aim of decreasing the morbidity of their hearing impairment. Of late, focus has shifted beyond speech and language outcomes to the overall performance of children with SNHL in real-world environments. To account for their residual deficits in such environments, clinicians must understand the extent of their sensory impairments. SNHL commonly coexists with other sensory deficits such as vestibular loss. Vestibular impairment is exceedingly common in children with SNHL with nearly half of children exhibiting vestibular end-organ dysfunction. These deficits naturally lead to impairments in balance and delay in motor milestones. However, this additional sensory deficit likely leads to further impairment in the performance of these children. This article focuses on the following: 1. Defining the coexistence of vestibular impairment in children with SNHL and cochlear implants. 2. Describing screening methods aimed at identifying vestibular dysfunction in children with SNHL. 3. Understanding the functional implications of this dual-sensory impairment. 4. Exploring possible rehabilitative strategies to minimize the impact of vestibular impairment in children with SNHL.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Cochlear Implant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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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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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: 59] [Impact Index Per Article: 8.4] [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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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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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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Investigation of Balance Function Using Dynamic Posturography under Electrical-Acoustic Stimulation in Cochlear Implant Recipients. Int J Otolaryngol 2010; 2010:978594. [PMID: 20671908 PMCID: PMC2910489 DOI: 10.1155/2010/978594] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 05/04/2010] [Accepted: 05/11/2010] [Indexed: 11/26/2022] Open
Abstract
Introduction. The purpose of the present study is to investigate the effect of electrical-acoustic stimulation on vestibular function in CI patients by using the EquiTest and to help answer the question of whether electrically stimulating the inner ear using a cochlear implant influences the balance system in any way. Material and Methods. A test population (n = 50) was selected at random from among the cochlear implant recipients. Dynamic posturography (using the EquiTest) was performed with the device switched off an switched on. Results. In summary, it can be said that an activated cochlear implant affects the function of the vestibular system and may, to an extent, even lead to a stabilization of balance function under the static conditions of dynamic posturography, but nevertheless also to a significant destabilization. Significant improvements in vestibular function were seen mainly in equilibrium scores under conditions 4 and 5, the composite equilibrium score, and the vestibular components as revealed by sensory analysis. Conclusions. Only under the static conditions are significantly poorer scores achieved when stimulation is applied. It may be that the explanation for any symptoms of dizziness lies precisely in the fact that they occur in supposedly noncritical situations, since, when the cochlear implant makes increased demands on the balance system, induced disturbances can be centrally suppressed.
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Niemczyk K, Olejniczak A, Kaczorowska M, Mikołajewska L, Pierchała K, Morawski K, Paprocki A. [Vestibular function in cochlear implant candidates]. Otolaryngol Pol 2009; 63:168-70. [PMID: 19681491 DOI: 10.1016/s0030-6657(09)70101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The main problem of a deaf patient is per se communication process. Some of the patients, who are candidates to cochlear implantation report vertigo or imbalance in some everyday situations. The relation of patients' complaints to vestibular loss was evaluated. The authors used electronystagmography which was realized in diagnostic process to cochlear implantation. The results come from the patients diagnosed in our department in 2006-2007. In accordance to the literature, the true vertigo, was rather rare. MATERIAL AND METHODS Medical history, caloric tests as electronystagmography results were evaluated retrospectively in 47 patients qualified for cochlear implantation in 2006-2007. RESULTS In the study group, 25 patients did not complain of vertigo; with symmetrical calorics in 10 subjects (40%). The true vertigo reported 6 subjects; 8 subjects had imbalance and unsteadiness on walking. In the group of 47 subjects 8 of them complainted the both- vertigo and imbalance. In the ENG of this group the results of symmetrical responces were evaluated in 57% cases and vestibular hypofunction in 43% subjects. In the group with vertigo (6), 4 subjects (66%) had diagnosed unilateral hypofunction, 1 (17%) bilateral areflexion, 1 subject (17%) had symmetrical responses. CONCLUSIONS The necessity of the confrontation ENG results to additional examination in audiological part of diagnostic process to cochlear implantation is underlined.
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Todt I, Basta D, Ernst A. Does the surgical approach in cochlear implantation influence the occurrence of postoperative vertigo? Otolaryngol Head Neck Surg 2008; 138:8-12. [DOI: 10.1016/j.otohns.2007.09.003] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 07/02/2007] [Accepted: 09/05/2007] [Indexed: 10/21/2022]
Abstract
Objective To investigate the impact of different cochleostomy techniques on vestibular receptor integrity and vertigo after cochlear implantation. Study Design Retrospective cohort study. Subjects A total of 62 patients (17 to 84 years of age) underwent implantation via an anterior or round window insertion approach. Methods Two groups of cochlear implant patients were compared with respect to their pre- and postoperative vestibular function and the occurrence of postoperative vertigo. The data were related to the different cochleostomy techniques. The patients were tested by a questionnaire (dizziness handicap inventory, DIH), caloric irrigation (vestibulo-ocular reflex, VOR) for the function of the lateral SCC and by vestibular evoked myogenic potential (VEMP) recordings for saccular function. RESULTS: Significant differences of postoperative VEMP responses (50% vs 13%) and electromystagmography (ENG) results (42.9% vs 9.4%) were found with respect to the 2 different insertion techniques. The number of patients with vertigo after the surgery as evidenced by DHI (23% vs 12.5%) was significantly different. Conclusion The used round window approach for electrode insertion should be preferred to decrease the risk of loss of vestibular function and the occurrence of vertigo.
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Affiliation(s)
- Ingo Todt
- Department of Otolaryngology at UKB, Hospital of the University of Berlin, Berlin, Germany
| | - Dietmar Basta
- Department of Otolaryngology at UKB, Hospital of the University of Berlin, Berlin, Germany
| | - Arne Ernst
- Department of Otolaryngology at UKB, Hospital of the University of Berlin, Berlin, Germany
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Zanetti D, Campovecchi CB, Balzanelli C, Pasini S. Paroxysmal positional vertigo after cochlear implantation. Acta Otolaryngol 2007; 127:452-8. [PMID: 17453469 DOI: 10.1080/00016480600951442] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
CONCLUSIONS We observed 4 cases of paroxysmal positional vertigo (PPV) among 62 cochlear implant (CI) recipients. They occurred in the implanted ear without chronological relation with the surgical procedure or the implant's activation. All of them relapsed within 3 months after an initially successful repositioning maneuver, and finally recovered after the second one. None of the patients showed labyrinthine weakness in the implanted ear. The outbreak of PPV did not affect the patients' speech perception performances. OBJECTIVES To report and discuss the occurrence of PPV after cochlear implantation. PATIENTS AND METHODS Among 32 adult patients who received a Nucleus CI, 4 suffered from PPV on the basis of Dix-Hallpike's maneuvers. After a Semont's repositioning maneuver, recurrences were similarly addressed. An electro-nystagmography (ENG) recording of caloric irrigation tests was obtained once the symptoms subsided. RESULTS The observed incidence of 12.5% exceeds the figures reported in the literature. No anatomic abnormalities were identified in these patients, nor were any intraoperative or postoperative complications reported. PPV developed 1-12 months after CI surgery in the posterior canal and relapsed within 3 months. ENG showed a normal reflectivity in two patients, while the other two had a significant prevalence of the implanted side. The outcomes of the speech perception tests after CI in all the four patients matched those of their corresponding categories.
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Affiliation(s)
- Diego Zanetti
- Otolaryngology Department, University of Brescia, Piazzale Spedali Civili 1, 5100 Brescia, Italy.
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Handzel O, Burgess BJ, Nadol JB. Histopathology of the Peripheral Vestibular System after Cochlear Implantation in the Human. Otol Neurotol 2006; 27:57-64. [PMID: 16371848 DOI: 10.1097/01.mao.0000188658.36327.8f] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to describe the histology of the peripheral vestibular system in temporal bones from patients who in life had undergone cochlear implantation and to correlate the findings with previous reports of vestibular dysfunction after cochlear implantation. This is the first quantitative report of the impact of implantation on the vestibular neuronal end organ. METHODSThere were 19 temporal bones available for histologic study. Of these, 17 were suitable for the description of the morphology of the membranous labyrinth, 8 for counting Scarpa's ganglion cells, and 6 for measuring the densities of vestibular hair cells. The bones were fixed, cut, and stained according to previously published methods. Preferably, the implanted electrode was left in situ. Vestibular hair cells were counted with Nomarski's optics. RESULTS Differences in Scarpa's ganglion cell counts and hair cell densities between the implanted and nonimplanted sides were not statistically significant. In 59% of the implanted bones, the cochlea was hydropic, and in the majority of these bones the saccule was collapsed. CONCLUSION Cochlear implantation does not cause deafferentation of the peripheral vestibular system. Cochlear hydrops accompanied by saccular collapse is common and may cause attacks of vertigo of delayed onset, similar to Ménière's syndrome as previously reported in several clinical series. Hydrops could be caused by obstruction of endolymphatic flow in the ductus reuniens or in the hook portion of the cochlea or by damage to the lateral cochlear wall caused by implantation.
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Affiliation(s)
- Ophir Handzel
- Department of Otology and Laryngology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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Karam HH, Ghaleb F, El-Latif YA. TOWARDS FAST AND SMOOTH SUBDIVISION SURFACE RECONSTRUCTION. INTERNATIONAL JOURNAL OF COMPUTERS AND APPLICATIONS 2006; 28. [DOI: 10.2316/journal.202.2006.2.202-1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
OBJECTIVES/HYPOTHESIS Cochlear implantation (CI) carries with it the potential risk for vestibular system insult or stimulation with resultant dysfunction. As candidate profiles continue to evolve and with the recent development of bilateral CI, understanding the significance of this risk takes on an increasing importance. STUDY DESIGN Between 1997 to 2001, a prospective observational study was carried out in a tertiary care medical center to assess the effects of unilateral CI on the vestibular system. METHODS Assessment was performed using the dizziness handicap inventory (DHI), vestibulo-ocular reflex (VOR) testing using both alternate bithermal caloric irrigations (ENG) and rotational chair-generated sinusoidal harmonic accelerations (SHA), and computerized dynamic platform posturography (CDP) at preoperative, 1-month, 4-month, 1-year and 2-year postimplantation visits. CI was carried out without respect to the preoperative vestibular function test results. RESULTS Specifically, 86 patients were entered into the study after informed consent. For the group as a whole, pair wise comparisons revealed few significant differences between preoperative and postoperative values for VOR testing (ENG and SHA) at any of the follow-up intervals. Likewise, DHI testing was also unchanged except for significant reductions (improvements) in the emotional subcategory scores at both the 4-month and 1-year intervals. CDP results demonstrated substantial improvements in postural sway in the vestibular conditions (5 and 6) as well as composite scores with the device "off" and "on" at the 1-month, 4-month, 1-year, and 2-year intervals. Device activation appeared to improve postural stability in some conditions. Excluding those patients with preoperative areflexic or hyporeflexic responses in the implanted ear (total [warm + cool] caloric response <or= 15 deg/s), substantial reductions (>or=21 deg/s maximum slow phase velocity) in total caloric response were observed for 8 (29%) patients at the 4-month interval. These persisted throughout the study period. These changes were accompanied by significant low frequency phase changes on SHA testing confirming a VOR insult. Of interest, no significant changes were detected in the DHI or CDP, and there were no effects of age, sex, device manufacturer, or etiology of hearing loss (HL) for these patients. CONCLUSIONS Unilateral CI rarely results in significant adverse effects on the vestibular system as measured by the DHI, ENG, SHA, and CDP. On the contrary, patients that underwent CI experienced significant improvements in the objective measures of postural stability as measured by CDP. Device activation in music appeared to have an additional positive effect on postural stability during CDP testing. Although VOR testing demonstrated some decreases in response, patients did not suffer from disabling vestibular effects following CI. The mechanism underlying these findings remains speculative. These findings should be considered in counseling patients about CI.
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Affiliation(s)
- Craig A Buchman
- Department of Otolaryngology, University of North Carolina at Chapel Hill, 27599-7600, USA.
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Fina M, Skinner M, Goebel JA, Piccirillo JF, Neely JG, Black O. Vestibular dysfunction after cochlear implantation. Otol Neurotol 2003; 24:234-42; discussion 242. [PMID: 12621338 DOI: 10.1097/00129492-200303000-00018] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence, symptom characteristics, and potential risk factors for vestibular symptoms after cochlear implantation. STUDY DESIGN Case-control study design embedded within an ongoing cohort of patients undergoing implantation. SETTING Academic medical center cochlear implant research program funded by the National Institutes of Health. PATIENTS Seventy five eligible consecutive patients undergoing cochlear implantation. INTERVENTION Medical record review. MAIN OUTCOME MEASURE Recorded symptoms of vestibular symptoms after cochlear implantation. Subjects with vestibular symptoms were considered case subjects; those without vestibular symptoms were considered control subjects. RESULTS Twenty-nine of 75 (39%) patients experienced dizziness postoperatively. Four patients experienced a single, transient acute vertigo attack occurring less than 24 hours after surgery. The majority, 25 patients, experienced delayed, episodic onset of vertigo. The median (interquartile range) time of delayed onset was 74 (26-377) days after implantation. Delayed dizziness manifested as spontaneous episodic or positional vertigo. Preoperative dizziness, age at implantation, and age at onset of hearing loss were significantly greater in the dizzy group. Preoperative electronystagmography did not differentiate between groups. CONCLUSIONS Thirty-nine percent (29/75) of subjects with implants were dizzy after implantation. The majority of subjects experienced dizziness in a delayed episodic fashion. Dizziness was not related to implant activation. It seemed that delayed dizziness was not related to immediate surgical intervention but could result from chronic changes occurring in the inner ear; there was some suggestion this could take the form of endolymphatic hydrops.
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Affiliation(s)
- Manuela Fina
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Campus Box 8115, 660 S. Euclid Ave. St. Louis, MO 63110, USA
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Vibert D, Häusler R, Kompis M, Vischer M. Vestibular function in patients with cochlear implantation. ACTA OTO-LARYNGOLOGICA. SUPPLEMENTUM 2002; 545:29-34. [PMID: 11677737 DOI: 10.1080/000164801750388063] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The aim of this work was to determine the influence of cochlear implantation (CI) on vestibular canal and otolithic function. Between 1995 and 1999, 15 patients (6 females, 9 males; 9-77 years old) underwent a vestibular examination before and after CI. Electronystagmography was performed between 5 and 8 days after CI in 9 patients, and with a time delay of 2-24 months in 10 patients. Pre- and postoperative evaluation included electronystagmography with caloric (44 degrees C, 30 degrees C, ice-water) and pendular rotatory testing. Otolithic function was measured postoperatively using off-vertical axis rotation (OVAR) in six patients. Preoperative data (n = 14) showed areflexia on caloric and rotatory pendular testing in deafness cases due to meningitis (n = 2) and in 2/5 patients with sudden idiopathic bilateral deafness. Two patients suffering from an idiopathic deafness had a unilateral hyporeflexia. Vestibular function was normal in the other eight patients. Immediately following CI, among patients with normal preoperative canal function, three developed vertiginous symptoms with spontaneous nystagmus, which disappeared within days to weeks. Later, postoperative canal evaluation was normal in 5/8 patients (62%) with initially preserved vestibular function: areflexia was measured ipsilaterally to the implanted ear in 1 patient and contralaterally in 2 patients. Hyporeflexia was measured ipsilateral to the implanted ear in two patients. OVAR examination, performed 2-19 months after surgery, showed a preserved otolithic function in all 6 tested patients. Transient vertigo on electrical CI stimulation was described in only one patient during the first postoperative weeks. The following conclusions can be drawn. Patients with deafness due to meningitis had an eradicated vestibular function. In other etiologies, vestibular function was most often preserved. CI did not usually abolish vestibular function, but the canal function was disturbed temporarily in 20% of cases. Otolithic function was preserved in all six CI patients tested in this series.
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Affiliation(s)
- D Vibert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University of Berne, Berne, Switzerland.
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Szirmai A, Ribári O, Répássy G. Air caloric computer system application in monitoring vestibular function changes after cochlear implantation. Otolaryngol Head Neck Surg 2001; 125:631-4. [PMID: 11743466 DOI: 10.1067/mhn.2001.120429] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The computer-based ENG system's analytical routine refinements are available only in research laboratories. The computer-based system contains a stimulator for saccadic eye-movement and an air caloric stimulator interconnected to the registration program and analysis software. Several authors have reported the preoperative and postoperative vestibular functions in cochlear implant patients. The safe examination of the operated ear and comparison of the preoperative and postoperative average slow phase velocities of the caloric nystagmus is possible using the air caloric computer system. METHODS The authors have used a computer-based ENG system with caloric air stimulation, which is very useful for examination of the operated ear. The vestibular system of patients with total deafness was examined before and after the cochlear implantation. The results of 60 vestibular examinations of 64 patients are reported. RESULTS The vestibular function in the operated ear was found unchanged in 20 patients. In 14 patients the vestibular function was worse. In 16 patients the postoperative vestibular responsiveness improved. The detailed data analysis of 10 patients in whom preoperative and postoperative vestibular examination was similar was performed by the authors. The preoperative and postoperative average slow phase velocity values and the relative canal paresis was observed. The values demonstrated that the caloric responsiveness of the operated ear improved in few cases. CONCLUSIONS The computer-based air caloric system is a useful and safe method in evaluation of the vestibular system changes after ear surgery. The reason of the improvement of vestibular responsiveness is not clear. The results need further investigation to solve the problem of vestibular responsiveness improvement after cochlear implantation.
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Affiliation(s)
- A Szirmai
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Semmelweis University, H-1083, Szigony u. 36, Budapest, Hungary
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