Effect on vestibular function of cochlear implantation by partial deafness treatment–electro acoustic stimulation (PDT–EAS)

Sosna, Magdalena; Tacikowska, Grażyna; Pietrasik, Katarzyna; Skarżyńśki, Henryk; Lorens, Artur

doi:10.1007/s00405-019-05425-5

Cited by 10 publications

(9 citation statements)

References 42 publications

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“…We also confirmed that the RWA is a preferable approach for the preservation of vestibular function (7,8). We compared the frequencies of vestibular preservation between RWA and cochleostomy patients in the literature (Figure 3) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The median preservation rates for RWA and cochleostomy patients were 81 and 61% based on caloric testing, and 63.5 and 39% based on cVEMP, respectively.…”

Section: Discussionmentioning

confidence: 53%

“…Chen et al reported that among the vestibular functions, the semicircular canal function was more frequently damaged ( 19 ). Sonsa et al showed that the frequencies of post-operative damage to these three vestibular functions were almost equal ( 20 ). Our present study showed that saccular function was more frequently damaged post-operatively.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports showed that the frequency of normal preoperative vestibular function in patients who were candidates for CI was about 41-84% based on caloric testing (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), 35-89% based on cVEMP (12,(14)(15)(16)(17)(19)(20)(21)(22)(23), and 50-71% based on oVEMP (19,20,23). In the present study, we found that the pre-operative frequencies of normal vestibular function in patients who received CI were 69.2, 62.1, and 66.7% for caloric testing (semicircular function), cVEMP (saccular function) and oVEMP (utricular function), respectively.…”

Section: Discussionmentioning

confidence: 99%

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Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

Tsukada

Usami

2021

Front. Neurol.

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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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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

Tsukada

Usami

2021

Front. Neurol.

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“…Optimal preservation of residual hearing requires a more atraumatic CI surgery which can be expected to diminish injury to the vestibular organ as well. However, there are indications of some damage to the vestibular receptors of the otolith organs and semicircular canals even when using soft surgery techniques ( 42 ). Insertion speed was found to influence hearing preservation and vestibular function.…”

Section: Discussionmentioning

confidence: 99%

Vestibular Organ and Cochlear Implantation–A Synchrotron and Micro-CT Study

Schart-Morén

Rajan

et al. 2021

Front. Neurol.

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Background: Reports vary on the incidence of vestibular dysfunction and dizziness in patients following cochlear implantation (CI). Disequilibrium may be caused by surgery at the cochlear base, leading to functional disturbances of the vestibular receptors and endolymphatic duct system (EDS) which are located nearby. Here, we analyzed the three-dimensional (3D) anatomy of this region, aiming to optimize surgical approaches to limit damage to the vestibular organ.Material and Methods: A total of 22 fresh-frozen human temporal bones underwent synchrotron radiation phase-contrast imaging (SR-PCI). One temporal bone underwent micro-computed tomography (micro-CT) after fixation and staining with Lugol's iodine solution (I2KI) to increase tissue contrast. We used volume-rendering software to create 3D reconstructions and tissue segmentation that allowed precise assessment of anatomical relationships and topography. Macerated human ears belonging to the Uppsala collection were also used. Drilling and insertion of CI electrodes was performed with metric analyses of different trajectories.Results and Conclusions: SR-PCI and micro-CT imaging demonstrated the complex 3D anatomy of the basal region of the human cochlea, vestibular apparatus, and EDS. Drilling of a cochleostomy may disturb vestibular organ function by injuring the endolymphatic space and disrupting fluid barriers. The saccule is at particular risk due to its proximity to the surgical area and may explain immediate and long-term post-operative vertigo. Round window insertion may be less traumatic to the inner ear, however it may affect the vestibular receptors.

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“…Today patients do not have to suffer from complete deafness, and also candidates with low-frequency residual hearing and unilateral hearing loss are eligible for this treatment (5). Surgery in terms of hearing preservation appears to reduce the postoperative risk of vertigo (6). While age is discussed as a potential risk factor in several studies (7,8), no significant correlation was found regarding gender and etiology of hearing loss (7,9,10).…”

Section: Introductionmentioning

confidence: 99%

Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle

et al. 2021

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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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Effect on vestibular function of cochlear implantation by partial deafness treatment–electro acoustic stimulation (PDT–EAS)

Cited by 10 publications

References 42 publications

Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

Vestibular Organ and Cochlear Implantation–A Synchrotron and Micro-CT Study

Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle

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