Impact of Cochlear Implantation on Canal and Otolith Function

Kwok, Belinda Y C; Rosengren, Sally M.; Kong, Jonathan; Birman, Catherine S.; Hoskisson, Emma; Young, Allison S.; Argaet, Emma C; Fratturo, Luke; Rivas, Cheryl; Greenberg, Simon; Saxby, Alexander J.; Welgampola, Miriam S.

doi:10.1097/mao.0000000000003459

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…Including these tests in future studies could improve the evaluation of postoperative vertigo in patients with MD who have undergone CI. It is known that CI can impact vestibular function [25,46] and aggravate existing MD [25]. Given this background and the fact that our study showed an improvement in vertigo-related impairment based on subjective vertigo assessment, it would be interesting to compare the subjective and objective vertigo assessments in future studies.…”

Section: Limitationsmentioning

confidence: 76%

Long-term outcome of patients with Ménière’s disease following cochlear implantation: a comprehensive outcome study with validated assessment tools

Yılmaz Topçuoğlu,

Plinkert,

Praetorius

et al. 2024

Eur Arch Otorhinolaryngol

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Purpose Patients suffering from Ménière’s disease (MD) experience vertigo, and impairments in hearing and quality of life (QoL). This study aims to investigate the impact of cochlear implantation (CI) on various aspects affecting patients with MD. Methods A single tertiary centre’s CI database for CI recipients with MD between 2014 and 2022 was screened retrospectively. Hearing, vertigo, tinnitus symptoms, and hearing-related QoL were assessed. Pre- and postoperative hearing tests in conjunction with subjective outcome measures by visual analogue scale (VAS) and validated tools such as the Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI) and Nijmegen Cochlear Implant Questionnaire (NCIQ), as well as the assessment of the pre- and postoperative Functional Level Scale (FLS) were examined. Results Eleven ears were included (median age: 59 years at implantation). Following implantation, there was a significant enhancement in Word Recognition Scores at sound levels of 65 dB and 80 dB compared to before treatment (preop vs. 12 months postop: p = 0.012). However, no significant enhancement was observed for 50 dB. MD-related impairments improved significantly postoperatively, as measured by the VAS (vertigo: p = 0.017; tinnitus: p = 0.042), DHI (p = 0.043), THI (p = 0.043) and NCIQ (p < 0.001). The FLS improved significantly (p = 0.020). Conclusion CI has positive effects on all areas examined in our cohort. However, discrimination of speech at low sound pressure levels remained problematic postoperatively. In patients suffering from MD, the prioritized treatment goals include not only improved hearing but also the rehabilitation of vertigo and tinnitus, as well as the enhancement of QoL. Validated instruments are useful screening tools.

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Section: Limitationsmentioning

confidence: 76%

Long-term outcome of patients with Ménière’s disease following cochlear implantation: a comprehensive outcome study with validated assessment tools

Yılmaz Topçuoğlu,

Plinkert,

Praetorius

et al. 2024

Eur Arch Otorhinolaryngol

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“…Table 1 details the demographic, clinical history, post-CI nystagmus, and audiovestibular test results of all 21 patients. Data for three of these patients were previously published in Kwok et al (26), which focused on vestibular function testing and not event monitoring as in the current study.…”

Section: Resultsmentioning

confidence: 99%

“…The average age at post-CI assessment was 55 ± 20 years (range, 17-93 yr). Because there is a high incidence of air-conduction (AC) VEMP loss after CI (26), only bone-conduction (BC) VEMP asymmetry ratio (AR) data (n = 21) were analyzed. Only five patients had preimplant VEMP and vHIT tests available.…”

Section: Audiovestibular Test Resultsmentioning

confidence: 99%

“…All patients underwent case history, neuro-otological examination, vestibular testing comprising 3D vHIT, cVEMP, and oVEMP, and caloric testing, where appropriate. Testing parameters and normative data used for 3D vHIT and VEMP are as detailed in Kwok et al (26). Patients were loaned a pair of vision-denied home video-oculography (VOG) goggles (Neuromed Electronics, Sydney, Australia) to self-record nystagmus during an attack of vertigo at home (21).…”

Section: Eligibility Criteriamentioning

confidence: 99%

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Post Cochlear Implantation Vertigo: Ictal Nystagmus and Audiovestibular Test Characteristics

Kwok,

Young,

Kong

et al. 2023

Otol Neurotol

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Objective To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). Study Design Retrospective and prospective case series. Patients Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. Interventions Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. Main Outcome Measures Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. Results Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s). VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. Conclusion High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.

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“…Finally, we analyzed the otolith function variation on the same cohort subjects and found the same results. A recent study revealed that conventional surgery could injure all five vestibular end-organ functions and the damage of some functions increased with time ( Kwok et al, 2022 ). Conversely, a different tendency was observed in this report.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical techniques in vestibular function preservation in patients with cochlear implants

Wang

Luo²,

Chao³

et al. 2022

Front. Neurosci.

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BackgroundCochlear implantation (CI) is an effective and successful method of treating individuals with severe-to-profound sensorineural hearing loss (SNHL). Coupled with it’s great clinical effectiveness, there is a risk of vestibular damage. With recent advances in surgical approach, modified electrode arrays and other surgical techniques, the potential of hearing preservation (HP) has emerged, in order to preserve the inner ear function. These techniques may also lead to less vestibular damage. However, a systematic study on this at different follow-ups after CI surgery has not been documented before.AimsTo investigate changes of vestibular function systematically in recipients at short and long follow-ups after a minimally invasive CI surgery.MethodsIn this retrospective study, 72 patients (72 ears) with minimally invasive CI were recruited. All participants selected had bilateral SNHL and pre-operative residual hearing (RH) and underwent unilateral CI. They were treated to comprehensive care. All patients underwent vestibular function tests 5 days prior to CI. During the post-operative period, follow-up tests were performed at 1, 3, 6, 9, and 12 months. The contemporaneous results of caloric, cervical vestibular-evoked myogenic potential (cVEMP), ocular vestibular-evoked myogenic potential (oVEMP), and video head impulse (vHIT) tests were followed together longitudinally.ResultsOn the implanted side, the percent fail rate of caloric test was significantly higher than that of vHIT at 1, 3, and 9 months post-operatively (p < 0.05); the percent fail rate of oVEMP was higher than vHIT of superior semicircular canal (SSC), posterior semicircular canal (PSC), or horizontal semicircular canal (HSC) at 1, 3, and 9 months (p < 0.05); at 3 and 9 months, the percent fail rate of cVEMP was higher than that of SSC and PSC (p < 0.05). There were no significant differences in the percent fail rates among all tests at 6 and 12 months post-CI (p > 0.05). The percent fail rates showed decreased trends in caloric (p = 0.319) and HSC tested by vHIT (p = 0.328) from 1–3 to 6–12 months post-operatively. There was no significant difference in cVEMP between 1–3 and 6–12 months (p = 0.597). No significant differences on percent fail rates of cVEMP and oVEMP between short- and long-terms post-CI were found in the same subjects (p > 0.05). Before surgery, the abnormal cVEMP and oVEMP response rates were both lower in patients with enlarged vestibular aqueduct (EVA) than patients with a normal cochlea (p = 0.001, 0.018, respectively).ConclusionThe short- and long-term impacts on the vestibular function from minimally invasive CI surgery was explored. Most of the vestibular functions can be preserved with no damage discrepancy among the otolith and three semicircular canal functions at 12 months post-CI. Interestingly, a similar pattern of changes in vestibular function was found during the early and the later stages of recovery after surgery.

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Impact of Cochlear Implantation on Canal and Otolith Function

Abstract: Supplemental Digital Content is available in the text

Cited by 7 publications

References 21 publications

Long-term outcome of patients with Ménière’s disease following cochlear implantation: a comprehensive outcome study with validated assessment tools

Long-term outcome of patients with Ménière’s disease following cochlear implantation: a comprehensive outcome study with validated assessment tools

Post Cochlear Implantation Vertigo: Ictal Nystagmus and Audiovestibular Test Characteristics

Minimally invasive surgical techniques in vestibular function preservation in patients with cochlear implants

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