The Role of Vestibular Caloric Tests in Cochlear Implantation

Parmar, Amit; Savage, Julian; Wilkinson, A; Hajioff, Daniel; Nunez, Desmond A.; Robinson, Philip

doi:10.1177/0194599812442059

Cited by 21 publications

(23 citation statements)

References 18 publications

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“…Ideally, until more is known about how cochlear implantation affects specific vestibular end organs, preoperative testing would identify the weaker ear using a broad panel of tests examining both canal function (such as with head impulse testing or caloric testing) and otolith function (provided by cVEMP and oVEMP tests, respectively). This recommendation is substantially different than may be drawn from another study, which reported that implantation on the stronger side (as measured by calorics) did not increase the chance of subjective dizziness postoperatively and could be used to justify not measuring balance function preoperatively [Parmar et al, 2012]. The conclusions of that article seem too optimistic given the lack of correspondence between symptoms of imbalance and actual balance testing, such as used here, which can quantify fall risk.…”

Section: Mitigation Of Imbalancementioning

confidence: 72%

Short-Term Risk of Falling after Cochlear Implantation

Stevens

Baudhuin

Hullar³

2014

Audiol Neurotol

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Cochlear implantation is a highly effective intervention for hearing loss, but insertion of an implant into the cochlea is often accompanied by loss of residual hearing function. Sometimes, postoperative testing also shows loss of function in the semicircular canals or otolith organs. The effect of this loss on equilibrium, particularly in the short term following surgery, and the risk of falling due to this loss is unknown. We prospectively measured balance in 16 consecutive adult cochlear implant patients before and 2 weeks after surgery. Subjects stood on a foam pad with eyes closed, feet together and arms at the side. The length of time over which this posture could be maintained was recorded up to a maximum value of 30 s indicating normal performance. Ten of 16 subjects reached a maximal time on preoperative testing. Nine of 16 subjects lost balance function after surgery. Four of the 10 subjects with normal preoperative balance function lost function. Subjects older than the age of 60 were more likely to lose balance function than younger subjects. We used previously published values relating balance performance on foam to risk of falling to calculate the fall risk among our subjects. The relative risk of falling increased after surgery by more than threefold in some patients. Imbalance after cochlear implantation may be much more common, particularly in the short term, than previously appreciated. This imbalance is accompanied by an increased risk of falling in many patients. Careful preoperative counseling before implantation and postoperative therapeutic intervention to improve comfort and reduce the chance of falling may be warranted, particularly in patients at a risk for injuries from falls (level of evidence: 2b). i 2014 S. Karger AG, Basel

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Section: Mitigation Of Imbalancementioning

confidence: 72%

Short-Term Risk of Falling after Cochlear Implantation

Stevens

Baudhuin

Hullar³

2014

Audiol Neurotol

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“…As they used bithermal caloric testing, this means that the function of the utricle, saccule, and other semicircular canals was not tested. In addition, caloric testing may not entirely reflect the physiological function of the lateral canal as it mimics only low frequency stimulation [25].…”

Section: Resultsmentioning

confidence: 99%

Association between Hearing Loss and Vestibular Disorders: A Review of the Interference of Hearing in the Balance

Santos¹,

Venosa²,

Sampaio³

2015

IJOHNS

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Introduction: Dizziness is very prevalent and makes a great impact on people's life. Because of anatomical and functional similarities of hearing and vestibular systems, it is noted that there is a big relation between hearing loss and vestibular disorders. Depending on the age onset of hearing loss, it can cause even delay on motor development. Objective: To find literature that demonstrates the relation between hearing and balance. Confirming that hearing loss or even intervention to improve quality of hearing can interfere on vestibular system. Methodology: Revision of literature was carried out, preferring recent research only in English. Conclusion: Cochlea and vestibular systems have a close relationship; changes in one of them can cause big damage in the other. So, a complete evaluation of vestibular system is recommended before ear surgeries. Video Head Impulse Test is a new procedure able to evaluate high frequency movements of the head. It was an additional exam of vestibular status and came to help detect problems that were not diagnosed before. Efforts must be directed in order to protect the balance.

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“…Parmer et al investigated the relationship between post-operative dizziness and cochlear implantation in the ear with the weaker caloric response. 3 These authors found no differences in post-operative dizziness in patients implanted on the side with the weaker caloric response by pre-operative ENG testing. However, they found impaired visual fixation suppression, an indicator of central involvement, to be a major risk factor for post-operative dizziness.…”

Section: Introductionmentioning

confidence: 90%

“…In the setting of asymmetric caloric responses, it has been recommended that the ear with the poorer caloric response should be preferentially selected for cochlear implant so as to preserve the ear with the better vestibular function and minimise postoperative vestibular symptoms. 3 The utility of pre-operative ENG in predicting postoperative vestibular symptoms is unclear. In a retrospective review, Fina et al found no significant difference in pre-operative caloric test results among cochlear implant recipients with and without postoperative dizziness.…”

Section: Introductionmentioning

confidence: 99%