Influence of cochlear implantation on the vestibular function (original) (raw)
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Otolaryngology - Head and Neck Surgery, 2008
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.
Frontiers in Neurology, 2021
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, ...
Vertigo following cochlear implantation: a review
Cochlear implantation may cause a detrimental effect on vestibular function and residual hearing. A significant number of patients with a cochlear implant present with vertigo. There are several mechanisms for dizziness following cochlear implantations. The causes may be surgical trauma, disruption of normal cochlear physiology, or ensuing endolymphatic hydrops. Vibratory trauma affecting the cochlea during cochleostomy plays a vital role in causing paroxysmal vertigo in patients with a cochlear implant. In addition, the vibrations affecting the cochlea are enough to dislodge otoconia particles. During cochlear implantation, it is necessary to insert an electrode array into the cochlea and thus the chance of damage to cochlear and function may happen. Dizziness or vertigo may develop after cochlear implantation. It usually occurs due to vestibular hypofunction. Vertigo following cochlear implantation has not frequently been documented in the literature previously. However, the increasing number of cochlear implantations in the current scenario is showing different postoperative complications like vestibular symptoms among patients with an implant. The vestibular symptoms following cochlear implantation range from a gradual sense of mild unsteadiness or lightheadedness to brief attacks of whirling vertigo. Vertigo following cochlear implantations affects the quality of life although vestibular therapy is often helpful to manage this condition. The article aims to provide a comprehensive review of vertigo following cochlear implantation.
Vestibular Symptoms After Cochlear Implantation: Clinical Overview After a 2-YEAR Follow-Up
Journal of hearing science, 2020
Background: Vestibular symptoms and balance disorders are still common complaints reported by the patients after cochlear implantation (CI). Much research has been devoted to assess dizzy patients after cochlear implantation using both self-prepared questionnaires as well as validated life-quality scales. From this work, various approaches to classifying symptoms according to their onset and duration have been recommended. Material and methods: We studied 101 patients after round window approach (RWA) cochlear implantation giving them a self-prepared questionnaire asking them to list their major vestibular complaints formulated according to the consensus document of the Barany Society Committee for the classification of vestibular disorders. Those with persistent symptoms (both postoperatively and existing preoperatively) also filled in a DHI questionnaire. Additionally, cVEMP, oVEMP, caloric, and vHIT tests were performed before and after the CI procedure. Results: The 101 patients...
Vestibular Dysfunction after Cochlear Implantation
Otology & Neurotology, 2003
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.
Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery
Audiology and Neurotology, 2019
Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily af...
Vestibular function after cochlear implant surgery
Cochlear Implants International, 2016
Introduction: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. Methods: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. Results: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. Discussion/Conclusion: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.
Preservation of vestibular function after scala vestibuli cochlear implantation
Auris Nasus Larynx, 2011
A 58-year-old man, in whom the cochlear implant (CI) had been inserted into the left ear, had right middle-ear cancer. The CI was removed immediately before receiving subtotal removal of right temporal bone. Four months later, the CI was again inserted in his left cochlea. Because of obliterated scala tympani, the 22 active electrodes of the CI were placed into the scala vestibuli. After the surgery, the patient complained that he experienced rotary vertigo and ''jumbling of vertical direction'' of objects on walking. Using rotation test, we evaluated vestibular function of remaining left ear. Numerous horizontal nystagmus beats were induced during earth-vertical axis rotation, whereas vertical downbeat nystagmus was scarcely induced during off-vertical axis rotation. The horizontal vestibulo-ocular reflex (VOR) was almost normally induced by sinusoidal stimulation at 0.8 Hz. These data suggest that the scala vestibuli insertion of CI would be not so invasive against the lateral semicircular canal. #
Vestibular dysfunction and postural balance in cochlear implant users: a narrative literature review
Revista CEFAC, 2018
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.