The effects of cochlear implantation on vestibular function

Thuy Anh N Melvin, Charles Coleman Della Santina, John P Carey, Americo A. Migliaccio

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Determine the risk posed by cochlear implantation (CI) to the labyrinth. STUDY DESIGN: Prospective cohort study. SETTING: Academic tertiary referral center. PATIENTS: Thirty-six ears belonging to 35 adult CI candidates (mean age, 46 yr; range, 23-69 yr). INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Vestibular function was assessed using the quantitative 3-dimensional head impulse test (qHIT), clinical head impulse test (cHIT), post-head shake nystagmus, caloric electronystagmography, vestibular-evoked myogenic potentials, dynamic visual acuity, and Dizziness Handicap Inventory. RESULTS: All 36 ears were tested using qHIT before CI, and 28 ears were tested 4 to 8 weeks after CI. qHIT showed that 1 of 28 ears had reduced function. cHIT was 44% sensitive and 94% specific for identification of severe-to-profound vestibular hypofunction confirmed by qHIT. Post-head shake nystagmus was unchanged in 11 of 11 subjects. New hyporeflexia was found in 1 of 16 electronystagmography-tested ears. Vestibular-evoked myogenic potential showed either a disappearance of response or an increase in threshold by greater than 10 dB in 5 of 16 ears. Passive dynamic visual acuity showed no change in 16 of 16 ears. Dizziness Handicap Inventory scores worsened in 3 of 28 and improved in 4 of 28 subjects. CONCLUSION: Although small, the observed rate of labyrinthine injury was comparable to that for other risks of CI. Thus, it is important to educate CI candidates regarding possible risk to balance function, particularly when CI of an "only balancing ear" is contemplated. cHIT is useful for detecting severe high-frequency vestibular hypofunction and should be part of the pre-CI physical examination.

Original languageEnglish (US)
Pages (from-to)87-94
Number of pages8
JournalOtology and Neurotology
Volume30
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Head Impulse Test
Cochlear Implantation
Ear
Vestibular Evoked Myogenic Potentials
Electronystagmography
Dizziness
Visual Acuity
Head
Physiologic Nystagmus
Equipment and Supplies
Abnormal Reflexes
Inner Ear
Tertiary Care Centers
Physical Examination
Cohort Studies
Prospective Studies

Keywords

  • Balance
  • Cochlear implant
  • Dynamic visual acuity
  • Electronystagmography
  • Head impulse test
  • Head shake nystagmus
  • Vestibular-evoked myogenic potential

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology
  • Sensory Systems
  • Medicine(all)

Cite this

The effects of cochlear implantation on vestibular function. / Melvin, Thuy Anh N; Della Santina, Charles Coleman; Carey, John P; Migliaccio, Americo A.

In: Otology and Neurotology, Vol. 30, No. 1, 01.2009, p. 87-94.

Research output: Contribution to journalArticle

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N2 - OBJECTIVE: Determine the risk posed by cochlear implantation (CI) to the labyrinth. STUDY DESIGN: Prospective cohort study. SETTING: Academic tertiary referral center. PATIENTS: Thirty-six ears belonging to 35 adult CI candidates (mean age, 46 yr; range, 23-69 yr). INTERVENTION: Cochlear implantation. MAIN OUTCOME MEASURES: Vestibular function was assessed using the quantitative 3-dimensional head impulse test (qHIT), clinical head impulse test (cHIT), post-head shake nystagmus, caloric electronystagmography, vestibular-evoked myogenic potentials, dynamic visual acuity, and Dizziness Handicap Inventory. RESULTS: All 36 ears were tested using qHIT before CI, and 28 ears were tested 4 to 8 weeks after CI. qHIT showed that 1 of 28 ears had reduced function. cHIT was 44% sensitive and 94% specific for identification of severe-to-profound vestibular hypofunction confirmed by qHIT. Post-head shake nystagmus was unchanged in 11 of 11 subjects. New hyporeflexia was found in 1 of 16 electronystagmography-tested ears. Vestibular-evoked myogenic potential showed either a disappearance of response or an increase in threshold by greater than 10 dB in 5 of 16 ears. Passive dynamic visual acuity showed no change in 16 of 16 ears. Dizziness Handicap Inventory scores worsened in 3 of 28 and improved in 4 of 28 subjects. CONCLUSION: Although small, the observed rate of labyrinthine injury was comparable to that for other risks of CI. Thus, it is important to educate CI candidates regarding possible risk to balance function, particularly when CI of an "only balancing ear" is contemplated. cHIT is useful for detecting severe high-frequency vestibular hypofunction and should be part of the pre-CI physical examination.

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