Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery

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.

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A case series shows independent vestibular labyrinthine function after major surgical trauma to the human cochlea

Communications Medicine ◽

10.1038/s43856-021-00036-w ◽

2021 ◽

Vol 1 (1) ◽

Author(s):

Stefan K. Plontke ◽

Torsten Rahne ◽

Ian S. Curthoys ◽

Bo Håkansson ◽

Laura Fröhlich

Keyword(s):

Case Series ◽

Vestibular Function ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Surgical Trauma ◽

Cochlear Function ◽

Receptor System ◽

Tertiary Referral Center ◽

Significant Difference

Abstract Background The receptors for hearing and balance are housed together in the labyrinth of the inner ear and share the same fluids. Surgical damage to either receptor system was widely believed to cause certain permanent loss of the receptor function of the other. That principle, however, has been called into question because there have been anecdotal reports in individual patients of at least partial preservation of cochlear function after major surgical damage to the vestibular division and vice versa. Methods We performed specific objective vestibular function tests before and after surgical trauma (partial or subtotal cochlear removal) for treatment of intracochlear tumors in 27 consecutive patients in a tertiary referral center. Vestibular function was assessed by calorics (low-frequency response of the lateral semicircular canal), vestibulo-ocular reflex by video head impulse test (vHIT) of the three semicircular canals, cervical and ocular vestibular evoked myogenic potentials (cVEMP, saccule and oVEMP, utricle). Preoperative and postoperative distributions were compared with paired t-tests. Results Here we show that there was no significant difference between pre- and post-operative measures for all tests of the five vestibular organs, and that after major surgical cochlear trauma, the vestibular receptors continue to function independently. Conclusions These surprising observations have important implications for our understanding of the function and the surgery of the peripheral auditory and vestibular system in general and open up new possibilities for the development, construction and evaluation of neural interfaces for electrical or optical stimulation of the peripheral auditory and vestibular nervous system.

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The resilience of the inner ear—vestibular and audiometric impact of transmastoid semicircular canal plugging

Journal of Neurology ◽

10.1007/s00415-021-10693-5 ◽

2021 ◽

Author(s):

Joost J. A. Stultiens ◽

Nils Guinand ◽

Vincent Van Rompaey ◽

Angélica Pérez Fornos ◽

Henricus P. M. Kunst ◽

...

Keyword(s):

Semicircular Canal ◽

Bone Conduction ◽

Vestibular Function ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Superior Semicircular Canal Dehiscence ◽

Caloric Response ◽

The Impact

Abstract Background Certain cases of superior semicircular canal dehiscence or benign paroxysmal positional vertigo can be treated by plugging of the affected semicircular canal. However, the extent of the impact on vestibular function and hearing during postoperative follow-up is not known. Objective To evaluate the evolution of vestibular function and hearing after plugging of a semicircular canal. Methods Six patients underwent testing before and 1 week, 2 months, and 6 months after plugging of the superior or posterior semicircular canal. Testing included caloric irrigation test, video Head Impulse Test (vHIT), cervical and ocular Vestibular Evoked Myogenic Potentials (VEMPs) and audiometry. Results Initially, ipsilateral caloric response decreased in all patients and vHIT vestibulo-ocular reflex (VOR) gain of each ipsilateral semicircular canal decreased in 4/6 patients. In 4/6 patients, postoperative caloric response recovered to > 60% of the preoperative value. In 5/6 patients, vHIT VOR gain was restored to > 85% of the preoperative value for both ipsilateral non-plugged semicircular canals. In the plugged semicircular canal, this gain decreased in 4/5 patients and recovered to > 50% of the preoperative value. Four patients preserved cervical and ocular VEMP responses. Bone conduction hearing deteriorated in 3/6 patients, but recovered within 6 months postoperatively, although one patient had a persistent loss of 15 dB at 8 kHz. Conclusion Plugging of a semicircular canal can affect both vestibular function and hearing. After initial deterioration, most patients show recovery during follow-up. However, a vestibular function loss or high-frequency hearing loss can persist. This stresses the importance of adequate counseling of patients considering plugging of a semicircular canal.

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Vestibular Function in Children and Adults Before and After Unilateral or Sequential Bilateral Cochlear Implantation

Frontiers in Neurology ◽

10.3389/fneur.2021.675502 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ruirui Guan ◽

Yanqi Wang ◽

Sasa Wu ◽

Bo Zhang ◽

Jingwu Sun ◽

...

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Low Frequency ◽

Vestibular Function ◽

Head Impulse Test ◽

Caloric Test ◽

Vestibular Evoked Myogenic Potential ◽

Before And After ◽

Adults And Children ◽

Window Approach

Background: Cochlear implantation (CI) helps patients with severe or profound sensorineural hearing loss (SNHL) restore hearing and speech abilities. However, some patients exhibit abnormal vestibular functions with symptoms such as dizziness or balance disorders, after CI. Whether age at CI and CI approach (unilateral or sequential bilateral) affect vestibular functions in users with cochlear implants remains unclear.Objectives: To investigate the vestibular functions in children and adults before and after unilateral or sequential bilateral CI.Materials and Methods: Thirty-seven patients with severe or profound SNHL who were candidates for a first- or second-side CI were divided into three groups: first-side CI-implanted adults (≥18 years), first-side CI-implanted children (6–17 years), and second-side CI-implanted children (6–17 years). All cases were implanted with the round window approach to minimize damage to the intra-cochlear structures. The caloric test, vestibular evoked myogenic potential (VEMP) test, video head impulse test (vHIT), Dizziness Handicap Inventory (DHI), Pediatric Vestibular Symptom Questionnaire (PVSQ), and audiometric tests were performed before and 1 month after CI.Results: The abnormal rates of caloric test and VEMP test after CI in the first-side CI-implanted adults and children significantly increased compared with those before CI. The pre-implantation VEMP test showed significantly higher abnormal rates between first- and second-side CI-implanted children. No other significant differences of abnormal rates between first- and second-side CI-implanted children or between first-side CI-implanted adults and children were found. In second-side CI-implanted children, PVSQ scores significantly increased at day 3 post-implantation but decreased at day 30.Conclusion: CI has a negative effect on the results of caloric and VEMP tests, but not on vHIT, indicating that the otolith and low-frequency semicircular canal (SCC) are more vulnerable to damage from CI. The alterations of vestibular functions resulting from CI surgery may be independent of age at CI and CI approach (unilateral or sequential bilateral). Long-term impacts on the vestibular function from CI surgery, as well as the chronic electrical stimulation to the cochlea, are still to be investigated.

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Objective vestibular function changes in children following cochlear implantation

Journal of Vestibular Research ◽

10.3233/ves-190763 ◽

2021 ◽

pp. 1-9

Author(s):

Ruijie Wang ◽

Xiuhua Chao ◽

Jianfen Luo ◽

Daogong Zhang ◽

Jiliang Xu ◽

...

Keyword(s):

Semicircular Canal ◽

Cochlear Implantation ◽

Vestibular Function ◽

Semicircular Canals ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Caloric Test ◽

Otolith Organs ◽

Deterioration Rate ◽

Vestibular Aqueduct

BACKGROUND: To date, systematically objective evaluations of vestibular function in children with cochlear implantation (CI) have been conducted sparsely, especiallyin children with large vestibular aqueduct syndrome (LVAS). OBJECTIVE: Our goal was to investigate the function of all five vestibular end-organs pre- and post-cochlear implantation in children with LVAS and normal CT. METHODS: In this retrospective cohort study, 34 children (age 4–17 years) with bilateral profound sensorineural hearing loss (SNHL) undergoing unilateral CI were included. Participants included 18 (52.9%) children with LVAS. Objective modalities to evaluate vestibular function included the caloric test, cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP), and video head impulse test (vHIT). All measurements were performed before surgery and 9 months after surgery. RESULTS: Mean age at CI was 8.1±3.7 years. Caloric testing showed hypofunction in 38.2%of cases before implantation and in 50%after (p > 0.05). We found a significant increase of overall abnormality rate in cVEMP and oVEMP from pre- to post-CI (p < 0.05). In all three semicircular canals tested by vHIT, there were no statistically significant mean gain changes (p > 0.05). Higher deterioration rates in cVEMP (53.3%) and oVEMP (52.0%) after surgery were observed (p < 0.05). In children with LVAS, cVEMP revealed a higher deterioration rate than superior semicircular canal (SSC) and posterior semicircular canal (PSC) (p < 0.05). In children with normal CT, the deterioration rates in VEMPs were both higher than those in vHIT (p < 0.05). CONCLUSIONS: In general, the otolith organs were the most affected peripheral vestibular sensors in children after cochlear implantation. The variations in otolith function influenced by CI were different between children with LVAS and normal CT. We recommend the use of this vestibular function test battery for children with cochlear implantation.

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Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

Journal of Vestibular Research ◽

10.3233/ves-200007 ◽

2020 ◽

Vol 30 (6) ◽

pp. 393-399

Author(s):

Yahav Oron ◽

Ophir Handzel ◽

Zohar Habot-Wilner ◽

Keren Regev ◽

Arnon Karni ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Vestibular Function ◽

Pure Tone Audiometry ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse and the cervical vestibular-evoked myogenic potentials (cVEMPs). OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cVEMPs and the vHIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

Frontiers in Neurology ◽

10.3389/fneur.2021.656592 ◽

2021 ◽

Vol 12 ◽

Author(s):

Keita Tsukada ◽

Shin-ichi Usami

Keyword(s):

Cochlear Implantation ◽

Round Window ◽

Surgical Techniques ◽

Vestibular Function ◽

Vestibular Evoked Myogenic Potential ◽

Flexible Electrodes ◽

Caloric Testing ◽

Before And After ◽

Window Approach ◽

Caloric Response

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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Dizziness, Vertigo, and Syndromes of the Medulla

Eye Movement Disorders in Clinical Practice ◽

10.1093/med/9780199921805.003.0008 ◽

2014 ◽

pp. 292-332

Author(s):

Shirley H. Wray

Keyword(s):

Vestibular Function ◽

Semicircular Canals ◽

Clear Distinction ◽

Head Impulse Test ◽

History Taking ◽

Clinical Detail ◽

Full Discussion ◽

Diagnostic Symptoms ◽

Inferior Olivary ◽

Intractable Hiccups

reviews the medulla’s vestibular components (the vestibular, perihypoglossal, and inferior olivary nuclei ), and the components of the vestibular labyrinth (the semicircular canals and the otolith receptors) preparatory to a full discussion of dizziness and vertigo as diagnostic symptoms. The model used for history-taking is extensive and allows for clear distinction to be made between the two symptoms and their implications for risk of stroke. Direction- changing nystagmus as a localizing sign is discussed in depth, and provocative tests to elicit nystagmus by suppression of fixation are presented in clinical detail. The head-thrust (head impulse) test is also described as a simple way to identify a complete unilateral or bilateral loss of vestibular function at the bedside. Medullary syndromes illustrated by case studies include oculopalatal tremor, benign paroxysmal positional vertigo, upbeat and apogeotropic nystagmus, Wallenberg’s syndrome due to infarction of the medulla, and a case of intractable hiccups.

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084 Separating stroke from vestibular neuritis by vestibular function test parameters

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.72 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A27.1-A27

Author(s):

Zeljka Calic ◽

Benjamin Nham ◽

Rachel Taylor ◽

Allison Young ◽

Craig Anderson ◽

...

Keyword(s):

Three Dimensional ◽

Vestibular Function ◽

Vestibular Neuritis ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Saccade Amplitude ◽

Vestibular Tests ◽

Acute Vestibular Syndrome ◽

Significant Difference ◽

Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

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Video Head Impulse Testing (vHIT) and the Assessment of Horizontal Semicircular Canal Function

Journal of the American Academy of Audiology ◽

10.3766/jaaa.14083 ◽

2015 ◽

Vol 26 (05) ◽

pp. 518-523 ◽

Cited By ~ 5

Author(s):

Kristal M. Riska ◽

Owen Murnane ◽

Faith W. Akin ◽

Courtney Hall

Keyword(s):

Semicircular Canal ◽

Objective Assessment ◽

Vestibular Function ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Clinical Test ◽

Horizontal Semicircular Canal ◽

Head Impulse ◽

New Instrument ◽

Qualitative Test

Background: Vestibular function (specifically, horizontal semicircular canal function) can be assessed across a broad frequency range using several different techniques. The head impulse test is a qualitative test of horizontal semicircular canal function that can be completed at bedside. Recently, a new instrument (video head impulse test [vHIT]) has been developed to provide an objective assessment to the clinical test. Questions persist regarding how this test may be used in the overall vestibular test battery. Purpose: The purpose of this case report is to describe vestibular test results (vHIT, rotational testing, vestibular evoked myogenic potentials, and balance and gait performance) in an individual with a 100% unilateral caloric weakness who was asymptomatic for dizziness, vertigo or imbalance. Data Collection and/or Analysis: Comprehensive assessment was completed to evaluate vestibular function. Caloric irrigations, rotary chair testing, vHIT, and vestibular evoked myogenic potentials were completed. Results: A 100% left-sided unilateral caloric weakness was observed in an asymptomatic individual. vHIT produced normal gain with covert saccades. Conclusions: This case demonstrates the clinical usefulness of vHIT as a diagnostic tool and indicator of vestibular compensation and functional status.

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Vestibular function assessment of Susac syndrome patients by the video head impulse test and cervical vestibular-evoked myogenic potentials

Journal of Vestibular Research ◽

10.3233/ves-200720 ◽

2020 ◽

pp. 1-7

Author(s):

Yahav Oron ◽

Ophir Handzel ◽

Zohar Habot-Wilner ◽

Keren Regev ◽

Arnon Karni ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Vestibular Function ◽

Pure Tone Audiometry ◽

Sensorineural Hearing ◽

Vestibular Evoked Myogenic Potentials ◽

Head Impulse Test ◽

Video Head Impulse Test ◽

Head Impulse ◽

Susac Syndrome

BACKGROUND: Susac syndrome (retino-cochleo-cerebral vasculopathy, SuS) is an autoimmune endotheliopathy characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. In contrast to data regarding auditory function, data measuring vestibular function is sparse. OBJECTIVE: To determine whether the video head impulse test (vHIT) can serve as a confirmatory assessment of vestibulocochlear dysfunction in cases of suspected SuS. METHODS: Seven patients diagnosed with SuS underwent pure tone audiometry, a word recognition test, cervical vestibular-evoked myogenic potentials (cVEMPs), and the v-HIT. RESULTS: Five patients were diagnosed with definite SuS, and two with probable SuS. Two patients were asymptomatic for hearing loss or tinnitus, and no sensorineural hearing loss was detected by audiograms. Four patients complained of tinnitus, and three patients reported experiencing vertigo. Three patients had abnormal cVEMPs results. All seven patients’ vHIT results were normal, except for patient #2, who was one of the three who complained of vertigo. The calculated gain of her left anterior semicircular canal was 0.5, without saccades. CONCLUSIONS: This is the first study to describe the results of the vHIT and cVEMPs among a group of patients with SuS. The results suggest that the vHIT should not be the only exam used to assess the function of the vestibular system of SuS patients.

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