Postural Control and Vestibular Function in Patients Selected for Cochlear Implantation

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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Vestibular Function Modulates the Benefit of Hearing Aids in People With Hearing Loss During Static Postural Control

Ear and Hearing ◽

10.1097/aud.0000000000000720 ◽

2019 ◽

Vol 40 (6) ◽

pp. 1418-1424 ◽

Cited By ~ 4

Author(s):

M. Maheu ◽

L. Behtani ◽

M. Nooristani ◽

M. S. Houde ◽

A. Delcenserie ◽

...

Keyword(s):

Hearing Loss ◽

Postural Control ◽

Hearing Aids ◽

Vestibular Function

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Different Visual Weighting due to Fast or Slow Vestibular Deafferentation: Before and after Schwannoma Surgery

Neural Plasticity ◽

10.1155/2019/4826238 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 2

Author(s):

Fredrik Tjernström ◽

Per-Anders Fransson ◽

Babar Kahlon ◽

Mikael Karlberg ◽

Sven Lindberg ◽

...

Keyword(s):

Postural Control ◽

Spatial Orientation ◽

Visual Cues ◽

Time Course ◽

Vestibular Function ◽

Sensory Systems ◽

Vestibular Loss ◽

Group 3 ◽

Group 2 ◽

Group 1

Background. Feedback postural control depends upon information from somatosensation, vision, and the vestibular system that are weighted depending on their relative importance within the central nervous system. Following loss of any sensory component, the weighting changes, e.g., when suffering a vestibular loss, the most common notion is that patients become more dependent on visual cues for maintaining postural control. Dizziness and disequilibrium are common after surgery in schwannoma patients, which could be due to interpretation of the remaining sensory systems involved in feedback-dependent postural control and spatial orientation. Objective. To compare visual dependency in spatial orientation and postural control in patients suffering from unilateral vestibular loss within different time frames. Methods. Patients scheduled for schwannoma surgery: group 1 (n=27) with no vestibular function prior to surgery (lost through years), group 2 (n=12) with remaining vestibular function at the time of surgery (fast deafferentation), and group 3 (n=18) with remaining function that was lost through gentamicin installations in the middle ear (slow deafferentation). All patients performed vibratory posturography and rod and frame investigation before surgery and 6 months after surgery. Results. Postural control improved after surgery in patients that suffered a slow deafferentation (groups 1 and 3) (p<0.001). Patients that suffered fast loss of remaining vestibular function (group 2) became less visual field dependent after surgery (p≤0.035) and were less able to maintain stability compared with group 1 (p=0.010) and group 3 (p=0.010). Conclusions. The nature and time course of vestibular deafferentation influence the weighting of remaining sensory systems in order to maintain postural control and spatial orientation.

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Does Intracochlear Implantation Jeopardize Vestibular Function?

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949410300805 ◽

1994 ◽

Vol 103 (8) ◽

pp. 609-614 ◽

Cited By ~ 25

Author(s):

Patrick L. M. Huygen ◽

Paul Van Den Broek ◽

Lucas H. M. Mens ◽

Teun H. Spies ◽

Ronald J. C. Admiraal

Keyword(s):

Cochlear Implantation ◽

Vestibular Function ◽

Step Test ◽

Caloric Test ◽

Vestibular Function Tests ◽

Function Tests ◽

Reported Data

We present the results of the vestibular function tests of 35 patients who were selected for cochlear implantation. Vestibular function was evaluated with a caloric test and a velocity step test. The preimplant data were compared to those in previously reported series. Intracochlear implantation was performed in 25 patients. The vestibular complications encountered in this group are presented and discussed. Six patients had normal or residual (but substantial) vestibular function in the ear eligible for implantation. Vestibular function was preserved in 3 patients and was lost in 3 patients, in 1 case through an iatrogenic cause. We estimate the risk of losing vestibular function as a result of intracochlear implantation as between 50% and 60% on the basis of the present and previously reported data.

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Postural control before and after cochlear implantation: Standard cochleostomy versus round window approach

Acta Oto-Laryngologica ◽

10.3109/00016480903373732 ◽

2009 ◽

Vol 130 (6) ◽

pp. 696-701 ◽

Cited By ~ 14

Author(s):

Heinz-Dieter Kluenter ◽

Ruth Lang-Roth ◽

Dirk Beutner ◽

Karl-Bernd Hüttenbrink ◽

Orlando Guntinas-Lichius

Keyword(s):

Postural Control ◽

Cochlear Implantation ◽

Round Window ◽

Before And After ◽

Window Approach

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Vestibular function after cochlear implantation: A test battery and case‐by‐case approach

Laryngoscope Investigative Otolaryngology ◽

10.1002/lio2.413 ◽

2020 ◽

Vol 5 (3) ◽

pp. 560-571

Author(s):

Erin G. Piker ◽

Kristal Riska ◽

Doug Garrison ◽

David M. Kaylie

Keyword(s):

Cochlear Implantation ◽

Vestibular Function ◽

Test Battery

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Vestibular function assessment following cochlear implantation using rotatory chair testing

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-020-06308-w ◽

2020 ◽

Author(s):

Hossam Sanyelbhaa Talaat ◽

Ahmed Ihab Fahime Chedid ◽

Ghada Mohamed Wageih ◽

Ahmed Mahmoud Zein El-Abedein

Keyword(s):

Cochlear Implantation ◽

Vestibular Function ◽

Function Assessment

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Detailed Clinical Features of Deafness Caused by a Claudin-14 Variant

International Journal of Molecular Sciences ◽

10.3390/ijms20184579 ◽

2019 ◽

Vol 20 (18) ◽

pp. 4579 ◽

Cited By ~ 1

Author(s):

Kitano ◽

Kitajiri ◽

Nishio ◽

Usami

Keyword(s):

Hearing Loss ◽

Inner Ear ◽

Cochlear Implantation ◽

Vestibular Function ◽

Sound Field ◽

Speech Discrimination ◽

Epithelial Barrier Function ◽

Pathogenic Variants ◽

Novel Variant ◽

Claudin 14

Tight junctions are cellular junctions that play a major role in the epithelial barrier function. In the inner ear, claudins, occludin, tricellulin, and angulins form the bicellular or tricellular binding of membrane proteins. In these, one type of claudin gene, CLDN14, was reported to be responsible for human hereditary hearing loss, DFNB29. Until now, nine pathogenic variants have been reported, and most phenotypic features remain unclear. In the present study, genetic screening for 68 previously reported deafness causative genes was carried out to identify CLDN14 variants in a large series of Japanese hearing loss patients, and to clarify the prevalence and clinical characteristics of DFNB29 in the Japanese population. One patient had a homozygous novel variant (c.241C>T: p.Arg81Cys) (0.04%: 1/2549). The patient showed progressive bilateral hearing loss, with post-lingual onset. Pure-tone audiograms indicated a high-frequency hearing loss type, and the deterioration gradually spread to other frequencies. The patient showed normal vestibular function. Cochlear implantation improved the patient’s sound field threshold levels, but not speech discrimination scores. This report indicated that claudin-14 is essential for maintaining the inner ear environment and suggested the possible phenotypic expansion of DFNB29. This is the first report of a patient with a tight junction variant receiving a cochlear implantation.

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