Video head impulse test saccades and loss of cervical vestibular evoked myogenic potentials are late vestibular footprints of cochlear implantation

2020 ◽  
pp. 1-7
Author(s):  
Niels West ◽  
Mads Klokker ◽  
Per Cayé-Thomasen
Keyword(s):  
Cochlear Implantation ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Before And After ◽  
The Mean ◽  
Vestibular Assessment

BACKGROUND: Cochlear implantation may be complicated by concurrent injury to the vestibular apparatus, potentially resulting in disabling vertigo and balance problems. Information on vestibular function before implantation as measured by the video head impulse test (VHIT) and cervical vestibular evoked myogenic potentials (cVEMPs) is scarce and literature on long-term effects is non-existing. OBJECTIVE: We aimed to evaluate how vestibular function was affected by cochlear implantation (CI), as measured by VHIT and cVEMPs in the late phase after implantation. METHODS: Retrospective repeated measurement study. Patients: Among the 436 patients elected for CI surgery during 2013 to 2018, 45 patients met the inclusion criteria (CI recipients with a vestibular assessment prior to the first CI and a repeated vestibular assessment after the CI operation). Intervention: VHIT and cVEMPs before and after cochlear implantation. Main outcome measures were vestibular function as evaluated by VHIT gain, saccades and cVEMPs. RESULTS: The mean time between first and second vestibular screening was 19 months. The mean VHIT gain on implanted ears was 0.79 before the operation and showed no change at follow-up (p = 0.65). Likewise, the number of abnormal VHIT gain values was equal before and after the operation (p = 0.31). Preoperatively, saccades were present on 12 ears (14% ) compared with 25 ears (29% ) postoperatively (p = 0.013) and were associated with significantly lower VHIT gain values. Preoperatively, positive cVEMPs were found in 20 CI ears (49% ) and 24 contralateral ears (62% ). 10 CI ears lost cVEMP postoperatively compared with 2 ears on the contralateral side (p = 0.0047). CONCLUSIONS: Even though VHIT gain has been reported to be affected in the immediate post-implantation period, the findings in this study show that VHIT gain is normalized in the long-term. However, cochlear implantation is associated with the occurrence of VHIT saccades in the long-term and these are associated with lower VHIT gain values. In addition, cVEMP responses are significantly reduced long-term on implanted ears, which agrees with other studies with shorter follow-up.

The Effects of Cochlear Implantation on Vestibular Function

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P60-P60
Author(s):  
Thuy-Anh N. Melvin ◽  
Americo Migliaccio ◽  
John P Carey ◽  
Charles Coleman Della Santina
Keyword(s):  
Cochlear Implantation ◽  
Full Range ◽  
Vestibular Function ◽  
Head Movements ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Vestibular Hypofunction ◽  
Before And After ◽  
Vestibulo Ocular Reflex

Objective 1) Measure vestibular function before and after cochlear implantation (CI) using a battery of tests covering the full range of stimulus frequencies over which the normal angular vestibulo-ocular reflex (VOR) stabilizes gaze. Methods Semicircular canal (SCC) function was assayed using head impulse test during 3-dimensional scleral search coil eye movement recordings (HIT), dynamic visual acuity during rapid head movements (DVA), head-shake nystagmus (HSN), and caloric electronystagmography (ENG). Saccular function was determined using vestibular-evoked myogenic potentials (VEMP). Patient self-assessment via the dizziness handicap inventory (DHI) and clinical head impulse testing (cHIT) were also measured. Results One of 28 post-implanted ears (4%) suffered severe loss of vestibular function in all 3 SCCs. HSN revealed no change in 11 subjects. ENG revealed new hypofunction in 1 of 16 ears (6%). Passive DVA revealed no significant change for 16 implanted ears. VEMP revealed significant increase or disappearance in threshold in 5 of 16 ears (31%). DHI scores were variable and correlated poorly with objective tests. The cHIT performed by one otolaryngologist in 14 subjects exhibited 44% sensitivity and 94% specificity for detection of severe hypofunction confirmed via quantitative HIT. Conclusions CI carries a small but nontrivial risk of iatrogenic vestibular hypofunction in the implanted ear. For bilateral simultaneous-CI, the risk of bilateral vestibular hypofunction is ∼0.16%, comparable to the likelihood of meningitis. The cHIT was highly specific for vestibular hypofunction in this study, but likely depends heavily on the examiner's threshold for abnormal.

scholarly journals Long-Term Vestibular Outcomes in Cochlear Implant Recipients

2021 ◽  
Vol 12 ◽  
Author(s):  
Kasper Møller Boje Rasmussen ◽  
Niels West ◽  
Luchen Tian ◽  
Per Cayé-Thomasen
Keyword(s):  
Cochlear Implantation ◽  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Vestibular Evoked Myogenic Potentials ◽  
Significant Deterioration ◽  
Caloric Irrigation ◽  
Vestibular Tests ◽  
Wide Range

Background: Vestibular dysfunction is likely the most common complication to cochlear implantation (CI) and may, in rare cases, result in persistent severe vertigo. Literature on long-term vestibular outcomes is scarce.Objective: This paper aims to evaluate vestibular dysfunction before and after cochlear implantation, the long-term vestibular outcomes, and follows up on previous findings of 35 consecutive adult cochlear implantations evaluated by a battery of vestibular tests.Methods: A prospective observational longitudinal cohort study was conducted on 35 CI recipients implanted between 2018 and 2019; last follow-up was conducted in 2021. At the CI work-up (T0) and two postoperative follow-ups (T1 and T2), 4 and 14 months following implantation, respectively, all patients had their vestibular function evaluated. Evaluation with a vestibular test battery, involving video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMP), caloric irrigation test, and dizziness handicap inventory (DHI), were performed at all evaluations.Results: vHIT testing showed that 3 of 35 ears had abnormal vHIT gain preoperatively, which increased insignificantly to 4 of 35 at the last follow-up (p = 0.651). The mean gain in implanted ears decreased insignificantly from 0.93 to 0.89 (p = 0.164) from T0 to T2. Preoperatively, 3 CI ears had correction saccades, which increased to 11 at T2 (p = 0.017). Mean unilateral weakness increased from 19 to 40% from T0 to T2 (p < 0.005), and the total number of patients with either hypofunctioning or areflexic semicircular canals increased significantly from 7 to 17 (p < 0.005). Twenty-nine percent of CI ears showed cVEMP responses at T0, which decreased to 14% (p = 0.148) at T2. DHI total mean scores increased slightly from 10.9 to 12.8 from T0 to T1 and remained at 13.0 at T2 (p = 0.368). DHI scores worsened in 6 of 27 patients and improved in 4 of 27 subjects from T0 to T2.Conclusion: This study reports significant deterioration in vestibular function 14 months after cochlear implantation, in a wide range of vestibular tests. vHIT, caloric irrigation, and cVEMP all measured an overall worsening of vestibular function at short-term postoperative follow-up. No significant deterioration or improvement was measured at the last postoperative follow-up; thus, vestibular outcomes reached a plateau. Despite vestibular dysfunction, most of the patients report less or unchanged vestibular symptoms.

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

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.

scholarly journals Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Fumio Uchiyama ◽  
Satoru Murata ◽  
Shiro Onozawa ◽  
Ken Nakazawa ◽  
Fumie Sugihara ◽  
...  
Keyword(s):  
Hepatic Function ◽  
Gastric Varices ◽  
Gastroesophageal Varices ◽  
Before And After ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
The Mean ◽  
Serum Ammonia

Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO) alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO) for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n= 6) or a combination of PTO and BRTO (n= 7). We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

scholarly journals Long-term follow-up of neodymium:YAG laser anterior capsulotomy for the treatment of anterior capsular phimosis

2018 ◽  
Vol 46 (9) ◽  
pp. 3692-3697 ◽  
Author(s):  
Hehua Ye ◽  
Jiming Zhang ◽  
Yiyong Qian
Keyword(s):  
Nd:Yag Laser ◽  
Case Series ◽  
Anterior Capsule ◽  
Long Term Study ◽  
Before And After ◽  
Long Term Follow Up ◽  
The Mean ◽  
Anterior Capsulotomy

Objective To investigate the long-term safety and efficacy of Nd:YAG laser anterior capsulotomy for the treatment of anterior capsular phimosis. Methods We retrospectively analyzed a consecutive case series of Nd:YAG laser anterior capsulotomy in patients with anterior capsular phimosis, who were treated between November 2012 and April 2014. Data collected included risk factors, interval between surgery and capsulotomy, best-corrected visual acuity (BCVA), and diameter of anterior capsule opening before and after Nd:YAG laser anterior capsulotomy. Results Eleven eyes of 11 patients were included in the study. The mean follow-up time was 30.1 ± 4.5 months (range: 26–42 months). At the last follow-up, the mean diameter of the anterior capsule opening was 5.1 ± 0.2 mm, which was significantly greater than the diameter before laser capsulotomy (2.2 ± 0.8 mm). BCVA remained stable or improved in nine eyes (81.8%) following capsulotomy. No patients experienced recurrence of phimosis. Conclusions In a long-term study of >2 years, we found that Nd:YAG laser anterior capsulotomy is safe and effective for the treatment of anterior capsule phimosis.

scholarly journals Case Report: Preservation of Otolithic Function After Triple Semicircular Canal Occlusion in a Patient With Intractable Ménière Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Yuzhong Zhang ◽  
Ying Cheng ◽  
Zichen Chen ◽  
Feiyun Chen ◽  
Qing Zhang
Keyword(s):  
Semicircular Canal ◽  
Present Report ◽  
Vestibular Evoked Myogenic Potentials ◽  
Meniere Disease ◽  
Before And After ◽  
Semicircular Canal Occlusion ◽  
Auditory Functions ◽  
Menière Disease

Operative measures are considered when medical treatment fails to control vertigo in patients with intractable Ménière disease. The present report discusses a case in which triple semicircular canal occlusion was performed in a 30-year-old female patient who responded poorly to previously performed endolymphatic sac surgery. Her vestibular and auditory functions were evaluated both before and after surgery. Class A control of vertigo was achieved during the 76-month postoperative follow-up period. Ocular and cervical vestibular evoked myogenic potentials could be elicited before and after surgery. This case suggests that relatively long-term preservation of otolithic function can be achieved following triple semicircular canal occlusion, highlighting its potential as an alternative treatment for patients with Ménière disease.

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

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.

Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia

2021 ◽  
pp. 019459982110452
Author(s):  
Ramón González-Herranz ◽  
Andrés Navarro-Mediano ◽  
Estefanía Hernández-García ◽  
Guillermo Plaza
Keyword(s):  
Medical Center ◽  
Statistical Significance ◽  
Vocal Folds ◽  
Demographic Variables ◽  
Long Term Results ◽  
Maximum Phonation Time ◽  
Before And After ◽  
The Mean

Objective This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. Study Design Retrospective cohort study. Setting Academic secondary medical center. Methods This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index–10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. Results At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds ( P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. Conclusions AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.

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

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.

Sign in / Sign up

Export Citation Format

Share Document