Objective vestibular function changes in children following cochlear implantation

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.

scholarly journals Skull Vibration-Induced Nystagmus Test in a Human Model of Horizontal Canal Plugging

2021 ◽  
Vol 11 (3) ◽  
pp. 301-312
Author(s):  
Georges Dumas ◽  
Christol Fabre ◽  
Anne Charpiot ◽  
Lea Fath ◽  
Hella Chaney-Vuong ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Human Model ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Slow Phase ◽  
Caloric Test ◽  
Horizontal Semicircular Canal ◽  
Horizontal Canal ◽  
Tertiary Referral Center

Background/Aim: the aim of this study was to assess the skull vibration-induced nystagmus test (SVINT) results and vestibular residual function after horizontal semicircular canal (HSCC) plugging. Methods: In this retrospective chart review performed in a tertiary referral center, 11 patients who underwent unilateral horizontal semicircular canal plugging (uHSCCP) for disabling Menière’s disease (MD) were included. The skull vibration-induced nystagmus (SVIN) slow-phase velocity (SPV) was compared with the results of the caloric test (CaT), video head impulse test (VHIT), and cervical vestibular-evoked myogenic potentials (cVEMP) performed on the same day. Results: Overall, 10 patients had a strong SVIN beating toward the intact side (Horizontal SVIN-SPV: 8.8°/s ± 5.6°/s), 10 had a significant or severe ipsilateral CaT hypofunction, 10 had an ipsilateral horizontal VHIT gain impairment, and 3 had altered cVEMP on the operated side. Five had sensorineural hearing worsening. SVIN-positive results were correlated with CaT and horizontal VHIT (HVHIT) results (p < 0.05) but not with cVEMP. SVIN-SPV was correlated with CaT hypofunction in % (p < 0.05). Comparison of pre- and postoperative CaT % hypofunction showed a significant worsening (p = 0.028). Conclusion: SVINT results in a human model of horizontal canal plugging are well correlated with vestibular tests exploring horizontal canal function, but not with cVEMP. SVINT always showed a strong lesional nystagmus beating away from the lesion side. SVIN acts as a good marker of HSCC function. This surgical technique showed invasiveness regarding horizontal canal vestibular function.

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.

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

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.

scholarly journals Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery

2019 ◽  
Vol 25 (Suppl. 1-2) ◽  
pp. 50-59 ◽  
Author(s):  
Maurizio Barbara ◽  
Rita Talamonti ◽  
Anna Teresa Benincasa ◽  
Silvia Tarentini ◽  
Chiara Filippi ◽  
...  
Keyword(s):  
Short Form ◽  
Statistical Significance ◽  
Round Window ◽  
Vestibular Function ◽  
Semicircular Canals ◽  
Vestibular Evoked Myogenic Potentials ◽  
Diagnostic Tools ◽  
Head Impulse Test ◽  
Early Assessment ◽  
Window Approach

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.

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

2015 ◽  
Vol 26 (05) ◽  
pp. 518-523 ◽  
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.

scholarly journals vHIT Testing of Vertical Semicircular Canals With Goggles Yield Different Results Depending on Which Canal Plane Being Tested

2021 ◽  
Vol 12 ◽  
Author(s):  
Louise Wittmeyer Cedervall ◽  
Måns Magnusson ◽  
Mikael Karlberg ◽  
Per-Anders Fransson ◽  
Anastasia Nyström ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Vertical Direction ◽  
Semicircular Canals ◽  
Vertical Movement ◽  
Head Impulse Test ◽  
Recording Device ◽  
Prospective Design ◽  
Vertical Semicircular Canal ◽  
Vertical Semicircular Canals

Objective: The use of goggles to assess vertical semicircular canal function has become a standard method in vestibular testing, both in clinic and in research, but there are different methods and apparatus in use. The aim of this study was to determine what the cause of the systematic differences is between gain values in testing of the vertical semicircular canals with two different video head impulse test (vHIT) equipment in subjects with normal vestibular function.Study Design: Retrospective analysis of gain values on patients with clinically deemed normal vestibular function (absence of a corrective eye saccade), tested with either Interacoustics or Otometrics system. Prospective testing of subjects with normal vestibular function with the camera records the eye movements of both eyes. Finally, 3D sensors were placed on different positions on the goggles measuring the actual vertical movement in the different semicircular planes.Results: In the clinical cohorts, the gain depended on which side and semicircular canal was tested (p &lt; 0.001). In the prospective design, the combination between the stimulated side, semicircular canal, and position of the recording device (right/left eye) highly influenced the derived gain (p &lt; 0.001). The different parts of the goggles also moved differently in a vertical direction during vertical semicircular canal testing.Conclusion: The gain values when testing the function of the vertical semicircular canals seem to depend upon which eye is recorded and which semicircular plane is tested and suggests caution when interpreting and comparing results when different systems are used both clinically as well as in research. The results also imply that further research and development are needed to obtain accurate vertical semicircular canal testing, in regard to both methodology and equipment design.

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.

Influence of vestibular rehabilitation on the recovery of all vestibular receptor organs in patients with unilateral vestibular hypofunction

2020 ◽  
Vol 47 (2) ◽  
pp. 227-235
Author(s):  
Anamarija Sestak ◽  
Sinisa Maslovara ◽  
Zeljko Zubcic ◽  
Andrijana Vceva
Keyword(s):  
Vestibular Function ◽  
Vestibular Rehabilitation ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Caloric Test ◽  
Vestibular Hypofunction ◽  
Sf 36 ◽  
Significant Difference ◽  
Different Types ◽  
Vestibular Receptor

BACKGROUND: Only a few studies in the literature demonstrate the effect of vestibular rehabilitation (VR) on all vestibular receptor organs. Furthermore, very little evidence of the effect of VR on isolated otolith dysfunction (IOD) is available. OBJECTIVE: The study aimed to investigate the effect of VR on all vestibular receptor organs in patients with different types of unilateral vestibular hypofunction (UVH). METHODS: We enrolled 80 patients with three different types of UVH; combined and isolated loss of semicircular canal and otolith organ function. All patients performed a 12-week customized program of VR and received a full battery of vestibular function tests, before and after the VR. The DHI and SF-36 were performed before, after 6 weeks, and 12 weeks of the VR. RESULTS: Parameters of the caloric test, video head impulse test, ocular and cervical vestibular evoked myogenic potentials were significantly improved after VR. A total of 59 (74%) patients fully recovered, with no significant difference in recovery regarding the type (p = 0.13) and stage of UVH (p = 0.13). All patients reported significantly lower disability and a better quality of life after the VR based on the DHI and SF-36 score. CONCLUSIONS: Vestibular rehabilitation has a positive effect on the recovery of all vestibular receptor organs and it should be used in patients with IOD.

Agreement between the Skull Vibration-Induced Nystagmus Test and Semicircular Canal and Otolith Asymmetry

2021 ◽  
Author(s):  
Yue Zhang ◽  
Jamie Soper ◽  
Christine M. Lohse ◽  
Scott D.Z. Eggers ◽  
Kenton R. Kaufman ◽  
...  
Keyword(s):  
Semicircular Canal ◽  
Vestibular Function ◽  
Chief Complaint ◽  
Vestibular Evoked Myogenic Potentials ◽  
Caloric Test ◽  
Otolith Organ ◽  
Organ Function ◽  
Test Sensitivity ◽  
Data Collection And Analysis ◽  
Higher Sensitivity

Abstract Background How significant asymmetries in otolith organ function in the presence of symmetrical and asymmetrical semicircular canal function influence skull vibration-induced nystagmus testing (SVINT) has not been well described. Purpose The aim of the study is to examine the agreement between SVINT and caloric testing, ocular vestibular-evoked myogenic potentials (oVEMP), and cervical vestibular-evoked myogenic potentials (cVEMP) for detecting asymmetric vestibular function. Research Design This is a retrospective study of patients presenting with the chief complaint of vertigo, dizziness, or imbalance. Study Sample A total of 812 patients were studied with a median age at testing of 59 years (interquartile range 46–70; range 18–93) and included 475 (59%) women. Intervention Either the monothermal warm caloric test or alternate binaural bithermal caloric test, oVEMP, and cVEMP tests were administered to all patients. All patients underwent the SVINT prior to vestibular laboratory testing. Data Collection and Analysis Agreement between tests categorized as normal versus abnormal was summarized using percent concordance (PC). Sensitivity and specificity values were calculated for SVINT compared with other tests of vestibular function. Results There was higher agreement between ipsilateral and contralateral SVINT with the caloric test (PC = 80% and 81%, respectively) compared with oVEMP (PC = 63% and 64%, respectively) and cVEMP (PC = 76% and 78%, respectively). Ipsilateral and contralateral SVINT showed higher sensitivity for the caloric test (sensitivity = 47% and 36%, respectively) compared with oVEMP (sensitivity = 26% and 21%, respectively), or cVEMP (sensitivity = 33% vs. 27%, respectively). Specificity of SVINT was high (>80%) for all assessments of vestibular function. Conclusion The presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears when making judgments about semicircular canal asymmetry but is less sensitive to asymmetries in otolith organ function.

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

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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