Hänsel Toni, Gauger Ulrich, Bernhard Nikolai, Behzadi Nina, Romo Ventura Maria Eugenia, Hofmann Veit, Olze Heidi, Knopke Steffen, Todt Ingo, Coordes Annekatrin
Department of Otorhinolaryngology, Head and Neck Surgery, Charité-University Hospital, Campus Benjamin Franklin, Berlin, Germany.
Private Statistical Office, Berlin, Germany.
Laryngoscope. 2018 Sep;128(9):2110-2123. doi: 10.1002/lary.27071. Epub 2018 Jan 4.
Postoperative vertigo is a common complaint after cochlear implantation, but published incidence rates differ vastly. The aim of the present study was to investigate both subjective complaints of vertigo before and after cochlear implantation and related vestibular diagnostic tests on cochlear implant candidates.
We performed a systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in PubMed, Cochrane Register, and EMBASE.
We presented 116 eligible studies investigating subjective complaints of vertigo after cochlear implantation and/or related vestibular diagnostic tests. We conducted three meta-analyses of 46 eligible studies with matched pre- and postoperative data to calculate the odds ratio of new vertigo onset, as well as the impairment of vestibular receptors measured by nystagmography and cervical vestibular evoked myogenic potentials (cVEMP). Postoperative vertigo was calculated from 95 studies and further subdivided by mean age with pooled data.
We observed a significant increase in postoperative vertigo and significant impairment of nystagmography and cVEMP detection. Vertigo after cochlear implantation was reported in 9.3% of the patients with a continuous increase in patient age at surgery. In a subgroup of studies, new onset of vertigo was found in 17.4% of the patients. In addition, 7.2% of the patients had persisting vertigo complaints, whereas 11.6% described an altered vertigo quality and 7.7% had their preoperative complaints resolved. A comparison of round window approach and cochleostomy revealed significantly increased vertigo after cochleostomy. Both insertion methods showed similar effects in nystagmography and cVEMP testing.
Cochlear implantation has a significant impact on subjective vertigo and vestibular receptor function. This is affected by the patient's age at the time of surgery. The surgical technique (round window or cochleostomy) may influence the outcome, but this requires further investigation. Younger patients may compensate better following vestibular dysfunction. Perioperative testing is required to correlate vestibular impairment and subjective complaints. Laryngoscope, 2018 Laryngoscope, 128:2110-2123, 2018.
术后眩晕是人工耳蜗植入术后常见的主诉，但已发表的发病率差异很大。本研究的目的是调查人工耳蜗植入术前和术后眩晕的主观主诉以及人工耳蜗植入候选者的相关前庭诊断测试。
我们根据系统评价和荟萃分析的首选报告项目声明，在PubMed、Cochrane注册库和EMBASE中进行了系统的文献检索。
我们展示了116项符合条件的研究，这些研究调查了人工耳蜗植入术后眩晕的主观主诉和/或相关前庭诊断测试。我们对46项符合条件的研究进行了三项荟萃分析，这些研究具有匹配的术前和术后数据，以计算新发性眩晕发作的比值比，以及通过眼震电图和颈前庭诱发肌源性电位（cVEMP）测量的前庭感受器损伤。术后眩晕由95项研究计算得出，并根据平均年龄和汇总数据进一步细分。
我们观察到术后眩晕显著增加，眼震电图和cVEMP检测显著受损。人工耳蜗植入术后，9.3%的患者报告有眩晕，且随着手术时患者年龄的增加而持续增加。在一组研究中，17.4%的患者出现了新发性眩晕。此外，7.2%的患者有持续性眩晕主诉，而11.6%的患者描述眩晕性质改变，7.7%的患者术前主诉得到缓解。圆窗入路和耳蜗造瘘术的比较显示，耳蜗造瘘术后眩晕显著增加。两种植入方法在眼震电图和cVEMP测试中显示出相似的效果。
人工耳蜗植入对主观眩晕和前庭感受器功能有显著影响。这受到手术时患者年龄的影响。手术技术（圆窗或耳蜗造瘘术）可能会影响结果，但这需要进一步研究。年轻患者在前庭功能障碍后可能有更好的代偿能力。需要进行围手术期测试，以关联前庭损伤和主观主诉。《喉镜》，2018年 《喉镜》，128:2110 - 2123，2018年。
