Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Otol Neurotol. 2021 Feb 1;42(2):e137-e144. doi: 10.1097/MAO.0000000000002898.
Cochlear implantation (CI) carries a risk of loss of vestibular function following surgery. Thus, vestibular assessment presurgery is used to identify vestibulopathy that may contraindicate implantation and guide in selecting the candidate ear. The aim of this study was to evaluate the clinical implications of preoperative vestibular assessment, and to identify challenges in performing vestibular testing in patients with profound hearing loss, i.e., CI candidates.
Retrospective study of all CI recipients implanted since the introduction of a vestibular screening program.
Tertiary referral center in 2013.
CI candidates routinely underwent testing with the video head impulse test (VHIT) and the cervical vestibular evoked myogenic potential (cVEMP) test as a part of the CI work up.
Three hundred thirty-five individuals were screened before the first CI and 74 individuals before the second CI. In 301 cases (73.6%), the vestibular function was considered normal and consequently carried no contraindications for surgery or implications for choice of ear to be implanted. Bilateral vestibular loss was found in 43 cases (10.5%) and unilateral vestibular loss was found in 62 cases (15.2%). In the latter cases, evaluation of multiple variables was indicated to select candidate ear. In nine implanted patients (2.2%), a relative contraindication to operate based on an "only balancing" ear was overruled by other factors. Vestibular testing was challenged by various factors (e.g., neck immobility, eye tracking issues, communication, and other patient issues), limiting the vestibular data output. This resulted in omittance, testing failure, or interpretation uncertainty 24 times (5.9%) for VHIT and 65 times (15.9%) for cVEMP.
Vestibular screening is an important part of the clinical workup with respect to selection of candidate ear for cochlear implantation, as 15.2% of CI candidates present with unilateral vestibulopathy. Challenges in performing the vestibular tests are not uncommon, as test failure occurred in 15.9% of cases for the cVEMP and 5.9% for the VHIT. The most common reasons for test failure were neck immobility, communication issues, and problems of pupil tracking.
人工耳蜗植入（CI）手术后存在前庭功能丧失的风险。因此，术前进行前庭评估是用于识别可能导致植入禁忌症的前庭疾病，并指导候选耳的选择。本研究的目的是评估术前前庭评估的临床意义，并确定在患有深度听力损失的患者（即 CI 候选者）中进行前庭测试的挑战。
对 2013 年引入前庭筛查计划以来所有接受 CI 植入的患者进行回顾性研究。
三级转诊中心。
CI 候选者常规接受视频头脉冲测试（VHIT）和颈性前庭诱发肌源性电位（cVEMP）测试，作为 CI 检查的一部分。
在第一次 CI 前筛查了 335 人，第二次 CI 前筛查了 74 人。在 301 例（73.6%）中，前庭功能被认为正常，因此不存在手术禁忌症或对植入耳朵的选择有影响。发现双侧前庭丧失 43 例（10.5%），单侧前庭丧失 62 例（15.2%）。在后一种情况下，需要评估多个变量来选择候选耳。在 9 名接受植入的患者（2.2%）中，基于“仅平衡”耳的相对禁忌症被其他因素推翻。前庭测试受到各种因素的挑战（例如，颈部活动受限、眼球跟踪问题、沟通问题和其他患者问题），限制了前庭数据的输出。这导致 VHIT 测试失败或解释不确定 24 次（5.9%），cVEMP 测试失败或解释不确定 65 次（15.9%）。
前庭筛查是选择人工耳蜗植入候选耳的临床评估的重要组成部分，因为 15.2%的 CI 候选者存在单侧前庭病。进行前庭测试并不常见，因为 cVEMP 的测试失败率为 15.9%，VHIT 的测试失败率为 5.9%。测试失败最常见的原因是颈部活动受限、沟通问题和瞳孔跟踪问题。
