Jiam Nicole T, Cai Yi, Wai Katherine C, Polite Colleen, Kramer Kurt, Sharon Jeffrey D
Department of Otolaryngology-Head and Neck Surgery University of California San Francisco School of Medicine San Francisco California USA.
World J Otorhinolaryngol Head Neck Surg. 2022 Apr 18;9(1):45-52. doi: 10.1002/wjo2.52. eCollection 2023 Mar.
Vestibular dysfunction is a known risk of cochlear implantation (CI). However, the utility of the physical exam to screen CI candidates for vestibular dysfunction is not well-studied. The objective of this study is to evaluate the preoperative role of the clinical head impulse test (cHIT) in subjects undergoing CI surgery evaluation.
We conducted a retrospective review of 64 adult CI candidacy cases between 2017 and 2020 at a tertiary health care center.
All patients underwent audiometric testing and evaluation by the senior author. Patients with an abnormal catch-up saccade contralateral to their worse hearing ear during cHIT were referred for formal vestibular testing. Outcomes included clinical and formal vestibular results, operated ear with regard to audiometric and vestibular results, and postoperative vertigo.
Among all CI candidates, 44% (= 28) reported preoperative disequilibrium symptoms. Overall, 62% (= 40) of the cHITs were normal, 33% (= 21) were abnormal, and 5% (= 3) were inconclusive. There was one patient who presented with a false positive cHIT. Among the patients who endorsed disequilibrium, 43% had a positive preoperative cHIT. Fourteen percent of the subjects (= 9) without disequilibrium had an abnormal cHIT. In this cohort, bilateral vestibular impairment (71%) was more common than unilateral vestibular impairment (29%). In 3% of the cases (= 2), surgical management was revisited or altered due to cHIT findings.
There is a high prevalence of vestibular hypofunction in the CI candidate population. Self-reported assessments of vestibular function are often not congruent with cHIT results. Clinicians should consider incorporating cHITs as part of the preoperative physical exam to potentially avoid bilateral vestibular dysfunction in a minority of patients.
前庭功能障碍是已知的人工耳蜗植入（CI）风险。然而，体格检查用于筛查人工耳蜗植入候选者前庭功能障碍的效用尚未得到充分研究。本研究的目的是评估临床头脉冲试验（cHIT）在接受人工耳蜗植入手术评估的受试者中的术前作用。
研究设计、设置和受试者：我们对2017年至2020年在一家三级医疗中心的64例成人人工耳蜗植入候选病例进行了回顾性研究。
所有患者均接受了听力测试和资深作者的评估。在临床头脉冲试验期间，对听力较差耳的对侧出现异常追随性扫视的患者进行正式的前庭测试。结果包括临床和正式的前庭结果、手术耳的听力和前庭结果，以及术后眩晕情况。
在所有人工耳蜗植入候选者中，44%（=28例）报告有术前平衡失调症状。总体而言，62%（=40例）的临床头脉冲试验结果正常，33%（=21例）异常，5%（=3例）不确定。有1例患者临床头脉冲试验结果呈假阳性。在认可平衡失调的患者中，43%术前临床头脉冲试验结果为阳性。在没有平衡失调的受试者中，14%（=9例）临床头脉冲试验结果异常。在该队列中，双侧前庭功能损害（71%）比单侧前庭功能损害（29%）更常见。在3%（=2例）的病例中，由于临床头脉冲试验结果，重新审视或改变了手术管理方案。
人工耳蜗植入候选人群中前庭功能减退的患病率很高。自我报告的前庭功能评估结果往往与临床头脉冲试验结果不一致。临床医生应考虑将临床头脉冲试验作为术前体格检查的一部分，以可能避免少数患者出现双侧前庭功能障碍。
