Assessment of Vestibular Functions in Cochlear Implant Children
Eman Mohamed Galal Mohamed;
Abstract
Several authors have investigated the effect of cochlear implantation on the vestibular system, with high variability in results.The aim of this study was to study the influence of cochlear implantation on vestibular functions in children in addition to the emphasis on the affection on the functional aspects. The study included 54 children divided into 2 groups; study group comprised of 40 children with severe to profound sensorineural hearing loss and control group comprised of 14 children, both groups were matching as regards age & gender. The most common etiology of HL among study group was the heredofamilial cause (40%) followed by unknown etiology representing (32.5%). Radiological studies showed abnormalities in only 2/40 (5%).
All cases of study group underwent cochlear implantation through round window approach and straight electrode was fully inserted in the scala tympani.
The preoperative parental complaints were history of delayed walking in 12/40 (30%) and imbalance while walking in 4/40 (10%). Then postoperatively, it was found that only onenew case had imbalance and motion sickness after 3 months. The other complaint was the facial nerve stimulation, that was present in 7 /40 (17.5%) of cases which was associated with headache to loud sounds in 2 cases.
Follow up was done for the entire study group twice; 1month and 3-6 months postoperatively by the sametests that were done preoperatively, in addition to the CDP that was done only 3-6 months postoperatively.
Test findings revealedoVEMPabnormalities in11/29 (37.9%) preoperatively that changed postoperatively to 13/29 (45%); denoting minimal utricular affection after CI.
On the other hand, cVEMP showed abnormal responses in 22/40(55%) preoperatively. Then postoperatively, the responses were categorized as either unchanged (stable) or changed (unstable) responses. Regarding the unchanged responses, it constituted the majority of the results (55%). On the contrary, the lost responses in both 1 and 3-6 months postoperative follow up represented 15%(6/ 40) of cases. There were cases with temporarily absent response in only the one month postoperative follow up then the response recovered in 3-6 months postoperative. It represented 15%(6/40). Finally the cases who showed deteriorated absent response at the 3-6 months follow up presented 10/40 (25%) of cases.
Regarding the preoperatively versus the postoperative findings of office tests, results revealed the following increase in abnormalities; for mCTSIB and one leg stance tests abnormalities increased in 12.5%&12.1% respectively. For both BOT and FGI abnormalities increased in 2.8% and 3.9% of cases respectively.
HTT showed abnormalityin 2/40 (5%) of cases that remained the same postoperatively. HST showed no abnormal cases preoperatively, and then only one case (1/40; 2.5%) had abnormal HSTonly in the 1 month follow up. This reflected minimal affection of the SCC-VOR. Fukuda testshowed no abnormal cases detected preoperatively, then 2/ 40(6.7%) of cases showed abnormality postoperatively.
Additionally,CDP was performed at the 3-6 m postoperatively in 25/ 40 children, 6/25 (24 %) showed abnormality in the composite scores. Most of these cases had abnormal cVEMP both pre and postoperatively.
Moreover, 28 out of 40 (70 %) had cVEMP response through the device. The response parameters of cVEMP through the CI showed non-significant difference between latencies of P13 and N23 waves and also amplitude of cVEMP through the CI and regular cVEMP in 1 month and 3-6 months follow up. There was significant correlation between the presence of facial nerve stimulation (FNS) and the presence of cVEMP response through the CI. All the cases suffered from FNS had cVEMP response through the CI.
Accordingly,pediatric cochlear implant candidates have
All cases of study group underwent cochlear implantation through round window approach and straight electrode was fully inserted in the scala tympani.
The preoperative parental complaints were history of delayed walking in 12/40 (30%) and imbalance while walking in 4/40 (10%). Then postoperatively, it was found that only onenew case had imbalance and motion sickness after 3 months. The other complaint was the facial nerve stimulation, that was present in 7 /40 (17.5%) of cases which was associated with headache to loud sounds in 2 cases.
Follow up was done for the entire study group twice; 1month and 3-6 months postoperatively by the sametests that were done preoperatively, in addition to the CDP that was done only 3-6 months postoperatively.
Test findings revealedoVEMPabnormalities in11/29 (37.9%) preoperatively that changed postoperatively to 13/29 (45%); denoting minimal utricular affection after CI.
On the other hand, cVEMP showed abnormal responses in 22/40(55%) preoperatively. Then postoperatively, the responses were categorized as either unchanged (stable) or changed (unstable) responses. Regarding the unchanged responses, it constituted the majority of the results (55%). On the contrary, the lost responses in both 1 and 3-6 months postoperative follow up represented 15%(6/ 40) of cases. There were cases with temporarily absent response in only the one month postoperative follow up then the response recovered in 3-6 months postoperative. It represented 15%(6/40). Finally the cases who showed deteriorated absent response at the 3-6 months follow up presented 10/40 (25%) of cases.
Regarding the preoperatively versus the postoperative findings of office tests, results revealed the following increase in abnormalities; for mCTSIB and one leg stance tests abnormalities increased in 12.5%&12.1% respectively. For both BOT and FGI abnormalities increased in 2.8% and 3.9% of cases respectively.
HTT showed abnormalityin 2/40 (5%) of cases that remained the same postoperatively. HST showed no abnormal cases preoperatively, and then only one case (1/40; 2.5%) had abnormal HSTonly in the 1 month follow up. This reflected minimal affection of the SCC-VOR. Fukuda testshowed no abnormal cases detected preoperatively, then 2/ 40(6.7%) of cases showed abnormality postoperatively.
Additionally,CDP was performed at the 3-6 m postoperatively in 25/ 40 children, 6/25 (24 %) showed abnormality in the composite scores. Most of these cases had abnormal cVEMP both pre and postoperatively.
Moreover, 28 out of 40 (70 %) had cVEMP response through the device. The response parameters of cVEMP through the CI showed non-significant difference between latencies of P13 and N23 waves and also amplitude of cVEMP through the CI and regular cVEMP in 1 month and 3-6 months follow up. There was significant correlation between the presence of facial nerve stimulation (FNS) and the presence of cVEMP response through the CI. All the cases suffered from FNS had cVEMP response through the CI.
Accordingly,pediatric cochlear implant candidates have
Other data
| Title | Assessment of Vestibular Functions in Cochlear Implant Children | Other Titles | تقييم وظائف الجهازالدهليزي في أطفا ل زراعة القوقعة | Authors | Eman Mohamed Galal Mohamed | Issue Date | 2015 |
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