Is the clinical head impulse test helpful in cochlear implantation candidacy evaluation?

Area of Science:

• Otolaryngology
• Neurology
• Audiology

Background:

• Vestibular dysfunction is a known risk associated with cochlear implantation (CI).
• The effectiveness of physical examinations in screening CI candidates for vestibular issues is not well-established.
• Preoperative assessment of vestibular function is crucial for managing potential risks of CI surgery.

Purpose of the Study:

• To evaluate the preoperative utility of the clinical head impulse test (cHIT) for screening cochlear implant (CI) candidates.
• To determine the correlation between cHIT results and self-reported vestibular symptoms.
• To assess the impact of cHIT findings on surgical planning for CI.

Main Methods:

• Retrospective review of 64 adult CI candidacy cases (2017-2020).
• All patients underwent audiometric testing and evaluation by the senior author.
• Patients with abnormal cHIT results (abnormal catch-up saccade) were referred for formal vestibular testing.

Main Results:

• 44% of CI candidates reported preoperative disequilibrium.
• 33% of cHITs were abnormal, with 43% of those reporting disequilibrium having a positive cHIT.
• Bilateral vestibular impairment (71%) was more common than unilateral (29%); 3% of cases had surgical management altered due to cHIT findings.

Conclusions:

• Vestibular hypofunction is highly prevalent in the CI candidate population.
• Self-reported vestibular symptoms do not always align with cHIT results.
• Integrating cHIT into preoperative evaluations may help mitigate bilateral vestibular dysfunction in some CI candidates.