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Published on: October 11, 2024
Vestibular Preservation in Pediatric Cochlear Implantation
Greg R Licameli1,2, Alicia Wang1, Guangwei Zhou1,2
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Insights
Pediatric cochlear implant surgery shows high rates of preserved vestibular function, with most children maintaining normal function post-operation. Modern surgical techniques and electrodes appear to minimize the risk of severe vestibular loss.
Area of Science:
- Otolaryngology
- Neurosurgery
- Pediatric Audiology
Background:
- Vestibular function preservation is a critical consideration in pediatric cochlear implantation.
- Understanding the impact of modern surgical techniques on vestibular outcomes is essential for optimizing patient care.
Purpose of the Study:
- To evaluate the rate of preserved vestibular function in children undergoing cochlear implant surgery.
- To assess the influence of contemporary surgical approaches on vestibular outcomes.
Main Methods:
- Retrospective case review of 44 children (59 implanted ears) over a 4-year period.
- Comparison of pre- and post-operative vestibular function tests, including rotary chair, vestibular evoked myogenic potentials, video head impulse testing, and posturography.
- Analysis of data from a tertiary level pediatric hospital.
Main Results:
- High preservation rates were observed across various vestibular tests: rotary chair (75%), cervical vestibular evoked myogenic potential (75%), ocular vestibular evoked myogenic potential (85.7%), video head impulse testing (100%), and computerized dynamic posturography (100%).
- Overall, 62.5% of patients experienced no new vestibular deficits post-operatively.
- The majority of implants utilized slim, non-styletted electrodes via a round window approach.
Conclusions:
- Pediatric cochlear implant surgery, particularly with modern electrodes and techniques, demonstrates favorable vestibular function preservation rates.
- The risk of new, severe bilateral vestibular loss appears low, suggesting improved surgical safety.
- Further research is recommended to elucidate the specific impacts of different electrode designs and insertion methods on vestibular outcomes.
Objectives:
Evaluate the rate of preserved vestibular function in pediatric cochlear implant surgery.
Study Design:
Retrospective case review.
Methods:
Pre- and post-operative vestibular tests were compared in children who underwent cochlear implantation at a tertiary level pediatric hospital over a 4-year period.
Results:
Data from 59 implanted ears in 44 children was included. Median age was 2.8 years at initial testing (range 7 months - 21 years) with 1:1 male/female ratio. Implant surgeries were 26 unilateral, 13 bilateral simultaneous, and 5 bilateral sequential. The majority were implanted with slim, non-styletted electrodes (86.4%) via a round window approach (91.5%). Normal pre-operative results were preserved post-operatively on rotary chair testing in 75% (21/28) of patients, cervical vestibular evoked myogenic potential testing in (75%) 30/40 of ears tested, ocular vestibular evoked myogenic potential testing in 85.7% (6/7) of ears tested, video head impulse testing in 100% (9/9) of ears tested, and computerized dynamic posturography in 100% (5/5) of patients tested. Overall, 62.5% of patients had no new deficits on any vestibular test performed post-operatively.
Conclusions:
Preservation rates of vestibular function following cochlear implant surgery were higher in this cohort than what has been reported in many earlier studies. Contemporary, less traumatic electrodes and insertion techniques may be a significant factor. The risk of causing a new, severe bilateral vestibular loss with long-term functional impacts appears to be low. Further study is warranted on the impacts of different cochlear implant electrode designs and insertion approaches on post-operative vestibular preservation.
Level Of Evidence:
4, Case Series Laryngoscope, 134:1913-1918, 2024.
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