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Vestibular Hypofunction Screening in Older Cochlear Implant Candidates
Benjamin D Lovin1, Daniel Gorelik2, Kenny F Lin2
1Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
Summary
Older adults undergoing cochlear implantation (CI) frequently have undiagnosed vestibular hypofunction (VH). Preoperative vestibular screening is crucial for identifying patients at risk of bilateral VH and informing surgical decisions.
Area of Science:
- Neuroscience
- Otolaryngology
- Audiology
Background:
- Vestibular loss is common with aging and hearing loss.
- Cochlear implantation (CI) can worsen or induce vestibular hypofunction (VH).
- Implanting the better-hearing ear may lead to bilateral VH in patients with pre-existing unilateral VH.
Purpose of the Study:
- To evaluate the prevalence of VH in older adults considered for CI.
- To identify CI candidates at higher risk for developing bilateral VH.
- To inform surgical planning and patient counseling regarding CI and vestibular function.
Main Methods:
- Retrospective cohort study (2019-2022) of 60-80 year olds undergoing videonystagmography (VNG).
- VNG included tests for spontaneous nystagmus, cVEMP, caloric stimulation, and rotary chair.
- Patients with prior CI or known vestibular disorders were excluded.
Main Results:
- CI candidates showed higher rates of unilateral VH (cVEMP) and bilateral VH (caloric, rotary chair) compared to controls.
- CI candidates exhibited more presbyvestibulopathy and incomplete vestibular compensation (rotary chair gain/asymmetry).
- Mean VNG measures (slow phase velocity sum, rotary chair gain) were significantly lower in CI candidates.
Conclusions:
- Vestibular hypofunction and incomplete compensation are prevalent in older CI candidates.
- Preoperative vestibular screening is recommended for older CI candidates.
- Screening aids in surgical counseling and planning to mitigate risks of bilateral VH.
