Towards a Personalized Vestibular Assessment in Older Patients with Cochlear Implant

Area of Science:

• Otolaryngology
• Audiology
• Geriatrics
• Vestibular Neuroscience

Background:

• Age-related vestibular decline often coexists with hearing loss, increasing vulnerability in older adults undergoing cochlear implantation (CI).
• Older adults have reduced compensatory capacity and more comorbidities, potentially exacerbating postoperative dizziness after CI.
• CI is effective for hearing loss, but its impact on vestibular function in the elderly requires careful evaluation.

Purpose of the Study:

• To compare pre- and postoperative vestibular function in older (≥65 years) versus younger CI patients.
• To identify risk factors for postoperative vestibular deterioration in older adults undergoing CI.
• To inform personalized preoperative counseling for older CI candidates regarding vestibular risks.

Main Methods:

• Monocentric observational study comparing older patients (OPS, ≥65) and younger patients (YPS, <65) undergoing CI.
• Vestibular function assessed preoperatively and one month postoperatively using Dizziness Handicap Inventory (DHI), fall history, clinical exam, video head impulse test (VHIT), bithermal caloric testing, and computerized dynamic posturography (SOT).
• Risk factors for vestibular worsening analyzed using ANOVA and chi-square statistics (p < 0.05).

Main Results:

• Older patients (OPS) exhibited higher preoperative vestibular abnormalities (caloric testing: 55.5% vs. 17.7%) and recurrent falls (33.3% vs. 4.4%) than younger patients (YPS).
• Age ≥ 65 was a significant risk factor for increased dizziness (≥10% DHI worsening; OR 2.2, p < 0.05).
• One month post-CI, younger patients returned to baseline DHI, while older patients had persistent dizziness (DHI scores: 29.2 vs. 12.9). Caloric testing was more sensitive than VHIT for detecting vestibular worsening in OPS.

Conclusions:

• Older age is a significant risk factor for persistent dizziness and vestibular impairment one month after cochlear implantation.
• Vestibular assessment is critical for preoperative decision-making in older adults, especially for CI side selection, due to reduced compensatory capacity.
• Bithermal caloric stimulation is recommended for sensitive detection of vestibular changes; preoperative counseling must address vestibular risks and potential rehabilitation needs for older CI candidates.