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Otology/Neurotology

(541) Vestibular Assessments Predict Intraoperative Pathology but Not Cochlear Implantation Outcomes

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Ari Saravia, MD

    Resident
    University of Alabama Birmingham Department of Otolaryngology - Head and Neck Surgery, LSUHSC School of Medicine
    New Orleans, Louisiana, United States

    • Co-Author(s)

  • Sara E. Bressler, MD

    Fellow
    Department of Otolaryngology, Childrens National Hospital, Washington DC
    Washington, District of Columbia, United States

  • Moises A. Arriaga, MD, MBA

    Clinical Professor of Otolaryngology and Neurosurgery
    Louisiana State University Health Sciences Center Department of Otolaryngology-Head and Neck Surgery, New Orleans, LA
    Metairie, Louisiana, United States

  • RM

    Rahul Mehta, MD, MS, FRCS

    Associate Professor
    Louisiana State University Health Sciences Center Department of Otolaryngology-Head and Neck Surgery, New Orleans, LA
    Baton Rouge, Louisiana, USA

  • AM

    Anne K. Maxwell, MD

    Assistant Professor
    University of Nebraska Medical Center Department of Otolaryngology-Head and Neck Surgery, Omaha, NE
    Omaha, Nebraska, United States

    • Senior Author(s)

  • AM

    Anne K. Maxwell, MD

    Assistant Professor
    University of Nebraska Medical Center Department of Otolaryngology-Head and Neck Surgery, Omaha, NE
    Omaha, Nebraska, United States

Disclosure(s):
Ari Saravia, MD: No relevant relationships to disclose.
Sara E. Bressler, MD: No relevant relationships to disclose.
Moises A. Arriaga, MD, MBA: No relevant relationships to disclose.
Anne K. Maxwell, MD: No relevant relationships to disclose.


Introduction: While cochlear implantation (CI) has been associated with loss of vestibular function, the ability of pre-implant vestibular findings to predict clinical factors and hearing outcomes has yet to be determined. This study aimed to define the association between abnormal vestibular findings to clinical profile, intraoperative pathology, and postoperative hearing outcomes among adults undergoing CI.

Methods: Retrospective cohort study of patients who underwent CI at a single tertiary-care institution from 2017 to 2020 was performed. Demographics, hearing history, subjective vestibular complaints, objective vestibular testing, and intraoperative details were assessed. Primary outcomes included pure tone average (PTA), word recognition score (WRS), speech reception threshold (SRT), consonant-nucleus-consonant (CNC) scores, and AzBio scores.

Results: Out of 125 CI surgeries, 37 had abnormal videonystagmography (VNG) and 53 had abnormal cervical vestibular evoked myogenic potentials (cVEMP) preoperatively. Abnormal results were highly associated with subjective vestibular symptoms pre-implantation (p < 0.0001), though only VNG was predictive of perioperative (p=0.009) and persistent vestibular issues (p=0.01). Round window fibrosis/ossification and middle ear inflammation were significantly associated with abnormal preoperative vestibular testing. Abnormal vestibular results were associated with worse baseline hearing status, but not with post-implant speech recognition outcomes.

Conclusions: Vestibular assessments prior to CI may help with preoperative planning to expect certain pathologies such as round window fibrosis/ossification or middle ear inflammation, which may require cochleostomy. While vestibular testing is associated with differences in baseline hearing status, it may not be a useful predictor of post-implant hearing and speech recognition outcomes.