Query: vestibular cochlear implant ADHD

title: Motor and cognitive performances in pre lingual cochlear implant adolescents, related with vestibular function and auditory input
abstract: Information about the role of auditory input and motor control is limited.  Assessment the relationship between auditory and vestibular information with specific motor and cognitive functions.  Posturography in 17 Pre lingual Cochlear Implant Adolescents, (PCIA) age 14.06 3.05 in four sensory conditions was analyzed: (A) eyes open, cochlear implant (CI) on, (B) eyes open, CI off, (C) eyes closed standing on a foam over a platform (ECFP) with CI on, and (D) ECFP, CI off. Gait velocity (GV) was registered by inertial sensors using a 10 meter test. Vestibulo ocular reflex (VOR) was evaluated with the video head impulse test (VHIT) and visual spatial skill (VS) assessed with the WISC V test.  SV had no significant difference between conditions A and B (p .2461) Comparing C and D, SV values decreased when CI was turned on (p .0036) A significant linear relationship between VOR and GV (p .0064) generating the VOR gain loss lower gait. Relationship between VOR and VS scores was no significant (p .685)  Auditory information is a relevant cue when somatosensory and visual inputs are modified and range of vestibular function influence in a dynamic motor activity as gait, facts which must be considered in the neurodevelopment control.

title: Perioperative Recording of Cochlear Implant Evoked Brain Stem Responses After Removal of the Intralabyrinthine Portion of a Vestibular Schwannoma in a Patient with NF2.
abstract: To predict and optimize hearing outcomes with a cochlear implant (CI) in patients with intracochlear schwannoma and neurofibromatosis type 2 (NF2) PATIENT A patient with NF2 and bilateral deafness.  The intracochlear portion of a vestibular schwannoma was removed with a partial cochleoectomy. During the procedure, a CI was implanted.  Perioperatively, electrically evoked auditory brainstem responses (eABRs) were recorded with a novel intracochlear, CI evoked, broad band stimulus to support the decision to implant a CI.  We found positive eABR responses, with thresholds at around the 200 current level. The eV wave was discernible at all stimulated electrodes, with a prolonged latency of about 6.5 ms. The eIII wave was detected at electrodes 9 and 13, with a latency of 4.5 ms. The acoustic reflex was detectable at all stimulated electrodes. Subjective auditory perception could be achieved by stimulating 3 days after surgery. In open set word recognition, the patient achieved 60% recognition of monosyllables after the first audio processor fitting and 100% 1 month later.  After a partial cochleoectomy, this method may serve as a peri operative, objective assessment of cochlear nerve integrity that could potentially impact the prediction of CI performance. Potential future applications might be assessments of cochlear nerve integrity in patients with inner ear malformations, radiologically suspected cochlear nerve deficiencies, and resected or irradiated spontaneous vestibular schwannomas or NF2.

title: Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery
abstract: Currently, cochlear implant procedures are becoming increasingly broad and have greatly expanded. Bilateral cochlear implants and cochlear implants are more frequently applied in children. Our hypothesis is that the video head impulse test may be more sensitive than the caloric test in detecting abnormal vestibular function before cochlear implant surgery. The objective of this study was to compare the video head impulse test and caloric test results of patients selected for cochlear implant procedures before surgery.  The patients selected for cochlear implant surgery were submitted to a bithermal caloric test and video head impulse test.  By comparing angular slow phase velocity values below 5deg in the bithermal caloric test (hypofunction) and video head impulse test with a gain lower than 0.8, we identified 37 (64.9% patients with vestibular hypofunction or canal paresis and 21 (36.8% patients with abnormal video head impulse test gain before the cochlear implant procedure. Of the 37 patients with caloric test vestibular hypofunction, 20 (54% patients exhibited an abnormal gain in the video head impulse test.  The caloric test is more sensitive than the video head impulse test (Fisher's exact test, p=0.0002) in detecting the impaired ear before cochlear implant delivery. The proportion of caloric test/video head impulse test positive identification of abnormal vestibular function or caloric test/video head impulse test sensitivity was 1.8:1.

title: Cochlear Implant Outcomes in Large Vestibular Aqueduct Syndrome Should We Provide Cochlear Implants Earlier?
abstract: Examine postoperative speech perception outcomes in a large vestibular aqueduct syndrome (LVAS) patients at a major cochlear implantation center.  Retrospective analysis of the Sydney Cochlear Implant Centre (SCIC) database and medical records from January 1994 to December 2015 was performed.  Tertiary referral center.  Patients with a diagnosis of LVAS who received a cochlear implant (CI) Only those with speech perception outcomes recorded at least 12 months post implant were included in our analysis.  Therapeutic.  Postoperative speech perception scores.  Between 1994 and 2015, 176 adult and pediatric patients with a diagnosis of LVAS underwent cochlear implantation at SCIC. Postoperative Bamford Kowal Bench (BKB) sentence test scores were obtained for 97 patients. The postoperative median BKB score was 93% with a lower quartile score of 85% and an upper quartile score of 98% Smaller numbers were available for post CI City University of New York (CUNY) and Consonant Nucleus Consonant (CNC) word scores yet similar excellent results were seen.  Our study results suggest the CI should be considered when BKB scores have dropped to 85% We suggest that rather than LVAS cases representing a challenge to cochlear implantation, they are amongst the best candidates for surgery, and should receive a CI at an earlier stage in hearing loss, when they have better speech perception. This allows stable hearing to be established earlier along with excellent speech perception outcomes.

title: CSF Gusher and Its Management in Cochlear Implant Patient with Enlarged Vestibular Aqueduct
abstract: Aim is to share our experience of CSF gusher and its management during cochlear implant surgery in patients with enlarged vestibular aqueduct. All cases underwent classic cochlear implant surgeries via Veria technique. It is a retrospective study done at Civil Hospital Ahmedabad from January 2013 to March 2018 with 415 patients. The study includes 39 children between age groups 2 8 years who have enlarged vestibular aqueduct. In all 39 patients with enlarged vestibular aqueduct during cochleostomy there was CSF gusher which was managed by the covering the cochleostomy site with temporalis fascia. There was no need for use of fibrin glue in any case. But it was kept in standby mode in case needed. And there was no post operative CSF otorrea in any patients. While preparing the patient for cochlear implant whenever you come across enlarged vestibular aqueduct via HRCT temporal bone and MRI of cochlea, be prepared for CSF gusher while doing the cochleostomy. Csf gusher is intra operative challenge rather than a bad prognostic determine for post operative audiologic out come. Keeping fibrin glue in stand by helps if major CSF leaks happens. Finally, we achieved a simple stepwise algorithm for the management of gusher during cochlear implantation.

title: Vestibular function assessment in cochlear implant patients
abstract: Anatomical and embryological relations between cochlear and vestibular end organs predispose them to same noxious or developmental factors, thus these may affect either or both systems. Cochlear implantation being a widely used procedure for restoration of hearing in patients who are not candidates for regular amplification, may affect by different means the vestibular system. One of these factors include the surgical procedure. The aim of this study is to assess the vestibular function in cochlear implant candidates before surgery to exclude co existing vestibular affection with the sensorineural hearing loss (SNHL) Reassessment after operation was done to determine the risk posed by surgery and for correlating the surgical approach to vestibular findings.  The case series presented herein is of cochlear implant candidates who underwent full audiological and radiological assessment. Vestibular assessment was done before and after operation and included cervical vestibular evoked myogenic potential (cVEMP) and ocular vemp (oVEMP) for evaluation of otolith organs. Video head impulse test (VHIT) was used to evaluate semicircular canal.  Preliminary results show that patients may exhibit vestibular loss concomitant to the SNHL even with the absence of vestibular complaints. Patients who had normal preoperative vestibular function showed affected vestibular tests after the surgery. There was a mismatch between these objective findings and the subjective complaint of imbalance or vertigo.  Despite the minor risk posed by cochlear implant (CI) surgery for the subjective vestibular affection, the side with worse vestibular function should be chosen for CI if other factors are equal to avoid postoperative vestibular loss.

title: Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery
abstract: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol.  In a group of 28 subjects undergoing CI, the video head impulse test (vHIT) the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA) except for 3 otosclerosis cases in which the extended RWA (eRWA) was used.  The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14% In those subjects (21.7% in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded.  The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.

title: Audio Vestibular Alterations During the Phases of the Menstrual Cycle in Patients with Cochlear Implant
abstract: The female hormones fluctuations in woman's life play a dominant role in homeostasis of the body and can influence the psycho neurological processes in different body systems. In particular, in the auditory system seems that hormonal alterations during the menstrual cycle can compromise the homeostasis of the labyrinthine fluids altering balance and/or hearing.  Our study aims to verify if hormonal changes during different menstrual phases may have an influence, in females with cochlear implants, on the trend of auditory and vestibular performances.  Tonal, speech audiometry, vestibular examination and a measure of cochlear implants electrodes impedances were realized in the follicular and luteal phases on a group of eight women who are at a fertile age, affected by profound sensorineural form of hearing loss and carrying a monolateral cochlear implant.  Audio vestibular alterations, as well as, an increase of impedance electrodes are reported in the luteal phase.  Our work suggests that audio vestibular alterations are related to the different phases of the menstrual cycle with consequent variation also of the performances of the implant. It is very important to keep in mind this aspect to avoid negative results during rehabilitation.

title: CVEMP testing for assessment of vestibular functions in cochlear implant patients.
abstract: This study aims to investigate the vestibular function status of cochlear implant patients using cervical vestibular evoked myogenic potential (cVEMP) testing and estimate the effects of cochlear implants on vestibular function.  The cVEMPs of 50 cochlear implant patients were measured preoperatively, and at one and six months postoperatively. Then, implanted ears and non implanted ears were compared in terms of p13/n23 wave response rates, latency, amplitude and threshold.  Preoperatively, the binaural cVEMP response rate was 92% while the cVEMP response rates of implanted ears vs. non implanted ears at postoperative one and six months were 24% vs. 80% and 52% vs. 82% respectively. No significant difference between implanted and non implanted ears was found preoperatively, in terms of latent period, amplitude, or threshold. However, significant changes were found in amplitude and threshold for implanted ears after the operation, but not in latency. No significant postoperative change was found in amplitude, latent period, or threshold for non implanted ears. Significant differences between implanted and non implanted ears were found in both amplitude and threshold.  Cochlear implants affect vestibular function, especially saccular function, and reduce the cVEMP amplitude and threshold of implanted ears.

title: Hearing rehabilitation outcomes in cochlear implant recipients with vestibular schwannoma in observation or radiotherapy groups: A systematic review
abstract: Vestibular schwannomas (VS) are rare benign tumours of the vestibular nerve that cause hearing loss. Management strategies include watchful waiting, radiotherapy or surgical resection. Historically, the presence of retrocochlear disease has been considered to be a contra indication to cochlear implantation (CI) The aim of this systematic review is to assess hearing rehabilitation outcomes for CI recipients with VS, either sporadic or associated with neurofibromatosis type 2, whose tumours have been managed with either observation or radiotherapy.  PubMed, Embase, and Cochrane Library databases were searched from inception through to November 2018. 50 cases from 12 studies met the inclusion criteria. Patient demographics, VS characteristics, management strategy, pre CI hearing status, electrical promontory stimulation testing, post CI hearing status and speech perception scores, functional benefits and follow up length are reported.  Radiotherapy and observation groups had similar patient demographics in terms of age at CI, tumour size and duration of deafness. Following CI, 64% and 60% of patients in the radiotherapy and observation groups achieved open set speech perception, respectively. Pure tone average thresholds (33 vs. 39 dB) and speech scores were also comparable between both groups.  Ipsilateral CI in patients with VS that have not been surgically resected can provide beneficial hearing rehabilitation outcomes.