Vestibular effects associated with implantation of a multiple channel cochlear prosthesis

Abstract

This study revealed that some patients with cochlear implants have symptoms of vertigo and imbalance following implant surgery. Although most experience a resolution of these symptoms, some patients have more persistent disturbances of balance. A total of 52 patients were implanted with a Nucleus 22 channel cochlear implant device between September 1988 and February 1994. Preoperatively, all but five of the patients received a vestibular evaluation. Twenty-two of the 52 patients received both pre- and postoperative vestibular evaluation. The cochlear implant was worn and activated during the postoperative vestibular assessment. The vestibular assessment included electronystagmography, computerized dynamic posturography, and harmonic acceleration testing. Five of the 22 patients demonstrated bilateral vestibular weakness preoperatively; that is, no response to caloric stimulation or a total of less than 30 degrees per second for the four irrigations. These patients were not included in the caloric analysis portion of the study. The remaining 17 were divided into groups under 60 years of age (7 patients) and over 60 years of age (10 patients). Analysis of the pre-and postoperative caloric response of the implanted ear showed a significant drop in output for the group over 60 years of age. The difference for the group under 60 years of age was not significant. Forty percent of the patients in the over 60 age group and 43% of those in the under 60 age group developed a peripheral vestibular weakness postoperatively. However, younger individuals in general did not seem to have balance complaints and did not require vestibular rehabilitation as frequently as the older group. Potential cochlear implant candidates should be advised of the possibility of postoperative vestibular effects following cochlear implantation. Most of the symptoms are transient; however, there may be persistent symptoms of imbalance that may be benefited by vestibular rehabilitation.