TY - JOUR
T1 - Post cochlear implantation vertigo
T2 - ictal nystagmus and audiovestibular test characteristics
AU - Kwok, Belinda Y. C.
AU - Young, Allison S.
AU - Kong, Jonathan H. K.
AU - Birman, Catherine S.
AU - Flanagan, Sean
AU - Greenberg, Simon L.
AU - Gibson, William P.
AU - Argaet, Emma C.
AU - Fratturo, Luke
AU - Pogson, Jacob M.
AU - Taylor, Rachael L.
AU - Rosengren, Sally M.
AU - Halmagyi, G. Michael
AU - Welgampola, Miriam S.
PY - 2024/1
Y1 - 2024/1
N2 - Objective: To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). Study Design: Retrospective and prospective case series. Patients: Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. Interventions: Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. Main Outcome Measures: Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. Results: Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s). VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. Conclusion: High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.
AB - Objective: To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). Study Design: Retrospective and prospective case series. Patients: Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. Interventions: Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. Main Outcome Measures: Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. Results: Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s). VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. Conclusion: High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.
KW - Audiovestibular tests
KW - Cochlear implantation
KW - Delayed endolymphatic hydrops
KW - Nystagmus
KW - Post-CI
KW - Vertigo
UR - http://www.scopus.com/inward/record.url?scp=85179778567&partnerID=8YFLogxK
U2 - 10.1097/MAO.0000000000004037
DO - 10.1097/MAO.0000000000004037
M3 - Article
C2 - 37853785
AN - SCOPUS:85179778567
SN - 1531-7129
VL - 45
SP - 65
EP - 74
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 1
ER -