Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery

Bittar, Roseli Saraiva Moreira; Sato, Eduardo; Silva-Ribeiro, Douglas Josimo; Oiticica, Jeanne; Mezzalira, Raquel; Tsuji, Robinson Koji; Bento, Ricardo Ferreira

doi:10.6061/clinics/2019/e786

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…It is possible to observe and analyze different parameters of the v-HIT, however the average gain of the VOR is one of the variables that is classically chosen to decide the vestibular hypofunction side ( 10 – 12 ). In our data set we could confirm other authors' findings ( 17 , 21 , 23 ) with respect to sensitivity and specificity of the v-HIT gain compared to the caloric test as the golden standard: When using the cut-off value of v-HIT gain <0.8 to classify vestibular hypofunction, we found a PPV of 65%, a NPV of 76%, a sensitivity of 46% and a specificity of 87%, which is in line with the literature.…”

Section: Discussionsupporting

confidence: 91%

“…We noticed a high specificity and moderate sensitivity of the v-HIT gain using the caloric testing as a reference. Similar outcomes were presented in previous studies when comparing both vestibular tests (17,21,23,29,30). However, the study of Aalling et al (29) showed a higher PPV of 90% compared with our PPV of 65%.…”

Section: Comparison With Other Studiessupporting

confidence: 90%

“…The VOR gain was calculated by the software as the ratio of peak slow phase eye velocity to peak head velocity (18,19). In line with the literature, we defined a cut-off value of 0.8 for the v-HIT gain indicating an abnormal horizontal VOR (9,20,21).…”

Section: Video Head Impulse Testmentioning

confidence: 99%

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Saccades Matter: Reduced Need for Caloric Testing of Cochlear Implant Candidates by Joint Analysis of v-HIT Gain and Corrective Saccades

et al. 2021

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Objectives: Video head impulse test (v-HIT) is a quick, non-invasive and relatively cheap test to evaluate vestibular function compared to the caloric test. The latter is, however, needed to decide on the optimal side to perform cochlear implantation to avoid the risk on inducing a bilateral vestibular areflexia. This study evaluates the effectiveness of using the v-HIT to select cochlear implant (CI) candidates who require subsequent caloric testing before implantation, in that way reducing costs and patient burden at the same time.Study Design: Retrospective study using clinical data from 83 adult CI-candidates, between 2015 and 2020 at the Leiden University Medical Center.Materials and Methods: We used the v-HIT mean gain, MinGain_LR, the gain asymmetry (GA) and a newly defined parameter, MGS (Minimal Gain & Saccades) as different models to detect the group of patients that would need the caloric test to decide on the ear of implantation. The continuous model MGS was defined as the MinGain_LR, except for the cases with normal gain (both sides ≥0.8) where no corrective saccades were present. In the latter case MGS was defined to be 1.0 (the ideal gain value).Results: The receiver operating characteristics curve showed a very good diagnostic accuracy with and area under the curve (AUC) of 0.81 for the model MGS. The v-HIT mean gain, the minimal gain and GA had a lower diagnostic capacity with an AUC of 0.70, 0.72, and 0.73, respectively. Using MGS, caloric testing could be avoided in 38 cases (a reduction of 46%), with a test sensitivity of 0.9 (i.e., missing 3 of 28 cases).Conclusions: The newly developed model MGS balances the sensitivity and specificity of the v-HIT better than the more commonly evaluated parameters such as mean gain, MinGain_LR and GA. Therefore, taking the presence of corrective saccades into account in the evaluation of the v-HIT gain can considerably reduce the proportion of CI-candidates requiring additional caloric testing.

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Section: Discussionsupporting

confidence: 91%

Section: Comparison With Other Studiessupporting

confidence: 90%

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Saccades Matter: Reduced Need for Caloric Testing of Cochlear Implant Candidates by Joint Analysis of v-HIT Gain and Corrective Saccades

et al. 2021

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“…The caloric irrigation test is a long-established measurement technique that has been used in multiple studies to investigate the function of hSCC after cochlear implantation (9,42,60,61). It has been described frequently that cochlear implantation has a significant impact on the outcome of this functional test (15,55).…”

Section: Caloric Irrigation Testmentioning

confidence: 99%

Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle

et al. 2021

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Objective: Vertigo is a common side effect of cochlear implant (CI) treatment. This prospective study examines the incidence of postoperative vertigo over time and aims to analyze influencing factors such as electrode design and insertion angle (IA).Study Design and Setting: This is a prospective study which has been conducted at a tertiary referral center (academic hospital).Patients: A total of 29 adults were enrolled and received a unilateral CI using one of six different electrode carriers, which were categorized into “structure-preserving” (I), “potentially structure-preserving” (II), and “not structure-preserving” (III).Intervention: Subjective vertigo was assessed by questionnaires at five different time-points before up to 6 months after surgery. The participants were divided into four groups depending on the time of the presence of vertigo before and after surgery. Preoperatively and at 6 months postoperatively, a comprehensive vertigo diagnosis consisting of Romberg test, Unterberger test, subjective visual vertical, optokinetic test, video head impulse test, and caloric irrigation test was performed. In addition, the IA was determined, and the patients were divided in two groups (<430°; ≥430°).Main Outcome Measures: The incidence of vertigo after CI surgery (group 1) was reported, as well as the correlation of subjective vertigo with electrode array categories (I–III) and IA.Results: Among the participants, 45.8% experienced new vertigo after implantation. Based on the questionnaire data, a vestibular origin was suspected in 72.7%. The results did not show a significant correlation with subjective vertigo for any of the performed tests. In group 1 with postoperative vertigo, 18% of patients showed conspicuous results in a quantitative analysis of caloric irrigation test despite the fact that the category I or II electrodes were implanted, which are suitable for structure preservation. Average IA was 404° for the overall group and 409° for group 1. There was no statistically significant correlation between IA and perceived vertigo.Conclusions: Though vertigo after CI surgery seems to be a common complication, the test battery used here could not objectify the symptoms. Further studies should clarify whether this is due to the multifactorial cause of vertigo or to the lack of sensitivity of the tests currently in use. The proof of reduced probability for vertigo when using atraumatic electrode carrier was not successful, nor was the proof of a negative influence of the insertion depth.

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“…Due to regularly performed vestibular diagnostics, it is possible to inform and consult in an optimized way regarding the risk of vestibular damage associated with cochlear implantation [50]. Furthermore, a vestibular test that reveals pathologic side differences may also support the decision of which side should be implanted [51].…”

Section: Assessment Of the Vestibular Diagnosticsmentioning

confidence: 99%

Welche Qualität macht den Unterschied in der Cochlea-Implantat-Versorgung?

2020

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ZusammenfassungDie Cochlea-Implantat (CI)-Versorgung hat seit ihrer Einführung eine nicht zu erwartende Entwicklung und Verbreitung erfahren. Neben den technischen Möglichkeiten hat sich auch die Indikationsstellung deutlich gewandelt. Beispiele hierfür sind die Versorgung sehr junger oder sehr alter Menschen, die bilaterale Versorgung oder auch die Nutzung des Restgehörs für eine kombiniert elektrisch-akustische Stimulation (EAS). Diese Entwicklung ist weiterhin sehr dynamisch und bietet enorme Möglichkeiten für die Hörrehabilitation betroffener Patienten. Sie stellt aber gleichzeitig auch erhebliche Ansprüche an die Sicherstellung einer qualitativ am Optimum orientierten Versorgung der Leistungserbringer. In den letzten Jahren hat eine intensive Diskussion stattgefunden, die die Zielsetzung hatte, Qualitätsparameter zu definieren, die als Eckpunkte einer CI-Versorgung dienen sollten. Diese orientierten sich zunächst an der Beschreibung eines festgelegten Ablaufs einer CI-Versorgung und damit an den Teilaspekten einer Prozess-, Struktur- und Ergebnisqualität zur Qualitätssicherung. Praktische Umsetzung erfuhren diese Erwägungen u. a. in dem „Weißbuch CI-Versorgung“ und dem Konzept eines „Nationalen CI-Registers“ der DGHNO-KHC. Neben einer inhaltlich orientierten, innerhalb der Fachgesellschaft DGNHNO-KHC geführten Diskussion, zeigen inzwischen auch Kostenträger Ansätze, auf den Prozess einer CI-Versorgung Einfluss zu nehmen (QuInCI-Initiative der Techniker Krankenkasse). Auch von Seiten des Gesetzgebers sind hierzu Maßnahmen in Vorbereitung, die die CI-Versorgung unmittelbar betreffen werden („Implantateregister-Gesetz“). Die hier vorgelegte Arbeit soll den derzeitigen Wissensstand der Qualitätssicherung in der CI-Versorgung darstellen und eine Standortbestimmung für Deutschland im Vergleich zu anderen Ländern vornehmen.

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Caloric test and video head impulse test sensitivity as vestibular impairment predictors before cochlear implant surgery

Cited by 8 publications

References 29 publications

Saccades Matter: Reduced Need for Caloric Testing of Cochlear Implant Candidates by Joint Analysis of v-HIT Gain and Corrective Saccades

Saccades Matter: Reduced Need for Caloric Testing of Cochlear Implant Candidates by Joint Analysis of v-HIT Gain and Corrective Saccades

Vertigo Associated With Cochlear Implant Surgery: Correlation With Vertigo Diagnostic Result, Electrode Carrier, and Insertion Angle

Welche Qualität macht den Unterschied in der Cochlea-Implantat-Versorgung?

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