Vestibular Outcome After Cochlear Implantation Is Not Related to Surgical Technique: A Double Blinded, Randomized Clinical Trial of Round Window Approach Versus Cochleostomy

Abstract

Objective:To establish whether the round window approach (RWA) leads to less vestibular dysfunction and dizziness than the standard cochleostomy approach (SCA) during cochlear implant (CI) surgery, as assessed using the video head impulse test (vHIT).Additionally, objective findings were compared with the subjective dizziness perceived by the patient.Study Design:Double blinded, clinical randomized trial.Setting:University Hospital.Patients:Fifty-two ears from 46 patients were included. Inclusion criterion was a gain value more than 0.50.Intervention:Patients were randomized to the RWA or the SCA. Evaluation with the vHIT was performed before surgery, 1 day after surgery, and 1 month after surgery. Subjective dizziness was measured using a visual analogue scale (VAS) and the dizziness handicap inventory (DHI).Main Outcome Measures:Gain values and the incidence of catch-up saccades.Results:Three out of 23 patients in the SCA group experienced catch-up saccades compared with no patients in the RWA group, indicating the occurrence of objective vestibular dysfunction after CI surgery; the difference was not statistically significant. The VAS increased in both groups the day after surgery. The difference between the groups was not statistically significant. No statistically significant changes in the gain value or the DHI score could were observed between the two groups.Conclusion:No statistically significant difference between the cochleostomy approach and the round window approach using the vHIT and subjective dizziness perceived by the patient was found.

Impact of cochlear implantation on the function of the three semicircular canals

“…This percentage is higher than found in the present study (7.7%), but they tested patients on the second day after surgery, which may mainly reflect a very acute change after surgery. In contrast, Korsager et al (2018) showed no difference of mean lateral SCC gain values up to one month postoperatively. Regarding mean lateral SCC VOR gain changes, the meta-analysis of Ibrahim et al that pooled five studies (n ¼ 122 patients) with several methods of HIT execution, including search coils, did not find a mean change after cochlear implantation (Ibrahim et al 2017).…”

Complications of Cochleostomy Versus Round Window Surgical Approaches: A Systematic Review and Meta-Analysis

“…Five papers were analyzed for speech perception [ 21 , 27 - 30 ]. Three papers were analyzed for vestibular dysfunction [ 31 - 33 ]. Due to the lack of homogeneity in the data, statistical analyses could not be carried out, and summative data was reported.…”

“…Three of the included studies evaluated vestibular dysfunction [ 31 - 33 ]. One study showed that the RW approach resulted in less vestibular dysfunction when compared to the C approach [ 32 ].…”

“…One study showed that the RW approach resulted in less vestibular dysfunction when compared to the C approach [ 32 ]. One study [ 33 ] showed that the C approach led to less vestibular dysfunction when compared to the RW approach while the last study [ 31 ] indicated that there was no difference (Table 3 , Figure 4 ).…”

Spectral resolution and speech perception after cochlear implantation using the round window versus cochleostomy technique

“…However, a recent study by Korsager et al . 9 indicated that surgical technique has no effect on vestibular function.…”