What vestibular tests to choose in symptomatic patients after a cochlear implant? A systematic review and meta-analysis

Abstract

Vestibular function after cochlear implantation is difficult to understand, as subjective vestibular symptoms seem uncorrelated with the results of objective tests. Consequently, clinicians may struggle to decide what assessments to perform for a symptomatic patient. We used a systematic review and meta-analysis approach to enlighten this point. After a study inclusion process, results were classified into four different groups for each test in each study: (1) 'true positive' if the test showed impairment from pre-operative to post-operative in symptomatic patients; (2) 'false positive' if the test showed impairment from pre-operative to post-operative in asymptomatic patients; (3) 'true negative' if the test showed no impairment in asymptomatic patients; and (4) 'false negative' if the test showed no impairment in symptomatic patients. From these groups, sensitivities and specificities of each test were calculated in a meta-analysis. After reviewing more than 3000 references, 16 studies were included, representing 957 patients. The meta-analysis revealed a sensitivity of 0.21 (CI 95 % 0.08-0.40) for the caloric tests, of 0.32 (CI 95 % 0.15-0.54) for the cervical vestibular evoked myogenic potentials (c-VEMP), and of 0.5 (CI 95 % 0.07-0.93) for the head impulse tests. The analysis of prevalence revealed that c-VEMPs were the most often impaired, and the HIT the most often conserved. Our review and meta-analysis revealed that no vestibular test is sensitive enough to be recommended as a single test. Ideally, all the five vestibular sensors should be tested. In clinical practice, we suggest a case-to-case strategy according to patient's symptoms and their suspected origin.

Vestibulo-Cochlear Function After Cochlear Implantation in Patients With Meniere’s Disease

“…Such differences are regardless of uni-or bilateral MD condition. However, our results for the VEMPs differ from those obtained in previous studies [24] wherein a disappearance and impairment of oVEMPs and cVEMPs after CI surgery has been reported. These authors suggest that some degree of damage occurs at the level of the utricle and saccule.…”

Meta‐analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

“…Abouzayd et al revealed in a meta-analysis the poor sensitivity of a single vestibular test to explain subjective symptoms after cochlear implantation and recommend the implementation of more extensive perioperative vestibular diagnostics for cochlear implant candidates. 97 Nevertheless, further studies are needed to correlate subjective symptoms with respective impairments of vestibular receptors. We conducted a systematic review and meta-analysis of a larger population of studies to determine reliable data on postoperative vertigo and diagnostic results.…”

Effect of cochlear implant surgery on vestibular function: meta-analysis study

“…Other authors [27, 28] reported that one-third of CI recipients complain of dizziness after surgery. A recent review aimed at determining the best test to evaluate vestibular function before and after CI surgery was published by Abouzayd et al, [29]. They found that the caloric test was least sensitive, VEMP results were most often impaired, and HIT results were generally conserved.…”