Air and Bone‐Conducted Vestibular Evoked Myogenic Potentials in Cochlear Implants

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Air and Bone‐Conducted Vestibular Evoked Myogenic Potentials in Cochlear Implants Aniket Saoji, PhD, CCC-A Director, Cochlear Implants at Mayo Clinic Rochester MN ©2017 MFMER | slide-1 Disclosure 13 years of employment with Advanced Bionics (AB). Consultant for AB. Research support from AB, Cochlear, Med-EL, and Envoy Medical. ©2017 MFMER | slide-2 Review Vestibular trauma is a side effect of cochlear implant surgery Causes of vestibular dysfunction from cochlear implant surgery 1) Electrode insertion trauma 2) Acute serous labyrinthitis from cochleostomy 3) Foreign body reaction with labyrinthitis 4) Endolymphatic hydrops 5) Electrical stimulation from the implant Ibrahim et al., 2017 ©2017 MFMER | slide-3 Review Vestibular system tests 1) Video head impulse test (vHIT) 2) Caloric tests 3) Vestibular evoked myogenic potentials (VEMPs) 1) Cervical VEMPs 2) Ocular VEMPs 4) Dizziness Handicap Investory (DHI) 5) Computerized dynamic posturography (CDP) ©2017 MFMER | slide-4 C-VEMPs Air-conduction C-VEMPs ©2017 MFMER | slide-5 C-VEMPs Saccule Inferior vestibular nerve Lateral vestibular nucleus 11th cranial nerve Sternocleidomastoid muscle ©2017 MFMER | slide-6 C-VEMPs Saccule Inferior vestibular nerve Lateral vestibular nucleus 11th cranial nerve P1 – N1 ~ 20 to 30 ms latency Sternocleidomastoid muscle ©2017 MFMER | slide-7 Air-conduction VEMPs & CI Pre-op C-VEMP N = 344 N = 227 N = 117 Post-op C-VEMP N = 341 N = 130 N = 211 Ibrahim et al., 2017 ©2017 MFMER | slide-8 CI and middle ear mechanics Wideband absorbance patterns in CI (shapiro et al 2019) Implanted ear Unimplanted ear Impairment of middle ear conduction (≥ 5 dB) can lead to absence of air-conduction VEMPs. ©2017 MFMER | slide-9 Unilateral CI recipients Unilateral cochlear implant recipients with no measurable hearing in the implanted ear. Duration Patients Age (Yrs) Gender Ear of use Etiology (months) CI 3 69 F Right 52 SNHL CI 7 59 M Right 12 SNHL CI 10 38 F Left 1 SNHL CI 13 53 M Right 61 SNHL CI 14 44 M Right 13 SNHL ©2017 MFMER | slide-10 C-VEMPs Acoustic pure tone stimulus presented via insert ear phones and bone vibrator (B-81). Stimulus: 500 Hz Duration: 4 ms (± 1 ms) Presentation level: 95 dB for air-conduction VEMPs and 75 dB for bone-conduction VEMPs. ©2017 MFMER | slide-11 Bone-conduction VEMPs & CI Unimplanted ear Implanted ear AC-VEMP BC-VEMP ©2017 MFMER | slide-12 Conclusion Changes in middle ear mechanics following cochlear implant surgery can lead to absence of air-conduction C-VEMPs in the implanted ear. Bone-conduction C-VEMPs can be used to ascertain vestibular trauma from cochlear implant surgery. ©2017 MFMER | slide-13.

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Thresholds of Audibility for Bone-Conduction Headsets
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