Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance.

Abstract

The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.