title: The effects of cochlear implantation on vestibular function.
abstract: OBJECTIVE
  Determine the risk posed by cochlear implantation (CI) to the labyrinth.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Thirty-six ears belonging to 35 adult CI candidates (mean age, 46 yr; range, 23-69 yr).
  
  
  METHODS
  Cochlear implantation.
  
  
  METHODS
  Vestibular function was assessed using the quantitative 3-dimensional head impulse test (qHIT), clinical head impulse test (cHIT), post-head shake nystagmus, caloric electronystagmography, vestibular-evoked myogenic potentials, dynamic visual acuity, and Dizziness Handicap Inventory.
  
  
  RESULTS
  All 36 ears were tested using qHIT before CI, and 28 ears were tested 4 to 8 weeks after CI. qHIT showed that 1 of 28 ears had reduced function. cHIT was 44% sensitive and 94% specific for identification of severe-to-profound vestibular hypofunction confirmed by qHIT. Post-head shake nystagmus was unchanged in 11 of 11 subjects. New hyporeflexia was found in 1 of 16 electronystagmography-tested ears. Vestibular-evoked myogenic potential showed either a disappearance of response or an increase in threshold by greater than 10 dB in 5 of 16 ears. Passive dynamic visual acuity showed no change in 16 of 16 ears. Dizziness Handicap Inventory scores worsened in 3 of 28 and improved in 4 of 28 subjects.
  
  
  CONCLUSIONS
  Although small, the observed rate of labyrinthine injury was comparable to that for other risks of CI. Thus, it is important to educate CI candidates regarding possible risk to balance function, particularly when CI of an "only balancing ear" is contemplated. cHIT is useful for detecting severe high-frequency vestibular hypofunction and should be part of the pre-CI physical examination.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: Thuy-Anh N
authors.initials: TA
authors.lastname: Melvin
authors.forename: Charles C
authors.initials: CC
authors.lastname: Della Santina
authors.forename: John P
authors.initials: JP
authors.lastname: Carey
authors.forename: Americo A
authors.initials: AA
authors.lastname: Migliaccio
mesh_terms: D000328:Adult; D000368:Aged; D019929:Cochlear Implantation / Q000009:adverse effects / Q000379:methods*; D003054:Cochlear Implants; D003638:Deafness / Q000209:etiology / Q000601:surgery; D004244:Dizziness / Q000453:epidemiology; D004584:Electronystagmography; D005072:Evoked Potentials, Auditory / Q000502:physiology; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification; D011184:Postoperative Period; D015837:Vestibular Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D014724:Vestibular Function Tests; D014792:Visual Acuity