Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study

Abstract Introduction: Cochlear implants are undeniably an effective method for the recovery of hearing function in patients with hearing loss. Objective: To describe the preoperative vestibular assessment protocol in subjects who will be submitted to cochlear implants. Methods: Our institutional protocol provides the vestibular diagnosis through six simple tests: Romberg and Fukuda tests, assessment for spontaneous nystagmus, Head Impulse Test, evaluation for Head Shaking Nystagmus and caloric test. Results: 21 patients were evaluated with a mean age of 42.75 ± 14.38 years. Only 28% of the sample had all normal test results. The presence of asymmetric vestibular information was documented through the caloric test in 32% of the sample and spontaneous nystagmus was an important clue for the diagnosis. Bilateral vestibular areflexia was present in four subjects, unilateral arreflexia in three and bilateral hyporeflexia in two. The Head Impulse Test was a significant indicator for the diagnosis of areflexia in the tested ear (p = 0.0001). The sensitized Romberg test using a foam pad was able to diagnose severe vestibular function impairment (p = 0.003). Conclusion: The six clinical tests were able to identify the presence or absence of vestibular function and function asymmetry between the ears of the same individual.摘要与引言：人工耳蜗（Cochlear implants）无疑是恢复听力损失患者听觉功能的有效临床手段。 目的：描述拟接受人工耳蜗植入术患者的术前前庭评估方案（vestibular assessment protocol）。 方法：本机构采用的前庭诊断方案包含六项简易检查：龙贝格试验（Romberg test）与福田试验（Fukuda test）、自发性眼震评估、头脉冲试验（Head Impulse Test）、摇头眼震评估及冷热试验（caloric test）。 结果：本研究共评估21例患者，平均年龄为42.75±14.38岁。仅28%的研究样本所有检查结果均处于正常范围。32%的样本经冷热试验证实存在前庭功能不对称表现；自发性眼震是重要的诊断线索。4例受试者存在双侧前庭反射消失（bilateral vestibular areflexia），3例为单侧反射消失，2例为双侧反射减退。头脉冲试验可显著提示受试耳反射消失（p=0.0001）。采用泡沫垫的强化龙贝格试验能够诊断重度前庭功能损害（p=0.003）。 结论：上述六项临床检查可明确受试者双侧耳的前庭功能状态及其功能不对称情况。