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Posture, Gait, Quality of Life, and Hearing with a Vestibular Implant.
Chow, Margaret R; Ayiotis, Andrianna I; Schoo, Desi P; Gimmon, Yoav; Lane, Kelly E; Morris, Brian J; Rahman, Mehdi A; Valentin, Nicolas S; Boutros, Peter J; Bowditch, Stephen P; Ward, Bryan K; Sun, Daniel Q; Treviño Guajardo, Carolina; Schubert, Michael C; Carey, John P; Della Santina, Charles C.
Afiliação
  • Chow MR; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Ayiotis AI; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Schoo DP; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Gimmon Y; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Lane KE; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Morris BJ; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Rahman MA; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Valentin NS; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Boutros PJ; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Bowditch SP; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Ward BK; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Sun DQ; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Treviño Guajardo C; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Schubert MC; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Carey JP; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
  • Della Santina CC; From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyri
N Engl J Med ; 384(6): 521-532, 2021 02 11.
Article em En | MEDLINE | ID: mdl-33567192
ABSTRACT

BACKGROUND:

Bilateral vestibular hypofunction is associated with chronic disequilibrium, postural instability, and unsteady gait owing to failure of vestibular reflexes that stabilize the eyes, head, and body. A vestibular implant may be effective in alleviating symptoms.

METHODS:

Persons who had had ototoxic (7 participants) or idiopathic (1 participant) bilateral vestibular hypofunction for 2 to 23 years underwent unilateral implantation of a prosthesis that electrically stimulates the three semicircular canal branches of the vestibular nerve. Clinical outcomes included the score on the Bruininks-Oseretsky Test of Motor Proficiency balance subtest (range, 0 to 36, with higher scores indicating better balance), time to failure on the modified Romberg test (range, 0 to 30 seconds), score on the Dynamic Gait Index (range, 0 to 24, with higher scores indicating better gait performance), time needed to complete the Timed Up and Go test, gait speed, pure-tone auditory detection thresholds, speech discrimination scores, and quality of life. We compared participants' results at baseline (before implantation) with those at 6 months (8 participants) and at 1 year (6 participants) with the device set in its usual treatment mode (varying stimulus pulse rate and amplitude to represent rotational head motion) and in a placebo mode (holding pulse rate and amplitude constant).

RESULTS:

The median scores at baseline and at 6 months on the Bruininks-Oseretsky test were 17.5 and 21.0, respectively (median within-participant difference, 5.5 points; 95% confidence interval [CI], 0 to 10.0); the median times on the modified Romberg test were 3.6 seconds and 8.3 seconds (difference, 5.1; 95% CI, 1.5 to 27.6); the median scores on the Dynamic Gait Index were 12.5 and 22.5 (difference, 10.5 points; 95% CI, 1.5 to 12.0); the median times on the Timed Up and Go test were 11.0 seconds and 8.7 seconds (difference, 2.3; 95% CI, -1.7 to 5.0); and the median speeds on the gait-speed test were 1.03 m per second and 1.10 m per second (difference, 0.13; 95% CI, -0.25 to 0.30). Placebo-mode testing confirmed that improvements were due to treatment-mode stimulation. Among the 6 participants who were also assessed at 1 year, the median within-participant changes from baseline to 1 year were generally consistent with results at 6 months. Implantation caused ipsilateral hearing loss, with the air-conducted pure-tone average detection threshold at 6 months increasing by 3 to 16 dB in 5 participants and by 74 to 104 dB in 3 participants. Changes in participant-reported disability and quality of life paralleled changes in posture and gait.

CONCLUSIONS:

Six months and 1 year after unilateral implantation of a vestibular prosthesis for bilateral vestibular hypofunction, measures of posture, gait, and quality of life were generally in the direction of improvement from baseline, but hearing was reduced in the ear with the implant in all but 1 participant. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02725463.).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Qualidade de Vida / Vestíbulo do Labirinto / Equilíbrio Postural / Neuroestimuladores Implantáveis / Vestibulopatia Bilateral / Marcha / Perda Auditiva Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: N Engl J Med Ano de publicação: 2021 Tipo de documento: Article
Texto completo
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Qualidade de Vida / Vestíbulo do Labirinto / Equilíbrio Postural / Neuroestimuladores Implantáveis / Vestibulopatia Bilateral / Marcha / Perda Auditiva Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: N Engl J Med Ano de publicação: 2021 Tipo de documento: Article