Skip to main content Accessibility help

Impaired fixation suppression is a risk factor for vertigo after cochlear implantation

  • E Krause (a1), J Wechtenbruch (a1), T Rader (a2), A Berghaus (a1) and R Gürkov (a1)...



To analyse the correlation between visual fixation suppression test results and the occurrence of post-operative vertigo in patients receiving a cochlear implant, and to compare this with other possible risk factors.


In a prospective study setting, caloric vestibular responses, visual fixation suppression and subjective vertigo symptoms were assessed in 59 adult patients undergoing cochlear implantation. These parameters were compared in patients with post-operative vertigo versus vertigo-free patients.


Vertigo symptoms were reported by 49 per cent of patients. Thirty-nine per cent of the patients had a decrease in caloric response on the implanted side. There was no statistically significant difference between the two patient groups regarding canal paresis, age, sex, implanted electrode type, implant side, surgeon, cause of deafness, petrous bone computed tomography findings and incidence of pre-operative vertigo. Patients with post-operative vertigo had a significantly greater prevalence of insufficient visual fixation suppression. All patients who suffered long-term post-operative vertigo had insufficient visual fixation suppression.


Pre-operative impaired visual fixation suppression is a major risk factor for the occurrence of vertigo after cochlear implantation.


Corresponding author

Address for correspondence: Dr Eike Krause, Department of Oto-rhino-laryngology, Head and Neck Surgery, Ludwig Maximilians University Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany. Fax: +49 89 70956869 E-mail:


Hide All
1 Fayad, JN, Linthicum, FH Jr. Multichannel cochlear implants: relation of histopathology to performance. Laryngoscope 2006;116:1310–20
2 Handzel, O, Burgess, BJ, Nadol, JB Jr. Histopathology of the peripheral vestibular system after cochlear implantation in the human. Otol Neurotol 2006;27:5764
3 Tien, HC, Linthicum, FH Jr. Histopathologic changes in the vestibule after cochlear implantation. Otolaryngol Head Neck Surg 2002;127:260–4
4 Todt, I, Basta, D, Ernst, A. Does the surgical approach in cochlear implantation influence the occurrence of postoperative vertigo? Otolaryngol Head Neck Surg 2008;138:812
5 Enticott, JC, Tari, S, Koh, SM, Dowell, RC, O'Leary, SJ. Cochlear implant and vestibular function. Otol Neurotol 2006;27:824–30
6 Steenerson, RL, Cronin, GW, Gary, LB. Vertigo after cochlear implantation. Otol Neurotol 2001;22:842–3
7 Vibert, D, Häusler, R, Kompis, M, Vischer, M. Vestibular function in patients with cochlear implantation. Acta Otolaryngol Suppl 2001;545:2934
8 Buchman, CA, Joy, J, Hodges, A, Telischi, FF, Balkany, TJ. Vestibular effects of cochlear implantation. Laryngoscope 2004;114:122
9 Brandt, T, Bartenstein, P, Janek, A, Dieterich, M. Reciprocal inhibitory visual-vestibular interaction. Visual motion stimulation deactivates the parieto-insular vestibular cortex. Brain 1998;121:1749–58
10 Jahn, K, Strupp, M, Krafczyk, S, Schüler, O, Glasauer, S, Brandt, T. Suppression of eye movements improves balance. Brain 2002;125:2005–11
11 Krause, E, Louza, JPR, Hempel, JM, Wechtenbruch, J, Rader, T, Gürkov, R. Prevalence and characteristics of preoperative balance disorders in cochlear implant candidates. Ann Otol Rhinol Laryngol 2008 Oct;117(10):764–8
12 Hallpike, CS. The caloric tests. J Laryngol Otol 1956;70:1528
13 Brey, RH, Facer, GW, Trine, MB, Lynn, SG, Peterson, AM, Suman, VJ. Vestibular effects associated with implantation of a multiple channel cochlear prosthesis. Am J Otol 1995;16:424–30
14 Filipo, R, Patrizi, M, La Gamma, R, D'Elia, C, La Rosa, G, Barbara, M. Vestibular impairment and cochlear implantation. Acta Otolaryngol 2006;126:1266–74
15 Ito, J. Influence of the multichannel cochlear implant on vestibular function. Otolaryngol Head Neck Surg 1998;118:900–2
16 Klenzner, T, Neumann, M, Aschendorff, A, Laszig, R. Caloric stimulation of the vestibular organ after cochlear implant surgery [in German]. Laryngorhinootologie 2004;83:659–64
17 Kubo, T, Yamamoto, K, Iwaki, T, Doi, K, Tamura, M. Different forms of dizziness occurring after cochlear implant. Eur Arch Otorhinolaryngol 2001;258:912
18 Jin, Y, Nakamura, M, Shinjo, Y, Kaga, K. Vestibular-evoked myogenic potentials in cochlear implant children. Acta Otolaryngol 2006;126:164–9
19 Mangham, CA. Effects of cochlear prostheses on vestibulo-ocular reflexes to rotation. Ann Otol Rhinol Laryngol Suppl 1987;128:101–4
20 Fina, M, Skinner, M, Goebel, JA, Piccirillo, JF, Neely, JG, Black, O. Vestibular dysfunction after cochlear implantation. Otol Neurotol 2003;24:234–42
21 Di Girolamo, S, Fetoni, AR, Di Nardo, W, Paludetti, G. An unusual complication of cochlear implant: benign paroxysmal positional vertigo. J Laryngol Otol 1999;113:922–3
22 Graham, SS, Dickins, JR. Postimplantation Meniere's syndrome with fluctuant electrical thresholds. Ann Otol Rhinol Laryngol Suppl 1995;166:412–14
23 Bance, ML, O'Driscoll, M, Giles, E, Ramsden, RT. Vestibular stimulation by multichannel cochlear implants. Laryngoscope 1998;108:291–4
24 Baloh, RW, Honrubia, V, Yee, RD, Hess, K. Changes in the human vestibulo-ocular reflex after loss of peripheral sensitivity. Ann Neurol 1984;16:222–8
25 Brandt, T. Management of vestibular disorders. J Neurol 2000;247:491–9
26 Straka, H, Dieringer, N. Basic organization principles of the VOR: lessons from frogs. Prog Neurobiol 2004;73:259309
27 Bense, S, Deutschländer, A, Stephan, T, Bartenstein, P, Schwaiger, M, Brandt, T et al. Preserved visual-vestibular interaction in patients with bilateral vestibular failure. Neurology 2004;63:122–8
28 Kato, I, Kimura, Y, Aoyagi, M, Mizukoshi, K, Kawasaki, T. Visual suppression of caloric nystagmus in normal individuals. Acta Otolaryngol 1977;83:245–51
29 Hillier, S, Hollohan, V. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database Syst Rev 2007, Issue 4:CD005397 (doi: 10.1002/14651858)
30 Schuchman, G, Uri, N. The variability of fixation suppression of caloric-induced nystagmus. J Laryngol Otol 1986;100:765–8


Impaired fixation suppression is a risk factor for vertigo after cochlear implantation

  • E Krause (a1), J Wechtenbruch (a1), T Rader (a2), A Berghaus (a1) and R Gürkov (a1)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed