A Systematic Review and Meta-Analysis of Post-Cochlear Implant Vestibular Dysfunction: Round Window Versus Standard Cochleostomy Approaches.

Abstract

Background: Two main techniques for cochlear implantation (CI) are commonly used: the standard cochleostomy (SCA) and the round window approach (RWA). Initially, the RWA was more utilized, followed by the SCA for cases with challenging visualization. Recent studies show that RWA is preferred due to SCA's risk of damaging cochlear structures.

Aim: We aim to compare post-CI complications between the RWA and SCA approaches.

Methods: Five electronic databases were systematically searched to identify relevant studies. Eligibility screening was performed to determine inclusion criteria, and data extraction from the selected studies was conducted independently. Dichotomous outcomes were pooled as rate ratios (RR) and standard errors (SE), with significance determined by a p value >0.05 between CI subgroups. The generic inverse variance analysis method was applied with the employment of the random-effect model.

Results: Our systematic review encompassed 82 studies, of which 58 were eligible for meta-analysis. Vertigo was documented in 10% of instances utilizing the RWA technique and in 8% of cases using the SCA method. Likewise, dizziness was noted in 18% of RWA cases and in 14% of SCA cases. The overall incidence of vestibular complications was 36% for RWA and 17% for SCA. However, statistical analysis revealed no significant differences between these approaches (p < 0.05).

Conclusion: Both the RWA and the SCA approaches demonstrate comparable post-CI complication profiles concerning dizziness, vertigo, and overall vestibular complications, with the RWA approach showing slightly higher incidences. However, no significant difference was found between the two techniques.