Vestibular and Balance Impairment Contributes to Cochlear Implant Failure in Children.

OBJECTIVE: To determine the role of vestibular and balance dysfunction in children with cochlear implant (CI) failure. STUDY
DESIGN: Retrospective case review.
SETTING: Tertiary referral center. PATIENTS: Thirty-five children with CI failure were compared to 165 children who did not experience CI failure. MAIN OUTCOME MEASURES: Vestibular function was compared between groups by horizontal canal function (measured by caloric, rotational, video Head Impulse Testing [vHIT]), saccular function (vestibular evoked myogenic potentials [VEMP]), and balance (measured by Bruininks-Oseretsky Test [BOT-2]).
RESULTS: Twenty-one patients completed vestibular and balance testing. Patients with CI failure demonstrated significantly more abnormal horizontal canal function than those who did not experience CI failure (caloric: 81 vs. 47%, p = 0.004; rotational/vHIT: 71 vs. 35%, p = 0.001). Absence of bilateral horizontal canal function increased the odds of CI failure 7.6 times. A greater proportion of children with CI failure had abnormal saccular function compared to those without CI failure (81 vs. 46%, p = 0.003). Children with CI failure had significantly worse balance (BOT-2 score: 7.8) than children who did not experience CI failure (BOT-2 score: 12.2) (p < 0.0001).
CONCLUSIONS: Vestibular end-organ dysfunction and its resulting balance impairment have been identified as important risk factors for CI failure in children. Early identification and treatment of such impairments may avoid or delay implant failures and prevent children from experiencing periods of sound deprivation that could impact speech and language acquisition.