Cochlear Implants and Children with Vestibular Impairments

Abstract

Sensorineural hearing loss (SNHL) in children occurs in 1 to 3% of live births and acquired hearing loss can additionally occur. This sensory deficit has far reaching consequences that have been shown to extend beyond speech and language development. Thankfully there are many therapeutic options that exist for these children with the aim of decreasing the morbidity of their hearing impairment. Of late, focus has shifted beyond speech and language outcomes to the overall performance of children with SNHL in real-world environments. To account for their residual deficits in such environments, clinicians must understand the extent of their sensory impairments. SNHL commonly coexists with other sensory deficits such as vestibular loss. Vestibular impairment is exceedingly common in children with SNHL with nearly half of children exhibiting vestibular end-organ dysfunction. These deficits naturally lead to impairments in balance and delay in motor milestones. However, this additional sensory deficit likely leads to further impairment in the performance of these children. This article focuses on the following: 1. Defining the coexistence of vestibular impairment in children with SNHL and cochlear implants. 2. Describing screening methods aimed at identifying vestibular dysfunction in children with SNHL. 3. Understanding the functional implications of this dual-sensory impairment. 4. Exploring possible rehabilitative strategies to minimize the impact of vestibular impairment in children with SNHL.

Hearing Loss in Children

“…In a US public health survey, hearing loss increased the likelihood of reporting child behavioral diagnoses (55% for hearing loss, adjusted odds ratio [OR] for autism, 2.9; 95% CI, 1.8-4.9), problems with behavior (95% for hearing loss, adjusted OR for attention-deficit disorder, 3.1; 95% CI, 2.5-3.9), and difficulties with socioemotional domains (90% for hearing loss, adjusted OR, 3.9; 95% CI, 3.2-4.7) . In addition, 17% to 48% of children with unilateral hearing loss and 50% with cochlear implant have impaired vestibular function, which can further influence their ability to participate in normal childhood activities . Long-term longitudinal studies have found significant relationships between childhood hearing loss and decreased well-being and self-esteem as well as anxiety and depression among women …”

Vestibular Infant Screening (VIS)–Flanders: results after 1.5 years of vestibular screening in hearing-impaired children

“…The rationale for vestibular screening at the age of 6 months is the following: (1) the hearing loss is confirmed in the majority of the children by that age 39 , (2) gross motor milestones can already give an idea of the child’s vestibular function 3 , and (3) most children have already developed sufficient head stabilisation due to sufficient development and control of neck musculature, which is fundamental for reliable cVEMP assessment 40 . In addition, possible cochlear implant surgery which entails a potential risk for vestibular (mainly otolith) deficits 31 , 41 – 43 , has not been performed yet 44 . As a result, the vestibular (mainly saccular) status is known before some of these children will undergo cochlear implant surgery.…”

Development of a new clinical tool to evaluate the balance abilities of children with bilateral vestibular loss: The Geneva Balance Test

“…This precise population endures a double sensory deficit, which means it is particularly at risk for developmental delays. To ensure better overall clinical management, potential vestibular disorders should be actively screened in children with hearing impairments, who are particularly at risk ( 5 ).…”