Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants

Abstract

There is a high incidence of vestibular loss in children with cochlear implants (CCI). However, the relationship between vestibular loss and various outcomes is unknown in children. Objectives 1) determine if age-related changes in peripheral vestibular tests occur; 2) quantify peripheral vestibular function in children with normal hearing (CNH) and CCI; 3) determine if amount of vestibular loss predicts visual acuity and balance performance. Design Eleven CCI and 12 CNH completed the following tests of vestibular function: ocular and cervical vestibular evoked myogenic potential (VEMP) to assess utricle and saccule function, and the video head impulse test (vHIT) to assess semicircular canal function. The relationship between amount of vestibular loss and the following balance and visual acuity outcomes was assessed: dynamic gait index, single leg stance, the sensory organization test, and tests of visual acuity, including dynamic visual acuity and the gaze stabilization test. Results 1) There were no significant age-related changes in peripheral vestibular testing with the exception of the n23 cervical VEMP latency, which was moderately correlated with age; 2) CCI had significantly higher rates of vestibular loss for each test of canal and otolith function; 3) Amount of vestibular loss predicted performance on single leg stance, the dynamic gait index, some conditions of the sensory organization test, and the dynamic visual acuity test. Age was also a contributing factor for predicting the performance of almost all outcomes. Conclusions Preliminarily, children with vestibular loss do not recover naturally to levels of their healthy peers, particularly with activities that utilize vestibular input; they have poorer visual acuity and balance function.

Preliminary results of video Head Impulse Testing (vHIT) in children with cochlear implants

“…In adults, changes are reported to occur in 20-40% of cases [1,8,9], while in children the prevalence ranges from 9 up to 50% [2,7,[10][11][12]. This variability seems to be independent from surgical technique [13,14] even though minimally invasive electrode insertion techniques are now considered mandatory also for vestibular function preservation [15,16].…”

“…Moreover, most studies report vestibular outcome many years after CI [2,7], so that it is not possible to establish whether the higher prevalence of vestibular dysfunction in CI children as compared to NH ones is an effect of CI or is due to the underlying disease.…”

“…The decision to perform vHIT without comparison with caloric testing was based on validation of vHIT testing in children made by other investigators who pointed out also the unpleasant sensations often caused by caloric and rotational testing in children [4,5,7].…”

Meta‐analysis of subjective complaints of vertigo and vestibular tests after cochlear implantation

“…Utricule dysfunction has been evaluated in some studies by subjective haptic vertical testing and ocular vestibular‐evoked myogenic potentials . Rotatory and video head impulse tests are established methods to examine each semicircular canal function separately .…”

Scoping Review of Systems to Train Psychomotor Skills in Hearing Impaired Children

“…Auditory inputs provide additional cues to control balance, creating a hearing “map” of surroundings that NH individuals use to maintain balance control and reduce postural sway [16,22]. HI children may experience balance difficulties, especially those with vestibular deficits [23,24] or within the first year of cochlear implants, when children exhibit higher rates of vestibular loss [25,26,27,28]. Thus, HI children have shown lower stability limits, faster and higher body sway, and higher energy expenditure to keep balance than NH children, indicating a deficit in static and dynamic balance [14,26,29,30].…”