title: Vestibular and Balance Impairment Contributes to Cochlear Implant Failure in Children.
abstract: OBJECTIVE
  To determine the role of vestibular and balance dysfunction in children with cochlear implant (CI) failure.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Thirty-five children with CI failure were compared to 165 children who did not experience CI failure.
  
  
  METHODS
  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.
authors: *Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto; †Archie's Cochlear Implant Laboratory and ‡Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Nikolaus E
authors: NE
authors: Wolter
authors: Karen A
authors: KA
authors: Gordon
authors: Blake C
authors: BC
authors: Papsin
authors: Sharon L
authors: SL
authors: Cushing
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003054:Cochlear Implants; D004424:Ear Canal / Q000503:physiopathology; D005260:Female; D064087:Head Impulse Test; D034381:Hearing Loss / Q000209:etiology / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D010037:Otolithic Membrane / Q000503:physiopathology; D004856:Postural Balance; D012086:Reoperation; D012189:Retrospective Studies; D012399:Rotation; D012678:Sensation Disorders / Q000150:complications*; D017211:Treatment Failure; D015837:Vestibular Diseases / Q000150:complications*; D058585:Vestibular Evoked Myogenic Potentials / Q000502:physiology; D014724:Vestibular Function Tests