Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report

Abstract

Objectives: 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. The objectives of this study are to (1) determine whether age-related changes in peripheral vestibular tests occur; (2) quantify peripheral vestibular function in children with normal hearing and CCI; and (3) determine whether amount of vestibular loss predicts visual acuity and balance performance.

Design: Eleven CCI and 12 children with normal hearing completed the following tests of vestibular function: ocular and cervical vestibular-evoked myogenic potential to assess utricle and saccule function and the video head impulse test 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 vestibular-evoked myogenic potential 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.

Figures

Figure 1

Relationship between mean horizontal canal vHIT gain and mean SHA rotary chair gain for normal control adults (closed circle), CNH (open circle) and CCI (open triangle). Line represents regression line through the data. Gray shaded region represents abnormal horizontal canal vHIT gain (

Figure 2

Mean vestibular loss rating of CNH (left) and CCI (right) where 10 = normal function and 0 = complete loss of function. One subject (CNH group), denoted by an asterisk, had borderline abnormally low vHIT gain in 4 canals.

Figure 3

Dynamic Visual Acuity. Mean active (left) and passive (right) DVA performance as it relates to Amount of Vestibular Loss (Open Circle = CNH, Open Triangle = CCI with normal vestibular function (NV), and Filled Triangles = CCI with vestibular loss (VL))

Figure 3

Dynamic Visual Acuity. Mean active (left) and passive (right) DVA performance as it relates to Amount of Vestibular Loss (Open Circle = CNH, Open Triangle = CCI with normal vestibular function (NV), and Filled Triangles = CCI with vestibular loss (VL))

Figure 4

Single Leg Stance (SLS) Eyes Open (EO) and Eyes Closed (EC). Mean SLS-EO and –EC performance as it relates to Amount of Vestibular Loss * (Open symbols= CNH, Closed symbols= CCI)