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The Vestibular Olympics

Sharon L. Cushing, MD; Ruth Chia, MSc, Aud(C); Adrian L. James, MA, BM, BCh, FRCS, FRCS(ORL-HNS); Blake C. Papsin, MD, FRCSC; Karen A. Gordon, PhD

Arch Otolaryngol Head Neck Surg. 2008;134(1):34-38.

Objectives  To determine the incidence of static and dynamic balance dysfunction in a group of children with profound sensorineural hearing loss receiving a cochlear implant and to assess the impact of cochlear implant activation on equilibrium.

Design  Observational cross-sectional study of children with single-sided implants, tested under 2 conditions: (1) implant on and (2) implant off in a random order.

Setting  Ambulatory setting within an academic, tertiary care children's hospital.

Participants  Forty-one children (ages 4-17 years) with cochlear implants comprised the study group. Fourteen children with normal hearing served as controls.

Intervention  All participants performed a standardized test of static and dynamic balance function (Bruininks-Oseretsky Test of Motor Proficiency 2 [BOT2], balance subset). Children with implants performed the BOT2 under the 2 randomized conditions.

Main Outcome Measures  Overall performance on the balance subset of the BOT2 and the influence of implant activation on performance.

Results  The mean (SD) age-adjusted scale score for our control group was 17 (5) points (95% confidence interval [CI], 14-20), which was not significantly different (P  = .15) from the published age-adjusted mean for the BOT2 balance subset (15 [5] points). The group that had undergone implantation, however, performed significantly more poorly (12 [ 6] points; 95% CI, 10-14) than either the control group or the published test mean (P = .004). Children with implants performed better with their implants on than with their implants off (mean [SD] difference, 1.3 [2.7] points; 95% CI, 0.3-2.3; P = .01).

Conclusions  Large differences exist in the balance ability of children with sensorineural hearing loss requiring cochlear implantation compared with age-matched controls. Implant activation, however, conferred a slight advantage in accomplishing balance-related tasks. These results substantiate the need to further quantify the baseline vestibular dysfunction of our study population of children with cochlear implants, as well as the impact of implant activation on the input and output of the vestibular system.

Author Affiliations: Departments of Otolaryngology–Head and Neck Surgery (Drs Cushing, James, and Papsin) and Communication Disorders (Ms Chia and Dr Gordon), Hospital for Sick Children, Toronto, Ontario, Canada.

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