Adults with cochlear implant and vestibular dysfunction: A scoping review

To determine the rate of vestibular dysfunction after cochlear implantation (CI), identify optimal preoperative testing to detect at-risk patients, examine correlations between objective dysfunction and symptoms, and summarize benefits of postoperative vestibular therapy.

A scoping review following PRISMA-ScR guidelines was conducted. Searches of PubMed/MEDLINE, Web of Science, Scopus, Embase, and CINAHL identified studies from inception to December 2024.

Thirty-five studies including 2,096 adults met criteria. Preoperative vestibular dysfunction in the implanted ear was reported in 47% on caloric testing and 34.9% on cVEMP, increasing postoperatively to 65.9% and 43.1%, respectively. Subjective symptoms rose from 25.1% to 29%, with most resolving by late follow-up. Caloric testing was the most frequently used assessment (66.6%), followed by cVEMP (59.2%) and vHIT (55.5%). Combined paradigms offered the most complete evaluation. Correlation between objective dysfunction and dizziness was weak. Vestibular rehabilitation improved dizziness, balance, and DHI scores in 80-100% of treated patients.

Most CI recipients experience mild and transient vestibular symptoms, though some require targeted management.

A substantial proportion of CI recipients develop vestibular dysfunction, supporting the need for comprehensive preoperative assessment.