Adults with cochlear implant and vestibular dysfunction: A scoping review

Area of Science:

• Otolaryngology
• Neuroscience
• Audiology

Background:

• Cochlear implantation (CI) is a common treatment for severe to profound hearing loss.
• Vestibular dysfunction is a potential complication of CI, affecting balance and causing dizziness.
• Understanding the incidence and characteristics of CI-related vestibular dysfunction is essential for patient care.

Purpose of the Study:

• Determine the rate of vestibular dysfunction following cochlear implantation.
• Identify optimal preoperative tests to detect patients at risk for vestibular issues.
• Examine the relationship between objective vestibular dysfunction and subjective symptoms.
• Summarize the benefits of postoperative vestibular therapy.

Main Methods:

• A comprehensive scoping review was conducted following PRISMA-ScR guidelines.
• Searches included major databases (PubMed/MEDLINE, Web of Science, Scopus, Embase, CINAHL) up to December 2024.
• Thirty-five studies involving 2,096 adult participants were included.

Main Results:

• Preoperative vestibular dysfunction was noted in 47% (caloric testing) and 34.9% (cVEMP), rising postoperatively to 65.9% and 43.1%.
• Subjective dizziness symptoms increased from 25.1% to 29% but mostly resolved.
• Caloric testing, cVEMP, and vHIT were common assessments; combined paradigms offered the most thorough evaluation.
• Vestibular rehabilitation effectively improved dizziness, balance, and quality of life (DHI scores) in 80-100% of patients.

Conclusions:

• A significant number of cochlear implant recipients develop vestibular dysfunction.
• Preoperative vestibular assessment is vital for identifying at-risk patients.
• While symptoms are often transient, targeted management and vestibular rehabilitation can be highly beneficial.