Vestibular dysfunction in children undergoing cochlear implantation: Prevalence and postoperative changes

OBJECTIVE: To determine the prevalence of vestibular dysfunction in children with sensorineural hearing loss (SNHL) undergoing cochlear implantation (CI), and to assess postoperative changes in vestibular function in the implanted ear. METHODS: This retrospective study included all children with SNHL who underwent CI at Aarhus University Hospital between 2020 and 2024 and received preoperative vestibular testing. Vestibular assessment comprised video head impulse testing (vHIT/HIT) and cervical vestibular evoked myogenic potentials (cVEMP). Paired pre- and postoperative data were available for a subset of children, in whom within-subject changes were analysed using McNemar's test. RESULTS: A total of 171 children completed preoperative vestibular testing. Preoperatively, 26.9% showed abnormalities on at least one vestibular modality, with otolith dysfunction on cVEMP being most frequent (31.2%). Paired pre- and postoperative assessments were available for 47 children. In the implanted ear, vestibular dysfunction increased from 8.5% preoperatively to 25.5% postoperatively. Otolith function deteriorated in 21.9% (9/41) of children with available cVEMP data (p = 0.0156), whereas semicircular canal changes on vHIT/HIT were infrequent and not statistically significant. Postoperative findings in the non-implanted ear were sparse and showed no systematic pattern. CONCLUSION: Vestibular dysfunction is common among children with SNHL prior to cochlear implantation. In the subgroup with paired data, CI was associated with a significant postoperative decline in otolith function, while semicircular canal responses remained largely stable. These findings highlight the importance of implementing systematic vestibular assessment in both the preoperative and postoperative CI work-up to support surgical planning and early rehabilitation.