Abstract
Vestibular end organ impairment is highly prevalent in children who have sensorineural hearing loss (SNHL) rehabilitated with cochlear implants (CIs). As a result, spatial perception is likely to be impacted in this population. Of particular interest is the perception of visual vertical because it reflects a perceptual tilt in the roll axis and is sensitive to an imbalance in otolith function. The objectives of the present study were thus to identify abnormalities in perception of the vertical plane in children with SNHL and determine whether such abnormalities could be resolved with stimulation from the CI. Participants included 53 children (15.2 ± 4.0 years of age) with SNHL and vestibular loss, confirmed with vestibular evoked myogenic potential (VEMP) testing. Testing protocol was validated in a sample of nine young adults with normal hearing (28.8 ± 7.7 years). Perception of visual vertical was assessed using the static Subjective Visual Vertical (SVV) test performed with and without stimulation in the participants with cochleovestibular loss. Trains of electrical pulses were delivered by an electrode in the left and/or right ear. Asymmetric spatial orientation deficits were found in nearly half of the participants with CIs (24/53 [45%]). The abnormal perception in this cohort was exacerbated by visual tilts in the direction of their deficit. Electric pulse trains delivered using the CI shifted this abnormal perception towards center (i.e., normal; p = 0.007). Importantly, this benefit was realized regardless of which ear was stimulated. These results suggest a role for CI stimulation beyond the auditory system, in particular, for improving vestibular/balance function.
Highlights
Vestibular dysfunction is overwhelmingly prevalent in children with sensorineural hearing loss (SNHL; O’Reilly et al, 2010), including 40–50% of those who receive cochlear implants (CIs; Jin et al, 2006; Cushing et al, 2013; Inoue et al, 2013; Janky and Givens, 2015; Thierry et al, 2015)
Subjective Visual Vertical (SVV) measurements from the participants with SNHL using CIs are shown in Figure 1, along with data from normalhearing adults for reference
The present study used the SVV test to investigate how children with SNHL rehabilitated with CIs perceive the vertical plane and to determine if CI stimulation affects their perception of the visual vertical
Summary
Vestibular dysfunction is overwhelmingly prevalent in children with sensorineural hearing loss (SNHL; O’Reilly et al, 2010), including 40–50% of those who receive cochlear implants (CIs; Jin et al, 2006; Cushing et al, 2013; Inoue et al, 2013; Janky and Givens, 2015; Thierry et al, 2015). CI Stimulation Corrects Abnormal Perception otolith function, assessed by cervical vestibular evoked myogenic potentials (cVEMPs) and the subjective visual horizontal (Tribukait et al, 2004). Such deficits are not without functional consequences, as children with concurrent vestibular and cochlear deficits perform poorly on tests of postural control (Licameli et al, 2009) and are at increased risk of CI hard failure (Wolter et al, 2015). The present study used the Subjective Visual Vertical (SVV) test to determine: (1) how children with SNHL using CIs perceive the vertical plane; and (2) whether or not stimulation from the CI improves the accuracy of vertical estimation
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