Vestibular dysfunction in pediatric patients with cochlear implantation: A systematic review and meta-analysis

Qiong Wu; Qin Zhang; Qianwen Xiao; Yuzhong Zhang; Zichen Chen; Shuyun Liu; Xueyan Wang; Yong Xu; Xin-Da Xu; Jingrong Lv; Yulian Jin; Jun Yang; Qing Zhang

doi:10.3389/fneur.2022.996580

Vestibular dysfunction in pediatric patients with cochlear implantation: A systematic review and meta-analysis

Front Neurol. 2022 Oct 17:13:996580. doi: 10.3389/fneur.2022.996580. eCollection 2022.

Authors

Qiong Wu^{1

2

3}, Qin Zhang^{1

2

3}, Qianwen Xiao^{1

2

3}, Yuzhong Zhang⁴, Zichen Chen⁴, Shuyun Liu⁵, Xueyan Wang⁶, Yong Xu⁴, Xin-Da Xu⁷, Jingrong Lv^{1

2

3}, Yulian Jin^{2

3

8}, Jun Yang^{1

2

3}, Qing Zhang^{2

3

8}

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Shanghai Key Laboratory of Translational Medicine in Ear and Nose Diseases, Shanghai, China.
⁴ Department of Otolaryngology Head and Neck Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China.
⁵ Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
⁶ Department of Otolaryngology Head and Neck Surgery, The Affiliated Hospital of Yanbian University, Yanji, Jilin, China.
⁷ Department of Otolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China.
⁸ Diagnosis and Treatment Center of Hearing Impairment and Vertigo, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.

Abstract

Objective: Vestibular dysfunction may delay the achievement of balance and perception milestones in pediatric patients after cochlear implantation (CIM).

Methods: A strategic literature search was done following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed, Medline, Embase, Web of Science, and Cochrane Library databases from inception to July 2022. Studies were included on the otoliths, semicircular canals, and balance function changes in children after CIM. Two reviewers independently assessed the level of evidence, methodological limitations, risk of bias, and characteristics of the cases. Matched pre- and postoperative vestibular functional test data, including ocular and cervical vestibular-evoked myogenic potential (oVEMP and cVEMP), caloric test, video head impulse test (vHIT), and Bruininks-Oseretsky Test 2 (BOT-2), were used to calculate the relative risk of vestibular disorders. Subgroup analyses were performed according to surgical approach, CIM device status, and etiology.

Results: Twenty studies that met the inclusion criteria were selected for the meta-analysis. We observed significant vestibular dysfunction in pediatric patients with CIM. The results showed a statistically significant increase in abnormal cVEMP response (RR = 2.20, 95% CI = 1.87, 2.58, P < 0.0001), abnormal oVEMP response (RR = 2.10, 95% CI = 1.50, 2.94, P < 0.0001), and abnormal caloric test results (RR = 1.62, 95% CI = 1.20, 2.19, P = 0.0018) after implantation. Statistically significant differences were not found in the vHIT test results of all three semicircular canals before and after the operation (P > 0.05). Regarding static and dynamic balance, we found significantly poorer BOT-2 scores in children with CIM than in the normal group (mean difference = -7.26, 95% CI = -10.82, -3.70, P < 0.0001).

Conclusion: The results showed that vestibular dysfunction might occur after CIM in pediatric patients. Some children experience difficulties with postural control and balance. Our results suggest that a comprehensive evaluation of vestibular function should be performed before and after CIM.

Keywords: cochlear implantation; pediatric patients; vestibular disorders; vestibular function test; vestibular-evoked myogenic potentials.

Publication types

Systematic Review