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Changes in balance control after cochlear implant surgery
Allum J.H. , Stieger C. , Honegger F. , Bodmer D.
University Hospital Basel, ORL, Basel, Switzerland
Background: Recently, the elderly hearing-impaired have received more focus as cochlear implant (CI)
candidates. Patients over the age of 60 years are very likely to have balance problems and suffer falls. Thus in
elderly CI patients, there is a potential risk for long-term balance problems to be acquired following the CI
surgery, especially if a peripheral vestibular deficit was present pre-operatively. We investigated whether CI
patients' balance problems worsened 2 months after CI surgery.
Methods: To date, we have investigated balance control of 9 CI patients of mean age 60 years, 4 months preoperatively and 2 months post-operatively (some 2 weeks after first speech processor stimulation). 7 patients
received a Nucleus and 2 a MED-EL CI. Trunk sway was measured during a battery of 14 stance and gait tasks
with a SwayStar system mounted at lumbar 1-3, recording trunk roll and pitch velocities. The task battery
comprised 4 two-legged stance tasks (eyes open and eyes closed, on a normal floor and on a foam support
surface) and 3 one-legged stance tasks (eyes open and eyes closed on normal surface, eyes open on foam)
lasting 20s or until balance control was lost. Also two semi-stance tasks (walking eight tandem steps on a normal
and foam support surface), three simple gait tasks (walking a distance of 3 meters, either with closed eyes or
rotating or pitching the head while walking) and two complex gait tasks (walking up and down a set of stairs with
two upward and two downward steps and walking over a series of four low (24 cm high) barriers) were used.
Task measures were compared pre- and post-operatively and with respect to age-matched healthy controls.
Pathological balance control was defined as sway greater than the 95% limit of controls.
Results: A combination of test results used to identify peripheral vestibular deficits (Allum JHJ &Adkin AL. Audiol
Neurootol 2003, 8:286-302) indicated that 44% of the patients had pathological balance control pre-operatively
and all except one had poorer balance control post-operatively with 66% pathological (pre-op score 471, post-op
572) . Those that remained normal had normal vestibular function pre-operatively. Both stance and gait tests
were worse preoperatively. Standing eyes closed on foam revealed an average 100% increase in pitch and roll
sway velocity. Walking with eyes closed showed a 12% increase in these measures with an 18% slowing in gait
velocity. All changes were greater than expected based on the 6 month interval between tests.
Conclusions: This pilot study is the first to indicate that post-operatively elderly CI patients are likely to suffer
increased balance problems due to vestibule-spinal deficits, especially if deficits were present pre-operatively.
Appropriate patient counselling and post-operative therapy is therefore recommended. Future studies should
investigate the effect of speech processor switch-on on the balance deficits.