RP306 - Exploring Vestibular Practice Patterns In Pediatric Cochlear Implant Centers

Abstract: Children with severe to profound sensorineural hearing loss are at increased risk of vestibular dysfunction due to pathological or acquired etiologies. Unaddressed vestibular loss is associated with delayed gross motor skill acquisition and decreased academic performance. The field increasingly emphasizes vestibular assessment in at-risk pediatric populations, as reflected in the AAA Clinical Consensus Statement: Assessment of Vestibular Function in the Pediatric Population. A sequential mixed methods study explored current trends in vestibular assessment for pediatric cochlear implant evaluations. This presentation examines existing trends, identifies gaps in clinical implementation, and highlights opportunities for age-appropriate vestibular assessments in cochlear implant pre-evaluation protocols.

Summary: Children with severe to profound sensorineural hearing loss are at elevated risk for vestibular dysfunction, stemming either from the underlying etiology or as a consequence of cochlear implantation. Vestibular impairment in this population has been linked to delays in gross motor development and reduced academic performance. In response to these concerns, the field has increasingly emphasized the importance of vestibular assessment in at-risk pediatric populations, as reflected in the AAA Clinical Consensus Statement: Assessment of Vestibular Function in the Pediatric Population.

Despite this growing awareness, there is limited data on current practices and protocols for vestibular assessment within pediatric cochlear implant centers. The purpose of this presentation is to explore existing trends, identify gaps in clinical implementation, and highlight opportunities to integrate age-appropriate vestibular assessments—including bedside evaluations, caregiver questionnaires, and objective measures—into cochlear implant pre-evaluation protocols.

Methods: A sequential mixed-methods design was completed to explore the study aims. This design included a survey distributed to identified cochlear implant centers and interview questions informed by the survey to consenting participants. In total, 132 sites received the survey email with a return rate of 26% (34/132).

Results: A total of 30 sites completed the survey, with six sites agreeing to an interview. Of the 30 completed surveys 27 sites completed pediatric cochlear implant evaluations. Two sites (7%) completed vestibular assessment as a part of their preimplantation process, with six sites completing assessments on children who are symptomatic or at risk of vestibular loss (22%). Common assessment tools used included: Case history (70%, 7/10), Video Head Impulse Testing (vHIT) (60%, 6/10), cervical Vestibular Evoked Myogenic Potentials (cVEMP) (60%, 6/10), ocular vestibular evoked myogenic potentials (oVEMP) (60%, 6/10), and rotational chair (50%, 5/10). The majority of respondents (63%) did not complete vestibular testing as a part of their pre-implantation process. The most frequently reported barriers to the completion of vestibular assessment in the cochlear implant evaluation process included: access to equipment (57%, 13/23), training of providers (43%,10/23), and that vestibular assessment is not required as a part of the cochlear implant candidacy process (39%, 9/23). Qualitative interviews are underway to explore concepts identified within the survey results anticipated completion in January 2026.

Conclusion: Findings from the current analysis indicate growing recognition within audiology of the importance of pediatric vestibular assessment, particularly in light of the documented consequences of unaddressed vestibular dysfunction. Given the elevated risk among children with severe to profound sensorineural hearing loss, pediatric cochlear implant centers are uniquely positioned to lead efforts in early identification and intervention.

Survey data reveal that vestibular assessment practices remain inconsistently implemented across cochlear implant programs. However, a range of clinically viable tools, including bedside assessments, caregiver questionnaires, and objective measures, are available and supported by the AAA Clinical Consensus Statement: Assessment of Vestibular Function in the Pediatric Population. These tools offer a pathway toward more standardized and comprehensive care for this vulnerable population.

Brief Summary of Clinical Takeaways: 1. Recognize the current gaps and practices in pediatric vestibular assessment within cochlear implant pre-evaluation protocols.

2. Identify opportunities to integrate age-appropriate vestibular tools, including bedside assessments, caregiver questionnaires, and objective measures, into pediatric cochlear implant evaluations, with clear referral pathways for follow-up care.

Assumptions: Attendees should possess a basic understanding of the vestibular system and vestibular assessments.