Objective Vestibular Outcomes Following Pediatric Cochlear Implantation Using the Round Window Approach

BACKGROUND: To objectively evaluate vestibular function changes following pediatric cochlear implantation via the round window approach. METHODS: Prospective study of 20 children undergoing cochlear implantation. Ethical approval was obtained, and written informed consent was secured from parents or legal guardians. Pre- and postoperative vestibular assessment included cervical vestibular evoked myogenic potentials (cVEMP), ocular vestibular evoked myogenic potentials (oVEMP), and video head impulse testing (vHIT). Primary outcomes were change in VEMP response presence, VEMP amplitude among patients with measurable responses at both time points, and vHIT vestibulo-ocular reflex gain and corrective saccades. Secondary outcomes were VEMP latency parameters. RESULTS: Among patients with measurable responses at both timepoints, significant postoperative amplitude reductions were observed for both cVEMP (n = 11; median 92.12-47.33 µV, P = .001) and oVEMP (n = 9; median 6.72-4.80 µV, P = .004). A significant increase in response absence rates was also documented for both cVEMP and oVEMP (McNemar test, P = .016 for each). No significant changes were detected in semicircular canal vHIT gains. CONCLUSION: Pediatric cochlear implantation using the round window approach was associated with early postoperative changes in VEMP-based measures of otolithic function, while high-frequency semicircular canal function assessed by vHIT remained largely preserved. These findings support the routine use of objective vestibular assessment in pediatric cochlear implant candidates and recipients.