We know that children with permanent hearing loss are more likely to have an associated balance problem. It is also thought that children with cochlear implants (CI) that fail do so because of an increased risk of falls and head injury, the falls presumably damaging the CI. The study itself looked at 35 children with CI failure compared to 165 children without failure. Children underwent a battery of vestibular tests (including calorics, vHIT, static and dynamic balance testing), and CI failures were significantly greater in children with vestibular impairment. If horizontal canal function was absent bilaterally, there was a 7.6 fold increased risk of CI failure. This study from Toronto advises us to refer our paediatric CI recipients to a paediatrician to identify those that have a vestibular impairment. Although the authors recognise that restoring vestibular input is not possible at present, future developments will allow such restoration (see work by Charley Della Santina at Johns Hopkins). We are reminded that identification of balance impairment can have a major impact on the management and counselling of the child and their family.