This paper examined the effect of cochlear implantation on balance function in 16 adult patients. The authors assessed balance pre- and (two weeks) post-operatively by timing how long each patient was able to stand on a foam pad with their eyes closed. Results ranged from 0 seconds (unable to stand) to a maximum of 30 seconds (considered to be normal function). All implantations were performed using ‘soft surgery’ techniques via the round window or antero-inferior cochleostomy. Post-operatively, balance function declined in nine patients, including four of the 10 patients with normal function pre-operatively. Each patient’s risk of falling was calculated using previously published data linking falls risk to the time achieved on the foam test. The average risk of falling increased by 1.6 times following surgery, though the increase was higher (2.1 times) in patients over 60 years of age. Although this paper has some methodological flaws: small numbers; multiple surgeons; a heterogenous group of patients; inclusion of bilateral as well as unilateral implantations; and no long-term follow-up it draws several important conclusions. Balance function is commonly reduced following cochlear implantation and may increase falls risk, particularly in older patients. This highlights the need for careful patient counselling and routine use of soft surgery techniques.

Falls after cochlear implantation.
Stevens MN, Baudhuin JE, Hullar TE.
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Stuart Burrows

FRCS (ORL-HNS), Wellington Regional Hospital, Newtown, Wellington, New Zealand.

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