BMJ Case Reports 2017; doi:10.1136/bcr-2017-220391
  • Reminder of important clinical lesson

Balance versus hearing after cochlear implant in an adult

  1. Eli Carmeli3
  1. 1Department of Physiotherapy, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  2. 2The Israeli Center for Treating Dizziness and Balance Disorders, Ra’anana, Israel
  3. 3Department of Physical Therapy, University of Haifa, Haifa, Israel
  4. 4Department of Neuroscience, The National Institute for Brain and Rehabilitation Sciences, Nazareth, Israel
  1. Correspondence to Professor Gerry Leisman, g.leisman{at}
  • Accepted 26 September 2017
  • Published 10 October 2017


The effect of vestibular rehabilitation (VR) on anxiety, dizziness and poor balance that developed after cochlear implant (CI) surgery is described. A 54-year-old woman, with profound hearing loss since the age of 2 years, underwent right CI surgery 2 years previously. On implant activation, the patient immediately felt dizziness and imbalance, which affected the ability to perform activities of daily living and increased anxiety to where the patient considered the CI removal. Prior to VR the patient was evaluated with the Dizziness Handicap Inventory and the Visual Vertigo Dizziness Questionnaire and clinically with the Zur Balance Scale and Video Head Impulse Test. The patient underwent 14 VR sessions over 4 months that included compensation, adaptation and habituation exercises. After VR the patient was able to maintain good balance while using the CI. Dizziness and anxiety improved dramatically. This report increases awareness that a CI could compromise balance, which can be overcome with personalised VR.


  • Contributors OZ contributed to the concept, planning and direct treatment of the patient and conduct of the study. HB-RS contributed to the treatment, acquisition of the data and conduct of the study. GL contributed to the reporting, data analysis and interpretation of the data, and reporting of the study. EC contributed to the concept, data analysis and reporting of the study.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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