Supporting information for quality assessment.

<div> Background Previous systematic reviews evaluated the effect of hearing interventions on static and dynamic stability and found several positive effects of hearing interventions. Despite numerous reviews on hearing interventions and balance, the impact of cochlear implantation on gait and fall risk remains unclear. Objective This systematic review examines the effects of cochlear implantation on gait performance in adults with hearing loss. Methods A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PEDro scale assessed the methodological quality, risk of bias, and study design of included articles. Results Seven studies met the inclusion criteria. Five focused solely on cochlear implantation, while two included both cochlear implants (CIs) and hearing aids. Methodological inconsistencies were evident in measurement approaches and follow-up durations, leading to variable outcomes. Short-term follow-up post-implantation showed no improvement or even worsened gait outcomes. However, a longer follow-up of three months post-implantation indicated partial improvements in specific gait measures like Tandem Walk speed, though not in comfortable walking speed. Cross-sectional studies comparing on-off CI conditions revealed no significant differences in gait outcomes. Conclusions Improvements in gait due to cochlear implantation require at least three months to manifest. The variability in study methodologies complicates understanding the full impact of cochlear implantation on gait. Given that only seven, methodologically inconsistent articles were found, it is necessary to conduct additional research to understand the relationship between hearing, gait and fall risk and to specifically include longer post-CI monitoring periods. </div>