Assessment Techniques for Vestibular Evaluation in Pediatric Patients

Video head impulse testing (VHIT) in the pediatric population

“…The VOR matures throughout childhood [15,16], which has implications for establishing normal ranges of VHIT gain. The ROC curve in our study demonstrates an optimal cut-off point where specificity is 100% and sensitivity is 67% which corresponds to a normal LSC gain cut-off value of 0.7, identical to that established for adults [8][9][10].…”

Rotatory and Collic Vestibular Evoked Myogenic Potential Testing in Normal-Hearing and Hearing-Impaired Children

“…We therefore limited the test battery for horizontal semicircular canal function to the rotatory test because it appears to be a frequently applied, nonthreatening, efficient, and reliable method of evaluating peripheral vestibular output in a difficult-to-test pediatric population and is easier to perform than the caloric test (Cyr et al 1985;Valente 2011). Analogous to the rotatory test, cVEMP testing may also be a viable, time-efficient, noninvasive, and objective diagnostic procedure for testing children (Valente 2007).…”

“…Children with vestibular complaints such as vertigo rarely present themselves to the ENT specialist due to limited communication abilities, the possible presence of atypical symptoms, and their quick adaptation and compensation abilities (Eviatar & Eviatar 1978;Weiss & Phillips 2006;Balatsouras et al 2007;Niemensivu et al 2007;Worden & Blevin 2007;Luxon & Mäki-Torkko 2008;Wiener-Vacher 2008;O'Reilly et al 2010O'Reilly et al , 2011Benun 2011;McCaslin et al 2011;Valente 2011). Consequently, their problems are often overlooked, sometimes even leading to an erroneous labeling of the child being clumsy, or HEARING,VOL.…”

“…Several elucidations for this limited pediatric vestibular awareness have been postulated. Children often lack the appropriate vocabulary or experience to express abnormal feelings of vertigo, dizziness, or imbalance (Balatsouras et al 2007;Luxon & Mäki-Torkko 2008;WienerVacher 2008;Benun 2011;McCaslin et al 2011;Valente 2011). Their clinical signs are often completely different from those of an adult population.…”

“…Despite the fact that the vestibular end organ is anatomically and structurally fully developed at birth, it continues to mature by developing central inhibitory influences, cerebellar control, and central vestibular adaptation, to finally reach adult-like developmental levels around the age of 15 years (Ornitz et al 1979(Ornitz et al , 1985Wiener-Vacher et al 1996;Valente 2007;Casselbrant et al 2010;O'Reilly et al 2011). Therefore, age-appropriate normative data are a prerequisite to analyze test results accurately to avoid misdiagnoses related to immature vestibular systems (Valente 2011;Valente et al 2012). …”