Pediatric Vestibular Evaluation: Two Children with Sensorineural Hearing Loss

Abstract

These two cases illustrate several important areas of vestibular evaluation with children. The two case reports represent two children who display very different vestibular findings despite having significant sensorineural hearing loss. These case reports highlight that pediatric findings can differ significantly from adult findings, stressing the importance of comparing pediatric results with pediatric normative data. These two cases also highlight that vestibular techniques may successfully be adapted for use with hearing-impaired children. That is, rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials can be adapted to use with children, including those who demonstrate significant sensorineural hearing loss. Although there is a paucity of research and clinical work in this area, some investigators (Eviatar and Eviatar, 1977; Buchman et al, 2004; Jacot et al, 2009) have reported very rapid recovery from pediatric vestibular deficits. However, it is important for audiologists to be aware that techniques may successfully be adapted for children and that many children should undergo thorough vestibular evaluation.

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

“…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). …”

Vestibular Infant Screening (VIS)–Flanders: results after 1.5 years of vestibular screening in hearing-impaired children

“…Recently, there is an increasing interest among clinicians in the vestibular function of hearing-impaired children and several researchers have proven the feasibility of vestibular testing from an early age on by adapting the standard test protocol to children [22][23][24][25] . However, paediatric vestibular dysfunction often goes unnoticed due to the atypical expression of vestibular symptoms and the limited communicative abilities of young children 18,26 .…”

Vestibular assessment in children aged zero to twelve years: an integrative review

“…After analyzing all the studies included in the integrative review, eight experimental studies were found, six of which were randomized clinical trials (level of evidence 2) 12 , 13 , 14 , 15 , 16 , 17 and two non-randomized ones (level of evidence 3) 18 , 19 ; eighteen observational studies (level of evidence 4) 5 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ; and six case studies (level of evidence 5), 36 , 37 , 38 , 39 , 40 , 41 according to the classification used. 11 …”

“…The included studies were carried out between the years 1969 and 2020, in the European, 5 , 12 , 13 , 14 , 18 , 21 , 22 , 27 , 36 , 41 American, 15 , 25 , 26 , 28 , 30 , 32 , 33 , 34 , 39 , 40 Asian 16 , 17 , 20 , 23 , 24 , 29 , 31 , 35 , 37 , 38 and African continents. 19 …”

“…Among the included studies, all performed some type of neurotological evaluation and some associated it with other tests. The vestibular function of the included studies was evaluated through the following tests: thirteen studies used rotary chair testing (RCT), 15 , 18 , 20 , 23 , 25 , 27 , 28 , 30 , 31 , 32 , 38 , 40 , 41 eight used caloric stimulation, 13 , 15 , 22 , 23 , 24 , 25 , 33 , 36 fourteen studies performed the cervical-vestibular evoked myogenic potential (cVEMP), 5 , 12 , 16 , 17 , 19 , 23 , 25 , 27 , 29 , 35 , 36 , 37 , 38 , 40 seven studies performed electronystagmography or vectoelectronystagmography (VECTO), 14 , 20 , 24 , 28 , 32 , 33 , 36 three analyzed the presence of spontaneous nystagmus, 19 , 26 , 39 two studies used the video head impulse test (vHIT), 27 , 41 two studied the oculomotor function, 26 , 30 two studies performed the vestibulo-ocular reflex (VOR) assessment, 21 , 38 one study performed the spinal vestibule reflex (SVR) assessment 14 and one applied the following tests: Romberg, Unterberger, Fukuda and Dix-Halpike. 13…”