Quantitative Vestibular Function Testing in the Pediatric Population

Abstract

Quantitative tests of vestibular function include the caloric test, cervical and ocular vestibular evoked myogenic potential (VEMP), rotary chair, and head impulse test, either at the bedside or utilizing video head impulse test (vHIT). The purpose of this article is to provide an overview of how to perform these tests in children, including which tests are recommended based on the child's age and any modifications or considerations that can be made. A variety of clinical measures have been recommended as screening measures for vestibular loss, which will be reviewed. Symptom questionnaires designed to assess the functional impact of dizziness and vestibular loss in children will also be discussed. If a child complains of dizziness or if vestibular loss is suspected (either by case history or positive screening measure), vestibular function testing is warranted. For vestibular function testing, children aged 0 to 2 years typically receive rotary chair, cervical VEMP, and vHIT if a remote system is available. For children aged 3 to 7 years, vHIT, cervical VEMP, and ocular VEMP are completed, and for children aged 8+ years, vHIT, caloric testing if vHIT is normal, and cervical and ocular VEMP are completed. For all children, modifications to testing can be made, as needed.

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

“…Additionally, paediatric vestibular assessment remains challenging and time-consuming, and child-friendly equipment and two experienced examiners are often needed. Therefore, paediatric vestibular assessment in clinical practice is only performed in specialized centres that have appropriate equipment, and is mostly limited to cochlear implant candidates [27][28][29][30][31] and children with a suspicion of vestibular dysfunction 32 . To overcome the lack of vestibular assessment in young hearing-impaired children, the Vestibular Infant Screening-Flanders (VIS-Flanders) project has been set up in June 2018 in Flanders (Belgium) in order to give each newborn with a confirmed hearing loss access to a basic screening of the vestibular function by using only one vestibular test.…”

Minimal outcome measurements in pediatric cochlear implant users: a consensus paper

“…For children 3 to 7 years of age, vHIT, cVEMP, and oVEMP are completed, and for children 8+ years of age, vHIT, caloric testing (if vHIT is normal), cVEMP, and oVEMP are completed. Vestibular testing can be achieved with modifications tailored for the pediatric population (26).…”

Perspectives: Evaluation of Older Adult Cochlear Implant Candidates for Fall Risk in a Developing Country Setting

“…Due to the inherent advantages of vHIT, which include ease of administration, acceptability to patients, and space and cost constraints, if only one piece of equipment were possible, then vHIT is a logical choice for under-resourced settings. Moreover, for CI centers with pediatric services, vHIT is far more acceptable to very young children (from 3 months) for whom calorics are not possible until the age of about 8 years ( 56 ). Therefore, combined with the results of bedside testing (oculo-motor tests, use of Frenzel lenses, and others) described in the next section, vHIT would feature strongly in a battery approach as a pass/fail criterion to identify CI candidates who require further evaluation and referral.…”