Vestibular and radiological evaluation of hearing impaired children with delayed Motor development

Abstract

Background: Combined hearing and vestibular loss in children pose potentially significant problems. Children and infants with vestibular problems are faced with motor problems that could limit their normal development. Objectives: the aim of the study is to assess the relationship between the vestibular disorders and the delayed motor development in hearing impaired children as well as to assess the integrity of the vestibular system through clinical testing and radiological imaging in those children with delayed motor development. Methods: Thirty hearing impaired children with history of delayed motor milestones, and a control group of 10 hearing impaired children with normal motor development were included with variable degree of hearing loss. Each child was subjected to careful history taking, general examination, otoscopic examination, motor and balance questionnaires were answered by the parents or caregivers, audiological evaluation either through conditioned play audiometry or conventional audiometry, speech audiometry and Immittancemetry. Vestibular evaluation through cVEMP and caloric tests and finally the radiological studies through CT and MRI of the petrous bone. Results: There were variable degrees of hearing loss among both groups. In the control group (10 HI children, 20 ears), 18 ears (90%) had VEMP response, while two ears (10%) had absent VEMP, while in the study group (30 HI children, 60 ears), 48 ears (80%) had VEMP response, while 12 ears (20%) had absent VEMP. All children in the control group had normal caloric response, while in the study group, 23 children (77%) had normal response, and seven children (23%) had abnormal caloric response, 4 children had bilateral weakness and 3 had unilateral weakness. CT and MRI study of petrous bone was done for the control group and revealed normal radiology, while in the study group, 21 children had normal imaging (70%) and the last 9 children (30%) had abnormal findings, the most common abnormalities was enlarged vestibular aqueduct (13%), followed by common cavity (7%). Conclusion: Children with hearing loss, irrespective of the degree of hearing loss, the vestibular system should be screened, assessed as it may be responsible for co-morbidities in fine and gross motor difficulties. Early intervention and effective therapy will be the proper way to get good outcome.

The incidence of enlarged vestibular aqueduct among hearing-impaired children: hospital-based tertiary care referral center

“…However, these findings contradicted the findings of Noguchi et al who reported that vertigo/dizziness/ imbalance accounts for approximately 8.8% of EVA patients [44]. Furthermore, Madden et al reported that vestibular symptoms were present in only three (4%) of the studied patients with EVA [45].…”

“…EVA is the most common abnormal inner ear anomalies. Its prevalence rate in pediatric patients ranges between 5 and 15% [32,44]. This study showed a higher prevalence of EVA among female population (54.4%), as shown in Table 1.…”

Cross-Sectional Study to Estimate the Prevalence of Inner-Ear Anomalies in Children With Congenital Sensorineural Hearing Loss by High-Resolution Computed Tomography (HRCT) Temporal Bone Scan

“… Jackler et al 1987 [ 5 ], Reilly et al 1989 [ 9 ], Antonelli et al 1999 [ 10 ], McClay et al 2002 [ 11 ], Abdullah et al 2003 [ 12 ], Wu et al 2005 [ 6 ], Shim et al 2006 [ 13 ], Ma et al 2008 [ 14 ], McClay et al 2008 [ 15 ], Yuan et al 2012 [ 16 ], Agarwal et al 2014 [ 1 ], Munjal et al 2015 [ 17 ], Dağkıran et al 2017 [ 18 ], Sengottuvelu et al 2017 [ 2 ], Bhagat et al 2018 [ 19 ], Elmoursy et al 2019 [ 20 ] …”