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

Abstract

Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening–Flanders (VIS–Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS–Flanders project aims to set an example for other regions worldwide.

Influence of screening devices and protocol on audiological outcome of 25 years of universal neonatal hearing and vestibular screening in Flanders

“…24 Children with vestibular dysfunction show delayed development of gross motor milestones, which is an important reason for early detection and treatment. 9 The incidence of vestibular dysfunction measured by cVEMP was 9,5 % in the first 3 years but significantly higher in children with severe or profound hearing loss in accordance with the literature. 9,24 Since cVEMP only tests the sacculus, further testing at a later age is necessary to confirm the results and test the other parts of the vestibular system.…”

“…Data on language development were available for 80 % of the children and showed a normal language development in 34,5 % of the children, a slight delay in 18,5 %, a moderate delay in 15,7 % and a severe delay in 12,2 %. 4,8 The first results of 1,5 year Vestibular Infant Screening (VIS)-Flanders 9 were published in 2020. A total of 210 infants were detected with a PCHL in that period, 169 (91,8 %) of the infants had a permanent uni-or bilateral sensorineural and 15 a permanent uni-or bilateral conductive hearing loss.…”

“…Unilateral or bilateral refer after vestibular screening occurred significantly more in infants with uni-or bilateral severe to profound hearing loss (> 71 dB) compared to infants with unilateral mild to moderate hearing loss (21-70 dB) (p=0,003). 9 The 3-year results are currently analyzed and will be published later this year.…”

“…In all centers the Neuro-Audio® commercial device and accompanying software (Neurosoft, Ivanovo, Russia) is used, presenting 500 Hz tone bursts with a rise/fall time of 1 ms and a 2 ms plateau time, intensity level of 59 dB nHL and a stimulation repetition rate of 5 Hz. 9…”

Vestibular Deficits in Deafness: Clinical Presentation, Animal Modeling, and Treatment Solutions

“…Some efforts have been made in this direction. For example, Belgium has implemented a vestibular defect screening test for children with hearing impairment ( 129 ) and the French Society for Otorhinolaryngology (SFORL) recommends a vestibular assessment for all children undergoing cochlear implantation in its latest guidelines on pediatric cochlear implantation ( 130 ).…”