How sacculo-collic function assessed by cervical vestibular evoked myogenic Potentials correlates with the quality of postural control in hearing impaired children?

Vestibular Function and Postural Control in Children with Autism Spectrum Disorder

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks-Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention.

Postural Sway Velocity of Deaf Children with and without Vestibular Dysfunction

BACKGROUND

Sensory information obtained from the visual, somatosensory, and vestibular systems is responsible for regulating postural control, and if damage occurs in one or more of these sensory systems, postural control may be altered.

OBJECTIVE

To evaluate and compare the postural sway velocity between children with normal hearing and with sensorineural hearing loss (SNHL), matched by sex and age group, and to compare the postural sway velocity between children with normal hearing and with SNHL, with and without vestibular dysfunction.

METHODS

Cross-sectional study that evaluated 130 children (65 with normal hearing and 65 with SNHL), of both sexes and aged between 7 and 11 years, from public schools of the city of Caruaru, Pernambuco state, Brazil. The postural sway velocity of the center of pressure (COP) was assessed by a force platform, in two directions, anteroposterior (AP) and mediolateral (ML)), in three positions, namely bipedal support with feet together and parallel (parallel feet (PF)), bipedal support with one foot in front of the other (tandem foot (TF)), and single-leg support (one foot (OF)), evaluated with the eyes open and closed.

RESULTS

Children with SNHL demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, with significant differences in the AP direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.003) and closed (PF: p = 0.050; TF: p = 0.005). The same occurred in the ML direction, with the eyes open (PF: p = 0.001; TF: p = 0.000; OF: p = 0.001) and closed (PF: p = 0.002; TF: p = 0.000). The same occurred in relation to vestibular function, where the children with SNHL with an associated vestibular dysfunction demonstrated greater postural sway velocity compared to children with normal hearing in all the positions evaluated, demonstrating significant differences in the AP direction, with the eyes open (TF: p = 0.001; OF: p = 0.029) and eyes closed (PF: p = 0.036; TF: p = 0.033). The same occurred in the ML direction, with the eyes open (TF: p = 0.000) and with the eyes closed (PF: p = 0.008; TF: p = 0.009).

CONCLUSIONS

Children with SNHL demonstrated greater instability of postural control than children with normal hearing in all the directions assessed. Children with SNHL and an associated vestibular dysfunction demonstrated the greatest instability of postural control in this study.

Effects of proprioception and core stability training on gait parameters of deaf adolescents: a randomized controlled trial

The current study aimed to explore the effects of proprioception versus core stability training over 8 weeks on the gait parameters of deaf adolescents. A total of 20 deaf adolescents were randomized into two groups: one group receiving proprioception training (PT, n = 10), another group receiving core stability training (CST, n = 10), and eleven typically developing adolescents assigned into the control group (CON; n = 11). Gait was recorded by two digital cameras; then, using the Kinovea software, the parameters of gait included: gait velocity, cadence, stride length, stride time, stance time, and swing time were calculated in terms of percentages of the walking cycle. After 8 weeks of PT, no significant differences were observed for all gait parameters between PT and control groups (p > 0.05). Also, after 8 weeks of CST, no significant differences were observed in gait velocity and cadence between the CST and control groups (p > 0.05). However, after 8 weeks of CST, stride length (p = 0.02) was higher in the control group; Stride time (p = 0.03), stance time (p = 0.04) and swing time (p = 0.04) were higher in the CST group. Moreover, after 8 weeks of PT, values showed significant improvements in all gait parameters (p = 0.001). Also, after 8 weeks of CST, values showed significant improvements in gait velocity and cadence (p = 0.001), but no significant differences were observed in other gait parameters (p > 0.05). The findings of this study indicated that PT improved all gait parameters, whereas CST improved gait velocity and cadence. The results of the present study also demonstrated that PT had a greater effect on gait parameters of deaf adolescents compared with CST. It seems that PT induces more training effects than CTS for enhancing gait parameters of deaf adolescents.Trial registration: Clinical trial registry number: IRCT20170312033029N2. URL: https://en.irct.ir/trial/25584 .

Use of Virtual Reality-Based Games to Improve Balance and Gait of Children and Adolescents with Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis

BACKGROUND

Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population.

OBJECTIVE

The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL.

METHODS

A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes.

RESULTS

Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; p = 0.37; I² = 0%).

CONCLUSION

Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.

The Narrowed Internal Auditory Canal: A Distinct Etiology of Pediatric Vestibular Paroxysmia

Vestibular paroxysmia (VP) is a disorder encountered in the pediatric population that etiology has been attributed to neurovascular cross-compression syndrome (NVCC). The purpose of this study was to report a new probable pathological condition, the narrowed internal auditory canal (IAC), which appears to be involved in the development of a clinical picture of VP in the pediatric population. A retrospective descriptive comparative study was conducted to compare clinical, electrophysiological, radiological, and therapeutic outcomes in both etiologies. Overall, 16 pediatric patients suffering from VP were included and divided into two groups: patients with narrowed internal auditory (Group 1) were compared to those with NVCC syndrome (Group 2). Patients in both groups were similar in terms of auditory complaints, as well as hearing, vestibular, and electrophysiological status. A narrowed IAC was encountered in the adolescent age category and females, especially those with rapid growth. The diagnosis requires a careful analysis of the shape and diameters of the IAC. Radiologic measurements in the axial plane do not seem to be sufficient to confirm the diagnosis, and, therefore, an analysis of diameters in the coronal plane is required. Treatment with sodium-channel blockers drugs showed promising results not only by relieving vertigo but also by normalizing the electrophysiological findings. In conclusion, a narrowed IAC can be considered in patients suffering from VP.

Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss

OBJECTIVES

Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results.

METHODS

Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included.

RESULTS

Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26).

CONCLUSIONS

The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.

A Cross-Sectional Study on the Effect of Chronic Noise Exposure on the Vestibular Function of Traffic Policemen and Automobile Drivers

Introduction

Noise is a preventable occupational hazard for certain professions like automobile drivers and traffic police personnel. The harmful auditory effects of noise are well known. However, little is known about the status of the vestibular function in chronic noise exposure without noise induced hearing loss. Our objective was to assess the vestibular function in chronic noise exposure.

Methodology

: The study was conducted with a sample size of 242 (chronic noise exposure group - 121, group without chronic noise exposure - 121). Noise estimation was carried out across various traffic intersections to assess the noise exposure levels of the exposed group. All participants underwent a detailed vestibular evaluation in the clinical vestibulometry laboratory.

Results

There was no difference in nystagmus, saccades, caloric function between the two groups. The latency and amplitude of vestibular evoked myogenic potentials (VEMP) were similar in both the groups. However, dynamic posturography showed a significant difference in the Adaptation test between the two groups (P < 0.05). We also found a statistically significant difference between the static and dynamic subjective visual vertical (SVV) and the dynamic visual acuity (DVA) between the two groups (P < 0.05).

Conclusion

We did not find any clinical evidence of vestibular dysfunction in the noise exposed group. However, the statistical significance of SVV and DVA as seen in this study needs to be evaluated further as an early marker for vestibular dysfunction. It remains to be seen whether the statistically significant prolongation is reversible after the noise exposure is withdrawn.

Efficacy of fine motor and balance exercises on fine motor skills in children with sensorineural hearing loss

BACKGROUND

Childhood hearing impairment is a major disability associated with delayed motor development. The affected Fine motor performance in children with sensorineural hearing loss (SNHL) could be due to dynamic balance deficits and visual-motor incoordination.

OBJECTIVE

This study was designed to investigate the effects of fine motor exercises with or without balancing exercises on fine motor skills in children with SNHL.

METHODS

One hundred and eighty (180) children their age ranged from 8 to 18 years old diagnosed with SNHL were selected. They were divided into three groups, 60 children (control group) practiced only their ordinary activities of daily living, 60 children (fine motor exercises group) practiced fine motor exercises, and 60 children (fine motor and balance exercise) group practiced fine motor and balance exercises. The outcomes were assessed by the Bruininks Oseretsky Test of the motor proficiency second edition scale (BOT-2).

RESULTS

Generally, there was a statistically significant difference between control group and fine motor exercises group where (p <  0.05), besides, there was a statistically significant difference between control group and fine motor and balance exercises group where (p <  0.05). But, there was no statistically significant difference between fine motor exercises group and fine motor and balance exercises group where (p >  0.05).

CONCLUSIONS

The Fine Motor performance of children with SNHL has been improved by Fine motor with or without balancing exercises according to (BOT-2).

Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss

OBJECTIVE

The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system.

METHODS

This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function.

RESULTS

The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF).

CONCLUSION

The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study.

IMPACT

Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.

A Systematic Review on the Association Between Vestibular Dysfunction and Balance Performance in Children With Hearing Loss

OBJECTIVES

The objective of this study was to understand the functional impact of vestibular dysfunction on balance control in children with hearing loss. The vestibular system is an important contributor to maintaining balance. In adults, vestibular dysfunction is known to lead to unsteadiness and falls. Considerably less is known about the effects of vestibular dysfunction in children with hearing loss.

DESIGN

We conducted a systematic review in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included articles on children with hearing loss who underwent vestibular and balance testing. The Downs and Black checklist was used to assess the risk of bias.

RESULTS

A total of 20 articles were included in this systematic review, of which, 17 reported an association between vestibular dysfunction and balance abnormalities in children with hearing loss. Bias (as measured by the Downs and Black Checklist) was a concern, as most studies were nonblinded cohort studies or case series selected through convenience sampling.

CONCLUSIONS

Research to date has predominantly found that children with concomitant hearing loss and vestibular impairment tend to perform more poorly on balance measures than either children with hearing loss and normal vestibular function or children with both normal-hearing and normal vestibular function. A standardized approach to assessing both vestibular function and balance would better characterize the impact of vestibular dysfunction in children with hearing loss at the population level.

Vestibular disorders in children: A retrospective analysis of vestibular function test findings

OBJECTIVE

This study was designed to describe the most common vestibular disorders in children and their associated findings on vestibular function testing.

METHOD

Data from 203 children with a mean age of 11.16 ± 3.87 (range, 1-17) years were collected from among 3400 patients who underwent vestibular assessment at a vertigo center in a tertiary hospital over a 3-year period. A retrospective data analysis was performed for 203 children.

RESULTS

Vestibular disorders were diagnosed in 78.3% (n = 159) of 203 children among 3400 patients, which revealed a 3-year incidence of 4.67% in our study. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis in our group of children (49%; n = 100), which involved both primary BPPV, and secondary BPPV that was associated with other vestibular pathologies. Vestibular migraine (VM) was the second most common diagnosis (41%; n = 83) followed by benign paroxysmal vertigo of childhood (BPVC; 4.5%, n = 9), vestibular neuritis (VN; 4.5%, n = 9), and psychogenic vertigo (4.5%, n = 9). Our study showed that Meniere's Disease (MD; 1.5%, n = 3) and central vertigo (1.5%, n = 3) were less commonly diagnosed in children. Perilymphatic fistula (PLF) was diagnosed and surgically confirmed in only one child.

CONCLUSION

BPPV and VM were the most common pediatric vestibular disorders in our study. Clinicians should be aware of the prevalence, signs, and symptoms of the most common vestibular disorders in children to enable diagnosis, treatment, and rehabilitation. Vestibular function testing with age-appropriate adaptations results in improved differential diagnosis, which guides medical treatment and rehabilitation.

Vestibular contributions to the Romberg test: Testing semicircular canal and otolith function

Normal stance relies on three sensory inputs: vision, proprioception and vestibular function. The Romberg test, trying to stand with feet together and eyes closed, is familiar to every medical student as a test of distal proprioceptive impairment. It remains the best known of Romberg's many remarkable contributions to clinical neurology. In Romberg's time almost nothing was known about the function of the vestibular system. We now know that standing with the eyes closed on a compliant rather than a firm surface is more a test of vestibular than proprioceptive function. Peripheral vestibular function tests in clinical use today all rely on measurements of oligosynaptic brainstem reflexes. Short-latency eye rotations in response to rapid, brief head rotations (head impulses) give an accurate, robust and reproducible measure of the function of any and each of the six semicircular canals. Short-latency evoked potentials from sternomastoid and inferior oblique muscles in response to loud clicks or skull taps (vestibular evoked myogenic potentials) give an accurate and reproducible measure of the function of each and any of the four otolith organs. In the present paper, we briefly review what is now known about the anatomy and physiology of the peripheral receptors and brainstem pathways mediating these reflexes and examine how this knowledge can help interpret the Romberg test.

Balanced Growth project: a protocol of a single-centre observational study on the involvement of the vestibular system in a child's motor and cognitive development

INTRODUCTION

The involvement of the vestibular system in the motor and higher (cognitive) performances of typically developing or vestibular-impaired children is currently unknown or has only scarcely been explored. Interestingly, arguments for an interaction between vestibular, motor and cognitive functions in children can also be supported by research on children known for their difficulties in motor and/or cognitive processing (eg, children with neurodevelopmental disorders (NDD)), as they often present with vestibular-like characteristics. Therefore, in order to elucidate this interaction, and to increase the understanding of the pathophysiology and symptomatology of vestibular disorders and NDD in children, the Balanced Growth project was developed. It includes the following objectives: (1) to understand the association between motor skills, cognitive performances and the vestibular function in typically developing school-aged children, with special focus on the added value of the vestibular system in higher cognitive skills and motor competence; (2) to investigate whether a vestibular dysfunction (with/without an additional auditory disease) has an impact on motor skills, cognitive performances and motor-cognitive interactions in children and (3) to assess if an underlying vestibular dysfunction can be identified in school-aged children with NDD, with documentation of the occurrence and characteristics of vestibular dysfunctions in this group of children using an extensive vestibular test battery.

METHODS AND ANALYSIS

In order to achieve the objectives of the observational cross-sectional Balanced Growth study, a single-task and dual-task test protocol was created, which will be performed in three groups of school-aged children (6-12 years old): (1) a typically developing group (n=140), (2) (audio) vestibular-impaired children (n=30) and (3) children with an NDD diagnosis (n=55) (ie, autism spectrum disorder, attention deficit/hyperactivity disorder and/or developmental coordination disorder). The test protocol consists of several custom-made tests and already existing validated test batteries and includes a vestibular assessment, an extensive motor assessment, eight neurocognitive tests, a cognitive-motor interaction assessment and includes also additional screenings to control for potential confounding factors (eg, hearing status, intelligence, physical activity, etc).

ETHICS AND DISSEMINATION

The current study was approved by the ethics committee of Ghent University Hospital on 4 June 2019 with registration number B670201940165 and is registered at Clinical Trials (clinicaltrials.gov) with identifier NCT04685746. All research findings will be disseminated in peer-reviewed journals and presented at vestibular as well as multidisciplinary international conferences and meetings.

TRIAL REGISTRATION NUMBER

NCT04685746.

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

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.