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Van Hecke R, Deconinck FJA, Danneels M, Dhooge I, Uzeel B, Maes L. A Clinical Framework for Video Head Impulse Testing and Vestibular Evoked Myogenic Potential Assessments in Primary School-Aged Children. Ear Hear 2024; 45:1216-1227. [PMID: 38632676 DOI: 10.1097/aud.0000000000001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVES This study aimed to offer normative data and age trends of an age-appropriate vestibular test protocol in a large group (n = 140) of school-aged children (6 to 13 years old) as well as to provide a practical and clinical framework for accurate performance and interpretation of vestibular test results in this specific age group. DESIGN The typically developing participants (mean age of 9.51 ± 2.04 years) were recruited to provide a representative group of 20 children for each of the seven age groups that were composed of children aged from 6 to 13 years in 1-year intervals. Each age group consisted of 10 boys and 10 girls. The protocol comprises the video head impulse test, and cervical and ocular vestibular evoked myogenic potential assessments to provide a child-friendly, noninvasive, short, and portable test battery, which is equally applicable in the hospital and office-practice, and which provides information on the integrity of all five parts of the peripheral vestibular system. RESULTS The study demonstrates that all included tests and methods, with an overall test duration of 25 min 12 sec ± 5 min 10 sec, were feasible to perform in primary school-aged children, taking into account some practical adaptations. Concerning the video head impulse test, no clinically relevant sex and age effects were noted. However, t tests revealed significant differences for the mean gain of the horizontal (right > left; t [139] = 14.563; p < 0.001) and posterior semicircular canals (left > right; t [139] = -4.823; p < 0.001) between both sides. For the cVEMP assessment, no laterality differences were observed for any of the parameters, but a significantly shorter N1 latencies in the youngest age categories (<8 years), compared with the oldest groups were observed [ F (6,118) = 8.336; p < 0.001; partial ƞ ² = 0.298]. For all oVEMP parameters, no laterality, sex, or age differences were seen. On the basis of the presented normative data, cutoff criteria were proposed with accompanying clinical recommendations to perform vestibular function testing in this target population. CONCLUSIONS This is the first study in a large group of school-aged children offering normative data and age trends of an age-appropriate vestibular test protocol that evaluates the integrity of all parts of the peripheral vestibular organ. The reported normative values and clinical cutoff values will enable appropriate and age-specific interpretation of clinical and scientific results. Moreover, in combination with extensive history taking, and additional vestibular testing (e.g., rotatory chair test, caloric testing) when needed, the results of this study may support clinicians in the diagnosis of side-specific and location-specific vestibular deficits, which is required for accurate counseling and referral for further follow-up and/or intervention.
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Affiliation(s)
- Ruth Van Hecke
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Maya Danneels
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Bo Uzeel
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Leen Maes
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Wiener-Vacher SR, Campi M, Caldani S, Thai-Van H. Vestibular Impairment and Postural Development in Children With Bilateral Profound Hearing Loss. JAMA Netw Open 2024; 7:e2412846. [PMID: 38780940 PMCID: PMC11117085 DOI: 10.1001/jamanetworkopen.2024.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Importance Children with profound hearing loss (HL) and vestibular impairment have worse cochlear implant outcomes compared with those without vestibular impairment. However, the decision for cochlear implantation is rarely based on vestibular function assessment as a complement to audiologic testing. Objectives To identify the prevalence of vestibular impairment according to HL origin and to assess the association between vestibular impairment and delayed posturomotor development in children with profound HL. Design, Setting, and Participants This cohort study was conducted in a pediatric referral center for cochlear implantation in Paris, France, using medical records data on HL origin, vestibular assessment, and ages of developmental milestone achievement. The cohort included children with profound HL (loss >90 dB HL) who completed vestibular assessment prior to cochlear implantation between January 1, 2009, and December 31, 2019. Data analyses were conducted between January and June 2023. Main Outcomes and Measures The primary outcome was prevalence of vestibular impairment according to HL origin. Children were classified into 3 groups according to their responses to vestibular testing: normal vestibular function (NVF), partially impaired vestibular function (PVF), and complete bilateral vestibular loss (CBVL). Generalized logit models were performed to evaluate the association between vestibular impairment and causes of HL as well as posturomotor development delay. Results A total of 592 children were included (308 males [52.0%]; mean [SD] age, 38 [34] months). In children with documented HL origin (n = 266), 45.1% (120) had HL with genetic origin, 50.0% of which were syndromic (mainly Usher and Waardenburg syndromes) and 50.0% were nonsyndromic (mainly associated with connexin 26). Among patients with infectious HL origin (n = 74), 70.3% (52) had cytomegalovirus (CMV) infection. Vestibular impairment was found in 44.4% (263 of 592) of the children; it was mostly symmetrical in 88.9% (526) and was CBVL in 5.7% (34) of the cases. Vestibular impairment was present in 78.3% (47) of children with genetic syndromic HL (56.7% [34] with PVF; 21.7% [13] with CBVL) and in 69.2% (36) of children with CMV infection (57.7% [30] with PVF; 11.5% [6] with CBVL). Genetic syndromic HL origin was found to be more often associated with both PVF and CBVL than other HL causes. The odds of having delays in 4 developmental milestones (head holding, sitting, standing with support, and independent walking) were higher in both PVF and CBVL (eg, head-holding odds ratios: 2.55 and 4.79) compared with NVF, and the age of achieving these milestones was higher in CBVL than PVF (eg, head holding: 7.33 vs 4.03 years; P < .001). All 4 developmental milestones were associated with the degree of vestibular impairment. Conclusions and Relevance This cohort study found that among children with profound HL, vestibular impairment was prevalent, varied according to HL origin, and associated with posturomotor development; while all developmental milestones were associated with vestibular impairment severity, not all HL causes were associated with vestibular impairment severity. Children with profound HL may benefit from complete vestibular assessment before cochlear implantation, which would support early and adapted management, such as physical therapy for CBVL and cochlear implantation strategy.
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Affiliation(s)
- Sylvette R Wiener-Vacher
- Institut de l'Audition, Institut Pasteur, Centre De Recherche et d'Innovation et Audiologie Humaine (CERIAH), Paris, France
- Service ORL, Centre d'Exploration Fonctionnelle de l'Equilibre Chez l'Enfant (EFEE), Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marta Campi
- Institut de l'Audition, Institut Pasteur, Centre De Recherche et d'Innovation et Audiologie Humaine (CERIAH), Paris, France
| | - Simona Caldani
- Institut de l'Audition, Institut Pasteur, Centre De Recherche et d'Innovation et Audiologie Humaine (CERIAH), Paris, France
- Service ORL, Centre d'Exploration Fonctionnelle de l'Equilibre Chez l'Enfant (EFEE), Hôpital Universitaire Robert Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hung Thai-Van
- Institut de l'Audition, Institut Pasteur, Centre De Recherche et d'Innovation et Audiologie Humaine (CERIAH), Paris, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot et Hôpital Femme Mère Enfant, Service d'Audiologie et Explorations Otoneurologiques, Lyon University, Lyon, France
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Dhondt C, Maes L, Van Acker E, Martens S, Vanaudenaerde S, Rombaut L, De Cuyper E, Van Hoecke H, De Leenheer E, Dhooge I. Vestibular Follow-up Program for Congenital Cytomegalovirus Based on 6 Years of Longitudinal Data Collection. Ear Hear 2023; 44:1354-1366. [PMID: 37122081 DOI: 10.1097/aud.0000000000001377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Congenital cytomegalovirus (cCMV), the leading nongenetic cause of pediatric sensorineural hearing loss, can also affect vestibular function. Literature findings suggest clinical presentation of vestibular loss in cCMV to be as variable as the hearing loss. Still, probably due to the considerable additional burden it entails for both patients and diagnostic centers, longitudinal vestibular follow-up in cCMV is not well-established in clinical practice. Therefore, this study aims to propose an evidence-based vestibular follow-up program with proper balance between its feasibility and sensitivity. DESIGN In this longitudinal cohort study, 185 cCMV-patients (mean age 3.2 years, SD 1.6 years, range 0.5-6.7 years) were included. Vestibular follow-up data were obtained through lateral video head impulse test (vHIT) and cervical vestibular evoked myogenic potential (cVEMP) evaluations around the ages of 6 months, 1 year, and 2 years. Around 3 and 4.5 years of age, data from vertical vHIT and ocular vestibular evoked myogenic potentials (oVEMP) were also collected. RESULTS At birth, 55.1% (102/185) of patients were asymptomatic and 44.9% (83/185) were symptomatic. The mean duration of follow-up for all patients was 20.8 (SD 16.3) months (mean number of follow-up assessments: 3.2, SD 1.5). Vestibular loss occurred at some point during follow-up in 16.8% (31/185) of all patients. Six percent (10/164) of patients with normal vestibular function at first assessment developed delayed-onset vestibular loss; 80.0% (8/10) of these within the first 2 years of life. Vestibular deterioration was reported both in patients who had been treated with postnatal antiviral therapy and untreated patients. At final evaluation, both the semicircular and the otolith system were impaired in the majority of vestibular-impaired ears (29/36, 80.6%). Dysfunctions limited to the semicircular system or the otolith system were reported in 4 (4/36, 11.1%) and 3 (3/36, 8.3%) ears, respectively. The occurrence of vestibular loss was highest in patients with first trimester seroconversion (16/59, 27.1%) or with an unknown timing of seroconversion (13/71, 18.3%), patients with sensorineural hearing loss (16/31, 51.6%), and patients with periventricular cysts on magnetic resonance imaging (MRI) (7/11, 63.6%). CONCLUSIONS Longitudinal vestibular follow-up, most intensively during the first 2 years of life, is recommended in cCMV-patients with vestibular risk factors (first trimester or unknown timing of seroconversion; sensorineural hearing loss; periventricular cysts on MRI). If those risk factors can be ruled out, a single evaluation early in life (around 6 months of age) might be sufficient. Both semicircular and otolith system evaluation should be part of the follow-up program, as partial losses were reported.
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Affiliation(s)
- Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Emmely Van Acker
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Elise De Cuyper
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Damien M, Wiener-Vacher SR, Reynard P, Thai-Van H. Bone Conduction Cervical Vestibular Evoked Myogenic Potentials as an Alternative in Children with Middle Ear Effusion. J Clin Med 2023; 12:6348. [PMID: 37834992 PMCID: PMC10573357 DOI: 10.3390/jcm12196348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To compare the amplitude ratio and P-wave latency of cervical vestibular evoked myogenic potentials (c-VEMPs) for bone conduction (BC) and air conduction (AC) stimulation in children with otitis media with effusion (OME). MATERIAL AND METHODS This is an observational study of a cohort of 27 children and 46 ears with OME. The c-VEMP amplitude ratio and P-wave latency were compared between BC and AC in children with OME and healthy age-matched children. RESULTS The c-VEMP response rate in children with OME was 100% when using BC stimulation and 11% when using AC stimulation. The amplitude ratio for BC was significantly higher in the OME group than the age-matched healthy control group (p = 0.004). When focusing on ears with an AC c-VEMP response (n = 5), there was a significant difference in the amplitude ratio between the AC and BC stimulation modes, but there was no significant difference in the AC results between the OME group and the age-matched control group. CONCLUSIONS BC stimulation allows for reliable vestibular otolith testing in children with middle ear effusion. Given the high prevalence of OME in children, clinicians should be aware that recording c-VEMPs with AC stimulation may lead to misinterpretation of otolith dysfunction in pediatric settings.
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Affiliation(s)
- Maxime Damien
- Service d’Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 69003 Lyon, France; (M.D.)
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Sylvette R. Wiener-Vacher
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Service ORL, Centre d’Exploration Fonctionnelle de l’Équilibre chez l’Enfant (EFEE), Hôpital Robert-Debré AP-HP, 75019 Paris, France
| | - Pierre Reynard
- Service d’Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 69003 Lyon, France; (M.D.)
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Hung Thai-Van
- Service d’Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 69003 Lyon, France; (M.D.)
- Centre de Recherche et d’Innovation en Audiologie Humaine, Institut Pasteur, Institut de l’Audition, rue du Docteur Roux, 75015 Paris, France
- Faculté de Médecine, Université Claude Bernard Lyon 1, 69003 Lyon, France
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Tighilet B, Trico J, Xavier F, Chabbert C. [Animal models of balance pathologies: New tools to study peripheral vestibulopathies]. Med Sci (Paris) 2023; 39:632-642. [PMID: 37695153 DOI: 10.1051/medsci/2023097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
The different types of peripheral vestibulopathies (PVs) or peripheral vestibular disorders (PVDs) are essentially diagnosed on the basis of their clinical expression. The heterogeneity of vestibular symptoms makes it difficult to stratify patients for therapeutic management. Animal models of PVs are a good mean to search for clinical evaluation criteria allowing to objectively analyze the kinetics of expression of the vertigo syndrome and to evaluate the benefits of therapeutic strategies, whether they are pharmacological or rehabilitative. The question of the predictability of these animal models is therefore crucial for the identification of behavioral and biological biomarkers that could then be used in the human clinic. In this review, we propose an overview of the different animal models of PVs, and discuss their relevance for the understanding of the underlying pathophysiological mechanisms and the development of new and more targeted therapeutic approaches.
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Affiliation(s)
- Brahim Tighilet
- Aix Marseille université-CNRS, Laboratoire de neurosciences cognitives, LNC UMR 7291, Marseille, France - Groupements de recherche (GDR) Vertige, Unité CNRS GDR2074, Marseille, France
| | - Jessica Trico
- Aix Marseille université-CNRS, Laboratoire de neurosciences cognitives, LNC UMR 7291, Marseille, France - Groupements de recherche (GDR) Vertige, Unité CNRS GDR2074, Marseille, France
| | - Frédéric Xavier
- Aix Marseille université-CNRS, Laboratoire de neurosciences cognitives, LNC UMR 7291, Marseille, France - Groupements de recherche (GDR) Vertige, Unité CNRS GDR2074, Marseille, France
| | - Christian Chabbert
- Aix Marseille université-CNRS, Laboratoire de neurosciences cognitives, LNC UMR 7291, Marseille, France - Groupements de recherche (GDR) Vertige, Unité CNRS GDR2074, Marseille, France
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Martens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Rombaut L, Maes L. Pediatric Vestibular Assessment: Clinical Framework. Ear Hear 2023; 44:423-436. [PMID: 36534710 DOI: 10.1097/aud.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Although vestibular deficits can have severe repercussions on the early motor development in children, vestibular assessment in young children has not yet been routinely integrated in clinical practice and clear diagnostic criteria to detect early vestibular deficits are lacking. In young children, specific adjustments of the test protocol are needed, and normative data are age-dependent as the vestibular pathways mature through childhood. Therefore, this study aims to demonstrate the feasibility of an extensive age-dependent vestibular test battery, to provide pediatric normative data with the concurrent age trends, and to offer a clinical framework for pediatric vestibular testing. DESIGN This normative study included 133 healthy children below the age of 4 years (mean: 22 mo, standard deviation: 12.3 mo, range: 5-47 mo) without history of hearing loss or vestibular symptoms. Children were divided into four age categories: 38 children younger than 1 year old, 37 one-year olds, 33 two-year olds, and 25 three-year olds. Children younger than 3 years of age were examined with the video Head Impulse Test (vHIT) of the horizontal semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) with bone conduction stimuli, and the rotatory test at 0.16, 0.04, and 0.01 Hz. In 3-year old children, the vHIT of the vertical semicircular canals and ocular vestibular evoked myogenic potentials (oVEMP) using a minishaker were added to the protocol. RESULTS The horizontal vHIT appeared to be the most feasible test across age categories, except for children younger than 1-year old in which the success rate was the highest for the cVEMP. Success rates of the rotatory test varied the most across age categories. Age trends were found for the vHIT as the mean vestibulo-ocular reflex (VOR) gain increased significantly with age (r = 0.446, p < 0.001). Concerning the cVEMP, a significant increase with age was found for latency P1 (r = 0.420, p < 0.001), rectified interpeak amplitude P1-N1 (r = 0.574, p < 0.001), and averaged electromyographic (EMG) activity (r = 0.430, p < 0.001), whereas age trends for the latency N1 were less pronounced (r = 0.264, p = 0.004). Overall, the response parameters of the rotatory test did not show significant age effects ( p > 0.01), except for the phase at 0.01 Hz (r = 0.578, p < 0.001). Based on the reported success rates and age-dependent normative vestibular data, straightforward cutoff criteria were proposed (vHIT VOR gain < 0.7, cVEMP rectified interpeak amplitude < 1.3, oVEMP interpeak amplitude < 10 µV) with accompanying clinical recommendations to diagnose early vestibular impairment. CONCLUSIONS In this large cohort of typically developing children below the age of 4 years, the vHIT and cVEMP were the most feasible vestibular tests. Moreover, the age-dependent normative vestibular data could specify age trends in this group of young children. Finally, based on the current results and clinical experience of more than ten years at the Ghent University Hospital (Belgium), a clinical framework to diagnose early vestibular deficits in young patients is proposed.
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Affiliation(s)
- Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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Martens S, Maes L, Dhondt C, Vanaudenaerde S, Sucaet M, De Leenheer E, Van Hoecke H, Van Hecke R, Rombaut L, Dhooge I. Vestibular Infant Screening-Flanders: What is the Most Appropriate Vestibular Screening Tool in Hearing-Impaired Children? Ear Hear 2023; 44:385-398. [PMID: 36534644 DOI: 10.1097/aud.0000000000001290] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES As children with sensorineural hearing loss have an increased risk for vestibular impairment, the Vestibular Infant Screening-Flanders project implemented a vestibular screening by means of cervical vestibular evoked myogenic potentials (cVEMP) at the age of 6 months for each child with hearing loss in Flanders (Belgium). Given that vestibular deficits can affect the child's development, this vestibular screening should allow early detection and intervention. However, less is currently known about which screening tool would be the most ideal and how vestibular impairment can evolve. Therefore, this study aimed to determine the most appropriate tool to screen for vestibular deficits, to assess the necessity of vestibular follow-up, and to set clinical guidelines for vestibular screening in children with hearing loss. DESIGN In total, 71 children with congenital or early-onset sensorineural hearing loss were enrolled (mean age at first appointment = 6.7 months). Follow-up was provided at 6 months, 1, 2, and 3 years of age. Below three years of age, the video Head Impulse Test (vHIT) of the horizontal semicircular canals (SCC), the cVEMP, and the rotatory test at 0.16, 0.04, and 0.01 Hz were applied. At 3 years of age, the vHIT of the vertical SCC and ocular vestibular evoked myogenic potentials (oVEMP) were added. To evaluate early motor development, the Alberta Infant Motor Scale (AIMS) results at 6 months and 1-year old were included. RESULTS At 6 months of age, the highest success rate was obtained with the cVEMP (90.0%) compared to the vHIT (70.0%) and the rotatory test (34.3-72.9%). Overall, vestibular deficits were found in 20.0% of the children, consisting of 13.9% with both SCC and otolith deficits (bilateral: 9.3%, unilateral: 4.6%), and 6.1% with unilateral isolated SCC (4.6%) or otolith (1.5%) deficits. Thus, vestibular deficits would not have been detected in 4.6% of the children by only using the cVEMP, whereas 1.5% would have been missed when only using the vHIT. Although vestibular deficits were more frequently found in severe to profound hearing loss (28.6%), characteristics of vestibular function were highly dependent on the underlying etiology. The AIMS results showed significantly weaker early motor development in children with bilateral vestibular deficits ( p = 0.001), but could not differentiate children with bilateral normal vestibular function from those with unilateral vestibular deficits ( p > 0.05). Progressive or delayed-onset vestibular dysfunction was only found in a few cases (age range: 12-36 months), in which the hearing loss was mainly caused by congenital cytomegalovirus (cCMV). CONCLUSIONS The cVEMP is the most feasible screening tool to assess vestibular function in 6-months-old children with hearing loss. Although the majority of children with vestibular deficits are detected with the cVEMP, the vHIT seems even more sensitive as isolated SCC deficits are associated with specific etiologies of hearing loss. As a result, the cVEMP is an appropriate vestibular screening tool, which is advised at least in severe to profound hearing loss, but certain etiologies require the addition of the vHIT (i.e., cCMV, meningitis, cochleovestibular anomalies with or without syndromic hearing loss).
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Affiliation(s)
- Sarie Martens
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- These authors contributed equally to this work
| | - Leen Maes
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- These authors contributed equally to this work
| | - Cleo Dhondt
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Els De Leenheer
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ruth Van Hecke
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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What Predictability for Animal Models of Peripheral Vestibular Disorders? Biomedicines 2022; 10:biomedicines10123097. [PMID: 36551852 PMCID: PMC9775358 DOI: 10.3390/biomedicines10123097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
The different clinical entities grouped under the term peripheral vestibulopathies (PVs) or peripheral vestibular disorders (PVDs) are distinguished mainly based on their symptoms/clinical expression. Today, there are very few commonly accepted functional and biological biomarkers that can confirm or refute whether a vestibular disorder belongs to a precise classification. Consequently, there is currently a severe lack of reliable and commonly accepted clinical endpoints, either to precisely follow the course of the vertigo syndrome of vestibular origin or to assess the benefits of therapeutic approaches, whether they are pharmacological or re-educational. Animal models of PV are a good means to identify biomarkers that could subsequently be exploited in human clinical practice. The question of their predictability is therefore crucial. Ten years ago, we had already raised this question. We revisit this concept today in order to take into account the animal models of peripheral vestibular pathology that have emerged over the last decade, and the new technological approaches available for the behavioral assessment of vestibular syndrome in animals and its progression over time. The questions we address in this review are the following: are animal models of PV predictive of the different types and stages of vestibular pathologies, and if so, to what extent? Are the benefits of the pharmacological or reeducational therapeutic approaches achieved on these different models of PV (in particular the effects of attenuation of the acute vertigo, or acceleration of central compensation) predictive of those expected in the vertiginous patient, and if so, to what extent?
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Dhondt C, Maes L, Martens S, Vanaudenaerde S, Rombaut L, Sucaet M, Keymeulen A, Van Hoecke H, De Leenheer E, Dhooge I. Predicting Early Vestibular and Motor Function in Congenital Cytomegalovirus Infection. Laryngoscope 2022. [PMID: 36054219 DOI: 10.1002/lary.30375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Congenital cytomegalovirus (cCMV) can affect vestibular function, which is an important cornerstone for early motor development. This study aims to identify risk factors for early vestibular dysfunction with severe repercussions on the motor outcome. METHODS This prospective cohort study included 169 cCMV-patients with complete vestibular assessment (lateral video Head Impulse Test and cervical Vestibular Evoked Myogenic Potentials) before the age of 18 months (mean 8.9, standard deviation 3.27 months). Motor results using the Alberta Infant Motor Scale were collected in 152 of these patients. Logistic and linear regression models were applied to identify risk factors for the vestibular and motor outcomes, respectively. RESULTS The odds of developing early vestibular dysfunction were 6 times higher in patients presenting with hearing loss at birth compared to those born with normal hearing (p = .002). Within the latter group, significant predictors for vestibular dysfunction were (delayed-onset) hearing impairment at the time of vestibular testing (p = .003) and the presence of periventricular cysts on magnetic resonance imaging (p = .005). Remarkably, none of the patients infected during the third trimester of pregnancy (n = 14) developed early vestibular dysfunction. On average, vestibular-impaired patients had a z-score on the Alberta Infant Motor Scale that was 1.17 points lower than patients without vestibular deficit (p < .001). CONCLUSION Early vestibular loss can have a significant adverse effect on motor development. Hearing and cranial imaging findings could facilitate the widespread implementation of a (targeted) vestibular assessment approach in the cCMV-population. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Cleo Dhondt
- Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Leen Maes
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Sarie Martens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Marieke Sucaet
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Annelies Keymeulen
- Neonatal Intensive Care Department, Ghent University Hospital, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Ingeborg Dhooge
- Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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10
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Chebib E, Maudoux A, Benoit C, Bernard S, Belarbi N, Parodi M, Picone O, Van Den Abbeele T, Wiener Vacher SR, Teissier N. Predictors of cochleovestibular dysfunction in children with congenital cytomegalovirus infection. Eur J Pediatr 2022; 181:2909-2918. [PMID: 35551461 DOI: 10.1007/s00431-022-04495-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/30/2022]
Abstract
UNLABELLED The purpose of this study is to assess the predictive factors of both hearing and vestibular impairment in congenitally cytomegalovirus-infected children (cCMV) through a multivariate analysis of clinical and imaging characteristics collected during pregnancy and at birth. This retrospective study was conducted between March 2014 and March 2020, including confirmed congenitally CMV-infected children with a complete vestibular and hearing assessment. Data concerning pregnancy, date of infection, clinical characteristics, and symptomatology at birth were collected. In total, 130 children were included, with a median age of 21 months. Eighty-three children (64%) presented with an inner ear impairment (both cochlear and vestibular impairment). Sex, modality of maternal infection (seroconversion or reactivation), pregnancy term, weight and head circumference at birth, neonatal clinical signs of infection, and treatment were not significantly correlated with inner ear impairment. However, multivariate analysis confirmed that there are two independent predictive factors of inner ear impairment: antenatal imaging lesions (ORa = 8.02 [1.74; 60.27], p-value = 0.01) and infection during the first trimester (ORa = 4.47 [1.21; 19.22], p-value = 0.03). Conversely, infections occurring during the second trimester were rarely associated with inner ear impairment: 4/13 (31%) in our series, with vestibular impairment alone (4/4) and no hearing loss. None of the children infected during the third trimester developed inner ear dysfunction. CONCLUSION Besides the symptomatic status of the CMV infection at birth, we found that antenatal imaging brain damage and early infection (mainly during the first trimester) constitute the two best independent predictive factors of inner ear involvement in congenitally CMV-infected children. WHAT IS KNOWN • Congenital cytomegalovirus infection is the leading infectious cause of neurological disabilities and sensorineural hearing loss in children and responsible of vestibular disorders, which are probably underestimated. • No articles have yet defined the predictive factors of the entire inner ear impairment (vestibule and cochlea). WHAT IS NEW • The timing of the infection during pregnancy (first and second trimester, ORa=4.47) and antenatal imaging lesions (ORa=8.02) are independently predictive (in a multivariate analysis) of inner ear involvement. • The symptomatic status at birth is a poor predictor of inner ear impairment.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.
| | - Audrey Maudoux
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France
| | - Charlotte Benoit
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
| | - Sophie Bernard
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France
| | - Nadia Belarbi
- Department of Pediatric Imaging, Hospital Robert Debré, Paris VII University, 48 Bd Serurier, 75019, Paris, France
| | - Marine Parodi
- Department of Otolaryngology, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France
| | - Olivier Picone
- Department of Gynecology-Obstetrics, Louis Mourier Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris University, Colombes, France.,Université de Paris, INSERM U1137, Inserm, 75018, Paris, France
| | - Thierry Van Den Abbeele
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
| | - Sylvette R Wiener Vacher
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
| | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, 48 boulevard Sérurier, 75019, Paris, France.,Université de Paris, INSERM U1141 NeuroDiderot, Inserm, 75019, Paris, France
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11
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Martens S, Dhooge I, Dhondt C, Vanaudenaerde S, Sucaet M, Van Hoecke H, De Leenheer E, Rombaut L, Boudewyns A, Desloovere C, Vinck AS, de Varebeke SJ, Verschueren D, Verstreken M, Foulon I, Staelens C, De Valck C, Calcoen R, Lemkens N, Öz O, De Bock M, Haverbeke L, Verhoye C, Declau F, Devroede B, Forton G, Deggouj N, Maes L. Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss. Pediatrics 2022; 150:188271. [PMID: 35698886 DOI: 10.1542/peds.2021-055340] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- Sarie Martens
- Faculty of Medicine and Health Sciences, Departments of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Ingeborg Dhooge
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Cleo Dhondt
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium
| | | | - Marieke Sucaet
- Faculty of Medicine and Health Sciences, Departments of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Helen Van Hoecke
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Els De Leenheer
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - Lotte Rombaut
- Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
| | - An Boudewyns
- Faculty of Medicine and Translational Neurosciences, Department of Otorhinolaryngology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | | | - Anne-Sophie Vinck
- Department of Otorhinolaryngology, AZ Sint-Jan Bruges, Bruges, Belgium
| | | | | | | | - Ina Foulon
- Department of Otorhinolaryngology, University Hospital Brussels, Brussels, Belgium
| | | | - Claudia De Valck
- Department of Otorhinolaryngology, AZ Turnhout, Turnhout, Belgium
| | | | - Nele Lemkens
- Department of Otorhinolaryngology, ZOL Genk, Genk, Belgium
| | - Okan Öz
- Ear, Nose, and Throat Clinic, The Eargroup, Antwerp, Belgium
| | | | - Lisa Haverbeke
- Department of Otorhinolaryngology, ASZ Aalst, Aalst, Belgium
| | - Christoph Verhoye
- Department of Otorhinolaryngology, AZ Sint-Lucas Bruges, Bruges, Belgium
| | - Frank Declau
- Department of Otorhinolaryngology, GZA Sint-Vincentius, Antwerp, Belgium
| | - Benoit Devroede
- Department of Otorhinolaryngology, Queen Fabiola Children's University Hospital, Brussels, Belgium
| | - Glen Forton
- Department of Otorhinolaryngology, AZ Delta Roeselare, Roeselare, Belgium
| | - Naima Deggouj
- Institute of Neurosciences and Department of Otorhinolaryngology, Université Catholique de Louvain, Brussels, Belgium
| | - Leen Maes
- Faculty of Medicine and Health Sciences, Departments of Rehabilitation Sciences, Ghent University, Ghent, Belgium.,Department of Otorhinolaryngology, Ghent University Hospital, Ghent, Belgium
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12
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Audiovestibular Consequences of Congenital Cytomegalovirus Infection: Greater Vulnerability of the Vestibular Part of the Inner Ear. Ear Hear 2022; 43:1730-1739. [PMID: 35687026 DOI: 10.1097/aud.0000000000001240] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the impact of congenital cytomegalovirus infection on cochlear and vestibular function. DESIGN This retrospective study conducted between March 2014 and March 2020 included children with confirmed congenital cytomegalovirus infection who underwent a complete audio-vestibular evaluation. It included a bithermal caloric test, a video head impulse test and a cervical vestibular evoked myogenic potential associated with a complete hearing assessment. RESULTS The cohort of 130 children included in the study had a median age of 21 months (interquartile range: 12 to 37 months). Eighty-three children (64%) showed an inner ear impairment (both cochlear and vestibular). The vestibular part of the inner ear was significantly more frequently impaired than the cochlear part (ρ = 0.003). Sixty-two children (48%) showed confirmed hearing impairment. The severity of hearing loss was variable, with a high proportion of profound hearing loss (30/62, 48%), which was often bilateral (47/62, 76%). The vestibular assessment showed a canal function disorder in 67 children (88%) and an otolith function disorder in 63 children (83%; ρ = 0.36). The video head impulse test was significantly less altered (64%) compared with the bithermal caloric test (80%; ρ = 0.02) and the cervical vestibular evoked myogenic potential (83%; ρ = 0.009). Only seven out of 83 children (8%) showed hearing loss without vestibular dysfunction, of which only one had a normal hearing screening test at birth. For the children who passed the hearing screening test at birth and presented an inner ear impairment [n = 36, median age: 16 (11 to 34) months], vestibular disorders were later found in 35 children (97%) and 17 of them (47%) developed hearing loss secondarily. This underlines the importance of assessing both vestibular and auditory parts of the inner ear. When comparing the agreement of cochlear and vestibular impairment, the severity and the laterality of the impairment were low [Cohen's kappa 0.31 (0.22 to 0.40) and 0.43 (0.32 to 0.55), respectively]. CONCLUSION In our study, we demonstrated that although both cochlear and vestibular parts of the inner ear can be impaired by congenital cytomegalovirus infection, the vestibular part seems more often impaired compared with the cochlear part. This underlines the importance of vestibular evaluation in the follow-up of cytomegalovirus-infected children associated with hearing assessment.
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13
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Maudoux A, Vitry S, El-Amraoui A. Vestibular Deficits in Deafness: Clinical Presentation, Animal Modeling, and Treatment Solutions. Front Neurol 2022; 13:816534. [PMID: 35444606 PMCID: PMC9013928 DOI: 10.3389/fneur.2022.816534] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
The inner ear is responsible for both hearing and balance. These functions are dependent on the correct functioning of mechanosensitive hair cells, which convert sound- and motion-induced stimuli into electrical signals conveyed to the brain. During evolution of the inner ear, the major changes occurred in the hearing organ, whereas the structure of the vestibular organs remained constant in all vertebrates over the same period. Vestibular deficits are highly prevalent in humans, due to multiple intersecting causes: genetics, environmental factors, ototoxic drugs, infections and aging. Studies of deafness genes associated with balance deficits and their corresponding animal models have shed light on the development and function of these two sensory systems. Bilateral vestibular deficits often impair individual postural control, gaze stabilization, locomotion and spatial orientation. The resulting dizziness, vertigo, and/or falls (frequent in elderly populations) greatly affect patient quality of life. In the absence of treatment, prosthetic devices, such as vestibular implants, providing information about the direction, amplitude and velocity of body movements, are being developed and have given promising results in animal models and humans. Novel methods and techniques have led to major progress in gene therapies targeting the inner ear (gene supplementation and gene editing), 3D inner ear organoids and reprograming protocols for generating hair cell-like cells. These rapid advances in multiscale approaches covering basic research, clinical diagnostics and therapies are fostering interdisciplinary research to develop personalized treatments for vestibular disorders.
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Affiliation(s)
- Audrey Maudoux
- Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut Pasteur, Institut de l'Audition, Université de Paris, INSERM-UMRS1120, Paris, France
- Center for Balance Evaluation in Children (EFEE), Otolaryngology Department, Assistance Publique des Hôpitaux de Paris, Robert-Debré University Hospital, Paris, France
| | - Sandrine Vitry
- Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut Pasteur, Institut de l'Audition, Université de Paris, INSERM-UMRS1120, Paris, France
| | - Aziz El-Amraoui
- Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut Pasteur, Institut de l'Audition, Université de Paris, INSERM-UMRS1120, Paris, France
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14
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Kunelskaya NL, Baybakova EV, Garov EV, Chugunova MA, Butaev FF. [Effects of cochlear implantation on vestibular function]. Vestn Otorinolaringol 2021; 86:92-98. [PMID: 34964337 DOI: 10.17116/otorino20218606192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The literature review is devoted to the effects arising from the effect of a cochlear implant on the vestibular system. Due to the pronounced anatomical proximity and physiological interaction of vestibular receptors with the cochlea, the installation of a cochlear implant and its electrical activity are associated with an effect on the vestibular system. The analysis of the works of foreign and domestic researchers who carried out monitoring of vestibular function in patients after cochlear implantation using modern objective methods was carried out.
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Affiliation(s)
- N L Kunelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Baybakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E V Garov
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - F F Butaev
- Pirogov Russian National Research Medical University, Moscow, Russia
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15
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Hazen M, Cushing SL. Vestibular Evaluation and Management of Children with Sensorineural Hearing Loss. Otolaryngol Clin North Am 2021; 54:1241-1251. [PMID: 34774232 DOI: 10.1016/j.otc.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vestibular dysfunction is the most common comorbidity associated with childhood sensorineural hearing loss. Early identification of vestibular dysfunction enables early intervention to mitigate its impact of motor, behavioral, and neurocognitive deficits of developing children. Screening for vestibular impairment can be achieved in the busy clinical setting.
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Affiliation(s)
- Melissa Hazen
- Department of Communication Disorders, Hospital for Sick Children, 555 University of Toronto, 6103C Burton Wing, Toronto, Ontario M5G1X8, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto; Department of Otolaryngology, Head & Neck Surgery, University of Toronto
| | - Sharon L Cushing
- Department of Communication Disorders, Hospital for Sick Children, 555 University of Toronto, 6103C Burton Wing, Toronto, Ontario M5G1X8, Canada; Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto; Department of Otolaryngology, Head & Neck Surgery, University of Toronto; Institute of Medical Sciences, University of Toronto.
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16
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Changes in Vestibular Function Following Pediatric Cochlear Implantation: a Prospective Study. Ear Hear 2021; 43:620-630. [PMID: 34593688 DOI: 10.1097/aud.0000000000001125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Given the close interconnection between the auditory and vestibular end organs, the increasingly broad application of (bilateral) cochlear implantation (CI) in children raises concern about its impact on the vestibular function. Unfortunately, literature on this matter is inconclusive and subject to several limitations. Therefore, this study aimed to elucidate the impact of pediatric CI on the vestibular function in a large sample of children, representative for the current CI population. DESIGN Fifty hearing-impaired children followed in the Ghent University Hospital were included in this prospective study. Twenty-seven patients underwent unilateral CI, and 23 were bilaterally implanted (9 sequentially, 14 simultaneously), adding up to 73 implanted ears. Children's median age at first implantation was 29 (range 8 to 194) months. Vestibular assessment was scheduled on average 2.8 months (SD: 3.6) before and 4.6 (SD: 4.0) months after implantation and consisted of video Head Impulse Testing of the lateral semicircular canals, rotatory testing (0.16, 0.04, and 0.01 Hz) and cervical vestibular evoked myogenic potential (cVEMP) testing with bone conduction stimulation. Caloric testing was added in children older than 3 years of age. RESULTS Overall, group analysis in our sample of 73 CI-ears did not reveal any significant impact on the vestibular function, except for a significantly shortened ipsilateral N1 latency of the cVEMP responses (p = 0.027) after CI. Complete ipsilateral loss of function after implantation was seen in 5% (3/54) of all CI-ears on the video head impulse testing, in 0% (0/10) on the caloric test and in 2% (1/52) on the cVEMP, notably all patients deafened by a congenital cytomegalovirus infection. CONCLUSIONS The impact of CI on the vestibular function in our dataset was limited. Therefore, the many advantages of simultaneous bilateral implantation may outweigh the risk for vestibular damage postoperatively. However, the impact on the vestibular function may be dependent on various factors (e.g., etiology of the hearing loss), and the clinical outcome is still difficult to predict. Vestibular assessment remains thus an important aspect in the pediatric CI population; first because the vestibular function should be considered in the decision-making process on (simultaneous or sequential bilateral) CI and second because it is essential to reveal a possible additional sensory deficit, allowing an opportunity for rehabilitation to improve the overall outcome of these children.
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17
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Reynard P, Ionescu E, Goulème N, Ortéga-Solis J, Spruyt K, Thai-Van H. High-frequency semicircular canal deficit affects postural control in hearing-impaired children. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 138:235-239. [PMID: 33071168 DOI: 10.1016/j.anorl.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The present study aimed to analyse the impact of vestibulo-ocular reflex (VOR) gain deficit on postural control (PC) in children with sensorineural hearing loss. METHODS A retrospective study included 55 children with sensorineural hearing loss between 4 and 17 years of age. The Video Head Impulse Test (vHIT®) was used to assess semicircular canal function. PC was assessed on the Balance Quest® posturographic platform testing sensory organisation. RESULTS Spatial and temporal postural parameters (area and mean speed of centre of pressure oscillation, spectral power index) in the OKN-U condition (optokinetic with unstable platform) were significantly better in children with than without VOR deficit. CONCLUSION Posturographic exploration in the OKN-U condition can screen for semicircular canal deficit in hearing-impaired children. VOR deficit also seems to predict PC deficit.
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Affiliation(s)
- P Reynard
- Service d'audiologie et explorations otoneurologiques, CHU Édouard-Herriot, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France; Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France.
| | - E Ionescu
- Service d'audiologie et explorations otoneurologiques, CHU Édouard-Herriot, Lyon, France; Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - N Goulème
- Service d'audiologie et explorations otoneurologiques, CHU Édouard-Herriot, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France
| | - J Ortéga-Solis
- Service d'audiologie et explorations otoneurologiques, CHU Édouard-Herriot, Lyon, France
| | - K Spruyt
- Centre de recherche en neurosciences de Lyon, INSERM U1028, CNRS UMR 5292, université Claude-Bernard Lyon 1, Lyon, France
| | - H Thai-Van
- Service d'audiologie et explorations otoneurologiques, CHU Édouard-Herriot, Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France; Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
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18
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Baghdadi M, Caldani S, Maudoux A, Audo I, Bucci MP, Wiener-Vacher SR. Subjective visual vertical in patients with Usher syndrome. J Vestib Res 2020; 30:275-282. [PMID: 32925128 DOI: 10.3233/ves-200711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Verticality, or more precisely the ability to perceive spatial orientation with regard to gravity, is based on
the integration of visual, vestibular and somesthetic information. OBJECTIVE The purpose of the present study was to compare the subjective visual vertical (SVV) in patients with Usher
(type I and type II) with visual or vestibular impairment, and in healthy participants, in order to explore the importance of the visual and vestibular functions on the vertical’s perception. METHODS We evaluated the SVV using a wall housing which projects on the opposite wall a red-light line of about 2
meters, obtained by laser cannon. The evaluation was carried out under two tilt conditions: clockwise and counter-clockwise randomly performed five times in each direction. The response to the SVV task was quantified by the mean of the absolute values of the SVV. RESULTS Responses to the SVV were significantly less accurate in patients with Usher with respect to healthy participants
while it was similar for the two groups of patients with Usher. CONCLUSIONS We hypothesize that visual inputs play a very important role in the perception of verticality and that the
symmetrical bilateral vestibular deficit in Usher type I does not have a strong impact in perception of verticality.
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Affiliation(s)
- Moetez Baghdadi
- EFEE - Center for children balance disorders evaluation. ENT Departement, Robert Debré Universitary Hospital , 48, Bld Sérurier, 75019 Paris, France.,UMR 7114 MoDyCo, CNRS-Université Paris Nanterre. Nanterre, France
| | - Simona Caldani
- EFEE - Center for children balance disorders evaluation. ENT Departement, Robert Debré Universitary Hospital , 48, Bld Sérurier, 75019 Paris, France.,UMR 7114 MoDyCo, CNRS-Université Paris Nanterre. Nanterre, France
| | - Audrey Maudoux
- EFEE - Center for children balance disorders evaluation. ENT Departement, Robert Debré Universitary Hospital , 48, Bld Sérurier, 75019 Paris, France
| | - Isabelle Audo
- CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS CIC1423, Paris, France
| | - Maria Pia Bucci
- EFEE - Center for children balance disorders evaluation. ENT Departement, Robert Debré Universitary Hospital , 48, Bld Sérurier, 75019 Paris, France.,UMR 7114 MoDyCo, CNRS-Université Paris Nanterre. Nanterre, France
| | - Sylvette R Wiener-Vacher
- EFEE - Center for children balance disorders evaluation. ENT Departement, Robert Debré Universitary Hospital , 48, Bld Sérurier, 75019 Paris, France
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Verrecchia L, Galle Barrett K, Karltorp E. The feasibility, validity and reliability of a child friendly vestibular assessment in infants and children candidates to cochlear implant. Int J Pediatr Otorhinolaryngol 2020; 135:110093. [PMID: 32422368 DOI: 10.1016/j.ijporl.2020.110093] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The pediatric vestibular assessment has developed significantly in the past two decades, especially in terms of assessment of cochlear implant (CI) candidates. Different methods and test protocols have been applied, however without a general consensus. We present here the feasibility, validity and reliability of a child friendly vestibular testing in use at our department for the assessment of pediatric CI candidates. METHODS The test battery consisted of head impulse test (HIT), video head impulse test (vHIT), cervical evoked myogenic potentials (cVEMP) and mini ice water caloric test (mIWC), all adapted from previous methods, mentioned in literature. We defined specific criteria for test feasibility, for test validity and test positivity (i.e. indicating vestibular insufficiency). The reliability of the whole protocol was assessed with test agreement analysis. RESULTS Complete data from 35 children, all CI candidates, age ranging 4-79 months (67% under 2 years) and recruited over two years, were obtained. All but one child could complete at least one test with valid responses bilaterally, with the best compliance for HIT (97,1%) and least for cVEMP (68,6%). Feasibility did not appear to be affected by age or hearing loss etiology. Among the valid responses there was a substantial test agreement between HIT and vHIT, moderate agreement between vHIT/HIT and mIWC and no apparent agreement between the canal tests and cVEMP. Simple clinical guidelines were introduced to solve the tests' disagreement and to improve the protocol reliability: a) a pathological response had to be confirmed in at least two different canal tests and in at least three cVEMP trials; b) a canal/otolith disagreement was interpreted as a partial vestibular loss to be opposed to a complete vestibular insufficiency. CONCLUSIONS The search for vestibular insufficiency in infants and young children can be attained with an opportunely adapted vestibular assessment, such the test battery proposed here. That assessment resulted easy to conduct and to interpret in a representative sample of CI candidates in preschool age, the most of whom were younger than 2 years. This method appears to particularly suit the demands of a vestibular assessment in young children CI candidates.
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Affiliation(s)
- Luca Verrecchia
- Hearing and Balance Section, Ear Nose and Throat Department, Karolinska University Hospital, Sweden; ENT Section, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden.
| | | | - Eva Karltorp
- Ear and Neck Surgery, Ear Nose and Throat Department, Karolinska University Hospital, Sweden; ENT Section, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Sweden
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West N, Sass H, Klokker M, Cayé-Thomasen P. Functional Loss After Meningitis-Evaluation of Vestibular Function in Patients With Postmeningitic Hearing Loss. Front Neurol 2020; 11:681. [PMID: 32849181 PMCID: PMC7406674 DOI: 10.3389/fneur.2020.00681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: The inner ear vestibular system is essential to balance function. Although hearing loss is well-described and quite common following meningitis, the literature evaluating vestibular function following meningitis is very limited. In particular, information on results of contemporary vestibular function tests, e.g., the video head impulse test (VHIT), is scarce. Using contemporary vestibular function tests, this study examines the vestibular function of patients with profound hearing loss (HL) after meningitis. Methods: Review of the literature and retrospective controlled study. Patients: Twenty-one consecutive patients with profound HL after meningitis (cochlear implant candidates) matched with 20 patients with profound HL of unknown etiology and examined during the period 2013-2018. Outcome Measure: Vestibular function loss, as evaluated with VHIT vestibulo-ocular reflex (VOR) gain, eye movement saccades, and cervical vestibular-evoked myogenic potentials (cVEMPs). The results of these tests were correlated to inner ear imaging findings (MRI/CT) and the level of hearing loss. Results: Mean VHIT gain was 0.48 in the meningitis group compared to 0.86 in the control group (p < 0.01). Saccades were present in 21 ears (62%) in the meningitis group compared to six ears (15%) among the controls (p < 0.01). cVEMP responses were present on five ears (18%) in the meningitis group and 25 ears (66%) in the control group (p < 0.01). Discussion: Postmeningitic hearing loss is associated with poor vestibular function, as evaluated by VHIT, saccades, and cVEMP. Loss of vestibular function correlates with the degree of hearing loss and inner ear imaging findings, although not in all cases. Vestibular function should be examined in patients surviving meningitis with hearing loss in order to individualize rehabilitation and improve balance outcome.
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Affiliation(s)
- Niels West
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Hjalte Sass
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mads Klokker
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hazen M, Cushing SL. Implications of Concurrent Vestibular Dysfunction in Pediatric Hearing Loss. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00298-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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Melo RS, Tavares-Netto AR, Delgado A, Wiesiolek CC, Ferraz KM, Belian RB. Does the practice of sports or recreational activities improve the balance and gait of children and adolescents with sensorineural hearing loss? A systematic review. Gait Posture 2020; 77:144-155. [PMID: 32036319 DOI: 10.1016/j.gaitpost.2020.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/10/2020] [Accepted: 02/02/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Balance and gait disorders have been observed in children and adolescents with sensorineural hearing loss (SNHL), justified by vestibular dysfunctions that these children may present, due to the injury to the inner ear. Therefore, some investigations have suggested that the practice of sports or recreational activities can improve the balance and gait of this population. OBJECTIVE Assess the evidence quality from randomized or quasi-randomized controlled trials that used sports or recreational activities as an intervention to improve the balance and /or gait of children and/or adolescents with SNHL. METHODS Systematic review that surveyed articles in nine databases, published up to January 10, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants from both groups with the clinical diagnosis of SNHL, aged 6-19 years old, without physical problems, cognitive or neurological deficits, except the vestibular dysfunction. (3) Using the practice of sports or recreational activities as an intervention, to improve the balance and/or gait outcomes. RESULTS 4732 articles were identified in the searches, after the removal of the duplicates articles and the reading of the titles and their abstracts, remained 16 articles for reading in full, being 5 trials eligible for this systematic review. Of the five eligible trials, three used sports activities and two recreational activities as intervention and presented very low-quality evidence for balance and gait outcomes. SIGNIFICANCE Sports and recreational practices seem to represent promising modalities to improve the balance and gait of children and adolescents with SNHL. However, due to the methodological limitations of the trials and the low quality of the current evidence on the topic, the results of the trials should be interpreted with caution. Due to the low quality of evidence observed, we suggest that new trials be proposed on this topic, with greater methodological rigor, to provide high-quality evidence on the effectiveness of sports and recreational practices to improve the balance and gait of children and adolescents with SNHL.
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Affiliation(s)
- Renato S Melo
- Post-Graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife, Pernambuco, Brazil; Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil.
| | - Afonso Rodrigues Tavares-Netto
- Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Alexandre Delgado
- Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Carine Carolina Wiesiolek
- Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Karla Mônica Ferraz
- Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Rosalie Barreto Belian
- Post-Graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife, Pernambuco, Brazil; Department of Medicine, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Ionescu E, Reynard P, Goulème N, Becaud C, Spruyt K, Ortega-Solis J, Thai-Van H. How sacculo-collic function assessed by cervical vestibular evoked myogenic Potentials correlates with the quality of postural control in hearing impaired children? Int J Pediatr Otorhinolaryngol 2020; 130:109840. [PMID: 31901767 DOI: 10.1016/j.ijporl.2019.109840] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Functional integrity of vestibular end organs is essential for gaze stabilization, dynamic visual acuity, postural control and spatial orientation. Some authors hypothesized on the importance of saccules for postural control and motor development in children, including achievements such as standing up and walking. The purpose of this article was to observe how saccular dysfunction assessed by cervical Vestibular Evoked Myogenic Potentials (cVEMPs) correlates with the quality of postural control in non-syndromic deaf children. METHOD Seventy-six non-syndromic hearing-impaired children were retrospectively included. Sacculo-collic pathway was assessed with cVEMPs elicited in bone conduction. The response was quoted "normal" if a reproducible wave P13-N23 of at least 50μV in amplitude was present, if not, it was quoted "absent". The sample was divided in 3 groups depending on the presence of the sacculo-collic responses: normal bilateral group (Group 1), normal unilateral (Group 2) and absent bilaterally group (Group 3). Motor assessment was achieved with Movement Assessment Battery for Children, second edition (MABC-2). Postural control (PC) was assessed using the dynamic Balance Quest platform. The scores obtained with MABC-2, and the postural parameters recorded on the Balance Quest platform (sway of Centre of Pressure and spectral power index) were analyzed and compared throughout the groups. RESULTS Group 1 (normal bilateral) showed the best scores regarding motor abilities and postural stability within available normative data. Group 3 (absent bilateral) had the lowest motor and postural control skills. A good correlation between the scores obtained by MABC-2 motor test and dynamic posturography (Balance Quest) was observed. CONCLUSIONS The presence of at least one sacculo-collic response would predict satisfactory static and dynamic motor and postural control skills in non-syndromic hearing-impaired children. MABC-2 and Dynamic Posturography Balance Quest appears reliable and comparable tools for PC assessment in hearing impaired children. In the light of these results, it appears that in young children candidates for uni- or bilateral CI whose walking is not yet acquired, should receive a vestibular assessment before surgery to avoid the risk of bilateral sacculo-collic function impairment.
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Affiliation(s)
- Eugen Ionescu
- Department of Audiology and Neurotology, Hospices Civils de Lyon, 5 Place D'Arsonval, 69003, Lyon, France; Paris Hearing Institute, Institut Pasteur, Inserm U1120, France.
| | - Pierre Reynard
- Department of Audiology and Neurotology, Hospices Civils de Lyon, 5 Place D'Arsonval, 69003, Lyon, France; Paris Hearing Institute, Institut Pasteur, Inserm U1120, France; University Claude Bernard Lyon 1, France
| | - Nathalie Goulème
- Department of Audiology and Neurotology, Hospices Civils de Lyon, 5 Place D'Arsonval, 69003, Lyon, France; Lyon Neuroscience Research Center. INSERM U1028, CNRS UMR 5292, Claude Bernard University Lyon 1, France
| | - Cécile Becaud
- Department of Audiology and Neurotology, Hospices Civils de Lyon, 5 Place D'Arsonval, 69003, Lyon, France
| | - Karen Spruyt
- Lyon Neuroscience Research Center. INSERM U1028, CNRS UMR 5292, Claude Bernard University Lyon 1, France
| | - José Ortega-Solis
- Department of Audiology and Neurotology, Hospices Civils de Lyon, 5 Place D'Arsonval, 69003, Lyon, France
| | - Hung Thai-Van
- Department of Audiology and Neurotology, Hospices Civils de Lyon, 5 Place D'Arsonval, 69003, Lyon, France; Paris Hearing Institute, Institut Pasteur, Inserm U1120, France; University Claude Bernard Lyon 1, France
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Sosna M, Tacikowska G, Pietrasik K, Skarzynski H, Skarzynski PH. Vestibular status in partial deafness. Braz J Otorhinolaryngol 2019; 87:379-388. [PMID: 31874831 PMCID: PMC9422694 DOI: 10.1016/j.bjorl.2019.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/31/2019] [Accepted: 09/26/2019] [Indexed: 01/11/2023] Open
Abstract
Introduction The hair cells of the cochlea and the vestibulum are closely connected and may be susceptible to the same noxious factors. The relationship between their function has been a continuing field of investigation. The indications for cochlear implantation have been broadened and now include the patients with partial deafness. This raises the question of their vestibular status. Objective The aim of the study was to investigate whether there is any difference between the vestibular function of patients with low frequency residual hearing and those with totally deaf ears. Methods A total of 360 ears with profound sensorineural hearing loss were analysed before cochlear implantation. The patients were divided into four groups, according to their low frequency residual hearing (Group 1 ‒ normal or slightly elevated low frequency residual hearing; Group 2 ‒ elevated threshold but still usable hearing at low frequencies; Group 3 – non-functional residual hearing; Group 4 ‒ no detectable hearing threshold within the limits of the audiometer). The patients underwent vestibular tests: cervical vestibular evoked myogenic potential, ocular vestibular evoked myogenic potential, caloric test and video-head impulse test. Results The rates of elicited responses in cervical vestibular evoked myogenic potential were as follows: in Group 1 (59.3 %); Group 2 (57.5 %); Group 3 (35.2 %); Group 4 (7.7 %). For ocular vestibular evoked myogenic potential the percentage of correct outcomes was: Group 1 (70.8 %); Group 2 (56.0 %); Group 3 (40.0 %); Group 4 (14.3 %). For the caloric test we counted normal responses in 88.9 % of Group 1; 81.6 % of Group 2; 57.9 % of Group 3; 53.3 % of Group 4. For video-head impulse test we also found markedly better results in Group1, followed by Group 2, and much worse in Group 3 and 4. Conclusion Patients with partial deafness not only have a better cochlea but also better vestibular function, which needs to be protected. In summary, the better the low frequency residual hearing, the better the vestibular status.
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Affiliation(s)
- Magdalena Sosna
- Institute of Physiology and Pathology of Hearing, Otorhinolaryngosurgery Clinic, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, Department of Otoneurology, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland.
| | - Grazyna Tacikowska
- Institute of Physiology and Pathology of Hearing, Department of Otoneurology, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Katarzyna Pietrasik
- Institute of Physiology and Pathology of Hearing, Department of Otoneurology, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Henryk Skarzynski
- Institute of Physiology and Pathology of Hearing, Otorhinolaryngosurgery Clinic, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland
| | - Piotr H Skarzynski
- Institute of Physiology and Pathology of Hearing, Otorhinolaryngosurgery Clinic, Warsaw, Poland; Institute of Physiology and Pathology of Hearing, World Hearing Center, Kajetany, Poland; Institute of Sensory Organs, Kajetany, Poland; Medical University of Warsaw, Heart Failure and Cardiac Rehabilitation Department, Warsaw, Poland
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Wolter NE, Gordon KA, Campos JL, Vilchez Madrigal LD, Pothier DD, Hughes CO, Papsin BC, Cushing SL. BalanCI: Head-Referenced Cochlear Implant Stimulation Improves Balance in Children with Bilateral Cochleovestibular Loss. Audiol Neurootol 2019; 25:60-71. [PMID: 31678979 DOI: 10.1159/000503135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To determine the impact of a head-referenced cochlear implant (CI) stimulation system, BalanCI, on balance and postural control in children with bilateral cochleovestibular loss (BCVL) who use bilateral CI. METHODS Prospective, blinded case-control study. Balance and postural control testing occurred in two settings: (1) quiet clinical setting and (2) immersive realistic virtual environment (Challenging Environment Assessment Laboratory [CEAL], Toronto Rehabilitation Institute). Postural control was assessed in 16 and balance in 10 children with BCVL who use bilateral CI, along with 10 typically developing children. Children with neuromotor, cognitive, or visual deficits that would prevent them from performing the tests were excluded. Children wore the BalanCI, which is a head-mounted device that couples with their CIs through the audio port and provides head-referenced spatial information delivered via the intracochlear electrode array. Postural control was measured by center of pressure (COP) and time to fall using the WiiTM (Nintendo, WA, USA) Balance Board for feet and the BalanCI for head, during the administration of the Modified Clinical Test of Sensory Interaction in Balance (CTSIB-M). The COP of the head and feet were assessed for change by deviation, measured as root mean square around the COP (COP-RMS), rate of deviation (COP-RMS/duration), and rate of path length change from center (COP-velocity). Balance was assessed by the Bruininks-Oseretsky Test of Motor Proficiency 2, balance subtest (BOT-2), specifically, BOT-2 score as well as time to fall/fault. RESULTS In the virtual environment, children demonstrated more stable balance when using BalanCI as measured by an improvement in BOT-2 scores. In a quiet clinical setting, the use of BalanCI led to improved postural control as demonstrated by significant reductions in COP-RMS and COP-velocity. With the use of BalanCI, the number of falls/faults was significantly reduced and time to fall increased. CONCLUSIONS BalanCI is a simple and effective means of improving postural control and balance in children with BCVL who use bilateral CI. BalanCI could potentially improve the safety of these children, reduce the effort they expend maintaining balance and allow them to take part in more complex balance tasks where sensory information may be limited and/or noisy.
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Affiliation(s)
- Nikolaus E Wolter
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Campos
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | | | - David D Pothier
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Centre for Advanced Hearing and Balance Testing, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Cían O Hughes
- UCL Ear Institute, Royal National Throat, Nose and Ear Hospital, London, United Kingdom
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada, .,Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada, .,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada, .,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada,
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Caldani S, Bucci MP, Tisné M, Audo I, Van Den Abbeele T, Wiener-Vacher S. Postural Instability in Subjects With Usher Syndrome. Front Neurol 2019; 10:830. [PMID: 31440199 PMCID: PMC6694594 DOI: 10.3389/fneur.2019.00830] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
This study investigated postural performances and vestibular impairment in Usher patients. The three groups studied were: 11 patients with Usher type I (with visual and vestibular impairment), 14 patients with Usher type II (with only visual impairment), and 14 healthy control subjects. Postural stability was measured with a Framiral Multitest Equilibre platform with three visual conditions: eyes open (EO), eyes closed (EC), and vision disturbed by optokinetic stimulation (OPT), and two different postural conditions: stable or unstable platform. The surface and mean velocity of the center of pressure displacement (CoP) were measured and a postural instability index (PII) was calculated. Usher type I and II patients were more unstable than control subjects, but only for the unstable platform. Patients with Usher type I (with severe vestibular impairment) were also significantly more unstable than patients with Usher type II (with normal vestibular function) on the unstable platform. The severity of the vestibular impairment was correlated with the surface of the CoP displacement. We suggest that poor postural control of Usher patients is due to the abnormalities in their visual and, when defective, vestibular inputs. Measurements of postural stability on an unstable platform can distinguish type I from type II Usher patients. We emphasize the importance of multisensory evaluation in these patients to guide development of personalized visuo-vestibular rehabilitation techniques to improve their postural stability and improve their quality of life.
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Affiliation(s)
- Simona Caldani
- UMR 1141 Inserm, Robert Debré Hospital, Université de Paris, Paris, France.,FEE, ENT Department, Center for Children Balance Disorders Evaluation, Robert Debré Hospital, Paris, France
| | - Maria Pia Bucci
- UMR 1141 Inserm, Robert Debré Hospital, Université de Paris, Paris, France.,FEE, ENT Department, Center for Children Balance Disorders Evaluation, Robert Debré Hospital, Paris, France
| | - Maud Tisné
- UMR 1141 Inserm, Robert Debré Hospital, Université de Paris, Paris, France.,FEE, ENT Department, Center for Children Balance Disorders Evaluation, Robert Debré Hospital, Paris, France
| | - Isabelle Audo
- CHNO des Quinze-Vingts, DHU Sight Restore, INSERM-DHOS, Paris, France
| | - Thierry Van Den Abbeele
- FEE, ENT Department, Center for Children Balance Disorders Evaluation, Robert Debré Hospital, Paris, France
| | - Sylvette Wiener-Vacher
- UMR 1141 Inserm, Robert Debré Hospital, Université de Paris, Paris, France.,FEE, ENT Department, Center for Children Balance Disorders Evaluation, Robert Debré Hospital, Paris, France
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Wiener-Vacher SR, Wiener SI, Ajrezo L, Obeid R, Mohamed D, Boizeau P, Alberti C, Bucci MP. Dizziness and Convergence Insufficiency in Children: Screening and Management. Front Integr Neurosci 2019; 13:25. [PMID: 31354441 PMCID: PMC6636600 DOI: 10.3389/fnint.2019.00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/26/2019] [Indexed: 11/13/2022] Open
Abstract
Objective In children screened for dizziness with vergence disorders, we tested short and long term efficacy of orthoptic vergence training (OVT) and instructions to reduce screen usage. Methods Prospective study: Of the 179 children referred for vertigo or dizziness (over 3 years) with ophthalmological disorder as the only problem after complete oto-neuro-vestibular testing, 69 presented vergence insufficiency, and 49 accepted to participate in this study. 109 healthy children served as controls. All subjects had classic orthoptic evaluation and video binocular movement recordings during various oculomotor tasks. Patients were evaluated before OVT (M0), 3 months after the end of OVT (M3) and 9 months after the end of OVT (M9). Statistics compared orthoptic and oculomotor parameters between patients and controls over time with one-way ANCOVA, and mixed models, controlling for age and gender. Results Patients reported vertigo that was usually rotatory, lasting <15 min, associated with or alternating with headache (50%). Their exposure to small video screens and TV was intensive (∼3.6 h per day). At M0, all orthoptic and oculomotor parameters were statistically different in patients relative to controls (p < 0.0001) except for divergence. At M3, vertigo symptoms had disappeared in all of the patients, and all eye movement parameters improved significantly (p < 0.0001). At M9, this improvement remained stable or continued. Conclusion Vergence disorders (assessed by abnormal orthoptic and oculomotor parameters) can generate symptoms of dizziness in children. Orthoptic treatment and instruction to reduce screen usage has a significant and long term effect on vertigo symptoms as well as oculomotor performances. Dizzy children should be screened for vergence disorders. WHAT THIS STUDY ADDS Dizziness in children can be associated exclusively with insufficient convergence. Orthoptic training and instructions to reduce screen exposure made dizziness symptoms disappear and improved all eye movement parameters for 6 months. Vergence disorders should be screened for in dizzy children.
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Affiliation(s)
- Sylvette R Wiener-Vacher
- Pediatric Balance Evaluation Center (EFEE), ENT Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France.,Hopital Robert Debré, UMR1141 INSERM-Université de Paris, Paris, France
| | - Sidney I Wiener
- Center for Interdisciplinary Research in Biology (CIRB), College de France, CNRS, INSERM, PSL Research University, Paris, France
| | - Layla Ajrezo
- Pediatric Balance Evaluation Center (EFEE), ENT Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Rima Obeid
- Pediatric Balance Evaluation Center (EFEE), ENT Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Damir Mohamed
- Clinical Epidemiology Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | - Priscilla Boizeau
- Clinical Epidemiology Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | - Corinne Alberti
- Clinical Epidemiology Unit, AP-HP, Hôpital Robert Debré, Paris, France.,UMR-S 1123, CIC-EC 1426, INSERM, Université de Paris, Paris, France
| | - Maria Pia Bucci
- Pediatric Balance Evaluation Center (EFEE), ENT Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France.,Hopital Robert Debré, UMR1141 INSERM-Université de Paris, Paris, France
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Van Hecke R, Danneels M, Dhooge I, Van Waelvelde H, Wiersema JR, Deconinck FJA, Maes L. Vestibular Function in Children with Neurodevelopmental Disorders: A Systematic Review. J Autism Dev Disord 2019; 49:3328-3350. [DOI: 10.1007/s10803-019-04059-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Vestibular and balance function is often impaired in children with profound unilateral sensorineural hearing loss. Hear Res 2019; 372:52-61. [DOI: 10.1016/j.heares.2018.03.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 03/11/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022]
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Abstract
This article focuses on vestibular rehabilitation (VR) for children. Reports of the presence of vestibular dysfunction in infants, young children, and adolescents have increased over the past decade. In addition to being a comorbidity of sensorineural hearing loss, vestibular dysfunction has been noted in children with cytomegalovirus, late prematurity, and concussion, to name a few. Despite ample evidence and reports of VR for adults, the selection and provision of exercises to be included in the VR protocol for children vary, depending on the nature of the lesion, impairments identified, age at the time of lesion, and developmental factors such as critical periods of development and intermodality interdependence. Unlike adults, children with loss of function or hypofunction of the vestibular apparatus since or shortly after birth present with a developmental delay that is progressive. Very young children may not be able to describe symptoms but rather only avoid activities or cry. This report provides a review of vestibular-related impairments in children, determinants of the symptoms and functional impairments of vestibular dysfunction, the mechanisms of recovery in children, the challenges of VR for children, and a summary of research on the efficacy for VR for children.
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Abstract
Sensorineural hearing loss (SNHL) in children occurs in 1 to 3% of live births and acquired hearing loss can additionally occur. This sensory deficit has far reaching consequences that have been shown to extend beyond speech and language development. Thankfully there are many therapeutic options that exist for these children with the aim of decreasing the morbidity of their hearing impairment. Of late, focus has shifted beyond speech and language outcomes to the overall performance of children with SNHL in real-world environments. To account for their residual deficits in such environments, clinicians must understand the extent of their sensory impairments. SNHL commonly coexists with other sensory deficits such as vestibular loss. Vestibular impairment is exceedingly common in children with SNHL with nearly half of children exhibiting vestibular end-organ dysfunction. These deficits naturally lead to impairments in balance and delay in motor milestones. However, this additional sensory deficit likely leads to further impairment in the performance of these children. This article focuses on the following: 1. Defining the coexistence of vestibular impairment in children with SNHL and cochlear implants. 2. Describing screening methods aimed at identifying vestibular dysfunction in children with SNHL. 3. Understanding the functional implications of this dual-sensory impairment. 4. Exploring possible rehabilitative strategies to minimize the impact of vestibular impairment in children with SNHL.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Cochlear Implant Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology, Head and Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Wiener-Vacher SR, Quarez J, Priol AL. Epidemiology of Vestibular Impairments in a Pediatric Population. Semin Hear 2018; 39:229-242. [PMID: 30038452 DOI: 10.1055/s-0038-1666815] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The purpose of this study was to report the prevalence of vestibular impairment (VI) in children ( n = 2,528) referred for complete vestibular testing because of balance disorders (BD) or hearing loss (H). A VI was shown in 51.5% of the children tested (1,304/2,528). For BD (e.g., vertigo, dizziness, instability, delay in posturomotor development), VI was found in 36.5% ( n = 379/1,037). The most frequent causes of BD with VI included inner ear malformation (13.5%), delay in posturomotor development (13.4%), hearing loss revealed with vertigo (3.9%), trauma (3.9%), vestibular neuritis (3.3%), meningitis (2.5%), Meniere-like syndrome (1.1%), BPPV posttrauma (1%), labyrinthitis (0.4%), and unknown etiology (19.6%). Normal responses to the complete battery of tests ( n = 658, 63.5%) excluded a vestibular origin to BD, leading to other diagnoses: principally migraine (15.6%), ophthalmological disorders (15.1%), neurological disorders (including delay in posturomotor development; 14.4%), orthostatic hypotension, or somatoform dizziness (<1%). Of the children referred for hearing loss ( n = 1,491), 68.5% were tested without cochlear implantation (CI; n = 1,022). In this group, 54.5% presented with VI ( n = 557). This was mostly found in cytomegalovirus infection, inner ear malformation, and genetic syndromes. Profound hearing loss candidates for cochlear implants had complete bilateral vestibular loss in 20% and delay in posturomotor development, and 80% had partial or normal vestibular function and normal posturomotor development. VI was found after CI in 50% on the side of the implant (partial in 41% and complete in 9%). VI is present in 36.5% of children referred to our center for BDs and 54.5% for hearing loss. Vestibular testing permits ruling out peripheral VI and hence seeking other causes for BDs such as migraine and ophthalmological disorders and also helps lower the risk of inducing bilateral complete vestibular loss in CI protocols.
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Affiliation(s)
- Sylvette R Wiener-Vacher
- Center for Evaluation of Balance Disorders in Children (EFEE), Robert Debré University Hospital, Paris, France
| | - Juliette Quarez
- Department of ENT, Robert Debré University Hospital, Paris, France
| | - Audrey Le Priol
- Center for Evaluation of Balance Disorders in Children (EFEE), Robert Debré University Hospital, Paris, France
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Balance performance of children and adolescents with sensorineural hearing loss: Repercussions of hearing loss degrees and etiological factors. Int J Pediatr Otorhinolaryngol 2018; 110:16-21. [PMID: 29859579 DOI: 10.1016/j.ijporl.2018.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Some studies have demonstrated a parallelism between the extent of hearing loss and the frequency of vestibular dysfunction in children with sensorineural hearing loss (SNHL). Despite this, little is known about the repercussion of degrees of hearing loss and etiological factors on the balance performance in this children. OBJECTIVE Compare the balance performance between normal hearing (NH) children and those with SNHL, considering the sex and age range of the sample, and analyze balance performance according to the degrees of hearing loss and etiological factors in the latter group. METHODS Cross-sectional study that assessed 96 children (48 NH and 48 with SNHL), aged between 7 and 18 years old. The balance performance was assessed by the Brazilian version of the Pediatric Balance Scale, validated for Brazilian child population and the Mann-Whitney test used for statistical analysis. RESULTS The group with SNHL showed lower average balance performance compared to NH (p = 0.000). This was also observed when the children were grouped by sex: female and male (p = 0.001). The same difference occurred when the children were stratified by age group: 7-14 years old (p = 0.000). There were no differences between the balance performance of the groups according to the degrees of hearing loss (p = 0.236) and the children with prematurity or post-natal meningitis as an etiological factor demonstrated the worst balance performance. CONCLUSION The children with SNHL showed worse balance performance compared to NH of the same sex and age range between seven to fourteen years. There were no differences between balance performance and hearing loss degrees, and those children with prematurity or post-natal meningitis as an etiological factor demonstrated the worst balance performances.
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Hain TC, Cherchi M, Yacovino DA. Bilateral Vestibular Weakness. Front Neurol 2018; 9:344. [PMID: 29904366 PMCID: PMC5990606 DOI: 10.3389/fneur.2018.00344] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023] Open
Abstract
Bilateral vestibular weakness (BVW) is a rare cause of imbalance. Patients with BVW complain of oscillopsia. In approximately half of the patients with BVW, the cause remains undetermined; in the remainder, the most common etiology by far is gentamicin ototoxicity, followed by much rarer entities such as autoimmune inner ear disease, meningitis, bilateral Ménière’s disease, bilateral vestibular neuritis, and bilateral vestibular schwannomas. While a number of bedside tests may raise the suspicion of BVW, the diagnosis should be confirmed by rotatory chair testing. Treatment of BVW is largely supportive. Medications with the unintended effect of vestibular suppression should be avoided.
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Affiliation(s)
- Timothy C Hain
- Department of Otolaryngology, Northwestern University, Chicago, IL, United States.,Department of Physical Therapy and Human Movement Science, Northwestern University, Chicago, IL, United States
| | - Marcello Cherchi
- Department of Neurology, Northwestern University, Chicago, IL, United States
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Letter to the Editor Regarding Oyewumi M, Wolter NE, Heon E, Gordon KA, Papsin BC, Cushing SL. "Using Balance Function to Screen for Vestibular Impairment in Children with Sensorineural Hearing Loss and Cochlear Implants". Otol Neurotol 2017; 38:611-612. [PMID: 28207627 DOI: 10.1097/mao.0000000000001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Verbecque E, Marijnissen T, De Belder N, Van Rompaey V, Boudewyns A, Van de Heyning P, Vereeck L, Hallemans A. Vestibular (dys)function in children with sensorineural hearing loss: a systematic review. Int J Audiol 2017; 56:361-381. [DOI: 10.1080/14992027.2017.1281444] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Evi Verbecque
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,
- Multidisciplinary Motor Centre Antwerp, University of Antwerp, Wilrijk, Belgium,
| | - Tessa Marijnissen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,
| | - Niels De Belder
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,
| | - Vincent Van Rompaey
- Department of Otorhinolargynology and Neck & Head Surgery, Antwerp University Hospital, Antwerp, Belgium,
| | - An Boudewyns
- Department of Otorhinolargynology and Neck & Head Surgery, Antwerp University Hospital, Antwerp, Belgium,
| | - Paul Van de Heyning
- Multidisciplinary Motor Centre Antwerp, University of Antwerp, Wilrijk, Belgium,
- Department of Otorhinolargynology and Neck & Head Surgery, Antwerp University Hospital, Antwerp, Belgium,
- Department of Translational Neurosciences, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium, and
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,
- Multidisciplinary Motor Centre Antwerp, University of Antwerp, Wilrijk, Belgium,
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium,
- Multidisciplinary Motor Centre Antwerp, University of Antwerp, Wilrijk, Belgium,
- Department of Functional Morphology, Faculty of Sciences, University of Antwerp, Antwerp, Belgium
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Kaya S, Schachern PA, Tsuprun V, Paparella MM, Cureoglu S. Deterioration of Vestibular Cells in Labyrinthitis. Ann Otol Rhinol Laryngol 2016; 126:89-95. [PMID: 27881797 DOI: 10.1177/0003489416675356] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To quantitatively assess the effect of serous labyrinthitis, suppurative labyrinthitis, and labyrinthitis ossificans on vestibular hair cells, dark cells, and transitional cells. METHODS We examined human temporal bone specimens with serous labyrinthitis, suppurative labyrinthitis, and labyrinthitis ossificans, then compared them with age-matched control groups without labyrinthitis. We evaluated the density of type I and II vestibular hair cells, dark cells, and transitional cells in the peripheral sensorial organs. RESULTS The mean density of type I vestibular hair cells in the maculae of the saccule significantly differed between the serous labyrinthitis group and its control group. The loss of type I and II vestibular hair cells in all of the peripheral sensorial organs was significantly higher in the suppurative labyrinthitis group than in its control group. The mean density of dark cells in the lateral and posterior semicircular canals was significantly lower in the suppurative labyrinthitis group than in its control group. The mean density of type I and II vestibular hair cells, dark cells, and transitional cells was significantly lower in the labyrinthitis ossificans group than in its control group. CONCLUSION The loss of vestibular hair cells and degenerative changes in dark cells and transitional cells could affect vestibular function in patients with labyrinthitis.
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Affiliation(s)
- Serdar Kaya
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA.,2 Department of Otolaryngology-Head and Neck Surgery, Gebze Fatih State Hospital, Gebze, Kocaeli, Turkey
| | - Patricia A Schachern
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Vladimir Tsuprun
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Sebahattin Cureoglu
- 1 Department of Otolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
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Wang J, Li Y, Chen S, Hao X. Long-term outcomes of a transmastoid lateral semicircular canal approach to congenital CSF otorrhea in children associated with recurrent meningitis and severe inner ear malformation. Int J Pediatr Otorhinolaryngol 2016; 87:185-9. [PMID: 27368469 DOI: 10.1016/j.ijporl.2016.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the long-term effectiveness of transmastoid lateral semicircular canal approach (TMLSCCA) to repair cerebrospinal fluid (CSF) leakage in children associated with recurrent meningitis and severe congenital inner malformation. METHOD A retrospective study was conducted in a university hospital, academic medical center. Fifteen children with recurrent meningitis, secondary to severe congenital inner ear malformation, were included in the study. All of them had CSF associated otorrhea and treated using TLSCCA to repair CSF otorrhea by packing the vestibule with muscle and fascia. Observation of the status of postoperative CSF leakage, recurrence of meningitis and complication were conducted. RESULTS None of the cases had recurrent meningitis and CSF leakage after their TLSCCA procedure in the follow-up period of 1-8.5 years. One case presented with transient facial nerve paralysis and completely recovered 3 months later. CONCLUSION TLSCCA for CSF otorrhea in children with recurrent meningitis secondary to congenital inner ear malformation is an alternative approach that offers some advantages.
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Affiliation(s)
- Jie Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China; Beijing Engineering Research Center of Audiology Technology, Beijing, 100730, China
| | - Yongxin Li
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China.
| | - Shubin Chen
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China
| | - Xinping Hao
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, 100730, China
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Otologic disorders causing dizziness, including surgery for vestibular disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:279-93. [PMID: 27638078 DOI: 10.1016/b978-0-444-63437-5.00020-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This chapter will focus on vertigo/dizziness due to inner-ear malformations, labyrinthine fistula, otosclerosis, infectious processes, and autoimmune inner-ear disorders. Inner-ear malformation due to dehiscence of the superior semicircular canal is the most recently described inner-ear malformation. Vertigo/dizziness is typically induced by sound and pressure stimuli and can be associated with auditory symptoms (conductive or mixed hearing loss). Labyrinthine fistula, except after surgery for otosclerosis, in the context of trauma or chronic otitis media with cholesteatoma, still remains a challenging disorder due to multiple uncertainties regarding diagnostic and management strategies. Otosclerosis typically manifests with auditory symptoms and conductive or mixed hearing loss on audiometry. Vertigo/dizziness is rare in nonoperated otosclerosis and should draw clinical attention to an inner-ear malformation. Computed tomography scan confirms otosclerosis in most cases and should rule out an inner-ear malformation, avoiding needless middle-ear surgical exploration. Labyrinth involvement after an infectious process is unilateral when it complicates a middle-ear infection but can be bilateral after meningitis. Labyrinth involvement due to an inflammatory disease is a challenging issue, particularly when restricted to the inner ear. The diagnosis relies on the bilateral and rapid aggravation of audiovestibular symptoms that will not respond to conventional therapy but to immunosuppressive drugs.
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van de Berg R, van Tilburg M, Kingma H. Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults. ORL J Otorhinolaryngol Relat Spec 2015; 77:197-218. [DOI: 10.1159/000433549] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Cochlear implantation and vestibular function in children. Int J Pediatr Otorhinolaryngol 2015; 79:101-4. [PMID: 25500550 DOI: 10.1016/j.ijporl.2014.11.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 11/02/2014] [Accepted: 11/03/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To analyze vestibular function Q2 (VF) after cochlear implantation (CI) in children. METHODS Retrospective cohort study at a tertiary pediatric referral center. 43 children that had vestibular testing (VT) after unilateral cochlear implantation, from 2001 to 2010, were included. CT scan of the temporal bone was done systematically before surgery. VT included three tests: head-impulse test, caloric tests, vestibular evoked myogenic potentials. VF was graded in: normal (type 1), partial dysfunction (type 2), severe dysfunction and areflexia (type 3). In 12 cases, VT was done before and after CI. Vestibular function was analyzed looking to side, etiology and preoperative status. RESULTS Mean age at CI was 2.9 years. Bilateral inner ear malformation were retrieved in 16%. Before surgery, 50% of children had normal vestibular responses, 4/12 had bilateral type 2, two had asymmetrical VF. In this group, after surgery, 2 children had VF worsening, none on the CI side only. Considering all 43 patients, post operative VT showed normal response in 48.8% and type 2&3 in 16.2%. Children had asymmetrical poorer vestibular function on the side of CI in 19%. Among them, 75% had normal contralateral VF. Sensorineural hearing loss etiologies known to be associated with vestibulopathy (Usher/Meningitis/Inner Ear Malformations/CMV) were associated to abnormal vestibular function more frequently than in other causes (p=0.01). CONCLUSION Half of the children had initial vestibular dysfunction. In our study, 20% of cochlear implantation could have worsened vestibular function. As vestibular function should be part of the choice in cochlear implantation, side of implantation and survey; and vestibular tests are uneasy to achieve in pediatric population, we propose a three-steps evaluation and gradation which allow easier comparison.
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Long-term effects from bacterial meningitis in childhood and adolescence on postural control. PLoS One 2014; 9:e112016. [PMID: 25405756 PMCID: PMC4236047 DOI: 10.1371/journal.pone.0112016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 10/12/2014] [Indexed: 11/19/2022] Open
Abstract
Bacterial meningitis in childhood is associated with cognitive deficiencies, sensorimotor impairments and motor dysfunction later in life. However, the long-term effects on postural control is largely unknown, e.g., whether meningitis subjects as adults fully can utilize visual information and adaptation to enhance stability. Thirty-six subjects (20 women, mean age 19.3 years) treated in childhood or adolescence for bacterial meningitis, and 25 controls (13 women, mean age 25.1 years) performed posturography with eyes open and closed under unperturbed and perturbed standing. The meningitis subjects were screened for subjective vertigo symptoms using a questionnaire, clinically tested with headshake and head thrust test, as well as their hearing was evaluated. Meningitis subjects were significantly more unstable than controls during unperturbed (p≤0.014) and perturbed standing, though while perturbed only with eyes open in anteroposterior direction (p = 0.034) whereas in lateral direction both with eyes open and closed (p<0.001). Meningitis subjects had poorer adaption ability to balance perturbations especially with eyes open, and they frequently reported symptoms of unsteadiness (88% of the subjects) and dizziness (81%), which was found significantly correlated to objectively decreased stability. Out of the 36 subjects only 3 had unilateral hearing impairment. Hence, survivors of childhood bacterial meningitis may suffer long-term disorders affecting postural control, and would greatly benefit if these common late effects became generally known so treatments can be developed and applied.
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Lien CH, Chang HY, Liu YP, Chi H, Chiu NC, Lin CY. There is something in the ear: mondini dysplasia. J Pediatr 2014; 165:638-638.e1. [PMID: 24929334 DOI: 10.1016/j.jpeds.2014.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/28/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Chi-Hone Lien
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Peng Liu
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chien-Yu Lin
- Department of Pediatrics and Radiology, Hsinchu Mackay Memorial Hospital, Hsinchu City, Taiwan; Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Wiener-Vacher SR, Hamilton DA, Wiener SI. Vestibular activity and cognitive development in children: perspectives. Front Integr Neurosci 2013; 7:92. [PMID: 24376403 PMCID: PMC3858645 DOI: 10.3389/fnint.2013.00092] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/21/2013] [Indexed: 01/24/2023] Open
Abstract
Vestibular signals play an essential role in oculomotor and static and dynamic posturomotor functions. Increasing attention is now focusing on their impact on spatial and non-spatial cognitive functions. Movements of the head in space evoke vestibular signals that make important contributions during the development of brain representations of body parts relative to one another as well as representations of body orientation and position within the environment. A central nervous system pathway relays signals from the vestibular nuclei to the hippocampal system where this input is indispensable for neuronal responses selective for the position and orientation of the head in space. One aspect of the hippocampal systems’ processing to create episodic and contextual memories is its role in spatial orientation and navigation behaviors that require processing of relations between background cues. These are also impaired in adult patients with vestibular deficits. However little is known about the impact of vestibular loss on cognitive development in children. This is investigated here with a particular emphasis upon the hypothetical mechanisms and potential impact of vestibular loss at critical ages on the development of respective spatial and non-spatial cognitive processes and their brain substrates.
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Affiliation(s)
- Sylvette R Wiener-Vacher
- Vestibular and Oculomotor Evaluation Unit, Department of Otorhinolaryngology, Robert Debré Pediatric Hospital Paris, France
| | - Derek A Hamilton
- Department of Psychology, University of New Mexico Albuquerque, NM, USA
| | - Sidney I Wiener
- Laboratoire de Physiologie de la Perception et de l'Action, UMR-7152, Centre National de la Recherche Scientifique - Collège de France Paris, France ; Memolife Laboratory of Excellence, Paris Science and Letters University Paris, France
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Gaertner C, Bucci MP, Obeid R, Wiener-Vacher S. Subjective visual vertical and postural performance in healthy children. PLoS One 2013; 8:e79623. [PMID: 24236146 PMCID: PMC3827351 DOI: 10.1371/journal.pone.0079623] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Verticality is essential in our life, especially for postural stability. Subjective vertical as well as postural stability depends on different sensorial information: visual, vestibular and somesthesic. They help to build the spatial referentials and create a central representation of verticality. Children are more visuo-dependant than adults; however, we did not find any study focusing on how children develop their sense of verticality. Methods We studied two groups of subjects: 10 children (from 6 to 8 years) and 12 young adults. We recorded postural stability with a Techno Concept plateform and perception of subjective visual vertical in the following conditions: while adjusting the vertical in the dark or with visual perturbation, while fixating the vertical bar, and with eyes closed. Results Children are more instable than adults in terms of postural parameters, and also while performing a double task, especially when no visual references are present. They also present a higher variability and lower accuracy than adults in reporting their perception of true vertical reference. Discussion Children might have limited attentional resources, and focus their attention on the more demanding task, corresponding to the U-shaped non-linear model.
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Affiliation(s)
- Chrystal Gaertner
- Université Pierre et Marie Curie, Paris, France
- Children balance Evaluation Center, Robert Debré Paediatric Hospital, Paris, France
| | - Maria Pia Bucci
- UMR 676, INSERM, Université Paris , Hôpital Robert Debré, Paris, France
| | - Rima Obeid
- UMR 676, INSERM, Université Paris , Hôpital Robert Debré, Paris, France
| | - Sylvette Wiener-Vacher
- Children balance Evaluation Center, Robert Debré Paediatric Hospital, Paris, France
- UMR 676, INSERM, Université Paris , Hôpital Robert Debré, Paris, France
- * E-mail:
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Martin W, Jelsma J, Rogers C. Motor proficiency and dynamic visual acuity in children with bilateral sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2012; 76:1520-5. [PMID: 22824199 DOI: 10.1016/j.ijporl.2012.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/02/2012] [Accepted: 07/04/2012] [Indexed: 11/16/2022]
Abstract
AIMS AND OBJECTIVES Due to the close relationship between the cochlea and the peripheral vestibular system, the function of the vestibular system may be impaired in children with sensorineural hearing loss. The aims of this study were to determine the prevalence of impairments of motor performance and dynamic visual acuity, and the nature and extent of interaction between these in children with sensorineural hearing loss between the ages of 4 and 14 years. METHODS This research utilized a correlational, cross-sectional, descriptive design. Thirty-two children with sensorineural hearing loss were matched according to age and gender with children with no hearing impairment. Motor performance was evaluated by means of the Movement Assessment Battery for Children-2 and dynamic visual acuity was evaluated with the dynamic visual acuity test. The performances of the two groups on the different tests were then compared. DATA ANALYSIS The one-sided chi-square test or Fisher's exact test was used to determine whether there was any association between sensorineural hearing loss, impaired motor performance and poor dynamic visual acuity. The Mann-Whitney U-test was used to determine the difference between children with sensorineural hearing loss and those with normal hearing on the Movement Assessment Battery for Children-2. Forward stepwise regression was used to establish the predictors of the Movement Assessment Battery for Children-2 total standard score. The Kruskal-Wallis test was used to compare scores of children with normal hearing and those with a mild to moderate sensorineural hearing loss on the Movement Assessment Battery for Children-2. RESULTS Reduced dynamic visual acuity is associated with sensorineural hearing loss (p=0.026). Motor performance is dependent on dynamic visual acuity and severity of sensorineural hearing loss (r(2)=0.41, p=0.001). CONCLUSIONS The results of this study indicate that in children with sensorineural hearing loss, the prevalence of reduced dynamic visual acuity is 15.6% and of motor impairment is 65.6%. Both abnormal dynamic visual acuity and motor impairment are associated with sensorineural hearing loss. It is important to evaluate children with sensorineural hearing loss for the presence of abnormal dynamic visual acuity as well as motor impairment, because it can have serious implications for the safety, education and general well being of these children.
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