Vestibular Evaluation and Management of Children with Sensorineural Hearing Loss

Developing a serious game for gaze stability rehabilitation in children with vestibular hypofunction

BACKGROUND

Children with vestibular hypofunction (VH) may have gaze instability, balance disorders, and delayed postural-motor development. Gaze stabilization exercises (GSE) are designed to improve dynamic visual acuity (DVA). We aimed to assess the acceptability of a serious game prototype called Kid Gaze Rehab (KGR) designed to implement GSE training in children with VH, combined with traditional vestibular rehabilitation. Effects on DVA and motor performance were also analyzed.

METHODS

Twelve children (6 to 9 years old) were included. Sessions were held at the hospital twice a week, for 5 weeks. An adapted French version of The Child Simulator Sickness Questionnaire (SSQ) and the Face Scale Pain-Revised (FPS-R) were used to assess pain in the cervical region and undesirable side effects after each session. Vestibular and motor function parameters (active and passive DVA and Movement Assessment Battery for Children-Second Edition, MABC-2) were assessed before and after the training.

RESULTS

All children included completed the 10 sessions. The FPS-R visual analog scale and SSQ showed good cervical tolerance and no oculomotor or vegetative adverse effects nor spatial disorientation. After training, active DVA scores were significantly improved for the right, left, and up directions (p < 0.05). Passive DVA scores were significantly improved for the left and down directions (p < 0.01 and p < 0.05, respectively). MABC-2 scores were improved in the balance and ball skill sections (p < 0.05).

CONCLUSION

An innovative pediatric training method, the use of a dedicated serious game for gaze stabilization was well-tolerated as a complement to conventional vestibular rehabilitation in children with VH. Moreover, both DVA and motor performance were found to improve in the study sample. Although replication studies are still needed, serious game-based training in children with VH could represent a promising rehabilitation approach for years to come.

TRIAL REGISTRATION

The study was conducted in accordance with the Declaration of Helsinki and approved by an Institutional Review Board (local ethics committee, CPP Sud-Est IV, ID 2013-799). The study protocol was registered on ClinicalTrials.gov (NCT04353115).

Normative values for the video Head Impulse Test in children without otoneurologic symptoms and their evolution across childhood by gender

PURPOSE

The video Head Impulse Test is routinely used to assess semicircular canal function in adults, but to date, pediatric reference values are scarce. This study aimed to explore the vestibulo-ocular reflex (VOR) in healthy children at different development stages and to compare the obtained gain values with reference to those in an adult population.

METHODS

This prospective, single-center study recruited 187 children from among patients without otoneurological diseases, healthy relatives of these patients, and staff families from a tertiary hospital. Patients were divided into three groups by age: 3-6 years, 7-10 years, and 11-16 years. The vestibulo-ocular reflex was assessed by video Head Impulse Test, using a device with a high-speed infrared camera and accelerometer (EyeSeeCam®; Interacoustics, Denmark).

RESULTS

We found a lower vestibulo-ocular reflex gain of both horizontal canals in the 3-6-year-old group when compared with the other age groups. No increasing trend was found in the horizontal canals from age 7-10 years to age 11-16 years, and no differences were found by sex.

CONCLUSION

Gain values in the horizontal canals increased with age until children reached age 7-10 years and matched the normal values for adults.

Task force Guideline of Brazilian Society of Otology ‒ hearing loss in children - Part I ‒ Evaluation

OBJECTIVES

To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years.

METHODS

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

RESULTS

The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss.

CONCLUSIONS

Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.