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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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Janky KL, Patterson JN, Vandervelde C. Goggle Versus Remote-Camera Video Head Impulse Test Device Comparison. Ear Hear 2024:00003446-990000000-00305. [PMID: 38965656 DOI: 10.1097/aud.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVES This study compared remote versus goggle video head impulse testing (vHIT) outcomes to validate remote-camera vHIT, which is gaining popularity in difficult to test populations. DESIGN Seventeen controls and 10 individuals with vestibular dysfunction participated. Each participant completed remote-camera and goggle vHIT. The main outcome parameters were canal gain, frequency of corrective saccades, and a normal versus abnormal rating. RESULTS Horizontal and vertical canal vHIT gain was significantly lower in the vestibular compared with the control group; remote-camera gains were significantly lower compared with goggle gain for the vestibular group only. The devices categorized control versus vestibular canals identically except for one vertical canal. In the vestibular group, there was not a significant difference in the percentage of compensatory saccades between devices. CONCLUSION These data provide validation that results obtained with a remote-camera device are similar to those obtained using a standard goggle device.
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Affiliation(s)
- Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Jessie N Patterson
- Department of Audiology, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Casey Vandervelde
- Department of Audiology, Boys Town National Research Hospital, Omaha, Nebraska, USA
- Department of Audiology, University of Utah, Salt Lake City, Utah, USA
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Nguyen TT, Kang JJ, Nguyen TT, Oh SY. Clinical characteristics and otolith dysfunction in presbyvestibulopathy: A retrospective cross-sectional analysis. Heliyon 2024; 10:e32536. [PMID: 38975104 PMCID: PMC11225758 DOI: 10.1016/j.heliyon.2024.e32536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Objective The Bárány Society recently established diagnostic criteria for presbyvestibulopathy, an age-related bilateral vestibular impairments in older individuals. Drawing upon a cross-sectional database, this study delves into the demographic and clinical features of presbyvestibulopathy patients and investigates the implications of otolith dysfunction. Methods The study retrospectively analyzed 1218 patients aged 60 years or older who visited the tertiary dizziness clinic in 2020, due to symptoms of dizziness or instability. By reviewing medical records, we gathered clinical information and laboratory vestibular test results, such as cervical and ocular vestibular evoked myogenic potentials, and subjective visual vertical. Results Out of 1218 patients aged 60 and above who reported dizziness or unsteadiness, 33 patients (2.7 %, with an average age of 74.2 ± 9.2 years) were diagnosed with presbyvestibulopathy. Deficiencies in horizontal angular vestibulo-ocular reflex were found in caloric tests (75 %), video head impulse tests (51.7 %), and rotatory chair tests (47.8 %), respectively. Otolith dysfunction was also observed, as shown by abnormal ocular and cervical vestibular evoked myogenic potentials in 62.96 % and 51.85 % of patients, and abnormal subjective visual vertical in 45.8 % of the cases. Conclusions Among elderly patients experiencing consistent dizziness or instability, the incidence of presbyvestibulopathy was approximately 2.7 % over one year. Alongside the abnormalities detected in the horizontal angular vestibulo-ocular reflex, significant changes were also noted in the ocular and cervical vestibular evoked myogenic potentials, as well as in the subjective visual vertical tests. As a result, it's vital to underscore the significance of both otolithic function and vestibulo-ocular reflex in the fundamental mechanisms of presbyvestibulopathy.
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Affiliation(s)
- Thanh Tin Nguyen
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea
- Department of Pharmacology, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Jin-Ju Kang
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
| | - Thi Thuy Nguyen
- Department of General Internal Medicine, Vinh City General Hospital, Nghe An, Viet Nam
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, South Korea
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Janky KL, Patterson J, Kelly EA. Clinical Utility of Remote Camera Video Head Impulse Testing Children Less Than 3 Years. Laryngoscope 2024. [PMID: 38922928 DOI: 10.1002/lary.31580] [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: 02/14/2024] [Revised: 05/21/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
The purpose of this case report is to highlight both the feasibility and clinical utility of remote camera video head impulse testing (vHIT) in children <3 years. Five cases are described where remote camera vHIT was used to quantify ear specific semicircular function in children at risk for vestibular dysfunction. Remote camera vHIT is a helpful clinical tool for quantifying ear specific semicircular function in children between 6 and 31 months. Remote camera vHIT is feasible and provides ear specific information regarding semicircular canal function, which can be used to augment or validate the presence of vestibular dysfunction in children <3 years. Laryngoscope, 2024.
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Affiliation(s)
- Kristen L Janky
- Boys Town National Research Hospital, Omaha, Nebraska, U.S.A
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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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Reynard P, Ortega-Solís J, Tronche S, Darrouzet V, Thai-Van H. Guidelines of the French Society of Otorhinolaryngology and Head and Neck Surgery (SFORL) for vestibular rehabilitation in children with vestibular dysfunction. A systematic review. Arch Pediatr 2024; 31:217-223. [PMID: 38697883 DOI: 10.1016/j.arcped.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/20/2024] [Accepted: 02/25/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION The consequence of complete or partial uncompensated vestibular dysfunction in children is usually balance disorders, with the risk of falls and increased fatigue, particularly during tasks requiring postural control. The aim of these recommendations is to establish guidelines for vestibular rehabilitation (VR) in children with vestibular impairment. MATERIAL AND METHODS The guidelines were developed based on a systematic review of the international literature, validated by a multidisciplinary group of French-speaking otorhinolaryngologists, scientists, and physiotherapists. They are classified as grade A, B, C, or expert opinion according to a decreasing level of scientific evidence. RESULTS A PubMed search of studies published between January 1990 and December 2021 was carried out using the keywords "vestibular," "rehabilitation," and "children". After filtering and reviewing the articles, a total of 10 publications were included to establish the recommendations. CONCLUSION It is recommended that a vestibular assessment be carried out before VR, including a study of vestibulo-ocular reflex, otolithic function, and postural control. In cases of vestibular dysfunction, physiotherapy treatment is recommended from an early age to train different aspects of postural control, including anticipatory and reactive postural adjustments. VR adapted to the pediatric population is recommended for children whose vestibular dysfunction leads to functional disorders or symptoms of vertigo for those who have suffered head trauma. It is recommended that children with bilateral vestibular impairment be treated using gaze stabilization exercises for adaptation and substitution. Optokinetic stimulation and virtual reality are not recommended for children and young adolescents.
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Affiliation(s)
- Pierre Reynard
- Department of Audiology and Otoneurological Evaluation, Hôpital Édouard Herriot & Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69003 Lyon, France; Center for Research and Innovation in Human Audiology (CERIAH), Institut de l'Audition, Institut Pasteur, Inserm, Paris, France; French Society of Vestibular Physiotherapy (SFKV), 31000 Toulouse, France.
| | - José Ortega-Solís
- Department of Audiology and Otoneurological Evaluation, Hôpital Édouard Herriot & Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69003 Lyon, France; French Society of Vestibular Physiotherapy (SFKV), 31000 Toulouse, France
| | - Sophie Tronche
- French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL), 75116 Paris, France
| | - Vincent Darrouzet
- Department of Otolaryngology Head and Neck Surgery, and Skull Base Surgery, University Hospital of Bordeaux, 33000 Bordeaux, France
| | - Hung Thai-Van
- Department of Audiology and Otoneurological Evaluation, Hôpital Édouard Herriot & Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 69003 Lyon, France; Center for Research and Innovation in Human Audiology (CERIAH), Institut de l'Audition, Institut Pasteur, Inserm, Paris, France; Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
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Hill M, Brayne L, Hosseini E, Duncan M, Muehlbauer T, Lord SR, Ellmers TJ. The influence of fear of falling on the control of upright stance across the lifespan. Gait Posture 2024; 109:226-232. [PMID: 38364509 DOI: 10.1016/j.gaitpost.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/20/2023] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Standing at height, and subsequent changes in emotional state (e.g., fear of falling), lead to robust alterations in balance in adults. However, little is known about how height-induced postural threat affects balance performance in children. Children may lack the cognitive capability necessary to inhibit the processing of threat and fear-related stimuli, and as a result, may show more marked (and perhaps detrimental) changes in postural control compared to adults. This work explored the emotional and balance responses to standing at height in children, and compared responses to young and older adults. METHODS Children (age: 9.7 ± 0.8 years, n = 38), young adults (age: 21.8 ± 4.0 years, n = 45) and older adults (age: 73.3 ± 5.0 years, n = 15) stood in bipedal stance in two conditions: at ground level and 80 cm above ground. Centre of pressure (COP) amplitude (RMS), frequency (MPF) and complexity (sample entropy) were calculated to infer postural performance and strategy. Emotional responses were quantified by assessing balance confidence, fear of falling and perceived instability. RESULTS Young and older adults demonstrated a postural adaptation characterised by increased frequency and decreased amplitude of the COP, in conjunction with increased COP complexity (sample entropy). In contrast, children demonstrated opposite patterns of changes: they exhibited an increase in COP amplitude and decrease in both frequency and complexity when standing at height. SIGNIFICANCE Children and adults adopted different postural control strategies when standing at height. Whilst young and older adults exhibited a potentially protective "stiffening" response to a height-induced threat, children demonstrated a potentially maladaptive and ineffective postural adaptation strategy. These observations expand upon existing postural threat related research in adults, providing important new insight into understanding how children respond to standing in a hazardous situation.
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Affiliation(s)
- M Hill
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom.
| | - L Brayne
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - E Hosseini
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - M Duncan
- Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, United Kingdom
| | - T Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, Essen, Germany
| | - S R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, New South Wales, Australia
| | - T J Ellmers
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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Amorim AM, Ramada AB, Lopes AC, Duarte Silva E, Lemos J, Ribeiro JC. Vestibulo-ocular reflex dynamics with head-impulses discriminates Usher patients type 1 and 2. Sci Rep 2024; 14:3701. [PMID: 38355682 PMCID: PMC10867007 DOI: 10.1038/s41598-024-54270-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/10/2024] [Indexed: 02/16/2024] Open
Abstract
Usher Syndrome classification takes into account the absence of vestibular function but its correlation with genotype is not well characterized. We intend to investigate whether video Head Impulse Test (vHIT) is useful in screening and to differentiate Usher Syndrome types. 29 Usher patients (USH) with a genetically confirmed diagnosis and 30 healthy controls were studied with vHIT and dizziness handicap inventory questionnaire (DHI). Statistical significant differences between USH1, USH2 and controls were found in the vestibulo-ocular-reflex (VOR) gain of all SCCs, with USH1 patients consistently presenting smaller gains. VOR gain of the right lateral SCC could discriminate controls from USH1, and USH2 from USH1 with an overall diagnostic accuracy of 90%. USH1 DHI correlated with VOR (ρ = - 0,971, p = 0.001). Occurrence rate of covert and overt lateral semicircular canals refixation saccades (RS) was significantly different between groups, being higher in USH1 patients (p < 0.001). USH1 peak velocity of covert and overt saccades was higher for lateral semicircular canals (p < 0.05 and p = 0.001) compared with USH2 and controls. Covert saccades occurrence rate for horizontal SCCs could discriminate USH1 from USH2 patients and controls with a diagnostic accuracy of 85%. vHIT is a fast and non-invasive instrument which allowed us to screen and distinguish Usher patients from controls with a high precision. Importantly, its use allowed further discrimination between USH1 from USH2 groups. Moreover, VOR gain seems to correlate with vertigo-related quality of life in more severe phenotypes.
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Affiliation(s)
- Ana Margarida Amorim
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal.
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Ana Beatriz Ramada
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal
| | - Ana Cristina Lopes
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal
| | | | - João Lemos
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Neurology, Coimbra University Hospital Centre, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Carlos Ribeiro
- Department of Otorhinolaryngology, Coimbra University Hospital Centre, Praceta Mota Pinto, 3000-135, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Gerdsen M, Hundscheid TM, Boudewyns A, Van Rompaey V, Van De Berg R, Widdershoven JCC. Vestibular assessment in children with sensorineural hearing loss: diagnostic accuracy and proposal for a diagnostic algorithm. Front Neurol 2024; 15:1349554. [PMID: 38361640 PMCID: PMC10867167 DOI: 10.3389/fneur.2024.1349554] [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: 12/04/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Vestibular assessment in children with sensorineural hearing loss (SNHL) is critical for early vestibular rehabilitation therapy to promote (motor) development or guide decision making towards cochlear implantation (timing of surgery and laterality). It can be challenging from a clinical viewpoint to decide which vestibular tests should be performed for a pediatric patient. The aim of this study was to evaluate the diagnostic accuracy of several clinically available vestibular tests in children with SNHL, and to provide recommendations for the implementation of vestibular testing of children in clinical practice, to screen for vestibular hypofunction (VH). Methods A two-center retrospective chart review was conducted. Eighty-six patients between the age of 0 and 18 years were included in this study with SNHL. Vestibular tests included video headimpulse test (VHIT), caloric test (performed at the age of four or higher), rotatory chair and cervical vestibular evoked myogenic potential (cVEMP). A combination of the clinical assessment and (combinations of) vestibular test outcomes determined the diagnosis. The diagnostic quality of tests and combination of tests was assessed by diagnostic accuracy, sensitivity and specificity. Results VH was diagnosed in 44% of the patients. The VHIT and caloric test showed the highest diagnostic accuracy compared to the rotatory chair and cVEMP. All combinations of VHIT, caloric test and cVEMP showed improvement of the diagnostic accuracy compared to the respective tests when performed singularly. All combinations of tests showed a relatively similar diagnostic accuracy, with the VHIT combined with the caloric test scoring the highest. Adding a third test did not substantially improve the diagnostic accuracy. Discussion Vestibular testing is feasible and VH is highly prevalent in children with SNHL. A proposed diagnostic algorithm recommends starting with VHIT, followed by cVEMP for children under the age of four, and caloric testing for older children if VH is not confirmed with the first test. Performing a third test is redundant as the diagnostic accuracy does not improve substantially. However, challenges remain, including the lack of a gold standard and the subjective nature of the diagnosis, highlighting the need for standardized testing and increased understanding of VH in this population.
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Affiliation(s)
- Max Gerdsen
- Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Tamara Maria Hundscheid
- Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of Pediatrics, Maastricht University Medical Center+, Maastricht, Netherlands
| | - An Boudewyns
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Raymond Van De Berg
- Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Josine Christine Colette Widdershoven
- Division of Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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Viola P, Scarpa A, Chiarella G, Pisani D, Astorina A, Ricciardiello F, De Luca P, Re M, Gioacchini FM. Instrumental Assessment and Pharmacological Treatment of Migraine-Related Vertigo in Pediatric Age. Audiol Res 2024; 14:129-138. [PMID: 38391768 PMCID: PMC10886403 DOI: 10.3390/audiolres14010011] [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: 11/21/2023] [Revised: 12/23/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The most frequent form of vertigo in pediatric age is represented by vertigo linked to migraine, with a prevalence of 32.7%. This group of pathologies has received a redefinition of the diagnostic criteria to adapt them to the pediatric age with a new classification of the clinical pictures. We have several kinds of problems with these conditions that often have a significant impact on patients' and parents' quality of life: the diagnostic approach involves different tools for the different age groups contained in the pediatric range; the treatment of this type of vertigo is not consolidated due to the limited availability of trials carried out on pediatric patients. Focusing on this topic, the aim of this review was to provide an update on the more recent clinical advances in the diagnosis and treatment of Vestibular Migraine (VM) in children. METHODS We searched the PubMed, Embase, and Cochrane library databases for articles published in English from January 2015 to April 2023. The secondary search included articles from reference lists, identified by the primary search. Records were first screened by title/abstract, and then full-text articles were retrieved for eligibility evaluation. The searches combined a range of key terms ("Pediatric" AND "Childhood" AND "dizziness" OR "vertigo" AND "vestibular"). RESULTS Migraine-related vertigo, in its most recent definitions and classifications, is the most frequent group of balance pathologies in pediatric age. The results from the various experiences present in the literature suggest a clinical approach to be integrated with the use of instrumental tests selected according to the age of the patient and the reliability of the results. CONCLUSION Knowing the timeline of the applicability of vestibular tests and the information that can be obtained from them is fundamental for diagnostic accuracy. Therapy is strongly conditioned by the limited availability of pediatric trials and by the wide range it includes, from very young children to adolescents.
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Affiliation(s)
- Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Pietro De Luca
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam, 8, 00184 Rome, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Federico Maria Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
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11
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Alnoury MK, Salameh S, Ostrovska A, Gurberg J. The First 100 Children Treated in a Newly Established Pediatric Vertigo Center. J Otolaryngol Head Neck Surg 2024; 53:19160216241265685. [PMID: 39113464 PMCID: PMC11311155 DOI: 10.1177/19160216241265685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/03/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Correctly diagnosing dizziness in children is essential for appropriate management; nevertheless, healthcare professionals face challenges due to children's limited ability to describe their symptoms and their cooperation during physical examination. The objective of this study is to describe the first 100 patients seen at a newly established pediatric vertigo center. METHODS This is a retrospective review of a consecutive series of 100 patients seen at our pediatric vertigo clinic in a tertiary referral center from August 2019 until June 2022. Comprehensive clinical data were collected. The diagnoses were established by 2 pediatric otolaryngologists based on validated diagnostic criteria. Trends in diagnosis, investigation, and treatment of these patients were analyzed. RESULTS A total of 100 children were included in the study. Vestibular migraine was the most common diagnosis (20%) followed by benign paroxysmal vertigo of childhood (14%). Eleven patients had combined pathologies. Fifteen out of 70 children (21%) had abnormal audiograms, 30 out of 48 children (62.5%) had abnormal vestibular testing, and 6 out of 31 (19%) patients had abnormal imaging. Fifty-one children received medical treatment, 23 received vestibular physiotherapy, and 9 patients had particle repositioning maneuvers; moreover, 17 of these patients received multimodal treatment. CONCLUSIONS Our analysis suggests that imaging and audiology testing have relatively low yield in the assessment of pediatric vertigo. On the other hand, vestibular testing detected a high proportion of abnormalities, such as saccadic pursuit, vertical nystagmus, central positional nystagmus, and abnormal directional preponderance, particularly associated with vestibular migraine. Given the complexity of diagnosing vertigo in children, it is critical to establish multidisciplinary specialized centers capable of providing accurate diagnosis and treatment for these children.
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Affiliation(s)
- Mohammed K. Alnoury
- Department of Otolaryngology—Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samer Salameh
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Aleksandra Ostrovska
- Vestibular Laboratory, Department of Otolaryngology—Head and Neck Surgery, The Royal Victoria Hospital (MUHC), Montreal, QC, Canada
| | - Joshua Gurberg
- Department of Otolaryngology—Head and Neck Surgery, McGill University, The Montreal Children’s Hospital (MUHC), Montreal, QC, Canada
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12
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Janky K, Steyger PS. Mechanisms and Impact of Aminoglycoside-Induced Vestibular Deficits. Am J Audiol 2023; 32:746-760. [PMID: 37319406 PMCID: PMC10721243 DOI: 10.1044/2023_aja-22-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Acquired vestibulotoxicity from hospital-prescribed medications such as aminoglycoside antibiotics affects as many as 40,000 people each year in North America. However, there are no current federally approved drugs to prevent or treat the debilitating and permanent loss of vestibular function caused by bactericidal aminoglycoside antibiotics. This review will cover our current understanding of the impact of, and mechanisms underlying, aminoglycoside-induced vestibulotoxicity and highlight the gaps in our knowledge that remain. CONCLUSIONS Aminoglycoside-induced vestibular deficits have long-term impacts on patients across the lifespan. Additionally, the prevalence of aminoglycoside-induced vestibulotoxicity appears to be greater than cochleotoxicity. Thus, monitoring for vestibulotoxicity should be independent of auditory monitoring and encompass patients of all ages from young children to older adults before, during, and after aminoglycoside therapy.
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Affiliation(s)
- Kristen Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
| | - Peter S. Steyger
- Bellucci Translational Hearing Center, Creighton University, Omaha, NE
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13
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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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Ortega Solís J, Reynard P, Spruyt K, Bécaud C, Ionescu E, Thai-Van H. Developing a serious game for gaze stability rehabilitation in children with vestibular hypofunction. J Neuroeng Rehabil 2023; 20:128. [PMID: 37752531 PMCID: PMC10521575 DOI: 10.1186/s12984-023-01249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
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).
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Affiliation(s)
- José Ortega Solís
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
| | - Pierre Reynard
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot - INSERM, Hôpital Robert Debré AP-HP, 48 Bd Sérurier, Bingen, Paris, 75019, France
| | - Cécile Bécaud
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
| | - Eugen Ionescu
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France
| | - Hung Thai-Van
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France.
- Université Claude Bernard Lyon 1, Lyon, France.
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France.
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15
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Rodríguez-Villalba R, Caballero-Borrego M. Normative values for the video Head Impulse Test in children without otoneurologic symptoms and their evolution across childhood by gender. Eur Arch Otorhinolaryngol 2023; 280:4037-4043. [PMID: 36892616 PMCID: PMC10382384 DOI: 10.1007/s00405-023-07900-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/22/2023] [Indexed: 03/10/2023]
Abstract
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.
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Affiliation(s)
- Rosana Rodríguez-Villalba
- Department of Otorhinolaryngology, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Otorhinolaryngology, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Miguel Caballero-Borrego
- Otorhinolaryngology-Head and Neck Surgery Department, Hospital Clínic, University of Barcelona, C/Villarroel, 170, Esc. 8, 2ª, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques Agusti Pi Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Coudert A, Parodi M, Denoyelle F, Maudoux A, Loundon N, Simon F. Paediatric vestibular assessment in French cochlear implant centres: Challenges and improvement areas. Int J Pediatr Otorhinolaryngol 2023; 171:111651. [PMID: 37454475 DOI: 10.1016/j.ijporl.2023.111651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Survey of paediatric vestibular activity in all 30 French paediatric cochlear implant (CI) centres to identify challenges and areas of improvement. METHOD All 30 French CI centres answered a 29-question questionnaire about their paediatric vestibular activity, equipment, and management in different clinical situations (e.g. vestibular assessment before a cochlear implantation or in cases of vertigo) at different ages. RESULTS Eighteen CI centres had dedicated paediatric vestibular clinics and 12 did not. Minimum age required for vestibular testing was 3 years in eight centres. Four vestibular tests stood out: caloric tests, video Head Impulse Test (vHIT), rotating chair, vestibular evoked myogenic potentials (VEMP). Depending on the centre's experience, the use of vestibular tests in clinical routine was very heterogeneous. Expert centres mostly used vHIT and cervical VEMP (in bone conduction) for assessments before the first cochlear implantation in 1-year-old children. Dizziness assessment in 4-year children was based on the use of vHIT, cervical VEMP on bone conduction, rotatory test, and caloric test. Ocular VEMP was rarely used. CONCLUSIONS Paediatric vestibular assessment requires specific expertise compared to adults. Due to a lack of specialised human resources, some centres may be unable to follow French paediatric CI guidelines. International recommendations could help standardise paediatric vestibular management and public health policies should be discussed to improve training and access for children.
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Affiliation(s)
- A Coudert
- Department of Paediatric Otolaryngology-Head & Neck Surgery, Femme Mere Enfant Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon 1, Lyon, France.
| | - M Parodi
- Department of Paediatric Otolaryngology-Head & Neck Surgery, AP-HP, Necker-Enfants Malades, F-75015, Paris, France
| | - F Denoyelle
- Department of Paediatric Otolaryngology-Head & Neck Surgery, AP-HP, Necker-Enfants Malades, F-75015, Paris, France; Université Paris Cité, F-75006, Paris, France
| | - A Maudoux
- Université Paris Cité, F-75006, Paris, France; Department of Pediatric Otolaryngology-Head & Neck Surgery, AP-HP, Robert-Debré Hospital, Paris, France
| | - N Loundon
- Department of Paediatric Otolaryngology-Head & Neck Surgery, AP-HP, Necker-Enfants Malades, F-75015, Paris, France
| | - F Simon
- Department of Paediatric Otolaryngology-Head & Neck Surgery, AP-HP, Necker-Enfants Malades, F-75015, Paris, France; Université Paris Cité, F-75006, Paris, France
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17
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Money-Nolan LE, Flagge AG. Factors affecting variability in vestibulo-ocular reflex gain in the Video Head Impulse Test in individuals without vestibulopathy: A systematic review of literature. Front Neurol 2023; 14:1125951. [PMID: 36970532 PMCID: PMC10034038 DOI: 10.3389/fneur.2023.1125951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
IntroductionThe purpose of this systematic review was to summarize and synthesize published evidence examining variations in vestibulo-ocular reflex (VOR) gain outcomes for the Video Head Impulse Test (vHIT) in healthy individuals without vestibulopathy in order to describe factors that may influence test outcomes.MethodsComputerized literature searches were performed from four search engines. The studies were selected based on relevant inclusion and exclusion criteria, and were required to examine VOR gain in healthy adults without vestibulopathy. The studies were screened using Covidence (Cochrane tool) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA-2020).ResultsA total of 404 studies were initially retrieved, of which a total of 32 studies met inclusion criteria. Four major categories were identified which lead to significant variation in VOR gain outcomes: participant-based factors, tester/examiner-based factors, protocol-based factors, and equipment-based factors.DiscussionVarious subcategories are identified within each of these classifications and are discussed, including recommendations for decreasing VOR gain variability in clinical practice.
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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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Vestibular Loss in Children Affected by LVAS and IP2 Malformation and Operated with Cochlear Implant. Audiol Res 2023; 13:130-142. [PMID: 36825951 PMCID: PMC9952810 DOI: 10.3390/audiolres13010013] [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: 12/26/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
This is a single center cohort study regarding the prevalence of vestibular loss in hearing impaired children affected by large vestibular aqueduct syndrome (LVAS) with incomplete cochlear partition malformation type II (IP2), fitted with cochlear implant (CI). Twenty-seven children received CI operations at 0.4-13 years on one or both ears and tested for vestibular loss with head impulse test, video head impulse test, mini ice-water test and cervical VEMP. Vestibular loss was found in 19% of operated ears and in 13.9% of non-operated ears. The difference was not statistically significant and was not significantly modified by age at implantation, age at testing, sex, presence of SLC26A4 gene mutation or bilaterality. However, the presence of anatomic anomalies at the level of the vestibulum or semicircular canals was significantly associated with a higher incidence of vestibular loss in CI operated children but not in those non-operated. No other factors, such as the surgical access, the electrode type, the presence of Gusher perioperatively, or post-operative vertigo modified significantly the prevalence of vestibular loss. In conclusion, LVAS/IP2 appears to be the major determinant of vestibular loss in these children, with a less obvious impact of CI, excluding the cases with vestibulum/canal anomalies: this group might have a higher risk for vestibular loss after CI surgery.
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21
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Wiener-Vacher SR, Campi M, Boizeau P, Thai-Van H. Cervical vestibular evoked myogenic potentials in healthy children: Normative values for bone and air conduction. Front Neurol 2023; 14:1157975. [PMID: 37143993 PMCID: PMC10152971 DOI: 10.3389/fneur.2023.1157975] [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: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 05/06/2023] Open
Abstract
Objectives To characterize cervical vestibular evoked myogenic potentials (c-VEMPs) in bone conduction (BC) and air conduction (AC) in healthy children, to compare the responses to adults and to provide normative values according to age and sex. Design Observational study in a large cohort of healthy children (n = 118) and adults (n = 41). The c-VEMPs were normalized with the individual EMG traces, the amplitude ratios were modeled with the Royston-Wright method. Results In children, the amplitude ratios of AC and BC c-VEMP were correlated (r = 0.6, p < 0.001) and their medians were not significantly different (p = 0.05). The amplitude ratio was higher in men than in women for AC (p = 0.04) and BC (p = 0.03). Children had significantly higher amplitude ratios than adults for AC (p = 0.01) and BC (p < 0.001). Normative values for children are shown. Amplitude ratio is age-dependent for AC more than for BC. Confidence limits of interaural amplitude ratio asymmetries were less than 32%. Thresholds were not different between AC and BC (88 ± 5 and 86 ± 6 dB nHL, p = 0.99). Mean latencies for AC and BC were for P-wave 13.0 and 13.2 msec and for N-wave 19.3 and 19.4 msec. Conclusion The present study provides age- and sex-specific normative data for c-VEMP for children (6 months to 15 years of age) for AC and BC stimulation. Up to the age of 15 years, c-VEMP responses can be obtained equally well with both stimulation modes. Thus, BC represents a valid alternative for vestibular otolith testing, especially in case of air conduction disorders.
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Affiliation(s)
- Sylvette R. Wiener-Vacher
- Institut de l’Audition, Institut Pasteur, CERIAH, Paris, France
- Service ORL, Centre d’Exploration Fonctionnelle de l’Equilibre chez l’Enfant (EFEE), Hôpital Universitaire Robert-Debré AP-HP, Paris, France
- *Correspondence: Sylvette R. Wiener-Vacher,
| | - Marta Campi
- Institut de l’Audition, Institut Pasteur, CERIAH, Paris, France
| | - Priscilla Boizeau
- Unité d’Epidémiologie Clinique, INSERM CIC1426, Hôpital Universitaire Robert-Debré AP-HP, Paris, France
| | - Hung Thai-Van
- Institut de l’Audition, Institut Pasteur, CERIAH, Paris, France
- Hospices Civils de Lyon, Hôpital Edouard Herriot & Hôpital Femme Mère Enfant, Service d’Audiologie & Explorations Oto-Neurologiques, University of Lyon, Lyon, France
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22
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Patterson JN, Chen S, Janky KL. Stability of Vestibular Testing in Children With Hearing Loss. Am J Audiol 2022; 31:1155-1166. [PMID: 36095287 PMCID: PMC9907441 DOI: 10.1044/2022_aja-21-00257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the stability of rotary chair, video head impulse test (vHIT), and vestibular evoked myogenic potential (VEMP) responses in children with normal hearing (NH) and children with cochlear implants (CIs). METHOD Retrospective analysis of 66 children (33 males, M age = 11.4 years, range: 3-18 years) seen in a tertiary clinic and/or research laboratory who completed rotary chair, VEMP, and vHIT across two test sessions between 2012 and 2019. The stability of these measures was compared between two groups: children with NH (n = 35) and children with CI (n = 31). For each outcome, the session difference was calculated by subtracting Session 1 from Session 2. RESULTS For rotary chair (gain and phase) and vHIT (gain), linear mixed-effects models revealed that there were no significant interactions or main effects for group (CI vs. NH), time between session, gender, or age on the session difference, suggesting that the outcomes of these measures are stable across sessions. For cervical and ocular VEMP amplitude, there was a significant interaction between group and time between sessions on the session difference. Specifically, children with NH demonstrated larger amplitudes at Session 2, whereas children with CI demonstrated smaller amplitudes at Session 2. Next, test findings were classified as normal, unilaterally abnormal, or bilaterally abnormal for Sessions 1 and 2. Misclassification was defined as a mismatch of classification between sessions. Rotary chair and vHIT had the fewest misclassifications, whereas cervical VEMPs had the most misclassifications in children with CI and ocular VEMPs had the most misclassifications in children with NH. Misclassifications in children with CI were mostly consistent with progressive vestibular loss, whereas misclassifications in children with NH were mostly consistent with improved vestibular function. CONCLUSIONS Stability and misclassification rates varied between tests and groups. Overall, rotary chair and vHIT outcomes were stable in both groups; however, VEMPs differentially changed between groups, improving in children with NH and declining in children with CI. Furthermore, despite relative stability, some children with CI evidenced progressive vestibular loss on all measures suggesting that vestibular testing should be completed serially due to the possibility of progression.
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Affiliation(s)
| | - Su Chen
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | - Kristen L. Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE
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Silva VAR, Pauna HF, Lavinsky J, Hyppolito MA, Vianna MF, Leal M, Massuda ET, Hamerschmidt R, Bahmad F, Cal RV, Sampaio ALL, Felix F, Chone CT, Castilho AM. Task force Guideline of Brazilian Society of Otology ‒ hearing loss in children - Part I ‒ Evaluation. Braz J Otorhinolaryngol 2022; 89:159-189. [PMID: 36529647 PMCID: PMC9874360 DOI: 10.1016/j.bjorl.2022.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mariana Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Recife, PE, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Rogério Hamerschmidt
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Fayez Bahmad
- Universidade de Brasília (UnB), Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brazil; Instituto Brasiliense de Otorrinolaringologia (IBO), Brasília, DF, Brazil
| | - Renato Valério Cal
- Centro Universitário do Estado do Pará (CESUPA), Departamento de Otorrinolaringologia, Belém, PA, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Felippe Felix
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Deng J, Zhu Q, Zhang K, Xie D, Wu W. Vestibular function in children with cochlear implant: Impact and evaluation. Front Neurol 2022; 13:938751. [PMID: 36090862 PMCID: PMC9449973 DOI: 10.3389/fneur.2022.938751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last 30 years, cochlear implant (CI) has been dedicated to improving the rehabilitation of hearing impairments. However, CI has shown potential detrimental effects on vestibular function. For children, due to atypical symptoms and difficulty in cooperating with vestibular function tests, systematic and objective assessments of vestibular function with CI have been conducted sparsely. This review focuses on the impact of vestibular function in children with CI and summarized the evaluation of vestibular function in children. In addition, some recommended strategies are summarized and proposed.
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The Narrowed Internal Auditory Canal: A Distinct Etiology of Pediatric Vestibular Paroxysmia. J Clin Med 2022; 11:jcm11154300. [PMID: 35893390 PMCID: PMC9332349 DOI: 10.3390/jcm11154300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
Vestibular paroxysmia (VP) is a disorder encountered in the pediatric population that etiology has been attributed to neurovascular cross-compression syndrome (NVCC). The purpose of this study was to report a new probable pathological condition, the narrowed internal auditory canal (IAC), which appears to be involved in the development of a clinical picture of VP in the pediatric population. A retrospective descriptive comparative study was conducted to compare clinical, electrophysiological, radiological, and therapeutic outcomes in both etiologies. Overall, 16 pediatric patients suffering from VP were included and divided into two groups: patients with narrowed internal auditory (Group 1) were compared to those with NVCC syndrome (Group 2). Patients in both groups were similar in terms of auditory complaints, as well as hearing, vestibular, and electrophysiological status. A narrowed IAC was encountered in the adolescent age category and females, especially those with rapid growth. The diagnosis requires a careful analysis of the shape and diameters of the IAC. Radiologic measurements in the axial plane do not seem to be sufficient to confirm the diagnosis, and, therefore, an analysis of diameters in the coronal plane is required. Treatment with sodium-channel blockers drugs showed promising results not only by relieving vertigo but also by normalizing the electrophysiological findings. In conclusion, a narrowed IAC can be considered in patients suffering from VP.
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Janky KL, Yoshinaga-Itano C. The Feasibility of Performing Vestibular Newborn Screening. Pediatrics 2022; 150:188270. [PMID: 35698890 DOI: 10.1542/peds.2022-056986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kristen L Janky
- Boys Town National Research Hospital, Department of Audiology, Omaha, Nebraska
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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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Piker EG, Picou E, Jacobson GP, Coltisor A. Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness. Am J Audiol 2022; 31:299-304. [PMID: 35286154 DOI: 10.1044/2021_aja-21-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population. METHOD This is a retrospective study of electronic records of pediatric patients (< 18 years old) who were referred for vestibular function testing and completed both hvHIT and caloric testing. Agreement between both test results was evaluated by examining measures of sensitivity, specificity, and calculating Cohen's kappa. RESULTS Results from 117 patients (mean age = 13.7 years, age range: 8-17 years, 37 males) were analyzed. Most patients (97/115 [84.3%]) demonstrated both normal hvHIT and caloric test results. Compared to caloric testing, the hvHIT had poor sensitivity (38.9%) and excellent specificity (98.0%). Cohen's kappa analysis revealed moderate agreement between the methods (coefficient = 0.49 [0.24, 0.73]). Where disagreement between the two tests occurred, the final diagnosis was not contingent on either test result. CONCLUSIONS There is a moderate agreement between the hvHIT and the caloric test in pediatric patients presenting to a tertiary care medical center for a vestibular evaluation. Most patients in this cohort presented with normal findings. The specificity of hvHIT was excellent, although the sensitivity was low. This may be related to the low prevalence of peripheral vestibular system disease in this study cohort, and these results do not generalize to centers that serve populations of children where vestibular disorders are more prevalent (e.g., children with sensorineural hearing loss).
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Affiliation(s)
- Erin G. Piker
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Erin Picou
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P. Jacobson
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Allison Coltisor
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
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Ertugrul G. Clinical use of child-friendly video head impulse test in dizzy children. Am J Otolaryngol 2022; 43:103432. [PMID: 35429844 DOI: 10.1016/j.amjoto.2022.103432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the high-frequency vestibular functions using a child-friendly video head impulse test and to classify vestibular symptoms using a standard nomenclature guideline in dizzy children. MATERIALS AND METHODS The video head impulse test with a remote camera was used in this study. The data of 40 dizzy children (7.30 ± 4.75 years) were analyzed retrospectively. RESULTS The high-frequency vestibulo-ocular reflex gains of 14 (35%) dizzy children in the study group were reduced, whereas the vestibulo-ocular reflex gains of 26 (65%) dizzy children were normal. Two of them had a dramatic reduction in vestibulo-ocular reflex gains on their affected SCCs, but no corrective saccades as their gazes had not been fixated on the target at the onset of head impulses. In dizzy children, the most common cause was inner ear malformation (15%) and the most common vestibular symptom was unsteadiness (25%). CONCLUSION The high-frequency vestibular function of the VOR in dizzy children, especially those suffering from IEM and unsteadiness, can be quickly screened using the vHIT device with the remote camera. However, clinicians should be careful during the interpretation of traces in the pediatric group.
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van der Veen SM, Stamenkovic A, Thomas JS, Pidcoe PE. Skill-Related Adaptive Modifications of Gaze Stabilization in Elite and Non-Elite Athletes. Front Sports Act Living 2022; 4:824990. [PMID: 35498518 PMCID: PMC9039283 DOI: 10.3389/fspor.2022.824990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
The vestibular ocular reflex (VOR) provides gaze stability during head movements by driving eye movements in a direction opposing head motion. Although vestibular-based rehabilitation strategies are available, it is still unclear whether VOR can be modulated by training. By examining adaptations in gaze stabilization mechanisms in a population with distinct visuomotor requirements for task success (i.e., gymnasts), this study was designed to determine whether experience level (as a proxy of training potential) was associated with gaze stabilization modifications during fixed target (VOR promoting) and fixed-to-head-movement target (VOR suppressing) tasks. Thirteen gymnasts of different skill levels participated in VOR and VOR suppression tasks. The gain between head and eye movements was calculated and compared between skill levels using an analysis of covariance. Across experience levels, there was a similar degradation in VOR gain away from −1 at higher movement speeds. However, during the suppression tasks, more experienced participants were able to maintain VOR gain closer to 0 across movement speeds, whereas novice participants showed greater variability in task execution regardless of movement speed. Changes in adaptive modifications to gaze stability associated with experience level suggest that the mechanisms impacting gaze stabilization can be manipulated through training.
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Affiliation(s)
- Susanne M. van der Veen
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States
- *Correspondence: Susanne M. van der Veen
| | - Alexander Stamenkovic
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States
| | - James S. Thomas
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States
| | - Peter E. Pidcoe
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA, United States
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, United States
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States
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Gerdsen M, Jorissen C, Pustjens DCF, Hof JR, Van Rompaey V, Van De Berg R, Widdershoven JCC. Effect of cochlear implantation on vestibular function in children: A scoping review. Front Pediatr 2022; 10:949730. [PMID: 36204666 PMCID: PMC9530705 DOI: 10.3389/fped.2022.949730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To provide a scoping review of the available literature for determining objectively the effect of cochlear implantation on vestibular function in children. METHODS A literature search was performed and the following criteria were applied: vestibular tests that were performed on subjects within the range of 0-18 years old before and after cochlear implantation. The papers conducted at least one of the following tests: (video) head impulse test, caloric test, cervical and ocular vestibular evoked myogenic potentials or rotatory chair test. Included papers underwent quality assessment and this was graded by risk of bias and directness of evidence. RESULTS Fourteen articles met the selection criteria. The included studies showed that cochlear implantation leads to a decrease in vestibular function in a proportion of the patient population. This loss of vestibular function can be permanent, but (partial) restoration over the course of months to years is possible. The pooling of data determined that the articles varied on multiple factors, such as time of testing pre- and post-operatively, age of implantation, etiologies of hearing loss, used surgical techniques, type of implants and the applied protocols to determine altered responses within vestibular tests. The overall quality of the included literature was deemed as high risk of bias and medium to low level of directness of evidence. Therefore, the data was considered not feasible for systematic analysis. CONCLUSION This review implicates that vestibular function is either unaffected or shows short-term or permanent deterioration after cochlear implantation in children. However, the heterogeneity of the available literature indicates the importance of standardized testing to improve our knowledge of the effect of cochlear implantation on the vestibular function and subsequent developmental consequences for the concerned children.
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Affiliation(s)
- Max Gerdsen
- Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Cathérine Jorissen
- Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | | | - Janke Roelofke Hof
- Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Vincent Van Rompaey
- Department of Otolaryngology-Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.,Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Raymond Van De Berg
- Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Josine Christine Colette Widdershoven
- Department of Otolaryngology-Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
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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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Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am 2021; 54:973-987. [PMID: 34304898 DOI: 10.1016/j.otc.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dizziness occurs in children with an estimated prevalence of 0.45% to 15.0%. Vestibular disorders in the pediatric population can impact gross motor function development, visual acuity, and contribute to psychological distress. Appropriate case history and focused direct examination can be helpful when determining the etiology of dizziness. Vestibular testing can be completed in children and guide management of suspected vestibular dysfunction. Vestibular dysfunction is commonly seen in patients with sensorineural hearing loss. Migraine disorders are the most common cause of dizziness in childhood. Etiologies of dizziness in children differ from those commonly seen in adults.
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Affiliation(s)
- Elizabeth A Kelly
- Department of Otolaryngology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA.
| | - Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA
| | - Jessie N Patterson
- Department of Audiology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA
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Emekci T, Uğur KŞ, Cengiz DU, Men Kılınç F. Normative values for semicircular canal function with the video head impulse test (vHIT) in healthy adolescents. Acta Otolaryngol 2021; 141:141-146. [PMID: 33151099 DOI: 10.1080/00016489.2020.1836396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The vHIT device, which has a mechanism based on measuring the VOR gain, helps us to quickly evaluate six semicircular canals. AIMS/OBJECTIVES The aim of this study was to establish normative values for semicircular canal function with the video head impulse test (vHIT) battery in normal adolescents. MATERIAL AND METHODS 100 (50 females, 50 males) individuals aged 11-18 years, with a mean age of 14.99 years, were included in the study. RESULTS As a result of the vHIT evaluations performed with vHIT Otometrics ICS Impulse A/S Taastrup, Denmark, the mean lateral canal vestibulo-ocular reflex (VOR) gain value was 0.96, the mean anterior canal VOR gain value was 0.89, and the mean posterior canal VOR gain value was 0.87, all of which were within the normal value range. CONCLUSION AND SIGNIFICANCE While the VOR gain values and asymmetry values are within the normal value range and are similar to the literature, no statistically significant correlation was observed between these values and age. As a result, the vHIT battery is an easy, fast, and practical test method that can be used in adolescents.
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Affiliation(s)
- Tuğba Emekci
- Faculty of Medicine ENT Clinic, Necmettin Erbakan University, Konya, Turkey
| | | | - Deniz Uğur Cengiz
- Faculty of Health Science, Department of Audiology, İnönü University, Malatya, Turkey
| | - Fatma Men Kılınç
- Faculty of Medicine ENT Clinic, Department of Audiology, Başkent University, Ankara, Turkey
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Vestibular Function in Children With a Congenital Cytomegalovirus Infection: 3 Years of Follow-Up. ACTA ACUST UNITED AC 2021; 42:76-86. [DOI: 10.1097/aud.0000000000000904] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Gedik Ö, Bal N, Özdemir S, Mutlu B, Taşdemir E, Kaya B, Kurt E, Kaya N, Durukan Z. Comparison of Video Head Impulse Test Findings in Individuals Aged between 20–39 and 40–60 Years. INDIAN JOURNAL OF OTOLOGY 2021. [DOI: 10.4103/indianjotol.indianjotol_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children. Sci Rep 2020; 10:21011. [PMID: 33273502 PMCID: PMC7713061 DOI: 10.1038/s41598-020-78049-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023] Open
Abstract
Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening–Flanders (VIS–Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS–Flanders project aims to set an example for other regions worldwide.
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Kim KS, Jung YK, Hyun KJ, Kim MJ, Kim HJ. Usefulness and practical insights of the pediatric video head impulse test. Int J Pediatr Otorhinolaryngol 2020; 139:110424. [PMID: 33039719 DOI: 10.1016/j.ijporl.2020.110424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The video head impulse test (vHIT) is a diagnostic tool to examine patients experiencing dizziness by assessing the function of the semicircular canals. vHIT has been widely studied in adults but relatively less so in children. The aim of this study was to evaluate the causes of dizziness and the results of vHIT in children. We also identified factors that affect the vHIT results such as artifacts and technical errors. STUDY DESIGN Retrospective review; SETTING: Tertiary care center. PATIENTS A total of 39 patients who visited our clinic for dizziness from 2014 to 2017. MAIN OUTCOME MEASURES The gain of vestibulo-ocular reflex, refixation saccades, and artifacts were analyzed using vHIT. We analyzed 691 individual vHIT traces and categorized the artifacts into 8 categories. RESULTS Twenty-three males and 16 females were included. The mean age was 13.84 ± 2.60 years (range, 7-18). Common causes of dizziness were benign paroxysmal vertigo of childhood (25.6%), vestibular neuritis (20.5%), and vestibular migraine (17.9%). The sensitivity and specificity of vHIT based on the bithermal caloric test results were 40% and 94%, respectively. The analysis of vHIT traces revealed that the children had higher artifact ratios of vHIT than the adults. The main artifacts were high gain and blinking eyes. CONCLUSION The vHIT results showed a higher percentage of artifacts in children than in the adults. More careful efforts are required to obtain more accurate results during the test, and it is necessary to check for technical errors while interpreting the results.
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Affiliation(s)
- Kyu-Sung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, South Korea.
| | - Yoon Kun Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, South Korea.
| | - Ki Jong Hyun
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, South Korea.
| | - Min Ji Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, South Korea.
| | - Hyun Ji Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, South Korea.
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Mutlu B, Cesur S, Topçu MT, Geçici CR, Aşkın ÖE, Derinsu EU. Evaluation of Interexaminer Variability in Video Head Impulse Test Results. J Am Acad Audiol 2020; 31:613-619. [PMID: 33080637 DOI: 10.1055/s-0040-1717124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The video head impulse test (vHIT) is a diagnostic tool to assess the function of the semicircular canals and branches of the vestibular nerve. The aim of this study was to analyze the interexaminer variability of vHIT results in healthy subjects. MATERIALS AND METHODS A total of 21 healthy participants were included in the study. vHIT responses were collected by four clinicians. Variability of the vHIT results between examiners was analyzed statistically. RESULTS The vestibulo-ocular reflex (VOR) velocity regression values were from 0.99 to 1.09 degrees per second for the lateral canals. For the vertical canals, VOR velocity regression values were from 0.87 to 1.21 degrees per second. According to repeated measures analysis of variance, the normality assumptions for the velocity regression of the left lateral canal (p = 0.002) and the right anterior canal (p < 0.01) were met and the differences were statistically significant. The normality assumptions were not met for 40, 60, and 80 ms median gain of the right lateral canal (p = 0.016, p = 0.038, and p = 0.001, respectively); 40 and 60 ms median gain of the left lateral canal (p < 0.001 and p = 0.008, respectively); and the velocity regression of the left posterior canal (p < 0.00). These differences were found to be statistically significant by using the Friedman test. CONCLUSION The interexaminer differences of the VOR gain values for the vHIT were statistically significant. Serial vHIT testing should be performed by the same examiner to reduce the effects of interexaminer variability.
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Affiliation(s)
- Başak Mutlu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sıdıka Cesur
- Department of Otorhinolaryngology, Subdepartment of Audiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Merve Torun Topçu
- Department of Audiology, School of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
| | - Cennet Reyyan Geçici
- Department of Otorhinolaryngology, Subdepartment of Audiology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Öyküm Esra Aşkın
- Department of Statistics, Yıldız Faculty of Arts and Sciences, Istanbul Technical University, Istanbul, Turkey
| | - Emine Ufuk Derinsu
- Department of Otorhinolaryngology, Subdepartment of Audiology, School of Medicine, Marmara University, Istanbul, Turkey
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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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Vestibulo-ocular reflex assessed with Video Head Impulse Test in children with Vestibular Migraine: Our experience. Int J Pediatr Otorhinolaryngol 2020; 137:110161. [PMID: 32739603 DOI: 10.1016/j.ijporl.2020.110161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/28/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022]
Abstract
UNLABELLED Vestibular Migraine in children can mimic other disorders, especially at presentation. Outcome is hard to predict and management may be challenging due to the fact that many of the patients are too young to describe their symptoms and these are not always accompanied by headache. OBJECTIVE To assess vestibulo-ocular reflex (VOR) in pediatric patients who meet criteria for defined Vestibular Migraine and to compare results to healthy controls. METHODS Twenty-one patients aged 11-16 years were included in this prospective multicentric study. VOR was assessed using the video Head Impulse Test by EyeSeeCam®(Interacoustics, Denmark). RESULTS Patients with Vestibular Migraine (VM) have higher values of gain compared to asymptomatic patients. CONCLUSION Video Head Impulse Test (vHIT) is a useful and relatively fast-to-perform examination in children compared to other vestibular tests. Patients with VM seem to have higher values of gain at vHIT.
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Ertugrul G, Sennaroglu G, Karakaya J, Sennaroglu L. Postural instability in children with severe inner ear malformations: Characteristics of vestibular and balance function. Int J Audiol 2020; 60:115-122. [PMID: 32885696 DOI: 10.1080/14992027.2020.1808250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the postural instability and vestibular functions in children with severe inner ear malformations (IEMs). DESIGN A prospective case-control study. STUDY SAMPLE The study group consisted of 10 children using unilateral auditory brainstem implant (ABI) with labyrinthine aplasia or rudimentary otocyst. The age-matched control groups consisted of 10 unilateral cochlear implant (CI) users with normal inner ear structures and 10 healthy peers. All tests were performed to implant users when the implants were off. RESULTS All median VOR gains in the ABI group (median anterior, lateral, and posterior canal 0.15, 0.05, and 0.05, respectively, for the non-implanted sides) were significantly lower than those of the control groups (median VOR gains ≥ 0.90 in both control groups). There were no oVEMP and cVEMP responses in the study group. The mean BOT-2 balance scores of the ABI (3.70 ± 1.34) group was dramatically lower than those of the CI (9.40 ± 2.88) and healthy control (16.20 ± 4.16, p < 0.001). CONCLUSIONS The postural instability in children with severe IEMs was higher than those in CI users with normal inner ear structures and healthy peers. The level of deficiency in the labyrinthine was more important for postural stability in children.
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Affiliation(s)
- Gorkem Ertugrul
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Gonca Sennaroglu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Levent Sennaroglu
- Department of Otorhinolaryngology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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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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Comparison of three video head impulse test systems for the diagnosis of bilateral vestibulopathy. J Neurol 2020; 267:256-264. [PMID: 32719974 PMCID: PMC7718202 DOI: 10.1007/s00415-020-10060-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A horizontal vestibulo-ocular reflex gain (VOR gain) of < 0.6, measured by the video head impulse test (VHIT), is one of the diagnostic criteria for bilateral vestibulopathy (BV) according to the Báràny Society. Several VHIT systems are commercially available, each with different techniques of tracking head and eye movements and different methods of gain calculation. This study compared three different VHIT systems in patients diagnosed with BV. METHODS This study comprised 46 BV patients (diagnosed according to the Báràny criteria), tested with three commercial VHIT systems (Interacoustics, Otometrics and Synapsys) in random order. Main outcome parameter was VOR gain as calculated by the system, and the agreement on BV diagnosis (VOR gain < 0.6) between the VHIT systems. Peak head velocities, the order effect and covert saccades were analysed separately, to determine whether these parameters could have influenced differences in outcome between VHIT systems. RESULTS VOR gain in the Synapsys system differed significantly from VOR gain in the other two systems [F(1.256, 33.916) = 35.681, p < 0.000]. The VHIT systems agreed in 83% of the patients on the BV diagnosis. Peak head velocities, the order effect and covert saccades were not likely to have influenced the above mentioned results. CONCLUSION To conclude, using different VHIT systems in the same BV patient can lead to clinically significant differences in VOR gain, when using a cut-off value of 0.6. This might hinder proper diagnosis of BV patients. It would, therefore, be preferred that VHIT systems are standardised regarding eye and head tracking methods, and VOR gain calculation algorithms. Until then, it is advised to not only take the VOR gain in consideration when assessing a VHIT trial, but also look at the raw traces and the compensatory saccades.
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Stultiens JJA, Kieft HW, Mylanus EAM, Pennings RJE, Terwoert L, Beynon AJ. Impact of cochlear implantation on the function of the three semicircular canals. Int J Audiol 2020; 59:843-849. [DOI: 10.1080/14992027.2020.1768310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joost J. A. Stultiens
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hieke W. Kieft
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Emmanuel A. M. Mylanus
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald J. E. Pennings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lotte Terwoert
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andy J. Beynon
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Ertugrul G, Konuskan B, Solmaz I, Anlar B, Aksoy S. Vestibulo-ocular reflex involvement in childhood-onset multiple sclerosis. Mult Scler Relat Disord 2020; 44:102329. [PMID: 32593962 DOI: 10.1016/j.msard.2020.102329] [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] [Received: 05/11/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS), an autoimmune demyelinating disease of the central nervous system, is an important cause of disability in young adults. The purpose of this cross-sectional study was to evaluate the vestibular system with video Head Impulse Test (vHIT) and determine the impairment of the Vestibulo-ocular Reflex (VOR) in childhood-onset MS. METHODS The study group, 20 persons with MS (pwMS) with onset before 18 years of age (6 M, 14 F; mean age 19.06 ± 1.66) and the control group, 20 healthy, age- and sex-matched individuals were retrieved from vHIT recordings. The mean age of MS onset in the study group was 14.60 ± 1.53 years. The VOR pathway was evaluated using vHIT. RESULTS The median VOR gains of right anterior (1.00), left lateral (0.96) and left posterior (0.91) semicircular canals were significantly lower in the pwMS group than those of the healthy control group (1.05, 1.00, 0.98 respectively, p < 0.05). Four of pwMS (20%) had abnormal VOR gains. The pwMS with dizziness had significantly lower VOR gains (median 0.91) compared with pwMS without dizziness (median 1.01, p < 0.05). CONCLUSION This study demonstrates vestibulo-ocular system can be affected in patients with childhood-onset MS and suggests using vHIT especially in the follow-up of pwMS with dizziness.
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Affiliation(s)
- Gorkem Ertugrul
- Hacettepe University, Faculty of Health Sciences, Department of Audiology, Ankara, Turkey.
| | - Bahadır Konuskan
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Ismail Solmaz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Songul Aksoy
- Hacettepe University, Faculty of Health Sciences, Department of Audiology, Ankara, Turkey; Hacettepe University, Dizziness and Balance Disorders Research and Application Center, Ankara, Turkey
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47
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Sinno S, Perrin P, Smith Abouchacra K, Dumas G. The skull vibration-induced nystagmus test: A useful vestibular screening test in children with hearing loss. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:451-457. [PMID: 32312623 DOI: 10.1016/j.anorl.2020.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Skull-Vibration-Induced-Nystagmus Test (SVINT), a non-invasive first line examination test, stimulates both otolith and canal structures and shows instantaneously a vestibular asymmetry. This study aimed to analyze the SVINT results observed in children with hearing loss (HL) amplified with hearing aids (HA) or unilateral cochlear implant (uCI) and healthy children. MATERIAL AND METHODS This case-control study compared the results of SVINT, caloric test (CaT) and video head-impulse-test (VHIT) in 120 controls to 30 children with HA and 30 with uCI, aged 5-18 years old. SVINT was recorded with videonystagmography after very high frequency (VHF) stimulation of mastoids and vertex. RESULTS SVINT results were non-pathological in 98% of the control group but modified in the HL group (P-value=0.04). In uCI participants, 13.3% had a bilateral weakness (BW) and 16.7% had a unilateral weakness (UW). In the HA group, 26.7% had BW, 10% had UW. SVINT was efficient to show a UW (6 out of 7 confirmed cases) but not efficient to show BW (1/12 confirmed cases). CONCLUSION SVINT can detect unilateral vestibular deficit in the VHF with a sensitivity of 86% and specificity of 96%. The positive predictive value is 75% and negative predictive value is 98%. In the case of bilateral deficit, the SVINT is inoperant. In amplified participants, a UW was equally detected whether using SVINT, CaT or VHIT. SVINT is a well-tolerated and useful test to screen vestibular asymmetry in children with HL when combined with other vestibular tests and shows its complementary at very high frequencies.
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Affiliation(s)
- S Sinno
- Audiology & Balance Center, Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Lebanon; Medical Audiology Sciences Program, Health Profession Department, Faculty of Health Sciences, American University of Beirut, Lebanon; EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, Villers-lès-Nancy, France
| | - P Perrin
- EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, Villers-lès-Nancy, France; Department of Paediatric Oto-Rhino-Laryngology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - K Smith Abouchacra
- Audiology & Balance Center, Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Lebanon; Medical Audiology Sciences Program, Health Profession Department, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - G Dumas
- EA 3450 DevAH, Development, Adaptation and Handicap, Faculty of Medicine and UFR STAPS, University of Lorraine, Villers-lès-Nancy, France; Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France.
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48
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Dasgupta S, Mandala M, Salerni L, Crunkhorn R, Ratnayake S. Dizziness and Balance Problems in Children. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-0615-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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49
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Verrecchia L, Karpeta N, Westin M, Johansson A, Aldenklint S, Brantberg K, Duan M. Methodological aspects of testing vestibular evoked myogenic potentials in infants at universal hearing screening program. Sci Rep 2019; 9:17225. [PMID: 31754248 PMCID: PMC6872559 DOI: 10.1038/s41598-019-53143-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022] Open
Abstract
Motor development in infants is dependent upon the function of the inner ear balance organ (vestibular organ). Vestibular failure causes motor delays in early infancy and suboptimal motor skills later on. A vestibular test for newborns and infants that is applicable on a large scale, safe and cost effective is in demand in various contexts: in the differential diagnosis of early onset hearing loss to determine forms associated with vestibular failure; in early hearing habilitation with cochlear implant, indicating the vestibular predominant side; and in the habilitation of children affected by motor skill disorders, revealing the contribution of a vestibular failure. This work explored the feasibility of cervical vestibular evoked myogenic potentials (VEMP) in conjunction with newborn universal hearing screening program. VEMP was measured after the hearing tests and was evoked by bone-conducted stimuli. Moreover, stimulus delivery was regulated by neck muscle activity, with infants rested unconstrained in their parents´ arms and with the head supported by the operator´s hand. This VEMP protocol showed a high level of feasibility in terms of test viability and result reproducibility. VEMP integrated into the newborn hearing screening program may represent a practical method for large-scale assessment of balance function in infants.
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Affiliation(s)
- Luca Verrecchia
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden. .,Division of Ear, Nose and Throat Diseases, Dept of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Niki Karpeta
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.,Division of Ear, Nose and Throat Diseases, Dept of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westin
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Johansson
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sonny Aldenklint
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Krister Brantberg
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Maoli Duan
- Audiology and Neurotology Unit, Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.,Division of Ear, Nose and Throat Diseases, Dept of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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50
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Lissner VMH, Devantier L, Ovesen T. Using the video head impulse test in healthy Danish adolescents. HEARING BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2019.1639383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Louise Devantier
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holstebro, Denmark
| | - Therese Ovesen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland, Holstebro, Denmark
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