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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Huang S, Zhou H, Zhou E, Zhang J, Feng Y, Yu D, Shi H, Wang J, Wang H, Yin S. A New Proposal for Severity Evaluation of Menière's Disease by Using the Evidence From a Comprehensive Battery of Auditory and Vestibular Tests. Front Neurol 2020; 11:785. [PMID: 33013611 PMCID: PMC7461919 DOI: 10.3389/fneur.2020.00785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/25/2020] [Indexed: 12/18/2022] Open
Abstract
To date, no widely accepted criteria exist to quantify the severity of Menière's disease (MD) by using vestibular tests. This study aimed to compare association of hearing loss and vertigo severity with association of accurate assessments of vestibular function and the vertigo severity. The severity of vertigo was documented by a comprehensive medical history with number of vertigo attacks in the past 6 months and a Dizziness Handicap Inventory (DHI) questionnaire. The involvement of vestibular organs was verified by audio-vestibular tests in 80 definite MD patients. Correlations between DHI scores, number of vertigo attacks in the past 6 months, audio-vestibular function, and the number of involved vestibular end organs were evaluated. We show that there are no significant differences in either severity of vertigo or laboratory results across the degree of hearing loss. Furthermore, the number of involved vestibular end organs was significantly correlated with vestibulo-ocular reflex gain in anterior and posterior canal video head impulse test (vHIT), interaural asymmetry ratio in vestibular-evoked myogenic potentials (VEMPs), and number of vertigo attacks in the past 6 months and DHI score. The vestibulo-ocular reflex gain in the rotatory chair test (RCT) was significantly correlated with the DHI Physical scores and number of involved vestibular end organs at 0.08 Hz. These results indicate that hearing loss is a poor indicator of vertigo severity in MD whereas the number of involved vestibular end organs may serve as an objective measure for MD progress. A battery of vestibular tests targeting different sensor organs is a complementary method for evaluating inner ear deficits and may aid in "grading" the severity of MD.
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Affiliation(s)
- Shujian Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huiqun Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Enhui Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Gongli Hospital, The Second Military Medical University, Shanghai, China
| | - Jiajia Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yanmei Feng
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Dongzhen Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Haibo Shi
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Jian Wang
- School of Communication Science and Disorders, Dalhousie University, Halifax, NS, Canada
| | - Hui Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otorhinolaryngology-Head and Neck Surgery, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Kim MT, Ahn JH, Kim SH, Choi JE, Jung JY, Lee MY. Persistent static imbalance among acute unilateral vestibulopathy patients could be related to a damaged velocity storage system. Acta Otolaryngol 2019; 139:552-556. [PMID: 31050584 DOI: 10.1080/00016489.2019.1606438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Acute unilateral vestibulopathy (AUV) is common but, the course of disease recovery is variable. Moreover, the final recovery status might vary between subjects. The remaining symptoms of these patients indicate the poor recovery of static imbalance, which could limit social activities and decrease their quality of life. Objective: To determine the possible predictive parameters of prolonged static imbalance (PSI) among acute AUV, we compared several vestibular function test (VFT) results between control vestibulopathy (CV) and PSI patients. Materials and methods: Subjects were divided into two groups: PSI and CV. PSI was determined by the observation of spontaneous nystagmus at 1 month after discharge from the hospital. VFT results taken during the initial symptoms were compared. Results: Increased phase lead was observed in low-frequency stimulations (p < .05), while the other test results failed to reveal a significant difference. These results indicate that a larger phase lead, which is related to a decrease in the time constant, could be responsible for the delayed recovery of static imbalance. Conclusion and significance: The phase lead was higher in the PSI group compared to the CV group, suggesting the possible role of phase as a parameter to predict the delayed compensation of static imbalance.
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Affiliation(s)
- Min Tae Kim
- Department of Otolaryngology-Head & Neck surgery, Dankook University, College of Medicine, Cheonan, Republic of Korea
| | - Jung Hyun Ahn
- Department of Otolaryngology-Head & Neck surgery, Dankook University, College of Medicine, Cheonan, Republic of Korea
| | - Sang Hyub Kim
- Department of Otolaryngology-Head & Neck surgery, Dankook University, College of Medicine, Cheonan, Republic of Korea
| | - Ji Eun Choi
- Department of Otolaryngology-Head & Neck surgery, Dankook University, College of Medicine, Cheonan, Republic of Korea
| | - Jae Yun Jung
- Department of Otolaryngology-Head & Neck surgery, Dankook University, College of Medicine, Cheonan, Republic of Korea
| | - Min Young Lee
- Department of Otolaryngology-Head & Neck surgery, Dankook University, College of Medicine, Cheonan, Republic of Korea
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