Vestibular dysfunction is a manifestation of 22q11.2 deletion syndrome

Hearing loss and history of otolaryngological conditions in adults with microdeletion 22q11.2

Previous studies have shown that the 22q11.2 microdeletion, associated with 22q11.2 deletion syndrome (22q11.2DS), conveys an increased risk of chronic otitis media, and hearing loss at young age. This study reports on hearing loss and history of otolaryngological conditions in adults with 22q11.2DS. We conducted a retrospective study of 60 adults with 22q11.2DS (41.7% male) at median age 25 (range 16-74) years who had visited an otolaryngologist and audiologist for routine assessment at a 22q11.2 expert center. Demographic, genetic, audiometric, and otolaryngological data were systematically extracted from the medical files. Regression analysis was used to evaluate the effect of age, sex, full-scale intelligence quotient, and history of chronic otitis media on the severity of hearing loss. Hearing loss, mostly high-frequency sensorineural, was found in 78.3% of adults. Higher age and history of chronic otitis media were associated with more severe hearing loss. Otolaryngological conditions with possible treatment implications included chronic otitis media (56.7%), globus pharyngeus (18.3%), balance problems (16.7%), and obstructive sleep apnea (8.3%). The results suggest that  in 22q11.2DS, high-frequency hearing loss appears to be common from a young adult age, and often unrecognized. Therefore, we recommend periodic audiometric screening in all adults, including high-frequency ranges.

Postural balance problems in people with intellectual disabilities: Do not forget the sensory input systems

BACKGROUND

This pilot study aimed to explore the impact of visual, auditory and vestibular dysfunctions on the postural balance performance in adults with intellectual disabilities. Additionally, a comparison was made between the subjects with intellectual disabilities and a control group concerning static and dynamic balance tasks.

METHOD

Thirty adults with intellectual disabilities and 25 control subjects received a postural balance assessment. Additionally, the experimental group was subjected to a visual, auditory and vestibular screening.

RESULTS

The experimental group performed significantly worse and/or showed more sway compared to the control group for all balance tasks (p < .01) except the timed up and go test. Within the experimental group, a significant positive correlation (r_s (24) = 0.513, p = .007) was observed between the number of failed sensory screening items and the number of failed balance tasks.

CONCLUSIONS

These findings suggest significant involvement of peripheral sensorial deficits in the balance problems that people with intellectual disabilities often experience.

Case Report: Ménière's Disease-Like Symptoms in 22q11.2 Deletion Syndrome

The 22q11.2 deletion syndrome (22q11.2DS), caused by a microdeletion on the long arm of chromosome 22, is characterized by congenital heart disease, hypoparathyroidism, immunodeficiency, developmental delay, and velopharyngeal insufficiency. Anatomic malformations of the middle and inner ears are frequently present, leading to high prevalence of hearing impairment. We present a first case of 22q11.2DS showing fluctuating hearing loss with recurrent vertigo attacks, resembling Ménière's disease. A 38-year-old male known to have 22q11.2DS developed recurrent vertigo, tinnitus, and fluctuating hearing loss in the left ear during a 10-year follow-up period. During vertigo attack, he had spontaneous left-beating nystagmus with downbeat components, but bithermal caloric and video head impulse tests showed normal vestibulo-ocular reflex functions. Sequential pure tone audiograms demonstrated fluctuating sensorineural hearing loss (SNHL) in both ears, which finally progressed to permanent hearing loss in the left ear. Computed tomography imaging of the temporal bone exhibited bilaterally malformed lateral semicircular canals, and delayed 3D-FLAIR sequences revealed cochlear endolymphatic hydrops with dilation of the scala media in the left ear. This case shows that acute vertigo with SNHL can be one of the audiovestibular presentations in 22q11.2DS caused by disturbance of endolymphatic flow.

Vestibular function in adults with intellectual disabilities: feasibility and outcome of a vestibular screening protocol in Special Olympics athletes

OBJECTIVE

This study aimed to evaluate the feasibility of a well-adapted vestibular screening battery to objectively examine the (peripheral) vestibular function, and to explore the characteristics of potential vestibular deficits in the adult ID population.

DESIGN

Cross-sectional study design.

STUDY SAMPLE

Compared to an age- and gender-weighted control group, a heterogeneous group of forty-five adults with ID participated in the vestibular screening at the National Games of Special Olympics Belgium (2019), which consisted of a bone conduction cervical Vestibular Evoked Myogenic Potential (cVEMP) measurement and video Head Impulse Test (vHIT).

RESULTS

The screening battery appeared to be feasible in the majority of the participants (cVEMP: 92%; vHIT: 72%). Overall, the occurrence of abnormal cVEMP and vHIT responses was significantly higher in the ID group, with significantly lower corrected peak-to-peak cVEMP amplitudes (p < 0.001), lower vHIT gains (p < 0.001), and higher cVEMP and vHIT asymmetry ratios in the ID group (p = 0.008 and p < 0.001 resp.).

CONCLUSIONS

Vestibular assessment using the cVEMP and vHIT technique shows a promising feasibility in adults with ID. In addition, this study suggests that people with ID exhibit an increased prevalence of (peripheral) vestibular deficits relative to the general population.

Vestibular Function Correlates with Radiologic Findings in a Gymnast with 22q11.2DS

BACKGROUND The 22q11.2 deletion syndrome (22q11.2DS) is the most common identified microdeletion in humans. Anomalies of the vestibular system can occur with great frequency and are reported in the radiology literature. Fewer reports exist regarding vestibular function or its clinical features. CASE REPORT We present a case report of a competitive gymnast with 22q11.2DS who was noted to be having specific issues related to balance under conditions of competition, specifically on the balance beam. Comprehensive balance assessment provided evidence of the absence of lateral semicircular canal function, correlating with computed tomography findings and her symptoms. Counselling and targeted training greatly improved her performance. CONCLUSIONS Comprehensive balance testing correlated with clinical and radiographic findings in a competitive gymnast with 22q11.2DS. Results demonstrated the functional aspect of this anomaly but also displayed the extent to which the complex interactions of all components of balance can work together to overcome balance issues under intense vestibular stress.