Implications of Concurrent Vestibular Dysfunction in Pediatric Hearing Loss

Clinical balance assessment tools for children with hearing loss: a scoping review

Balance dysfunction exists in children with hearing loss, especially sensorineural loss, impacting on cognitive development, socio-emotional development and literacy. However, there is limited assessment of balance in this population, which further impedes childhood development. The objective of this review was to identify clinical, low- technology and inexpensive tools used to evaluate balance in children with hearing loss.

METHODS

A scoping review method with reference to the JBI, was used where a search was conducted on electronic databases including, but not limited to, EBSCOHost, MEDLINE, PubMED, Web of Science and Wiley. In addition, grey literature and hand searches were also used. The review included children between 3 and 15 years of age with hearing loss.

RESULTS

A total of 68 articles were found where 27% of the tests were norm-referenced tests, 64% were criterion referenced tests and 9% could not be identified.

CONCLUSION

Tests such as the Tandem gait test, Pediatric Balance Scale (PBS), Clinical Test of Sensory Interaction for Balance (mCTSIB)/Pediatric Version of Clinical Test for Sensory Interaction of Balance (P-CTSIB), Dynamic Gait Index and the Timed-up-and-Go were identified to be relatively inexpensive and low-technology clinical tools and have thus, been summarized in this review.

Effects of dance sports exercise on vestibular function and balance of children with sensorineural hearing loss; a randomized quasi-experimental trial

Background

Sensorineural hearing loss (SNHL) children have difficulty living and limited movement due to impaired vestibular function and reduced balance ability.

Objectives

The present study evaluated the effects of Latin dance training on the vestibular function and balance of SNHL children.

Methods

Thirty SNHL children with no difference in vestibular function and balance ability were randomly divided into two groups, the Latin dance training group (LTG, n = 15) and the control group (CONG, n = 15). Vestibular function, timed eyes-closed static (ECS) and functional reach test (FRT) were measured before and after the intervention, and a two-way repeated-measures analysis of variance was performed.

Results

After training, the vestibular function performance of LTG was higher than that of CONG (CONG: 16.425 ± 3.616 vs. LTG: 12.241 ± 2.610, p = 0.0411, ES = 1.3914), the left foot ECS performance of LTG was higher than that of CONG (CONG: 2.765 ± 0.872 vs. LTG: 4.688 ± 1.113, p = 0.0026, ES = 1.9857), the right foot ECS performance of LTG was higher than that of CONG (CONG: 3.113 ± 0.639 vs. LTG: 4.797 ± 1.071, p = 0.0137, ES = 2.01), the FRT performance of LTG was higher than that of CONG (CONG: 32.009 ± 6.134 vs. LTG: 43.797 ± 6.616, p = 0.0021, ES = 1.9135).

Conclusions

After Latin dance training, SNHL children improved vestibular function and balance. The static balance ability of the left foot has been improved significantly than right foot.

Vestibular Infant Screening-Flanders: What is the Most Appropriate Vestibular Screening Tool in Hearing-Impaired Children?

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).

Three Years of Vestibular Infant Screening in Infants With Sensorineural Hearing Loss

OBJECTIVES

Although vestibular deficits are more prevalent in hearing-impaired children and can affect their development on many levels, a pediatric vestibular assessment is still uncommon in clinical practice. Since early detection may allow for timely intervention, this pioneer project has implemented a basic vestibular screening test for each six-month-old hearing-impaired infant in Flanders, Belgium. This study aims to report the vestibular screening results over a period of three years and to define the most important risk factors for abnormal vestibular screening results.

METHODS

Cervical Vestibular Evoked Myogenic Potentials with bone-conduction were used as a vestibular screening tool in all reference centers affiliated to the Universal Newborn Hearing Screening Program in Flanders. From June 2018 until June 2021, 254 infants (mean age: 7.4 months, standard deviation: 2.4 months) with sensorineural hearing loss were included.

RESULTS

Overall, abnormal vestibular screening results were found in 13.8% (35 of 254) of the infants. The most important group at risk for abnormal vestibular screening results were infants with unilateral or bilateral severe to profound sensorineural hearing loss (20.8%, 32 of 154) (P < .001, odds ratio = 9.16). Moreover, abnormal vestibular screening results were more prevalent in infants with hearing loss caused by meningitis (66.7%, 2 of 3), syndromes (28.6%, 8 of 28), congenital cytomegalovirus infection (20.0%, 8 of 40), and cochleovestibular anomalies (19.2%, 5 of 26).

CONCLUSIONS

The vestibular screening results in infants with sensorineural hearing loss indicate the highest risk for vestibular deficits in severe to profound hearing loss, and certain underlying etiologies of hearing loss, such as meningitis, syndromes, congenital cytomegalovirus, and cochleovestibular anomalies.

IGST Combined with Conventional Drug Therapy and TCM Therapy for Treatment of Bilateral Vestibular Hypofunction

Objective

To investigate the effects of intensive gaze stability training (IGST) combined with conventional drug therapy and traditional Chinese medicine (TCM) therapy on hearing recovery and quality of life (QOL) in patients with bilateral vestibular dysfunction.

Materials and Methods

A total of 120 patients with bilateral vestibular dysfunction admitted to our hospital from January 2019 to January 2020 were recruited and assigned to group A (n = 60) and group B (n = 60) based on the order of admission. Group B received conventional medication and TCM therapy, and group A received IGST plus conventional medication and TCM therapy. The serum biochemical indexes, blood rheology indexes, symptoms disappearance time, hearing recovery time, pure-tone hearing threshold, vestibular symptom index (VSI), and QOL of the two groups were compared.

Results

The serum biochemical indexes and blood rheology indexes in group A were lower than those in group B after treatment (P < 0.001). Patients in group A had a shorter time lapse before symptoms disappearance and hearing recovery than those in group B (P < 0.001). Group A had lower results of the pure-tone hearing threshold (P < 0.001) and of VSI (P < 0.05) than group B. Patients in group A had higher QOL scores than those in group B after treatment (P < 0.001).

Conclusion

IGST plus conventional drug therapy effectively improves the serum biochemical indexes and blood rheological indexes of patients with bilateral vestibular hypofunction, accelerates their hearing recovery process, and alleviates their clinical symptoms, thereby improving their QOL, which shows good potential in clinical application.

Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss

OBJECTIVE

The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system.

METHODS

This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function.

RESULTS

The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF).

CONCLUSION

The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study.

IMPACT

Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.