Vestibular Function In Children Research Articles

Vestibular Function and Postural Control in Children with Autism Spectrum Disorder.

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks-Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention.

Long-term outcome of vestibular function and hearing in children with congenital cytomegalovirus infection: a prospective cohort study

PurposeCongenital cytomegalovirus infection (cCMV) is the most frequent nonhereditary cause for sensorineural hearing loss (SNHL) in children. Data on vestibular function in children with cCMV are, however, scarce, although some evidence for cCMV-associated vestibular dysfunction exists. In this prospective cohort study, we evaluated long-term vestibular function and hearing outcomes in a cohort of children with cCMV.MethodsParticipants were 6–7-year-old children with cCMV from a large population-based screening study. Controls were age and gender matched healthy children, who were CMV-negative at birth. Hearing was examined with pure tone audiometry. Definition of hearing loss was pure-tone average > 20 dB. Vestibular function was assessed using the video head impulse test that provides a measure of semicircular canal function. Definition of vestibular dysfunction was lateral semicircular canal gain < 0.75.ResultsVestibular dysfunction occurred in 7/36 (19.4%) of children with cCMV and in 1/31 (3.2%) of controls (p = 0.060). SNHL was recorded in 4/38 (10.5%) of children with cCMV and in 0/33 of controls (p = 0.118). Hearing loss was unilateral in all cases. In cCMV group, the two children with bilateral vestibular dysfunction also had SNHL, whereas those with unilateral vestibular dysfunction (n = 5) had normal hearing.ConclusionsIn this cohort of children with cCMV identified using newborn screening, vestibular dysfunction was more common than SNHL at 6 years of age. Vestibular dysfunction occurred both in children with and without SNHL. Based on these data, inclusion of vestibular tests in follow-up protocol of cCMV should be considered.

Commentary: Effect of cochlear implantation on vestibular function in children: A scoping review.

Commentary: Effect of cochlear implantation on vestibular function in children: A scoping review.

Modern methods of investigating the vestibular function in children

ABSTRACT. Worldwide, there are about 466 million people (6.1%) with hearing loss and approximately 34 million of them (7%) are children, two-thirds of whom live in developing countries. In the course of research, it has been proven that in 60% of cases, sensorineural deafness is combined with vestibular disorders, which can be both obvious (rarely in children) and hidden. Timely detection of vestibular disorders in young children, especially hidden ones, prevents delay in the child’s motor development and significantly reduces the risk of vestibular dizziness development in older age. The aim of the article was to study modern instrumental methods of balance function research in children based on scientific analysis of contemporary literary data. Materials and methods: A comprehensive search of relevant literature sources was conducted in December 2021 using electronic databases RubMed, EMBASE, MEDLINE, U.S. National Library of Medicine Clinical Trials, Research Gate and Cocharane Library. The results: Despite highly developed technological diagnostic capabilities of present-day medicine, the study of etiology, prevention and correction of various balance and hearing disorders in children of different ages is one of the most acute issues to be solved by modern medical community. Up-to-date improvements in the diagnostic methods of the auditory and vestibular analyzer expand the possibilities of interpreting their results and allow a deeper understanding of the degree of the stato-acoustic analyzer damage. To investigate the vestibular function, vestibulometry and otoneurological examinations are usually carried out, which are the same tests that are used in adults. However, such examinations require more patience from the child and they should be conducted in a playful manner. Detection of hidden vestibular dysfunctions ought to be comprehensive, in particular, using instrumental methods, one of which is static computer stabilometry, that creates an opportunity to determine translational and motor disorders. The conclusion. Long-term problems with balance in children can lead to a delay of motor functions development, which can further slow down the child's achievement of age-appropriate psychomotor stages and have a negative impact on school performance, and in general, on social, speech and intellectual development. Therefore, detection of vestibular dysfunction at an early age is of great medical and social importance. Acute otitis media is currently a curable disease in most cases, if undesirable consequences are prevented during the period of examination and treatment. Vestibular function can be adequately assessed using reliable instrumental tests. In this sense, static stabilometry is a very useful method for the objective determination of vestibular deficits in children, regardless of the presence or absence of any subjective complaints.

Evaluating children with vestibular migraine through vestibular test battery: A cross-sectional investigation.

The present study aimed to investigate the status of vestibular function in children with vestibular migraine of childhood (VMC) reflected by vestibular function test battery and explore the pathophysiological implication of these instrument-based findings. The clinical data of 22 children (mean age 10.7 ± 2.9 years) with VMC who met the diagnostic criteria of the Barany Society were collected from September 2021 to March 2022. A vestibular function test battery on these children included a caloric test, video head impulse test (vHIT), cervical vestibular-evoked myogenic potential (cVEMP), and ocular vestibular-evoked myogenic potential (oVEMP); these parameters were triggered by air-conducted sound (ACS) and galvanic vestibular stimulation (GVS). The subjects were further divided into two groups: <3 months and >3 months according to the disease duration from symptom onset. The functional abnormalities and their characteristics reflected by the vestibular test battery, as well as the outcomes in children with or without aura, were analyzed. (1) The abnormal rate of the caloric test was 15.8% and that of vHIT was 0%. The response rates of ACS-cVEMP and ACS-oVEMP were 100% and 90.5%, respectively. The response rates of GVS-cVEMP and GVS-oVEMP were 100% and 88.9%, respectively. (2) No statistical difference was observed in the abnormal rate of the caloric test (P = 0.55) and the response rate of ACS-oVEMP (P = 0.21) between the two groups, irrespective of the course duration. (3) No statistical difference was detected in the abnormal rate of the caloric test (P = 0.53) and the response rate of ACS-oVEMP (P = 1.00) in children with or without aura. Vestibular function status comprehensively reported by the vestibular test battery did not show an aggravation with the disease duration in children with VMC. Also, it was not affected by the existence of aura in children with VMC. The high abnormal rates of the caloric test and oVEMPs (ACS-oVEMP and GVS-oVEMP) suggested that the lateral semicircular canal (low-frequency function component), the utricle, and the superior vestibular conduction pathway might be involved in VMC.

Vestibular function in children with generalized epilepsy and treated with valproate

ABSTRACT Background Studies that evaluated vestibular function with epilepsy are fewer than auditory studies. We assessed vestibular function in children with epilepsy in inter-ictal period. Research design and methods This cross-sectional study included 35 children with generalized epilepsy (boys=15; girls=20; age=11.20±1.21 years; epilepsy duration=3.54±1.80 years) and treated with valproate (VPA) and 24 healthy children. Vestibular evaluation was conducted using videonystagmography (VNG) and cervical vestibular evoked myogenic potentials (cVEMPs). Results Dizziness was the vestibular symptom in 22.86% of cases. Vestibular dysfunctions (VDs) were found in 65.71%. Manifestations of peripheral VD (65.71%) included unilateral caloric weakness and reduced cVEMP amplitudes. Manifestations of central VD (28.57%) included oculomotor abnormalities, positional nystagmus with normal calorics, and prolonged cVEMPs latencies. Significant correlations were found between VDs and duration of epilepsy and its treatment [r = −0.368, P=0.01] and VPA dose [r = −0.286, P=0.02] and level [r = −0.355, P=0.01]. Logistic regression analysis showed that duration of epilepsy and its treatment [OR = 3.55 (95% CI = 2.54–6.50), P=0.001] were independently associated with VDs. Conclusions VDs are common in children with epilepsy. Bilateral peripheral VD was more common than central VD, suggesting an adverse effect of VPA. However, epilepsy cannot be excluded as a cause of central VD.

Vestibular function in children with cochlear implant: Impact and evaluation.

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.

Balance and Vestibular Deficits in Pediatric Patients with Autism Spectrum Disorder: An Underappreciated Clinical Aspect.

Children with autism spectrum disorder (ASD) not only have communication and social difficulties, but also exhibit poor balance and motor control ability, which frequently affect daily activities. Effective balance and motor control rely on the integration of somatosensory, visual, and vestibular inputs. Although reports of balance dysfunction in ASD have been documented, comprehensive studies of balance and vestibular function in children with ASD are scarce. In this study, we retrospectively reviewed 36 pediatric patients diagnosed with ASD who underwent balance/vestibular laboratory testing in our speciality clinic. Results from sensory organization test (SOT) or modified clinical test for sensory integration of balance (mCTSIB) found that out of 15 patients, 80% had abnormal findings. Of the children who successfully completed each vestibular test, abnormal responses were observed in 12 (80%) sensory organization tests, 5 (24%) vestibular evoked myogenic potential (VEMP), 22 (66%) videonystagmography (VNG), and 11 (32%) sinusoidal rotary chair tests. These results indicate that balance and vestibular testing may be of diagnostic value for clinicians and providers as an aid in early detection, intervention, and the development of appropriate management and therapies for this patient population. Increased awareness of this topic is warranted to promote better clinical management of this special group of patients and improve their quality of life.

Evaluation of posturographic indicators in children with non-purulent acute otitis media

Nowadays otitis media still remains one of the most common diseases of the middle ear in children [1]. The interconnection between otitis media and its effect on vestibular function in children has not been thoroughly studied yet. The aim of the study is to conduct a comparative analysis of stabilometric indicators of preschool children, diagnosed with non-purulent acute otitis media, and their relatively healthy typically developed peers. Materials and methods: 22 children, diagnosed with non-purulent acute otitis media, and their 25 relatively healthy typically developed peers aged 4 to 7, have been examined on the device "MPFI Stabilograph 1" (AS-TER IT, LLC, Kharkiv, Ukraine). The research has taken into account indicators of variation and shape of pressure center distribution, spectral-correlation indicators of stabilograms, as well as integral indicators of stability (length, velocity and angle of postural oscillations) and quality of equilibrium function in two sensory states (open and closed eyes). The obtained data have been calculated in the StabiliS software. Results: In children with non-purulent otitis, the coordinates of the pressure center are (7.04 [2.16 – 10.09]; -1.14 [-28.90 - 9.11]), and in the control group – (7.04 [3.30-16.16]; -13.72 [(-25.17) – (-10.30)]) with eyes closed. The average project ion figure of the pressure center in the sample with closed eyes is actually represented by a circle (ratio of Y / X axes = 0.98 [0.88; 1.14]) in non-purulent otitis media, and in the control group - an ellipse (Y / X axis ratio) = 1.16 [1.01; 1.33]). This indicates the lack of dominance of the ankle strategy to maintain posture in non-purulent otitis in the absence of visual control, and points to the presence of hidden vestibular disorders in non-purulent acute otitis media. Conclusion: The main result of our study is the discovery of the statistically significant decrease in the stability of the main posture and predictability of oscillatory movements in preschool children with acute nonpurulent otitis media compared with the control group only in the absence of visual control, i.e. in closed eyes. Also, statistically significant (p ≤ 0.05) differences have been found between children with acute non-purulent otitis media and control, namely the coefficient of equilibrium function only in the state with closed eyes. Decreased KFR values in children with non-purulent otitis indicate a decrease in the quality of postural control compared to control group. Given the almost asymptomatic nature of otitis media in preschool children, violations of postural control in non-purulent otitis media indicate the presence of latent vestibular disorders, which must be considered for the diagnosis and treatment of otitis media in children.

Determination of vestibular function in children with purulent otitis media

The aim of the study is to assess the vestibular function of children with acute purulent otitis media by computer static stabilometry compared with typically developed peers. Materials and methods. In the course of the study 52 children aged 4 to 7 were examined by static stabilometry on the device «MPFI Stabilograph 1» (Kharkiv, Ukraine). 22 of them were diagnosed with purulent otitis media and their 30 peers were found to be practically healthy. Indicators of variations and forms of pressure center distribution, spectral-correlation indicators of stabilograms, as well as integral indicators of stability (length, velocity and angle of postural oscillations) and quality of equilibrium function in two sensory states (open and closed eyes) calculated in StabiliS software were taken into account. Results. Purulent otitis media causes posterior displacement of absolute coordinates of the pressure center. In the state with closed eyes, children with purulent otitis differ from their healthy peers in 14 of 24 stabilometric parameters, including stabilogram length, speed, angle and amplitude of oscillations, inferior to them in the balance. Children with purulent otitis media are more sensitive to the visual canal of postural control than their peers. Involvement of visual afferents in postural control significantly improves balance in children with purulent otitis by reducing deviations, postural fluctuations, which is reflected in the probable changes of 9 out of 24 stabilometric parameters compared to control. Conclusion. In preschool age, purulent otitis media leads to latent vestibular dysfunction, which is manifested by a violation of the stability of the vertical posture with the closed eyes and is compensated by visual-vestibular-proprioceptive integration in postural control.

Objective vestibular function changes in children following cochlear implantation.

BACKGROUND:To date, systematically objective evaluations of vestibular function in children with cochlear implantation (CI) have been conducted sparsely, especially in children with large vestibular aqueduct syndrome (LVAS).OBJECTIVE:Our goal was to investigate the function of all five vestibular end-organs pre- and post-cochlear implantation in children with LVAS and normal CT.METHODS:In this retrospective cohort study, 34 children (age 4–17 years) with bilateral profound sensorineural hearing loss (SNHL) undergoing unilateral CI were included. Participants included 18 (52.9%) children with LVAS. Objective modalities to evaluate vestibular function included the caloric test, cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP), and video head impulse test (vHIT). All measurements were performed before surgery and 9 months after surgery.RESULTS:Mean age at CI was 8.1±3.7 years. Caloric testing showed hypofunction in 38.2% of cases before implantation and in 50% after (p > 0.05). We found a significant increase of overall abnormality rate in cVEMP and oVEMP from pre- to post-CI (p < 0.05). In all three semicircular canals tested by vHIT, there were no statistically significant mean gain changes (p > 0.05). Higher deterioration rates in cVEMP (53.3%) and oVEMP (52.0%) after surgery were observed (p < 0.05). In children with LVAS, cVEMP revealed a higher deterioration rate than superior semicircular canal (SSC) and posterior semicircular canal (PSC) (p < 0.05). In children with normal CT, the deterioration rates in VEMPs were both higher than those in vHIT (p < 0.05).CONCLUSIONS:In general, the otolith organs were the most affected peripheral vestibular sensors in children after cochlear implantation. The variations in otolith function influenced by CI were different between children with LVAS and normal CT. We recommend the use of this vestibular function test battery for children with cochlear implantation.

Evaluation of vestibular function in children with purulent media otitis by computer stabilometry

The aim of the research – assessment of vestibular function in children with acute purulent otitis media by computer static stabilometry compared with typically developed children of the same age.&#x0D; Materials and methods: 22 children with purulent otitis media aged 4 to 7 years and 30 practically healthy peers were examined by static stabilometry on the device “MPFI stabilograph 1” (Kharkiv, Ukraine). Indicators of variation and shape of the pressure center distribution, spectral-correlation indicators of stabilograms, as well as integral indicators of stability (length, velocity and angle of postural oscillations) were taken into account and the equilibrium functions of the two sensory states (open and closed eyes) are calculated in the StabiliS software.&#x0D; Results: purulent otitis media causes posterior displacement of the absolute coordinates of the pressure center. In the state with closed eyes, children with purulent otitis differ from their healthy coevals by 14 of 24 stabilometric parameters, including stabilogram length, speed, angle and amplitude of oscillations, giving way to them in the stability of equilibrium. Children with purulent otitis media are more sensitive to the visual canal of postural control than their coevals. Involvement of visual afferents in postural control significantly improves balance maintenance in children with purulent otitis by reducing deviations of postural oscillations, which is reflected in the probable changes of 9 out of 24 stabilometric parameters compared to control.&#x0D; Conclusions: In preschool age, purulent otitis media leads to latent vestibular dysfunction, which is manifested by a violation of the stability of the vertical posture in a state with closed eyes and is compensated by visual-vestibulo-proprioceptive integration in the process of postural control.

Stabilometric assessment of vestibular function in children with a medium otitis

Otitis media is one of the most common infectious diseases of the middle ear in preschool age, but its relationship with vestibular dysfunction remains controversial.&#x0D; The aim of the study was to carry out a comparative analysis of stabilometric indicators of preschool children with suppurative and non-suppurative otitis media.&#x0D; Materials and methods: 22 children with suppurative otitis media and 22 children with non-suppurative otitis media at the age from 4 to 7 years were examined by the method of static stabilometry on the device “MPFI Stabilograph 1” (LLC "ASTER IT", Kharkov, Ukraine). We took into account the indices of variation and distribution of the center of pressure, spectral and correlation indices of the stabilogram, as well as integral indices of stability (length, velocity and angle of postural oscillations) and the quality of the balance function in two sensory states (open and closed eyes), which were calculated in the software providing StabiliS.&#x0D; Results. In children with non-suppurative otitis media, the coordinates of the center-of-pressure corresponded (7.04 [2.16–10.09]; -1.14 [-28.90–9.11]), and with suppurative otitis media – (7.04 [3.30–16.16]; -13.72 [(-25.17)–(-10.30)]) with closed eyes. The averaged figure of the projection of the center-of-pressure in the test with eyes closed is actually represented by a circle in both groups, but with open eyes it is represented by an ellipse, which, in case of non-suppurative otitis media, is stretched along the sagittal axis, and in case of suppurative otitis media, along the frontal axis. In both sensory states, children with non-suppurative otitis media were characterized by large (p≤0.05) values of KurtosisX, Length and lower (p≤0.05) values of CC0X, Pup2Sigma compared with non-purulent otitis media.&#x0D; Conclusions: In preschool age, suppurative otitis media more significantly disrupts the balance function compared with non-suppurative otitis media, which was manifested by a significant decrease in the stability of the main stance and the predictability of oscillatory movements compared with non-suppurative otitis media

Vestibular Function in Children with Type 1 Diabetes: Videonystagmography Testing

Background: Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG). Patients and Methods: This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG. Results: Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (n = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (>5 years), higher levels of HbA1c (>7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration >5 years (odds ratio [OR] = 4.52 [95% confidence interval [CI] = 3.55–7.04], p = 0.001), HbA1c% levels >7% (OR = 3.42 [95% CI = 2.84–5.75], p = 0.001), and presence of hypoglycemic attacks (OR = 4.65 [95% CI = 2.85–7.55]). Conclusions: -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs.

Vestibular nerve deficiency and vestibular function in children with unilateral hearing loss caused by cochlear nerve deficiency

Background High-resolution MR imaging enables the visualization of individual nerves in the internal auditory canal (IAC). Cochlear nerve deficiency (CND) is recognized as one of the major causes of sensory neural hearing loss (SNHL), especially in cases of unilateral hearing loss in childhood. Some patients with CND are thought to have accompanying vestibular nerve deficiency (VND). However, there have been few reports focusing on VND and vestibular function in these children. Aims The aim of this study was to evaluate the frequency of VND and vestibular dysfunction in children with unilateral SNHL caused by CND. Material and Methods Thirty-eight children with unilateral SNHL, who were diagnosed with CND by 3 T-MRI, were evaluated for VND and underwent caloric testing and cervical vestibular evoked potential (cVEMP). Results Fourteen of 38 patients (37%) had VND, and eleven (29%) of the patients [ten of the patients (71%) with VND] had at least one vestibular dysfunction. The patients with VND had significantly worse hearing and an IAC of smaller diameter than did patients without VND. Conclusions and significance We should pay attention to VND as well as vestibular dysfunction in hearing loss patients with CND.

Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Routine Vestibular Function Assessment in Children With Congenital CMV: Are We Ready?

Vestibular Function in Children and Adults Before and After Unilateral or Sequential Bilateral Cochlear Implantation.

Background: Cochlear implantation (CI) helps patients with severe or profound sensorineural hearing loss (SNHL) restore hearing and speech abilities. However, some patients exhibit abnormal vestibular functions with symptoms such as dizziness or balance disorders, after CI. Whether age at CI and CI approach (unilateral or sequential bilateral) affect vestibular functions in users with cochlear implants remains unclear.Objectives: To investigate the vestibular functions in children and adults before and after unilateral or sequential bilateral CI.Materials and Methods: Thirty-seven patients with severe or profound SNHL who were candidates for a first- or second-side CI were divided into three groups: first-side CI-implanted adults (≥18 years), first-side CI-implanted children (6–17 years), and second-side CI-implanted children (6–17 years). All cases were implanted with the round window approach to minimize damage to the intra-cochlear structures. The caloric test, vestibular evoked myogenic potential (VEMP) test, video head impulse test (vHIT), Dizziness Handicap Inventory (DHI), Pediatric Vestibular Symptom Questionnaire (PVSQ), and audiometric tests were performed before and 1 month after CI.Results: The abnormal rates of caloric test and VEMP test after CI in the first-side CI-implanted adults and children significantly increased compared with those before CI. The pre-implantation VEMP test showed significantly higher abnormal rates between first- and second-side CI-implanted children. No other significant differences of abnormal rates between first- and second-side CI-implanted children or between first-side CI-implanted adults and children were found. In second-side CI-implanted children, PVSQ scores significantly increased at day 3 post-implantation but decreased at day 30.Conclusion: CI has a negative effect on the results of caloric and VEMP tests, but not on vHIT, indicating that the otolith and low-frequency semicircular canal (SCC) are more vulnerable to damage from CI. The alterations of vestibular functions resulting from CI surgery may be independent of age at CI and CI approach (unilateral or sequential bilateral). Long-term impacts on the vestibular function from CI surgery, as well as the chronic electrical stimulation to the cochlea, are still to be investigated.

Influence of Cochlear Implantation on Vestibular Function in Children With an Enlarged Vestibular Aqueduct.

Background: Cochlear implantation (CI) is becoming increasingly used in the rehabilitation of hearing-impaired patients. Children with an enlarged vestibular aqueduct (EVA) need CI for severe or profound hearing loss, with excellent outcomes in hearing rehabilitation. However, vestibular function influenced by CI in children with EVA has not been clarified. We compared the characteristics of vestibular function in implanted children with EVA and those with a normal cochlea.Methods: In this retrospective case-control study, 16 children with large vestibular aqueduct syndrome (LVAS) and 16 children with a normal cochlea were recruited as the Study and Control Group, respectively. All children (mean age, 10.3 ± 4.4 years) had bilateral profound sensorineural hearing loss (SNHL) and normal pre-operative vestibular functions and underwent unilateral CI. Otolith and canal functions were assessed before CI and 12 months thereafter. Cervical vestibular-evoked myogenic potential (cVEMP), ocular vestibular-evoked myogenic potential (oVEMP), and video head impulse test (vHIT) were evaluated.Results: Full insertion of the electrode array was achieved in all the cases. Preoperatively, no significant differences in parameters in cVEMP between the Study and Control Group were revealed (p > 0.05). In pre-operative oVEMP, shorter N1 latencies (p = 0.012), shorter P1 latencies (p = 0.01), and higher amplitudes (p = 0.001) were found in the Study than in the Control Group. The Study Group had shorter P1 latency in cVEMP (p = 0.033), and had lower amplitude in oVEMP after implantation (p = 0.03). Statistically significant differences were not found in VOR gains of all three semicircular canals before and after surgery (p > 0.05). VEMP results revealed that the Control Group had significantly lower deterioration rates after CI (p < 0.05). The surgical approach and electrode array had no statistically significant influence on the VEMP results (p > 0.05).Conclusion: oVEMP parameters differed between children with EVA and children with a normal cochlea before surgery. Systematic evaluations before and after CI showed that otolith function was affected, but all three semicircular canals functions were essentially undamaged after implantation. In contrast to subjects with a normal cochlea, children with EVA are more likely to preserve their saccular and utricular functions after CI surgery. Possible mechanisms include less pressure-related damage, a reduced effect in terms of the air-bone gap (ABG), or more sensitivity to acoustic stimulation.

Vestibular Function in Children With a Congenital Cytomegalovirus Infection: 3 Years of Follow-Up.

Congenital cytomegalovirus (cCMV) infection is the most common nongenetic cause of sensorineural hearing loss in children. Due to the close anatomical relationship between the auditory and the vestibular sensory organs, cCMV can also be an important cause of vestibular loss. However, the prevalence and nature of cCMV-induced vestibular impairment is still underexplored. The aim of this study was to investigate the occurrence and characteristics of vestibular loss in a large group of cCMV-infected children, representative of the overall cCMV-population. Ninety-three children (41 boys, 52 girls) with a confirmed diagnosis of cCMV were enrolled in this prospective longitudinal study. They were born at the Ghent University Hospital or referred from another hospital for multidisciplinary follow-up in the context of cCMV. The test protocol consisted of regular vestibular follow-up around the ages of 6 months, 1 year, 2 years, and 3 years with the video Head Impulse Test, the rotatory test, and the cervical Vestibular Evoked Myogenic Potential test. On average, the 93 patients (52 asymptomatic, 41 symptomatic) were followed for 10.2 months (SD: 10.1 mo) and had 2.2 examinations (SD: 1.1). Seventeen (18%) patients had sensorineural hearing loss (7 unilateral, 10 bilateral). Vestibular loss was detected in 13 (14%) patients (7 unilateral, 6 bilateral). There was a significant association between the occurrence of hearing loss and the presence of vestibular loss (p < 0.001), with 59% (10/17) vestibular losses in the group of hearing-impaired children compared to 4% (3/76) in the group of normal-hearing subjects. In the majority of the cases with a vestibular dysfunction (85%, 11/13), both the semicircular canal system and the otolith system were affected. The remaining subjects (15%, 2/13) had an isolated semicircular canal dysfunction. Sixty-one patients already had at least one follow-up examination. Deterioration of the vestibular function was detected in 6 of them (10%, 6/61). cCMV can impair not only the auditory but also the vestibular function. Similar to the hearing loss, vestibular loss in cCMV can be highly variable. It can be unilateral or bilateral, limited or extensive, stable or progressive, and early or delayed in onset. As the vestibular function can deteriorate over time and even normal-hearing subjects can be affected, vestibular evaluation should be part of the standard otolaryngology follow-up in all children with cCMV.

Effect of otitis media with effusion on vestibular function in children: a pilot study

Objective:To investigate the effect of otitis media with effusion（OME） on vestibular function in children. Method:A total of 57 patients diagnosed with OME were collected and treated with grommet insertion and returned to our hospital 2 weeks later. Sixty children were also included as control group. Bone conducted vestibular evoked myogenic potentials（VEMP） and video head impulse（vHIT） were performed with OME patients both preoperatively and postoperatively. Control group received the same examination. The N1 latency, P1 latency, N1-P1 amplitude, N1-P1 latency were recorded with 60 dB nHL bone conducted stimulus, also bone conducted VEMP threshold. Single factor analysis of variance and paired t-test were used for statistical analysis. Result:In OME group, threshold value of oVEMP was higher and amplitude of N1-P1 in OME group was lower after grommet insertion. In cVEMP, amplitude of N1-P1 in the normal group and OME preoperative group was larger than that in postoperative group. In oVEMP, there was no significant difference in N1-P1 amplitude between control group and OME preoperative group, N1 latency, P1 latercy and N1-P1 latency showed no significant difference as well. In cVEMP, there was no significant difference in N1-P1 amplitude between control group and OME group. There were no significant differences in threshold, N1 latency, P1 latency and N1-P1 latency. In vHIT, there was no significant difference between OME group, postoperative group and control group. After grommet insertion, instantaneous gain of the horizontal semicircular canal at 60 ms was lower than that before surgery. Conclusion:Vestibular test results of children with OME are different from those of normal children, and the corresponding changes also occur after grommet insertion, which deserves further clinical attention.