Vestibular evoked myogenic potentials in children with sensorineural hearing loss

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Abstract

Objective of the study

To assess the saccular function using the vestibular evoked myogenic potential (VEMP) test in children with severe to profound sensorineural hearing loss.

Methods

15 children (12 males and 3 females) with severe to profound sensorineural hearing loss in the age range of 4–12 years constituted the study group. 10 children (6 males and 4 females) with normal hearing constituted the control group. All the children were evaluated for saccular function by using the vestibular evoked myogenic potentials (VEMP).

Results

For study group the mean P1 and N1 latencies values were 15.12 ms and 23.86 ms, respectively. For control group the mean P1 and N1 latencies were 15.39 ms and 23.68 ms. The comparison of mean P1 and N1 latencies values between study and control groups revealed no significant difference (p > 0.05). Furthermore, the mean amplitude values of VEMP responses for study and control groups were 75.78 μV and 160.51 μV, respectively. The comparison mean amplitude values between study and control groups revealed statistically significant difference (p < 0.05). Out of 15 children in the study group 2 children had the absent VEMP response in both the ears.

Conclusion

Because the vestibular function plays an important role in gross motor development in children, audiologists and otologist should recognize and understand the vestibular dysfunction in hearing impaired children and be prepared to undertake appropriate evaluations.

However, additional research is needed on a larger sample size to determine the value of routine vestibular evaluation in children with sensorineural hearing loss and its potential benefit on the clinical outcome of these patients along with VEMP testing.

Introduction

It is well known that anatomically and phylogenetically, the cochlea and vestibular receptors, the semicircular canals and otolith organs, are closely related. They share the continuous membranous labyrinth of the inner ear and function by means of very similar receptor cells. Hence, it is reasonable to presume that many children with hearing impairment have concomitant vestibular abnormalities [1], [2], [3]. Although the incidence of profound sensorineural hearing loss is estimated at 1 in 1000 live births, the incidence of vestibular loss is unknown. Published reports have shown that vestibular dysfunction is found in 20–70% of children with hearing loss of different causes [4].

In recent years, there has been a growing awareness of vestibular dysfunction in children with hearing impairment. Efforts to create child friendly vestibular evaluation procedures have yielded important progress [5], [6], [7]. One such test to assess vestibular abnormalities is vestibular evoked myogenic potential (VEMP). It is an objective, non-invasive, time saving, and well tolerable test to evaluate the function of the saccule and inferior vestibular nerve. The VEMP responses arise from modulation of background electromyographic (EMG) activity and differ from neural potentials in that it requires tonic contraction of the sternocleidomastoid (SCM) muscles [8].

Section snippets

Objective of the study

To assess the saccular function using the VEMP test in children with severe to profound sensorineural hearing loss.

Need for the study

Children with congenital and early onset SNHL are usually well managed. But vestibular function deficits in hearing-impaired children are often overlooked and not thoroughly investigated, in contrast to the adult population.

Hence there is a need to assess the vestibular problems in hearing impaired children for better diagnosis and management.

Participants

The present study includes two groups, i.e., study group and control group. The study group consisted of 15 children (mean age 6.7 years) with severe to profound sensorineural hearing loss including 12 males and 3 females in the age range of 4–12 years. The control group consisted of 10 normal hearing children (mean age 7.7 years) including 6 males and 4 females in the age range of 4–12 years.

Audiological and vestibular evaluation

A detailed case history was taken along with audiological and vestibular assessment. Prior to testing, each participant was given verbal instructions describing the experiment and his/her task to be performed. Pure tone audiometry was done to find out the type and degree of hearing loss. It includes air conduction thresholds from 250 Hz to 8000 Hz and bone conduction threshold from 250 Hz to 4000 Hz. For all children in the study group pure tone thresholds were in the range of 70–90 dBHL or above.

Results

Table 1 depicts the comparison of mean and SD values of P1 and N1 latencies and amplitude in the study and control groups. No significant difference was observed for the latencies of P1 and N1 (p > 0.05). However a significant reduction in the amplitude was observed in the study group as compared with the control group (p < 0.05). Moreover, out of 15 children in the study group 2 children had the absent VEMP response in both the ears. These findings suggested peripheral vestibular deficit (i.e.,

Discussion

Published reports show that vestibular dysfunctions found in 20–70% of children with hearing loss of different causes [4]. To verify vestibular dysfunction in children with hearing loss we used VEMP test as it is feasible and relatively easy method to conduct vestibular evaluation in children. The test usually takes only 15–30 min and is well tolerated by children at any age group.

Our study of saccular function by VEMP testing showed a high percentage of abnormality in hearing impaired children.

Conclusion

The present study has shown vestibular abnormalities in children with severe to profound sensorineural hearing loss as revealed by the VEMP findings. Findings of the present study will add to the scanty literature to increase the accuracy of the data relating to the need of vestibular testing in children with severe-profound hearing loss.

Moreover, additional research is needed on a larger sample size to determine the value of routine vestibular evaluation in children with sensorineural hearing

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