International Journal of Pediatric Otorhinolaryngology
Vestibular evoked myogenic potentials in children with sensorineural hearing loss
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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Why and when to refer patients for vestibular evoked myogenic potentials: A critical review
2019, Clinical NeurophysiologyVestibular Infant Screening – Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders
2019, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :During the test period from June 2018 until May 2021, approximately 400 infants will be referred for the vestibular screening. Since a screening test should be short, sensitive, objective and in this case also child-friendly, the cVEMP is selected as standard vestibular screening test [15,18,24,25,48,53–55]. Moreover, literature suggests a higher occurrence of saccular deficits, which the cVEMP examines [52], compared to semicircular canal dysfunctions in hearing-impaired children [20,22,23].
The relationship between senile hearing loss and vestibular activity
2016, Brazilian Journal of OtorhinolaryngologyOtolithic organ function in patients with profound sensorineural hearing loss
2016, Journal of OtologyCitation Excerpt :The cochlea and vestibule are functionally and anatomically associated as they share a continuous membranous labyrinth and similar receptor cell ultrastructures, and are supplied by a common arterial vessel known as the labyrinthine artery (Xu et al., 2016; Wang et al., 2016). Therefore, it is reasonable to hypothesize that inner ear diseases may affect both the vestibular system and the cochlea, or in other words, that people with cochlear hearing damage may also have vestibular deficiency (Singh et al., 2012). Therefore, patients with PSHL should have their vestibular organ functions tested, especially those of the otolithic organs.
Cervical vestibular evoked myogenic potentials in children
2015, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :The latency and amplitude values we found in this study are similar to those reported in the literature in similar age groups (4–19 years). In other pediatric samples without otoneurologic disease using the head rotation method, the mean latency of P1 ranged between 11.3 and 15.4 ms, the mean latency of N2 ranged from 18.2 to 23.7 ms, and the mean total amplitude ranged from 126.7 to 160.5 μV, with asymmetry indices between 16–20%.12–14,18 The differences observed among studies are probably explained by the use of different devices, hence the importance of standardizing the reference values by type of equipment.