1Department of Speech, Language and Hearing Sciences, 2Department of Rehabilitation Sciences and Physiotherapy, and 3Department of Oto-rhino-laryngology, Artevelde University College, Ghent University, Ghent, Belgium.
Ear Hear. 2014 Mar-Apr;35(2):e21-32. doi: 10.1097/AUD.0b013e3182a6ca91.
Vertigo and imbalance are often underestimated in the pediatric population, due to limited communication abilities, atypical symptoms, and relatively quick adaptation and compensation in children. Moreover, examination and interpretation of vestibular tests are very challenging, because of difficulties with cooperation and maintenance of alertness, and because of the sometimes nauseatic reactions. Therefore, it is of great importance for each vestibular laboratory to implement a child-friendly test protocol with age-appropriate normative data. Because of the often masked appearance of vestibular problems in young children, the vestibular organ should be routinely examined in high-risk pediatric groups, such as children with a hearing impairment. Purposes of the present study were (1) to determine age-appropriate normative data for two child-friendly vestibular laboratory techniques (rotatory and collic vestibular evoked myogenic potential [cVEMP] test) in a group of children without auditory or vestibular complaints, and (2) to examine vestibular function in a group of children presenting with bilateral hearing impairment.
Forty-eight typically developing children (mean age 8 years 0 months; range: 4 years 1 month to 12 years 11 months) without any auditory or vestibular complaints as well as 39 children (mean age 7 years 8 months; range: 3 years 8 months to 12 years 10 months) with a bilateral sensorineural hearing loss were included in this study. All children underwent three sinusoidal rotations (0.01, 0.05, and 0.1 Hz at 50 degrees/s) and bilateral cVEMP testing.
No significant age differences were found for the rotatory test, whereas a significant increase of N1 latency and a significant threshold decrease was noticeable for the cVEMP, resulting in age-appropriate normative data. Hearing-impaired children demonstrated significantly lower gain values at the 0.01 Hz rotation and a larger percentage of absent cVEMP responses compared with normal-hearing children. Seventy-four percent of hearing-impaired children showed some type of vestibular abnormality when examined with a combination of rotatory and cVEMP testing, in contrast to an abnormality rate of 60% with cVEMP and a rate of 49% with rotatory testing alone.
The observed pediatric age correlations underscore the necessity of age-appropriate normative data to guarantee accurate interpretation of test results. The high percentages of abnormal vestibular test results in hearing-impaired children emphasize the importance of vestibular assessment in these children because the integrity of the vestibular system is a critical factor for motor and psychological development.
由于儿童沟通能力有限、症状不典型以及儿童适应和代偿能力较强，儿科人群中的眩晕和失衡问题常被低估。此外，由于儿童合作和保持警觉存在困难，以及有时会出现恶心反应，因此对前庭测试进行检查和解释极具挑战性。因此，对于每个前庭实验室来说，制定一个具有年龄适宜的正常数据的儿童友好型测试方案非常重要。由于幼儿的前庭问题常表现不明显，因此应在听力障碍等高危儿科人群中常规检查前庭器官。本研究的目的是：（1）在一组无听觉或前庭主诉的儿童中，确定两种儿童友好型前庭实验室技术（旋转和球囊性前庭诱发肌源性电位[cVEMP]测试）的年龄适宜的正常数据；（2）检查双侧听力障碍儿童的前庭功能。
本研究纳入 48 名无任何听觉或前庭主诉且发育正常的儿童（平均年龄 8 岁 0 个月；范围：4 岁 1 个月至 12 岁 11 个月），以及 39 名双侧感音神经性听力损失儿童（平均年龄 7 岁 8 个月；范围：3 岁 8 个月至 12 岁 10 个月）。所有儿童均接受了 3 次正弦旋转（0.01、0.05 和 0.1 Hz，50°/s）和双侧 cVEMP 测试。
旋转测试无显著年龄差异，而 cVEMP 的 N1 潜伏期显著延长，阈值显著降低，从而得到了年龄适宜的正常数据。与听力正常的儿童相比，听力受损儿童在 0.01 Hz 旋转时的增益值明显较低，且 cVEMP 反应缺失的百分比更大。与仅进行 cVEMP 检查时的异常率 60%和仅进行旋转检查时的异常率 49%相比，当结合旋转和 cVEMP 检查时，74%的听力受损儿童表现出某种类型的前庭异常。
观察到的儿科年龄相关性强调了使用年龄适宜的正常数据来保证测试结果准确解释的必要性。听力受损儿童异常前庭测试结果的高百分比强调了对这些儿童进行前庭评估的重要性，因为前庭系统的完整性是运动和心理发育的关键因素。
