Janky Kristen L, Thomas Megan L A, High Robin R, Schmid Kendra K, Ogun Oluwaseye Ayoola
Department of Audiology, Boys Town National Research Hospital, Omaha, NE.
Department of Biostatistics, University of Nebraska Medical Center, Omaha.
Am J Audiol. 2018 Mar 8;27(1):137-146. doi: 10.1044/2017_AJA-17-0058.
The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss.
A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for vestibular testing from 1999 to 2015 through neurosensory genetics clinic or cochlear implant candidacy. Each child's medical chart was reviewed to obtain the following data: vestibular loss severity (classified as normal, bilateral, or mild to moderate), degree of hearing loss (bilateral pure-tone average [PTA]), imaging abnormalities (classified as "normal" or "abnormal"), parental concerns for gross motor delay (classified as "yes, there is concern" or "no, there is not a concern"), parent report of age when their child sat (months) and walked independently (months), comorbidities (classified as "yes" if there were 1 or more comorbidities or "no" if there were no comorbidities), and score on the Developmental Profile-3.
Children were grouped according to vestibular loss severity; 115 children had normal vestibular function, 31 had bilateral vestibular loss, and 40 had mild-to-moderate vestibular loss. As severity of vestibular loss increased, children (a) sat and walked later, (b) scored more poorly on the Developmental Profile-3 physical subscale, (c) had more severe hearing loss, (d) had parents who more frequently reported concern for gross motor delay, and (e) were more likely to have other comorbidities. Of these factors, age-to-sit, age-to-walk, PTA, and parental concerns for gross motor developmental delay had the greatest ability to differentiate children with vestibular loss from children with normal vestibular function. For age-to-sit, using a cutoff value of 7.25 months yielded a sensitivity of 62% and a specificity of 81%. For age-to-walk, a cutoff value of 14.5 months yielded a sensitivity of 78% and a specificity of 77%. For PTA for the neurosensory genetics group, a cutoff value of 40 dB yielded a sensitivity of 80% and a specificity of 55%; however, a cutoff value of 66 dB yielded a sensitivity of 33% and an improved specificity of 91%.
A referral for vestibular evaluation should be considered for children whose hearing loss is greater than 66 dB and particularly those who sit later than 7.25 months or walk later than 14.5 months or whose parents report concerns for gross motor development. Collectively, these factors appear to be more sensitive for identifying children with bilateral vestibular loss compared with children with mild-to-moderate vestibular loss. Because of the benefit of physical therapy, children identified with vestibular loss should then be referred to physical therapy for further evaluation and treatment.
本研究旨在确定是否存在能够预测听力损失儿童是否也会出现前庭功能损失的因素。
对1999年至2015年期间在博伊城国家研究医院通过神经感觉遗传学诊所或人工耳蜗植入候选资格接受前庭测试的186名听力损失儿童进行了回顾性病历审查。查阅了每个儿童的病历以获取以下数据：前庭功能损失严重程度（分为正常、双侧或轻度至中度）、听力损失程度（双侧纯音平均听阈[PTA]）、影像学异常（分为“正常”或“异常”）、父母对粗大运动发育迟缓的担忧（分为“是，存在担忧”或“否，不存在担忧”）、父母报告孩子坐立（月龄）和独立行走（月龄）的年龄、合并症（如果有1种或更多合并症则分为“是”，如果没有合并症则分为“否”）以及发展概况-3的得分。
根据前庭功能损失严重程度对儿童进行分组；115名儿童前庭功能正常，31名儿童双侧前庭功能损失，40名儿童轻度至中度前庭功能损失。随着前庭功能损失严重程度的增加，儿童（a）坐立和行走较晚，（b）在发展概况-3身体分量表上得分较低，（c）听力损失更严重，（d）父母更频繁地报告对粗大运动发育迟缓的担忧，（e）更有可能患有其他合并症。在这些因素中，坐立年龄、行走年龄、PTA以及父母对粗大运动发育迟缓的担忧最能区分前庭功能损失儿童和前庭功能正常的儿童。对于坐立年龄，使用7.25个月的临界值时，敏感性为62%，特异性为81%。对于行走年龄，14.5个月的临界值时，敏感性为78%，特异性为77%。对于神经感觉遗传学组的PTA，40 dB的临界值时，敏感性为80%，特异性为55%；然而，66 dB的临界值时，敏感性为33%，特异性提高到91%。
对于听力损失大于66 dB的儿童，尤其是那些坐立晚于7.25个月或行走晚于14.5个月或父母报告对粗大运动发育有担忧的儿童，应考虑进行前庭功能评估转诊。总体而言相比轻度至中度前庭功能损失的儿童，这些因素似乎对识别双侧前庭功能损失的儿童更敏感。由于物理治疗有益，因此被确定为前庭功能损失的儿童应转诊至物理治疗进行进一步评估和治疗。
