Children, Only, Vestibular Disorder, Vestibular Function, Sensorineural Hearing Loss
Conditions
Keywords
Vestibular dysfunction, Balance problem, Children, Hearing Loss, Dizziness, Vestibular assessment, video Head Impulse Test, Vestibular Evoked Myogenic Potential, Computerized Dynamic Posturography, Quality of life
Brief summary
The goal of this prospective cohort study is to investigate the vestibular function in children with unilateral or bilateral sensorineural hearing loss. The main hypothesis of the study is that abnormal vestibular test results will be found in 20-30 % of the children with sensorineural hearing loss. The participants will be children in the age of 3-10 years with sensorineural hearing loss. The test protocol consists of questionnaires and vestibular and postural assessments.
Detailed description
Balance problems in children are an overlooked issue in the Danish healthcare system. Dysfunction of the vestibular system, i.e. vestibular dysfunction (VD), can have significant consequences for children's development and quality of life. In particular, children with sensorineural hearing loss are at risk of developing VD. Hence, VD has been reported in 14 % to 91 % of children with sensorineural hearing loss. The close anatomical and embryological relationship between the hearing system and the vestibular system may of course explain this correlation. The investigators aim for a child friendly and reliable vestibular test protocol in the study. According to the investigators studies as well as international reports, the investigators have chosen a vestibular test protocol with Video Head Impulse Test (v-HIT), cervical and ocular Vestibular Evoked Myogenic Potential (c and oVEMP) as the tests are feasible, valid, and child friendly. To evaluate overall balance ability, the children are tested on a Computerized Dynamic Posturography. The aim of the study is to investigate the vestibular function in children with unilateral or bilateral sensorineural hearing loss. Hypothesis: The investigators expect that abnormal vestibular test results will be found in 20-30 % of the children with sensorineural hearing loss. Methods: The study is a prospective cohort study. Participants are a prospective, unselected group of children in the age of 3-10 years with either unilateral or bilateral sensorineural hearing loss. The participants are recruited at The Audiologic Clinic at Viborg Regional Hospital, Denmark. All participants will go through a test protocol consisting of questionnaires and vestibular and postural assessments. The primary endpoints are results of v-HIT, c and oVEMP, and posturography, which are compared to normative values. The secondary endpoints are prevalence of vestibular dysfunction and mean total Dizziness Handicap Inventory for patient caregivers (DHI-PC) score. A number of variables are collected such as demographics, developmental milestones, family history with focus on hearing and balance.
Interventions
DIAGNOSTIC_TESTvideo Head Impulse Test
For v-HIT, the Synapsys v-HIT Ulmer device is used.
DIAGNOSTIC_TESTCervical Vestibular Evoked Myogenic Potential
For cVEMP, the Eclipse (Interacoustic, Middelfart, Denmark) is used. To bypass the frequent middle ear problems bone conduction stimuli (B-81, Interacoustic, Middelfart, Denmark) are administrated. The bone conductor is placed on the mastoid process and two trials at 70 dB nHL are conducted to check waveform reproducibility. 500 Hz short tone bursts (2-2-2 ms) are applied at 5 per second stimulus repetition rate.
DIAGNOSTIC_TESTOcular Vestibular Evoked Myogenic Potential
For oVEMP, the Eclipse (Interacoustic, Middelfart, Denmark) is used. To bypass the frequent middle ear problems bone conduction stimuli (B-81, Interacoustic, Middelfart, Denmark) are administrated. The bone conductor is placed on the mastoid process and two trials at 70 dB nHL are conducted to check waveform reproducibility. 500 Hz short tone bursts (2-2-2 ms) are applied at 5 per second stimulus repetition rate.
DIAGNOSTIC_TESTComputerized Dynamic Posturography
To evaluate functional balance of the children and the relative contributions of the vision, proprioception, and vestibular system a CDP from Virtualis (Virtualis, Montpellier, France) is used.
DHI is a caregiver-reported 21- item questionnaire. It is designed to evaluate the perceived quality of life and handicap resulting from dizziness and unsteadiness for the pediatric population. For each question there are three possible answers: yes, sometimes or no. Each answer provides respectively 4, 2 and 0 points. The total DHI scores range from 0 to 84 with higher score being consistent with more limitation and more severe handicap. Scores under 16 are characterized as no limitation or handicap. A score from 16-26 present a mild perceived handicap and mild limitations. A DHI-score between 26-43 is classified as a moderate problem, and a score above 43 describes a severe perceived handicap and severe limitations.
Sponsors
Gødstrup Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
3 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* Children in the age of 3-10 years * Uni- or bilateral sensorineural hearing loss \> 20 dB bone conduction pure tone average measured at frequencies 0.5, 1, 2, 4 kHz * Written informed consent from the parents.
Exclusion criteria
* Previous inner ear surgery * Visual impairment to such a degree that the child is not able to maintain fixation on a dot one meter away. * Congenital nystagmus * Compromised eye muscle mobility * VEMP-electrode allergy * History of symptomatic head or neck trauma * Prescription of medicine which alters vestibular outputs (for instance sedative antihistamines)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| video Head Impulse Test (vHIT) | Measured at baseline. | Outcome measures: mean VOR gain |
| Cervical Vestibular Evoked Myogenic Potential (cVEMP): | Measured at baseline. | Outcome measures: latency P1 and latency N1 in milliseconds (ms) |
| Ocular Vestibular Evoked Myogenic Potential (oVEMP): | Measured at baseline. | Outcome measures: latency N1 and latency P1 in milliseconds |
| Computerized Dynamic Posturography (CDP) | Measured at baseline. | Outcome measures: Sensory Organization Test (SOT): * Average equilibrium score (ES) for SOT1-6. Equilibrium scores is the average of three trials for each of the six conditions SOT1-6. * The SOT Composite score. It is a weighted average of the six conditions (SOT1-6) with greater weight given to the more difficult conditions. * The preference score. The preference score = (SOT3 + SOT6) / (SOT2 + SOT5)). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Vestibular dysfunction | Measures at baseline | Prevalence of vestibular dysfunction |
| Dizziness Handicap Inventory for patient caregivers (DHI-PC): | Measured at baseline. | Outcome measures: Mean total DHI-PC score. DHI-PC is a caregiver-reported 21-item questionnaire. For each question there are three possible answers: yes, sometimes or no. Each answer provides respectively 4, 2 and 0 points. The total DHI scores range from 0 to 84 with higher score being consistent with more limitation and more severe handicap. |
Countries
Denmark
Contacts
Primary ContactSigne F Bønløkke, PhD student
Outcome results
None listed