Pediatric Vestibular Assessment: Clinical Framework

Abstract

Objectives: Although vestibular deficits can have severe repercussions on the early motor development in children, vestibular assessment in young children has not yet been routinely integrated in clinical practice and clear diagnostic criteria to detect early vestibular deficits are lacking. In young children, specific adjustments of the test protocol are needed, and normative data are age-dependent as the vestibular pathways mature through childhood. Therefore, this study aims to demonstrate the feasibility of an extensive age-dependent vestibular test battery, to provide pediatric normative data with the concurrent age trends, and to offer a clinical framework for pediatric vestibular testing. Design: This normative study included 133 healthy children below the age of 4 years (mean: 22 mo, standard deviation: 12.3 mo, range: 5–47 mo) without history of hearing loss or vestibular symptoms. Children were divided into four age categories: 38 children younger than 1 year old, 37 one-year olds, 33 two-year olds, and 25 three-year olds. Children younger than 3 years of age were examined with the video Head Impulse Test (vHIT) of the horizontal semicircular canals, cervical vestibular evoked myogenic potentials (cVEMP) with bone conduction stimuli, and the rotatory test at 0.16, 0.04, and 0.01 Hz. In 3-year old children, the vHIT of the vertical semicircular canals and ocular vestibular evoked myogenic potentials (oVEMP) using a minishaker were added to the protocol. Results: The horizontal vHIT appeared to be the most feasible test across age categories, except for children younger than 1-year old in which the success rate was the highest for the cVEMP. Success rates of the rotatory test varied the most across age categories. Age trends were found for the vHIT as the mean vestibulo-ocular reflex (VOR) gain increased significantly with age (r = 0.446, p < 0.001). Concerning the cVEMP, a significant increase with age was found for latency P1 (r = 0.420, p < 0.001), rectified interpeak amplitude P1-N1 (r = 0.574, p < 0.001), and averaged electromyographic (EMG) activity (r = 0.430, p < 0.001), whereas age trends for the latency N1 were less pronounced (r = 0.264, p = 0.004). Overall, the response parameters of the rotatory test did not show significant age effects (p > 0.01), except for the phase at 0.01 Hz (r = 0.578, p < 0.001). Based on the reported success rates and age-dependent normative vestibular data, straightforward cutoff criteria were proposed (vHIT VOR gain < 0.7, cVEMP rectified interpeak amplitude < 1.3, oVEMP interpeak amplitude < 10 µV) with accompanying clinical recommendations to diagnose early vestibular impairment. Conclusions. In this large cohort of typically developing children below the age of 4 years, the vHIT and cVEMP were the most feasible vestibular tests. Moreover, the age-dependent normative vestibular data could specify age trends in this group of young children. Finally, based on the current results and clinical experience of more than ten years at the Ghent University Hospital (...

Cervical vestibular evoked myogenic potentials in healthy children: Normative values for bone and air conduction

“…Different protocols have been proposed to record c-VEMPs in children (12,13,(17)(18)(19)(20)22). However, their results are difficult to compare because some were obtained with BC stimulation and others with AC stimulation.…”

“…It has even been reported that AC c-VEMPs can be recorded in term (17) and pre-term newborns (18), but not with a 100% success rate. BC c-VEMPs have been successfully used as a vestibular screening test in a large group of hearing-impaired infants tested at the age of 6 months (19) and the feasibility of BC c-VEMPs in a newborn hearing screening protocol has also been demonstrated (20). A decrease in AC c-VEMP amplitude response with age has been reported in healthy adult subjects (3,4,21), as well as in a wider population of 85 healthy participants (10 patients aged 10-19 years) for both AC and BC c-VEMP amplitude responses (16).…”

“…Martens et al(19) used, as here, the normalization method based on EMG quantification from individual trace EMGs. This was recently reported as the best approach by van Tilburg et al…”

Predicting Early Vestibular and Motor Function in Congenital Cytomegalovirus Infection

“…vHIT maneuvres were performed with an amplitude between 10 and 20 degrees and peak velocity above 150 degrees per second. Gain values between 0.7 and 0.4 were considered mild lateral SCC dysfunction 32 and values below 0.4 were defined as severe impairment 10 . Saccular function was evaluated through bone‐conducted cVEMP measurements (Bio‐Logic Navigator‐Pro platform, Mundelein, IL, and Neuro‐Audio version 2010, Neurosoft, Ivanovo, Russia) using linear 500 Hz tone bursts presented at the mastoid at 59 dB HL (129 dB force level) intensity.…”

“…Saccular function was evaluated through bone‐conducted cVEMP measurements (Bio‐Logic Navigator‐Pro platform, Mundelein, IL, and Neuro‐Audio version 2010, Neurosoft, Ivanovo, Russia) using linear 500 Hz tone bursts presented at the mastoid at 59 dB HL (129 dB force level) intensity. Rectified interpeak amplitudes below 0.3 (Bio‐Logic) or 1.3 (Neuro‐Audio) were classified as mild saccular dysfunction 32 . Severe saccular dysfunction was concluded if no reproducible cVEMP‐response could be elicited at all 10 .…”