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Vestibular Dysfunction Associated with Hearing Impairment

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Vestibular Dysfunction Associated with Hearing Impairment Vestibular Dysfunction Associated with Hearing Impairment Presented by, Teri Travisano, PT, DPT UNC Pediatric PT Resident Why this topic? Clinical experience and observations Curiosities related to an apparent void Difficult for children to describe symptoms To address a self identified area of deficit Personal relationship Multidisciplinary Implications Pediatricians Audiologists Speech Therapists Neurotologists (Pediatric) Occupational Ophthalmologists and Physical Therapists Otolaryngologists with advanced training Otologists + Others possible Causes of Vestibular Dysfunction in Kids Etiology: Benign Paroxymal Vertigo of Childhood Viral Infections Vestibular neuritis Labyrinthitis Otitis Media Migraine Head Trauma Meniere’s disease Tumors Also associated with: Sensorineural and Conductive Hearing Loss A Brief context A Brief context Prevalence of mod-profound hearing loss, including sensorineural and conductive, is 1-6/1000. 10% fall in profound range (Rajendran V, 2011) Deaf Children demonstrate greater motor delays than hearing peers (Maes L, 2014) Vestibular dysfunction is found in ~30-70% of HI children (Fernandes R, 2015) So Why the Association? Why Does it Affect Balance? Vestibular Rehabilitation Therapy (VRT) Is an exercise-based program for reducing disequilibrium and dizziness Can include balance, eye gaze, and coordination exercises Current research indicates that intervention in children with HI is ideal at 3–4 years of age This is the critical period of balance skill development. Children of other ages also demonstrate gains with VRT. Research is ongoing to determine role of treatment for children. Eg. Efficacy, parameters, and how this can be part of a team approach to best help a child. References: R Fernandes, S Hariprasad, and VK Kumar. “Physical therapy management for balance deficits in children with hearing impairments: A systematic review.” Journal of Paediatrics and Child Health (2015) 753–758. A De Kegel, et al. “Examining the Impact of Cochlear Implantation on the Early Gross Motor Development of Children With a Hearing Loss.” EAR & HEARING, VOL. 36, NO. 3, e113–e121. F Gheysen, G Loots, and H Van Waelvelde. “Motor Development of Deaf Children With and Without Cochlear Implants.” Journal of Deaf Studies and Deaf Education (Spring 2008) 215-224. GW. Cronin, and RM Rine. “Pediatric Vestibular Disorders Recognition, Evaluation and Treatment.” Vestibular Disorders Association. www.vestibular.org V Rajendran, FG Roy, and D Jeevanantham. “Postural control, motor skills, and health-related quality of life in children with hearing impairment: a systematic review.” Eur Arch Otorhinolaryngol (2012) 269:1063–1071. Janky, Kristen L., and Diane Givens. "Vestibular, Visual Acuity, and Balance Outcomes in Children with Cochlear Implants: A Preliminary Report." Ear & Hearing Web. Maes, L., et al. "Association between Vestibular Function and Motor Performance in Hearing-Impaired Children." Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 35.10 (2014): e343-7. Web. Rajendran, V., et al. "A Preliminary Randomized Controlled Study on the Effectiveness of Vestibular-Specific Neuromuscular Training in Children with Hearing Impairment." Clinical rehabilitation 27.5 (2013): 459-67. Web. DL McCaslin, GP Jacobson, JM Gruenwald. “The Predominant Forms of Vertigo in Children and Their Associated Findings on Balance Function Testing.” Otolaryngol Clin N Am 44 (2011) 291–307. DG Balatsouras, et al. “Etiology of vertigo in children.” International Journal of Pediatric Otorhinolaryngology 71 (2007): 487-494. KJ Mickle, BJ Munro, and JR Steele. “Gender and age affect balance performance in primary school-aged children.” Journal of Science and Medicine in Sport; (2011): 243-248. YH Choung, et al. “Various causes and clinical characteristics in vertigo in children with normal eardrums.” International Journal of Pediatric Otorhinolaryngology 67 (2003): 889/894 R D’Agostino. “Otoneurologic evaluation of child vertigo.” International Journal of Pediatric Otorhinolaryngology 40 (1997): 133-139. RM Rine, and S Wiener-Vacher. “Evaluation and treatment of vestibular dysfunction in children.” NeuroRehabilitation 32 (2013): 507-518. K Jahn. “Vertigo and balance in children- Diagnostic approach and insights from imaging.” European Journal of Paediatric Neurology 15 (2011): 289-294. A Chariot. “Vestibulo-Ocular Reflex and Balance Maturation in Healthy Children Aged from Six to Twelve Years.” AudiolNeurotol 15 (2010): 203-210. RM Rine, E Dannenbaum, and J Szabo. “2015 Section of Pediatrics Knowledge Translation Lecture: Pediatric Vestibular-Related Impairments. Pediatric Physical Therapy 28 (2016): 2-6. Aknowledgements Catherine Wilson Dana McCarty Deborah Thorpe Paula Geier Audiologists LEND and CIDD UNC PT Faculty and Staff Abby Ampil Tina, My Parents, My Husband .
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