Vestibular Dysfunction Associated with Hearing Impairment

Presented by, Teri Travisano, PT, DPT UNC Pediatric PT Resident

Why this topic?

š Clinical experience and observations š Curiosities related to an apparent void š Difficult for children to describe symptoms š To address a self identified area of deficit š Personal relationship Multidisciplinary Implications

š Pediatricians š Audiologists š Speech Therapists š Neurotologists š (Pediatric) Occupational š Ophthalmologists and Physical Therapists š Otolaryngologists š with advanced training š Otologists + Others possible Causes of Vestibular Dysfunction in Kids

Etiology: š Benign Paroxymal Vertigo of Childhood š Viral Infections š Vestibular neuritis š Labyrinthitis š Otitis Media š Migraine š Head Trauma š Meniere’s disease š Tumors Also associated with: Sensorineural and Conductive Hearing Loss

A Brief context A Brief context

š Prevalence of mod-profound hearing loss, including sensorineural and conductive, is 1-6/1000.

š 10% fall in profound range (Rajendran V, 2011)

š Deaf Children demonstrate greater motor delays than hearing

peers (Maes L, 2014)

š 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)

š Is an exercise-based program for reducing disequilibrium and dizziness š Can include balance, eye gaze, and coordination exercises š Current research indicates that intervention in children with HI is ideal at 3–4 years of age š This is the critical period of balance skill development. š Children of other ages also demonstrate gains with VRT. š Research is ongoing to determine role of treatment for children. š Eg. Efficacy, parameters, and how this can be part of a team approach to best help a child.

References:

š 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. š 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. š 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. š GW. Cronin, and RM Rine. “Pediatric Vestibular Disorders Recognition, Evaluation and Treatment.” Vestibular Disorders Association. www.vestibular.org š 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. š Janky, Kristen L., and Diane Givens. "Vestibular, Visual Acuity, and Balance Outcomes in Children with Cochlear Implants: A Preliminary Report." Ear & Hearing Web. š 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. š 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. š 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. š DG Balatsouras, et al. “Etiology of vertigo in children.” International Journal of Pediatric Otorhinolaryngology 71 (2007): 487-494. š 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. š 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 š R D’Agostino. “Otoneurologic evaluation of child vertigo.” International Journal of Pediatric Otorhinolaryngology 40 (1997): 133-139. š RM Rine, and S Wiener-Vacher. “Evaluation and treatment of vestibular dysfunction in children.” NeuroRehabilitation 32 (2013): 507-518. š K Jahn. “Vertigo and balance in children- Diagnostic approach and insights from imaging.” European Journal of Paediatric Neurology 15 (2011): 289-294. š A Chariot. “Vestibulo-Ocular Reflex and Balance Maturation in Healthy Children Aged from Six to Twelve Years.” AudiolNeurotol 15 (2010): 203-210. š 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

š Catherine Wilson š Dana McCarty š Deborah Thorpe š Paula Geier š Audiologists š LEND and CIDD š UNC PT Faculty and Staff š Abby Ampil š Tina, My Parents, My Husband