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

� Audiologists

� Neurotologists

� Ophthalmologists

� Otolaryngologists

� Otologists

� Pediatricians

� Speech Therapists

� (Pediatric) Occupational and Physical Therapists

� with advanced training

+ 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