MM201 - Inclusion of a Balance Screening Tool in Pediatric Hearing Test Battery

Abstract:
The prevalence of vestibular dysfunction in children with sensorineural hearing loss (SNHL) is estimated between 20% and 70%. There are functional, behavioral, neurocognitive, and neuromotor implications of VD on a developing child. Early identification and intervention of VD among these children will help improve balance and promote neurocognitive, spatial, and motor development. The purpose of this mini module is to highlight the significance of vestibular screening in children with hearing loss, to describe the role of the audiologist in vestibular screening in pediatric population, and to provide evidence-based literature regarding available vestibular screening tests for pediatric population.

Summary:
Many children with hearing loss often experience vertigo, general dizziness, or unsteadiness. Children are typically unable to express complex symptoms of imbalance or dizziness. When identifying vestibular dysfunction (VD) in the pediatric population, clinicians often rely on parental reporting or the case history. While these are valuable pieces of information, relying solely on parental reporting may cause clinicians to miss an underlying vestibular dysfunction when the parent might think that it is typical for young children to be unsteady or fall often and thus not report to medical professionals. It is important to include a vestibular function screening tool as part of the pediatric evaluation, specifically when the child presents with hearing loss.

The repercussions of missing a vestibular dysfunction may weigh heavily on a child’s motor milestone development and cognitive functioning (Cushing et al., 2007). There are considerable impacts on one’s cognitive load that will require additional focus in order to remain upright and steady throughout the day. Additionally, studies suggest that increased tiredness, memory deficits, and decreased school performance are associated with untreated vestibular dysfunction in the pediatric population (Hazen & Cushing, 2021). New research has shown a link between vestibular dysfunction and specific language disorders (SLD) which further shows the need for vestibular screening and diagnostic testing. It was originally thought to only impact children with sensorineural hearing loss, but research has shown that it can impact those with conductive and mixed losses as well.

The surmounting impacts of vestibular dysfunction can be reduced or eliminated with early identification and intervention. The use of balance screenings will allow clinicians to efficiently determine if a child would benefit from a referral for diagnostic vestibular testing. A study by Hazen and Cushing recommends three components including a review of the patient’s motor milestones, a direct balance assessment, and an assessment of horizontal semicircular canal function. The following screenings have been selected and are recommended for use in newborns to age 21. These screenings include the Bruininks – Oseretsky Test of Motor Proficiency (2nd Ed.) which is intended for ages 4 to 15 years of age, the Pediatric Berg Balance Scale which is intended for ages 5 to 15 years of age, the Video Head Impulse Test (vHIT) and lastly the cervical vestibular evoked myogenic potential (cVEMP) test (appropriate for all ages). The usage of these screening tools will be crucial in identifying children who may need further diagnostic testing and treatment to set them up to reach their communication and educational goals.