LM103 - Vestibular Assessment of Infants and Adolescents: It's as Simple as ABC

Abstract:
Audiologists are the professionals most likely to see children presenting with balance dysfunction with or without hearing loss. This presentation will provide attendees with a comprehensive look at common causes of congenital and acquired balance conditions in infants and adolescents including; syndromes, mitochondrial conditions, trauma, migraine and those with special needs. Child-directed behavioral and age-appropriate neurodiagnostic protocols will be presented and supported by video case studies. Attendees will gain an understanding of their role in the process and learn how to use gold-standard protocols to evaluate at risk children.

Summary:
Congenital or acquired deficits may affect all or part of a child’s balance function. It is estimated that over 500 syndromes and non-syndromes are known to have an audio-vestibular expressivity. Many have greater vestibular expressivity alone. The presentation will begin by discussing the embryological development and a review of the most common syndromes, non-syndromes, and mitochondrial and acquired conditions which cause balance dysfunction in the pediatric population.

The majority of equilibrium problems in infants and children manifest as balance problems, not vertigo or dizziness. Delayed maturational motor milestones typically are the initial indication of an equilibrium dysfunction. Possible indicators of peripheral-central vestibular dysfunction may include the infant’s inability to hold their head upright, delayed crawling, standing and then walking. There is age-specific normative data in the form of maturational motor milestones and neural responses of the vestibulo-collic, vestibul-ocular and vestibulo-spinal reflexes. Testing can be accurately conducted as early as 3 months of age with neonates who are suspected of congenital hearing loss. The presentation will use demonstration of age-appropriate behavioral protocols through video-case studies. Sport and non-sport related concussion and head trauma is a leading cause of acquired balance dysfunction in children and adolescents. With increasing interest in this important topic, a special section on balance assessment within the concussion diagnosis continuum, recovery and return to play (RTP) decision making process will be highlighted.

Neurodiagnostic evaluation of infants and children may be conducted with infants as young as 3-months of age. Cervical Vestibular Evoked Myogenic Potentials (c-VEMPS) is the most reliable early pediatric assessment tool and are easily and comfortably obtained. Additional protocols to be presented include: Video Head Impulse Test (vHIT), active (VORTEQ) and passive rotation testing (Rotary Chair) and modified (age-appropriate) VideoNystagmography (mVNG). A comprehensive review and demonstration of these protocols will be presented through the use of video case studies for infants and children and modification for those children with special needs.

The early identification and intervention of infants and young children with balance dysfunction is critically important in establishing appropriate management strategies. A child's safety, physical and social well-being is dependent on their ability to have normal activities of childhood. The audiologist has a unique role in the identification and triage of this population for children with or without hearing loss. Attendees will gain an understanding of their role in the process and learn how to use behavioral and neurodiagnostic protocols to evaluate at risk children.