Evidence of Vestibular and Balance Dysfunction in Children With Profound Sensorineural Hearing Loss Using Cochlear Implants
Evidence of Vestibular and Balance Dysfunction in Children With Profound Sensorineural Hearing Loss Using Cochlear Implants
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DOI：
10.1097/mlg.0b013e31817fadfa
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发表时间：
2008-10-01
期刊：
影响因子：
2.6
通讯作者：
Gordon, Karen A.
中科院分区：
文献类型：
--
作者：
Cushing, Sharon L.;Papsin, Blake C.;Gordon, Karen A.
目的/假设：外周听觉系统和前庭系统之间的相似性表明，感音神经性听力损失（SNHL）儿童可能表现出前庭和平衡障碍。研究设计：前瞻性横断面研究，重复测量。方法：前庭功能用冷热、旋转和前庭诱发肌源性电位测试进行评估;平衡使用Bruininks-Oseretsky运动技能测试II的平衡子集进行评估，这是一种静态和动态平衡的标准化测试。结果：50%（16/32）的水平半规管功能对热刺激的反应异常，其中大部分[6/16（38%）]反映了轻度至中度的单侧异常。水平半规管对旋转的反应异常率为38%（14/37）。前庭诱发肌源性电位双侧5/26例（19%），单侧5/26例（19%），球囊功能缺失。与正常听力对照组[mu = 17 +/-5（SD）; P = 0.0006]相比，研究人群[mu = 12.9 +/-5（SD）]的年龄标准化平衡能力明显较差，并且与旋转刺激下水平耳道功能的相关性最好（P = 0.004; R-2 = 0.24）。结论：1/3以上的SNHL和人工耳蜗植入患儿存在前庭和平衡功能障碍，且与病因密切相关。尽管所有测试的依从性都很高，但旋转椅测试评估更高频率的运动（0.25-5 Hz），从而评估更多“真实世界”的前庭功能，与动态平衡相关性最好。出于这个原因，旋转椅子测试可能代表了这一人群的测试选择，特别是考虑到它适合测试所有年龄段的儿童。
Objectives/Hypothesis: Similarities between the peripheral auditory and vestibular systems suggest that children with sensorineural hearing loss (SNHL) may demonstrate vestibular and balance impairments. This hypothesis was studied in 40 children with severe to profound SNHL and unilateral cochlear implants.Study Design: Prospective cross-sectional study with repeated measures.Methods: Vestibular function was assessed with caloric, rotational, and vestibular evoked myogenic potential testing; balance was assessed using the balance subset of the Bruininks-Oseretsky Test of Motor Proficiency-II, a standardized test of static and dynamic balance.Results: Horizontal semicircular canal function was abnormal in response to a caloric stimulus in 50% (16/32), with a large proportion of those [6/16 (38%)] reflecting mild to moderate unilateral abnormalities. In comparison, horizontal semicircular canal function in response to rotation was abnormal in 38% (14/37). Saccular function was absent bilaterally in 5/26 (19%) and unilaterally in 5/26 (19%) with vestibular evoked myogenic potential. Age standardized balance abilities were significantly poorer in the study population [mu = 12.9 +/- 5(SD)] compared with normal hearing controls [mu = 17 +/- 5(SD); P =.0006] and correlated best with horizontal canal function in response to a rotational stimulus (P =.004; R-2 = 0.24). SNHL from meningitis was associated with worse balance function than other etiologies.Conclusions: Vestibular and balance dysfimction occurred in >1/3 of children with SNHL and cochlear implants, and is highly dependent on etiology. Although compliance with all tests was high, rotational chair testing, which assesses higher frequency motion (0.25-5 Hz) and thus more "'real world" vestibular function, correlated best with dynamic balance. For this reason, rotational chair testing may represent the test of choice in this population, particularly given that it is amenable to testing children of all ages.