Predictive Factors for Vestibular Loss in Children With Hearing Loss Purpose The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss. Method A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for ... Research Article
Research Article  |   March 08, 2018
Predictive Factors for Vestibular Loss in Children With Hearing Loss
 
Author Affiliations & Notes
  • Kristen L. Janky
    Department of Audiology, Boys Town National Research Hospital, Omaha, NE
  • Megan L. A. Thomas
    Department of Audiology, Boys Town National Research Hospital, Omaha, NE
  • Robin R. High
    Department of Biostatistics, University of Nebraska Medical Center, Omaha
  • Kendra K. Schmid
    Department of Biostatistics, University of Nebraska Medical Center, Omaha
  • Oluwaseye Ayoola Ogun
    Creighton University, Omaha, NE
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Kristen L. Janky: kristen.janky@boystown.org
  • Editor-in-Chief: Sumitrajit Dhar
    Editor-in-Chief: Sumitrajit Dhar×
  • Editor: Owen Murnane
    Editor: Owen Murnane×
Article Information
Hearing Disorders / Balance & Balance Disorders / Research Articles
Research Article   |   March 08, 2018
Predictive Factors for Vestibular Loss in Children With Hearing Loss
American Journal of Audiology, March 2018, Vol. 27, 137-146. doi:10.1044/2017_AJA-17-0058
History: Received June 20, 2017 , Revised October 3, 2017 , Accepted November 5, 2017
 
American Journal of Audiology, March 2018, Vol. 27, 137-146. doi:10.1044/2017_AJA-17-0058
History: Received June 20, 2017; Revised October 3, 2017; Accepted November 5, 2017

Purpose The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss.

Method A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for vestibular testing from 1999 to 2015 through neurosensory genetics clinic or cochlear implant candidacy. Each child's medical chart was reviewed to obtain the following data: vestibular loss severity (classified as normal, bilateral, or mild to moderate), degree of hearing loss (bilateral pure-tone average [PTA]), imaging abnormalities (classified as “normal” or “abnormal”), parental concerns for gross motor delay (classified as “yes, there is concern” or “no, there is not a concern”), parent report of age when their child sat (months) and walked independently (months), comorbidities (classified as “yes” if there were 1 or more comorbidities or “no” if there were no comorbidities), and score on the Developmental Profile-3.

Results Children were grouped according to vestibular loss severity; 115 children had normal vestibular function, 31 had bilateral vestibular loss, and 40 had mild-to-moderate vestibular loss. As severity of vestibular loss increased, children (a) sat and walked later, (b) scored more poorly on the Developmental Profile-3 physical subscale, (c) had more severe hearing loss, (d) had parents who more frequently reported concern for gross motor delay, and (e) were more likely to have other comorbidities. Of these factors, age-to-sit, age-to-walk, PTA, and parental concerns for gross motor developmental delay had the greatest ability to differentiate children with vestibular loss from children with normal vestibular function. For age-to-sit, using a cutoff value of 7.25 months yielded a sensitivity of 62% and a specificity of 81%. For age-to-walk, a cutoff value of 14.5 months yielded a sensitivity of 78% and a specificity of 77%. For PTA for the neurosensory genetics group, a cutoff value of 40 dB yielded a sensitivity of 80% and a specificity of 55%; however, a cutoff value of 66 dB yielded a sensitivity of 33% and an improved specificity of 91%.

Conclusions A referral for vestibular evaluation should be considered for children whose hearing loss is greater than 66 dB and particularly those who sit later than 7.25 months or walk later than 14.5 months or whose parents report concerns for gross motor development. Collectively, these factors appear to be more sensitive for identifying children with bilateral vestibular loss compared with children with mild-to-moderate vestibular loss. Because of the benefit of physical therapy, children identified with vestibular loss should then be referred to physical therapy for further evaluation and treatment.

Acknowledgments
Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award P20GM109023 (awarded to Walt Jesteadt) and by the National Institute on Deafness and Other Communication Disorders under Award R03DC015318 (awarded to Kristen L. Janky). Kristen L. Janky designed the study. Megan L. A. Thomas, Oluwaseye Ayoola Ogun, and Kristen L. Janky retrospectively reviewed and compiled the data. Kendra K. Schmid, Robin R. High, and Kristen L. Janky completed the statistical analyses. Kristen L. Janky and Megan L. A. Thomas wrote the manuscript. All authors read and provided critical feedback of the manuscript.
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