Vestibular function and balance performance in children with sensorineural hearing loss

Figures & data

Table 1. Group demographics for children with normal sound detection and children with sensorineural hearing loss including anthropometric correlates, hearing levels and proportion of normal peripheral vestibular structures (expressed as a percentage).

						Audiometry		vHIT						cVEMP		oVEMP
						4FA HL		HSCC		ASCC		PSCC		Saccule		Utricle
	N	M:F ratio	Mean age (range)	Height (cm) (SD)	Weight (kg) (SD)	Left (SD) (range)	Right (SD) (range)	Left (%)	Right (%)	Left(%)	Right (%)	Left (%)	Right (%)	Left(%)	Right (%)	Left (%)	Right (%)
NSD	11	7:4	8.8 (5.9–11.3)	135.4 (12.7)	33.7 (0.6)	8.4 (5.2) (1.3–13.8)	7.7 (4.7) (1.3–12.5)	100	100	100^a	100^a	100^a	100^a	91	100	100	100
SNHL	11	9:2	8.8 (5.8–11.5)	134.5 (16.0)	32.8 (9.7)	106.6 (25.0) (51.3–120)	91.9 (35.7) (25v120)	63	72	77^b	55^b	67^b	67^b	60^a	60^a	70^a	70^a

NSD: normal sound detection; SNHL: sensorineural hearing loss; 4FAHL: four frequency average hearing level; vHIT: video head impulse test; HSCC: horizontal semicircular canal; ASCC: anterior semicircular canal; PSCC: posterior semicircular canal; cVEMP: cervical vestibular evoked myogenic potentials; oVEMP: ocular vestibular evoked myogenic potentials

^a Denotes responses from 10 children.

^b Denotes responses from 9 children.

Table 2. Hearing loss aetiology, proportion of normal vestibular responses, and amplification type for children with sensorineural hearing loss.

Participant	Aetiology	Amplification type	Proportion of normal SCC responses (/6)	Proportion of normal otolith responses (/4)
SN01	Cytomegalovirus	Cochlear implant	2	0
SN02	Enlarged Vestibular Aqueduct	Cochlear implant	5	4
SN03	Ushers Type 1	Cochlear implant	0	0
SN04	Enlarged Vestibular Aqueduct	Hearing aids	6	4
SN05	Connexin 26	Bimodal	2^a	4
SN06	Connexin 26	Hearing aids	6	4
SN07	Enlarged Vestibular Aqueduct	Hearing aids	6	4
SN08	Ushers Type 1	Cochlear implant	0^a	0
SN09	Connexin 26	Cochlear implant	6	3
SN10	Meningitis	Bimodal	6	3
SN11	Branchio-Oto-Renal	Cochlear implant	0	NT

^a Denotes only HSCC vHIT completed, NT denotes not tested.

Proportion of normal SCC responses based on VOR gain values of ≥0.81 for the lateral condition and ≥0.75 for vertical conditions.

Proportion of normal otolith responses based on presence of a repeatable cVEMP or oVEMP response.

Table 3. Group comparisons for all measures of peripheral vestibular function (vHIT, cVEMP and oVEMP).

			SNHL			NSD
vHIT		N	Median (IQR)	Range	N	Median (IQR)	Range	Adj p
VOR gain	HSCC	22	0.87 (0.59)	0.14-1.10	22	0.94 (0.11)	0.87-1.11	0.035
	PSCC	18	0.86 (0.63)	0.11-1.01	20	0.90 (0.14)	0.80-1.13	0.048
	ASCC	18	0.84 (0.23)	0.16–1.06	20	0.96 (0.12)	0.76-1.05	0.013
cVEMP			Mean (SD)	Range		Mean (SD)	Range	Adj p
Latencies (ms)	P13	12	14.20 (0.89)	13.11–16.13	21	13.40 (1.36)	10.44–15.75	0.080
	N23		20.28 (1.12)	17.48- 21.96		19.46 (1.42)	17.2–22.10	0.101
oVEMP			Mean (SD)	Range		Mean (SD)	Range	Adj p
Latencies (ms)	N10	14	10.13 (0.65)	9.05–11.37	22	10.30 (1.21)	7.38–12.07	0.634
	P16		13.31 (1.23)	10.51–15.40		13.09 (1.27)	10.82–15.5	0.607
cVEMP			Median (IQR)	Range		Median (IQR)	Range	Adj p
Amplitude (µV)	P13-N23	12	10.02 (12.86)	4.07–29.82	21	13.29 (8.83)	5.39–49.2	0.359
oVEMP			Median (IQR)	Range		Median (IQR)	Range	Adj p
Amplitude (µV)	B-N10	14	9.5 (6.03)	4.50–16.45	22	6.81 (3.51)	3.62–31.71	0.263
	N10-P16		16.74 (20.68)	3.00–32.48		9.62 (4.72)	3.53–41.19	0.485

Significant values in bold (p < 0.05).

SNHL: sensorineural hearing loss; NSD: normal sound detection; vHIT: video head impulse test; HSCC: horizontal semicircular canal; PSCC: posterior semicircular canal; ASCC: anterior semicircular canal; cVEMP: cervical vestibular evoked myogenic potentials; oVEMP: ocular vestibular evoked myogenic potentials

Figure 1. Mean path velocity across the four standing conditions for children with normal sound detection and children with SNHL. Children with SNHL showed reduced postural stability, as indicated by increased path velocities, in conditions where somatosensory information was modified (FEO and FEC conditions). Additionally, large variability in standing balance was observed in children with SNHL across all conditions when compared to children with normal sound detection. *Denotes p < 0.05.

Table 4. Group comparisons for DWT bandwidth velocity across frequency bands for all standing balance conditions.

Standing balance condition		EO				EC				FEO				FEC
		SNHL	NSD	ES	Adj p	SNHL	NSD	ES	Adj p	SNHL	NSD	ES	Adj p	SNHL	NSD	ES	Adj p
		Mean (SD)	Mean (SD)			Mean (SD)	Mean (SD)			Mean (SD)	Mean (SD)			Mean (SD)	Mean (SD)
DWT ba velocity (cm/s)	Ultralow	0.11 (0.06)	0.09 (0.04)	0.56	0.204	0.10 (0.03)	0.10 (0.04)	0.09	0.827	0.13 (0.06)	0.11 (0.05)	0.40	0.374	0.16 (0.06)	0.13 (0.04)	0.71	0.110
	Very low	0.47 (0.25)	0.28 (0.09)	1.00	0.030	0.56 (0.27)	0.38 (0.09)	0.89	0.050	0.78 (0.42)	0.46 (0.16)	0.94	0.040	1.20 (0.76)	0.90 (0.33)	0.51	0.267
	Low	1.05 (0.70)	0.74 (0.25)	0.60	0.174	1.28 (0.79)	1.12 (0.43)	0.26	0.545	1.87 (1.06)	1.14 (0.31)	0.94	0.040	3.21 (1.17)	2.24 (0.74)	0.99	0.031
	Moderate	1.04 (0.59)	0.74 (0.26)	0.67	0.135	1.30 (0.76)	0.92 (0.25)	0.67	0.150	1.82 (1.06)	1.06 (0.29)	0.98	0.033	3.19 (1.32)	2.18 (0.76)	0.94	0.038

Significant values in bold (p < 0.05).

DWT: discrete wavelet transform; cm/sec: centimetres per second; EO: eyes open; EC: eyes closed; FEO: foam eyes open; FEC: foam eyes closed; SNHL: sensorineural hearing loss; NSD: normal sound detection; ES: effect size (calculated using Hedges g); Adj p: adjusted p value (Tukey post-hoc analysis).