Unilateral Hearing Loss Is Associated With Impaired Balance in Children: A Pilot Study
Nikolaus E Wolter1, Sharon L Cushing, Luis D Vilchez-Madrigal
1*Department of Otolaryngology-Head and Neck Surgery†Department of Otolaryngology, National Children's Hospital, San Jose, Costa Rica‡Toronto Rehabilitation Institute§Archie's Cochlear Implant Laboratory, Department of Otolaryngology-Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Insights
Children with unilateral hearing loss (UHL) have poorer balance and rely more on vision for stability compared to normal hearing peers. These findings suggest potential inner ear vestibular deficits alongside hearing impairment.
Area of Science:
- Audiology
- Vestibular Science
- Pediatric Neurology
Background:
- Unilateral hearing loss (UHL) in children can impact development beyond auditory function.
- Assessing balance and postural control is crucial for understanding the broader effects of UHL.
- Previous research has not fully elucidated the balance deficits associated with UHL in pediatric populations.
Purpose of the Study:
- To investigate whether children with unilateral sensorineural hearing loss (UHL) exhibit impaired balance compared to their normal hearing (NH) peers.
- To quantify postural control differences using objective measures in a controlled environment.
- To explore the role of visual input in maintaining balance for children with UHL.
Main Methods:
- A prospective, case-control study involving 14 children with UHL and 14 NH children.
- Balance was assessed using the Bruininks-Oseretsky Test-2 (BOT-2) and time to fall (TTF) in a virtual-reality laboratory.
- Postural control was measured via center of pressure (COP) using force plates, with and without visual input.
Main Results:
- Children with UHL demonstrated significantly worse balance scores on the BOT-2 compared to NH children (p=0.004).
- Time to fall (TTF) was significantly shorter in UHL children during challenging tasks with limited sensory input (p<0.01).
- While vision improved postural control in both groups, UHL children showed greater reliance on vision, especially in moderately difficult tasks (p=0.02).
Conclusions:
- Children with UHL exhibit poorer balance skills than their NH counterparts.
- Subtle balance deficits in UHL may be missed in routine clinical assessments, particularly those involving time to fall.
- Findings suggest that children with UHL may have vestibular system involvement in addition to hearing loss, highlighting the need for comprehensive audiological and vestibular evaluations.
Objective:
To determine if children with unilateral sensorineural hearing loss (UHL) demonstrate impaired balance compared with their normal hearing (NH) peers.
Study Design:
Prospective, case-control study.
Methods:
Balance was assessed in14 UHL and 14 NH children using the Bruininks-Oseretsky Test-2 (BOT-2) and time to fall (TTF) in an immersive, virtual-reality laboratory. Postural control was quantified by center of pressure (COP) using force plates. The effect of vision on balance was assessed by comparing scores and COP characteristics on BOT-2 tasks performed with eyes open and closed.
Results:
Balance ability as measured by the BOT-2 score was significantly worse in children with UHL compared with NH children (p = 0.004). TTF was shorter in children with UHL compared with NH children in the most difficult tasks when visual and somatosensory inputs were limited (p < 0.01). Visual input improved postural control (reduced COP variability) in both groups in all tasks (p < 0.05) but postural control as measured by COP variability was more affected in children with UHL when visual input was removed while performing moderately difficult tasks (i.e., standing on one foot) (p = 0.02).
Conclusion:
In this pilot study, children with UHL show poorer balance skills than NH children. Significant differences in TTF between the two groups were only seen in the most difficult tasks and therefore may be missed on routine clinical assessment. Children with UHL appear to rely more on vision for maintaining postural control than their NH peers. These findings may point to deficits not only in the hearing but also the vestibular portion of the inner ear.
Related Concept Videos
01:15Equilibrium and Balance
01:17Auditory Perception
00:50Unrenewable Cells
Photoreceptors
The retina is composed of several layers and contains specialized cells called photoreceptors. The photoreceptors (rods and cones) change their membrane potential when stimulated by light energy. There are two types of photoreceptors—rods and cones—which differ in the shape of...
01:29The Vestibular System
01:13The Cochlea
01:28Major Somatic Sensory Pathways