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Pediatric vestibular testing: Tolerability of test components in children
Peter J Ciolek1, Elise Kang2, Julie A Honaker1
1Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA.
International Journal of Pediatric Otorhinolaryngology
|September 4, 2018
Summary
Most children can complete interpretable pediatric vestibular testing (VT), even if they cannot finish all components. Initial tests like spontaneous and gaze-evoked nystagmus are recommended before more challenging procedures.
Area of Science:
- Pediatric Otolaryngology
- Neuroscience
- Audiology
Background:
- Vestibular testing (VT) is crucial for diagnosing balance disorders in children.
- Understanding completion rates of pediatric VT components is essential for optimizing diagnostic yield.
- Previous studies have not fully elucidated the feasibility of obtaining interpretable results in pediatric populations with varying tolerance levels.
Purpose of the Study:
- To determine the success rates of individual components within pediatric vestibular testing (VT).
- To identify factors associated with the inability to complete all aspects of VT in children.
- To assess the diagnostic value of partially completed VT protocols.
Main Methods:
- Retrospective review of vestibular testing (VT) data from pediatric patients (<18 years) between 2004 and 2015.
- Analysis of completion rates for 12 standard VT components.
- Multivariate analysis to identify predictors of incomplete testing and diagnostic success.
Main Results:
- 188 pediatric patients underwent VT; 18.6% had abnormal results.
- Patients unable to complete all 12 components still finished an average of 7.9 components.
- Omission of Nylen-Barany and Dix-Hallpike testing was linked to an inability to reach a final VT diagnosis.
Conclusions:
- Interpretable vestibular testing (VT) is achievable in the majority of children, even those who do not tolerate the entire protocol.
- Prioritizing tests like spontaneous and gaze-evoked nystagmus may improve diagnostic success before attempting less tolerated tests (e.g., bithermal calorics, VNG goggles).
- This suggests a flexible approach to pediatric VT can yield valuable diagnostic information.
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