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Pediatric Vestibular Assessment: Clinical Framework.

Sarie Martens1, Ingeborg Dhooge2,3, Cleo Dhondt2

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This study establishes feasible vestibular tests for children under four, providing age-specific data to diagnose early vestibular deficits and support motor development. Normative data and cutoff criteria are presented for clinical use.

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Area of Science:

  • Pediatric Neurology
  • Vestibular System Assessment
  • Child Development

Background:

  • Vestibular deficits significantly impact early motor development in children.
  • Routine clinical vestibular assessment and diagnostic criteria for young children are lacking.
  • Age-dependent maturation of vestibular pathways necessitates specific testing protocols and normative data.

Purpose of the Study:

  • To demonstrate the feasibility of an age-dependent vestibular test battery for children under four.
  • To provide pediatric normative data and identify age trends for vestibular function.
  • To establish a clinical framework for diagnosing early vestibular deficits in young patients.

Main Methods:

  • Included 133 healthy children under 4 years old, categorized by age.
  • Utilized video Head Impulse Test (vHIT), cervical vestibular evoked myogenic potentials (cVEMP), and rotatory tests.
  • Expanded protocols for 3-year-olds to include vertical vHIT and ocular vestibular evoked myogenic potentials (oVEMP).

Main Results:

  • Horizontal vHIT and cVEMP were the most feasible tests across age groups.
  • Significant age-related increases were observed in vHIT vestibulo-ocular reflex (VOR) gain and cVEMP parameters (latency P1, amplitude P1-N1).
  • Proposed cutoff criteria for diagnosing early vestibular impairment based on test results and age-specific normative data.

Conclusions:

  • vHIT and cVEMP are feasible and valuable for assessing vestibular function in young children.
  • Age-dependent normative data and established cutoff criteria aid in diagnosing early vestibular deficits.
  • A clinical framework is proposed to integrate these findings into pediatric vestibular testing practices.