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International Pediatric Otolaryngology Group (IPOG) Consensus on Vestibular Testing in Children
A Coudert1, J R Brodsky2, I Dhooge3
1Department of Pediatric Otolaryngology, Hôpital Femme Mere Enfant, Hospices Civils De Lyon - Université Claude Bernard Lyon 1, Lyon, France.
Insights
This study established consensus guidelines for pediatric vestibular testing. Key recommendations include video head impulse testing (vHIT) and cervical VEMPs for non-expert teams and younger children, with expanded testing for expert teams and older children.
Area of Science:
- Pediatric Vestibular Assessment
- Audiology and Vestibular Science
Background:
- Lack of standardized protocols for pediatric vestibular testing leads to variability in clinical practice.
- Existing approaches to assessing vestibular function in children differ significantly between expert and non-expert centers.
Purpose of the Study:
- To establish a consensus guideline for minimum pediatric vestibular tests.
- To provide recommendations for both expert and non-expert centers conducting pediatric vestibular assessments.
Main Methods:
- A modified Delphi process involving 21 international pediatric vestibular experts was utilized.
- Three rounds of expert opinion were conducted to achieve consensus.
- Consensus was defined as agreement by over 80% of participants.
Main Results:
- For non-expert teams, minimal testing includes lateral canal video head impulse testing (vHIT) with remote camera and bone conduction cervical VEMPs.
- For expert teams, testing 1-year-olds requires lateral canal vHIT and bone conduction cervical VEMPs.
- For expert teams testing 4-year-olds, minimal testing includes vHIT in all canals, cervical and ocular VEMPs (bone or air conduction), and rotary chair.
Conclusions:
- This international consensus provides a framework for comparable, age-dependent pediatric vestibular testing protocols.
- The guidelines aim to foster collaboration and establish minimal standards for new pediatric vestibular teams.
- Video head impulse testing (vHIT) and cervical VEMPs (cVEMP) in bone conduction are identified as key tests for children.
Objectives:
To date, there are no clear guidelines in the literature on protocols for pediatric vestibular testing, and approaches may differ between teams. The objective of this study was to establish a consensus guideline for the minimum pediatric vestibular tests that should be conducted in both expert and non-expert centers.
Methods:
The leadership group identified 21 international experts in the pediatric vestibular field to participate. A modified Delphi process conducted over three rounds was employed to quantify consensus based on expert opinion. Consensus was considered achieved when over 80% of the participants agreed on a given proposition.
Results:
For a non-expert team wishing to develop a pediatric vestibular protocol and irrespective of the child's age, 17 respondents (81%) agreed that the minimal vestibular testing should include lateral canal vHIT with remote camera (and/or rotary chair) and bone conduction cervical VEMPs. The same tests were selected by 17 respondents (81%) for testing 1-year-old children with an expert team. For an expert team testing a 4-year-old child, 17 respondents (81%) agreed that the minimal testing should include vHIT in all canals, cervical and ocular VEMPs using bone or air conduction, and rotary chair. No consensus emerged for the testing of eight-year-old children.
Conclusion:
This international consensus aims to help both expert and non-expert teams conduct more comparable age-dependent vestibular test protocols in children, fostering collaboration and establishing minimal standards for new teams. The key vestibular tests for children seem to be vHIT (and/or rotary chair) and cVEMP in bone conduction.
Level Of Evidence:
NA.
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