Assessment of Balance Deficits in at Risk Pediatric Populations

This study aimed to assess balance deficits in children at risk due to hearing loss or dizziness. The specific objectives were to: (1) measure the prevalence of poor balance in children presenting with these risks; (2) determine whether vestibular test results can predict balance deficits in these children.

While vestibular impairment is a known predictor of poor balance, poor balance may also occur for reasons unrelated to vestibular impairment. Poor balance in some children with hearing loss relates directly to the risks to the vestibular system due to its shared anatomical and physiological characteristics with the cochlea. Balance and/or vestibular problems may also be present in children with normal hearing who report dizziness or in children with hearing loss who have intact vestibular systems. Variability in the impact of risk factors for poor balance can lead to gaps and delays in identification as well as access to appropriate treatment.

A retrospective analysis of vestibular and balance function from two sources, the SickKids Vertigo Clinic and the SickKids Cochlear Implant Vestibular database, was conducted. The average age of children with hearing loss (n = 107) was 11.56 years (SD = 3.94), while the average age of children without hearing loss (n = 227) was 11.52 years (SD = 3.74). Both groups included children who had available vestibular and balance testing. Balance function was measured using the Bruininks-Oseretsky Test of Motor Proficiency. Vestibular assessments included tests of vestibulo-collic reflex (VCR) (cervical vestibular evoked myogenic potentials [cVEMP]) and the vestibulo-ocular reflex (VOR) (caloric testing and the video head impulse test [vHIT]). Mixed model regression was used to compare balance results between groups and evaluate the effects of vestibular findings (vestibular impairment versus normal vestibular), degree of vestibular loss, and site of vestibular impairment (VCR versus VOR) on balance.

Results revealed a higher prevalence of abnormal balance in children with hearing loss compared to children presenting with dizziness complaints and normal hearing [38% versus 17%, t (198.37) = -4.90, p < 0.01]. Abnormal balance function was more frequent in children with hearing loss, where VOR tests were abnormal (27.38% versus 14.52%, χ² = 3.95, p < 0.05). Children with hearing loss had significantly higher odds of having abnormal balance if they had >75% abnormal VOR test results (odds ratio of 13.71 [95% confidence interval: 2.88, 65.36]). Abnormal vestibular findings were most common in children whose hearing loss was associated with congenital cytomegalovirus, infections, or genetic syndromes. There was no consistent pattern of vestibular test abnormalities linked to balance issues in the dizzy normal hearing group.

Balance problems are prevalent in children at risk, occurring more often in children with hearing loss than in children reporting dizziness, and are more clearly associated with VOR than VCR impairments. Balance function should be assessed in children with hearing loss who are old enough to do the test. Vestibular testing, particularly assessment of the VOR, can be used in younger children to highlight the present as well as the potential for future balance problems.