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Towards Policy Integration of Vestibular Management in Pediatric Hearing Health Care: Global Service Delivery Gaps
Katijah Khoza-Shangase1, Ayanda Gina2, Sphilile Mbhele2
1Department of Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa.
Background:
Vestibular dysfunction (VD) is a common yet often overlooked comorbidity in children with hearing loss, particularly those with sensorineural hearing loss (SNHL), congenital anomalies, or cochlear implants. These challenges are global, but they are especially critical in low- and middle-income countries (LMICs), including South Africa, where diagnostic resources and service integration are limited. Motor development, gaze stability, school performance, and quality of life (QoL) are affected by VD, yet it is seldom included in pediatric hearing health-care frameworks or routine clinical practice.
Purpose:
This review synthesizes global evidence of VD in children with hearing loss and examines how vestibular care is integrated into pediatric audiology with a focus on service delivery gaps and policy implications in LMIC contexts.
Methods:
A narrative review of peer-reviewed literature (2015-2025) was conducted using databases including PubMed, Scopus, and Web of Science. Twenty studies met the inclusion criteria and were thematically analyzed for prevalence, assessment and management practices, developmental impacts, and policy considerations.
Results:
An estimated 20 to 85 percent of children with hearing loss, depending on diagnostic tools, age, and underlying etiology, are affected by VD, which contributes to delayed motor milestones, reduced balance control, learning challenges, and poorer psychosocial adjustment. Despite the prevalence and developmental impact of VD, vestibular care remains inconsistently implemented worldwide. Major gaps persist in pediatric-appropriate diagnostic protocols, rehabilitation strategies, workforce training, and policy integration. These limitations are most pronounced in LMICs, where audiology services are often constrained by limited infrastructure and competing health priorities.
Conclusions:
Integrating vestibular assessment and management into pediatric audiology represents a critical step toward comprehensive and equitable child hearing health care. Coordinated policy development, capacity building, and context-adapted clinical pathways are urgently required to close this gap globally.
Clinical Relevance Statement:
This review highlights the importance of incorporating vestibular considerations into pediatric audiology practice. Feasible screening and rehabilitation strategies may improve developmental outcomes, enhance educational participation, and strengthen more holistic and multidisciplinary models of care for children with hearing loss.
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