Using Balance Function to Screen for Vestibular Impairment in Children With Sensorineural Hearing Loss and Cochlear Implants.

OBJECTIVES: 1) To determine if bilateral vestibular dysfunction can be predicted by performance on standardized balance tasks in children with sensorineural hearing loss (SNHL) and cochlear implants (CI). 2) To provide clinical recommendations for screening for vestibular impairment in children with SNHL.

STUDY DESIGN: Retrospective cohort study.

SETTING: Tertiary care pediatric implant center.

PATIENTS: Pediatric patients (4.8-18.6 years) with profound SNHL using CIs.

INTERVENTIONS: Vestibular end-organ (horizontal canal and otoliths), and balance assessment.

MAIN OUTCOME MEASURES: Comparison of balance skills, measured by the Bruininks Oseretsky Test of Motor Proficiency II (BOT-2), was performed between two groups of children with SNHL and CI: 1) total bilateral vestibular loss (TBVL) (n = 45), and 2) normal bilateral vestibular function (n = 20). Sensitivity, specificity, and suitability of each task as a screening tool for the detection of TBVL were assessed.

RESULTS: Balance as measured by the BOT-2 balance subtest was significantly poorer in children with TBVL then those with normal vestibular function (p < 0.0001). "Eyes closed" tasks best identified children with TBVL having the highest sensitivity and specificity. One-foot standing eyes closed was found to have the best performance as a screening tool for TBVL using a timed cutoff of 4 seconds.

CONCLUSION: A brief in-office screen of balance function using one of the BOT-2 balance subtest tasks, one-foot standing eyes closed, is able to identify children at risk of TBVL with excellent sensitivity and specificity and should be used to screen for TBVL in all children presenting with SNHL.