gms | German Medical Science

Objectives: Vestibular impairment in children with profound hearing loss (HL) has a major impact on psychomotor development [LV1]. Our objectives wereT to determine the prevalence of vestibular impairment in a cohort of cochlear implant (CI) candidate children with profound HL and its impact on postural and motor development.

Methods: Retrospective study. Pediatric referral center for CI. All children with profound HL (loss >90 dB HL) who completed vestibular assessment prior to CI between 2009 and 2019. Data collected from medical record included: complete vestibular assessment results allowing to distinguish three groups of children: normal vestibular function (NVF), partially-impaired vestibular function (PVF) and complete bilateral vestibular loss (CBVL), etiologies of HL and ages for developmental milestones achievement. Generalized logit models were performed to investigate predictive factors of vestibular impairment. and etiology.

Results: Among 592 participants (284 females, 308 males, mean (SD) age 38 (34) months, 2months–18 years), documented HL etiologies (n=266) show that genetic origin represented 45% of the cases (120/266), with 50% syndromic (principally Usher and Waardenburg), and 50% non-syndromic (principally connexin-26), Cytomegalovirus infection (CMV) represented 73% of the infectious origin (74/266). Vestibular impairment on the total cohort (n=592) was present in 44% of the cases, mostly symmetrical (89%) and complete in 6% of the cases (CBVL). Vestibular impairment was preferentially found in Syndromic HL (78.3% (47/60) with more PVF (56.6%) than CBVL (21.6%)) and CMV (69.2% (with more PVF (57.6%) than CBVL (11.5%)). Children with non-syndromic genetic HL had no CBVL and 25% PVF. Only some etiologies (syndromic HL, CMV, meningitis) might offer some predictive value for vestibular impairment. The delay of posturomotor milestones achievement increased significantly with the degree of severity of the vestibular loss (CBVL> PVF > NVF group; p<0.001). Delayed posturomotor development milestone could predict vestibular impairment particularly CBVL.

Conclusions: In CI candidate children with profound HL, vestibular impairment is frequent with differential incidences according to deafness etiology. In this population, vestibular deficit (complete or partial) correlated with delay in posturomotor control but could not be predicted from hearing loss etiology. Therefore, in profoundly deaf children, a comprehensive vestibular assessment is necessary before CI in the perspective of an individualized timely CI strategy and physical therapy.