Diagnosing Vestibular Hypofunction in Children with Sensorineural Hearing Loss: Using the Video Head Impulse Test or the Caloric Test First Not the Cervical Vestibular Evoked Myogenic Potential

Abstract

Background/Objectives: Children with sensorineural hearing loss (SNHL) can develop, or have concurrent vestibular hypofunction (VH). Assessing the vestibular function is challenging in the pediatric population. The objective of the current study was to identify the most effective test battery for objectively diagnosing and screening VH in children with SNHL. Methods: A two-center retrospective chart review included 71 children aged six months to 18 years old with unilateral or bilateral SNHL. Testing consisted of the video head impulse test (VHIT), the caloric test and cervical vestibular evoked myogenic potential (cVEMP). Pairwise agreement between tests was calculated by the proportion of overall agreement and unweighted Cohen’s kappa. Results: Vestibular hypofunction was diagnosed less often by cVEMP compared to VHIT or the caloric test. The overall disagreement observed between VHIT and cVEMP and the caloric test and cVEMP was explained by a higher proportion of ears diagnosed with VH by VHIT (18 versus four) or the caloric test (14 versus 0). Several cases with normal cVEMP responses had abnormal test results for VHIT (18 of 71 ears) or the caloric test (14 of 32 ears). VHIT and the caloric test showed a moderate inter-test agreement (Kappa 0.591; p = 0.018). Conclusions: VHIT and the caloric test had a higher likelihood of diagnosing VH, as opposed to cVEMP. It would therefore be advised to use VHIT or the caloric test as the first-line vestibular test for children with SNHL to screen for VH. The clinical value of cVEMP seems low in children with SNHL.