Cervical Vestibular-Evoked Myogenic Potentials and Balance Testing in Children with Down Syndrome.

Introduction Vestibular otolith function plays a major role in balance control. Objective To investigate the saccular and balance functions of children with Down syndrome (DS). Methods In total, 15 children with DS aged between 9 and 11 years were included. An age- and gender-matched control group (CG) composed of 15 normal participants was also included. The subjects with DS had trisomy 21, without hearing or organic problems, and they had independence in stance. The saccular function among the children with DS and among the controls was tested using air-conduction cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, the static and dynamic balance statuses were evaluated using the following assessments; the Pediatric Balance Scale (PBS), the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), the Romberg test, and the Timed Up and Go (TUG) test. Results In the present study, the results of the saccular function test showed that there was a significant difference between children with and without DS ( p < 0.05). The DS subjects had significantly earlier N1 latancy and lower amplitude of the cVEMPs (< 70 µV) compared with the control subjects. The static-dynamic balance ability was statistically and significantly different in children with DS compared with the controls ( p < 0.05). Conclusion These results revealed that saccular function seems to be affected in DS subjects. The dysfunction in static and dynamic balance abilities of the children with DS may be attributed to vestibular dysfunction as well as low gross motor skills. This knowledge should be taken into account when assessing motor performance in those subjects. Additional larger studies testing other dimensions of the vestibular system in children with DS are needed.

Early-auditory intervention in children with hearing loss and neurodevelopmental outcomes: cognitive, motor and language development.

BACKGROUND: To date, studies have mostly focused on the language outcome of early-auditory interventions including amplification for congenital hearing loss within the first 6 months. We aimed to examine the effect of early-auditory intervention in patients with congenital hearing loss on cognitive, motor and language outcomes, and determine the clinical variables that affect developmental outcomes. METHODS: The medical records of 104 patients were retrospectively reviewed. Children were evaluated by the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS: The median ages of confirmation of hearing loss, amplification, starting auditory-verbal intervention and cochlear implantation were 9, 10, 13 and 19 months, respectively. Of the patients, 26% received a hearingaid fitting ≤6 months of age. Fifty-one children (49%) had additional disabilities. The median cognitive, language and motor scores of children with no additional disabilities were 95 (65-115), 68 (47-103) and 97 (58- 130), respectively and children with early-auditory intervention (≤6 months) demonstrated higher cognitive, receptive and expressive language subscale scores than late-auditory intervention group (p < 0.05) whereas there was no significant difference in motor scores (p > 0.05). A significant negative correlation was found between additional disability and cognitive, language and motor outcomes (r=-0.78, r=-0.54 and r=-0.75, respectively p < 0.01). There was a significant negative correlation between language outcomes and the degree of hearing loss (r=-0.20, p < 0.05). Multiple regression analyses revealed that additional disability and early-auditory intervention showed a significant amount of variance in cognitive and language scores. The early intervention did not make a significant, independent contribution on motor outcomes whereas additional disability did. CONCLUSIONS: Presence of additional disability was the strongest significant variable on developmental outcomes in hearing-impaired children. In children with no additional disability, significantly better cognitive and language scores were associated with the early-auditory intervention. Motor skills were not affected by the early-auditory intervention.

Is There Any Effect of Subjective Tinnitus on Vestibular Evoked Myogenic Potentials.

Idiopathic subjective tinnitus has a complex pathophysiology in which not only cochlear and central classical auditory pathways but also nonclassical auditory pathways of different parts of the brain are involved. Vestibuloocular and vestibulocollic pathways are the central projections of utricle and saccule used in the vestibular evoked myogenic potential (VEMP) test. Aim of this study was to investigate the effects of idiopathic subjective tinnitus on vestibuloocular and vestibulocollic pathways via VEMP. We prospectively analyzed 30 unilateral idiopathic subjective tinnitus patient's cervical, ocular VEMP tests, tinnitus handicap index scores, symptom duration and compared with contralateral ear and 35 healthy volunteers. The latencies and amplitudes of P1 and N1 waves were recorded and pathologic wave criteria was calculated according to healthy volunteer's data. In cervical VEMP there were significant longer latencies of P1 and N1 waves with respect to contralateral ear and control group. In ocular VEMP test, N1 and P1 latencies and amplitudes were not significantly different. The percentages of pathologic wave of the tinnitus side were not significantly higher in both cervical VEMP and ocular VEMP tests with respect to contralateral side. Tinnitus handicap index scores and symptom duration had no relationship with latency and amplitude of VEMP tests. Although cervical VEMP P1 and N1 latencies were significantly longer, subjective tinnitus did not result in pathological alterations in the VEMP test. Presence of subjective tinnitus is not an influencing factor in the VEMP interpretation.

Satisfaction and compliance of adult patients using hearing aid and evaluation of factors affecting them.

The aims of this study are to reveal patient compliance and satisfaction in hearing aid-prescribed adult population and to determine the relevant clinical factors. The study was designed retrospectively, and those patients who have been using hearing aid for at least 6 months were invited for evaluation. Demographical data, hearing aid type (digital vs analog), general satisfaction, and daily usage time were asked. Then, the Hearing Aid Satisfaction Questionnaire (HASQ) was applied to all patients which included visual analog scale (VAS)-based 10 questions about the effects of hearing aid on social communication, efficiency, cosmetics, life quality and cost. Totally 400 patients were included in the study. The HASQ was confirmed to be highly reliable by "Kaiser Meyer Olkin and Bartlett Sphericity" tests after exclusion of aid-cost question. There was a negative correlation between age and satisfaction, and a positive correlation between hearing aid usage time (years) and satisfaction (p < 0.05). There was no significant difference between mean HASQ scores regarding gender, employment status, hearing aid type and the site of hearing aid wearing. HASQ scores were significantly worse in pure sensorineural loss type, lower educational status, shorter daily usage time, but better in higher pure tone threshold levels (p < 0.05). Age, time of hearing aid usage daily, type of hearing impairment, the threshold of hearing and education were the factors affecting satisfaction. Regular daily usage of hearing aid should be encouraged in patients, since by this way aid usage and satisfaction may be improved.