Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness.

OBJECTIVE: The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population. METHOD: This is a retrospective study of electronic records of pediatric patients (< 18 years old) who were referred for vestibular function testing and completed both hvHIT and caloric testing. Agreement between both test results was evaluated by examining measures of sensitivity, specificity, and calculating Cohen's kappa. RESULTS: Results from 117 patients (mean age = 13.7 years, age range: 8-17 years, 37 males) were analyzed. Most patients (97/115 [84.3%]) demonstrated both normal hvHIT and caloric test results. Compared to caloric testing, the hvHIT had poor sensitivity (38.9%) and excellent specificity (98.0%). Cohen's kappa analysis revealed moderate agreement between the methods (coefficient = 0.49 [0.24, 0.73]). Where disagreement between the two tests occurred, the final diagnosis was not contingent on either test result. CONCLUSIONS: There is a moderate agreement between the hvHIT and the caloric test in pediatric patients presenting to a tertiary care medical center for a vestibular evaluation. Most patients in this cohort presented with normal findings. The specificity of hvHIT was excellent, although the sensitivity was low. This may be related to the low prevalence of peripheral vestibular system disease in this study cohort, and these results do not generalize to centers that serve populations of children where vestibular disorders are more prevalent (e.g., children with sensorineural hearing loss).

Case Study: Depersonalization and Vestibular Impairment.

BACKGROUND: We describe herein the case of a patient whose primary complaints were episodic vertigo and "depersonalization," a sensation of detachment from his own body. PURPOSE: This case study aims to further clinical knowledge and insight into the clinical evaluation of vertiginous patients with complaints of depersonalization. RESEARCH DESIGN: This is a case study. DATA COLLECTION AND ANALYSIS: A retrospective chart review of vestibular function testing done on a vertiginous patient with complaints of depersonalization was performed. RESULTS: Vestibular function testing revealed absent cervical and ocular vestibular evoked myogenic potentials on the left side with normal vHIT or video Head Impulse Test, videonystagmography, and rotational chair results, suggesting peripheral vestibular impairment isolated to the left saccule and utricle. CONCLUSION: The otolith end organ impairment explains the patient's postural deviation to the left side during attempts to ambulate. We recommend that clinicians should be attentive to patient complaints of depersonalization and perform vestibular evoked myogenic potential testing to determine whether evidence of at least a unilateral peripheral otolith end organ impairment exists.

Optimizing maps for electric acoustic stimulation users.

OBJECTIVES: To optimize patient's maps in Electric Acoustic Stimulation (EAS) users based on the degree of post-operative aided hearing thresholds. METHODS: Twenty-one adult EAS patients participated in this study. Patients were subdivided into three groups, based on their unaided hearing threshold: (1) electric complementary (EC, n = 6) patients with ≤30 dB HL at 125-500 Hz with severe to profound hearing loss at higher frequencies who only use electric stimulation, (2) EAS (n = 8) patients with 30-70 dB HL from 125 to 250 Hz and profound hearing loss in high frequencies who use combined EAS, and (3) Marginal-EAS (M-EAS, n = 7) patients with 70-95 dB HL at frequencies ≤250 Hz who use combined EAS. Sentence perception in noise, melodic contour identification, and subjective preference were measured using Full Overlap, Narrow Overlap, Gap, and Meet maps. RESULT: Of the 21 patients that participated, 12 subjects were classified as complete hearing preservation and 9 subjects were classified as partial hearing preservation. The highest performing maps in sentence-in-noise perception and melodic contour identification were Gap, Meet, and Full Overlap for the EC, EAS, and the M-EAS groups, respectively. These results are consistently across different test materials and align with subject preference as well. CONCLUSION: These results suggest that clinical fitting in EAS listening should be individually tailored. EAS performance can be enhanced by optimizing maps between acoustic and electric stimulation based on the degree of aided hearing thresholds.