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Abstract Objective This study compared the prevalence of sudden deafness (SD) in children to investigate the evolution of pediatric SD during the past two decades. Methods From 1996 to 2005, totaling 358 SD patients were experienced. Of them, 25 patients (7%) aged <15 years were assigned to Group A. In contrast, 5 patients (2%) aged <15 years of 242 SD patients encountered during the period 2006–2015 were assigned to Group B. All patients underwent audiovestibular function testing. Results The measles-mumps-rubella (MMR) vaccination reached to 95% vaccination rate in Taiwan after 1994. As 1994 (MMR vaccination years) + 11 (mean age of pediatric SD) equals 2005, this study found that declining prevalence of pediatric SD was from 7% (1996–2005) to 2% (2006–2015) at our hospital, consistent with declining annual cases of SD in Taiwan during the past decades. A significantly higher abnormality rate of mean hearing level (93%) than abnormal caloric responses (20%) was identified indicating that pediatric SD predominately affected the cochlear partition. Conclusion The prevalence of pediatric SD cases has significantly declined during the past 20 years, probably due to global vaccination policy. Other causal factors such as growing numbers of hospital and advancement in radiological diagnostic technique may also contribute to the declining prevalence. [ABSTRACT FROM AUTHOR]

Objectives Although the caloric test, rotational test, and posturography have been used to investigate balance function conventionally, and they are older than tests of otolithic organs, yet it seems that most clinicians are less familiar with the development of otolithic (saccular and utricular) function in children. This study reviewed the electrophysiological testing used to assess the functional development of the otolithic system in growing children. Methods Based on the literature, studies of cervical vestibular-evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) tests in children ranging from newborns, small children to adolescents were reviewed. Papers concerning foam posturography in children were also included. Results The cVEMPs can be elicited in newborns at day 5, whereas the oVEMPs are absent in neonatal period. When children grow to 2 years old, the oVEMPs can be induced with eyes closed condition, while the oVEMPs with eyes up condition can be elicited in children aged >3 years old, with the characteristic parameters similar to adult levels. In contrast with cVEMPs, it is until the neck length >15.3 cm (aldolesence), one need not account for neck length in evaluating cVEMP latency. Additionally, foam posturography indicated by the Romberg quotient of the sway velocity/area on foam pad is considered to reflect the otolithic function, which reached adult levels when the children at 12 years old. Conclusions For the functional development of the otolithic system in growing children to approach adult levels, the earliest occurrence is the oVEMP test, followed by the foam posturography, and cVEMP test. [ABSTRACT FROM AUTHOR]

Summary: Objective: This study applied caloric and vestibular evoked myogenic potential (VEMP) tests to evaluate whether children with benign paroxysmal vertigo (BPV) shares similar vestibular features with basilar type migraine. Methods: Twenty subjects of each group including healthy and BPV children were enrolled in this study. Each subject underwent audiometry, caloric and VEMP tests. Diagnosis of BPV was based on the International Classification of Headache Disorder, second edition. Results: All BPV children had normal hearing, bilaterally. Caloric test revealed normal responses in 13 patients and abnormal responses in 7 patients (35%). VEMP test showed 50% abnormality in BPV children, including absent and delayed responses. However, when results of caloric and VEMP testing were considered together, 70% of BPV children had abnormality, exhibiting non-significant difference compared with 75% abnormality in basilar type migraine. Conclusions: A combination of caloric and VEMP results reveals higher abnormality (70%) in BPV children, sharing similar features with basilar type migraine in adults, given the similarity of the two disorders. Thus, caloric and VEMP tests may serve as supplementary diagnostic tools in evaluating children with BPV. [Copyright &y& Elsevier]

A 5 year-old boy was rather healthy until one month ago when loss of balance and muscle tone was noted by the parents. A battery of tests comprising electroencephalography, audiometry, caloric test and ocular vestibular evoked myogenic potential (oVEMP) test were performed, yet all tests showed normal responses. Conversely, cervical VEMP (cVEMP) test showed delayed responses bilaterally. MR imaging demonstrated bilaterally intrameatal vascular loops extending into both internal auditory canals. After a 3-month medication, delayed cVEMPs were resolved and returned to normal cVEMPs bilaterally, accompanied by subsidence of dysequilibrium. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study utilized a combined ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) test in children with benign paroxysmal vertigo (BPV) to investigate whether the upper or lower brainstem is more frequently affected in BPV children. Methods: Fifteen BPV children aged 4–14 years, and 15 age- and sex-matched healthy children were enrolled. All subjects underwent pure tone audiometry, stabilometry, and a combined oVEMP and cVEMP test using acoustic stimulation. Results: All BPV patients displayed normal hearing and clear oVEMPs. However, 11 (73%) of 15 BPV patients had delayed cVEMPs, showing significant difference when compared with 100% normal cVEMPs in healthy children. The sway path and sway area in stabilometry were significantly different between BPV and healthy children, regardless of whether their eyes were open or closed. However, neither the sway path nor sway area correlated significantly with cVEMP results. Conclusion: Normal oVEMPs in BPV children indicate an intact vestibulo-ocular reflex pathway, which travels through the upper brainstem. In contrast, delayed cVEMPs in BPV children reflect a retrolabyrinthine lesion along the sacculo-collic reflex pathway, which descends via the lower brainstem. Hence, the lower brainstem is more frequently affected than the upper brainstem in children with BPV. [Copyright &y& Elsevier]

Abstract: Objective: This study assessed the development of balance function in children using platform stabilometry. Methods: A total of 251 healthy children aged from 3 to 12 years were enrolled in this study. Each subject underwent stabilometry under four various conditions (A: firm surface with eyes open; B: firm surface with eyes closed; C: foam pad with eyes open; and D: foam pad with eyes closed). Another 23 healthy adults were also tested with the same protocol for comparison. Sway magnitudes such as sway velocity and circular area were calculated and compared. Results: Since the age was positively correlated with body height and body weight, age factor was used to correlate with the sway magnitude. The sway velocity under conditions A through D reached adult level when the child grew up to 7, 7, 8 and 12 years, respectively. In contrast, the circular area under conditions A through D reached adult level when the child was at the age of 5, 6, 8 and 7 years, respectively. Thus, balance function can be up to adult levels by age 12 years. Conclusions: Compared to adults, higher sway velocity and larger circular area in children indicate incomplete development of vestibular and central nervous systems integration. Our results suggest that age factor serves the most reliable index to estimate the functional development of balance system, and a child at the age of 12 years is supposed to reach balance level of an adult. [Copyright &y& Elsevier]

Objective This study adopted an inner ear test battery comprising audiometry, and ocular vestibular evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests to investigate the sequence of inner ear deficits in pediatric Meniere's disease (MD). Methods From 2005 to 2016, a total of 24 MD children aged <15 years old underwent otoscopy, CT scan, blood test, and an inner ear test battery. Nine subjects were males and 15 were females, with mean age of 12 years. Right ear was affected in 3 patients, left ear in 5 patients, and both ears in 16 patients (67%). Eight (33%) of the 24 MD children had positive family history. Results Inner ear deficits in MD children ran from abnormal hearing (25%) to abnormal cVEMP (20%), oVEMP (13%), and caloric (12%) tests, exhibiting a significantly declining sequence from the cochlea, to the saccule, utricle and semicircular canals. Analysis between the laterality and family history revealed a significantly positive correlation. Conclusion Pediatric MD is rare, accounting for 2.3% prevalence in MD patients. The inner ear deficits in pediatric MD showed a significantly declining sequence from the cochlea, to the saccule, utricle and semicircular canals, mimicking the sequence in adult MD. One-third MD children had positive family history, which may explain the high rate of bilateral affliction and symmetrical hearing levels on both ears. [ABSTRACT FROM AUTHOR]