Vestibular Infants Screening-Flanders
Condition: Vestibular Disorder; Hearing Impaired Children
MeSH terms: Vestibular Diseases; Deafness; Hearing Loss
Study type: Interventional

Summary: 
      Hearing-impaired children are at risk for a vestibular impairment, as the auditory and
      vestibular end organs are closely related. Although this can compromise a child's development
      on many levels, vestibular testing is not routinely performed in this vulnerable group. This
      project aims to give each congenitally hearing-impaired child in Flanders (Belgium) access to
      a basic vestibular screening at a young age and set an example for other regions worldwide.
    

Detailed description: 
      The implementation of a vestibular screening in hearing-impaired babies of six months old
      will timely discover vestibular problems to limit the impact on the (motor) development. The
      cervical vestibular evoked myogenic potential (cVEMP) technique will be used as a vestibular
      screening tool. Flanders is the first region worldwide that will implement a vestibular
      screening. All official Flemish reference centres of Kind en Gezin (Child and Family) will
      participate in this project.

      Study purpose:

      The final utilisation goal of this project is to limit the impact of a vestibular dysfunction
      on the (motor) development of children. Since hearing-impaired children have a higher risk
      for deficits of the vestibular (balance) organ, the researchers will focus on this vulnerable
      group.

      This will be accomplished by:

        -  The implementation of a standard vestibular screening protocol in Flanders in
           hearing-impaired children at the age of 6 months, enabling early diagnosis of vestibular
           deficits and adequate referral for extensive vestibular testing, motor assessment and
           rehabilitation.

        -  Increasing the awareness for vestibular dysfunctions and its associated symptoms in
           hearing-impaired children among parents, teachers, paramedics, specialists and other
           social workers who are in close contact with hearing-impaired children. This should go
           hand in hand with more effective patient care, because adequate therapy will start
           sooner.

      Methodology:

      The aim of the project is to add a vestibular screening to the existing auditory screening
      programme (MAICO test). The following steps will be performed to guarantee an accurate
      vestibular follow-up in Flemish hearing-impaired children:

        -  In case of a 'refer' on the second MAICO test, Kind en Gezin (Child and Family) will
           refer the child to the reference centres of Kind en Gezin in Flanders.

        -  These reference centres will perform a diagnostic hearing test (brainstem evoked
           response audiometry: BERA) to confirm the permanent hearing loss (standard of care).

        -  Each child with a confirmed hearing loss (BERA 'refer') will be subjected to a
           vestibular screening at the age of six months (on average 120/year), combined with
           tympanometry, in that specific reference centre at the age of six months. The cervical
           vestibular evoked myogenic potential (cVEMP) technique will be used.

        -  In case of a refer on the vestibular screening (cVEMP 'refer'), the reference centres
           will refer the child for motor assessment and, if necessary, for rehabilitation.
    

Intervention name(s): cervical vestibular evoked myogenic potentials (cVEMP)
Intervention type(s): Diagnostic Test
Intervention description(s): cVEMPs are ipsilateral, short latency, inhibitory myogenic potentials that assess otolith (mainly saccular) function and the integrity of the inferior branch of the vestibular nerve.
Intervention model: Single Group Assignment
Intervention model description: Multicenter non-commercial interventional academic research
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: vestibular; balance; hearing loss; infants