Implementation of a Clinical Test of Vestibular Self-Motion Perception in Children and Adults With Hearing Loss

OBJECTIVES: In adult populations, tests of vestibular self-motion perception have been shown to be sensitive to vestibular loss, including subclinical vestibular changes. However, tests of vestibular perception have not been adequately studied in pediatric populations and are not currently possible in a standard clinical environment. To address these gaps, the present study aimed to determine (i) the feasibility of measuring vestibular perception in pediatric populations and (ii) the validity of vestibular perceptual thresholds captured using a standard clinical rotational chair and software. DESIGN: We enrolled 12 individuals with hearing loss plus normal vestibular function (HL + NV; mean age: 14.4, range 9 to 23 yr), 9 individuals with hearing loss plus vestibular loss (HL + VL; n = 9; mean age: 22, range 8 to 47 yr; 4 unilateral and 5 bilateral vestibular loss), and 23 age-matched normal control participants (NC; mean age: 16.9, range: 9 to 45 yr). Perception of a yaw rotation motion stimulus was assessed in a light-tight enclosure, using a commercially available rotational chair. The chair rotated at one of four constant accelerations (1°/sec2, 2°/sec2, 3°/sec2, and 4°/sec2), and participants were instructed to use a keyboard to indicate their perception of rotation direction (left versus right) as quickly as possible. Yaw rotation vestibular perceptual thresholds were defined as the median chair velocity at the time of button press for each acceleration of chair rotation. RESULTS: Two participants (ages 13, HL + VL, and 10, HL + NV) were unable to complete the test protocol due to fear of the dark, yielding a 95.45% completion rate for all participants and a 93.75% completion rate for participants under age 19. Of the 42 participants who completed the test, 1 participant (age 37, HL + VL) was excluded after data collection due to their admission that motion was never sensed, and each response was a guess. For the remaining 41 participants at each acceleration condition, post-hoc pairwise comparisons revealed a significant increase in thresholds for the HL + VL group compared with the NC group (1°/sec2: p = 0.001, 2°/sec2: p = 0.007, 3°/sec2: p = 0.006, 4°/sec2: p = 0.01). In addition, a subset of 5 individuals in the HL + NV group had thresholds that were more than 1 SD above the mean of the NC group, despite having normal vestibular function testing, suggesting the potential identification of subclinical vestibular impairment. CONCLUSIONS: A clinical test of yaw rotation perception is a valid tool for measuring vestibular impairment and is feasible in children with hearing loss as young as 8 yr. Yaw rotation perception may complement existing vestibular function tests by capturing subclinical changes in vestibular performance.