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G509 Balancing the act – evaluation of a paediatric vestibular service
  1. S Ratnayake1,
  2. M Turner2,
  3. P Holiday2,
  4. D Corbett2
  1. Paediatrics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
  2. Audiology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK

Abstract

Aim There is a growing interest in paediatric vestibular disorders but dedicated services are not widely available in UK. Children may present with otological, neurological, psychological, neurodevelopmental and other aetiologies. The aim of this study is to demonstrate this variation in the clinical presentation and corresponding diagnostics.

Method This is a retrospective service evaluation of the first 2 years (November 2014 to October 2016) of a dedicated paediatric vestibular service. Only a limited number of older children who completed vestibular diagnostics were included. This is due to numerous limitations in service delivery.

Children are initially assessed clinically along with auditory tests. Selected children subsequently undergo Video-Nystagmography (VNG) and Caloric tests, carried out on a monthly basis. There is access to other medical investigations and multi-professional rehabilitation services.

Results During the 24 months, 18 children (11 boys and 7 girls) completed clinical and diagnostic vestibular assessments. They ranged from 8 to 16 years (median age=13.5 years).

Referrals came from Paediatrics (10), Occupational Therapy (3), ENT (2), GP (1), Physiotherapy (1) and a Community Children’s Nurse (1). They had medical, neurological, neuro-developmental, otological, ophthalmological and psychological backgrounds.

Audiologically, 14 children had normal hearing. Two had newly-diagnosed sensorineural hearing loss (SNHL), one had progressive SNHL and one had congenital profound SNHL (unilateral cochlear-implant user).

Fourteen children had normal clinical vestibular examination. Abnormalities included ocular-motor dysfunction (2), significant central neurological signs (1) and abnormal Unterberger’s test (1).

VNG was normal in 15 children. Two had abnormal nystagmus without visual fixation and one had significant central neurological features.

Caloric test was normal in 10 children. Seven had unilateral Canal Paresis ranging from 24%–41%, indicating peripheral vestibular dysfunction (PVD). One had bilateral absent responses.

The final impression of aetiology was multi-factorial (4), migraine-related (3), neuro-developmental (3), psychogenic (2), normal (2), PVD only (1), Pendred syndrome (1), encephalomyelitis (1) and labyrinthitis along with psychogenic overlay (1).

Conclusion Vestibular presentations in children are heterogeneous. Therefore, clinicians should be aware and explore the multifaceted reasons, over and beyond otological causes, in children.

We are currently working around the service delivery limitations and are networking with stakeholder colleagues.

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