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An overview of motor skill performance and balance in hearing impaired children



Abstract Childhood hearing impairment is a common chronic condition that may have a major impact on acquisition of speech, social and physical development. Numerous literature states that injury to the vestibular organs may result in accompanying balance and motor development disorders. But still postural control and motor assessments are not a routine procedure in hearing impaired children. Hence, we aim to provide an overview on motor skill performance and balance in hearing impaired children.
REVIEW Open Access
An overview of motor skill performance and
balance in hearing impaired children
Venkadesan Rajendran
and Finita Glory Roy
Childhood hearing impairment is a common chronic condition that may have a major impact on acquisition of
speech, social and physical development. Numerous literature states that injury to the vestibular organs may resul t
in accompanying balance and motor development disorders. But still postural control and motor assessments are
not a routine procedure in hearing impaired children. Hence, we aim to provide an overview on motor skill
performance and balance in hearing impaired children.
Childhood hearing impairment is a significant public
health problem, which is associated with long-term aca-
demic and communicative difficulties [1,2]. The preva-
lence of moderate to profound hearing loss in children,
including sensorineural hearing loss and conductive
hearing loss is 1 to 6 of 1000, of which, 10% hav e hea r-
ing levels that fall in the profound range [3-6]. More-
over, it is estimated that about 440 million children
worldwide have hearing loss above 85 decibels, and this
increases to about 800 million when the threshold is
reduced to 50 dB [7,8]. Although many children have
hearing impairments, each child is unique.
Newborn hearing screening has led to earlier identifi-
cation and treatment of infantswithhearingloss[7,8].
However, t he earlier identification of childhood hearing
impairment is considered critical for normal speech, lan-
guage, cognitive and social development [4].
As routine screening does not include assessment of
balance and motor deficits, physical therapy ser vices are
not included in the educational programme, unless
obvious neurological or orthopedic disorders are diag-
nosed. However teachers and parents of these children
often report inco-ordination, clumsiness and balance
deficits which may hinder the child s optimal perfor-
mance [9]. Moreover, many pediatric health care provi-
ders are often too busy or i nadequately trained in
conducti ng elaborate developmental screening tests dur-
ing the regular clinics. These tests are performed only
when the child present with an obvious deficit [10].
Hence, we aim to provide a concise description on bal-
ance and motor performance in hearing impaired
Degree of hearing impairment
The degree o f hearing loss explains the severity of hear-
ing impairment. Table 1 shows the degrees of hearing
loss according to American Speech-Language Hearing
Association [11].
Classification of hearing impairment
American speech-lang uage hearing association has cate-
gorized hearing loss based on the part of the auditory
system damaged. Accordingly there are three basic types
of hearing loss: conduc tive hearing loss, sensorineural
hearing loss, and mixed hearing loss [12].
Conductive hearing loss
Results from disruption in any of the mechanism, which
conduct sound waves from external canal to the oval
window. eg. Outer ear, ear drum or middle ear. It
usually involves inability to hear faint sounds.
Sensorineural hearing loss (SNHL)
It is the most common type of permanent hearing
impairment and results from damage to the inner ear or
the nerve pathway from the inner ear to the brain.
Mixed hearing loss
It is a combination of both conductive and sensorineural
hearing impairment.
Further more, hearing impairment may exist as unilat-
eral or bilateral, and pre-lingual or post-lingual.
* Correspondence:
Department of Rehabilitation Science, Holy Cross College affiliated to
Bharathidasan University, Tiruchirappalli-620 002, India
Rajendran and Roy Italian Journal of Pediatrics 2011, 37:33
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People have impairment in only one ear.
People have impairment in both the ears.
Pre-lingual deafness
It refers to hearing impairment that is sustained prior to
the acquisition of language. eg. Congenital, early infancy.
Post-lingual deafness
It refers t o hearing impairment that is sustained after
the acquisition of lang uag e, which can occu r as a result
of disease, trauma or a side-effect of a medicine [13].
Davidson et al has proposed an e tiologic classification
which c larifies the i nterac tion between time of insult,
causation and time of expression of hearing loss. Most
of the SNHL are idiopathic, and appears to occur almost
twice as often as in developed countries. Where the
cause is known it may be genetic; pre-natally acquired;
peri-natally acquired; pos t-natally acquired; cranio-facial
anomalies; and other [13,14].
Almost 50% of permanent childhood hearing impair-
ments have a genetic cause and influenced by consangui-
nity. It may be autosoma l domi nant, autosomal rece ssive
and sporadic inheritance [ 13,15]. Parker et al studied the
family history of hearing loss, the results pointing
towards different genetic disorders with autosomal domi-
nant, autosomal recessive and sporadic inheritance [16].
Prenatal Factors
Prenatal Infections such as rubella and toxoplasmosis
are considered to be the main cause of prenatally
acquired hearing impairment. Maternal exposure to
alcohol, streptomycin, quinine and chloroquine phos-
phate may destroy neural elements of the inner ear and
contribute to congenital hearing loss [13]. Sever et al
has r eported in his study that 38.7% mothers had anti-
bodies to toxoplasmosis during pregnancy, and their
children had double the risk of developing permanent
childhood hearing loss by age 7 [17].
Perinatal factors
Perinatal factors such as prematurity, low birth weight,
hypoxia, Apgar scores 0-4 at 1 min; and 0-6 at 5 min,
ventilation required for five days or more, hyperbilirubi-
nemia r equiring transfusion, and admission to the neo-
natal intensive care unit for 48 hours or longer may
predispose to permanent childhood hearing impairment
[18]. Davis and wood found that one in 174 NICU grad-
uates had a hearing impairmen t compared with one in
1278 non-NICU babies [19].
Post natal factors
There are many and varied postnatal causes for child-
hood deafness, which may result in sensorineural or
conductive loss or both. The postnat al cause for child-
hood deafness includes bacterial meningitis, infectio n
(eg. middle-ear infection, CMV infection), viral labyr-
inthitis (eg. measles and mumps), recurrent or persistent
OME for at least 3 months, complications of otitis
media, immunization, genetic causes, and head trauma
with loss of consciousness or skull fracture [15].
Hearing- a reflex process
Hearing is a reflex during the first couple of the month
of li fe. Responses to sound at a threshold are yet to
obtain during this period. The onl y response the child
posses during this period is the startle reflex- a response
to a l oud sound, which is analogo us to the protective
reflex of hearing in animals. Fol lowing this, there is a
development of comprehension hearing. The child
begins to understand the sound with the help of experi-
ence and learning as the cerebral cortex takes over the
control of auditory responses, with the simultaneous
inhibition of the reflex h earing. Thus the child at the
age of six to seven months does not give any response
to a loud sound, but turn and look towards a faint
sound that the child feels to be pleasant [20].
Age appropriate hearing milestones
It is hard to know whether a child has a hearing problem
or not. Hearing problems may be suspected if a child
does not respond to so und or does not develop language
skills appropriately. The National Institute on Deafness
and Other Communication Disorders (NIDCD) has listed
age-appropriate hearing milestones [21].
Auditory development
Several hierarchies of auditory development have been
proposed by numerous researchers and interventionists.
Pollack et al has ranked auditory development in four
stages [22].
Hearing a sound, pay attention to auditory signals,
attend to sounds at a distance, search for and turn to
the source of sound.
Discriminate the auditory stimuli, monitor the informa-
tion and modify the speech production.
Table 1 Degree of hearing impairment
Degree of hearing loss Hearing loss range (dB)
Normal -10 to 15
Slight 16 to 25
Mild 26 to 40
Moderate 41 to 55
Moderately severe 56 to 70
Severe 71 to 90
Profound 91+
Rajendran and Roy Italian Journal of Pediatrics 2011, 37:33
Page 2 of 5
Select a word from group of wo rds spoken, rem ember
and recall information and language make cognitive
Synthesize meaning a nd respond to spoken language
Neurophysiology of postural control and motor
It is necessa ry to understa nd the neurophysiology of
postural control and motor development to get a clear
construct of dys function. T he ability to maintain a sta-
tic posture (eg. sitting, standing) and dynamic posture
(eg. walking) is operationally defined as static and
dynamic balance respectively. Both the static and
dynamic postural control are very important and
necessary to exe cute mov ement [23 ,24]. The de velop-
ment an d mainte nance of postural control are known
to be a p re-requisite for the performance of skilled
movement. Simple or complex gross and fine motor
tasks necessitate a person to maintain his or her center
of gravity over the base of support. The development
and maintenance of postural stability are a complex
process that necessitates the involvement of multiple
systems such as sensory system, central nervous system
processing and co-ordination of motor output and the
vestibular system. Three sensory systems (sensory triad
of postural control) contribute to provide information
from somatosensory, visual, and vestibular sources to
maintain postural control, which is achieved by coordi-
nated motor outputs. The visual and somatosensory
system gathers information from the environment (eg.
position in relative to other o bjects) and the vestibular
system provides an internal reference (eg. headsorien-
tation in space). Maturation of the vestibular system is
responsible for the stabilization of eyes, head and body
in space that helps to maintain an upright posture.
The vestibular system is composed of two parts; (i) the
vestibular ocular system, which maintains t he visual
stabilization, (ii) the vestibular-spinal system, which is
responsible for the orientation of the body in space
and maintenan ce of the postural tone, which is neces-
sary for the development of motor milestone. It is nor-
mal for a human to have a certain amount of postural
sway for various age groups and both the sexes have
been documented. However, the child imitates the
adult pattern of postural control by the age of seve n to
ten years. According to the sensory systems perspec-
tive, young children depend on the visual system t o
maintain balance. As they grow older, there is a pro-
gressive domination of the somato-sensory system and
the v estibular system [25-27].
Patho-physiology of postural control and motor
development in hearing impairment
Delayed postural development and motor development
is a common sensorimotor impairment in profoundly
deaf children. The vestibular en d-organ and coch lea are
closely related both anatomically and functionally.
Therefore, injury or trauma prenatally, perinatally, or
postnatally may cause damage to one or both systems
[28-30]. Moreover, damage to portions of the vestibule-
cochlear nerve is a presumed cause of sensorineural
hearing loss, may include damage to both co chlear
vestibular system is also critical for gaze stabilizati on.
Thus damage to vestibular system ca uses gaze and bal-
ance impairments [32]. Potter and Silvermann has stated
that many deaf children compensate for vestibular defi-
cits through v isual and kinesthetic systems to maintain
static balance with eyes open or closed [33]. In a cross-
sectional study Sharon et al studied 40 c hildren with
SNHL and found that 50% had abnormality in horizon-
tal semicircular canal function, 38% had dysfunc tion in
higher frequency canal function and 40% had abnormal-
ities of saccular fu nction [34]. Since damage to vestibu-
lar structures is known to cause the balance deficit,
which may interfere with no rmal motor development, it
has been postu lated as the primary cause of motor defi-
cit [35,36]. Crowe and Horak in a cross-sectional study
found that hearing impaired children with sens ory orga-
nization deficits have poor balance and motor profi-
ciency in many areas [37]. Esther Hartman et al
examined the motor performance in deaf elementary
school children and found that deaf children had signifi-
cantly more borderline and definite motor problems
than the normative sample [38].
Early identification and intervention
Early identification of childhood hearing impairment
and prompt intervention are crucial for improved out-
comes. Vestibular deficit related impairments and the
efficiency of therapy i ntervention for such impairments
in children are only recently documented [39-41]. In
spite of the existing documentation, postural control
and motor assessments are not a routine procedure in
hearing impaired children. Moreover, in developing
countries, early detection poses a significant practical
challenge. Many pediatri c health care providers a re
often too busy or inadequately trained to conduct an
elaborate developmental screening test in re gular clinics
[42]. Consequently, balance and motor deficits in child-
hood are an overlooked entity and intervention to ame-
liorate th ese impairments is not provided. While testing
the vestibular function, test s of canal and oto lith func-
tion should also be included as semici rcular canals and
Rajendran and Roy Italian Journal of Pediatrics 2011, 37:33
Page 3 of 5
otoliths, mediate the vestibular ocular reflex and vesti-
bule-spinal respo nses [32] . There is amp le evidence that
children with SNHL have concurrent mo tor and balance
deficit. However, there is paucity in investigations of inter-
vention for balance and motor performance deficits in
hearing impaired children. Gheysen et al investigated the
consequences of cochlear implantation on the motor abil-
ities of deaf chi ldren and foundthatdeafchildrenwith
cochlear implantation did not perform better on balance
and motor skills than children without cochlear implanta-
tion [43]. Hence exercise intervention should be incorpo-
rated to improve balance and motor performance. Lewis et
al found improvement in balance skill in 6-8 year old chil-
dren following participation in balance and body awareness
program [44]. Braswell and Rine found improvement in
dynamic visual acuity, critical print size, and reading acuity
following visual-vestibular exercises [45]. Rine et al
reported improvement in sensory organization for postural
control and halt of progressive motor delay following exer-
cise intervention that focused on enhancement of sensory
integrative postural control abilities [46].
Childhood hearing impairments are a world-wide pro-
blem that causes the most serious limitation that can
befall a child, as it prevents his optimal develop ment. It
has to be viewed as a multifaceted condition as a variety
of factors determines the effect of hearing impairment
on child s dev elopment. The focus of evaluation and
treatment for these children is primarily on the language
development. Therefore in order to minimize the
adverse effects on normal development of hearing disor-
ders, it is crucial to carryout screening examinations
and appropriate interventions of balance and motor def-
icits, which enable early detection of these dysfunc tions,
which are often either not noticed or under estimated.
It is also important to re-evaluate motor function in
these children during t he course of their childhood in
order to assure early intervention.
The authors thank Deepa J (Physiotherapist) who provided writing
Authors contributions
Both the authors contributed to the conception of the study and were
involved in writing, revising and approving the final draft of the manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 29 December 2010 Accepted: 14 July 2011
Published: 14 July 2011
1. McCormick B: Screening and surveillance for hearing impairment in pre-
school children. In Paediatric Otolaryngology. Volume 6.. sixth edition. Edited
by: Kerr AG. Scott Browns Otolaryngology; 6/6/1-6/6/5, DA Adams, MJ
Cinnamond (Volume Eds.), Butterworth Heinemann, Oxford.
2. Davis A: Epidemiology of hearing impairment. In Scott Browns
Otolaryngology. Volume 4.. sixth edition. Edited by: Kerr AG, Stephens D.
Butterworth Heinemann, Oxford; 1997:18-19.
3. Sokol J, Hyde M: Hearing Screening. Pediatr Rev 2002, 23:155-161.
4. Windmill IM: Universal screening of infants for hearing loss: Further
justification. J Pediatr 1998, 318-319.
5. Denoyelle F, Marlin S, Weil D, Moatti L, Chauvin P, Garabédian EN, Petit C:
Clinical features of the prevalent form of childhood deafness, DFNB1,
due to connexin-26 gene defect:implications for genetic counseling.
Lancet 1999, 353:1298-1303.
6. Mehl AL, Thomson V: Newborn hearing screening: the great omission.
Pediatrics 1998, 101:1-6.
7. Newton VE, Macharia I, Mugwe P, Ototo B, Kan SW: Evaluation of the use
of a questionnaire to detect hearing loss in kenyan pre-school children.
Int J Paediatr Otorhinolaryngol 2001, 57(3):229-334.
8. Smith AW, Hatcher J, Mackenzie IJ, Thompson S, Bal I, Macharia I, Mugwe P,
Okoth-Olende C, Oburra H, Wanjohi Z: Randomized controlled trial of
treatment of chronic suppurative otitis media in Kenyan school children.
Lancet 1996, 348:1128-1133.
9. Butterfield SA: Gross motor profiles of deaf children. Percept Mot Skills
1986, 62:68-70.
10. Dickens Omondi, Calistus Ogol, Syprine Otieno, Isaac macharia: Parental
awareness of hearing impairment in their school-going children and
health care seeking behaviour in kisumu district, Kenya. Int J Pediatr
Otorhinolaryngol 2007, 71 :415-423.
11. American Speech-Language-Hearing Association: Degree of hearing loss.
12. American Speech-Language-Hearing Association: Types of hearing loss.
13. Angeles Espeso, David Owens, Gareth Williams: The diagnosis of hearing
loss in children: Common presentations and investigations. Current
pediatrics 2006, 16:484-488.
14. Davidson J, Hyde ML, Alberti PW: Epidemiology of hearing impairment in
childhood. Scand Audiol Suppl 1988, 30:13-20.
15. Davidson J, Hyde ML, Alberti PW: Epidemiologic patterns in childhood
hearing loss: a review. Int J Pediatr Otorhinolaryngol 1989, 17(3):239-66.
16. Parker MJ, Fortnum HM, Young ID, Davis AC, Mueller RF: Population-based
genetic study of childhood hearing impairment in the Trent region of
the United Kingdom. Audiology 2000, 39(4):226-231.
17. Sever JL, Ellenberg JH, Ley AC, Madden DL, Fuccillo DA, Tzan NR,
Edmonds DM: Toxoplasmosis: maternal and pediatric findings in 23,000
pregnancies. Pediatrics 1988, 82(2):181-192.
18. Razi MS, Das VK: Effects of adverse perinatal events on hearing. Int J
Pediatr Otorhinolaryngol 1994, 30:29-40.
19. Davis A, Wood S: The epidemiology of childhood hearing impairment:
factor relevant to planning of services. Br J Audiol 1992, 26(2):77-90.
20. The lancet London: Saturday, February 23. 403-1026, 195.
21. Speech and Language Developmental Milestones. [http://www.nidcd.nih.
22. Pollack D, Goldberg DM, Caleffe-Schenck N: Educational Audiology For the
Limited Hearing Infant: Auditory-Verbal Practice. 3 edition. Springfield, IL:
Charles C. Thomas; 1997.
23. Shumway-Cook A, Woollacott MH: Motor Control: Theory and Practical
Applications Baltimore, Md: Williams & Wilkins; 1995.
24. Shumway-Cook A, McCollum G: In Assessment and treatment of balance
deficits. Edited by: Montgomery PC, Connolly BH. illotm Control and
Physical Therapy: Theoretical Framework and Practical Applications. Hixson,
Tenn: Chattanooga Group Inc; 1991:123-137.
25. Weisz S: Studies in equilibrium reaction. J Nerv Ment Dis 1938,
26. Forssberg H, Nashner LM: Ontogenic development of postural control in
man: adaptation to altered support and visual conditions during stance.
J Neurosci 1982, 2 :545-552.
27. Foundriat BA, Di Fabio RP, Anderson JH: Sensory organization of balance
responses in children 3-6 years of age: A normative study with
diagnostic implications. Int J Paediatrics Otorhinolaryngol 1993, 27:255-271.
28. Anna Pajor, Magdalena Jozefowicz-korczynsks: Prognostic factors for
vestibular impairment in sensorineural hearing loss. Ear Arch
Otorhinolaryngol 2008, 265:403-407.
Rajendran and Roy Italian Journal of Pediatrics 2011, 37:33
Page 4 of 5
29. Wilson VJ, Peterson BW: In The role of the vestibular system in posture and
movement Edited by: mountcastle VB , medical physiology, ed 14, St. Louis,
MO, CV Mosby Co, 1980, vol 1, pp 813-836.
30. Kimitaka kaga: Vestibular compensation in infants and children with
congenital and acquired vestibular loss in both ears. International journal
of pediatric otorhinolaryngology 1999, 49 :215-224.
31. Siegel JC, Marchetti M, Tecklin JS: Age-related balance changes in
hearing-impaired children. Phys Ther 1991, 71(3):183-9.
32. Rine RM: Growing evidence for balance and vestibular problems in
children. Audiological medicine 2009, 7(3):138-142.
33. Potter CN, Silverman LN: Characteristics of vestibular function and static
balance skills in deaf children. Phys Ther 1984, 64(7):1071-5.
34. Cushing SL, Papsin BC, Rutka JA, James AL, Gordon KA: Evidence of
vestibular and balance dysfunction in children with profound
sensorineural hearing loss using cochlear implants. Laryngoscope 2008,
35. Rine RM, Cornwall G, Gan K, Locascio C, OHare T, Robinson E, Rice M:
Evidence of progressive delay of motor development in children with
sensorineural hearing loss and concurrent vestibular dysfunction. Percept
motor skills 2000, 90:1101-12.
36. Horak FB, Nashner LM, Doemer HC: Postural strategies associated with
somatosensory and vestibular loss. Exp Brain Res 1990, 82:167-78.
37. Crowe TK, Horak FB: Motor proficiency associated with vestibular deficits
in children with hearing impairments. Phys Ther 1988, 68(10):1493-9.
38. Hartman Esther, Houwen Suzanne, Visscher Chris: Motor Skill Performance
and Sports Participation in Deaf Elementary School Children. APAQ 2011,
39. Rine RM, Cornwall G, Gan K, LoCascio C, OHare T, Robinson E: Evidence of
progressive delay of motor development in children with sensorineural
hearing loss and concurrent vestibular dysfunction. Percept motor skills
2000, 90:1101-12.
40. Rine RM, Spielholz NI, Buchman C: In Postural control in children with
Sensorineural hearing loss and vestibular hypofunction: deficits in sensory
system effectiveness and vestibulospinal function. Edited by: Duysens J, Smits-
Engelsman BCM, Kingma H. Control of postural and gait. Amsterdam:
Springer-Verlag; 2001:40-5.
41. Cohen H, Friedman EM, Lai D, Pellicer M, Duncan N, Sulek M: Balance in
children with otitis media with effusion. Int J Pediatr Otorhinolaryngol
1997, 42:107-15.
42. CDC, Internet Communications. [
43. Gheysen F, Loots G, Van Waelvelde H: Motor development of deaf
children with and without cochlear implants. J Deaf Stud Deaf Educ
44. Lewis S, Higham L, Cherry DB: Development of an exercise program to
improve the static and dynamic balance of profoundly hearing impaired
children. Am Ann Deaf 1985, 130:278-283.
45. Braswell J, Rine RM: Preliminary evidence of improved gaze stability
following exercise in two children with vestibular hypofunction. Int J
Pediatr Otorhinolaryngol 2006, 70(11):1967-73.
46. Rine RM, Braswell J, Fisher D, Joyce K, Kalar K, Shaffer M: Improvement of
motor development and postural control following intervention in
children with sensorineural hearing loss and vestibular impairment. Int J
Pediatr Otorhinolaryngol 2004, 68(9):1141-8.
Cite this article as: Rajendran and Roy: An overview of motor skill
performance and balance in hearing impaired children. Italian Journal of
Pediatrics 2011 37 :33.
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Rajendran and Roy Italian Journal of Pediatrics 2011, 37:33
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... During development the oticplacode develops as a simple sheet of epidermal cells and then transforms into a complicated system of ducts, recesses, hair cells, and sensory neurons of the vestibular and cochlear apparatus. The evolution of the vertebrate ear into a complex three-dimensional system requires coordinated development of morphology (2).Non sensory structures such as cupula and tectorial membranes; and sensory structures, including neurons connect the ear to the brain (3,4) Since birth onwards, both auditory stimuli and visual orientation are closely related. A child's early responses to auditory stimuli are basically visual motor responses such as eye blinking, head turn or moving eye towards source of sound (5). ...
... Cochlea and the vestibular apparatus are inter related in terms of innervations and vascular supply and lies in close proximity (6).Deficits in cochlear function resulting in sensory neural hearing loss (SNHL) could in turn cause vestibular impairment because the cochlea and vestibule has the common membranous labyrinth of the inner ear. Thus any high risk factors causing cochlear impairment could cause deficit in the vestibule also [3,5]. Prevalence of SNHL among pediatric population is estimated to be around 0.2% at birth and 0.35% during adolescence. ...
... Since it is very hard to notice symptoms of vestibular dysfunction in children, there could be a large number of hearing impaired children with vestibular dysfunction, requiring identification, education, and therapy. Many studies reported semicircular canal function was abnormal in response to a caloric stimulus in around 50% of children with severe to profound SNHL [8,3,9,10]. ...
Full-text available
This study was conducted from an Audiology & rehabilitation clinic in Kerala- India from January 2022 to August 2022.In both evolutionary and embryonic perspective, the organs responsible for hearing and balance (auditory & vestibular system) have a common origin and developmental pattern. Sensory neural hearing loss (SNHL) is a common congenital sensory deficit occurring in large number of children and it is extensively investigated and has well defined management protocols such as hearing aids or cochlear implants and speech-language rehabilitation. But in comparison with the case of SNHL, very little effort has been done to investigate and treat the vestibular deficits which can co-occur along with SNHL. This study is an attempt to throw some light about the incidence of vestibular deficits in hearing impaired children. It was found that abnormal/absent VEMP responses were found in 57% of children with SNHL. VEMP responses were completely absent in 65% of ears with severe to profound hearing loss. Vestibular dysfunction was also present in 19% of children with moderate to moderately severe hearing loss. Incidence of vestibular deficits increases in higher degree of hearing loss such as severe to profound category. Motor delay was also reported in 10 out of 26 participants in this study which could be attributed to lack of visual motor development in children with vestibular deficits. However a large number of vestibular deficits in children with SNHL still remain under reported and uninvestigated which points to the need for conducting vestibular assessment in children diagnosed with SNHL.
... Vestibular injury, which impacts sensorineural function and psychomotor development, was the root cause of the auditory issue. When compared to children with normal hearing, previous studies have revealed that hearing impairment causes some abnormalities in the psychomotor development as well as delays in learning motor skill performance, like balance, coordination, fine and gross motor skills, power, speed, agility etc. (Gheysen & Loots, 2008;Melo et al., 2015;Rajendran & Roy, 2011;Wiegersma & Velde, 1983). Few previous studies revealed that a poor hearing ability hinders the motor development of the children (Dummer et al., 1996;Gayle & Pohlman, 1990;Weiss & Phillips, 2006). ...
... Many studies have also shown that hearing impairments minimize balance & coordination ability and reduced physical ability (Al-Rahamneh et al., 2013;Livingstone & McPhillips, 2011). Most studies on individuals with hearing impairment have focused on the components of balance & stability that are due to the functional problem in the vestibular mechanism of the inner ear (Rajendran & Roy, 2011). According to the smoothness of the vestibular function of the inner ear hearing impairment can also vary to a different degree . ...
... pment and when compared to children with normal hearing, previous studies have revealed that hearing impairment causes some abnormalities in the psychomotor development as well as delays in learning motor skill performance, like balance, coordination, fine and gross motor skills, power, speed, agility etc. (Gheysen & Loots, 2008;Melo et al., 2015.;Rajendran, 2011;Wiegersma & Velde, 1983). Few previous studies revealed that a poor hearing ability hinders the gross motor development of the children (Gayle, & Pohlman, 1990;Dummer et al., 1990;Weiss & Phillips, 2006). Different studies on the physical & motor fitness level of the hearing impaired population have already been attempted (Caglar et al., ...
Full-text available
Physical/motor fitness level of the hearing-impaired population have already attempted in previous studies where degree of hearing-loss of the subjects were not considered so far. Therefore, the aim of the study was to compare agility among children with different degree hearing-loss in India. Total of two-hundred-fifty-two (N=252, Boy=126 & Girls=126) hearing-impaired children (aged 13-20 years) were selected as subjects. Degree of Hearing-loss was measured by audiometric technique and divided into six different groups’ viz. Profound, Severe, Moderately-Severe, Moderate, Mild and Normal with twenty one subjects in each group for each sex. Agility was measured through 4×10 meter shuttle run test. 2-way-ANOVA followed by Tukey's test was used as necessary statistics. The significance was tested at p <.05 level. In agility, boys ware significantly better than the girls in all respect, when different hearing impaired groups were combined. Significant differences in agility among the different hearing impaired groups were observed except in few cases when both sexes were combined. No significant interaction between Sex and degree of hearing loss were observed. An increasing linear trend in agility was observed with decreasing degree of hearing Loss. Thus, an inverse relationship between agility and degree of hearing loss (dB HL) is observed.
... cts sensorineural function and psychomotor development. Previous research has suggested that hearing impairment cause some deficits in the psychomotor development as well as delays in learning motor skill performance, balance (static or dynamic), and coordination when compared to normal-hearing children (Gheysen & Loots, 2008;Melo RD et al., 2015.;Rajendran, 2011;Wiegersma & Velde, 1983). ...
... On the basis of the damage in the parts of the auditory system (inner, middle, or outer ear), the American Speech-language Hearing Association (ASHA) has classified HL into three types: i) Conductive Hearing Lossthe inability to hear faint sound waves that cannot pass through the external (outer ear) and internal ear (middle ear). ii) Sensorineural Hearing Loss-due to damage in the auditory nerve pathways and innermost part of the ear, and iii) Mixed Hearing Loss-i.e. conductive as well as sensorineural hearing loss (Weber & Klein, 1999;Rajendran, 2011). Furthermore, depending on the ability to receive the sound frequency, ASHA classified the degree of hearing loss, usually expressed in decibels of hearing loss (dB HL), into the following types: profound, severe, moderately severe, moderate, mild, slight, normal (Clark J G., 1981). ...
... Again few studies were also conducted to measure the level of static & dynamic balance of the players of different games (Alpay C B & Işık Ö, 2017; Coşkun, B. et al., 2019;Eliöz et al., 2013;Halil et al., 2015;Bressel, E. et al., 2007;Nunomura, M., & Oliveira, M. S., 2013;Caglar et al., 2013). A few different studies have also been conducted on hearing impaired populations to find out the effect of age, gender, etiology, etc. on static and dynamic balance abilities, and most of those studies showed that balance was affected negatively in terms of age, gender, etiology, etc. (Rajendran, 2011;Weiss, A. H. & Phillips, J. O., 2006;Berg K., 1989;Siegel, J. C., Marchetti, M., & Tecklin, J. S., 1991;Tetik, S., Koç, H., & Atar, Ö., 2016;Caglar et al., 2013;Butterfield & Ersing, 1986). Some researchers also conducted a few randomised control trials with a view to developing the balance ability of the hearing impaired population (Rong-Ju Cherng et al., 2009;Hazar F, & Taşmektepligil Y., 2008;Kaya & Sarıtaş, 2019;Fotiadou, E. et al., 2002;Nacaroglu & Karakoc, 2018;Arumugam, 2015;Sanjari & Qasemi, 2016). ...
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Abstract: Background: The present study attempted to measure the dynamic balance of the children with varying degrees of hearing loss from a comparative stand point to establish the association of dynamic balance with degree of hearing loss. Purpose: It was aimed to evaluate the differences of dynamic balance of school children with different degrees of hearing loss. Problem Statement: The present research work is stated as a study on dynamic balance of school children in India with varying degrees of hearing impairments. Approach: Two hundred & fifty two (N=252) children, both Boys (NB=126) and Girls (NG=126) with varying degree of hearing impairments having age ranging from 13-16 years were selected as subjects. On the basis of hearing ability, they were divided into six equal sub groups for each sex, namely Profound, Severe, Moderately Severe, Moderate, Mild and Normal Groups as assessed through audiometric techniques. In each subgroup the no. of subjects was twenty one (n=21). In this study dynamic balance was measured by Modified Bass Test (BASS; maximum score = 100). Collected data on dynamic balance for different sub groups (twelve) were presented as mean and standard deviation (SD). Data normality was tested through Kolmogorov-Smirnov (K-S) Test. The values of K-S test statistic were greater than the respective p-values (not differed significantly) in all twelve cases (row × column) for raw-data set of dynamic balance, it was confirmed that the data sets were normally distributed. Therefore, groups were compared by using 2-way ANOVA as parametric statistical tools in dynamic balance. Exact differences between the pair of groups were calculated separately in row, column and interaction to be confirmed by using Tukey’s LSD test- a post hoc test. The significance was tested at p<.05 level. Results: In dynamic balance, 1) the girls were better than the boys when all six varying degrees of hearing impaired groups were combined. 2) Significant differences were observed between most of the pairs of groups with varying degrees of hearing impairments when both sexes are combined except in the few pairs of groups. 3) No interaction was observed between degree of hearing loss and sex. Conclusions: The dynamic balance of the girls is better than boys and it decreases almost linearly with increasing degree of hearing impairment. Thus, in dynamic balance there is a linear increasing trend with positive gradient from profound towards the normal group. Keywords: Balance, Static balance; Sensorinural hearing loss; Degree of hearing loss; Deaf & Dumb; Decibels of hearing loss
... The prevalence of moderate to profound hearing loss in children, including sensorineural hearing loss and conductive hearing loss is 1 to 6 of 1000, of which, 10% have hearing levels that fall in the profound (2) range. ...
... Degree of hearing impairment: The degree of hearing loss explains the severity of hearing impairment. The degrees of hearing loss according to American Speech-Language (2) Hearing Association. ...
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Comparison Of Conventional Balance Training Alone & Conventional Balance Training With Visual Feedback Activities In Children With Sensorineural Deafness, International Journal Of Advances In Orthopaedics
... To maintain the principle of the child's autonomy, with the literal meaning attributed to it, the intervention decision could be postponed until an older age. However, it should be remembered that for the proper sensorimotor and speech development, it is important to take appropriate action as early as possible [27]. It is also crucial for supporting a child's psychosocial development (Figure 2). ...
... The application of justice in research should be reflected in social life and the availability of the most appropriate solutions for the patient [28]. Justice in research emphasizes the fundamental principle of "health for all" [27]. This means access to health, regardless of gender, ethnicity, place of birth, political beliefs, religion, economic or social status. ...
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Translational research moves promising primary research results from the laboratory to practical application. The transition from basic science to clinical research and from clinical research to routine healthcare applications presents many challenges, including ethical. This paper addresses issues in the ethics of translational audiology and discusses the ethical principles that should guide research involving people with hearing loss. Four major ethical principles are defined and explained, which are as follows: beneficence, nonmaleficence, autonomy, and justice. In addition, the authors discuss issues of discrimination and equal access to medical services among people with hearing loss. Despite audiology’s broad field of interest, which includes evaluation and treatment of auditory disorders (e.g., deafness, tinnitus, misophonia, or hyperacusis) and balance disorders, this study focuses primarily on deafness and its therapies.
... It has been reported that only 20% of boys, girls, and adolescents with hearing impairment comply with the recommended quantity by the World Health Organization (WHO, 2010), being 60 minutes daily of moderate to vigorous physical activity (Li et al., 2019). Research in basic education that has assessed the physical activity of students with hearing impairment reports sedentary behaviors during the school day (Sit et al., 2007;Sit et al., 2019), which is unfavorable for this section of the population, due to the etiological nature of hearing impairment; which partially or limits hearing in one or both ears (Franco & Panhoca, 2008), which generates poor motor skills with low levels of coordinative physical capacities (Jafarnezhadgero et al., 2017;Rajendran & Roy, 2011;Walicka-Cupryś et al., 2014). Based on intervention studies in Physical Education, the practice of physical activity for motor skill development in students with hearing impairment has been widely recommended Ochoa-Martínez et al., 2019). ...
... In the case of teaching Physical Education to deaf and hearing-impaired students, specifi c methods have been recommended, adapting communication through sign language and strategies that promote motor skill development (Andrade & Freitas, 2016;Barboza et al., 2019;Fiorini & Manzini, OCHOA MARTÍNEZ, P.Y.;HALL LÓPEZ, J.A.;TEIXEIRA, A.M. 2018). However, when analyzing the results, knowing the multiple benefits of physical activity in terms of quality of life for deaf and hearing-impaired schoolchildren (Kitterick et al., 2015), constructively, strategies are required so that teachers increase the time of moderate to vigorous physical activity during Physical Education class, focusing on tasks that promote coordination (Dantas & Manoel, 2009), that in the case of people with hearing impairment, would favor the motor skill learning difficulties associated to rhythm, synchronization, adaptation, location in space-time, laterality, orientation and reaction speed (Jafarnezhadgero et al., 2017;Rajendran & Roy, 2011;Walicka-Cupryś et al., 2014). ...
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The objective of this study was to determine comparatively the physical activity in Physical Education and school recess of hearing-impaired students in Primary Education. Fifty-eigth Physical Education classes and recess in Primary Education were evaluated in a representative way, in specialized educational institutions for people with hearing disabilities. Physical activity was determined using the system for observing fitness instruction time (SOFIT). Inferential statistics, using the Student’s t-test, reported significant differences with more moderate to vigorous physical activity performed during recess than in Physical Education. The same pattern was identified in schoolchildren without diagnosed disabilities. It is recommended that teachers guide the content for the development of coordinating skills that favor the gross and fine motor conditions of this population, implementing didactic strategies that increase the amount of moderate to vigorous activity in Physical Education that is greater than that performed during recess.
... After neomycin induced hearing loss, rats were impaired on the Rotarod, a test traditionally used to assess motor deficits in rodents (Hamm et al., 1994;Brooks et al., 2012). In humans, hearing loss in children is associated with motor developmental deficits (Rajendran and Roy, 2011;Kamel et al., 2021), whereas motor function in adults with age-related hearing loss has not been extensively explored. However, reduced motor learning has been described in deaf adults performing a serial reactiontime task (Lévesque et al., 2014), which may be associated with cortical reorganization after age-related hearing loss. ...
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Background Hearing loss was proposed as a factor affecting development of cognitive impairment in elderly. Deficits cannot be explained primarily by dysfunctional neuronal networks within the central auditory system. We here tested the impact of hearing loss in adult rats on motor, social, and cognitive function. Furthermore, potential changes in the neuronal activity in the medial prefrontal cortex (mPFC) and the inferior colliculus (IC) were evaluated. Materials and methods In adult male Sprague Dawley rats hearing loss was induced under general anesthesia with intracochlear injection of neomycin. Sham-operated and naive rats served as controls. Postsurgical acoustically evoked auditory brainstem response (ABR)-measurements verified hearing loss after intracochlear neomycin-injection, respectively, intact hearing in sham-operated and naive controls. In intervals of 8 weeks and up to 12 months after surgery rats were tested for locomotor activity (open field) and coordination (Rotarod), for social interaction and preference, and for learning and memory (4-arms baited 8-arms radial maze test). In a final setting, electrophysiological recordings were performed in the mPFC and the IC. Results Locomotor activity did not differ between deaf and control rats, whereas motor coordination on the Rotarod was disturbed in deaf rats ( P < 0.05). Learning the concept of the radial maze test was initially disturbed in deaf rats ( P < 0.05), whereas retesting every 8 weeks did not show long-term memory deficits. Social interaction and preference was also not affected by hearing loss. Final electrophysiological recordings in anesthetized rats revealed reduced firing rates, enhanced irregular firing, and reduced oscillatory theta band activity (4–8 Hz) in the mPFC of deaf rats as compared to controls ( P < 0.05). In the IC, reduced oscillatory theta (4–8 Hz) and gamma (30–100 Hz) band activity was found in deaf rats ( P < 0.05). Conclusion Minor and transient behavioral deficits do not confirm direct impact of long-term hearing loss on cognitive function in rats. However, the altered neuronal activities in the mPFC and IC after hearing loss indicate effects on neuronal networks in and outside the central auditory system with potential consequences on cognitive function.
... Mental health disorders were found to be major health issues in young adults between ages 18-24 (3). Hereditary causes acounted for 50% to 75% of all children complaining from deafness (4). Several surveys have found that the main mental health problems among deaf adult population were depression and anxiety resulting from the challenge of adjustments (5). ...
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Due to lack of attention to mental healthcare services, awareness of the Palestinian population of mental health problems is relatively insufficient. The main objective of this study is to assess the prevalenc of depression symptoms among Palestinian deaf adults. Cross-sectional design and Patient Health Questionnaire (PHQ-9 scale) were used to assess the symptoms of depression. The population of the study consisted of 217 adults. After data collection and analysis, the results showed four levels of depression: minimal (OR=2. 0) (95% CI, 1.2-3.4), mild (OR= 1.7) (95% CI, 1.2-2.3) moderate, (OR=1. 4) (95% CI, 1.1-1.9), and severe (OR=0. 9) (95% CI, 0.7-1.2). Depression symptoms were found to be a common health problem among the deaf adult population.
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Background: The main focus of this study was to identify challenges experienced in sports participation by children with disabilities. Objective: To examine the main problems and prospectus for special population towards their participation in sports. Methodology: This study employed a cross-sectional and analytical research design. Convenient sampling technique was used for the selection of sample. Requisite information on the different variables such as the nature of the disability, the duration in the institution and sports related data were obtained through the questionnaire. The descriptive analysis involved the computation of frequency distributions of the responses. Non-Parametric analysis was done for hypothesis testing as the data was categorical. Results: The results indicated that physical challenges were being experienced by children with disabilities (CWDs). There were 3% students who reported "having no opportunity, 8% reported not having special aids and equipment, and 19% reported lack of sports fields, and 5% reported poor fitness" are the main challenges in sports participation. They also reported that psychological challenges also hindered their participation in sports. There were 6.1% who reported "fear of being rejected, 15.2% reported not being able to do sports, and 78.8% reported their own health" as challenges to take part in sports. They also reported that social factors including "financial problems (93.9%) and non-availability of trained coaches (6.1%)" as another type of challenge to take part in sports.
Objective: To characterize the patterns of hearing loss and methods of hearing rehabilitation in the UK national cohort of adults with Alström syndrome. Study design: Retrospective review of electronic patient records. Setting: UK National multi-disciplinary team (MDT) Alström service held at the Queen Elizabeth Hospital, Birmingham. Patients: Forty one adult patients with a diagnosis of Alström syndrome, confirmed via ALMS1 gene sequencing, are under ongoing review within the UK National MDT Alström service. Main outcome measures: Magnitude and type of hearing loss were analyzed using patients' audiometric data. Deterioration of hearing was calculated using serial pure tone audiograms. Methods of hearing rehabilitation used by patients and potential candidacy for cochlear implantation were analyzed. Results: Of 34 patients with available audiograms, all had sensorineural hearing loss (SNHL). Dual sensory (visual and hearing) loss was present in 32/34 (94%) patients. Hearing deteriorated with advancing age, at 1.23 dB/yr. Severe- profound SNHL was present in 9/34 (26%) cases. Air conduction hearing aids were used in 27/34 (79%) cases, and cochlear implants in 2/34 (5%). Conclusions: Alström syndrome is an ultra-rare genetic disorder with progressive, debilitating multi-system manifestations, including SNHL. The UK National MDT Alström service represents one of the largest reported adult cohorts in the world. SNHL in this group was ubiquitous, showing a rapid decline in hearing with age. Annual audiometric assessment to enable early diagnosis of hearing loss and optimum rehabilitation are paramount to minimize the impact of hearing loss in this condition.
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The objective of the study was to investigate childhood hearing impairment in a population-based sample from a genetic perspective. Participants included 82 families with hearing-impaired children (aged 4-13) previously ascertained in the Trent Health Region. A questionnaire was mailed to all families, followed by a home visit and Connexin-26 35delG mutation screen. The Connexin-26 35delG mutation was identified in seven families (approximately 10 per cent of non-syndromal hearing impairment). Children of these families were significantly more likely than children with other modes of inheritance to have a profound hearing loss with a flat audiogram profile. The families of children with a significant admission to a neonatal intensive care unit were significantly less likely to have had genetic counselling. Eight families visited were found to have features suggestive of a genetic syndrome that had not been previously assigned a specific diagnosis. The study concluded that hearing-impaired children should be investigated systematically according to an agreed-upon protocol, which should include Connexin-26 35delG mutation analysis at least for those with severe-to-profound hearing loss. Sumario El objetivo de este estudio fue investigar, desde una perspectiva genética, los trastornos auditivos en niños, con base en una muestra poblacíonal. Se incluyeron 82 familias de niños hipoacúsicos (edades 4–13 años), evaluados previamente en la región de Trent. Se envió un cuestionario a todas las familias, seguido de una visita al hogar y de un tamizaje para la mutación Connexina-26 35delG. Esta mutación fue identificada en 7 familias (aproximadamente un 10% de las hipoacusias no sindrómicas). Los niños de estas familias tenían una significativa mayor propensidn a mostrar una pérdida auditiva profunda con un perfil audiométrico piano, que aquellos con otros modos de herencia. Las familias de ninos con un numero sígnificativo de admisiones a unidades de cuidados intensivos neonatales recibieron menor consejo genético. Ocho de las familias visitadas mostraron aspectos sugestivos de un síndrome genetico al que no se le ha dado un diagnóstico específico. El estudio concluye que los niños con trastornos auditivos deben ser investigados systemáticamente de acuerdo con un protocolo acor-dado, que debe incluir un análsis de la mutación Connexina-26 35delG, al menos para aquellos con perdidas severas a profundas.
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Reports of vestibular deficits and related impairments in children are increasing in number. However, vestibular dysfunction in childhood appears to be an under-reported and overlooked entity. This report provides an overview of current literature regarding the incidence of vestibular deficits in children, the related impairments of gaze stability and balance and intervention for vestibular related impairments in children.
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This study aimed to examine motor performance in deaf elementary school children and its association with sports participation. The population studied included 42 deaf children whose hearing loss ranged from 80 to 120 dB. Their motor skills were assessed with the Movement Assessment Battery for Children, and a questionnaire was used to determine their active involvement in organized sports. The deaf children had significantly more borderline and definite motor problems than the normative sample: 62% (manual dexterity), 52% (ball skills), and 45% (balance skills). Participation in organized sports was reported by 43% of the children; these children showed better performance on ball skills and dynamic balance. This study demonstrates the importance of improving deaf children's motor skill performance, which might contribute positively to their sports participation.
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This study examines the roles of somatosensory and vestibular information in the coordination of postural responses. The role of somatosensory information was examined by comparing postural responses of healthy control subjects prior to and following somatosensory loss due to hypoxic anesthesia of the feet and ankles. The role of vestibular information was evaluated by comparing the postural responses of control subjects and patients with bilateral vestibular loss. Postural responses were quantified by measuring 1) spatial and temporal characteristics of leg and trunk EMG activation; 2) ankle, knee, and hip joint kinematics, and 3) surface forces in response to anterior and posterior surface translations under different visual and surface conditions. Results showed that neither vestibular nor somatosensory loss resulted in delayed or disorganized postural responses. However, both types of sensory deficits altered the type of postural response selected under a given set of conditions. Somatosensory loss resulted in an increased hip strategy for postural correction, similar to the movement strategy used by control subjects while standing across a shortened surface. Vestibular loss resulted in a normal ankle strategy but lack of a hip strategy, even when required for the task of maintaining equilibrium on a shortened surface. Neither somatosensory nor vestibular loss resulted in difficulty in utilizing remaining sensory information for orientation during quiet stance. These results support the hypothesis that cutaneous and joint somatosensory information from the feet and ankles may play an important role in assuring that the form of postural movements are appropriate for the current biomechanical constraints of the surface and/or foot. The results also suggest that vestibular information is necessary in controlling equilibrium in a task requiring use of the hip strategy. Thus, both somatosensory and vestibular sensory information play important roles in the selection of postural movement strategies appropriate for their environmental contexts.
Hearing loss is a common disorder in the paediatric community, with between 1 and 3 per 1000 live births being affected with severe-to-profound loss. Without early diagnosis, the sequelae of this condition can affect the child's social and future professional development. Paediatricians may be the first clinicians to review and suspect hearing problems and therefore need a framework for further investigation and management. This article aims to give clinicians an overview of the management of hearing loss in children and to provide a logical approach to the detection, investigation and diagnosis of hearing impairment. The relevance of the early diagnosis cannot be overstated in order to negate and treat this disability, with its potential profound consequences.
Background: This is an update of the review published in Issue 4, 2003. Bone metastasis cause severe pain as well as pathological fractures, hypercalcaemia and spinal cord compression. Treatment strategies currently available to relieve pain from bone metastases include analgesia, radiotherapy, surgery, chemotherapy, hormone therapy, radioisotopes and bisphosphonates. Objectives: To determine efficacy and safety of radioisotopes in patients with bone metastases to improve metastatic pain, decrease number of complications due to bone metastases and improve patient survival. Search strategy: We sought randomised controlled trials (RCTs) in MEDLINE, EMBASE, CENTRAL, and the PaPaS Trials Register up to October 2010. Selection criteria: Studies selected had metastatic bone pain as a major outcome after treatment with a radioisotope, compared with placebo or another radioisotope. Data collection and analysis: We assessed the risk of bias of included studies by their sequence generation, allocation concealment, blinding of study participants, researchers and outcome assessors, and incomplete outcome data. Two review authors extracted data. We performed statistical analysis as an "available case" analysis, and calculated global estimates of effect using a random-effects model. We also performed an intention-to-treat (ITT) sensitivity analysis. Main results: This update includes 15 studies (1146 analyzed participants): four (325 participants) already included and 11 new (821 participants). Only three studies had a low risk of bias. We observed a small benefit of radioisotopes for complete relief (risk ratio (RR) 2.10, 95% CI 1.32 to 3.35; Number needed to treat to benefit (NNT) = 5) and complete/partial relief (RR 1.72, 95% CI 1.13 to 2.63; NNT = 4) in the short and medium term (eight studies, 499 participants). There is no conclusive evidence to demonstrate that radioisotopes modify the use of analgesia with respect to placebo. Leucocytopenia and thrombocytopenia are secondary effects significantly associated with the administration of radioisotopes (RR 5.03; 95% CI 1.35 to 18.70; Number needed to treat to harm (NNH) = 13). Pain flares were not higher in the radioisotopes group (RR 0.74; 95% CI 0.27 to 2.06). There are scarce data of moderate quality when comparing Strontium-89 ((89)Sr) with Samarium-153 ((153)Sm), Rhenium-186 ((186)Re) and Phosphorus-32 ((32)P). We observed no significant differences between treatments. Similarly, we observed no differences when we compared different doses of (153)Sm (0.5 versus 1.0 mCi). Authors' conclusions: This update adds new evidence on efficacy of radioisotopes versus placebo, (89)Sr compared with other radioisotopes, and dose-comparisons of (153)Sm and (188)Re. There is some evidence indicating that radioisotopes may provide complete reduction in pain over one to six months with no increase in analgesic use, but severe adverse effects (leucocytopenia and thrombocytopenia) are frequent.
Similarities between the peripheral auditory and vestibular systems suggest that children with sensorineural hearing loss (SNHL) may demonstrate vestibular and balance impairments. This hypothesis was studied in 40 children with severe to profound SNHL and unilateral cochlear implants. Prospective cross-sectional study with repeated measures. Vestibular function was assessed with caloric, rotational, and vestibular evoked myogenic potential testing; balance was assessed using the balance subset of the Bruininks-Oseretsky Test of Motor Proficiency-II, a standardized test of static and dynamic balance. Horizontal semicircular canal function was abnormal in response to a caloric stimulus in 50% (16/32), with a large proportion of those [6/16 (38%)] reflecting mild to moderate unilateral abnormalities. In comparison, horizontal semicircular canal function in response to rotation was abnormal in 38% (14/37). Saccular function was absent bilaterally in 5/26 (19%) and unilaterally in 5/26 (19%) with vestibular evoked myogenic potential. Age standardized balance abilities were significantly poorer in the study population [micro = 12.9 +/- 5(SD)] compared with normal hearing controls [micro = 17 +/- 5(SD); P = .0006] and correlated best with horizontal canal function in response to a rotational stimulus (P = .004; R = 0.24). SNHL from meningitis was associated with worse balance function than other etiologies. Vestibular and balance dysfunction occurred in >1/3 of children with SNHL and cochlear implants, and is highly dependent on etiology. Although compliance with all tests was high, rotational chair testing, which assesses higher frequency motion (0.25-5 Hz) and thus more "real world" vestibular function, correlated best with dynamic balance. For this reason, rotational chair testing may represent the test of choice in this population, particularly given that it is amenable to testing children of all ages.
In the Nottingham District Health Authority we found that one in 943 babies born between 1983-1986 have a sensorineural or mixed hearing impairment (at 50 dB HL or greater in the better ear averaged over the frequencies 0.5, 1, 2, 4 kHz) that is either congenital or progressive in nature. If this figure is broken down between non-neonatal intensive care unit babies and neonatal intensive care unit (NICU) graduates, we find that one in 174 NICU graduates have a hearing impairment compared with one in 1278 non-NICU babies. Excluding from the non-NICU baby population those with a known family history of hearing impairment, and those with a known relevant syndrome at birth, there is a 10.2 to 1 odds ratio for babies in NICU to have such hearing impairments compared to this restricted 'normal' baby population. In addition NICU babies with a hearing impairment were considerably more likely to have another disability (odds ratio 8.7 to 1). Acquired sensorineural or mixed impairments comprised about 9% of the children with impairments by 3 years of age. Twenty per cent of the patients seen at the Children's Hearing Assessment Centre (CHAC) with better-ear impairment of 95 dB HL or greater had acquired hearing impairments. The mean age of referral for congenital hearing impairments was found to be a function of severity and NICU status. For children with better-ear hearing impairments of 80 dB HL or greater, the mean and median ages of referral were both 8 months (s.d. 4 months).
This study compared balance skills of hearing-impaired children with those of hearing children in order to determine whether a deficit in balance exists in hearing-impaired children and to ascertain whether this deficit is age-related. Twenty-eight hearing-impaired subjects were chosen as a sample of convenience from the Pennsylvania School for the Deaf and placed into one of three age groups. Ten subjects were in the 4.5 to 6.5-year-old age group, 8 in the 8- to 10-year-old age group, and 10 in the 12.5 to 14.5-year-old age group. Selection criteria included bilateral sensorineural hearing loss of greater than or equal to 65 dB and normal intelligence (IQ greater than or equal to 80). Balance was measured by the use of the Balance subtest of the Bruininks-Oseretsky Test of Motor Proficiency. For each age group, a z test was used to compare the subjects' scores with the Balance subtest standard scores. The results showed that for each age group, the mean score for the hearing-impaired children was lower than the standard score. Both older groups had significantly higher scores than the youngest group, but the mean scores of the older groups were not significantly different. No difference between the subjects' balance scores and the Balance subtest standard scores was found among the age groups, suggesting that the balance deficit was not age-related. Gender differences were not found for balance scores.
In an attempt to clarify international epidemiologic trends, a review of the published literature pertaining to childhood hearing loss is presented. Inconsistencies of methodology and classification, which complicate the interpretation of data and make difficult the quantification of the influence of genuine population differences, are discussed. Selective review of the literature allows certain crude statements to be made regarding childhood hearing loss. In developed countries, serous otitis media is the most common cause of hearing loss in children, affecting up to two thirds of preschool children. In addition, 1.0-2.0/1000 children have bilateral SNHL of at least 50 dB. In underdeveloped countries, suppurative middle ear disease is common and is still frequently associated with either an intratemporal or intracranial complication. SNHL appears to occur almost twice as often as in developed countries, with a greater proportion being of infectious etiology. In specific populations, the Inuits, Amerindians and Aboriginals, acute and chronic suppurative otitis media are almost endemic, yet both cholesteatoma and serous otitis media are uncommon.