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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 26  |  Issue : 3  |  Page : 132-134

Vestibular evaluation in patients with congenital profound hearing loss using ice cold water caloric test and rotational chair test


Department of ENT and HNS, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India

Date of Submission06-Feb-2019
Date of Decision26-Aug-2019
Date of Acceptance17-Feb-2020
Date of Web Publication22-Dec-2020

Correspondence Address:
Dr. Viraj Gaikwad
310-B Amar Cottages, Hadapsar, Pune - 411 028, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/indianjotol.INDIANJOTOL_11_19

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  Abstract 


Introduction: With the introduction of newborn hearing screening, hearing problems are often detected at the neonatal stage and in early infancy, and holistic approach including not only auditory but also vestibular function is needed. This study hopes to establish some corelation between cochlear and vestibular system dysfunction in a patient born with congenital profound hearing loss (CPHL). Materials and Methods: In this observational and descriptive study conducted at a tertiary care hospital, we evaluated eighty patients with bilateral CPHL from 2016 to 2018. After taking a detailed history and thorough ear, nose, and throat examination, the patients underwent vestibular function evaluation by ice cold water caloric test (ICCT) and rotational chair test (RCT) in the outpatient department, and the duration of nystagmus was calculated based on which hypoactive or absent vestibular function was found out. Results: In the present study, out of eighty patients with CPHL, vestibular function of 62 (77.50%) was normal, 9 (11.25%) hypoactive, and 9 (11.25%) with absent vestibular function. Conclusion: In the outpatient department where sophisticated equipment and laboratory facilities are not available, ICCT can be used to determine the vestibular function and also RCT can be used. From the present study, it can be concluded that vestibular dysfunction is present in 22.50% of patients with CPHL with the use of ICCT and RCT. There is a strong possibility of genetic origin etiology for vestibular dysfunction. The present study also concludes that consanguinity may be major etiological factor for vestibular dysfunction.

Keywords: Congenital profound hearing loss, ice cold water caloric test, rotational chair test, vestibular evaluation


How to cite this article:
Dehadaray A, Gaikwad V, Kaushik M, Mishra P, Belsare S. Vestibular evaluation in patients with congenital profound hearing loss using ice cold water caloric test and rotational chair test. Indian J Otol 2020;26:132-4

How to cite this URL:
Dehadaray A, Gaikwad V, Kaushik M, Mishra P, Belsare S. Vestibular evaluation in patients with congenital profound hearing loss using ice cold water caloric test and rotational chair test. Indian J Otol [serial online] 2020 [cited 2021 Apr 10];26:132-4. Available from: https://www.indianjotol.org/text.asp?2020/26/3/132/304277




  Introduction Top


The vestibular system provides a sense of balance and an awareness of spatial orientation. The auditory system is the sensory system for the sense of hearing. The development of both these systems starts around the 5th week of intrauterine life, and more rapid development is seen between the 26th and 49th days.[1] The cochlea and the vestibular apparatus are in close proximity with each other anatomically, phylogenetically, and also in terms of innervation and vascular supply.[2] Disturbances in the cochlear function, which can result in sensorineural hearing loss, could accompany vestibular impairment because the cochlea and vestibule share continuous membranous labyrinth of the inner ear. Therefore, prenatal, perinatal, or postnatal injury or trauma may cause damage to one or both the systems. Even though patients come with complete nonfunctional cochlear system and are thoroughly worked up for the same, evaluation of the vestibular system is not done. This study hopes to establish some corelation between cochlear and vestibular system dysfunction and to find the possibility of genetic cause in patient born with congenital profound hearing loss (CPHL). Pure tone audiometry (in adult) and brainstem-evoked response audiometry (BERA) (in children) were used to assess the auditory function, and ice cold caloric irrigation test and rotational chair test (RCT) were used to assess the function of the vestibular system.


  Materials and Methods Top


The study was conducted after the approval from the institute ethics committee. Written informed consent was obtained from all the participants and guardians. This was an observational and descriptive study carried out at a tertiary care hospital during September 2016–August 2018. A total of eighty patients with CPHL, who were willing to undergo test were included in the study. A detailed history of the patient was taken, and a thorough ear, nose, and throat examination was carried out. Patients with CPHL and with age 6 months to 40 years were included in this study, whereas patients with external and middle ear pathologies, conductive hearing loss, and congenital external ear deformities were excluded from the study.

Hearing evaluation of these patients was done using pure tone audiometry for adults. Maico MA 42 audiometer was used for the same and BERA in children with eclipse interacoustic. Ice cold caloric irrigation test was used to determine the vestibular function in which the patient was placed in supine position with 30° propped up position and 10 cc of ice cold water (0°C–4°C) was irrigated in one ear over 30 s and nystagmus was observed with duration; the same was done for other ear after 10 min interval [Figure 1]. Post irrigation with ice cold water nystagmus was observed as present or absent also nystagmus duration in seconds was noted. RCT was also used to determine the vestibular function. Patient was placed in a rotational chair (rotating office chair was used) and it was rotated for 20 s at a speed of 1 rev/2 s and after 20 s, nystagmus was observed [Figure 2]. Immediately post rotation nystagmus was observed as present or absent along with time duration, if nystagmus lasted for less than 10 sec vestibular response was considered hypoactive if more than 10 sec it was considered normal. The analysis of data was performed using Microsoft Excel.
Figure 1: Ice cold caloric test procedure

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Figure 2: Rotational chair test procedure

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  Results Top


The present study shows that eighty cases of congenital profound hearing was a male predominance (55%).

In the present study, out of a total of eighty patients with CPHL, vestibular function of 62 (77.50%) was normal, 9 (11.25%) hypoactive, and 9 (11.25%) with absent vestibular function [Graph 1]. Ice cold water irrigation caloric test showed the same results, whereas on RCT, it was observed 62 (77.50%) were with normal vestibular function, 5 (6.25%) hypoactive, and 13 (16.25%) had absent vestibular function.



Out of a total of 18 patients with vestibular dysfunction based on etiology, 1 (5.55%) was syndromic, nonsyndromic was nil, whereas 7 (38.88%) had consanguinity and rest 10 (55.55%) were with unknown etiology [Table 1] and [Graph 2].
Table 1: Distribution of patients with vestibular dysfunction based on etiology

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In this study, gender-wise distribution of patients according to age group is as follows: for male, out of total 44.26 (59.09%) were from age group of 1–5 years, 4 (9.09%) from 6 to 10 years, 10 (22.72%) from 11 to 15 years, and 14 (31.18%) from 16 to 20 years, whereas for female, out of total 36, 18 (50%) were from age group of 1–5 years, 9 (25%) from 6 to 10 years, 2 (5.55%) from 11 to 15 years, and 7 (19.44%) from 16 to 20 years.


  Discussion Top


In the outpatient department where sophisticated equipment and laboratory facilities are not available, ice cold water irrigation caloric test can be used to determine the vestibular function and also RCT can be used as both the tests are cheap and easy to perform, former having advantage and said to be gold standard test for the evaluation of unilateral vestibular function. Ice cold water caloric test also tests the function of lateral Semi circular canal (SCC) of both ears separately.

In the present study, the vestibular function was normal in 77.50% of the patients and 22.50% had vestibular dysfunction; Similar observation were observed with different studies such as Brookhouser et al.[3] in their study 78% were with normal and 22% with hypoactive vestibular function. Studies such as Tribukait el al.,[4] Shambaugh et al.,[5] and Shinjo et al.[6] showed 70% with normal and 30% with vestibular dysfunction using similar tests.

In the present study, the distribution of patients with vestibular dysfunction based on etiology shows 5.55% were syndromic, 38.88% were consanguinity, and 55.55% were with unknown etiology which can be compared with Arnvig's study in which they had 34.4% children with inherited cause and 56.8% with unknown etiology, and 8.8% with pre- and paranatal cause.[7]

From the present study, it can be concluded that vestibular dysfunction is present in 22.50% of the patients with CPHL with the use of ice cold water irrigation caloric test and RCT. Both these tests are easy to perform and cheap cost wise.

There is a strong possibility of genetic origin etiology for vestibular dysfunction. The present study also concludes that consanguinity may be a major etiological factor for vestibular dysfunction, and it can be used in marriage counseling. Marriage between deaf people is not advised; still, most of deaf people marry deaf person, in such cases, there is a possibility that their child can be born deaf. By evaluating vestibular function in such people, it may give more insight about the possibility of child born with congenital deafness and based on which they can be counseled about the same; still, further studies are needed to understand about genetic etiology.


  Conclusion Top


It can be concluded that vestibular dysfunction is present in 22.50% of the patients with CPHL with the use of ice cold water irrigation caloric test and RCT. Both these tests are easy to perform and cheap cost wise.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank the principal, Bharati Vidyapeeth (deemed to be) University and Medical College, Pune, for letting us carry out this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brookhouser PE, Cyr DG, Beauchaine KA. Vestibular findings in the deaf and hard of hearing. Otolaryngol Head Neck Surg 1982;90:773-7.  Back to cited text no. 1
    
2.
Rajendran V, Roy FG. An overview of motor skill performance and balance in hearing impaired children. Ital J Pediatr 2011;37:33.  Back to cited text no. 2
    
3.
Brookhouser PE, Cyr DG, Beauchaine KA. Vestibular findings in the deaf and hard of hearing. Otolaryngol Head Neck Surg 1982;90:773-7.  Back to cited text no. 3
    
4.
Tribukait A, Brantberg K, Bergenius J. Function of semicircular canals, utricles and saccules in deaf children. Acta Otolaryngol 2004;124:41-8.  Back to cited text no. 4
    
5.
Shambaugh GE, Hayden DB, Hagens EW, Watkins RW. Statistical studies of the children in public schools for the deaf: Additional report of committee, division of medical sciences, national research counci. Arch Otolaryngol 1930;12:190-245.  Back to cited text no. 5
    
6.
Shinjo Y, Jin Y, Kaga K. Assessment of vestibular function of infants and children with congenital and acquired deafness using the ice-water caloric test, rotational chair test and vestibular-evoked myogenic potential recording. Acta Otolaryngol 2007;127:736-47.  Back to cited text no. 6
    
7.
Arnvig J. Vestibular function in deafness and severe hardness of hearing. Acta Otolaryngol 1955;45:283-8.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

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