听力损失儿童和成人前庭自我运动感知临床测试的实施

文献信息

中文摘要

目的： 在成人群体中，前庭自我运动感知测试已被证明对前庭损失敏感，包括亚临床前庭变化。然而，前庭感知测试尚未在儿科人群中得到充分研究，并且目前在标准临床环境中不可行。为解决这些空白，本研究旨在确定（i）在儿科人群中测量前庭感知的可行性，以及（ii）使用标准临床旋转椅和软件捕获的前庭感知阈值的有效性。
设计： 我们招募了12名听力损失伴前庭功能正常的个体（HL + NV；平均年龄：14.4，范围9至23岁）、9名听力损失伴前庭损失的个体（HL + VL；n = 9；平均年龄：22，范围8至47岁；4名单侧和5名双侧前庭损失），以及23名年龄匹配的正常对照参与者（NC；平均年龄：16.9，范围9至45岁）。在遮光 enclosure 中，使用市售旋转椅评估偏航旋转运动刺激的感知。椅子以四种恒定加速度之一旋转（1°/秒2、2°/秒2、3°/秒2和4°/秒2），参与者被指示使用键盘尽快表明他们对旋转方向的感知（左 versus 右）。偏航旋转前庭感知阈值定义为在椅子旋转的每个加速度下按下按钮时的椅子速度中位数。
结果： 两名参与者（年龄13岁，HL + VL，和10岁，HL + NV）因害怕黑暗而无法完成测试方案，所有参与者的完成率为95.45%，19岁以下参与者的完成率为93.75%。在完成测试的42名参与者中，1名参与者（年龄37岁，HL + VL）在数据收集后被排除，因为他们承认从未感知到运动，并且每次反应都是猜测。对于剩余41名参与者在每个加速度条件下，事后成对比较显示，与NC组相比，HL + VL组的阈值显著增加（1°/秒2：p = 0.001，2°/秒2：p = 0.007，3°/秒2：p = 0.006，4°/秒2：p = 0.01）。此外，HL + NV组中有5名个体的阈值超过NC组平均值1个标准差以上，尽管其前庭功能测试正常，提示可能识别出亚临床前庭损伤。
结论： 偏航旋转感知的临床测试是测量前庭损伤的有效工具，并且在年仅8岁的听力损失儿童中是可行的。偏航旋转感知可以通过捕获前庭表现的亚临床变化来补充现有的前庭功能测试。

英文摘要

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.