迈向儿童听力保健中前庭管理的政策整合：与中低收入国家相关的全球服务提供差距

文献信息

中文摘要

背景： 前庭功能障碍（VD）是听力损失儿童中常见却常被忽视的共病，尤其是患有感音神经性听力损失（SNHL）、先天性异常或人工耳蜗的儿童。这些挑战具有全球性，但在包括南非在内的中低收入国家（LMICs）尤为严峻，因为这些国家的诊断资源和服务整合有限。运动发育、凝视稳定性、学业表现和生活质量（QoL）均受VD影响，然而它很少被纳入儿童听力保健框架或常规临床实践。
目的： 本综述综合了听力损失儿童中VD的全球证据，并探讨前庭照护如何被整合到儿童听力学中，重点关注LMIC背景下的服务提供差距和政策启示。
方法： 使用PubMed、Scopus和Web of Science等数据库对2015—2025年的同行评议文献进行了叙述性综述。二十项研究符合纳入标准，并针对患病率、评估和管理实践、发育影响及政策考量进行了主题分析。
结果： 据估计，20%至85%的听力损失儿童受VD影响，具体取决于诊断工具、年龄和潜在病因；VD可导致运动里程碑延迟、平衡控制下降、学习困难和心理社会适应较差。尽管VD患病率高且对发育有影响，前庭照护在全球范围内的实施仍不一致。在儿童适宜的的诊断方案、康复策略、人员培训和政策整合方面仍存在重大差距。这些局限在LMIC最为突出，因为那里的听力学服务常受限于基础设施不足和相互竞争的卫生优先事项。
结论： 将前庭评估和管理整合到儿童听力学中，是迈向全面且公平的儿童听力保健的关键一步。亟需协调的政策制定、能力建设和适应当地情况的临床路径，以在全球范围内弥合这一差距。
临床相关性声明： 本综述强调了将前庭考量纳入儿童听力学实践的重要性。可行的筛查和康复策略可能改善发育结局、增强教育参与，并为听力损失儿童强化更整体、多学科的照护模式。

英文摘要

BACKGROUND: Vestibular dysfunction (VD) is a common yet often overlooked comorbidity in children with hearing loss, particularly those with sensorineural hearing loss (SNHL), congenital anomalies, or cochlear implants. These challenges are global, but they are especially critical in low- and middle-income countries (LMICs), including South Africa, where diagnostic resources and service integration are limited. Motor development, gaze stability, school performance, and quality of life (QoL) are affected by VD, yet it is seldom included in pediatric hearing health-care frameworks or routine clinical practice.
PURPOSE: This review synthesizes global evidence of VD in children with hearing loss and examines how vestibular care is integrated into pediatric audiology with a focus on service delivery gaps and policy implications in LMIC contexts.
METHODS: A narrative review of peer-reviewed literature (2015-2025) was conducted using databases including PubMed, Scopus, and Web of Science. Twenty studies met the inclusion criteria and were thematically analyzed for prevalence, assessment and management practices, developmental impacts, and policy considerations.
RESULTS: An estimated 20 to 85 percent of children with hearing loss, depending on diagnostic tools, age, and underlying etiology, are affected by VD, which contributes to delayed motor milestones, reduced balance control, learning challenges, and poorer psychosocial adjustment. Despite the prevalence and developmental impact of VD, vestibular care remains inconsistently implemented worldwide. Major gaps persist in pediatric-appropriate diagnostic protocols, rehabilitation strategies, workforce training, and policy integration. These limitations are most pronounced in LMICs, where audiology services are often constrained by limited infrastructure and competing health priorities.
CONCLUSIONS: Integrating vestibular assessment and management into pediatric audiology represents a critical step toward comprehensive and equitable child hearing health care. Coordinated policy development, capacity building, and context-adapted clinical pathways are urgently required to close this gap globally.
CLINICAL RELEVANCE STATEMENT: This review highlights the importance of incorporating vestibular considerations into pediatric audiology practice. Feasible screening and rehabilitation strategies may improve developmental outcomes, enhance educational participation, and strengthen more holistic and multidisciplinary models of care for children with hearing loss.