الفهرس 
Dedication
Development, Maturation and FunctionOnly 14 pages are availabe for public view
 |  | from | 187 |  |  |
| | | from | 187 | | |
Abstract
The cochlea shares both an anatomic proximity, histological and physiologic similarities to the neighboring vestibular end organs, solesions or insults that lead to auditory dysfunction may also lead to dysfunction of the vestibular end organs Combined hearing and vestibular loss in a child poses potentially significantproblems, even though this combined loss might only be expressed insubtle disturbances of normal development. Children and infants with vestibular problems are faced with motor incoordinationand locomotorproblems that could limit their normal development.Unlike adults, the most common presentations of peripheral vestibularloss in young children are delayed motor development and loss of postural control. So the aim of the study was to assess the relationship between the vestibular disorders and the delayed motor development in hearing impaired children as well as to assess the integrity of the vestibular system through clinical testing and radiological imaging in those children with delayed motor development. The subject in the study was divided into two groups, the study group and it was consisted of 30 hearing impaired children with history of delayed motor milestones, and the control group that consisted of 10 hearing impaired children with no history of delayed motor milestones. Both groups had a variable degree of hearing loss.
Each child was subjected to carefulhistory taking from the parents or caregivers of the children, general and neurological examination, ENT examination with emphasis on otoscopic examination, motor and balance questionnaires also were answered by the parents, caregivers, audiological evaluation either through conditioned play audiometry or conventional audiometry, speech audiometry and immittancemetry, vestibular evaluation through Cervical VEMP and caloric test and finally the radiological investigation including CT and MRI studies of the petrous bone. History of head trauma was present in two children (6.7%) of the study group, while family history of hearing loss were present in eight children (26.7%) of the study group, and in the control group, there were three cases (30%) had positive family of HL. In the study group, seven children (23.3%) had syndromic HL, four children had EVAS (13.3%), two children are Pendred (6.7%), and one is Usher syndrome (3.3%), while all control children were nonsyndromic. The motor and balance questionnaires were answered by the parents or caregivers;there were statistically significant differences in the motor milestones for the study group. There were variable degrees of hearing loss among both groups.There were statistically significant differences mainly for the moderate and profound degrees of hearing loss. Also there were statistically significant differences of thresholds among different frequencies for the study group.In the study group; there were 20 children (66.7%) had symmetrical HL and 10 children had asymmetric HL (33.3%), while for the control group, only two HI children (20%) had asymmetric HL. The course of HL was monitored during the study and classified into stationary, progressive and fluctuant. All children in the control group had stationary course. However in the study group 24 (80%) children had stationary course, four (13.3%) children had progressive course and two (6.7%) children had fluctuant HL.
In the control group (10 HI children, 20 ears), 18 ears (90%) had VEMP response, while two ears (10%) had absent VEMP, while in the study group (30 HI children, 60 ears), 48 ears (80%) had VEMP response, while 12 ears (20%) had absent VEMP.
The asymmetry ratio (AR) for the study group was 8.88 ± 8.98 and for the control group was 5.16 ± 3.52,there were no statistical significant differences between the control and the studied groups. All hearing impaired children in the control group had normal caloric response, while in the study group, 23 hearing impaired children (77%) had normal response, and seven children (23%) had abnormal caloric response, 4 children had bilateral weakness and 3 had unilateral weakness (two had right weakness and one child had left weakness).There were no other abnormalities in the caloric response as abnormal fixation, inversion, perversion. CT and MRI study of petrous bone was done for the control group and revealed normal radiology,while in the study group, 21 children had normal imaging (70%) while the last 9 children (30%) had abnormal findings, the most common abnormalities was enlarged vestibular aqueduct (13%), followed by common cavity (7%) and mondini (3%). There were significant correlation between the VEMP latencies (right P1, N1 and left P1) and the caloric response, while the amplitude showed no significant correlation. There were significant negative correlation (right r = -0.552 and for left ear r = -0.440) (right P =0.002 and for left P = 0.015) betweenthresholds of hearing loss in both ears and the caloric response. There were significant positive correlations between ”walking alone” and the threshold of hearing loss in both right and left ears (r= 0.529 & P= 0.003*) and (r= 0.474 & P= 0.008*)
There is ample evidence that children with SNHL have concurrent motor and balance deficit that may be related to vestibular system disorders,so children with hearing loss, irrespective of the degree of hearing loss, the vestibular system should be screened, assessed as it may be responsible for co-morbidities in fine and gross motor difficulties so early intervention and effective therapy will be the proper way to get good outcome.