Identification of vestibular loss in children with sensorineural hearing loss using the balance subset of the BOT-2 test

Background Vestibular loss in children with sensorineural hearing loss (SNHL) is quite high. Despite the high prevalence of vestibular loss and balance impairment in children with SNHL, they are rarely assessed by clinicians and therefore are commonly undiagnosed. The purpose of the study was to evaluate the balance subset of the Bruininks-Oseretsky Test (BOT-2) as a tool to identify vestibular loss in children with SNHL and to determine its predictive values for vestibular loss.Methods The study included 210 children allocated into 4 groups: group 1 (control healthy children), group II (children with SNHL but without vestibular loss), group III (children with SNHL and unilateral vestibular loss), and group IV (children with SNHL and bilateral vestibular loss). Caloric test, video head impulse test (vHIT), and cervical vestibular evoked myogenic potential (c-VEMP) test were used for vestibular assessment in children with SNHL and to allocate them accordingly into one of the aforementioned groups. Scores of the balance subset of the BOT-2 were compared among the three groups and compared to the control healthy children.Results 21.4% of children with SNHL but without vestibular loss have balance deficit revealed by the balance subset of the BOT-2, reflecting its better sensitivity for detecting balance deficit than the physiologic vestibular tests. Children with unilateral or bilateral vestibular loss (groups III and IV) showed a more significant balance deficit than children without vestibular loss (group II). The worst balance score was found in children with bilateral vestibular loss. The positive predictive value of the BOT-2 for peripheral vestibular loss in children with SNHL was 88%.Conclusion The balance subset of the BOT-2 has particularly good predictive values for vestibular loss in children with SNHL. The test is a simple, easy, fast office test which does not require any costly equipment.