Abstract: Rotational test is a standard procedure to measure the Vestibulo-Ocular Reflex (VOR) and plays an important role in the evaluation of patients with dizziness. Although rotational testing is often uneventful in adults, it can be technically challenging in pediatric patients, especially with infants and toddlers. To provide a comprehensive evaluation for all pediatric patients with suspected vestibular disorders, our clinic implemented practical methods to conduct rotational tests for young children. The goal of this presentation is to demonstrate our approach and the outcomes of rotational testing, sharing our clinical experience.
Summary: Introduced by Robert Bárány, rotational test is used to assess the function of the lateral semicircular canals. In contemporary vestibular laboratories, the rotational test with sinusoidal harmonic acceleration has become a standard procedure to measure the functional status of VOR, which plays an important role in the evaluation of patients with dizziness. Although the rotational test is a typical evaluation for adults, it can be technically difficult in pediatric patients, especially with younger children. Even with the child seated in the parent’s lap, the testing can elicit fear or anxiety since it requires the young children to sit inside a dark space, often with an enclosure. Some children may refuse to wear video goggles due to discomfort, further compounding their fear and anxiety with the test. Also, the heads of many young children are too small for the video goggles to fit properly, even if the child can tolerate them. Therefore, many vestibular testing facilities that have a rotary chair will not conduct this test in infants and young children due to these practical reasons.
While hearing loss can be identified in infancy, aided by the universal newborn hearing screening program in the United States, vestibular loss in young children is likely underdiagnosed. Early identification of vestibular loss in infants and young children may help to facilitate timely initiation of physiotherapy to prevent motor delay as well as potential injuries. Options or objective vestibular testing in infants and young children have historically been very limited, until the advent of the cervical vestibular evoked myogenic potential (VEMP) test, which can be administered to young children, though it is limited to only assess the saccular function.
Other vestibular tests are very difficult for young children to tolerate (e.g., caloric test) or not feasible (e.g., subjective visual vertical or dynamic visual acuity).Therefore, the rotational test in young children is a particular important tool for objective assessment of VOR function. Unfortunately, previous clinical studies on the use of rotational test in young children have been very limited.
Our pediatric vestibular specialty program provides comprehensive vestibular workups for children with suspected vestibular disorders, including the rotational test. In the past few years, we have implemented the use of an observational camera during rotational testing for infants and toddlers when video goggles can’t be used successfully. In this presentation, we will demonstrate the usefulness of observational camera with clinical findings from 200+ patients and to describe our experience with this technique.
Learning Objectives:
Recognize the barriers in pediatric rotational testing
Describe the use observational camera in rotational test for young children.
Define the abnormal VOR findings in these young children
