Question
What would be considered the gold standard in pediatric vestibular evaluation?
Answer
Great question. I would consider video-oculography (VOG)/videonystagmography (VNG) and particularly the bithermal caloric irrigation subtest as the gold standard with adults and with children, although certainly other measures nicely complement VNG findings. I have heard it said by some, however, that there may not be a gold standard. If this type of testing can't be performed due to the challenges with a pediatric population, a combination of rotary chair and posturography when they can be performed is important. Vestibular evoked myogenic potential (VEMP) testing is also a viable technique with children. Much depends on the child and each case is different. Of course, these important sections of a vestibular evaluation battery are also performed within a larger framework including comprehensive audiologic evaluation, other electrophysiologic measures, thorough otolaryngologic examination, possible referral for imaging, other diagnostic measures, and overall team approach.
This Ask the Expert question was based on information in the recorded course, "Pediatric Vestibular Evaluation", www.audiologyonline.com/ceus/
Maureen Valente, Ph.D., earned her Bachelor of Science and Master of Science degrees in Speech and Hearing Science from the University of Illinois in Champaign-Urbana. She spent her Clinical Fellowship Year in the Chicago area, in the office of G.E. Shambaugh, M.D. Subsequent work experiences included private practice and medical settings in the Kansas City and Omaha areas, including employment at Boys Town National Research Hospital in Omaha. After moving to the St. Louis area, Dr. Valente was employed as a full-time faculty member for 18 years at Saint Louis University. She graduated with her Doctor of Philosophy degree in Speech and Hearing Sciences from Washington University in St. Louis. Shortly thereafter, she was delighted to accept a position as the Director of Audiology Studies within the Program in Audiology and Communication Sciences (PACS) at Washington University School of Medicine. She carries a joint appointment within PACS and as an Assistant Professor within the university's Department of Otolaryngology. Areas of interest include development of Au.D. education, diagnostic audiology, auditory processing disorders and vestibular evaluation in the pediatric patient.