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12 pages, 532 KB

Open AccessArticle

Non-Instrumented DVA: Assessment of Performance and Clinical Feasibility in Children Ages 2 Through 13 Years

by Cathey P. Norton, Nancy S. Darr, Mary Katherine Beshears, Katherine Catalano, Tyra Dillard, Mahayla J. K. Gamble, Magdalene Olerich and Sadie Rodell Rupp

Children 2026, 13(4), 456; https://doi.org/10.3390/children13040456 - 26 Mar 2026

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Abstract

Background/Objectives: Vestibular disorders can have functional consequences for children, including balance and gross motor delays, academic difficulties and behavioral manifestations; however, they are frequently undiagnosed in children. The purposes of this study were to evaluate the feasibility and clinical utility of performing a [...] Read more.

Background/Objectives: Vestibular disorders can have functional consequences for children, including balance and gross motor delays, academic difficulties and behavioral manifestations; however, they are frequently undiagnosed in children. The purposes of this study were to evaluate the feasibility and clinical utility of performing a non-instrumented dynamic visual acuity (DVA) test as a primary screening tool for children and to examine typical performance on this non-instrumented DVA test in a large sample of children ages 2 through 13 years. Methods: A clinical DVA test was administered to a convenience sample of 208 children aged 2–13 years. Static visual acuity was assessed using a standard Snellen or LEA eye chart, depending on the child’s ability to read letters. Dynamic visual acuity was then measured while the examiner manually rotated the child’s head at 2 Hz (240 bpm). DVA was calculated as the number of lines of visual acuity lost with head movement. Results: All children aged 4 years and older and 67% of 3-year-olds successfully completed DVA testing. Most 2-year-olds and 33% of 3-year-olds were unable to complete DVA testing. Although the number of visual acuity lines lost with rotational head oscillations at 2 Hz varied between age groups, Kruskal–Wallis test indicated no significant difference in DVA scores between age groups (K = 12.721, DF = 9, P = 0.176). Ninety percent of children who were able to perform DVA testing lost two or fewer lines of visual acuity with head rotations consistent with adult norms. Conclusions: This method of DVA testing is an easily accessible and promising clinically feasible screening tool for identifying children with vestibular dysfunction. The authors recommend widespread vestibular screening of children to facilitate rapid referral for diagnosis and treatment of children with vestibular dysfunction. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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14 pages, 845 KB

Open AccessArticle

ABR Features in Ski-Slope Hearing Loss for Hearing Threshold Estimation: A Comparative Clinical Study of Click and CE-Chirp Stimuli

by Davide Brotto, Giuseppe Impalà, Elisa Lovato, Elena Mazzaro, Marco Maculan, Elisabetta Zanoletti, Nicole Galoforo and Patrizia Trevisi

Children 2026, 13(3), 410; https://doi.org/10.3390/children13030410 - 17 Mar 2026

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Abstract

Background: Auditory brainstem responses (ABRs) are widely used for objective hearing threshold estimation in both adults and children. Click and CE-Chirp stimuli differ substantially in cochlear activation and neural synchrony, yet their relative performance in patients with ski-sloping hearing loss remains insufficiently characterized, [...] Read more.

Background: Auditory brainstem responses (ABRs) are widely used for objective hearing threshold estimation in both adults and children. Click and CE-Chirp stimuli differ substantially in cochlear activation and neural synchrony, yet their relative performance in patients with ski-sloping hearing loss remains insufficiently characterized, particularly with regard to pediatric diagnostic implications. Methods: This study compared ABRs elicited by click and CE-Chirp stimuli in adults with ski-sloping sensorineural hearing loss. The same comparison was also performed in a pediatric cohort including hearing-impaired and normal-hearing children. Adult subjects were further stratified according to audiometric configuration (DROP 1 kHz vs. DROP 2 kHz). ABR thresholds, wave V latency, amplitude, and detectability were analyzed across stimulus types and intensity levels. Associations between ABR thresholds and behavioral audiometric measures were also examined. Results: In adults with ski-sloping hearing loss, CE-Chirp stimulation yielded significantly lower ABR threshold estimates than click stimulation, particularly in the DROP 2 kHz subgroup, and showed stronger correlations with behavioral pure-tone averages across low-, mid-, and high-frequency ranges. Wave V latencies were consistently shorter with CE-Chirp stimulation, while wave V amplitudes did not differ significantly between stimuli at suprathreshold levels. In children, ABR thresholds obtained with CE-Chirp were generally equal to or lower than those obtained with clicks, although statistical significance was limited by sample size. CE-Chirp stimulation was associated with shorter wave V latencies in both hearing-impaired and normal-hearing children and produced larger wave V amplitudes at selected suprathreshold intensities in hearing-impaired children. Conclusions: Click and CE-Chirp stimuli provide complementary information in ABR assessment. While click stimulation remains essential for robust waveform identification, CE-Chirp stimulation appears to offer advantages in threshold estimation and neural synchrony, particularly in ski-sloping hearing loss and pediatric evaluations. Discrepancies between click- and CE-Chirp-derived ABR thresholds should not be attributed solely to maturational or synchrony-related factors but may warrant further frequency-specific audiological assessment to optimize diagnosis and rehabilitation strategies. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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13 pages, 768 KB

Open AccessArticle

The Impact of Follow-Up on Etiological Classification of Pediatric Vertigo

by Nina Božanić Urbančič, Dejan Mladenov and Saba Battelino

Children 2026, 13(3), 376; https://doi.org/10.3390/children13030376 - 6 Mar 2026

Cited by 1 | Viewed by 411

Abstract

Background: Vertigo and dizziness in children represent diagnostically challenging conditions with heterogeneous etiologies. At initial presentation, a substantial proportion of pediatric patients remain without a definitive etiological diagnosis. Evidence on the impact of longitudinal follow-up on etiological classification in pediatric vertigo is limited. [...] Read more.

Background: Vertigo and dizziness in children represent diagnostically challenging conditions with heterogeneous etiologies. At initial presentation, a substantial proportion of pediatric patients remain without a definitive etiological diagnosis. Evidence on the impact of longitudinal follow-up on etiological classification in pediatric vertigo is limited. Methods: This observational cohort study uses prospectively collected clinical data. Children aged 1–17 years who presented to a tertiary ENT clinic with vertigo and/or dizziness between 2015 and 2020 were systematically enrolled and followed. The present study represents a retrospective revision of a previously published cohort of 257 children. In 2025, extended follow-up data were reviewed to reassess etiological classification using the same diagnostic categories as in the original analysis. Descriptive statistics were applied to compare etiological distributions at initial evaluation and after follow-up revision. Results: After data revision, the proportion of children with unclassified etiology decreased from 44% to 10%. Central etiologies accounted for 35% of cases, peripheral vestibular disorders for 18%, hemodynamic causes for 16%, psychogenic etiologies for 10%, and other specific causes for 7%. Follow-up duration ranged from 0 to 132 months (mean 17.6 months; median 4.5 months). Diagnostic investigations were frequently performed; however, the etiological yield of certain tests, particularly cranial computed tomography, was low. Conclusions: Extended follow-up significantly improves etiological classification in children with vertigo and dizziness, demonstrating that diagnostic uncertainty at initial presentation often reflects evolving clinical phenotypes rather than the absence of an underlying disorder. A longitudinal, clinically guided, and multidisciplinary approach is essential to enhance diagnostic accuracy and optimize the use of diagnostic investigations in pediatric vertigo. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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13 pages, 486 KB

Open AccessArticle

A National Forecast and Clinical Analysis of Pediatric Acute Mastoiditis in Kazakhstan

by Nazik Sabitova, Timur Shamshudinov, Assiya Kussainova, Dinara Toguzbayeva, Bolat Sadykov, Yevgeniya Rahanskaya and Laura Kassym

Children 2026, 13(2), 170; https://doi.org/10.3390/children13020170 - 26 Jan 2026

Viewed by 553

Abstract

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition [...] Read more.

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition while also describing its clinical and epidemiological characteristics. Materials and Methods: This study combined an analysis of national healthcare and demographic statistics in Kazakhstan from 1998 to 2024 with a retrospective review of pediatric AM patients treated at a tertiary referral center. Long-term trends in healthcare resources were assessed, and future needs were projected via average annual percentage change (AAPC) and time series forecasting methods. Clinical, laboratory, and radiological data were extracted from medical records. Statistical analyses were performed via SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Results: From 1998 to 2024, the number of pediatricians and ENT hospital beds declined, whereas the density of ENT physicians remained relatively stable, and the proportion of ENT surgical procedures increased. Projections to 2030 suggest continued constraints in pediatric and ENT workforce capacity and further reductions in inpatient beds despite sustained growth in surgical demand. Among 95 pediatric AM cases, complications, most commonly subperiosteal abscess and zygomatic abscess, were identified in 40% of patients. Conclusions: AM may be considered a contextual indicator of pressures within specialized pediatric ENT services rather than a direct measure of healthcare system performance. These findings highlight the need for further studies to validate these observations and better inform healthcare planning. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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10 pages, 205 KB

Open AccessArticle

Paediatric Utilisation of Ophthalmic Antibiotics in the Ear in Aotearoa/New Zealand

by Isabella Mei Yan Cheung, Tary Yin and Akilesh Gokul

Children 2025, 12(5), 557; https://doi.org/10.3390/children12050557 - 25 Apr 2025

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Abstract

Background/Objectives: Some ophthalmic antibiotics are publicly subsidised in New Zealand (NZ) for off-label use in the ear, however, this utilisation has not previously been described. This study compared the utilisation of ophthalmic chloramphenicol and ciprofloxacin in the eye and ear, among NZ children. [...] Read more.

Background/Objectives: Some ophthalmic antibiotics are publicly subsidised in New Zealand (NZ) for off-label use in the ear, however, this utilisation has not previously been described. This study compared the utilisation of ophthalmic chloramphenicol and ciprofloxacin in the eye and ear, among NZ children. Methods: This study involved clinical record review, and included 11,617 prescriptions of ophthalmic chloramphenicol and ciprofloxacin in 2022, for children aged five years or under in Auckland, NZ. Prescriptions of chloramphenicol and ciprofloxacin for eye and ear use were compared by: patient age, gender, ethnicity and socioeconomic deprivation, indication, community or hospital prescribing and number of repeat prescriptions. Statistical analysis was performed using Chi-squared test and multinomial regression. Results: Most ophthalmic ciprofloxacin was used in the ear (84%). In contrast, almost all chloramphenicol was used in the eye (96%). Post-operative use following tympanostomy tube insertion accounted for half of all hospital-prescribed ophthalmic ciprofloxacin used in the ear. Utilisation of chloramphenicol and ciprofloxacin in the eye and ear was similar, with more prescriptions for children aged one year and males, and most children received only one prescription. Māori and Pacific children generally received fewer prescriptions. Pacific children were more likely than Māori children to receive hospital-prescribed ophthalmic ciprofloxacin for use in the ear (adjusted OR 6.7, p = 0.025). Conclusions: These findings highlight the utilisation of ophthalmic ciprofloxacin in the ear in NZ children. These findings will inform decision-making in the public funding of medications, policy development in equitable medication access, and more collaborative efforts to improve antimicrobial use. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

10 pages, 190 KB

Open AccessArticle

Endoscopic Myringoplasty for Pediatric Tympanic Membrane Perforations: Is It Worth It?

by Riccardo Nocini, Daniele Monzani, Valerio Arietti, Flavia Bonasera, Luca Bianconi and Luca Sacchetto

Children 2025, 12(3), 293; https://doi.org/10.3390/children12030293 - 27 Feb 2025

Cited by 1 | Viewed by 2448

Abstract

Background/Objectives: The endoscopic repair of the tympanic membrane is an established method for addressing perforations in the tympanic membrane. However, there are limited studies in the literature examining the success rate of this procedure in the pediatric population. Methods: This study [...] Read more.

Background/Objectives: The endoscopic repair of the tympanic membrane is an established method for addressing perforations in the tympanic membrane. However, there are limited studies in the literature examining the success rate of this procedure in the pediatric population. Methods: This study retrospectively analyzed data from the tertiary referral center at the University Hospital of Verona, Italy. This medical record contains data from 84 type 1 transcanal endoscopic tympanoplasties performed in pediatric patients between November 2014 and February 2022. Seventy-seven pediatric patients aged 4 to 16 years who underwent type 1 transcanal endoscopic tympanoplasty (seven of whom underwent bilateral surgery at different time points) were included in the study. Our study did not include more extensive procedures than type 1 endoscopic tympanoplasty. Only patients with tympanic membrane perforation due to simple chronic otitis media, trauma or when no apparent cause was found were included. Chronic otitis with cholesteatoma and other pathologies of the external or middle ear were exclusion criteria. Patients with a follow-up of less than 12 months were excluded from this study. The technique was based on the endoscopic placement of an underlay graft of temporal fascia or tragal cartilage to repair a tympanic membrane perforation. Demographic, clinical, audiologic, and surgical data were collected from each patient. In the study, we considered the reduction of the air-bone gap (ABG) as a functional outcome and the integrity of the reconstruction as an anatomic outcome of success. Results: The primary surgery had a closure rate of 92.9% (78 of 84). All patients underwent audiological evaluation 4–6 months post-surgery, with 84 ears tested. The mean preoperative ABG was 17.13 dB HL, reduced to 9.16 dB HL postoperatively, showing a mean reduction of 7.97 dB HL. No significant complications occurred. Conclusions: Transcanal endoscopic type 1 tympanoplasty should be considered a safe procedure with a high success rate for the repair of tympanic membrane perforations, even in pediatric patients. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

11 pages, 779 KB

Open AccessArticle

Audiophonologopedic Telerehabilitation: Advantages and Disadvantages from User Perspectives

by Maria Lauriello, Anna Maria Angelone, Sara Iannotti, Eleonora Nardecchia, Benedetta Scopano, Alessandra Fioretti, Irene Ciancarelli and Alberto Eibenstein

Children 2024, 11(9), 1073; https://doi.org/10.3390/children11091073 - 31 Aug 2024

Cited by 1 | Viewed by 1913

Abstract

Introduction: Technological advancements and the COVID-19 pandemic have highlighted the importance of digital tools for patient care and rehabilitation. This study explores user perspectives on telerehabilitation, comparing it to traditional methods and identifying criteria for determining its suitability for different patients and clinical [...] Read more.

Introduction: Technological advancements and the COVID-19 pandemic have highlighted the importance of digital tools for patient care and rehabilitation. This study explores user perspectives on telerehabilitation, comparing it to traditional methods and identifying criteria for determining its suitability for different patients and clinical conditions. Methods: This study was carried out during the period of May–September 2021. Questionnaires were administered to 48 users in rehabilitation for audiophonologopedic and neurodevelopmental disorders in three rehabilitation centres in central Italy. Results: The user responses predominantly emphasize the benefits of time saving (68.75%) and cost-efficiency (37.5%), specifically regarding time saving due to travel and expenses incurred to go to where the therapy is carried out. The disadvantages include increased distraction (60.42%) in following the instructions remotely and logistic problems (39.58%). Patients with hearing loss were subjected to a larger number of telerehabilitation sessions, positively rating this alternative method. Patients with speech and language delay and autism spectrum disorder (ASD) prefer traditional treatment. Discussion: This study reveals a favourable perception of telerehabilitation as a therapy approach to be regarded as a supplement or temporary option to the irreplaceable face-to-face one. More research, as well as a larger sample sizes, will be useful to increase the significance of the correlations reported in this study. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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13 pages, 1541 KB

Open AccessArticle

Pediatric Acute Mastoiditis in Saudi Arabia: Demographic Insights, Clinical Profiles, and Prognostic Factors

by Sarah Alshehri and Khalid A. Alahmari

Children 2024, 11(4), 402; https://doi.org/10.3390/children11040402 - 28 Mar 2024

Cited by 2 | Viewed by 3106

Abstract

Acute mastoiditis, a complication of otitis media, poses significant challenges in diagnosis and treatment, particularly in pediatric populations. This study aims to comprehensively evaluate the demographic characteristics, clinical features, and prognostic factors associated with acute mastoiditis in pediatric patients in Saudi Arabia. Analysis [...] Read more.

Acute mastoiditis, a complication of otitis media, poses significant challenges in diagnosis and treatment, particularly in pediatric populations. This study aims to comprehensively evaluate the demographic characteristics, clinical features, and prognostic factors associated with acute mastoiditis in pediatric patients in Saudi Arabia. Analysis of a multicenter dataset was conducted to assess demographic variables, symptomatology, disease course, and predictors of acute mastoiditis in pediatric patients. Significant associations were found between demographic variables (age group, gender, nationality) and acute mastoiditis risk. Symptomatology analysis revealed consistent frequencies of otalgia across age groups and genders. Disease course analysis highlighted a mean duration from symptom onset to diagnosis of 14.11 days, with frequent complications like mastoid abscess and meningitis. Predictor identification identified symptoms (otalgia, fever, otorrhea), duration of illness, and complications as significant predictors of disease severity. These findings contribute valuable insights into the epidemiology and clinical management of acute mastoiditis, informing targeted interventions to improve patient outcomes. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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14 pages, 448 KB

Open AccessEditor’s ChoiceArticle

Unilateral Sensorineural Hearing Loss in Children: Etiology, Audiological Characteristics, and Treatment

by Mirko Aldè, Diego Zanetti, Umberto Ambrosetti, Eleonora Monaco, Anna Maria Gasbarre, Lorenzo Pignataro, Giovanna Cantarella and Stefania Barozzi

Children 2024, 11(3), 324; https://doi.org/10.3390/children11030324 - 9 Mar 2024

Cited by 10 | Viewed by 6805

Abstract

The aim of this study was to evaluate audiological characteristics and parents’ opinions on hearing device use in children with unilateral sensorineural hearing loss (USNHL) who attended a tertiary-level audiologic center. The medical charts of 70 children aged 6 to 12 years with [...] Read more.

The aim of this study was to evaluate audiological characteristics and parents’ opinions on hearing device use in children with unilateral sensorineural hearing loss (USNHL) who attended a tertiary-level audiologic center. The medical charts of 70 children aged 6 to 12 years with USNHL were reviewed. In 51.4% of cases, the children were diagnosed with USNHL after the age of 2 years. The main causes of USNHL were congenital cytomegalovirus infection (21.4%) and unilateral cochlear nerve hypoplasia (12.9%). The percentage of patients wearing a hearing device was 45.7% (32/70); of these, 28 (87.5%) wore a conventional hearing aid, 2 (6.3%) a CROS device, and 2 (6.3%) a cochlear implant. Regarding the choice to use a hearing device, no significant differences were found between the subcategories of hearing loss degree (p = 0.55) and audiometric configuration (p = 0.54). Most parents of children with mild-to-severe USNHL observed improved attention (90.9%), and reduced fatigue and restlessness (86.4%) using the hearing aid. These children performed significantly better on all audiological tests (speech perception in quiet and in noise conditions, and sound localization) while wearing the hearing aid (p < 0.001). More efforts should be made to raise awareness among professionals and parents about the negative consequences of uncorrected USNHL. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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Review

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18 pages, 307 KB

Open AccessReview

Music-Based Interventions in Childhood Hearing Loss: A Comprehensive Narrative Review

by Mirko Aldè, Letizia Casella, Umberto Ambrosetti, Stefania Barozzi, Eleonora Gandolfo, Federica Di Berardino and Diego Zanetti

Children 2026, 13(4), 574; https://doi.org/10.3390/children13040574 - 21 Apr 2026

Viewed by 378

Abstract

Background/Objectives: Childhood hearing loss (HL) affects auditory, linguistic, and social development. Alongside conventional rehabilitation, music-based interventions have gained increasing attention for their potential to support both auditory and non-auditory domains. This narrative review aims to summarize current evidence on the use of music-based [...] Read more.

Background/Objectives: Childhood hearing loss (HL) affects auditory, linguistic, and social development. Alongside conventional rehabilitation, music-based interventions have gained increasing attention for their potential to support both auditory and non-auditory domains. This narrative review aims to summarize current evidence on the use of music-based interventions in children with HL. Methods: A narrative review of the literature was conducted, examining studies involving pediatric cochlear implant or hearing aid users. Publications were categorized into three main areas: musical auditory perception, musical training, and music therapy. Results: Studies on musical auditory perception demonstrate persistent limitations in pitch and timbre perception in children with HL, while rhythmic abilities appear relatively preserved. Musical training interventions, particularly those targeting rhythm, have been associated with improvements in auditory perception, linguistic processing, and selected cognitive skills, although parental involvement and long-term designs remain limited. Existing literature on music therapy is scarce but suggests potential benefits extending beyond auditory skills to emotional regulation, social interaction, and quality of life. Conclusions: Music-based interventions represent a promising complementary approach in pediatric hearing rehabilitation. While musical training is more widely studied, music therapy is still underrepresented despite its holistic focus. Further structured studies are needed to define standardized protocols and outcome measures for music therapy in children with HL. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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