(0973) Vestibular Rehabilitation Outcomes in Children With Enlarged Vestibular Aqueduct

Introduction: Vestibular symptoms can manifest in 40-50% of patients with enlarged vestibular aqueduct (EVA). However, no study has analyzed the efficacy of vestibular rehabilitation (VR) in children with EVA. We hypothesize that symptomatic children with EVA may have worse VR outcomes when compared to children without EVA.

Methods: A retrospective cohort analysis of 39 pediatric patients with EVA and vestibular symptoms who underwent vestibular testing at a single pediatric tertiary care center from January 2016 to June 2023 was performed. 14 of the 39 EVA patients (36%) underwent VR with a PT with measurement of the following outcomes: number and duration of VR sessions, duration above the predicted VR duration, and achievement rate of VR session goals. Age-matched controls without EVA who participated in VR were identified. Statistical analysis of outcomes was performed using analysis of variance between EVA patients and age-matched controls.

Results: In comparison to age-matched controls, pediatric EVA patients demonstrated an increased number of VR sessions (8.0 sessions vs. 5.6), duration of VR (4.8 months vs. 3.5) and additional VR duration above the predicted duration (+0.9 months vs. -0.5 months). Further, EVA patients were less likely to meet all the VR goals set by the PT (50% vs. 79%). Given the small sample size, none of these outcomes were statistically significant (p>0.05). Average operculum or midpoint size, or the presence of cochlear dysplasia or bilateral EVA were not predictive of VR outcomes (p>0.05). However, a history of a cochlear implant (CI) correlated with significantly increased duration of VR (7.1 months vs. 3.4; p=0.013).

Conclusions: Symptomatic children with EVA may require more frequent and longer duration of VR to achieve VR goals compared to their non-EVA counterparts, however additional analysis with a larger cohort is needed. While VR outcomes did not correlate with EVA size or laterality, outcomes significantly worsened in EVA patients who had prior CI placement. These findings are important in guiding future discussions of expected VR outcomes with EVA pediatric patients and their families.