Measurements

It is a 7-question form that was prepared by the researchers and includes information such as age, gender, presence of chronic disease, middle ear or vestibular disease, and patient contact information.

The Turkish adaptation of this semi-structured interview schedule, which was updated according to the DSM-5 diagnostic criteria by Kaufman et al,¹⁴ was made by the researchers, and the differences in the translation and back-translation texts and the operability of the interview schedule were evaluated by reviewing the trial interviews with parents and children, and by reviewing the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation, it has taken its final shape. Its validity and reliability were determined by Ünal et al¹⁵ in 2019. This interview was conducted by a child psychiatrist trained in this field, and the participant was excluded from the study in the presence of additional psychiatric illness.

Videonystagmography Test: One of the most important parameters used in the evaluation of vestibular functions is nystagmus. Videonystagmography is a group test in which the vestibulo-ocular reflex (VOR) is evaluated based on the evaluation and recording of eye movements that occur spontaneously or as a result of visual-vestibular stimuli. The VNG device includes gaze test, pursuit test, saccade test, optokinetic test, positional test, spontaneous nystagmus test, and head shake test. This test was performed with a Micromedical Technologies brand Visual Eyes 4 channel model VNG device. This non-invasive test is also useful to differentiate peripheral or central pathology in the vestibulo-ocular pathway and provides information about the progression and improvement of the pathology.

The child is asked to sit in an upright position by wearing VNG test glasses, and a light bar is placed in front of him, leaving a distance of 1 m. With these glasses, the eye movements of the patient while at rest and during various visual and vestibular stimuli are tracked and recorded in the computer environment; afterwards, the obtained information is analyzed by the computer and the evaluation is completed.

Video Head Impulse Test: It is a new and useful tool used to identify semicircular canal (SCC) dysfunctions. In v-HIT evaluation, the relationship between rapid head movement and eye movement in the plane of the channels is examined. This test was performed with a Micromedical Technologies brand EyeSeeCam model v-HIT device. During the test, the child puts on glasses with a camera that records eye movements. The patient is then asked to look at a fixed target. While the patient’s eyes are fixed on the target, the tester quickly turns the patient’s head 20°-30° in the test plane. Meanwhile, eye movements are recorded, and these movements are analyzed by the computer. As a result of the test, the VOR gain ratio, the presence of saccades, and the percentage of asymmetry are evaluated. While the gain value represents the ratio between head speed and eye speed, the asymmetry value is a value representing the difference between the VOR gains of the symmetrical canals between the ears. A VOR gain less than 0.8, a percentage of asymmetry greater than 6.9, and the presence of saccade are considered pathological v-HIT responses.¹⁶

Vestibular Evoked Myogenic Potential Test: The test was performed with a Neurosoft brand Neuro-Audio model device. In the c-VEMP test, the electrodes are placed on the sternum, the reference electrode is placed in the middle 1/3 of the sternocleidomastoid muscle (SCM), and the ground electrode is placed on the nasion point in the midline on the forehead, and the SCM is requested to contract by turning the head.

In the o-VEMP test, electrodes are placed in the middle of the forehead, 15-20 mm below the orbits, and on the cheeks. The child is asked to look up, and the N1 and P1 absolute latencies, N1-P1 interlatency, N1-P1 amplitude, and asymmetry percentage (which represents the ratio of the amplitudes of the waves formed between the two ears) of the obtained waves are evaluated and recorded. Prolonged wave latencies, increased asymmetry rates, or failure to obtain VEMP waves are considered as pathological.¹⁷ While c-VEMP mainly evaluates saccular function and vestibulo-colic reflex, o-VEMP evaluates utricular function and VOR.