Vestibular Dysfunction in Deaf and Hard of Hearing (HoH) Children: The Hidden Challenge

Vestibular Dysfunction in Deaf and Hard of Hearing (HoH) Children: The Hidden Challenge

When a child is diagnosed as deaf or hard of hearing (HoH), the focus naturally turns to communication and language acquisition. However, many families notice something else: their child struggles to sit up, balance, or walk on time. Often, these delays are dismissed as unrelated to their deafness. Yet research shows that up to 70% of children who are deaf or HoH experience vestibular dysfunction, a condition that affects balance, spatial awareness, motor skills, and even language development.

Despite its significant impact, vestibular dysfunction is frequently overlooked during early intervention. Families are left searching for answers and fighting for essential supports like occupational therapy (OT) and vestibular rehabilitation.

What Is Vestibular Dysfunction, and How Does It Affect Children?

The vestibular system, located in the inner ear, controls balance, coordination, and spatial awareness. When it doesn’t work properly, it can delay development and create challenges that ripple through a child’s life. For children who are deaf or HoH, vestibular dysfunction can:

- Delay Developmental Milestones:

Children with vestibular dysfunction often learn to sit, crawl, and walk later than their peers. They may struggle to maintain balance, making activities like climbing stairs or running more challenging.

- Create Academic Barriers:

The vestibula-ocular reflex (VOR), which stabilises vision during movement, is often impaired. This can make reading and writing difficult, as children may find it hard to track words on a page or switch focus between a whiteboard and their notebook.

- Limit Physical Participation:

Poor balance and coordination can discourage children from participating in sports, playground activities, or even simple games with friends. This can affect their confidence, social skills, and ability to form connections with peers.

- Cause Physical Discomfort:

Some children experience dizziness, fatigue, or a sense of disorientation, making everyday activities feel overwhelming.

Vestibular dysfunction doesn’t only affect a child’s physical and academic abilities—it also significantly impacts language development. Whether a child is acquiring spoken language or sign language, vestibular challenges can delay their progress:

- Speech and Listening Development:

For children pursuing auditory-verbal communication, vestibular dysfunction can hinder the motor control needed for clear speech production. Poor head and neck stability can make it harder for children to manage the fine motor movements required for articulation. Vestibular dysfunction can also limit their ability to maintain attention, a critical skill for listening and language processing.

- Sign Language Acquisition:

For children learning sign language, delays in motor development can impact their ability to form signs accurately and fluidly. Sitting stability and hand-eye coordination, both affected by vestibular dysfunction, are essential for signing. Additionally, limited spatial awareness can affect their understanding of the signing space and how signs are oriented in relation to their body.

- Reduced Interaction Opportunities:

Vestibular dysfunction often makes children hesitant to explore or engage with others. This limits their exposure to incidental language learning—whether through overheard conversations, signed exchanges, or interactions with their environment.

- Cognitive Overload:

When children are expending significant energy on maintaining balance or navigating their surroundings, they have fewer cognitive resources available for language learning. This can slow their progress in both speech and sign language development.

The Impact of Cochlear Implants on Vestibular Function

For children who are deaf or HoH, cochlear implants can provide significant benefits in hearing and Speech development. However, the surgical procedure also carries a heightened risk of vestibular dysfunction. Studies show that:

- Cochlear Implant Surgery Can Damage Inner Ear Structures:

The electrode insertion process can harm the semicircular canals and otolith organs, which are critical for balance.

- Vestibular Dysfunction Is More Common in Children with Implants:

Research suggests that children with cochlear implants are more likely to experience severe vestibular deficits than those without implants.

- The Impact on Motor and Language Development Is Significant:

Delays in sitting, crawling, walking, and running are more pronounced in children with cochlear implants who experience vestibular dysfunction. These motor delays can further hinder speech development and sign language acquisition.

This underscores the importance of comprehensive pre- and post-implantation assessments to monitor vestibular function and ensure timely intervention.

The Role of Occupational Therapists and Vestibular Specialists

For children with vestibular dysfunction, a multidisciplinary approach involving occupational therapists (OTs) and vestibular specialists is critical. Together, these professionals provide targeted interventions to address the challenges children face:

Occupational Therapists:

- Support Motor Development: Helping children achieve milestones like sitting, standing, and walking with confidence.

- Enhance Spatial Awareness: Teaching children how to navigate their environment safely.

- Improve Balance and Coordination: Using sensory integration techniques and tailored exercises to build physical confidence.

Vestibular Specialists:

- Diagnose Vestibular Dysfunction: Conducting thorough assessments to identify and understand balance issues.

- Provide Rehabilitation: Developing targeted therapies to improve balance, reduce dizziness, and enhance coordination.

- Collaborate with Other Professionals: Working alongside audiologists, OTs, and educators to ensure a comprehensive care plan.

These interventions not only address physical challenges but also support language development by improving motor skills critical for speech and signing.

Accessing Support Through the NDIS

In Australia, the National Disability Insurance Scheme (NDIS) is a vital resource for children with disabilities, including those who are deaf or HoH. However, many families face significant barriers when seeking funding for OT and vestibular rehabilitation:

- Lack of Awareness: NDIS planners often fail to recognise vestibular dysfunction as a common comorbidity of deafness.

- Advocacy Burdens: Families must educate planners, gather evidence, and repeatedly explain why these supports are essential.

- Financial Barriers: Without funding, therapies can become prohibitively expensive, leaving many children without access to critical interventions.

What Needs to Change

To ensure children who are deaf or HoH receive the care they need, systemic changes are essential:

1. Routine Vestibular Assessments: Every child who is deaf or HoH should undergo vestibular screening, particularly those receiving cochlear implants.

2. Automatic Inclusion of OT and Vestibular Rehabilitation in NDIS Plans: Recognising the link between hearing loss and vestibular dysfunction would eliminate advocacy battles for families.

3. Educating Professionals: NDIS planners, healthcare providers, and educators need training to understand how vestibular dysfunction affects physical, academic, and language development.

4. Increased Research: Continued studies are critical to improving diagnostic tools, intervention strategies, and long-term outcomes for children with vestibular dysfunction.

A Holistic Approach to Supporting Deaf or HoH Children

By acknowledging the connection between deafness or hearing loss and vestibular dysfunction, we can ensure children receive the comprehensive support they need to thrive. Access to occupational therapy and vestibular rehabilitation can help address physical, motor, and language challenges, enabling children who are deaf or HoH to build confidence, reach developmental milestones, and actively engage with the world around them. Every child deserves the opportunity to overcome these barriers and realise their full potential, and it is our responsibility to create systems that make this possible.

Research References

1. Vestibular Assessment in Children with Hearing Impairment: A Clinical Study – This study highlights that up to 70% of children with hearing loss experience vestibular dysfunction.

2. Hearing Loss & Vestibular Dysfunction: A Common Comorbidity – This eBook chapter discusses developmental delays, academic impacts, and intervention strategies for children with vestibular dysfunction.

3. Vestibular Deficits in Deafness (2022) – This document explores vestibular deficits in individuals with hearing loss, including impacts on language development and potential interventions.

4. Frontiers in Neurology (2024) – This study emphasises the increased risk of vestibular dysfunction in children with cochlear implants and the need for targeted interventions.