TABLE 6.
Age-appropriate vestibular assessment for aminoglycoside monitoring.
| Age group | Primary assessment | Secondary assessment | Practical considerations | Indications for testing |
|---|---|---|---|---|
| Neonates (0–27 days) | Developmental vestibular assessment Positioning reflex testing |
Modified cVEMPs, adapted vHIT (specialist center/where available) | Brief assessment during periods of alertness Parental assistance for positioning Specialized infant equipment Developmental milestone surveillance as a universal default |
Extended therapy with gentamicin/streptomycin Abnormal motor patterns Known genetic risk (e.g., m.1555A>G carrier) |
| Infants (28 days–12 months) | Rotational chair with infant visual targets Developmental milestone assessment |
Modified VEMPs, positional testing (specialist center/where available) | Testing during optimal alertness Age-appropriate stimuli Brief assessment duration |
Extended aminoglycoside exposure Delayed motor milestones Abnormal head/eye movement patterns |
| Young children (1–5 years) | Modified CTSIB Functional gait assessment |
Rotational chair testing; adapted computerized posturography | Play-based assessment approaches Dynamic balance challenges Short testing intervals |
Symptoms of imbalance Motor skill regression History of vestibulotoxic aminoglycosides |
| Older children (≥5 years) | Video head impulse test VEMPs (cervical and ocular) |
Computerized dynamic posturography; rotary chair testing | Self-report of symptoms Standard testing protocols Quantitative measurement |
Patient-reported dizziness Balance difficulties Extended aminoglycoside therapy |
Age groupings are pragmatic, based on audiology and vestibular testing feasibility, and do not strictly follow ICH E11 (R1) categories used elsewhere in the manuscript. Audiological testing feasibility, rather than pharmacological classification, determines the monitoring strategy and, therefore, the age groupings used here. Neonatal and infant vestibular assessment beyond developmental milestone surveillance typically requires access to a specialist center. Specialized tests (e.g., cVEMP, vHIT) may require dedicated equipment and trained personnel. Cumulative exposure, symptomatology, genetic risk factors, developmental stage, and availability of specialized equipment should guide testing indications.
Abbreviations: CTSIB, clinical test of sensory integration for balance; cVEMP, cervical vestibular evoked myogenic potential; MT-RNR1, mitochondrially encoded 12S ribosomal RNA; VEMP, vestibular evoked myogenic potential; vHIT, video head impulse test.