A new doctoral thesis from Karolinska Institutet shows that the balance system can be assessed during the first months of life. Using new, child-friendly methods, healthcare services can detect vestibular dysfunction in children with hearing impairment at an earlier stage and offer targeted habilitation.
When a child is born with severe hearing loss, the primary focus is often placed on hearing and speech development. However, the inner ear is responsible not only for hearing but also for balance. The vestibular system helps us stabilise our gaze while moving, turning our head, and orienting ourselves in our surroundings. If the balance organ is impaired from birth, children may experience delayed motor development. They may begin walking independently later than expected, have increased difficulties with balance and falls, and may also develop concentration and reading difficulties during school age.
The doctoral thesis demonstrate how vestibular function can be assessed in newborns, infants, and adolescents. The research is based on several studies investigating objective vestibular testing methods in children.
An important part of the thesis focuses on screening and early diagnosis. The research shows that bone-conducted vestibular testing, known as BCcVEMP (Bone-Conducted Cervical Vestibular Evoked Myogenic Potentials), can be performed alongside routine newborn hearing screening early in infancy. The method is quick, child-friendly, and does not require active cooperation from the child.
“We can obtain important information about vestibular function even in very young children, without causing discomfort or placing any burden on the child,” says Niki Karpeta at the Department of Clinical Science, Intervention and Technology .
The thesis proposes that children diagnosed with hearing loss should undergo further vestibular assessment, including video Head Impulse Testing (vHIT) at approximately five to six months of age. Such an approach would allow healthcare providers to identify vestibular dysfunction early and offer early intervention and rehabilitation when needed.
The thesis also highlights the importance of long-term follow-up. Vestibular function may deteriorate over time due to congenital inner ear malformations, cochlear implantation, or infections. Early detection is therefore important not only for treatment but also for the child’s overall quality of life. The research demonstrates that hearing and balance are closely interconnected functions and suggests that vestibular assessment should become a routine part of the evaluation of children with hearing loss.
One of the studies included in the thesis examined adolescents who had received bilateral cochlear implants early in life. Although all participants showed some degree of vestibular impairment many years later, many had developed effective compensatory mechanisms and functioned well in everyday life.
“However, the relationship between hearing and balance is only part of the story. Vestibular disorders affect children’s motor development, for example, the timeframe they learn to sit, stand, and walk, as well as their risk of falling. Our research demonstrates that vestibular dysfunction in children can now be diagnosed and monitored at an early stage, allowing support and interventions to be tailored to each child’s needs,” says Niki Karpeta.
The doctoral work was supervised by Maoli Duan , Docent of Neurotology, Luca Verrecchia , Docent of Neurotology, and Sten Hellström , Professor of Otorhinolaryngology. The public thesis defence took place on March 20, 2026.
Doctoral thesis
Development of objective balance tests in newborns and young children
Karpeta, Niki (2026). Karolinska Institutet. Thesis.
