Audio-vestibular Evaluation of Children and Young Adults With Osteogenesis Imperfecta

Recruiting

• Conditions: Osteogenesis Imperfecta
• Interventions: Diagnostic Test: Vestibular Assessment; Diagnostic Test: Petrous bone Computed Tomography (CT); Diagnostic Test: Magnetic Resonance Imaging (MRI)

• Registration Number: NCT05419960
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

The aim is to determine whether vestibular deficits are present in OI, then to establish whether a correlation exists between genetic type, severity of OI and audiovestibular phenotype. OI patients aged 12 to 20 years will undergo an audiometric, immittance, and vestibular assessment. When hearing loss is conductive or mixed or in cases where vestibular deficits are identified, a CT scan without injection will be performed. In case of sensorineural hearing loss or abnormal CT results, an MRI will be performed.

Detailed Description

Osteogenesis Imperfecta (OI), or Lobstein's disease, is a form of congenital osteoporosis, with a prevalence between 1/10,000 and 1/20,000 in France. As of 1979, four phenotypes have been described according to severity: moderate (type I), lethal (type II), severe (type III), and moderate-to-severe (type IV). OI exhibits phenotypic and genotypic variability, however, to date no correlations have been established between specific mutations and clinical presentation.

There is a well-established association between OI and hearing loss, however, the reported prevalence of hearing loss varies between 2% to 94.1%.

In patients with OI, Computed Tomography (CT) has revealed bone demineralization that progresses with age.

The extent of the hypodense areas on the CT corresponds to the type of hearing loss: conductive hearing loss is associated with lesions of the fissula ante fenestram and round and oval windows while mixed hearing loss is associated with additional retrofenestral lesions. Severity of hearing loss is positively correlated with OI-related bone damage in the petrous bone. Magnetic Resonance Imaging (MRI) has also revealed in the pericochlear lesions with soft tissue hypersignal and enhancement on contrast medium injection in the otic capsule. Bone demineralization has also been linked to vestibular deficits, and some studies have reported correlations between Osteogenesis Imperfecta and vestibular deficits in adult patients, however, this relationship is less clear.

The aim of the study is to determine whether vestibular deficits are also present in OI. Furthermore, the study will aim to establish whether a correlation exists between genetic type, severity of OI and audiovestibular phenotype. OI patients aged 12 to 20 years will be recruited and an audiometric, immittance, and vestibular assessment (videonystagmography, video Head Impulse Test (vHIT), vestibular evoked muscular potentials (cVEMP)) will be performed during their annual visit to the Centre de Référence des Maladies Rares des maladies osseuses constitutionnelles (henceforth CRMR OI) of Hôpital Necker-Enfants malades, Paris, France. When hearing loss is conductive, or mixed or in cases where vestibular deficits are identified, a CT scan without injection will be performed for the care. In case of sensorineural hearing loss, or abnormal CT results, an MRI will be proposed for the care. The investigation team will try to establish if there is a significant association between OI and vestibular deficit, and if so, whether the degree of vestibular impairment is correlated to radiological findings with respect to bone abnormalities, as well as the type and severity of the deafness.

Study Timeline

• Study First Submitted: 2022-05-12
• Study First Submitted QC: 2022-06-10
• Study First Posted: 2022-06-15
• Study Start: 2022-12-22
• Status Verified: 2025-05
• Last Update Submitted: 2025-05-26
• Last Update Posted: 2025-05-28
• Primary Completion: 2027-12-22
• Study Completion: 2027-12-22

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 44

Inclusion Criteria

• Patients between the ages of 12-20 years at the time of inclusion
• Diagnosis of Osteogenesis Imperfecta of any type
• Currently followed by a physician at the CRMR OI
• Information and non-opposition of major patients, holders of parental authority and minor patients to participate in the study

Exclusion Criteria

• Patients with hearing loss of alternate origin e.g. Cochlear nerve deficiency, atresia, etc.
• Neurological or developmental deficits limiting participation
• Cervico-occipital instability e.g. Chiari's malformation
• Limitations in mobility of the spine e.g. scoliosis, spinal fractural fusion
• Ophthalmologic pathologies e.g. strabism or severe refraction disorder
• Patients under AME (State Medical Aid)
• Protected adult patients, adults unable to express their consent, pregnant or breastfeeding women

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Patients	Petrous bone Computed Tomography (CT)	Patients between the ages of 12-20 years with a diagnosis of Osteogenesis Imperfecta of any type and followed by a physician at the Centre de Référence des Maladies Rares des maladies osseuses constitutionnelles (CRMR OI) of Hôpital Necker-Enfants malades.
Patients	Vestibular Assessment	Patients between the ages of 12-20 years with a diagnosis of Osteogenesis Imperfecta of any type and followed by a physician at the Centre de Référence des Maladies Rares des maladies osseuses constitutionnelles (CRMR OI) of Hôpital Necker-Enfants malades.
Patients	Magnetic Resonance Imaging (MRI)	Patients between the ages of 12-20 years with a diagnosis of Osteogenesis Imperfecta of any type and followed by a physician at the Centre de Référence des Maladies Rares des maladies osseuses constitutionnelles (CRMR OI) of Hôpital Necker-Enfants malades.

Primary Outcome Measures

Name	Time	Method
Ocular Vestibular Evoked Myogenic Potential (oVEMP)	24 months	Utricular Function Research of eventual vestibular disorder to determine if vestibular disorders can be linked to Osteogenesis Imperfecta.; The oVEMP assesses utricular function and reflects the function of the vestibular nuclei and the crossed vestibulo-ocular reflex (VOR) pathways, mostly contained in the medial longitudinal fasciculus (MLF).; Clinical norms will be applied to determine whether the exam is either within normal limits or abnormal.
Cervical Vestibular Evoked Myogenic Potential (cVEMP)	24 months	Saccular Function Research of eventual vestibular disorder to determine if vestibular disorders can be linked to Osteogenesis Imperfecta.; The cVEMP assesses the saccular function via the saccular cervical reflex (sternocleidomastoid muscle's activation secondary to saccular auditory stimulation).; Clinical norms will be applied to determine whether the exam is either within normal limits or abnormal.; The otolith organs are comprised of the vestibular saccule and utricule. The cVEMP assesses the saccular function via the saccular cervical reflex (sternocleidomastoid muscle's activation secondary to saccular auditory stimulation).; Clinical norms will be applied to determine whether the exam is either within normal limits or abnormal.; Research of eventual vestibular disorder to determine if vestibular disorders can be linked to Osteogenesis Imperfecta.
Central Vestibular Function	24 months	Is evaluated by videonystagmography (VNG). The purpose of this test battery is to separate the vestibular disorders from disorders of the central neural system.; Clinical norms will be applied to determine whether the exam is either within normal limits or abnormal.; Research of eventual vestibular disorder to determine if vestibular disorders can be linked to Osteogenesis Imperfecta.
Semi-circular canal function	24 months	Video Head Impulse Test (vHIT). The vHIT assesses the vestibular ocular reflex linked to the semi-circular canal function when stimulated at a high frequency.; Clinical norms will be applied to determine whether the exam is either within normal limits or abnormal.; Research of eventual vestibular disorder to determine if vestibular disorders can be linked to Osteogenesis Imperfecta.
Subjective Visual Vertical (SVV)	24 months	Utricular Function Research of eventual vestibular disorder to determine if vestibular disorders can be linked to Osteogenesis Imperfecta.; The patient is asked to orient a line on the vertical axis. An angle of 3 degrees from the vertical indicates an otolithic utricular disorder.; Clinical norms will be applied to determine whether the exam is either within normal limits or abnormal.

Secondary Outcome Measures

Name	Time	Method
Immittance testing	24 months	Audiological phenotype Immittance testing can indicate whether middle ear structures are in tact; * Middle ear pressure and compliance of the tympanic membrane; * Ipsilateral acoustic reflex thresholds
Pure-tone audiometry	24 months	Audiometry performance Pure tone audiometry is used to establish the type and degree of hearing loss. This measure is important to characterize the audiological phenotype. Hearing thresholds established in air and bone conduction between 250-8000Hz in each ear.; Pure tone audiometry assessed as normal or abnormal Audiometry is considered abnormal if any threshold is greater than or equal to 25 dB HL.
Speech Audiometry	24 months	Audiometry performance Speech audiometry is used to establish the lowest intensity level in dB at which the patient can comprehend 50% of speech. This measure is important to confirm reliability of the pure tone audiometry, and to confirm that speech is both audible and intelligible.; Speech audiometry assessed as normal or abnormal.
Petrous bone Computed Tomography (CT)	24 months	CT is used to evaluate the presence and localization of petrous bone anomalies, for patients with conductive or mixed hearing loss and/or vestibular deficits.
Severity of OI	24 months	OI medical diagnosis. The OI diagnosis is clinical, based on the following signs: ligament laxity, bluish discoloration of the sclera, hearing loss, vascular tissue abnormalities, hemostatic disorder, elevated basal metabolic rate, renal disorder, neurological disorder, history family.; Depending on symptom severity, OI patient's diagnosis will be classified into on of four phenotypes : moderate (type I), lethal (type II), severe (type III), and moderate-to-severe (type IV).
Magnetic Resonance Imaging (MRI)	24 months	MRI is used to evaluate the presence and characteristics of anomalies of inner ear soft tissues, for patients with sensorineural hearing loss and for patients with abnormal CT scan results.

Trial Locations

Locations (1)

Hôpital Necker-Enfants Malades; 🇫🇷 Paris, France