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Doerfer KW, Harvey E, LaPrade S. Evaluation and diagnosis of pediatric patients with dizziness. Curr Opin Otolaryngol Head Neck Surg 2024; 32:339-345. [PMID: 39146209 DOI: 10.1097/moo.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Children experiencing dizziness frequently go unevaluated or experience delays in correct diagnosis due to systemic and inherent barriers. While most causes of pediatric dizziness do not involve the peripheral vestibular system, otolaryngologists are frequently consulted for expert opinion. This study offers a broad overview of the leading causes of pediatric dizziness and imbalance to assist otolaryngologists with evaluating and managing this challenging population. RECENT FINDINGS Evaluation of children with dizziness should exclude serious central nervous system conditions. Approximately 70% of nonhazardous cases of pediatric dizziness are caused by migraine-related conditions, concussion, or functional disorders. Etiologies for peripheral vestibular dysfunction include inner ear malformations and vestibular disorders more commonly seen in adults. Audiometric and vestibular testing can provide helpful information, although correct diagnosis depends on a detailed history. SUMMARY Otolaryngologists should be familiar with the conditions that cause dizziness in children. While most underlying causes are outside their scope of practice, understanding possible etiologies can facilitate correct diagnosis and appropriate management.
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Affiliation(s)
- Karl W Doerfer
- Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, 9200 W. Wisconsin Ave., Milwaukee, Wisconsin, USA
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Viola P, Scarpa A, Chiarella G, Pisani D, Astorina A, Ricciardiello F, De Luca P, Re M, Gioacchini FM. Instrumental Assessment and Pharmacological Treatment of Migraine-Related Vertigo in Pediatric Age. Audiol Res 2024; 14:129-138. [PMID: 38391768 PMCID: PMC10886403 DOI: 10.3390/audiolres14010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/23/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The most frequent form of vertigo in pediatric age is represented by vertigo linked to migraine, with a prevalence of 32.7%. This group of pathologies has received a redefinition of the diagnostic criteria to adapt them to the pediatric age with a new classification of the clinical pictures. We have several kinds of problems with these conditions that often have a significant impact on patients' and parents' quality of life: the diagnostic approach involves different tools for the different age groups contained in the pediatric range; the treatment of this type of vertigo is not consolidated due to the limited availability of trials carried out on pediatric patients. Focusing on this topic, the aim of this review was to provide an update on the more recent clinical advances in the diagnosis and treatment of Vestibular Migraine (VM) in children. METHODS We searched the PubMed, Embase, and Cochrane library databases for articles published in English from January 2015 to April 2023. The secondary search included articles from reference lists, identified by the primary search. Records were first screened by title/abstract, and then full-text articles were retrieved for eligibility evaluation. The searches combined a range of key terms ("Pediatric" AND "Childhood" AND "dizziness" OR "vertigo" AND "vestibular"). RESULTS Migraine-related vertigo, in its most recent definitions and classifications, is the most frequent group of balance pathologies in pediatric age. The results from the various experiences present in the literature suggest a clinical approach to be integrated with the use of instrumental tests selected according to the age of the patient and the reliability of the results. CONCLUSION Knowing the timeline of the applicability of vestibular tests and the information that can be obtained from them is fundamental for diagnostic accuracy. Therapy is strongly conditioned by the limited availability of pediatric trials and by the wide range it includes, from very young children to adolescents.
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Affiliation(s)
- Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy
| | | | - Pietro De Luca
- Otolaryngology Department, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam, 8, 00184 Rome, Italy
| | - Massimo Re
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
| | - Federico Maria Gioacchini
- Ear, Nose, and Throat Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Via Conca 71, 60020 Ancona, Italy
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Nascimento J, Araújo P, Moreira I, Henriques MM, Amorim M, Machado E, Monteiro C. Visual vertigo in children: Adaptation and validation of the visual vertigo analogue scale to European Portuguese. J Vestib Res 2024; 34:177-184. [PMID: 38875066 DOI: 10.3233/ves-230140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Visual vertigo occurs after vestibular and non-vestibular pathology and can be present in children and adolescents. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a questionnaire with a Portuguese version for adults. OBJECTIVES To perform the adaptation to pediatric age and validation of VVAS in European Portuguese. METHODS This prospective study involved the pediatric adaptation of the Portuguese VVAS, according to recognized guidelines. It was then completed by 30 healthy controls and 18 children with vestibulopathy. Patient caregivers also completed the Dizziness Handicap Inventory - Patient Caregivers (DHI-PC) to further explore the link between questionnaires. Groups were compared for severity of visual vertigo and VVAS test-retest reliability was tested. RESULTS The VVAS score was significantly higher in vestibular group (p < 0.001). No statistically significant differences were found between VVAS initial and re-test scores (p = 0.33). VVAS severity scores showed a positive correlation with DHI-PC (r = 0.598, p = 0.009). CONCLUSION The present Pediatric adaptation of VVAS in European Portuguese shows good psychometric properties for the assessment of visual vertigo. A positive correlation with the DHI-PC was showed, establishing the potential use of both questionnaires in the evaluation of vertigo children.
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Affiliation(s)
- Joana Nascimento
- Department of ENT, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro Araújo
- Department of ENT, Hospital da Luz, Lisbon, Portugal
| | - Inês Moreira
- Department of ENT, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Margarida Amorim
- Department of ENT, Centro Hospitalar de Coimbra, Coimbra, Portugal
| | - Eugénia Machado
- Department of ENT, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Anderson M, Tomczyk CP, Zynda AJ, Pollard-McGrandy A, Loftin MC, Covassin T. Preliminary Baseline Vestibular Ocular Motor Screening Scores in Pediatric Soccer Athletes. J Sport Rehabil 2024; 33:5-11. [PMID: 37758258 DOI: 10.1123/jsr.2022-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/23/2023] [Accepted: 08/06/2023] [Indexed: 10/03/2023]
Abstract
CONTEXT The utility of baseline vestibular and ocular motor screening (VOMS) in high school and collegiate athletes is demonstrated throughout the literature; however, baseline VOMS data at the youth level are limited. In addition, with the recent adoption of the change scoring method, there is a need to document baseline VOMS total and change scores in a pediatric population. OBJECTIVE To document baseline VOMS total and change scores and to document the internal consistency of the VOMS in pediatric soccer athletes. We hypothesized that the VOMS would demonstrate strong internal consistency in pediatric soccer athletes. DESIGN Cross-sectional study. METHODS Pediatric soccer athletes (N = 110; range = 5-12 y) completed the VOMS at baseline. Descriptive statistics summarized demographic information, VOMS total scores, and VOMS change scores. Cronbach α assessed internal consistency for VOMS total scores and change scores. RESULTS Twenty-one (19.1%) participants had at least one total score above clinical cutoffs (≥2 on any VOMS component and ≥5 cm on average near point convergence). Forty (36.4%) participants had at least one change score above clinical cutoffs (≥1 on any VOMS component and ≥3 cm on average near point convergence). The internal consistency was strong for total scores with all VOMS components included (Cronbach α = .80) and change scores (Cronbach α = .89). CONCLUSIONS Although results suggest VOMS items measure distinct components of the vestibular and ocular motor systems, caution should be taken when interpreting VOMS total and change scores in pediatric athletes, as overreporting symptoms is common, thereby impacting the false-positive rate.
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Affiliation(s)
- Morgan Anderson
- Sports Therapy and Research, Baylor Scott & White Health, Frisco, TX, USA
| | | | - Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | | | - Megan C Loftin
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
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Rigal T, Parodi M, Brisse F, Denoyelle F, Loundon N, Simon F. Translation and validation of the PVSQ and DHI-PC questionnaires for pediatric dizziness. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:5-12. [PMID: 37225531 DOI: 10.1016/j.anorl.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS Validation of the PVSQ self-report questionnaire (diagnosis) and the DHI-PC caregiver report questionnaire (Dizziness Handicap Inventory) aims to improve the management of pediatric vertigo, which is often under-diagnosed. MATERIALS AND METHODS The PVSQ and DHI-PC questionnaires were translated according to the Forward-Backward method and presented to a group of patients consulting for dizziness in a referral center and to a control group. A retest was performed at 2weeks for both questionnaires. Statistical validation consisted in calculating discriminatory capacity, ROC curve, reproducibility and internal consistency. The main study objective was the translation and validation of the PVSQ and DHI-PC questionnaires in French. The secondary objectives were to compare results in two subgroups according to the vestibular or non-vestibular etiology of dizziness and to assess the correlation between the two questionnaires. RESULTS In total, 112 children, in two comparable groups (53 cases and 59 controls), were included. Mean PVSQ score was 14.62 for cases and 6.55 for controls (P<0.001). Reproducibility was moderate, and internal consistency and construct validity were satisfactory. A cut-off of 11 corresponded to maximum Younden index. Mean DHI-PC score was 41.6 (cases only). Reproducibility was moderate, and internal consistency and construct validity were satisfactory. CONCLUSION The validation of the PVSQ and DHI-PC questionnaires offers two new tools in the management of dizziness, for both screening and follow-up.
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Affiliation(s)
- T Rigal
- Service d'ORL de chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France
| | - M Parodi
- Service d'ORL de chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France
| | - F Brisse
- Service d'ORL de chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France
| | - F Denoyelle
- Service d'ORL de chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Université Paris Cité, 75006 Paris, France
| | - N Loundon
- Service d'ORL de chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France
| | - F Simon
- Service d'ORL de chirurgie cervico-faciale pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France; Université Paris Cité, 75006 Paris, France.
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Picciotti PM, Rossi G, Settimi S, Fetoni AR, Coppola M, Galli J. Validity of Italian adaptation of the Vanderbilt Paediatric Dizziness Handicap Inventory. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:341-347. [PMID: 37519142 PMCID: PMC10551725 DOI: 10.14639/0392-100x-n2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/23/2023] [Indexed: 08/01/2023]
Abstract
Objective The paediatric caregiver version of the Dizziness Handicap Inventory (DHI-PC) questionnaire is a useful Quality of Life (QoL) evaluation instrument for children experiencing dizziness, vertigo or unsteadiness. Its English version has been validated for use with a paediatric population between 5 and 12 years of age. The aim of this work is to validate the DHI-PC into Italian for both patient assessment and appropriate rehabilitative treatment planning. Materials and methods Cross-cultural adaptation of the DHI-PC was performed using standard techniques. Items of the original questionnaire were translated into Italian by two bilingual investigators. Two native English speakers carried out a back translation of the new version that was compared with the original to check that they had the same semantic value. A pre-final version was obtained by an expert committee and was applied in a pilot test. Results A total of 42 patient caregivers completed the final adapted questionnaire twice with an interval of 2 weeks. Internal consistency was excellent, with Cronbach's alpha = 0.95. Conclusions Our study showed evidence that the Italian version of DHI-PC is a valid and reliable tool to quantify the degree of dizziness handicap and its application is recommended.
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Affiliation(s)
- Pasqualina Maria Picciotti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, Rome, Italy
| | - Giorgia Rossi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Settimi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, Rome, Italy
| | - Anna Rita Fetoni
- Department of Neuroscience, Reproductive sciences and Dentistry - Audiology Section, University of Naples Federico II, Naples, Italy
| | - Maria Coppola
- Neonatal Intensive Care Unit, sub TIN, Neonatal Pathology and Neonatology, San Giovanni Calibita Fatebenefratelli Hospital - Gemelli Isola, Rome, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Head and Neck and Sensory Organs, Catholic University of the Sacred Hearth, Rome, Italy
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Beretti T, Desnous B. Vertigo and dizziness in children: When to consider a neurological cause. Arch Pediatr 2023; 30:505-509. [PMID: 37537083 DOI: 10.1016/j.arcped.2023.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/04/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
Vertigo is common in childhood and adolescence. Although children and adults share common causes of vertigo, epidemiology changes with aging. For instance, ischemic stroke is less frequent in childhood, whereas audiovestibular disorders, such as vestibular neuritis and the migraine equivalent, are the leading causes of vertigo. However, even if severe causes of vertigo are rare, clinicians must not miss them. In this review, we discuss the neurological causes of central vertigo in children. The diagnostic approaches reviewed here are focused on the search for signs of severity, such as an abrupt onset, infectious context, or intracranial hypertension, which may subsequently require brain imaging.
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Affiliation(s)
- Thibault Beretti
- Department of Paediatric Neurology, La Timone Children Hospital, Aix-Marseille University, France
| | - Béatrice Desnous
- Department of Paediatric Neurology, La Timone Children Hospital, Aix-Marseille University, France.
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Ortega Solís J, Reynard P, Spruyt K, Bécaud C, Ionescu E, Thai-Van H. Developing a serious game for gaze stability rehabilitation in children with vestibular hypofunction. J Neuroeng Rehabil 2023; 20:128. [PMID: 37752531 PMCID: PMC10521575 DOI: 10.1186/s12984-023-01249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Children with vestibular hypofunction (VH) may have gaze instability, balance disorders, and delayed postural-motor development. Gaze stabilization exercises (GSE) are designed to improve dynamic visual acuity (DVA). We aimed to assess the acceptability of a serious game prototype called Kid Gaze Rehab (KGR) designed to implement GSE training in children with VH, combined with traditional vestibular rehabilitation. Effects on DVA and motor performance were also analyzed. METHODS Twelve children (6 to 9 years old) were included. Sessions were held at the hospital twice a week, for 5 weeks. An adapted French version of The Child Simulator Sickness Questionnaire (SSQ) and the Face Scale Pain-Revised (FPS-R) were used to assess pain in the cervical region and undesirable side effects after each session. Vestibular and motor function parameters (active and passive DVA and Movement Assessment Battery for Children-Second Edition, MABC-2) were assessed before and after the training. RESULTS All children included completed the 10 sessions. The FPS-R visual analog scale and SSQ showed good cervical tolerance and no oculomotor or vegetative adverse effects nor spatial disorientation. After training, active DVA scores were significantly improved for the right, left, and up directions (p < 0.05). Passive DVA scores were significantly improved for the left and down directions (p < 0.01 and p < 0.05, respectively). MABC-2 scores were improved in the balance and ball skill sections (p < 0.05). CONCLUSION An innovative pediatric training method, the use of a dedicated serious game for gaze stabilization was well-tolerated as a complement to conventional vestibular rehabilitation in children with VH. Moreover, both DVA and motor performance were found to improve in the study sample. Although replication studies are still needed, serious game-based training in children with VH could represent a promising rehabilitation approach for years to come. TRIAL REGISTRATION The study was conducted in accordance with the Declaration of Helsinki and approved by an Institutional Review Board (local ethics committee, CPP Sud-Est IV, ID 2013-799). The study protocol was registered on ClinicalTrials.gov (NCT04353115).
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Affiliation(s)
- José Ortega Solís
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
| | - Pierre Reynard
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot - INSERM, Hôpital Robert Debré AP-HP, 48 Bd Sérurier, Bingen, Paris, 75019, France
| | - Cécile Bécaud
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Société française de kinésithérapie vestibulaire, Toulouse, France
| | - Eugen Ionescu
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France
| | - Hung Thai-Van
- Service d'Audiologie & Explorations Oto-Neurologiques, Hospices Civils de Lyon, 5 Place d'Arsonval, Lyon, 69003, France.
- Université Claude Bernard Lyon 1, Lyon, France.
- Centre de Recherche et d'Innovation en Audiologie Humaine, Institut Pasteur, Institut de l'Audition, rue du Docteur Roux, Paris, 75015, France.
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Teggi R, Colombo B, Familiari M, Cangiano I, Bussi M, Filippi M. Phenotypes, bedside examination, and video head impulse test in vestibular migraine of childhood compared with probable vestibular migraine and recurrent vertigo in childhood. Front Pediatr 2023; 11:1152928. [PMID: 37377754 PMCID: PMC10291096 DOI: 10.3389/fped.2023.1152928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Vestibular impairment and vertigo in the pediatric population have an estimated prevalence ranging between 0.4% and 5.6% and are a topic of interest in recent years. The Bárány Society has recently reclassified migraine-related vertigo syndromes as vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (probable VMC), and recurrent vertigo of childhood (RVC). Methods Applying the criteria established by the Bárány Society, we retrospectively analyzed data on 95 pediatric patients suffering from episodic vertigo that were recruited from 2018 to 2022. In applying the revised criteria, 28 patients had VMC, 38 had probable VMC, and 29 had RVC. Results Visuo-vestibular symptoms (external vertigo) or internal vertigo were reported by 20 of 28 VMC patients (71.4%) compared to 8 of 38 probable VMC patients (21%) (P < .001). None of the RVC patients reported external vertigo. Duration of vertigo was demonstrably longer in the VMC patients than in the probable VMC (P < .001) and RVC (P < .001) patients. Cochlear symptoms were reported by 28.6% of VMC patients and by 13.1% of probable VMC patients. No cochlear symptoms were reported by any RVC patients. Familial cases for headache and episodic vertigo showed no significant difference between groups. Discussion The most frequent finding during bedside examination in all three groups was central positional nystagmus. Differences in the duration of attacks and in accompanying symptoms may underline different pathophysiological mechanisms.
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Affiliation(s)
- Roberto Teggi
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Bruno Colombo
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Familiari
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Iacopo Cangiano
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Mario Bussi
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- “Vita-Salute” University, San Raffaele, Milan, Italy
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Gurberg J, Tomczak KK, Brodsky JR. Benign paroxysmal vertigo of childhood. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:229-240. [PMID: 38043965 DOI: 10.1016/b978-0-12-823356-6.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Benign paroxysmal vertigo of childhood (or recurrent vertigo of childhood) is the most common cause of vertigo in young children. It is considered a pediatric migraine variant or precursor disorder, and children with the condition have an increased likelihood of developing migraine later in life than the general population. Episodes are typically associated with room-spinning vertigo in conjunction with other migrainous symptoms (e.g. pallor, nausea, etc.), but it is rarely associated with headaches. Episodes typically only last for a few minutes and occur with a frequency of days to weeks without interictal symptoms or exam/test abnormalities. Treatment is rarely necessary, but migraine therapy may be beneficial in cases where episodes are particularly severe, frequent, and/or prolonged. An appreciation of the typical presentation and characteristics of this common condition is essential to any provider responsible for the care of children with migraine disorders and/or dizziness. This chapter will review the current literature on this condition, including its proposed pathophysiology, clinical presentation, and management. This chapter also includes a brief introduction to pediatric vestibular disorders, including relevant anatomy, physiology, embryology/development, history-taking, physical examination, testing, and a review of other common causes of pediatric dizziness/vertigo.
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Affiliation(s)
- Joshua Gurberg
- Department of Otolaryngology, Montreal Children's Hospital, Montreal, QC, Canada; Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Kinga K Tomczak
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States; Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Jacob R Brodsky
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States; Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, United States.
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Zhang J, Zhu Q, Shen J, Chen J, Jin Y, Zhang Q, Duan M, Yang J. Etiological classification and management of dizziness in children: A systematic review and meta-analysis. Front Neurol 2023; 14:1125488. [PMID: 36937528 PMCID: PMC10018681 DOI: 10.3389/fneur.2023.1125488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background Dizziness in children, which could not be diagnosed at an early stage in the past, is becoming increasingly clear to a large extent. However, the recognition of the diagnosis and management remains discrepant and controversial due to their complicated and varied etiology. Central and peripheral vestibular disorders, psychogenic and systemic diseases, and genetic pathogeny constitute childhood etiological entities. Further understanding of the etiology and the prevalence of vertigo disorders is of crucial importance and benefit in the diagnosis and management of pediatric patients. Methods This systematic review and meta-analysis were conducted by systematically searching Embase, PubMed, the Cochrane Library, CNIK, the Chinese Wan-Fang database, CBM, the Chinese VIP database, and the Web of Science for literature on childhood vertigo disorders published up to May 2022. The literature was evaluated under strict screening and diagnostic criteria. Their quality was assessed using the Agency for Healthcare and Research Quality (AHRQ) standards. The test for homogeneity was conducted to determine the fixed effects model or random-effect model employed. Results Twenty-three retrospective cross-sectional studies involving 7,647 children with vertigo disorders were finally included, with an AHRQ score >4 (high or moderate quality). Our results demonstrated that peripheral vertigo (52.20%, 95% CI: 42.9-61.4%) was more common in children than central vertigo (28.7%, 95% CI: 20.8-37.4%), psychogenic vertigo (7.0%, 95% CI: 4.8-10.0%), and other systemic vertigo (4.7%, 95% CI: 2.6-8.2%). The five most common etiological diagnoses associated with peripheral vertigo included benign paroxysmal vertigo of childhood (BPVC) (19.50%, 95% CI: 13.5-28.3%), sinusitis-related diseases (10.7%, 95% CI: -11.2-32.6%), vestibular or semicircular canal dysfunction (9.20%, 95% CI: 5.7-15.0%), benign paroxysmal positional vertigo (BPPV)(7.20%, 95% CI: 3.9-11.5%), and orthostatic dysregulation (6.8%, 95% CI: 3.4-13.0%). Vestibular migraine (20.3%, 95% CI: 15.4-25.2%) was the most seen etiological diagnosis associated with central vertigo in children. In addition, we found the sex-based difference influenced the outcome of psychogenic vertigo and vestibular migraine, while there was no significant difference in other categories of the etiology. For the management of vertigo, symptomatical management is the first choice for most types of vertigo disorder in pediatrics. Conclusion Complex etiology and non-specific clinical manifestations of vertigo in pediatrics are challenging for their diagnoses. Reliable diagnosis and effective management depend on the close cooperation of multiple disciplines, combined with comprehensive consideration of the alternative characteristics of vertigo in children with growth and development.
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Affiliation(s)
- Jifang Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Qi Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Yuyao People's Hospital, Yuyao, Zhejiang, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maoli Duan
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Jun Yang
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12
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Li X, Liu Y, Lyu Y, Li Y, Jian H, Li X, Fan Z, Wang H, Zhang D. Sensory organization of balance control in children with vestibular migraine and recurrent vertigo of childhood. Front Neurol 2022; 13:970610. [DOI: 10.3389/fneur.2022.970610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
BackgroundMigraine plays an important role in some subgroups of children with recurrent vertigo. Moreover, the migraine component varies from definite to possibly absent as defined in this spectrum of three disorders—vestibular migraine of childhood (VMC), probable VMC (pVMC), and recurrent vertigo of childhood (RVC). However, studies on the sensory organization of balance control in these three disorders are rare.ObjectiveTo explore the balance control of children with RVC, VMC, and pVMC, when the three sensory systems are challenged.MethodA retrospective analysis was performed on 125 children with VMC (18 female and 15 male; aged 11.64 ± 2.74), pVMC (10 female and eight male; aged 11.78 ± 2.51), and RVC (32 female and 42 male; aged 11.10 ± 2.60). All children in each subtype were divided into groups of children aged ≤ 12 years old and 13–17 years old. Vestibular examination screening and assessment for postural control using the six conditions of the sensory organization test (SOT) were performed. The three primary outcome measures were: equilibrium score (ES), strategy score (SS), and sensory analysis score of the SOT.ResultsEquilibrium score under six different conditions and composite score increased with age (all P-values < 0.05). The somatosensory and visual scores also improved with growing (P-values < 0.05). However, vestibular scores did not increase significantly with age as the other senses did (P > 0.05). In the children ≤ 12 year-old group, children with VMC had a significantly higher visual preference score than those with pVMC and RVC (P < 0.05). There was an effect of age on the horizontal HIT. Ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and unilateral weakness (UW) values showed no significant difference among three diseases.ConclusionCompared with patients at the age of 13–17 years old and with RVC and pVMC (both ≤ 12 years old), children with VMC had a higher degree of reliance on visual signals to maintain their balance and a poorer central integration of peripheral information before reaching 12 years of age. In addition, vision may predominate by weakening vestibular function based on visuo-vestibular interactions. It must be noted that peripheral vestibular examinations could not distinguish the three disease subtypes.
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Xiao Q, Zhang Q, Wu Q, Shen J, Wang L, Chen Y, Lv J, Yang J, Jin Y, Zhang Q. Effects of acoustic stimulation intensity on air-conducted vestibular evoked myogenic potential in children. Front Neurol 2022; 13:996246. [PMID: 36303562 PMCID: PMC9592712 DOI: 10.3389/fneur.2022.996246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the effects of acoustic stimulation intensity on ocular and cervical vestibular evoked myogenic potential (oVEMP and cVEMP) responses elicited by air-conducted sound (ACS) in healthy children. Methods Thirteen healthy children aged 4–10 years and 20 healthy adults aged 20-40 years with normal hearing and tympanometry were enrolled in this study. All subjects received oVEMP and cVEMP tests under different acoustic stimulation intensities (131, 126, 121, 116, 111 and 106 dB SPL). Mean n1 latency, p1 latency, interpeak latency, amplitude and response rate were investigated and analyzed. Results As the acoustic stimulation intensity decreased, for oVEMP, the response rate of children decreased from 100% (131, 126 and 121 dB SPL) to 57.69% (116 dB SPL), 26.92% (111 dB SPL) and 11.54% (106 dB SPL). The response rate of adults decreased from 100% (131 and 126 dB SPL) to 95% (121 dB SPL), 55% (116 dB SPL), 12.5% (111 dB SPL) and 2.5% (106 dB SPL). There were lower n1 latency, p1 latency and higher amplitude in children when comparing by acoustic stimulation intensities (p < 0.05). Regarding cVEMP, the response rate of children decreased from 100% (131, 126 and 121 dB SPL) to 88.46% (116 dB SPL), 53.85% (111 dB SPL) and 26.92% (106 dB SPL). The response rate of adults decreased from 100% (131 and 126 dB SPL) to 95% (121 dB SPL), 85% (116 dB SPL), 37.5% (111 dB SPL) and 7.5% (106 dB SPL). A statistically significant difference was found in amplitude at different acoustic stimulation intensities in both children and adults (p < 0.05). When stimulated by 131 dB SPL acoustic stimulation, there were lower n1 latency, p1 latency and higher amplitude in children in oVEMP and cVEMP compared with adults (p < 0.05). Conclusion The response rate and amplitude of oVEMP and cVEMP in children and adults presented significant differences with a decrease in acoustic stimulation intensity. In this study, using 121 dB SPL for children and 126 dB SPL for adults during VEMP test could be regarded as safer stimulation intensities and thus reduced sound exposure.
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Affiliation(s)
- Qianwen Xiao
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qiong Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yanfei Chen
- Department of Otolaryngology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingrong Lv
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Jun Yang
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Yulian Jin
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Department of Otolaryngology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Qing Zhang
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14
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Prasetio AD, Irsalina P, Islamiyah WR, Ardiansyah D. Neuro-otology symptoms as the early sign in pediatric patient with a pineal gland tumor: a case report. Radiol Case Rep 2022; 17:3051-3054. [PMID: 35789558 PMCID: PMC9249574 DOI: 10.1016/j.radcr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
Patients with pineal tumors are often asymptomatic and the symptoms depend on the location of the mass. In fact, around 3%-8% of pediatric brain tumor cases are pineal tumors. Children with pineal tumors may present with dizziness and vertigo as early signs. These symptoms are common conditions among 5-15 years old children and could probably lead to misdiagnoses. We present a case of 14-year-old who came to the emergency room of DR. Soetomo Hospital Surabaya with neurotologic symptoms. After a series of radiographic and laboratory examinations, he was diagnosed with germinoma. A ventriculoperitoneal shunt was performed in the emergency room and intravenous dexamethasone was administered.
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15
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Deng J, Zhu Q, Zhang K, Xie D, Wu W. Vestibular function in children with cochlear implant: Impact and evaluation. Front Neurol 2022; 13:938751. [PMID: 36090862 PMCID: PMC9449973 DOI: 10.3389/fneur.2022.938751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Over the last 30 years, cochlear implant (CI) has been dedicated to improving the rehabilitation of hearing impairments. However, CI has shown potential detrimental effects on vestibular function. For children, due to atypical symptoms and difficulty in cooperating with vestibular function tests, systematic and objective assessments of vestibular function with CI have been conducted sparsely. This review focuses on the impact of vestibular function in children with CI and summarized the evaluation of vestibular function in children. In addition, some recommended strategies are summarized and proposed.
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16
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Janky KL, Yoshinaga-Itano C. The Feasibility of Performing Vestibular Newborn Screening. Pediatrics 2022; 150:188270. [PMID: 35698890 DOI: 10.1542/peds.2022-056986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kristen L Janky
- Boys Town National Research Hospital, Department of Audiology, Omaha, Nebraska
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17
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Piker EG, Picou E, Jacobson GP, Coltisor A. Agreement Between Caloric and Horizontal Video Head Impulse Testing in School-Aged Children Presenting With Dizziness. Am J Audiol 2022; 31:299-304. [PMID: 35286154 DOI: 10.1044/2021_aja-21-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The purpose of this investigation was to determine the relationship between the horizontal semicircular canal video head impulse test (hvHIT) and the caloric test in a sample of school-age children evaluated due to complaints of dizziness or imbalance. In adults, these two tests provide different but complementary information regarding vestibular function and/or pathology. However, the most common causes of vestibular loss in children are different than those in adults, and it is not clear how these two tests of horizontal semicircular canal function are related in a pediatric population. METHOD This is a retrospective study of electronic records of pediatric patients (< 18 years old) who were referred for vestibular function testing and completed both hvHIT and caloric testing. Agreement between both test results was evaluated by examining measures of sensitivity, specificity, and calculating Cohen's kappa. RESULTS Results from 117 patients (mean age = 13.7 years, age range: 8-17 years, 37 males) were analyzed. Most patients (97/115 [84.3%]) demonstrated both normal hvHIT and caloric test results. Compared to caloric testing, the hvHIT had poor sensitivity (38.9%) and excellent specificity (98.0%). Cohen's kappa analysis revealed moderate agreement between the methods (coefficient = 0.49 [0.24, 0.73]). Where disagreement between the two tests occurred, the final diagnosis was not contingent on either test result. CONCLUSIONS There is a moderate agreement between the hvHIT and the caloric test in pediatric patients presenting to a tertiary care medical center for a vestibular evaluation. Most patients in this cohort presented with normal findings. The specificity of hvHIT was excellent, although the sensitivity was low. This may be related to the low prevalence of peripheral vestibular system disease in this study cohort, and these results do not generalize to centers that serve populations of children where vestibular disorders are more prevalent (e.g., children with sensorineural hearing loss).
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Affiliation(s)
- Erin G. Piker
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Erin Picou
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P. Jacobson
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Allison Coltisor
- Division of Vestibular Sciences, Vanderbilt University Medical Center, Nashville, TN
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Viola P, Marcianò G, Casarella A, Pisani D, Astorina A, Scarpa A, Siccardi E, Basile E, De Sarro G, Gallelli L, Chiarella G. The Pharmacological Treatment of Pediatric Vertigo. CHILDREN 2022; 9:children9050584. [PMID: 35626761 PMCID: PMC9139449 DOI: 10.3390/children9050584] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 12/25/2022]
Abstract
Vertigo in children is a challenging topic. The lack of dedicated trials, guidelines and papers causes inhomogeneity in the treatment of vertigo in children. Meniere’s disease, migraine equivalents, vestibular neuritis, paroxysmal positional benign vertigo (BPPV), persistent postural-perceptual dizziness (PPPD) and motion sickness may affect children with various degrees of incidence and clinical severity compared to adults. Several drugs are proposed for the management of these conditions, even if their use is subordinated to the child’s age. In this review, we summarize the existing evidence related to the use of drugs for this clinical condition in children as a start point for new trials, stating the urgent need for international guidelines.
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Affiliation(s)
- Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
| | - Gianmarco Marcianò
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
| | - Alessandro Casarella
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
| | - Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy;
| | | | - Emanuele Basile
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
| | - Giovambattista De Sarro
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
- Medifarmagen SRL, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
- Correspondence: ; Tel.: +39-0961364-7124
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Janky KL, Thomas M, Al-Salim S, Robinson S. Does vestibular loss result in cognitive deficits in children with cochlear implants? J Vestib Res 2022; 32:245-260. [PMID: 35275585 PMCID: PMC10141688 DOI: 10.3233/ves-201556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In adults, vestibular loss is associated with cognitive deficits; however, similar relationships have not been studied in children. OBJECTIVE Evaluate the effect of vestibular loss on working memory and executive function in children with a cochlear implant (CCI) compared to children with normal hearing (CNH). METHODS Vestibular evoked myogenic potential, video head impulse, rotary chair, and balance testing; and the following clinical measures: vision, hearing, speech perception, language, executive function, and working memory. RESULTS Thirty-eight CNH and 37 CCI participated (26 with normal vestibular function, 5 with unilateral vestibular loss, 6 with bilateral vestibular loss). Children with vestibular loss demonstrated the poorest balance performance. There was no significant reduction in working memory or executive function performance for either CCI group with vestibular loss; however, multivariate regression analysis suggested balance performance was a significant predictor for several working memory subtests and video head impulse gain was a significant predictor for one executive function outcome. CONCLUSIONS CCI with vestibular loss did not have significantly reduced working memory or executive function; however, balance performance was a significant predictor for several working memory subtests. Degree of hearing loss should be considered, and larger sample sizes are needed.
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Affiliation(s)
- Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE, USA
| | - Megan Thomas
- Department of Audiology, Boys Town National Research Hospital, Omaha, NE, USA
| | - Sarah Al-Salim
- Boys Town National Research Hospital, Center for Childhood Deafness, Language and Learning, Omaha, NE, USA
| | - Sara Robinson
- Boys Town National Research Hospital, Center for Childhood Deafness, Language and Learning, Omaha, NE, USA
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20
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Tamaki C, Maul K, Talian DS, Sparks S. Deaf Individuals Who Report Having Good Balance Function Present with Significant Vestibular Deficits. J Am Acad Audiol 2021; 32:510-520. [PMID: 34965597 DOI: 10.1055/s-0041-1731732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Vestibular and/or balance deficits are well documented in deaf individuals. In the adult population, poor vestibular and/or balance function can lead to activity limitations and increased risk of falling. An effective case history by health care providers to probe for potential balance concerns is necessary for appropriate referral; however, patients may not consistently report vestibular and balance symptoms. Currently, there is little information available as to how deaf individuals report these symptoms and how their reported balance ability relates to measures of balance and vestibular functions. PURPOSE The aim of the current study was to evaluate self-perceived balance ability in participants who self-identify as either deaf or hearing, and compare these results to measures of balance and vestibular functions. RESEARCH DESIGN This is a prospective, between-group design. STUDY SAMPLE Data from 57 adults between the ages of 18 to 29 years who self-reported as deaf (39) or hearing (18) were evaluated. Participants completed the activities-specific balance confidence (ABC) scale, a brief case history, self-report rating of balance (SRRB), the Modified Clinical Test of Sensory Integration of Balance (mCTSIB), along with both ocular vestibular-evoked myogenic potentials (oVEMPs) and cervical vestibular-evoked myogenic potentials (cVEMPs). Only participants with SRRBs of good or excellent were included in the inferential analyses. RESULTS Proportions of participants rating their balance ability as either good or excellent were similar between both groups, as were the results on the ABC scale. Statistical analyses revealed significant associations between the groups on both oVEMPs and cVEMPs. No significant differences were observed on sway velocities in any of the mCTSIB conditions; however, more than one-third of deaf participants had mCTSIB Condition 4-on foam, eyes closed-scores above 2 standard deviations of the hearing group. CONCLUSION Deaf participants self-report similar ratings of balance ability as hearing participants despite significant differences in vestibular function. A relatively large subset of deaf participants had increased sway velocity on balance function testing that required increased reliance on vestibular cues. A thorough discussion of balance and vestibular symptoms should be completed when a patient who self-identifies as deaf is seen by a health care provider so that appropriate screenings or referrals can be completed as necessary.
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Affiliation(s)
- Chizuko Tamaki
- Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, District of Columbia
| | - Kristen Maul
- Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, District of Columbia
| | - Daniel S Talian
- Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, District of Columbia
| | - Sarah Sparks
- Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, District of Columbia
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Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2021; 46:118-177. [PMID: 34864777 PMCID: PMC8920012 DOI: 10.1097/npt.0000000000000382] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. Discussion: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. Limitations: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. Disclaimer: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).
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Bertholon P, Thai-Van H, Bouccara D, Esteve-Fraysse MJ, Wiener-Vacher S, Ionescu E. Conseils de bonnes pratiques de la Société française d’ORL et de chirurgie cervico-faciale (SFORL) pour la téléconsultation du patient vertigineux en pandémie COVID. ANNALES FRANÇAISES D'OTO-RHINO-LARYNGOLOGIE ET DE PATHOLOGIE CERVICO-FACIALE 2021. [PMCID: PMC8628166 DOI: 10.1016/j.aforl.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bertholon P, Thai-Van H, Bouccara D, Esteve-Fraysse MJ, Wiener-Vacher SR, Ionescu E. Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:459-465. [PMID: 33334700 PMCID: PMC7833948 DOI: 10.1016/j.anorl.2020.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care. METHODS These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020. RESULTS The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation. CONCLUSION The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.
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Affiliation(s)
- P Bertholon
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Nord, CHU Saint-Étienne, Avenue A Raimond, 42270 Saint Priest en Jarez, France
| | - H Thai-Van
- Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France.
| | - D Bouccara
- Service d'ORL et de Cancérologie Cervico-Faciale, AP-HP, Hôpitaux Universitaires Paris-Ouest, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M-J Esteve-Fraysse
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Purpan, 1, place du Docteur Baylac, 31300 Toulouse, France
| | - S R Wiener-Vacher
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre d'exploration de l'équilibre de l'enfant (EFEE), Hôpital Universitaire Robert Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - E Ionescu
- Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France
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Clark JE, Pate R, Rine RM, Christy J, Dalton P, Damiano DL, Daniels S, Holmes JM, Katzmarzyk PT, Magasi S, McCreery R, McIver K, Newell KM, Sanger T, Sugden D, Taveras E, Hirschfeld S. NCS Assessments of the Motor, Sensory, and Physical Health Domains. Front Pediatr 2021; 9:622542. [PMID: 34900852 PMCID: PMC8661476 DOI: 10.3389/fped.2021.622542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.
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Affiliation(s)
- Jane E. Clark
- Department of Kinesiology, School of Public Health, University of Maryland, College Park, MD, United States
| | - Russell Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Jennifer Christy
- Department of Physical Therapy, University of Alabama, Birmingham, AL, United States
| | - Pamela Dalton
- Monell Chemical Senses Center, Monell Center, Philadelphia, PA, United States
| | - Diane L. Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, United States
| | - Stephen Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Jonathan M. Holmes
- Department of Ophthalmology and Vision Science, University Arizona, Tucson, AZ, United States
| | - Peter T. Katzmarzyk
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, United States
| | - Ryan McCreery
- Boys Town National Research Hospital, Boys Town, NE, United States
| | - Kerry McIver
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Karl M. Newell
- Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Terence Sanger
- Department of Biomedical Engineering, Neurology, and Biokinesiology, University of Southern California, Los Angeles, CA, United States
| | - David Sugden
- School of Education, University of Leeds, Leeds, United Kingdom
| | - Elsie Taveras
- Department of Pediatrics, Harvard Medical School and Mass General Hospital for Children, Boston, MA, United States
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Vertigo and Dizziness in Children: An Update. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111025. [PMID: 34828738 PMCID: PMC8623325 DOI: 10.3390/children8111025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/24/2023]
Abstract
Background: Vertigo and dizziness are relatively infrequent in paediatric patients, but specific data on the prevalence of these disorders are limited and influenced by various factors, including the age of the examined population. These conditions often have a significant impact on patients’ and parents’ quality of life. The aim of this paper is to investigate the prevalence of different aetiologies of vertigo in the paediatric population through a systematic review. Methods: According to PRISMA guidelines, a systematic review of the literature was performed. Medline and Embase were searched from January 2011 through to 10 September 2021. The search yielded 1094 manuscripts, which were reduced to 7 upon the application of inclusion criteria. Results: A total of 2470 paediatric patients were evaluated by the selected papers. Vestibular Migraine was the most frequently diagnosed condition, occurring alone or in association with other diseases. Overall, audio-vestibular disorders represented the second cause of vertigo, and the prevalence appears to increase according to age growth. Over the years, even though we assisted in the amelioration of diagnostic rates, partially related to an improvement in diagnostic tools, the aetiology of vertigo remains still unclear in a variable percentage of patients. Conclusion: Vertigo in children, despite being an uncommon symptom, requires a multidisciplinary approach, often involving Paediatricians, Neurologists and Otorhinolaryngologists. A comprehensive evaluation of children suffering from vertigo is crucial for establishing a successful therapy and reducing parental worries.
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Melo RS, Lemos A, Raposo MCF, Monteiro MG, Lambertz D, Ferraz KM. Repercussions of the Degrees of Hearing Loss and Vestibular Dysfunction on the Static Balance of Children With Sensorineural Hearing Loss. Phys Ther 2021; 101:6322542. [PMID: 34270771 DOI: 10.1093/ptj/pzab177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/16/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the static balance of children with sensorineural hearing loss (SNHL) according to the degrees of SNHL and the function of the vestibular system. METHODS This cross-sectional study was conducted in public schools located in Caruaru, Pernambuco state, Brazil, with 130 children (65 with normal hearing and 65 with SNHL as documented by air and bone conduction audiometry) of both sexes between 7 and 11 years old. Static balance was assessed by a stabilometric analysis using a force platform consisting of the circular area of center-of-pressure displacement of the children evaluated in 3 positions: bipedal support with feet together and parallel (PF), tandem feet (TF), and 1 foot (OF), carried out under 2 sensory conditions each, with eyes open and eyes closed. After balance assessments, the children with SNHL received examinations of auditory and vestibular functions-through audiometry and computerized vectoelectronystagmography, respectively-to compose the groups according to degrees of SNHL and vestibular function. RESULTS The children with severe and profound SNHL demonstrated more static balance instabilities than the children with normal hearing in 5 positions assessed with eyes open (PF, TF, and OF) and eyes closed (PF and TF). The same phenomenon occurred in children with SNHL and associated vestibular dysfunction in all of the positions assessed with eyes open and eyes closed (PF, TF, and OF). CONCLUSION The larger the degree of SNHL, the greater the balance instability of the children. The children with SNHL and associated vestibular dysfunction showed the highest balance instabilities in this study. IMPACT Children with larger degrees of SNHL and associated vestibular dysfunction might require prolonged periods to rehabilitate their balance.
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Affiliation(s)
- Renato S Melo
- Department of Physical Therapy, Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Andrea Lemos
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Milena Guimarães Monteiro
- Department of Physical Therapy, Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Daniel Lambertz
- Department of Physical Therapy, Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Karla Mônica Ferraz
- Department of Physical Therapy, Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am 2021; 54:973-987. [PMID: 34304898 DOI: 10.1016/j.otc.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dizziness occurs in children with an estimated prevalence of 0.45% to 15.0%. Vestibular disorders in the pediatric population can impact gross motor function development, visual acuity, and contribute to psychological distress. Appropriate case history and focused direct examination can be helpful when determining the etiology of dizziness. Vestibular testing can be completed in children and guide management of suspected vestibular dysfunction. Vestibular dysfunction is commonly seen in patients with sensorineural hearing loss. Migraine disorders are the most common cause of dizziness in childhood. Etiologies of dizziness in children differ from those commonly seen in adults.
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Affiliation(s)
- Elizabeth A Kelly
- Department of Otolaryngology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA.
| | - Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA
| | - Jessie N Patterson
- Department of Audiology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA
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Vestibular disorders in children: A retrospective analysis of vestibular function test findings. Int J Pediatr Otorhinolaryngol 2021; 146:110751. [PMID: 33964674 DOI: 10.1016/j.ijporl.2021.110751] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/07/2021] [Accepted: 04/26/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study was designed to describe the most common vestibular disorders in children and their associated findings on vestibular function testing. METHOD Data from 203 children with a mean age of 11.16 ± 3.87 (range, 1-17) years were collected from among 3400 patients who underwent vestibular assessment at a vertigo center in a tertiary hospital over a 3-year period. A retrospective data analysis was performed for 203 children. RESULTS Vestibular disorders were diagnosed in 78.3% (n = 159) of 203 children among 3400 patients, which revealed a 3-year incidence of 4.67% in our study. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis in our group of children (49%; n = 100), which involved both primary BPPV, and secondary BPPV that was associated with other vestibular pathologies. Vestibular migraine (VM) was the second most common diagnosis (41%; n = 83) followed by benign paroxysmal vertigo of childhood (BPVC; 4.5%, n = 9), vestibular neuritis (VN; 4.5%, n = 9), and psychogenic vertigo (4.5%, n = 9). Our study showed that Meniere's Disease (MD; 1.5%, n = 3) and central vertigo (1.5%, n = 3) were less commonly diagnosed in children. Perilymphatic fistula (PLF) was diagnosed and surgically confirmed in only one child. CONCLUSION BPPV and VM were the most common pediatric vestibular disorders in our study. Clinicians should be aware of the prevalence, signs, and symptoms of the most common vestibular disorders in children to enable diagnosis, treatment, and rehabilitation. Vestibular function testing with age-appropriate adaptations results in improved differential diagnosis, which guides medical treatment and rehabilitation.
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Haripriya GR, Lepcha A, Augustine AM, John M, Philip A, Mammen MD. Prevalence, clinical profile, and diagnosis of pediatric dizziness in a tertiary care hospital. Int J Pediatr Otorhinolaryngol 2021; 146:110761. [PMID: 34000496 DOI: 10.1016/j.ijporl.2021.110761] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/14/2021] [Accepted: 05/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Pediatric dizziness is an uncommon complaint presenting to the Otolaryngology clinic. While the term dizziness may be used to describe any altered sensation of orientation to the environment which includes presyncope, light-headedness and ataxia, vertigo refers to a false sensation of motion of self or surroundings. Although a variety of etiologies are known to cause dizziness and vertigo, evaluation of this symptom becomes challenging in children who are unable to clearly explain what they experience, the provoking factors, associated symptoms and the duration of attacks. Vestibular tests are also difficult to conduct in the pediatric age group leading to apathy from the clinician. OBJECTIVES To ascertain the prevalence of pediatric vertigo in children under 18 years of age, presenting to the Otolaryngology Clinic of a tertiary care hospital, and to describe the clinical profile, investigations and diagnosis in these children. METHODS A prospective cross-sectional, descriptive clinical study was undertaken from January 1, 2018 to April 30, 2019. All children below the age of 18 years presenting to our department with primary complaints of dizziness were included in the study. After a thorough history and physical examination, screening methods and diagnostic tests were conducted to make a diagnosis. Referrals were sought from other specialties when necessary. RESULTS The number of children visiting the Department for various ENT ailments during the study period was 10,950. Among these 89 children presented with a primary complaint of dizziness. Their ages ranged from 3 to 18 years; mean age was 11.42 years (SD 3.45). A diagnosis was made in all except two children. The most common cause of dizziness in the age group less than 6 years was benign paroxysmal vertigo of childhood (BPVC) and in the older children was migraine associated vertigo, which was also the commonest overall diagnosis made (28.1%). This was followed by circulation related dizziness like orthostatic hypotension and vasovagal syncope (15.7%). CONCLUSIONS The prevalence of pediatric dizziness in children presenting to the Otolaryngology clinic was 0.8%. The diagnosis of pediatric vertigo may be challenging, but careful history and examination along with guided investigations and referrals results in correct diagnosis in almost all patients.
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Affiliation(s)
- G R Haripriya
- Otorhinolaryngology, MGM Healthcare Hospital, Chennai, Tamil Nadu, 600029, India.
| | - Anjali Lepcha
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Ann Mary Augustine
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Mary John
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Ajay Philip
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
| | - Manju Deena Mammen
- Department of Otorhinolarynglogy Unit IV, Christian Medical College Vellore, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India
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Erden A, Acar Arslan E, Dündar B, Topbaş M, Cavlak U. Reliability and validity of Turkish version of pediatric balance scale. Acta Neurol Belg 2021; 121:669-675. [PMID: 32077065 DOI: 10.1007/s13760-020-01302-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Abstract
Assessment tool is a key point to evaluate balance disturbances in children. The aim of this study was to analyze reliability and validity of Turkish version of pediatric balance scale. The present study included 34 children (13 girls; 21 boys) with balance impairments. The scale consists of 14 items. Eight observers assessed the video records of the participants for interrater agreement. One observer evaluated the records twice in 2 weeks for intrarater agreement. Intraclass correlation coefficient was used for the interobserver and intraobserver agreement. The Functional Reach Test was used to calculate concurrent validity. Mean age of the sample was 11.68 ± 3.53 years. The Turkish version of the scale was found to be reliable, perfectly (intraclass correlation coefficient for interobserver agreement = 0.915). Intraobserver agreement was also reliable, perfectly (ICC = 0.927). The strong correlation between pediatric balance scale and functional reach test was found (r = 0.692; p < 0.001). The Turkish version of the scale is a valid and reliable tool to evaluate children with balance impairments. Moreover, it is easy to use for health providers working with disabled children.
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Affiliation(s)
- Arzu Erden
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karadeniz Technical University, 61080, Trabzon, Turkey.
| | - E Acar Arslan
- Department of Pediatric Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - B Dündar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Avrasya University, Trabzon, Turkey
| | - M Topbaş
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - U Cavlak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Avrasya University, Trabzon, Turkey
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Giannantonio S, Scorpecci A, Montemurri B, Marsella P. Case of COVID-19-induced vestibular neuritis in a child. BMJ Case Rep 2021; 14:14/6/e242978. [PMID: 34078625 PMCID: PMC8173285 DOI: 10.1136/bcr-2021-242978] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Since the outbreak of the COVID-19 pandemic, there has been a growing need to fully understand all the possible clinical features of the epidemic, which often presents with unusual manifestations, especially in children. In this report, we describe the case of a child with a COVID-19 infection and suffering exclusively from vertigo and fever. Altogether, considering the clinical manifestation, laboratory tests and imaging, given the patient’s positivity to SARS-CoV-2 infection and its neurotropic potential, we assumed that the child had COVID-19-induced vestibular neuritis, which, in consideration of the spontaneous improvement of symptoms, did not require any therapeutic adjustments, apart from the natural compensation of the central nervous system. This case suggests the importance of having an index of suspicion for a COVID-19 infection in patients with paediatrics presenting with vertigo and adds valuable information to the limited literature on COVID-19 presentation and management in children.
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Affiliation(s)
- Sara Giannantonio
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
| | - Alessandro Scorpecci
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
| | - Berardo Montemurri
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
| | - Pasquale Marsella
- Audiology and Otosurgery Department, "Bambino Gesù" Children's Hospital, Rome, Lazio, Italy
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Vestibular and Balance Disorders in Mexican Children and Adolescents: Review of 8-Year Clinical Records. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otoeng.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Singh A, Raynor EM, Lee JW, Smith SL, Heet H, Garrison D, Wrigley J, Kaylie DM, Riska KM. Vestibular Dysfunction and Gross Motor Milestone Acquisition in Children With Hearing Loss: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:493-506. [PMID: 33430703 DOI: 10.1177/0194599820983726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the impact of vestibular dysfunction on gross motor development in children with hearing loss. DATA SOURCES MEDLINE (PubMed), Embase (Elsevier), Web of Science (Clarivate), and the Cumulative Index of Nursing and Allied Health Literature (EBSCO). REVIEW METHODS A systematic review was reported in concordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Articles on children with hearing loss who underwent at least 1 instrumented measure of vestibular function and had gross motor milestones assessed were included. The Downs and Black checklist was used to assess risk of bias and methodological quality. RESULTS Eleven articles were included in the systematic review. Three articles stratified quantitative results of gross motor milestone acquisition by severity of vestibular impairment. Over half of studies were case series published within the last 5 years. This systematic review showed that children with hearing loss and severe, bilateral vestibular dysfunction demonstrate delayed gross motor milestones. However, it was difficult to draw conclusions on whether milder forms of vestibular dysfunction significantly affect gross motor milestone acquisition in children with hearing loss. The reason is that most studies were of low to moderate quality, used different assessment methods, and contained results that were descriptive in nature. CONCLUSIONS This emerging area would benefit from future research, such as higher-quality studies to assess vestibular function and gross motor milestones. This would allow for better characterization of the impacts of vestibular impairment, especially milder forms, in children with hearing loss.
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Affiliation(s)
- Anisha Singh
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Eileen M Raynor
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Janet W Lee
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sherri L Smith
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Hannah Heet
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Doug Garrison
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jordan Wrigley
- Medical Center Library and Archives, Duke University, Durham, North Carolina, USA
| | - David M Kaylie
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Kristal M Riska
- Department of Head and Neck Surgery and Communication Sciences, School of Medicine, Duke University, Durham, North Carolina, USA.,Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina, USA
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How often do neurological disorders lead to dizziness in childhood? Turk Arch Pediatr 2021; 56:249-253. [PMID: 34104917 DOI: 10.14744/turkpediatriars.2020.43410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/08/2020] [Indexed: 01/03/2023]
Abstract
Objective The aim of the study was to determine the features and differential diagnosis of childhood dizziness and find out the prevalence of neurological diseases in children who were referred to the pediatric neurology outpatient clinic. A secondary aim was to evaluate the outcome of dizziness after 12 months. Material and Methods The records of children with a complaint of dizziness that were referred to the pediatric neurology outpatient clinic were retrospectively reviewed, and detailed medical and family history, clinical characteristics, laboratory investigations including vitamin B12 levels, and neuroimaging tests were analyzed. Patients were grouped as neurological disorders and non-neurological disorders. Neurological disorders included vestibular migraine, benign paroxysmal vertigo, and epilepsy, and non-neurological disorders contained the remaining disorders. Results The study consisted of 60 children (36 females, 24 males) with a mean age of 11.7±4.1 years. The most common diagnoses were vestibular migraine (21.7%) and orthostatic hypotension (20%). We found that the incidence of neurological diseases was 40% (vestibular migraine, 21.7%; epilepsy, 10%; benign paroxysmal vertigo, 8.3%). When we compared the neurological disorders with non-neurological disorders, there was a significant difference in terms of age at onset and duration of attacks (p=0.001 for both), whereas no significant difference was detected in terms of gender, frequency of attacks, and vitamin B12 levels. We detected ongoing symptoms in 10% of the patients who were diagnosed with vestibular migraine and psychogenic dizziness. Conclusion Both non-neurological and neurological diseases are common in etiology of children with dizziness.
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Duarte JA, Leão EM, Fragano DS, Marquez GJ, Pires APBDÁ, Silva MLS, Ganança FF. Vestibular Syndromes in Childhood and Adolescence. Int Arch Otorhinolaryngol 2020; 24:e477-e481. [PMID: 33101514 PMCID: PMC7575395 DOI: 10.1055/s-0039-3402443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/03/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction
The prevalence of vestibular disorders in childhood ranges from 0.4% to 15%; they may be the result of several factors, but most of the time it's an episodic vestibular syndrome related to migraine equivalents.
Objective
To evaluate the diagnostic and therapeutic aspects of children with vestibular signs and symptoms.
Methods
The present cross-sectional study evaluated data from the records of patients treated in an outpatient pediatric neurotology clinic over a 10-year period. These data included sociodemographic and clinical variables, results of complementary examinations, the treatment provided, and the clinical evolution.
Results
The sample was composed of 117 patients, with 54.7% of female subjects with a mean age of 10 years. The most prevalent diagnosis was benign paroxysmal vertigo of childhood (BPVC) (41.9%), followed by vestibular migraine (16.2%). The most prevalent complaint was vertigo (53.9% of the cases). Most patients (66.7%) had inadequate eating habits. Improvement of symptoms was observed in 40.4% of the patients treated with dietary guidance alone. In 80% of the cases, dietary counseling in combination with vestibular rehabilitation therapy achieved therapeutic success without the need of a drug treatment.
Conclusion
The predominant diagnosis was of BPVC, and its close relationship with the personal and family history of migraine, its benign evolution, and the importance of dietary guidance and vestibular rehabilitation for therapeutic success were observed.
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Affiliation(s)
- Juliana Antoniolli Duarte
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Elisa Morais Leão
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Daniel Sobral Fragano
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Germana Jardim Marquez
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Anna Paula Batista de Ávila Pires
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Maria Laura Solferini Silva
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
| | - Fernando Freitas Ganança
- Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
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Vestibular and balance disorders in Mexican children and adolescents: Review of 8-year clinical records. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 72:137-142. [PMID: 32843142 DOI: 10.1016/j.otorri.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Vertigo is a seldom studied symptom in the paediatric population, where the prevalence is less than 1%. Vestibular disorders in children are not comparable to those of adults and are often underdiagnosed. Identifying the main causes of these disorders would provide reliable and accurate data of the diseases in certain age groups, improving the diagnostic process. MATERIAL AND METHODS Observational, cross-sectional, and retrospective study. Consecutive records of patients, aged 3 to 17years, attended due to vestibular, balance and associated symptoms (vertigo, dizziness, hearing loss, balance disorders and headache), attended by the otoneurology service of a tertiary hospital, between September 2010 and September 2018, were included. Descriptive and inferential statistics were used for the analysis. All p-values reported from these analyses were two-tailed with a significance level <.05. RESULTS 212 cases were registered from 6,444 consultations (3.3%). The proportion between males and females was similar. The mean age of the group was 14.5 (±3.9) years, the median age of onset of symptoms was 11 (IQR 8-14) years and that of the first consultation was 13 (IQR 10-15) years. As a cardinal symptom, 51.9% attended due to vertigo, 25.5% due to dizziness, 9.9% due to gait instability, 7.5% due to hearing loss and 5.2% due to headache. Of the episodes of vertigo, 61.8% were of peripheral origin, 69 32.5% central and 12 5.7% outside the vestibular system. Benign paroxysmal vertigo of childhood, dysfunction and vestibular migraine accounted for more than 65% of cases. No differences were found between the diagnoses regarding the sex and age of the participants (P>.05). CONCLUSION Vestibular and balance disorders are rare in the study population and most of the causes are benign and potentially self-limited disorders.
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Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial Characteristics of Pediatric Dizziness and Imbalance. Laryngoscope 2020; 131:E1308-E1314. [PMID: 32809223 DOI: 10.1002/lary.29024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the relative prevalence of individual diagnoses in children and adolescents presenting with dizziness and/or imbalance, and to assess the proportion of patients assigned multiple contributing diagnoses. STUDY DESIGN Retrospective cohort study. METHODS We retrospectively reviewed our internal database of all patients seen at our pediatric vestibular program between January 2012 and March 2019 to determine the incidence of common diagnoses and groups of diagnoses for patients ages 21 or younger. RESULTS One thousand twenty-one patients were included with a mean age of 12.5 ± 4.9 years (range: 9 months-21 years). Of this total, 624 patients were female and 397 were male. Common diagnoses included vestibular migraine (VM; 35.0%), benign paroxysmal positional vertigo (BPPV; 21.6%), primary dysautonomia (15.7%), anxiety disorder (13.5%), and persistent postural perceptual dizziness (PPPD; 11.2%). A high proportion of patients (44.4%) received multiple contributing diagnoses. VM was frequently diagnosed with BPPV or PPPD, and 22 patients were diagnosed with all three concurrently. CONCLUSION The causes of dizziness and imbalance in the pediatric population are diverse, and many patients have multiple diagnoses that are often interrelated. It is important that providers recognize that the causes of vestibular symptoms in children and adolescents may be multifactorial and may span across multiple specialties. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1308-E1314, 2021.
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Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sophie Lipson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Tufts School of Medicine, Boston, Massachusetts, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Meghan Corcoran
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
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YILDIRIM M, DOĞAN MT, KEÇELİ AM. Çocuk nöroloji bölümüne baş dönmesi şikâyeti ile konsülte edilen hastaların retrospektif değerlendirmesi. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.756284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bilodeau M, Jacobson GP, Roberts RA, Hatton K. Short Communication: The Belly-Tendon Derivation Yields Superior Ocular Vestibular Evoked Myogenic Potential Amplitudes in a Normal Pediatric Sample. Am J Audiol 2020; 29:88-93. [PMID: 31841353 DOI: 10.1044/2019_aja-19-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The purpose of the investigation was to determine whether the "belly-tendon" electrode derivation produced ocular vestibular evoked myogenic potentials (oVEMPs) in children that were superior to those recorded with the infraorbital-chin electrode derivation. Method This was a prospective observational study using a sample of convenience at a tertiary care medical center. Subjects were 13 children between the ages of 5 and 12 years. We compared the latency of the N1 wave and the N1-P1 peak-to-peak amplitude for the belly-tendon electrode derivation to the infraorbital-chin electrode derivation. Results The belly-tendon electrode derivation was associated with superior N1-P1 amplitudes compared to the infraorbital-chin electrode derivation. However, the large amplitude was also associated with greater variability compared to the infraorbital-chin derivation. There were no significant electrode derivation-based differences in N1 latency. Additionally, there was no predictable relationship between age and oVEMP amplitude. Conclusion As shown previously in adults, the belly-tendon electrode derivation produces significantly larger oVEMP amplitudes compared to the infraorbital-chin electrode derivation.
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Affiliation(s)
- Megan Bilodeau
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Gary P Jacobson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Richard A Roberts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Kelsey Hatton
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
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Erden A, Acar Arslan E, Dündar B, Topbaş M, Cavlak U. Reliability and validity of Turkish version of pediatric balance scale. Acta Neurol Belg 2020. [PMID: 32077065 DOI: 10.1007/s13760-020-01302-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Assessment tool is a key point to evaluate balance disturbances in children. The aim of this study was to analyze reliability and validity of Turkish version of pediatric balance scale. The present study included 34 children (13 girls; 21 boys) with balance impairments. The scale consists of 14 items. Eight observers assessed the video records of the participants for interrater agreement. One observer evaluated the records twice in 2 weeks for intrarater agreement. Intraclass correlation coefficient was used for the interobserver and intraobserver agreement. The Functional Reach Test was used to calculate concurrent validity. Mean age of the sample was 11.68 ± 3.53 years. The Turkish version of the scale was found to be reliable, perfectly (intraclass correlation coefficient for interobserver agreement = 0.915). Intraobserver agreement was also reliable, perfectly (ICC = 0.927). The strong correlation between pediatric balance scale and functional reach test was found (r = 0.692; p < 0.001). The Turkish version of the scale is a valid and reliable tool to evaluate children with balance impairments. Moreover, it is easy to use for health providers working with disabled children.
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Affiliation(s)
- Arzu Erden
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karadeniz Technical University, 61080, Trabzon, Turkey.
| | - E Acar Arslan
- Department of Pediatric Neurology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - B Dündar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Avrasya University, Trabzon, Turkey
| | - M Topbaş
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - U Cavlak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Avrasya University, Trabzon, Turkey
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Dasgupta S, Mandala M, Salerni L, Crunkhorn R, Ratnayake S. Dizziness and Balance Problems in Children. Curr Treat Options Neurol 2020. [DOI: 10.1007/s11940-020-0615-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Melo RS, Lemos A, Paiva GS, Ithamar L, Lima MC, Eickmann SH, Ferraz KM, Belian RB. Vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with sensorineural hearing loss: A systematic review. Int J Pediatr Otorhinolaryngol 2019; 127:109650. [PMID: 31466025 DOI: 10.1016/j.ijporl.2019.109650] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies have demonstrated that children with sensorineural hearing loss (SNHL) exhibit postural instabilities, as well as balance and gait disorders, due to the vestibular dysfunction that they are prone to display as a consequence of inner ear injury. Thus, some experiments have proposed vestibular rehabilitation exercises programs as a treatment to improve these motor skills in children with SNHL. OBJECTIVE Assess the evidence quality of the trials that used vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL. METHODS This is a systematic review that surveyed articles in nine databases, published up to July 4, 2019, in any language, using the following inclusion criteria: (1) Randomized or quasi-randomized controlled trials. (2) Participants of both groups with clinical diagnosis of SNHL, aged up to 12 years old, with no physical problems, cognitive or neurological impairments, except the vestibular dysfunction. (3) Using vestibular rehabilitation exercises programs to improve the following outcomes: postural control, balance and/or gait. RESULTS Six experiments, including 153 children, met the inclusion criteria of this systematic review. Two randomized controlled trials (45 children) on the postural control exhibited low evidence quality and four others; three randomized and controlled trials (90 children) on the balance and one quasi-randomized (18 children) on the gait demonstrated very low evidence quality, respectively. CONCLUSION There is promising evidence that vestibular rehabilitation exercises programs improve the postural control, balance and gait of children with SNHL. However, due to the methodological limitations of the trials and low quality of current evidence on this topic, the trials results analyzed by this systematic review should be interpreted with caution. Due to the low quality of evidence observed in this review, we suggest that new trials be proposed on this topic, with better methodological quality, to prove the effectiveness of vestibular rehabilitation exercises programs to improve the postural control, balance and gait of children with SNHL.
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Affiliation(s)
- Renato S Melo
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife, Pernambuco, Brazil; Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil.
| | - Andrea Lemos
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Giselle S Paiva
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Lucas Ithamar
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Marília C Lima
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Department of Maternal and Child Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Sophie Helena Eickmann
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Department of Maternal and Child Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Karla Mônica Ferraz
- Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | - Rosalie Barreto Belian
- Post-graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil; Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife, Pernambuco, Brazil; Department of Medicine, Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brazil
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Brodsky JR, Lipson S, Bhattacharyya N. Prevalence of Pediatric Dizziness and Imbalance in the United States. Otolaryngol Head Neck Surg 2019; 162:241-247. [DOI: 10.1177/0194599819887375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ObjectivesUnderstand the prevalence of vestibular symptoms in US children.Study DesignCross-sectional analysisSetting2016 National Health Interview Survey.Subjects and MethodsResponses from the 2016 National Health Interview Survey for children ages 3 to 17 years were examined to determine the prevalence of vestibular symptoms and provider-assigned diagnoses.ResultsDizziness or imbalance was reported in 3.5 (95% confidence interval, 3.1-3.9) million patients (5.6%) with a mean age of 11.5 years. Dizziness was reported in 1.2 million patients (2.0%) with a mean age of 12.7 years and balance impairment in 2.3 million patients (3.7%) with a mean age of 10.6 years. Prevalence of dizziness and imbalance did not vary by sex ( P = .6, P = .2). Evaluation by a health professional was reported for 42% of patients with dizziness and 43% of patients with imbalance, with diagnoses reported in 45% and 48% of patients with dizziness and imbalance, respectively. The most common diagnoses reported for dizziness were depression or child psychiatric disorder (12%), side effects from medications (11%), head/neck injury or concussion (8.4%), and developmental motor coordination disorder (8.3%). The most common diagnoses reported for imbalance were blurred vision with head motion, “bouncing” or rapid eye movements (9.1%), depression or child psychiatric disorder (6.2%), head/neck injury or concussion (6.1%), and side effects from medications (5.9%).ConclusionThe national prevalence of childhood vestibular symptoms is more common than previously thought. Reported diagnoses varied greatly from the literature, suggesting a need for increased awareness of causes of vestibular symptoms in children.
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Affiliation(s)
- Jacob R. Brodsky
- Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sophie Lipson
- Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Storey EP, Wiebe DJ, DʼAlonzo BA, Nixon-Cave K, Jackson-Coty J, Goodman AM, Grady MF, Master CL. Vestibular Rehabilitation Is Associated With Visuovestibular Improvement in Pediatric Concussion. J Neurol Phys Ther 2019; 42:134-141. [PMID: 29912034 DOI: 10.1097/npt.0000000000000228] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Vision and vestibular-related deficits are common after concussion and are associated with prolonged recovery times, substantially impacting the quality of life for children. The utility of targeted vestibular rehabilitation for these deficits in children after concussion is unknown. The purpose of this study was to determine whether active vestibular rehabilitation is associated with an improvement in visuovestibular signs and symptoms in children with concussion. METHODS A retrospective cohort study of children diagnosed with concussion and referred to vestibular rehabilitation between 2012 and 2014 was conducted. Patient-reported symptoms and visuovestibular performance measures were assessed in the medical practice and physical therapy settings. RESULTS One hundred nine children were included in the study with a mean age of 11.8 (3.4) years. Among this group, 59 (54%) were male and 48 (44%) had a sports-related concussion. Children presented to a pediatric sports medicine office and physical therapy a median of 24 (interquartile range [IQR], 14-42) and 55 (IQR, 39-94) days after injury, respectively. Concussion symptoms decreased from a median of 9 (IQR, 5-13) symptoms at initial evaluation to a median of 0 (IQR, 0-2) symptoms at final assessment. Performance on all visuovestibular tasks improved significantly over the course of therapy except for near point of convergence. For the 45 children who completed the Balance Error Scoring System at both initial and final therapy visits, there was a significant improvement in mean level of performance (P < 0.0001). Characteristics between those who completed a full versus partial course of physical therapy were similar. DISCUSSION AND CONCLUSIONS Vestibular rehabilitation in children with concussion is associated with improvement in symptoms as well as visuovestibular performance. This active intervention may benefit children with persistent symptoms after concussion. Future prospective studies are needed to determine the efficacy and optimal postinjury timing of vestibular rehabilitation.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A208).
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Affiliation(s)
- Eileen P Storey
- The Children's Hospital of Philadelphia, Division of Orthopaedics, Sports Medicine and Performance Center, Philadelphia, Pennsylvania (E.P.S., K.N-C., J.J-C., M.F.G., C.L.M.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.F.G., C.L.M.); Saint Peter's Sports Medicine Institute, Somerset, New Jersey (A.M.G.); and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (D.J.W., B.D.)
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Hülse R, Warken C, Biesdorf A, Erhart M, Rotter N, Hörmann K, Wenzel A. Prävalenz peripher-vestibulärer Erkrankungen bei Kindern in Deutschland. HNO 2019; 68:360-366. [DOI: 10.1007/s00106-019-00747-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mahmood AN, Abulaban O, Janjua A. (Doctor…My child keeps falling over) unexpected MRI findings in children with history of frequent falls and dizziness: a case series. BMJ Case Rep 2019; 12:e229849. [PMID: 31272995 PMCID: PMC6613963 DOI: 10.1136/bcr-2019-229849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2019] [Indexed: 11/03/2022] Open
Abstract
Frequent falls and dizziness are common complaints in children. These symptoms can be caused by wide range of underlying pathologies including peripheral vestibular deficits, cardiac disease, central lesions, motor skills delay and psychogenic disorders. We report three paediatric cases who presented with complaints of repeated falls and imbalance. MRI scan revealed underlying brain lesions (frontal lobe arteriovenous malformation, exophytic brain stem glioma and cerebellomedullary angle arachnoid cyst with cerebellar tonsillar ectopia). By reporting these cases, we would like to emphasise the importance of a thorough assessment of children with similar symptoms by detailed clinical history, physical examination and maintaining low threshold for investigations, including radiological imaging. Taking in consideration, the wide range of differential diagnosis, the challenge of obtaining detailed history and difficulty of performing reliable physical examination in this age group. Management of underlying disorders can be medical, surgical or just observational.
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Affiliation(s)
- Ashraf Nabeel Mahmood
- ENT Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Osama Abulaban
- ENT Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Arshad Janjua
- ENT Department, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Martens S, Dhooge I, Dhondt C, Leyssens L, Sucaet M, Vanaudenaerde S, Rombaut L, Maes L. Vestibular Infant Screening - Flanders: The implementation of a standard vestibular screening protocol for hearing-impaired children in Flanders. Int J Pediatr Otorhinolaryngol 2019; 120:196-201. [PMID: 30849604 DOI: 10.1016/j.ijporl.2019.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/09/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The Vestibular Infant Screening - Flanders (VIS-Flanders) project aims to implement and refine a vestibular screening protocol for all children with neonatal hearing loss in Flanders (Belgium) to limit the impact of a vestibular dysfunction on the motor, cognitive and psychosocial development of hearing-impaired children. METHODS Each child with a confirmed neonatal hearing loss in Flanders will undergo a vestibular screening at the age of 6 months in the reference centers involved in the neonatal hearing screening program. The cervical Vestibular Evoked Myogenic Potential (cVEMP) test will be used as a screening tool. The test is short, child-friendly, feasible at a young age and highly correlated with motor and balance performance. The results of an extensive follow-up protocol at the Ghent University Hospital will enable further refinement of the screening protocol. RESULTS Data collection in all reference centers has started since June 2018. This paper outlines the rationale for the screening and the set-up of this four-year project. CONCLUSIONS Current available literature strongly favors vestibular assessment in congenitally hearing-impaired children. A standard vestibular screening for these children should lead to early identification of vestibular deficits and subsequent prompt referral for further motor assessment and rehabilitation, in order to limit the impact of a vestibular dysfunction in developing children and improve their quality of life.
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Affiliation(s)
- Sarie Martens
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10 (2P1), 9000, Ghent, Belgium.
| | - Ingeborg Dhooge
- Department of Oto-rhino-laryngology, Ghent University Hospital, Corneel Heymanslaan 10 (1P1), 9000, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Head and Skin, Corneel Heymanslaan 10 (1P1), Ghent University, 9000, Ghent, Belgium.
| | - Cleo Dhondt
- Faculty of Medicine and Health Sciences, Department of Head and Skin, Corneel Heymanslaan 10 (1P1), Ghent University, 9000, Ghent, Belgium.
| | - Laura Leyssens
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10 (2P1), 9000, Ghent, Belgium.
| | - Marieke Sucaet
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10 (2P1), 9000, Ghent, Belgium.
| | - Saartje Vanaudenaerde
- Department of Oto-rhino-laryngology, Ghent University Hospital, Corneel Heymanslaan 10 (1P1), 9000, Ghent, Belgium.
| | - Lotte Rombaut
- Department of Oto-rhino-laryngology, Ghent University Hospital, Corneel Heymanslaan 10 (1P1), 9000, Ghent, Belgium.
| | - Leen Maes
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10 (2P1), 9000, Ghent, Belgium; Department of Oto-rhino-laryngology, Ghent University Hospital, Corneel Heymanslaan 10 (1P1), 9000, Ghent, Belgium.
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Levi J, Basa K, Wong K, Morlet T, O'Reilly R. Cofactors of Pediatric Tinnitus: A Look at the Whole Picture. Clin Pediatr (Phila) 2019; 58:320-327. [PMID: 30501502 DOI: 10.1177/0009922818816426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Retrospective chart review of 248 children (1-19 years old) with tinnitus who presented to a tertiary pediatric hospital between 2006 and 2011, looking at which cofactors are predictors of pediatric tinnitus. In our review, we extracted demographics, symptoms, historical data, imaging, and laboratory results; we compared with the general population. Eighty-seven percent had normal hearing. Age distribution, noise exposure, and frequency of psychiatric diagnoses in our cohort were consistent with previous reports. We found a lower incidence of otitis media and the same prevalence of dizziness, asthma, and hearing loss as the general population, a lower prevalence of Eustachian tube dysfunction, otitis media, headaches, and higher incidence of rhinosinusitis. Lack of patient reporting and objective testing complicate the ability to detect pediatric tinnitus. We revealed a gap in the literature regarding rhinosinusitis as a cofactor, imaging during diagnosis, and if psychiatric diagnoses are associated with tinnitus in younger children.
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Affiliation(s)
- Jessica Levi
- 1 Boston Medical Center, Boston, MA USA.,2 Boston University, Boston, MA, USA
| | - Krystyne Basa
- 1 Boston Medical Center, Boston, MA USA.,2 Boston University, Boston, MA, USA
| | - Kevin Wong
- 1 Boston Medical Center, Boston, MA USA.,2 Boston University, Boston, MA, USA
| | - Thierry Morlet
- 3 Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,4 University of Delaware, Newark, DE, USA.,5 Salus University, Elkins Park, PA, USA
| | - Robert O'Reilly
- 6 Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Soylemez E, Ertugrul S, Dogan E. Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2019; 116:75-78. [PMID: 30554713 DOI: 10.1016/j.ijporl.2018.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the balance skills and falling risk in children with a congenital bilateral profound sensorineural hearing loss (CBPSNHL). METHODS 25 children with CBPSNHL and healthy 25 children with similar age and gender were included in the study. The flamingo balance test, the tandem stance test, and the one-leg standing test were performed to assess the patients' static balance skills. The pediatric balance scale (PBS) was used to evaluate the dynamic balance. Visual analog scale (VAS) was applied to the patients assess the frequency of falls. RESULTS The flamingo balance test, the tandem stance test, and the one-leg standing test in the children with CBPSNHL were all significantly worse than the control group. Although the scores of PBS in patients with CBPSNHL were significantly lower than the control group (p < 0.001), the results of both groups were consistent with a low risk of falls. There was no significant difference between the VAS scores indicating the frequency of falls among the groups (p = 0.552). CONCLUSION Static and dynamic balance skills of the children with CBPSNHL are significantly impaired compared to their healthy peers. Children with CBPSNHL also have a lower risk of falling just like their healthy peers and there is no significant difference between their falling frequencies. Balance skills of children with CBPSNHL can be assessed quickly and effectively on a hard floor (eyes closed), with a tandem standing test or a one-leg standing test.
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Affiliation(s)
- Emre Soylemez
- Department of Audiology, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Suha Ertugrul
- Department of Otorhinolaryngology, Karabuk University, Faculty of Medicine, Karabuk, Turkey.
| | - Erkan Dogan
- Department of Pediatrics, Karabuk University, Faculty of Medicine, Karabuk, Turkey
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