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Kaplan B, Altın B, Akyol MU, Aksoy S. Evaluation of Balance with Computerized Dynamic Posturography in Children with Otitis Media. Laryngoscope 2024. [PMID: 38597754 DOI: 10.1002/lary.31444] [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: 01/17/2024] [Revised: 03/03/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Otitis media with effusion (OME) frequently leads to vestibular symptoms in children. However, young children face difficulty expressing their symptoms due to their limited language abilities. METHODS The balance of study and patient group evaluated with computer dynamic posturography, single-leg stance test with eyes closed and regular Head Impulse Test. The study group was assessed once again after the insertion of a ventilation tube two months later. RESULTS In the Sensory Organization Test, the scores for conditions 5, 6, and composite equilibrium of the preoperative patient group were notably lower compared with both the control and postoperative patient groups (p < 0.05). Additionally, a significant correlation was found between single-leg stance test with eyes closed results and conditions 5, 6, and composite equilibrium scores. CONCLUSION The impact of OME on the vestibular system is negative. This effect can be objectively assessed using Computer Dynamic Posturography and following tube insertion, there is a notable improvement in vestibular function. Furthermore, the single-leg stance (SLS) test with eyes closed has shown its reliability in assessing balance disorders, notably in children with OME. LEVEL OF EVIDENCE Level 2 Laryngoscope, 2024.
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Affiliation(s)
- Büşra Kaplan
- Department of Audiology, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
| | - Büşra Altın
- Department of Audiology, Faculty of Health Sciences, Hacettepe University Hospitals, Ankara, Turkey
| | - Mehmet Umut Akyol
- Department of Otorhinolaryngology-Head and Neck Surgery, Hacettepe University Hospitals, Ankara, Turkey
| | - Songül Aksoy
- Department of Audiology, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
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Nguyen J, Berger J, Curthoys I, Held V, Zaubitzer L, Hülse R, Rotter N, Schell A. Vestibular testing in children - The suppression head impulse (SHIMP) test. Int J Pediatr Otorhinolaryngol 2021; 151:110921. [PMID: 34537549 DOI: 10.1016/j.ijporl.2021.110921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The incidence of vestibular disorders and vertigo during childhood is increasing and pediatric clinicians have become more sensitive to children's balance disorders; thus, there is a need for appropriate detection test procedures for peripheral vestibular hypofunction. In order to ensure a reliable diagnosis and minimize misdiagnosis, a standardized clinical procedure via careful history and clinical examination is recommended. However, children, especially, are often unable to verbalize "vertigo" in a concrete manner, which often necessitates a consultation with a pediatrician holding nonspecific symptoms. The so-called suppression of the head impulse test (SHIMPs) represents a modification of the video head impulse test (HIMP) and is used for a more sensitive assessment of residual vestibular functions. In adults, SHIMPs are already an established diagnostic method. Nevertheless, to date, nothing is known about the applicability and standard values in childhood. MATERIAL AND METHODS In this monocentric, prospective study, we investigated whether SHIMPs enable a sensitive functional analysis of the vestibular system in healthy children of different ages. For this purpose, SHIMPs were performed in 40 children aged 3-18 years. RESULTS In this study, we demonstrated that SHIMPs can be easily performed in children (3-18 years). It is vital that the test be appropriately explained for children to ensure sufficient test tolerance and compliance. CONCLUSION SHIMPs are a helpful supplement to clinically established vestibular tests such as the HIMP in pediatric vestibular balance disorder diagnostics and can be integrated into the clinical routine, especially in children who have minimal verbal abilities or understanding of the instructions for HIMP. Similar to the HIMP, SHIMPs are characterized by a short test duration and a high tolerance.
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Affiliation(s)
- J Nguyen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - J Berger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - I Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, Australia
| | - V Held
- Department of Neurology, University Hospital Mannheim, Germany
| | - L Zaubitzer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - R Hülse
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - N Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - A Schell
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany.
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Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111056. [PMID: 34828769 PMCID: PMC8625109 DOI: 10.3390/children8111056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/31/2022]
Abstract
(1) Background: To assess the prevalence and frequency distribution of balance disorders in children and adolescents to delineate the planning of a targeted clinical and instrumental diagnostic work-up; (2) Methods: Retrospective analysis of the clinical documentation of patients under 18 years suffering from balance disorders from 2010 to 2019. Detailed collection of clinical history, accurate clinical examination, including both nystagmus and vestibulospinal signs examinations, and specific instrumental testing were the basis of the diagnostic process. (3) Results: A total of 472 participants were included in the study. Vestibular loss (26.1%) was the most frequent cause of vertigo in children, followed by vestibular migraine (21.2%) and benign paroxysmal positional vertigo (10.2%). In 1.1% of patients, the cause of vertigo remained undefined; (4) Conclusions: The diagnostic process applied was effective in understanding the cause of balance disorders in most cases and prevents more complex and expensive investigations reserved for only a few selected cases.
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Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness. PLoS One 2021; 16:e0250357. [PMID: 33983960 PMCID: PMC8118351 DOI: 10.1371/journal.pone.0250357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to investigate the incidence and patterns of nystagmus in adult patients with acute otitis media (AOM) or otitis media with effusion (OME) without dizziness or vertigo, and discuss possible mechanisms. From February 2018 to November 2018, 34 consecutive patients with AOM or OME without dizziness were included. Nystagmus was examined with video Frenzel glasses. Of 34 adult AOM or OME patients without dizziness, nystagmus was observed in 28 patients (82%). In unilateral AOM or OME (n = 30), the most commonly observed nystagmus pattern was irritative-type direction-fixed nystagmus (n = 13), followed by paretic-type direction-fixed nystagmus (n = 8), and direction-changing positional nystagmus (n = 4). In bilateral AOM or OME (n = 4), direction-fixed nystagmus and direction-changing positional nystagmus were observed in two and one patients, respectively. Nystagmus was observed in as many as 82% of adult AOM or OME patients even though they did not complain of dizziness, and the pattern of nystagmus was either direction-fixed or direction-changing. Direct effect of inflammatory mediators penetrated from the middle ear and biochemical alteration in the inner ear fluids due to blood-perilymph barrier dysfunction may result in the presence of nystagmus in AOM or OME patients without dizziness.
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Balzanelli C, Spataro D, Redaelli de Zinis LO. Benign Positional Paroxysmal Vertigo in Children. Audiol Res 2021; 11:47-54. [PMID: 33535402 PMCID: PMC7930952 DOI: 10.3390/audiolres11010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to assess the prevalence and analyze clinical parameters of benign positional paroxysmal vertigo (BPPV) in a pediatric age. A cohort of 423 children under the age of 15 (median age 11. interquartile range 9-13) was submitted to vestibular assessment for balance disorders. Dix-Hallpike and Roll-Supine tests were performed to look for positioning nystagmus using video-infrared goggles. BPPV was found in 43 of 423 children evaluated for balance disorders (10.2%). There were 28 females (65.1%) and 15 (34.9%) males. The posterior canal was involved in 79% of cases and the horizontal canal in 21% of cases. No apogeotropic bilateral or anterior canal form were seen. Thus, BPPV is not an infrequent type of vertigo in children and must be evaluated as soon as possible in order to plan the most appropriate maneuver and restore daily activities as soon as possible, avoiding anxiety and fear.
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Affiliation(s)
| | - Daniele Spataro
- ENT Department—ARNAS Garibaldi of Catania, 95123 Catania, Italy;
| | - Luca Oscar Redaelli de Zinis
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Section of Audiology, University of Brescia, 25123 Brescia, Italy
- Pediatric Otolaryngology Head Neck Surgery Unit, Children Hospital—ASST Spedali Civili of Brescia, 25123 Brescia, Italy
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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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Abstract
OBJECTIVES Vertigo is a relatively common complaint in children with 5.3% of pediatric patients complaining of this symptom. Although the causes of vertigo have been well established in adults, the diagnoses in children have not been well described. The aims of this systematic review are to discover the current information regarding etiologies of vertigo in children and to determine the most common diagnoses that present with vertigo in pediatric patients. METHODS PubMed, Scopus, and Embase were searched using the PRISMA guidelines. The inclusion and exclusion criteria were established a priori. All results were analyzed using a Bayesian methodology for point estimation and credible interval calculation. RESULTS From the database searches, 1419 titles were reviewed. Twenty-two studies met inclusion criteria. From these studies, a total of 2726 children aged 2 months to 19 years were reported. The top 4 diagnoses associated with childhood vertigo include vestibular migraine (23.8%; credible interval, 22.3%-25.5%), benign paroxysmal vertigo of childhood (13.7%; credible interval, 12.4%-15%), idiopathic or no identified association (11.7%; credible interval, 10.5%-12.9%), and labyrinthitis/vestibular neuronitis (8.47%, credible interval, 7.46%-9.55%) accounting for approximately 57% of cases. Less common diagnoses included Meniere disease and central nervous system tumors. CONCLUSIONS Although the most common causes of pediatric vertigo include vestibular migraine and benign paroxysmal vertigo of childhood, the etiologies are myriad. Rates and credible intervals are provided to permit a probabilistic diagnostic approach to these children.
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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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Clinical significance of spontaneous nystagmus in pediatric patients. Int J Pediatr Otorhinolaryngol 2018; 111:103-107. [PMID: 29958590 DOI: 10.1016/j.ijporl.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To analyze spontaneous nystagmus recorded in pediatric patients and determine its diagnostic value. MATERIALS AND METHODS Retrospective review of 86 patients (mean age = 13.9 ± 4.7 years) with definitive spontaneous nystagmus recorded by videonystagmography (VNG). Spontaneous nystagmus was categorized and analyzed based on its characteristics. Correlations between spontaneous nystagmus and established clinical diagnoses were explored. RESULTS Among the patients seen in a period of three years at our pediatric vestibular clinic, 15.4% (86 out of 560) were found to have spontaneous nystagmus and half of them had horizontal nystagmus with a fixed-direction. The majority of cases with spontaneous nystagmus (77%, 66/86) were present without fixation only, while the presence of spontaneous nystagmus with and without fixation was found in 16 patients (19%). Most patients with spontaneous nystagmus without fixation only (68%) were diagnosed with a peripheral vestibular disorder (e.g., vestibular neuritis) or vestibular migraine. In contrast, vertical nystagmus was found in 15 patients, most of whom had central vestibular disorders. Other rare forms of nystagmus or abnormal eye movements, such as pendular nystagmus, ocular oscillation or flutter were recorded in only four patients. CONCLUSIONS Spontaneous nystagmus in children and young adults with possible vestibular impairments may vary in clinical presentation. Identification of its characteristics may help to make an accurate clinical diagnosis. While spontaneous nystagmus associated with peripheral vestibular disorders can be readily recognized, spontaneous nystagmus in pediatric patients with vestibular migraine appears to be more complex and variable in form.
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Benign course of episodic dizziness disorders in childhood. J Neurol 2017; 264:4-6. [DOI: 10.1007/s00415-017-8408-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/25/2017] [Accepted: 01/27/2017] [Indexed: 01/03/2023]
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Langhagen T, Landgraf MN, Huppert D, Heinen F, Jahn K. Vestibular Migraine in Children and Adolescents. Curr Pain Headache Rep 2016; 20:67. [DOI: 10.1007/s11916-016-0600-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
During the last decades a new vestibular syndrome has emerged that is now termed vestibular migraine (VM). The main body of evidence for VM is provided by epidemiologic data demonstrating a strong association between migraine and vestibular symptoms. Today, VM is recognized as one of the most common causes of episodic vertigo. The clinical presentation of VM is heterogeneous in terms of vestibular symptoms, duration of episodes, and association with migrainous accompaniments. Similar to migraine, there is no clinical or laboratory confirmation for VM and the diagnosis relies on the history and the exclusion of other disorders. Recently, diagnostic criteria for VM have been elaborated jointly by the International Headache Society and the Bárány Society. Clinical examination of patients with acute VM has clarified that the vast majority of patients with VM suffer from central vestibular dysfunction. Findings in the interval may yield mild signs of damage to both the central vestibular and ocular motor system and to the inner ear. These interictal clinical signs are not specific to VM but can be also observed in migraineurs without a history of vestibular symptoms. How migraine affects the vestibular system is still a matter of speculation. In the absence of high-quality therapeutic trials, treatment is targeted at the underlying migraine.
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Affiliation(s)
- M von Brevern
- Department of Neurology, Park-Klinik Weissensee and Vestibular Research Group, Berlin, Germany.
| | - T Lempert
- Department of Neurology, Schlosspark-Klinik and Vestibular Research Group, Berlin, Germany
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Goto F, Suzuki N, Hara M, Tsuchihashi N, Morimoto N. [A Retrospective Series of 77 Pediatric Patients with Vertigo at a National Center for Child Health and Development]. NIHON JIBIINKOKA GAKKAI KAIHO 2015; 118:860-866. [PMID: 26427126 DOI: 10.3950/jibiinkoka.118.860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The evaluation and management of vertigo in children varies among institutional and medical specialties. The aim of this study was to describe the characteristics of vertigo in children presenting at a national pediatric center. Patients < 16 years old presenting with vertigo to the department of otolaryngology at a national center for child health and development from April 2004 to October 2009 were included (N = 77; 42 males and 35 females; average age, 8.7 ± 3.4 years) in this study. The most common diagnoses were vestibular migraine (VM; N = 21), benign paroxysmal vertigo (BPV; N =16), unilateral vestibulopathy (N = 12), and psychogenic vertigo (N = 8). Significant differences were observed in the frequency of the diagnoses between children aged older and younger than 7 years: BPV was most common in children < 7 years of age (p < 0.01) and VM was most common in ≥ 27 years of age (p < 0.05). Because obtaining adequate information from children for making a correct diagnosis is sometimes difficult, acquiring sufficient information from the parents is important. In addition, getting the parents to record the nystagmus during a vertigo attack with a digital camera or cellular phone can be useful because observing the nystagmus recorded on the video is helpful for making a diagnosis. Furthermore, the parents are participating in their child's care by attempting to record the attack, strengthening the relationship between the parents and the child. The incidence of psychogenic vertigo is low (less than 10%). Therefore, although physicians have recently tended to define the disorder as psychogenic when no objective abnormality is found in a patient, making a diagnosis of psychogenic vertigo is not recommended. Because vertigo can sometimes make a child anxious, delivering the correct diagnosis and treatment at the early stage is important for preventing anxiety in affected children.
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Vestibular evaluation in children with otitis media with effusion. The Journal of Laryngology & Otology 2015; 129:326-36. [DOI: 10.1017/s0022215115000535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Fifty per cent of children with serous otitis media may have some balance disturbances.Objective:To evaluate vestibular function in children with otitis media with effusion.Methods:The control group comprised 25 children with bilateral normal hearing and middle-ear function. The study group consisted of 30 children with bilateral otitis media with effusion; these were divided into 2 subgroups according to air–bone gap size. Measures included the Arabic Dizziness Handicap Inventory, an imbalance evaluation sheet for children, vestibular bedside tests for children, and air- and bone-conducted vestibular-evoked myogenic potential testing.Results:Arabic Dizziness Handicap Inventory scores and some vestibular bedside test results were significantly abnormal, with normal video-nystagmography results, in children with otitis media with effusion. Air-conducted vestibular-evoked myogenic potentials were recorded in 73 per cent of children with otitis media with effusion, with significantly delayed latencies. Bone-conducted vestibular-evoked myogenic potentials were successfully detected in 100 per cent of children with otitis media with effusion with similar results to the control group.Conclusion:The Arabic Dizziness Handicap Inventory and vestibular bedside tests are valuable tools for detecting vestibular impairment in children. Bone-conducted vestibular-evoked myogenic potentials are useful for vestibular system evaluation.
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Batu ED, Anlar B, Topçu M, Turanlı G, Aysun S. Vertigo in childhood: a retrospective series of 100 children. Eur J Paediatr Neurol 2015; 19:226-32. [PMID: 25548116 DOI: 10.1016/j.ejpn.2014.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/02/2014] [Accepted: 12/09/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Evaluation and management of vertigo in children vary between institutions and medical specialties. The aim of this study is to describe the characteristics of vertigo in children presenting to a pediatric neurology referral center and to investigate the relationship between vertigo and migraine. STUDY DESIGN Patients <18 years old presenting with vertigo to Hacettepe University Ihsan Dogramaci Children's Hospital Neurology Unit between January 1996-January 2012 were included (n = 100). Data were obtained from patient files and phone interviews. RESULTS Mean age was 7.5 years. The most common etiological groups were benign paroxysmal vertigo of childhood (BPVC) (39%), psychogenic vertigo (21%), epileptic vertigo (15%), and migraine-associated vertigo (MAV) (11%). BPVC was the most common diagnosis in children ≤5 years of age while psychogenic vertigo prevailed in children >5 years. Staring episodes characterized epileptic vertigo patients (p = 0.021) while headache was more often described by MAV patients (p < 0.001). Vertigo attacks >5 min were uncommon in BPVC patients compared to others (p = 0.013). Twenty percent of BPVC patients contacted through phone interviews were experiencing migraine type headaches that started at a median age of 7.5 years. An algorithm for evaluation of children with vertigo was formed based on data obtained from this study and the literature. When this algorithm was applied to 100 cases of this series, 88 (88%) were correctly diagnosed. CONCLUSION While most vertigo cases in children can be diagnosed accurately by a detailed medical history, physical and neurological examination, a standard algorithm can help with the correct classification.
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Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey.
| | - Banu Anlar
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Meral Topçu
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Güzide Turanlı
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | - Sabiha Aysun
- Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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Langhagen T, Lehrer N, Borggraefe I, Heinen F, Jahn K. Vestibular migraine in children and adolescents: clinical findings and laboratory tests. Front Neurol 2015; 5:292. [PMID: 25674076 PMCID: PMC4306301 DOI: 10.3389/fneur.2014.00292] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/23/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Vestibular migraine (VM) is the most common cause of episodic vertigo in children. We summarize the clinical findings and laboratory test results in a cohort of children and adolescents with VM. We discuss the limitations of current classification criteria for dizzy children. METHODS A retrospective chart analysis was performed on 118 children with migraine related vertigo at a tertiary care center. Patients were grouped in the following categories: (1) definite vestibular migraine (dVM); (2) probable vestibular migraine (pVM); (3) suspected vestibular migraine (sVM); (4) benign paroxysmal vertigo (BPV); and (5) migraine with/without aura (oM) plus vertigo/dizziness according to the International Classification of Headache Disorders, 3rd edition (beta version). RESULTS The mean age of all patients was 12 ± 3 years (range 3-18 years, 70 females). 36 patients (30%) fulfilled criteria for dVM, 33 (28%) for pVM, 34 (29%) for sVM, 7 (6%) for BPV, and 8 (7%) for oM. Somatoform vertigo (SV) co-occurred in 27% of patients. Episodic syndromes were reported in 8%; the family history of migraine was positive in 65%. Mild central ocular motor signs were found in 24% (most frequently horizontal saccadic pursuit). Laboratory tests showed that about 20% had pathological function of the horizontal vestibulo-ocular reflex, and almost 50% had abnormal postural sway patterns. CONCLUSION Patients with definite, probable, and suspected VM do not differ in the frequency of ocular motor, vestibular, or postural abnormalities. VM is the best explanation for their symptoms. It is essential to establish diagnostic criteria in clinical studies. In clinical practice, however, the most reasonable diagnosis should be made in order to begin treatment. Such a procedure also minimizes the fear of the parents and children, reduces the need to interrupt leisure time and school activities, and prevents the development of SV.
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Affiliation(s)
- Thyra Langhagen
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Nicole Lehrer
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Ingo Borggraefe
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Florian Heinen
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Department of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-University of Munich , Munich , Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University of Munich , Munich , Germany ; Schön Klinik Bad Aibling , Bad Aibling , Germany
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Utility of Psychological Screening for the Diagnosis of Pediatric Episodic Vertigo. Otol Neurotol 2014; 35:e324-30. [DOI: 10.1097/mao.0000000000000559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Henriques IF, Douglas de Oliveira DW, Oliveira-Ferreira F, Andrade PMO. Motion sickness prevalence in school children. Eur J Pediatr 2014; 173:1473-82. [PMID: 24893949 DOI: 10.1007/s00431-014-2351-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/23/2014] [Accepted: 05/26/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED This study aimed to determine the prevalence of motion sickness in schoolchildren and related the finding to the postural balance and quality of life. A population-based cross-sectional study was carried out with 831 children aged 7 to 12 years. The frequency of motion sickness was evaluated based on the Motion Sickness Susceptibility Questionnaire-Short (MSSQ-short). Postural balance was assessed using the Romberg test under different sensory conditions. The Dizziness Handicap Inventory was used in order to assess the quality of life. The statistical analyses were performed using the chi-square, Kruskal-Wallis, Mann-Whitney, and Spearman correlation tests. The prevalence of motion sickness was 43.4 % in car, 43.2 % on bus, 11.7 % on park swing, and 11.6 % on Ferris wheel. Mean unadjusted scores on the MSSQ-short ranged from 5.0 (SE = 0.5) for 10-year-olds to 6.8 (SE = 0.5) for 9-year-olds. The most prevalent symptoms following the balance tests were dizziness (89.2 %), vertigo (54.9 %), headache (10.6 %), and nausea (8.2 %). Significant correlations were found between the MSSQ-short score and all postural balance tests. Significant correlations were found between the MSSQ and modified DHI (Dizziness Handicap Inventory) at all ages. CONCLUSION The prevalence of motion sickness in schoolchildren is greater when in a car or on a bus. An association was found between motion sickness and postural balance tests and motion sickness and quality of life.
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Affiliation(s)
- Isadora Ferreira Henriques
- Department of Physical Therapy, Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, MG, Brazil,
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Abstract
Vertiginous headache encompasses patients with dizziness or vertigo as well as headache, even though the symptoms may not occur in an obvious temporal relationship. The type of dizziness experienced by patients is different from the heavy-headedness experienced during rhinogenic headache. Patients may have a personal or family history of typical or atypical migraine. They should be evaluated for possible Meniere syndrome, migraine headaches, and/or eye movement disorders. Management is directed to treatment of the underlying abnormality. Long-term follow-up of these patients is necessary, because further otologic abnormalities may present later.
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Affiliation(s)
- Sujana S Chandrasekhar
- New York Otology, 1421 Third Avenue, 4th Floor, New York, NY 10028, USA; James J. Peters Veterans Administration Medical Center, Bronx, NY, USA; New York Head & Neck Institute, Northshore-LIJ Medical Center, New York, NY, USA; Mount Sinai School of Medicine, New York, NY, USA.
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[Vertigo in children and adolescents. Part 1: Epidemiology and diagnosis of peripheral vestibular disorders]. HNO 2013; 61:791-802; quiz 803-4. [PMID: 23963261 DOI: 10.1007/s00106-013-2705-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Migraine equivalents are the most common cause of vertigo in children and adolescents. Vertigo and balance disorders occur frequently in children during the course of otitis media, middle ear effusion and viral infections. If otitis media is associated with reduced hearing and vertigo, labyrinthitis must be considered. Craniocerebral injury is another important cause of vertigo in children. In contrast, spontaneous benign paroxysmal positional vertigo is rare among children. The isolated cases of endolymphatic hydrops that occur in children are usually secondary. Perilymph fistula can have congenital, infectious or trauma-related causes. The following characteristics are useful for differentiating between different vertiginous syndromes: type and duration of vertigo, triggering/aggravating/alleviating factors and accompanying symptoms. A neuro-ophthalmologic examination is essential to rule out central vestibular disorders.
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Gruber M, Cohen-Kerem R, Kaminer M, Shupak A. Vertigo in children and adolescents: characteristics and outcome. ScientificWorldJournal 2012; 2012:109624. [PMID: 22272166 PMCID: PMC3259473 DOI: 10.1100/2012/109624] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 11/22/2011] [Indexed: 11/17/2022] Open
Abstract
Objectives. To describe the characteristics and outcome of vertigo in a pediatric population. Patients. All children and adolescents presenting with vertigo to a tertiary otoneurology clinic between the years 2003–2010 were included in the study. Results. Thirty-seven patients with a mean age of 14 years were evaluated. The most common etiology was migraine-associated vertigo (MAV) followed by acute labyrinthitis/neuritis and psychogenic dizziness. Ten patients (27%) had pathological findings on the otoneurological examination. Abnormal findings were documented in sixteen of the twenty-three (70%) completed electronystagmography evaluations. Twenty patients (54%) were referred to treatment by other disciplines than otology/otoneurology. A follow-up questionnaire was filled by twenty six (70%) of the study participants. While all patients diagnosed with MAV had continuous symptoms, most other patients had complete resolution. Conclusions. Various etiologies of vertigo may present with similar symptoms and signs in the pediatric patient. Yet, variable clinical courses should be anticipated, depending on the specific etiology. This is the reason why treatment and follow up should be specifically tailored for each case according to the diagnosis. Close collaboration with other medical disciplines is often required to reach the correct diagnosis and treatment while avoiding unnecessary laboratory examinations.
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Affiliation(s)
- Maayan Gruber
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa 34362, Israel
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O’Reilly R, Grindle C, Zwicky EF, Morlet T. Development of the Vestibular System and Balance Function: Differential Diagnosis in the Pediatric Population. Otolaryngol Clin North Am 2011; 44:251-71, vii. [DOI: 10.1016/j.otc.2011.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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McCaslin DL, Jacobson GP, Gruenwald JM. The Predominant Forms of Vertigo in Children and Their Associated Findings on Balance Function Testing. Otolaryngol Clin North Am 2011; 44:291-307, vii. [DOI: 10.1016/j.otc.2011.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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