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Characteristics and diagnostic approach of vestibular migraine in children and adolescents: A systematic review. Auris Nasus Larynx 2023; 50:218-227. [PMID: 35843849 DOI: 10.1016/j.anl.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Vestibular migraine (VM) is the most common cause of episodic vertigo afflicts 1% of the general population. The complexity of VM is owing to the migrainous, and vestibular components and much knowledge have been gained in recent years on VM in the adult population. Akin to that, numerous studies focusing on VM in children and adolescent has emerged. We reviewed the literature to understand the characteristics and diagnostic approach of VM in children and adolescents. METHODS A literature search was conducted over a period of one month (April 2022). RESULTS 16 articles were selected based on our objective and selection criteria. A total of patients was included, with a median age of 10.9 years. 11 studies diagnosed VM based on diagnostic criteria. Caloric test and electro/videonystagmography are the most favoured investigation used (50%). Imaging was performed in 56.2% of included studies. CONCLUSION Deciphering the ideal diagnostic approach for VM is prudent to ensure children and adolescents suffering from VM are treated earlier. VM can be diagnosed using the established diagnostic criteria, which requires thorough and meticulous history taking. The available oto-neurological examination aims to exclude other disorders as its significance in diagnosing VM is still debatable.
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Wang A, Zhou G, Brodsky JR. Characteristics of Benign Paroxysmal Positional Vertigo in Young Children. Laryngoscope 2023; 133:694-699. [PMID: 35524589 DOI: 10.1002/lary.30172] [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: 01/11/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to determine the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in young children. STUDY DESIGN Retrospective case review. METHODS All children <10 years old that have been diagnosed with BPPV at our pediatric vestibular program between December 2012-July 2021 were selected. Clinical features were identified by medical record review, including demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS A total of 34 children were diagnosed with BPPV with a mean age of 7.9 years old (SD ± 1/7; range 5-9) at the time of diagnosis and a male:female ratio of 1:1. Involved semicircular canals included posterior in 82% (n = 28), horizontal in 41% (n = 14), and superior in 24% (n = 8) of patients, respectively. Comorbid diagnoses included migraine (n = 14), concussion (n = 10), acute vestibular syndrome (n = 4), and persistent postural perceptual dizziness (n = 6). Recurrence with initially confirmed resolution occurred in 10 patients (29%) with a mean of 2.5 recurrences per patient (SD: 2.2; range 1-8). A family history of vertigo or migraine was identified in 11 and 17 patients, respectively. CONCLUSIONS BPPV is a cause of vertigo in children that may be overlooked. A relatively high proportion of patients demonstrated horizontal or superior canal involvement, recurrence, and additional comorbid causes of dizziness. Thus, providers evaluating young children with dizziness should perform diagnostic maneuvers to evaluate BPPV of all semicircular canals and continue to monitor children after successful treatment for recurrence. LEVEL OF EVIDENCE 4, Case Series Laryngoscope, 133:694-699, 2023.
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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.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Castillo-Bustamante M, Barona Cabrera M, Suárez Angulo S, García Campuzano M, García A, Madrigal J. Facts of Vertigo in Adolescents: Controversies and Challenges – A Narrative Review. Cureus 2022; 14:e28294. [PMID: 36168384 PMCID: PMC9506299 DOI: 10.7759/cureus.28294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/27/2022] Open
Abstract
Vertigo is a common complaint in the general population affecting 5% of adults in one year. At least 29.5% of adults have referred vertigo during life. Even though the prevalence of vertigo is well known in adults the epidemiologic data in adolescents is sparse. To date, it is known that adolescent females are usually affected by vertigo and some conditions such as depression and anxiety are found in this population. However, the lack of information about the prevalence of most common types of vertigo in adolescents, predisposing factors, challenges, and controversies in clinics in the literature, present a challenge for clinicians regarding the approach and follow-up of this population. Herein, we performed a literature review including data about the prevalence, most common types of vertigo and controversial events in the approach of vertigo in adolescents over the last two decades.
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Božanić Urbančič N, Vozel D, Kordiš Š, Hribar M, Urbančič J, Battelino S. Indicators of pediatric peripheral vestibular disorder: A retrospective study in a tertiary referral center. Int J Pediatr Otorhinolaryngol 2022; 159:111221. [PMID: 35785585 DOI: 10.1016/j.ijporl.2022.111221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/19/2021] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aims to present characteristics of pediatric patients with peripheral vertigo and dizziness and their clinical workup results in the tertiary otorhinolaryngology center. We wanted to investigate whether the detailed history could replace the extensive vestibular testing and whether the clinical presentation could guide the first contact physician to appropriately directed specialist referral. METHODS Retrospective case review of consecutive pediatric vertigo and dizziness patients referred to the tertiary otorhinolaryngology center from 2015 to 2020. The data about the signs and symptoms of vertigo and dizziness and the results of audiological and vestibular tests were collected. RESULTS Of 257 children aged 10.9±4.3 years (R: 1-17 years), 32 (12.5%) had peripheral, and 49 (19%) had central vertigo and dizziness. Acute vestibulopathy was diagnosed in 22/257 (8.5%) children, sudden sensorineural hearing loss and benign paroxysmal positional vertigo in 5/257 (2%) children each. 60% of children with peripheral vertigo and dizziness had emesis, and 55.6% had nausea. 8% of children had spontaneous horizontal-rotatory nystagmus that followed Alexander's law. Goodman and Kruskal's л for determining whether the type of nystagmus could predict the type of vertigo and dizziness (central or peripheral) was 0.481 (p = 0.001). 12/26 (60%) of children with peripheral vertigo and dizziness had emesis compared to 14 (30.04%) children without emesis, a difference in proportions of 0.296 (p = 0.024, chi-square test of homogeneity). Binomial logistic regression to ascertain the effects of duration, nausea and emesis on the likelihood of the presence of peripheral vertigo was statistically significant (χ2(3) = 10.626, p = 0.014). CONCLUSION Unlike adults, peripheral vestibular causes of vertigo and dizziness in children may be rare but have the same typical signs and symptoms. The detailed history and careful clinical examination are crucial in differentiating between peripheral and central causes. This guides the first contact physician for further referral to appropriate specialists included in a multidisciplinary workup. Namely, nausea, emesis, horizontal nystagmus and a longer duration of symptoms in a child with vertigo and dizziness indicate a peripheral etiology. Therefore, a referral to an otorhinolaryngologist is reasonable.
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Affiliation(s)
- Nina Božanić Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Domen Vozel
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Špela Kordiš
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia.
| | - Manja Hribar
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Jure Urbančič
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
| | - Saba Battelino
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška cesta 2, SI-1000, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia.
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Suh ES. Dizziness in children and adolescents. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Dizziness in children is a common cause for a visit to the pediatric outpatient department. The reported prevalence is 6% to 8% but evaluating the symptoms in children who cannot clearly explain and describe their experience is challenging.Current Concepts: The most common causes of dizziness in children and adolescents—which account for approximately 35% of the cases—are benign paroxysmal vertigo of childhood and vestibular migraine. These two diseases and head trauma are the primary causes of dizziness in over 50% of the cases. A thorough history-taking is key for the diagnosis of dizziness in children and adolescents. Additionally, a complete physical examination, including ear and neurologic tests, is essential.Discussion and Conclusion: As the department of pediatrics includes children and adolescents, the number of young patients presenting with dizziness is continuously increasing. This article presents the general definition, etiology, diagnosis, treatment strategies, and recommendations for the management of dizziness in children and adolescents. Further studies are warranted to differentiate the cause of dizziness in children. Moreover, drug abuse related to dizziness and headaches shouldn’t be underdiagnosed at schools or in the community.
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Kabel AEMH, Afifi KH, ElFakhrany SM, Moaty AS. Cervical and ocular vestibular evoked myogenic potentials in epileptic patients. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2021; 37:51. [DOI: 10.1186/s43163-021-00114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/06/2021] [Indexed: 09/02/2023]
Abstract
Abstract
Background
Vertigo and dizziness are very common complaints that may be related to epilepsy. The purpose of this study was to assess vestibulo-spinal and linear vestibulo-ocular function in epileptic patients in the inter ictal period. The current observational study was carried out in audio-vestibular unit Menoufia University. Subjects in the current study were divided into two groups: The control group included 30 normal individuals not complaining from any dizzy symptoms and the epileptic cases group included 30 epileptic patients. All subjects in the study were submitted to cervical and ocular vestibular evoked myogenic potential.
Results
There was no significant difference between the control and epileptic group regarding the age and sex distribution. Sixty-seven percent of epileptic cases had dizzy symptoms. There was statistically significant difference in the latency and amplitude of c and o VEMP between the control and the epileptic group, 39/60 ears (65%) in the study group had cVEMP abnormalities, 32/60 ears (53%) had oVEMP abnormalities. Abnormal c and o VEMP were reported in 28/60 ears (46.7%). There was statistically significant relationship between VEMP abnormalities and duration of seizures, frequency of epileptic attacks, and type of therapy.
Conclusion
Vestibular abnormalities were frequently reported in epileptic patients in the current study which may be related to the severity and control of epilepsy.
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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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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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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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Unraveling the Etiology of Pediatric Vertigo and Dizziness: A Tertiary Pediatric Center Experience. ACTA ACUST UNITED AC 2021; 57:medicina57050475. [PMID: 34064850 PMCID: PMC8151727 DOI: 10.3390/medicina57050475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood—BPV). We aimed to provide the possible etiological background of vertigo and dizziness in Slovenian children. Materials and Methods: A retrospective case series of pediatric vertigo and dizziness children referred to the tertiary pediatric otorhinolaryngology center from 2015 to 2020. Children received a complete audiological and vestibular workup and were referred to pediatric specialists depending on the clinical presentation. Results: Of 257 children (42% male, 58% female) aged 1–17 years (M = 10.9, SD = 4.3 years) in 19.1% vertigo and dizziness were classified as central, in 12.4% as a peripheral vestibular, in 10.9% as a hemodynamic, in 5.8% as a psychological and none as visual by pediatric neurologists, otorhinolaryngologists, cardiologists, psychologists or ophthalmologists, respectively. 40.8% (20) children with central vertigo had BPV (7.8% of all children) and 8.2% (4) migrainous vertigo. In 43.6% (112 children), the etiology remained unclassified. Conclusions: After a thorough multidisciplinary workup, the etiology of vertigo and dizziness was unraveled in the majority of children referred to our tertiary otorhinolaryngology center. The most common cause was central; however, in a considerable number, the etiology remained unclassified. The latter could be attributed to the self-limiting nature of vertigo spells. Hence, a child presenting with dizziness and vertigo requires a multidisciplinary approach, in which referral to a neurologist is, in most cases, essential.
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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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12
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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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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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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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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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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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Devaraja K. Vertigo in children; a narrative review of the various causes and their management. Int J Pediatr Otorhinolaryngol 2018; 111:32-38. [PMID: 29958611 DOI: 10.1016/j.ijporl.2018.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/03/2023]
Abstract
Vertigo is a not an uncommon symptom in children, but often the treating doctors are unsure of the diagnosis and the management of these cases. This narrative review of the literature discusses the brief etiopathology, the clinical manifestations and the management algorithm of most of the conditions causing vertigo in children. The relevant information has been condensed into a table for the perusal of the readers, which would assist in the appropriate management of these children.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal, Udupi, Karnataka, 576104, India.
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Brodsky J, Kaur K, Shoshany T, Lipson S, Zhou G. Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features. Eur J Paediatr Neurol 2018; 22:667-673. [PMID: 29656928 DOI: 10.1016/j.ejpn.2018.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/30/2018] [Accepted: 03/25/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Migraine variant disorders of childhood include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC). This study aimed to review our experience with BPTI and BPVC and determine the incidence of children transitioning between each of these disorders and to vestibular migraine (VM). METHODS We retrospectively reviewed the medical records of patients seen at the Balance and Vestibular Program at Boston Children's Hospital between January 2012 and December 2016 who were diagnosed with BPTI, BPVC, and/or VM. RESULTS Fourteen patients were diagnosed with BPTI, 39 with BPVC, and 100 with VM. Abnormal rotary chair testing was associated with progression from BPTI to BPVC (n = 8, p = 0.045). Eight (57.1%) patients with BPTI and 11 (28.2%) with BPVC had motor delay. Eleven (78.6%) patients with BPTI and 21 (53.8%) with BPVC had balance impairment. Six BPTI patients developed BPVC (42.9%), six BPVC patients developed VM (15.4%), and two patients progressed through all three disorders (2%). One BPTI patient progressed directly to VM. DISCUSSION Most patients with BPTI will experience complete resolution in early childhood, but some will progress to BPVC, and similarly many patients with BPVC will progress to VM. Parents of children with these disorders should be made aware of this phenomenon, which we refer to as "the vestibular march." Children with BPTI and BPVC should also be screened for hearing loss, otitis media, and motor delay.
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Affiliation(s)
- Jacob Brodsky
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
| | - Karampreet Kaur
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Vanderbilt University School of Medicine, 1161 21st Ave South, Nashville, TN, 37232, USA
| | - Talia Shoshany
- Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Sophie Lipson
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Guangwei Zhou
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA; Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
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Long-term evaluation of the effect of middle ear effusion on the vestibular system in children. Int J Pediatr Otorhinolaryngol 2018; 109:13-16. [PMID: 29728166 DOI: 10.1016/j.ijporl.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Otitis media with effusion (OME) is one of the most common clinical conditions in childhood. Fluid accumulation in the middle ear may impact inner ear. OBJECTIVES The purpose of this random sample cohort study was to investigate whether the past history of middle ear effusion has a long-term negative impact on the vestibular system in children. MATERIAL AND METHODS The study was carried out on 22 children aged 7-15 years who had undergone drainage of the middle ear 5 years before evaluation. The control group consisted of 29 healthy children aged 4-17 years. Vestibular function was examined using sway posturography and electronystagmography (ENG). RESULTS The stabilogram parameters of the study group and the control group were compared. The field of developed area (FDA) and the average body sway velocity (ASV) were analyzed. Elevated stabilogram parameters of FDA and ASV, both with eyes open and eyes closed, were found in the study group. Statistically significant values (p < 0.05) were present for ASV with eyes open and with eyes closed. The ENG recordings were analyzed in both groups. In the study group, spontaneous nystagmus was observed in 40.9% of the children and positional nystagmus occurred in 63.6% of the children. According to tests, eye tracking test was impaired in 27.3% of cases. Rotatory chair testing revealed asymmetry in 18.2% of the children. CONCLUSION The presence of effusion in the middle ear in the past has a negative impact on the vestibular part of the inner ear. Clinicians should be aware of the possible negative impact of middle ear effusion on the vestibular function in children with a history of otitis media with effusion. With seeimingly asymptomatic children clinicians should inquire parents about symptoms of dysequlibrium and imbalance.
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Filippopulos FM, Albers L, Straube A, Gerstl L, Blum B, Langhagen T, Jahn K, Heinen F, von Kries R, Landgraf MN. Vertigo and dizziness in adolescents: Risk factors and their population attributable risk. PLoS One 2017; 12:e0187819. [PMID: 29131843 PMCID: PMC5683632 DOI: 10.1371/journal.pone.0187819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/26/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To assess potential risk factors for vertigo and dizziness in adolescents and to evaluate their variability by different vertigo types. The role of possible risk factors for vertigo and dizziness in adolescents and their population relevance needs to be addressed in order to design preventive strategies. STUDY DESIGN The study population consisted of 1482 school-children between the age of 12 and 19 years, who were instructed to fill out a questionnaire on different vertigo types and related potential risk factors. The questionnaire specifically asked for any vertigo, spinning vertigo, swaying vertigo, orthostatic dizziness, and unspecified dizziness. Further a wide range of potential risk factors were addressed including gender, stress, muscular pain in the neck and shoulder region, sleep duration, migraine, coffee and alcohol consumption, physical activity and smoking. RESULTS Gender, stress, muscular pain in the neck and shoulder region, sleep duration and migraine were identified as independent risk factors following mutual adjustment: The relative risk was 1.17 [1.10-1.25] for female sex, 1.07 [1.02-1.13] for stress, 1.24 [1.17-1.32] for muscular pain, and 1.09 [1.03-1.14] for migraine. The population attributable risk explained by these risk factors was 26%, with muscular pain, stress, and migraine accounting for 11%, 4%, and 3% respectively. CONCLUSION Several established risk factors in adults were also identified in adolescents. Risk factors amenable to prevention accounted for 17% of the total population risk. Therefore, interventions targeting these risk factors may be warranted.
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Affiliation(s)
- Filipp M. Filippopulos
- Department of Neurology, University Hospital, LMU, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU, Munich, Germany
| | - Lucia Albers
- Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, LMU, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital, LMU, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU, Munich, Germany
| | - Lucia Gerstl
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, LMU, Munich, Germany
| | - Bernhard Blum
- Department of Neurology, University Hospital, LMU, Munich, Germany
| | - Thyra Langhagen
- German Center for Vertigo and Balance Disorders, LMU, Munich, Germany
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, LMU, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, LMU, Munich, Germany
- Department of Neurology, Schön Klinik Bad Aibling, Bad Aibling, Germany
| | - Florian Heinen
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, LMU, Munich, Germany
| | - Rüdiger von Kries
- Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, LMU, Munich, Germany
| | - Mirjam N. Landgraf
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children’s Hospital, LMU, Munich, Germany
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Kim SH. Dizziness and orthostatic intolerance in pediatric migraine. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.2.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Seung Hyo Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
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Parisi P, Pagani J, Galiffa S, Villa MP. Migrainous Vertigo Unresponsive to Antimigraine Therapy in a Child with ‘Asymptomatic’ Cerebellar Lesion: Casual or Causal Association? Cephalalgia 2016; 25:831-5. [PMID: 16162262 DOI: 10.1111/j.1468-2982.2005.00960.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P Parisi
- Child Neurology Unit and Paediatric Headache Centre, University of Rome La Sapienza, Il faculty Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy.
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Brodsky JR, Cusick BA, Zhou G. Vestibular neuritis in children and adolescents: Clinical features and recovery. Int J Pediatr Otorhinolaryngol 2016; 83:104-8. [PMID: 26968063 DOI: 10.1016/j.ijporl.2016.01.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Describe the clinical presentation and recovery of vestibular neuritis in children and adolescents. STUDY DESIGN Retrospective case series. SETTING Pediatric tertiary care center. SUBJECTS AND METHODS Eleven patients diagnosed with vestibular neuritis were identified from a database of 301 patients evaluated at our pediatric vestibular clinic from January 2012 through January 2015. Medical records were reviewed to determine clinical presentation, vestibular testing results, treatment, and recovery. Incomplete recovery was defined as residual dizziness or imbalance at most recent follow-up >30 days from symptom onset. RESULTS Patients were 5-19 years old (mean 13.1±5.34) and included 6 boys and 5 girls. All presented with a sudden rotational vertigo, imbalance, and nausea for an average of 10 days without other associated symptoms. Testing included rotary chair (8 of 9 abnormal), caloric (2 of 2 abnormal), video head impulse (5 of 8 abnormal), subjective visual vertical (4 of 8 abnormal), and cervical vestibular evoked myogenic potential (0 of 6 abnormal) tests. All patients with incomplete recovery (n=4; 36%) were ≥15 years old at symptom onset. All patients with incomplete recovery that underwent vestibular rehabilitation (n=2) initiated it ≥90 days from symptom onset, while 3 out of 4 patients with complete recovery that underwent vestibular rehabilitation initiated it ≤14 days from symptom onset. Two patients received oral steroids, neither of whom had incomplete recovery. CONCLUSION Vestibular neuritis should be considered in pediatric patients with vertigo and may result in longstanding symptoms, particularly in adolescents. The treatment of pediatric vestibular neuritis with rehabilitation and steroids deserves further study.
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Affiliation(s)
- Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement (J.R.B., B.A.C., GW.Z.), Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology (J.R.B., GW.Z.), Harvard Medical School, Boston, MA, USA.
| | - Brandon A Cusick
- Department of Otolaryngology and Communication Enhancement (J.R.B., B.A.C., GW.Z.), Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology (J.R.B., GW.Z.), Harvard Medical School, Boston, MA, USA
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement (J.R.B., B.A.C., GW.Z.), Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology (J.R.B., GW.Z.), Harvard Medical School, Boston, MA, USA
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Brodsky JR, Cusick BA, Zhou G. Evaluation and management of vestibular migraine in children: Experience from a pediatric vestibular clinic. Eur J Paediatr Neurol 2016; 20:85-92. [PMID: 26521123 DOI: 10.1016/j.ejpn.2015.09.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/09/2015] [Accepted: 09/28/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Epidemiologic studies have shown Vestibular migraine (VM) to be the most common cause of vertigo in children, but little is known about the typical presentation and response to treatment of this disorder in the pediatric population. The aim of this study was to evaluate the diagnostic features and response to therapy of VM in children managed at a pediatric vestibular clinic. METHODS Twenty-eight patients ≤18 years old with a diagnosis of VM were identified from 208 patients seen at the Balance and Vestibular Program at Boston Children's Hospital from July 2012-July 2014, after excluding 12 patients with a history of major otologic or neurologic surgery, recent concussion, or additional vestibular disorders. Patients' electronic medical records and testing results were retrospectively reviewed. RESULTS Patients ranged in age from 9 to 18 years old (mean 14.48). All included patients met criteria for definite (n = 25) or probable (n = 3) VM as defined by the International Classification of Headache Disorders. Rotary chair (n = 17), caloric (n = 8), cervical vestibular evoked myogenic potential (n = 16), and video head impulse (n = 3) tests were normal. Medications effectively reduced reported vestibular symptoms in 88% of those treated with tricyclics (n = 8), 86% of those treated with cyprohepatadine (n = 7), 80% of those treated with topiramate (n = 5), 80% of those treated with triptans (n = 10), and 25% of those treated with gabapentin (n = 4). CONCLUSIONS Vestibular migraine is a common cause of vertigo in the pediatric population that is frequently responsive to medical therapy.
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Affiliation(s)
- Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
| | - Brandon A Cusick
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
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Pavlou M, Whitney S, Alkathiry AA, Huett M, Luxon LM, Raglan E, Godfrey EL, Eva-Bamiou D. The Pediatric Vestibular Symptom Questionnaire: A Validation Study. J Pediatr 2016; 168:171-177.e1. [PMID: 26522978 DOI: 10.1016/j.jpeds.2015.09.075] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/22/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop and validate the Pediatric Vestibular Symptom Questionnaire (PVSQ) and quantify subjective vestibular symptom (ie, dizziness, unsteadiness) severity in children. STUDY DESIGN One hundred sixty-eight healthy children (female, n = 91) and 56 children with postconcussion dizziness or a vestibular disorder (female, n = 32), between ages 6 and 17 years, were included. The PVSQ contains questions regarding vestibular symptom frequency during the previous month. The Strengths and Difficulties Questionnaire (SDQ), a brief behavioral screening instrument, was also completed. RESULTS The PVSQ showed high internal consistency (10 items; Cronbach α = 0.88). A significant between-group difference was noted with higher (ie, worse) PVSQ scores for children with vestibular symptoms (P < .001); no significant differences were noted between patient groups. The optimal cut-off score for discriminating between individuals with and without abnormal levels of vestibular symptoms was 0.68 out of 3 (sensitivity 95%, specificity 85%). Emotional and hyperactivity SDQ subscale scores were significantly worse for patients compared with healthy participants (P ≤ .01). A significant relationship was noted between mean PVSQ and SDQ (parent-rated version) hyperactivity and total scores for patients (P ≤ .01) and the SDQ (self-rated) emotional, hyperactivity, and total score (P ≤ .01) in healthy controls. However, mean SDQ subscale and total scores were within normal ranges for both groups. CONCLUSIONS Self-reported vestibular symptoms, measured by the PVSQ, discriminated between children presenting with vestibular symptoms and healthy controls and should be used to identify and quantify vestibular symptoms that require additional assessment and management.
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Affiliation(s)
- Marousa Pavlou
- Center of Human and Aerospace Physiological Sciences, King's College London, London, United Kingdom.
| | - Sue Whitney
- Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Abdulaziz A Alkathiry
- Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, College of Applied Medical Sciences Majmaah University, Majmaah, Saudi Arabia
| | - Marian Huett
- Department of Physiology, King's College London, London, United Kingdom
| | - Linda M Luxon
- Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ewa Raglan
- Department of Audiological Medicine, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Emma L Godfrey
- Division of Health and Social Care, King's College London, London, United Kingdom
| | - Doris Eva-Bamiou
- Department of Neuro-Otology, National Hospital for Neurology and Neurosurgery, London, United Kingdom; Department of Audiological Medicine, Great Ormond Street Hospital for Children, London, United Kingdom; University College London Ear Institute, London, United Kingdom
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Raucci U, Vanacore N, Paolino MC, Silenzi R, Mariani R, Urbano A, Reale A, Villa MP, Parisi P. Vertigo/dizziness in pediatric emergency department: Five years’ experience. Cephalalgia 2015; 36:593-8. [DOI: 10.1177/0333102415606078] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/10/2015] [Indexed: 01/03/2023]
Abstract
Background Vertigo/Dizziness in childhood is not a rare cause of visits to the emergency department (ED). We analyzed a selected group with vertigo/dizziness to identify signs and symptoms that may help to guide the diagnostic approach and management. Methods A total of 616 children admitted for vertigo to the ED over a five-year period were retrospectively reviewed. Their medical history, clinical characteristics, laboratory and neuroimaging tests, final diagnoses and management were analyzed. Results Migraine and syncope were the most frequent causes. Two patients were affected by life-threatening cardiac syncope, while structural life-threatening central nervous system diseases were found in 15 patients, none of whom presented with vertigo as an isolated clinical finding. Conclusions Most cases of vertigo/dizziness in childhood that consist mainly of migraine and syncope are of benign origin. The prompt identification of neurological or cardiological signs or symptoms associated with vertigo in children is mandatory to rule out life-threatening conditions.
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Affiliation(s)
- Umberto Raucci
- Emergency Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Italy
| | - Nicola Vanacore
- National Centre for Epidemiology, Surveillance, and Health Promotion, National Institute of Health, Italy
| | - Maria Chiara Paolino
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| | - Romina Silenzi
- Department of Pediatrics (DPUO), University of Rome Tor Vergata, Bambino Gesù Children's Hospital, IRCCS, Italy
| | - Rosanna Mariani
- Emergency Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Italy
| | - Antonella Urbano
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| | - Antonino Reale
- Emergency Pediatric Department, Bambino Gesù Children’s Hospital, IRCCS, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, c/o Sant’Andrea Hospital, Italy
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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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Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Re M. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol 2014; 78:718-24. [PMID: 24612555 DOI: 10.1016/j.ijporl.2014.02.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To systematically review and discuss the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent advances in diagnosis and therapy. METHODS One appropriate string was run on PubMed to retrieve articles dealing with the topics mentioned above. A cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. A non-comparative meta-analysis concerning the rate of singular vertiginous forms was performed. RESULTS Ten articles were identified comprising a total of 724 subjects. Overall, the articles we analyzed indicated benign paroxysmal vertigo of childhood (18.7%) and migraine-associated vertigo (17.6%) as the two main entities connected with vertigo and dizziness in children. Head trauma (14%) was the third most common cause of vertigo. The mean (95% CI) rate of every vertiginous form was also calculated in relation to the nine studies analyzed with vestibular migraine (27.82%), benign paroxysmal vertigo (15.68%) and vestibular neuritis (9.81%) being the three most common forms. There appeared to be a paucity of recent literature concerning the development of new diagnostic methods and therapies. CONCLUSIONS On the basis of the literature study, when evaluating a young patient with vertigo and dizziness, the otolaryngologist should be aware that, in children, these symptoms are often connected to different pathologies in comparison to the entities observed in the adult population.
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Affiliation(s)
| | | | - Shaniko Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health University Hospital of Modena, Modena, Italy
| | - Giuseppe Magliulo
- Department of Otorhinolaryngology "G. Ferreri", "La Sapienza" University, Rome, Italy
| | - Massimo Re
- Otorhinolaryngology Department, Marche Polytechnic University, Ancona, Italy
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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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Batuecas-Caletrío A, Martín-Sánchez V, Cordero-Civantos C, Guardado-Sánchez L, Marcos MR, Fabián AH, Benito González JJ, Santa Cruz-Ruiz S. Is benign paroxysmal vertigo of childhood a migraine precursor? Eur J Paediatr Neurol 2013; 17:397-400. [PMID: 23434307 DOI: 10.1016/j.ejpn.2013.01.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/23/2013] [Accepted: 01/26/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Benign Paroxysmal Vertigo of Childhood (BPVC) is a common cause of vertigo in children and it is characterized by recurrent attacks of vertigo without warning resolving spontaneously after minutes to hours. It has been considered the equivalent of migraine in childhood. METHODS Twenty-seven patients diagnosed with BPVC were recruited between 1991 and 1997 with a follow up of at least 15 years. The incidence of migraine, inner ear disorders and family medical history is analyzed. RESULTS The average age for the onset of the attacks of BPVC was 3 years and 11 months, and for spontaneous resolution, it was around 5 years and 7 months. The average age for follow up was 18 years. Nine patients developed migraine during adulthood. Nineteen of them had a family history of migraine. CONCLUSION We have observed that the prevalence of migraine in patients that had been diagnosed with BPVC is higher than in the general population, which leads us to propose BPVC as a precursor of migraine during childhood.
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Inoue Y, Yabe T. Lomerizine therapy for the treatment of benign paroxysmal vertigo of childhood transitioning into atypical basilar migraine: A case report. Exp Ther Med 2013; 5:1573-1575. [PMID: 23837033 PMCID: PMC3702696 DOI: 10.3892/etm.2013.1035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/20/2013] [Indexed: 11/06/2022] Open
Abstract
We report a rare case of benign paroxysmal vertigo (BPV) of childhood transitioning into basilar migraine (BM) that was effectively treated with lomerizine. A 6-year-old male visited our hospital complaining of repeated attacks of vertigo for 3 months. The patient's vertigo attacks lasted for several hours and were accompanied by nausea, vomiting, intense fear and loss of consciousness. No nystagmus was observed during the vertigo attacks. Blood tests and imaging examinations revealed no abnormal findings. The results of electronystagmography and the caloric test were unremarkable. Pure-tone audiometry revealed profound right-side sensorineural hearing loss. Among the differential diagnoses, delayed endolymphatic hydrops, epilepsy and BM were considered. Delayed endolymphatic hydrops was considered unlikely since no nystagmus occurred during the vertigo attacks and there was no change in hearing; electroencephalography revealed no epileptic seizure waves. The attacks of vertigo were well-controlled with lomerizine. The patient was diagnosed with BM since the use of lomerizine, an agent for the treatment for migraine, was effective. Since it was reported that BPV is closely related to migraine and the onset of the vertigo attacks was accompanied by a loss of consciousness, we concluded that this patient had BM transitioning from BPV.
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Affiliation(s)
- Yuta Inoue
- Department of Otolaryngology, Tokyo Metropolitan Hiroo Hospital, Tokyo 150-0013, Japan
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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: 28] [Impact Index Per Article: 2.3] [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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Jahn K. Vertigo and balance in children--diagnostic approach and insights from imaging. Eur J Paediatr Neurol 2011; 15:289-94. [PMID: 21571558 DOI: 10.1016/j.ejpn.2011.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/22/2011] [Indexed: 02/02/2023]
Abstract
Common causes of vertigo and dizziness in childhood are vestibular migraine and associated syndromes (benign paroxysmal vertigo), unilateral vestibular failure due to labyrinthitis, positioning vertigo, and somatoform syndromes. Although the same spectrum of diseases as in adults can be found, the frequency differs widely. Further, balance disorders not related to vestibular function, like cerebral palsy, can present with dizziness. Vestibular function can reliably be addressed at the bedside by head impulses to test vestibulo-ocular reflex function, ocular motor testing of the central vestibular system, and balance tests for vestibulo-spinal function. Vestibulo-ocular reflex function can now be quantified by recording eye and head movements with high resolution video-oculography (256 Hz) and inertial sensors. Posturographic measures using artificial neuronal networks are used to classify dysbalance. Quantitative gait analysis further helps to distinguish balance disorders caused by e.g. sensory dysfunction or supraspinal disturbances. Recently, functional neuroimaging opened a view to the brain network for the control of posture and locomotion. From frontal cortex the locomotor signal is conveyed via the basal ganglia to the centers for locomotion and postural control in the brainstem tegmentum. The cerebellum is involved in sensory integration and rhythm generation during postural demands. To summarize, most syndromes causing dizziness, vertigo and imbalance can be diagnosed based on history and clinical tests. However, new data from neurophysiology and imaging help to understand the pathophysiology and the therapeutic principles in these disorders.
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Affiliation(s)
- Klaus Jahn
- Department of Neurology and Integrated Center for Research and Treatment of Vertigo, Balance and Ocular Motor Disorders IFB, Ludwig-Maximilians University of Munich, Klinikum Grosshadern, Marchioninistr 15, 81377 Munich, Germany.
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Goto F, Morimoto N, Ohara T, Honmura T, Taiji H. [Clinical characteristics of benign paroxysmal vertigo of childhood (BPVC)]. NIHON JIBIINKOKA GAKKAI KAIHO 2011; 114:562-567. [PMID: 21770306 DOI: 10.3950/jibiinkoka.114.562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pediatric subjects with vertigo or dizziness are rare in Japan, although considerable statistical data accumulated, mostly indicating that orthostatic hypotension is the most frequent clinical symptoms in Japan, as opposed to Benign paroxysmal vertigo of childhood (BPVC), reported to be most frequent abroad. We studied BPVC incidence and clinical features. Subjects were 5 boys and 7 girls aged 4 to 15 years old (average +/- sd 9.5 +/- 3.1 years). The predominant diagnosis was BPVC in 8, orthostatic hypotension in 6, labyrinthitis in 2, and delayed endolymphatic hydrops, and conversion disorder in 1 case each. BPVC was most common. All subjects with BPVC had a history or a family history of migraine. Based on BPVC diagnostic criteria, subjects had neither organic nor functional abnormalities. Information is thus required on attack, injury, and personal or family migraine history to determine a final diagnosis. Note that subjects with BPVC have high orthostatic hypotension. These statistics indicate the importance of diagnostic BPVC criteria in pediatric subjects with dizziness or vertigo.
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Affiliation(s)
- Fumiyuki Goto
- Department of Otorhinolaryngology, Hino Municipal Hospital, Hino
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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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Gaul C, Kraya T, Holle D, Benkel-Herrenbrück I, Schara U, Ebinger F. Migränevarianten und ungewöhnliche Manifestationen der Migräne im Kindesalter. Schmerz 2011; 25:148-56. [DOI: 10.1007/s00482-011-1021-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Humphriss RL, Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int J Pediatr Otorhinolaryngol 2011; 75:395-400. [PMID: 21239067 DOI: 10.1016/j.ijporl.2010.12.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Current data about the prevalence and characteristics of dizziness in the paediatric population is very limited and the generalisability of extant studies to the UK population has not been explored. Our study aims to provide a robust estimate of the prevalence of dizziness in 10 year old children in the UK, to describe the characteristics of this dizziness and to explore whether this dizziness is socially patterned. METHODS Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) was analysed (N=13,988). A total of 6965 of these children attended for a balance assessment session at age 10. Those who reported rotary vertigo were interviewed about their symptoms. Logistic regression was used to explore whether dizziness at age 10 is socially patterned. RESULTS A total of 400 children reported rotary vertigo, giving a prevalence estimate of 5.7% [CI 5.2, 6.3%]. 13.1-20.6% of children reported experiencing their dizziness between 1 and 4 times a week (depending on the symptom). 51.5% of children had to stop what they were doing because of the dizziness making them feel unwell. A total of 60% of children reported headache as an accompanying symptom, tentatively suggesting a diagnosis of migraine, although there was no association between reports of headache and a maternal family history of migraine. 20.3% of children with dizziness also reported tinnitus and 17.3% reported that their hearing changed when they were dizzy. CONCLUSIONS Dizziness in 10 year old children is not uncommon and in about half limits current activities. Rotary vertigo is commonly accompanied by dizziness of another description and also by headache. There is no evidence that dizziness at this age is socially patterned.
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Affiliation(s)
- Rachel L Humphriss
- Centre for Hearing and Balance Studies, University of Bristol, Bristol, UK.
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40
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Affiliation(s)
- Jacques Benun
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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O’Reilly RC, Greywoode J, Morlet T, Miller F, Henley J, Church C, Campbell J, Beaman J, Cox AM, Zwicky E, Bean C, Falcheck S. Comprehensive Vestibular and Balance Testing in the Dizzy Pediatric Population. Otolaryngol Head Neck Surg 2011; 144:142-8. [DOI: 10.1177/0194599810393679] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To describe the spectrum of balance disease in a large population of children presenting to a tertiary care vestibular and balance laboratory. Study Design. Case series with chart review. Setting. Tertiary care pediatric hospital. Main Outcome Measures. Results of audiometric, vestibular, and balance tests and final diagnosis. Subjects and Methods. Retrospective review of audiometric, vestibular, balance testing, and final diagnosis from a patient database. Results. Between September 2003 and September 2007, 132 children were evaluated at the Alfred I. duPont Hospital for Children Vestibular Disorders Program. Sixty-nine of the patients were boys and 63 were girls. The average age was 9.7 ± 5.0 years (range, 1-17 years). Although not all were able to complete the entire test battery (99 children completed at least 50% of the tests in the protocol), a diagnosis was achieved in most cases. The most common diagnoses were peripheral vestibulopathy (29.5%), migraine/benign recurrent vertigo of childhood (24.2%), motor/developmental delay (10.6%), traumatic brain injury (9.8%), and central nervous system structural lesion (9.1%). Conclusions. Peripheral vestibular deficits and migraine disease account for most of the pathology in the pediatric population. With a multidisciplinary approach, diagnosis of the source of vertigo and imbalance is possible in most children.
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Affiliation(s)
- Robert C. O’Reilly
- Division of Pediatric Otolaryngology, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Jewell Greywoode
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Thierry Morlet
- Center for Pediatric Auditory and Speech Sciences, Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Freeman Miller
- Gait Laboratory, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - John Henley
- Gait Laboratory, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Chris Church
- Gait Laboratory, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Jeffrey Campbell
- Division of Pediatric Neurosurgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Jason Beaman
- Department of Physical Therapy, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Anne Marie Cox
- Department of Audiology, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Emily Zwicky
- Department of Audiology, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Charles Bean
- Neurology Associates, P.A., Newark, Delaware, USA
| | - Stephen Falcheck
- Department of Neurology, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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42
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Szirmai A. Vestibular disorders in childhood and adolescents. Eur Arch Otorhinolaryngol 2010; 267:1801-4. [DOI: 10.1007/s00405-010-1283-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Accepted: 05/06/2010] [Indexed: 11/30/2022]
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A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx 2009; 36:30-5. [DOI: 10.1016/j.anl.2008.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 10/30/2007] [Accepted: 03/05/2008] [Indexed: 11/19/2022]
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Park JY, Nam SO, Eun SH, You SJ, Kang HC, Eun BL, Chung HJ. Multicenter clinical study of childhood periodic syndromes that are common precursors to migraine using new criteria of the International Classification of Headache Disorders (ICHD-II). KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.5.557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jae Yong Park
- Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Korea
| | - Sang-Ook Nam
- Department of Pediatrics, Pusan National University School of Medicine, Korea
| | - So-Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Korea
| | - Su Jeong You
- Department of Pediatrics, Inje University College of Medicine, Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Inje University College of Medicine, Korea
| | - Baik-Lin Eun
- Department of Pediatrics, Korea University College of Medicine, Korea
| | - Hee Jung Chung
- Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Korea
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Herreros Fernández ML, Beato Martínez A, Barja Tur J, Moreno Juara A, González Laguillo A. [Benign paroxysmal positional vertigo: provocation and freeing manoeuvres]. An Pediatr (Barc) 2008; 69:167-70. [PMID: 18755124 DOI: 10.1157/13124898] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The benign paroxystic positional vertigo (BPPV) is defined by brief episodic vertigo attacks and accompanied by a rotary-linear nystagmus, triggered by head position changes and is always produced in that position. The theory that better explains the BPPV is canalithiasis: free-floating particles leave the utricular macula and enter one of the semicircular canals, producing an endolymphatic movement that stimulates the cupula and produces vertigo and nystagmus. The diagnosis is based on a typical clinical history, normal ear and neurological examination and provocation maneuvers, such as the Dix-Hallpike test, reproduce the vertigo attacks. The treatments are the liberatory maneuvers, such as the Epley maneuver which makes the vertigo disappear. We present two cases of vertigo with a compatible clinic history of BPPV, where the Dix-Hallpike maneuver confirmed the diagnosis. The treatment in both cases was the Epley maneuver.
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Salami A, Dellepiane M, Crippa B, Barettini L, Mora R. Visual-vestibular interaction test in the diagnosis of vertigo in children. Int J Pediatr Otorhinolaryngol 2008; 72:1-7. [PMID: 17959256 DOI: 10.1016/j.ijporl.2007.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/23/2007] [Accepted: 08/24/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study has been to test to determine the diagnostic value of a visual-vestibular test with a rotatory cylindrical chamber in the diagnosis of peripheral and central vertigo in children. METHODS Ten children affected by posttraumatic and migrainous vertigo were enrolled (group A): as a control group 10 healthy children were identified. All the children underwent to electronystagmography (ENG) recording: the children, head blocked, sat on a "Tonnies rotatory chair Pro model", which was placed in the middle of a rotatory cylindrical chamber (2 m in diameter and 1.9 m in height), and underwent to rotatory vestibular stimulation by Stop test, to optokinetic stimulation and to contemporary rotatory vestibular and optokinetic stimulation (visual--vestibular-ocular-reflex): opening the light on the stop test, by an angular velocity of 90 degrees s(-1) obtained from a chair subliminal acceleration of 0.5 degrees s(-2), and making for 60s the optokinetic stimulation by rotation of the optical contrasts to determinate a nystagmus with a opposite direction to the postrotatory nystagmus and homodirectional to optokinetic nystagmus (in both clockwise and counterclockwise directions). RESULTS For the analysis of the results we have considered nystagmus mean gain and direction of visual-vestibular-ocular-reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular-ocular-reflex (VOR). In control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus. CONCLUSIONS In the healthy patients, VVOR nystagmus is always homodirectional to optokinetic nystagmus and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. These data show the diagnostic role of our visual-vestibular interaction test in children affected by vertigo.
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Affiliation(s)
- Marc J Dinkin
- Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA
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Worden BF, Blevins NH. Pediatric vestibulopathy and pseudovestibulopathy: differential diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2007; 15:304-9. [PMID: 17823544 DOI: 10.1097/moo.0b013e3282bf139e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Evaluation of children with vestibular complaints may be challenging. The approach to these patients is often quite different than the approach to adults with similar complaints. This review will discuss the evaluation of pediatric vestibular disease with an emphasis on recent evidence in the literature RECENT FINDINGS Recent evidence has elucidated the most common etiologies of vertigo in children, documented the utility and feasibility of objective diagnostic testing such as electronystagmography and vestibular evoked myogenic potentials in this population, and demonstrated the efficacy of new therapies such as rizatriptan for the treatment of migraine in children. SUMMARY An evidence-based approach to the evaluation of pediatric vestibular dysfunction may improve diagnostic yield and facilitate timely initiation of appropriate therapy.
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Affiliation(s)
- Brian F Worden
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, California 94305-5739, USA
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Novalo ES, Goffi-Gomez MVS, Medeiros ÍRTD, Pedalini MEB, Santos RMRD. A afecção vestibular infantil: estudo da orientação espacial. REVISTA CEFAC 2007. [DOI: 10.1590/s1516-18462007000400013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: verificar como é a percepção do espaço na criança com vertigem periférica. MÉTODOS: estudo prospectivo de 18 crianças, com faixa etária de três a 15 anos, sob acompanhamento no Ambulatório de Otorrinolaringologia / Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. A percepção espacial foi avaliada por meio de atividade livre (desenho livre) e dirigida (blocos lógicos e teste de Frostig). Das 18 crianças avaliadas, nove constituíram o grupo estudo (diagnóstico de vestibulopatia e queixa de tontura) e nove constituíram o grupo controle (sem história de vestibulopatia e sem queixa de tontura). Foram excluídas crianças que apresentassem comprometimento de Sistema Nervoso Central que interferisse na interpretação da avaliação. Os resultados obtidos foram comparados entre o grupo estudo e controle qualitativamente. RESULTADOS: em relação ao desenho livre, 77,78% das crianças do grupo controle e 55,55% do grupo estudo utilizaram o papel inteiro. Quanto à proporção dos objetos, 100% das crianças do grupo controle e apenas 48,86% das crianças do grupo estudo desenharam com proporção adequada. Nos blocos lógicos, houve maior dificuldade do grupo estudo. No teste de Frostig, foi observada diferença significativa do ponto de vista clínico entre os grupos quanto ao Quociente Perceptual. CONCLUSÃO: as crianças com vestibulopatia, ao desenhar, aproveitaram o papel de forma menos homogênea, com maior dificuldade para desenhar figuras humanas e proporção inadequada entre os objetos. Desta forma, é importante que seja realizado o diagnóstico de vestibulopatia precocemente, para que o tratamento/reabilitação seja iniciado e sintomas, como a desorientação espacial, não influenciem na aprendizagem da criança.
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