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Teggi R, Colombo B, Familiari M, Cangiano I, Bussi M, Filippi M. Phenotypes, bedside examination, and video head impulse test in vestibular migraine of childhood compared with probable vestibular migraine and recurrent vertigo in childhood. Front Pediatr 2023; 11:1152928. [PMID: 37377754 PMCID: PMC10291096 DOI: 10.3389/fped.2023.1152928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Vestibular impairment and vertigo in the pediatric population have an estimated prevalence ranging between 0.4% and 5.6% and are a topic of interest in recent years. The Bárány Society has recently reclassified migraine-related vertigo syndromes as vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (probable VMC), and recurrent vertigo of childhood (RVC). Methods Applying the criteria established by the Bárány Society, we retrospectively analyzed data on 95 pediatric patients suffering from episodic vertigo that were recruited from 2018 to 2022. In applying the revised criteria, 28 patients had VMC, 38 had probable VMC, and 29 had RVC. Results Visuo-vestibular symptoms (external vertigo) or internal vertigo were reported by 20 of 28 VMC patients (71.4%) compared to 8 of 38 probable VMC patients (21%) (P < .001). None of the RVC patients reported external vertigo. Duration of vertigo was demonstrably longer in the VMC patients than in the probable VMC (P < .001) and RVC (P < .001) patients. Cochlear symptoms were reported by 28.6% of VMC patients and by 13.1% of probable VMC patients. No cochlear symptoms were reported by any RVC patients. Familial cases for headache and episodic vertigo showed no significant difference between groups. Discussion The most frequent finding during bedside examination in all three groups was central positional nystagmus. Differences in the duration of attacks and in accompanying symptoms may underline different pathophysiological mechanisms.
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Affiliation(s)
- Roberto Teggi
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Bruno Colombo
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Familiari
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Iacopo Cangiano
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Mario Bussi
- ENT Division, San Raffaele Scientific Institute, Vita e Salute University, Milano, Italy
| | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- “Vita-Salute” University, San Raffaele, Milan, Italy
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Peterson JD, Brodsky JR. Evaluation and management of paediatric vertigo. Curr Opin Otolaryngol Head Neck Surg 2022; 30:431-437. [PMID: 36165009 DOI: 10.1097/moo.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most current information on cause, evaluation and treatment of dizziness in children. RECENT FINDINGS There has been an increased understanding of the multifactorial cause of dizziness in the paediatric population. Quantitative vestibular testing is increasingly used and valuable as a diagnostic adjunct. Vestibular rehabilitation, migraine hygiene, psychological therapies, pharmaceuticals and/or surgery can be used as well tolerated and effective treatments for vertigo in children and adolescents when tailored to cause. SUMMARY Paediatric vertigo can be effectively evaluated through careful history taking and physical examination along with adjunctive tests, such as vestibular testing and audiometry, when appropriate. Options for treatment of vestibular disorders in children and adolescents have greatly expanded in recent years allowing for the effective management of nearly all cases of paediatric vertigo, though a multimodal and/or multidisciplinary approach is often needed.
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Affiliation(s)
- Joseph D Peterson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
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Tian R, Zhang H, Xie D, Ding J, Jiang J. A Preliminary Study on the Characteristics and Standard Diagnosis and Treatment of Vestibular Dysfunction in Children. EAR, NOSE & THROAT JOURNAL 2022:1455613221139399. [PMID: 36380438 DOI: 10.1177/01455613221139399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE To understand the pathogenesis of vestibular dysfunction in children and to provide a reference for the diagnosis and treatment of vestibular dysfunction in children. METHODS A retrospective analysis was conducted on 80 children who visited our hospital from June 2011 to July 2020, aged between 4 and 17 years, with a duration of 1 day to 3 years. They were admitted to the hospital for treatment upon vestibular function-related examinations confirmed that there was peripheral vestibular function impairment. RESULTS Children aged 6-12 years old who are diagnosed are significantly more than other two age groups (4-6) and (12-17) (X2 = 101.738, P < .001). There was a significant statistical difference (X2 = 91.195, P < .001) in comparison of abnormal rates of vestibular function-related examinations. The Mann test had the highest abnormal rate and the lowest Cervical Vestibular Evoked Myogenic Potential (cVEMP) abnormality rate. Comparison of abnormal consistency rates for quantitative and qualitative examination of vestibular function, the abnormal rates (double temperature test and Mann test) were significantly better than other abnormal consistency rates, and there were statistical differences (X2 = 7.485, P = .024 < .05). Among the children with vestibular dysfunction, the etiology was most common in 58 cases (72.50%) of benign paroxysmal vertigo, 4 cases of vestibular migraine (5.00%), 8 cases (10.00%) of vestibular neuronitis, of which 22 cases (27.50%) were combined with other diseases, and the most common was 15 cases (18.75%) of sinusitis. CONCLUSION A limited number of studies were conducted on vestibular dysfunction in children. The current retrospective analysis suggests that age, gender, and side of ear pain have no significant effects, while children aged 6-12 are more likely to suffer from vestibular dysfunction. On children's vestibular dysfunction, more etiology is unclear, and special attention should be paid to differential diagnosis when giving treatment and the child's medical history should be examined in detail and appropriate vestibular function tests should be selected in order to provide timely, effective, and accurate treatment for the child.
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Affiliation(s)
- Ruru Tian
- Otorhinolaryngology Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Haiqin Zhang
- Otorhinolaryngology Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Daoyu Xie
- Otorhinolaryngology Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jinv Ding
- Otorhinolaryngology Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Jianhua Jiang
- Otorhinolaryngology Department, Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
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Zhang F, Shen J, Zhu Q, Wang L, Ma X, He B, Yang Y, Wang W, Chen X, Zhang Q, Jin Y, Duan M, Chen J, Yang J. Evaluating children with vestibular migraine through vestibular test battery: A cross-sectional investigation. Front Neurol 2022; 13:997217. [PMID: 36388219 PMCID: PMC9659754 DOI: 10.3389/fneur.2022.997217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The present study aimed to investigate the status of vestibular function in children with vestibular migraine of childhood (VMC) reflected by vestibular function test battery and explore the pathophysiological implication of these instrument-based findings. Methods The clinical data of 22 children (mean age 10.7 ± 2.9 years) with VMC who met the diagnostic criteria of the Barany Society were collected from September 2021 to March 2022. A vestibular function test battery on these children included a caloric test, video head impulse test (vHIT), cervical vestibular-evoked myogenic potential (cVEMP), and ocular vestibular-evoked myogenic potential (oVEMP); these parameters were triggered by air-conducted sound (ACS) and galvanic vestibular stimulation (GVS). The subjects were further divided into two groups: <3 months and >3 months according to the disease duration from symptom onset. The functional abnormalities and their characteristics reflected by the vestibular test battery, as well as the outcomes in children with or without aura, were analyzed. Results (1) The abnormal rate of the caloric test was 15.8% and that of vHIT was 0%. The response rates of ACS-cVEMP and ACS-oVEMP were 100% and 90.5%, respectively. The response rates of GVS-cVEMP and GVS-oVEMP were 100% and 88.9%, respectively. (2) No statistical difference was observed in the abnormal rate of the caloric test (P = 0.55) and the response rate of ACS-oVEMP (P = 0.21) between the two groups, irrespective of the course duration. (3) No statistical difference was detected in the abnormal rate of the caloric test (P = 0.53) and the response rate of ACS-oVEMP (P = 1.00) in children with or without aura. Conclusion Vestibular function status comprehensively reported by the vestibular test battery did not show an aggravation with the disease duration in children with VMC. Also, it was not affected by the existence of aura in children with VMC. The high abnormal rates of the caloric test and oVEMPs (ACS-oVEMP and GVS-oVEMP) suggested that the lateral semicircular canal (low-frequency function component), the utricle, and the superior vestibular conduction pathway might be involved in VMC.
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Affiliation(s)
- Fan Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qi Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Yuyao People's Hospital, Yuyao, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiaobao Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Baihui He
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yang Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xiangping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Maoli Duan
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maoli Duan
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
- Jianyong Chen
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China
- Jun Yang
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Nguyen J, Berger J, Curthoys I, Held V, Zaubitzer L, Hülse R, Rotter N, Schell A. Vestibular testing in children - The suppression head impulse (SHIMP) test. Int J Pediatr Otorhinolaryngol 2021; 151:110921. [PMID: 34537549 DOI: 10.1016/j.ijporl.2021.110921] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The incidence of vestibular disorders and vertigo during childhood is increasing and pediatric clinicians have become more sensitive to children's balance disorders; thus, there is a need for appropriate detection test procedures for peripheral vestibular hypofunction. In order to ensure a reliable diagnosis and minimize misdiagnosis, a standardized clinical procedure via careful history and clinical examination is recommended. However, children, especially, are often unable to verbalize "vertigo" in a concrete manner, which often necessitates a consultation with a pediatrician holding nonspecific symptoms. The so-called suppression of the head impulse test (SHIMPs) represents a modification of the video head impulse test (HIMP) and is used for a more sensitive assessment of residual vestibular functions. In adults, SHIMPs are already an established diagnostic method. Nevertheless, to date, nothing is known about the applicability and standard values in childhood. MATERIAL AND METHODS In this monocentric, prospective study, we investigated whether SHIMPs enable a sensitive functional analysis of the vestibular system in healthy children of different ages. For this purpose, SHIMPs were performed in 40 children aged 3-18 years. RESULTS In this study, we demonstrated that SHIMPs can be easily performed in children (3-18 years). It is vital that the test be appropriately explained for children to ensure sufficient test tolerance and compliance. CONCLUSION SHIMPs are a helpful supplement to clinically established vestibular tests such as the HIMP in pediatric vestibular balance disorder diagnostics and can be integrated into the clinical routine, especially in children who have minimal verbal abilities or understanding of the instructions for HIMP. Similar to the HIMP, SHIMPs are characterized by a short test duration and a high tolerance.
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Affiliation(s)
- J Nguyen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - J Berger
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - I Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, Australia
| | - V Held
- Department of Neurology, University Hospital Mannheim, Germany
| | - L Zaubitzer
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - R Hülse
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - N Rotter
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany
| | - A Schell
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Germany.
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Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111056. [PMID: 34828769 PMCID: PMC8625109 DOI: 10.3390/children8111056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 12/31/2022]
Abstract
(1) Background: To assess the prevalence and frequency distribution of balance disorders in children and adolescents to delineate the planning of a targeted clinical and instrumental diagnostic work-up; (2) Methods: Retrospective analysis of the clinical documentation of patients under 18 years suffering from balance disorders from 2010 to 2019. Detailed collection of clinical history, accurate clinical examination, including both nystagmus and vestibulospinal signs examinations, and specific instrumental testing were the basis of the diagnostic process. (3) Results: A total of 472 participants were included in the study. Vestibular loss (26.1%) was the most frequent cause of vertigo in children, followed by vestibular migraine (21.2%) and benign paroxysmal positional vertigo (10.2%). In 1.1% of patients, the cause of vertigo remained undefined; (4) Conclusions: The diagnostic process applied was effective in understanding the cause of balance disorders in most cases and prevents more complex and expensive investigations reserved for only a few selected cases.
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Vertigo and Dizziness in Children: An Update. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8111025. [PMID: 34828738 PMCID: PMC8623325 DOI: 10.3390/children8111025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 01/24/2023]
Abstract
Background: Vertigo and dizziness are relatively infrequent in paediatric patients, but specific data on the prevalence of these disorders are limited and influenced by various factors, including the age of the examined population. These conditions often have a significant impact on patients’ and parents’ quality of life. The aim of this paper is to investigate the prevalence of different aetiologies of vertigo in the paediatric population through a systematic review. Methods: According to PRISMA guidelines, a systematic review of the literature was performed. Medline and Embase were searched from January 2011 through to 10 September 2021. The search yielded 1094 manuscripts, which were reduced to 7 upon the application of inclusion criteria. Results: A total of 2470 paediatric patients were evaluated by the selected papers. Vestibular Migraine was the most frequently diagnosed condition, occurring alone or in association with other diseases. Overall, audio-vestibular disorders represented the second cause of vertigo, and the prevalence appears to increase according to age growth. Over the years, even though we assisted in the amelioration of diagnostic rates, partially related to an improvement in diagnostic tools, the aetiology of vertigo remains still unclear in a variable percentage of patients. Conclusion: Vertigo in children, despite being an uncommon symptom, requires a multidisciplinary approach, often involving Paediatricians, Neurologists and Otorhinolaryngologists. A comprehensive evaluation of children suffering from vertigo is crucial for establishing a successful therapy and reducing parental worries.
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