Benign Paroxysmal Vertigo Of Childhood Research Articles

Childhood vertigo: A retrospective series of 791 cases

Background: Vertigo is one of the most common complaints leading to admissions in pediatric neurology clinics. Diagnosis of vertigo in children is often challenging due to limited communication capacity in defining symptoms, the unreliability of neurovestibular investigations in children and the variability of etiologies. The aim of this study is to evaluate clinical and etiological profile of vertigo in childhood and to assess the diagnostic yield of neuroimaging and electroencephalography (EEG). Methods: All patients under the age of 18 years presented with vertigo to the pediatric neurology outpatient clinic of Ankara Keçiören Research and Training Hospital were included in the study. Demographic data, accompanying symptoms, family history, physical and neurological examination findings, neuroimaging, and EEG results were retrospectively analyzed. The etiological spectrum was also evaluated according to age groups. Results: A total of 791 patients (female/male=2.1) with a mean age of 13.1 years were included in the study. The most common etiologies were vestibular migraine (27.3%) and psychogenic vertigo (14.9%) in the entire cohort; whereas benign paroxysmal vertigo of childhood was the top diagnosis in children ≤12 years (25%). The most common accompanying symptom was headache (36.7%) which was most frequently associated with vertigo attacks in migrainous patients. In most cases there was no correlation between neuroimaging findings and vertigo. Additionally, the contribution of EEG to the diagnosis was found to be limited. Conclusion: Most of the childhood vertigo cases can be diagnosed accurately by a detailed medical history, physical and neurological examination. A multidisciplinary approach is essential for evaluating childhood vertigo and all the signs and symptoms accompanying vertigo should be considered while planning further investigations including neuroimaging and EEG.

The First 100 Children Treated in a Newly Established Pediatric Vertigo Center.

Correctly diagnosing dizziness in children is essential for appropriate management; nevertheless, healthcare professionals face challenges due to children's limited ability to describe their symptoms and their cooperation during physical examination. The objective of this study is to describe the first 100 patients seen at a newly established pediatric vertigo center. This is a retrospective review of a consecutive series of 100 patients seen at our pediatric vertigo clinic in a tertiary referral center from August 2019 until June 2022. Comprehensive clinical data were collected. The diagnoses were established by 2 pediatric otolaryngologists based on validated diagnostic criteria. Trends in diagnosis, investigation, and treatment of these patients were analyzed. A total of 100 children were included in the study. Vestibular migraine was the most common diagnosis (20%) followed by benign paroxysmal vertigo of childhood (14%). Eleven patients had combined pathologies. Fifteen out of 70 children (21%) had abnormal audiograms, 30 out of 48 children (62.5%) had abnormal vestibular testing, and 6 out of 31 (19%) patients had abnormal imaging. Fifty-one children received medical treatment, 23 received vestibular physiotherapy, and 9 patients had particle repositioning maneuvers; moreover, 17 of these patients received multimodal treatment. Our analysis suggests that imaging and audiology testing have relatively low yield in the assessment of pediatric vertigo. On the other hand, vestibular testing detected a high proportion of abnormalities, such as saccadic pursuit, vertical nystagmus, central positional nystagmus, and abnormal directional preponderance, particularly associated with vestibular migraine. Given the complexity of diagnosing vertigo in children, it is critical to establish multidisciplinary specialized centers capable of providing accurate diagnosis and treatment for these children.

Clinical diagnoses of patients showing caloric inversion

ObjectivesWhen air irrigation is used for caloric stimulation in patients with a perforated ear, warm irrigation may elicit a nystagmus that initially beats in the opposite direction of what is expected for warm irrigations, which is referred to as “caloric inversion”. This study aimed to investigate the disease group in which caloric inversion appeared in patients who underwent caloric testing and to classify the patterns of caloric inversion. MethodsWe conducted a retrospective review of bithermal caloric test results that were collected in our dizziness clinic between 2005 and 2022. Caloric inversion was defined when nystagmus induced by caloric stimulation appeared in the opposite direction to that expected. The incidence of caloric inversion among all patients who underwent bithermal caloric tests was calculated. To confirm the clinical diagnoses of the patients with caloric inversion, their clinical records were reviewed. ResultsOut of 9923 patients who underwent bithermal caloric tests, 29 patients (0.29%) showed a caloric inversion. The most common clinical diagnosis was chronic otitis media (21 of 29, 72%). Of the 21 patients with chronic otitis media, 20 patients showed a caloric inversion by warm air irrigation and one patient showed caloric inversion by cold air stimulation. Patients with clinical diagnoses other than chronic otitis media such as sudden sensorineural hearing loss, benign paroxysmal vertigo of childhood and recurrent vestibulopathy showed caloric inversion by warm air irrigation. Caloric inversion by warm water irrigation was observed in patients with lateral semicircular canal cupulopathy and recurrent vestibulopathy. Two patients (one with Meniere’s disease and one with age-related dizziness) showed caloric inversion by cold water irrigation. ConclusionCaloric inversion can be observed in various diseases other than chronic otitis media with tympanic membrane perforation. Special care should be taken in the interpretation of caloric test results. Level of EvidenceLevel 4.

Benign paroxysmal vertigo of childhood: A case report

Benign Paroxysmal Vertigo of Childhood (BPVC) is a disorder characterized by recurrent episodes of dizziness which are often sudden, occurring in the first decade of life, last a few seconds to one minute, recover completely after the episode and often would re-occur several times a month for several years. The present case study was to highlight the clinical features of BPVC in a 3 year old female child. Audiologists must be well aware of the typical features and clinical perspectives of BPVC.

Recurrent Vertigo of Childhood: Clinical features and prognosis.

Introduction“Recurrent Vertigo of Childhood” (RVC) has recently replaced the term “Benign Paroxysmal Vertigo of Childhood” and was defined as recurrent spells of vertigo without evidence of a vestibular migraine of childhood (VMC). RVC and VMC are considered the most frequent causes of vertigo and dizziness in children below 18 years of age. Diagnosis might be challenging since clinical features of RVC and VMC may overlap.ObjectiveThis study aims to characterize clinical and instrument-based findings in patients with RVC and to evaluate the course of the disorder.MethodsWe prospectively collected clinical and instrument-based data of children/adolescents younger than 18 years, who presented at the German Center for Vertigo and Balance Disorders (DSGZ) at the LMU University Hospital in Munich. All patients underwent a comprehensive neurological, ocular motor, vestibular and cochlear examination. Furthermore, findings from follow-up examinations were analyzed.ResultsOverall 42 children (24 male and 18 female) with RVC were included in the study. The mean age at diagnosis was 7 ± 3.6 years with a mean onset of symptoms at the age of 5.6 ± 3.4 years. Attack duration ranged between 1 min and 4 h. The most common accompanying symptoms included nausea, vomiting, expression of fear, and falls. Non-migrainous headaches were reported by 11 patients during initial presentation, 7 of whom were later diagnosed with migraine. Female patients showed a higher age at symptom onset, a higher attack frequency, and attack duration. Eleven of the 24 patients seen at a 3.5 year follow-up reported a complete cessation of attacks. Patients still experiencing vertigo attacks had a significantly reduced attack frequency, especially those who implemented at least one prophylactic measure.ConclusionA precise characterization of symptoms is essential for diagnosing children with RVC. Age at symptom onset does not exceed the age of 12. Gender-specific differences should be considered and may further support the evidence of an association with migraine. The disease course of RVC is benign, nevertheless implementing prophylactic measures such as regular exercise, increased fluid intake, sleep hygiene, and relaxation exercises, can improve attack frequency.

Evolution of pediatric vertigo/dizziness during the past two decades

Background Increasing life expectancy and declining birth rate are two key drivers of population aging globally, resulting in a falling population. Objective This study investigated the evolution of pediatric patients with vertigo/dizziness during the past two decades. Methods From 2001 to 2010, a total of 17,123 new patients with vertigo/dizziness visited our neurotological clinic. Of them, 472 (2.8%) were children (Group A). In contrast, 260 children (1.3%) out of 20,404 new patients with vertigo/dizziness were experienced during the period 2011–2020 (Group B). All patients underwent an inner ear test battery before diagnosis. Results The incidence of pediatric vertigo/dizziness in relation to overall neurotological cases significantly decreased from the first decade (2.8%) to the second decade (1.3%). Approximately 80% prevalence of pediatric vertigo/dizziness cases were referred to as vestibular migraine and benign paroxysmal vertigo of childhood regardless of Group A or B. Correlation between annual birth rate (x) and incidence of pediatric vertigo/dizziness cases in relation to overall neurotological cases (y) represented as y = 6.488x − 0.037 via linear regression analysis. Conclusion The evolution of pediatric vertigo/dizziness revealed decreased incidence from 2.8% (2001–2010) to 1.3% (2011–2020), which may be related to the declined annual birth rate from 11.7‰ (2001) to 7.0‰ (2020).

Benign Paroxysmal Positional Vertigo in Children: A Narrative Review.

Benign paroxysmal positional vertigo is a rare vestibular disorder in the pediatric population. It is a vestibulopathy characterized by brief attacks of vertigo, which occur after specific movements. This review aims to provide the current evidence regarding benign paroxysmal positional vertigo in children. This is a narrative review of the available literature on benign paroxysmal positional vertigo in children. The studies were retrieved from systematic searches on PubMed and by cross referencing. Few studies have focused on pediatric benign paroxysmal positional vertigo, and most are retrospective non-controlled studies that include a small number of children. The vast majority of cases of benign paroxysmal positional vertigo in children have been reported to be secondary. The most frequent forms involve the posterior canal and the horizontal canal. The diagnosis is based on positional maneuvers, respectively the Dix–Hallpike maneuver, which reveals a torsional upbeating nystagmus; and the supine roll test, which reveals a geotropic, horizontal nystagmus. The treatment consists of physical repositioning maneuvers: the Semont or the modified Epley maneuver for benign paroxysmal positional vertigo involving the posterior canal and the Gufoni or the Barbecue maneuver in case of the horizontal canal. Benign paroxysmal positional vertigo in children can be resistant to treatment and repetitive positional maneuvers may be necessary, particularly for children with vestibular migraine or benign paroxysmal vertigo of childhood, who have a statistically significant major risk of having recurrences compared to patients who do not. Benign paroxysmal positional vertigo in children is a rare but well-recognized clinical entity. It is diagnosed by positional testing and treated by repositioning maneuvers. Wide awareness and education among pediatric providers and otolaryngologists are needed in order to avoid a delay in identification and treatment.

Common vestibular disorders in children in Fayoum governorate: a cross-sectional study

BackgroundVertigo in paediatric age is not a rare condition. However, a lack of awareness about causes of dizziness in children besides the absence of standard diagnostic workup often leads to unnecessary procedures in managing these cases. The purpose of this cross-sectional study was to determine the prevalence and frequency distribution of balance abnormalities in dizzy children. Additionally, the questionnaire’s utility as a screening tool and its predictive accuracy are discussed. Thus, an organized strategy can be allocated to assist the diagnostic process, which is likely to eliminate unnecessary and costly evaluations.ResultsThis study comprised 848 children who presented with any of the dizzy symptoms referred to the Audio-Vestibular Unit, Fayoum University Hospital. The suggested diagnosis was 23.9% of the cases suffered from otitis media either alone or combined with other diseases, while 17.6% had benign paroxysmal vertigo of childhood. Migraine patients represented 11.2% of the cases. Only 5.5% of subjects had benign paroxysmal positional vertigo. 78.3% of cases with possible diagnosis showed agreement in diagnosis by both paediatric dizziness questionnaire and the final diagnosis reached by a full assessment of the patients.ConclusionDiagnosing dizziness in children is challenging; nevertheless, a structured history taken in conjunction with a vestibular examination is crucial for establishing an accurate diagnosis. The questionnaire appears to be an even-handed tool for diagnosing dizzy children.

Dizziness in children and adolescents

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.

Benign paroxysmal vertigo of childhood

Background: Benign paroxysmal vertigo (BPV), one of the most common causes of pediatric vertigo, is characterized by recurrent sudden short-lived attacks of vertigo, which resolve spontaneously without residual disability in otherwise healthy children. In this report, we present a literature review on BPV in childhood.Current Concepts: A child with BPV appears frightened and experiences a spinning sensation with occasional nystagmus and vomiting. Episodes usually last less than a minute and are not associated with hearing loss and altered consciousness. Most patients present with a relapsing-remitting clinical course for weeks to years, after which they usually resolve spontaneously. Based on current evidence, BPV of childhood is considered a variant of migraine, and vasospasm observed in patients with migraine plays an important role in the pathogenesis of this disorder. It is important to differentiate BPV from other diseases that present with vertigo, including basilar migraine, closed head injury, psychiatric dizziness, and acute labyrinthitis.Discussion and Conclusion: BPV is a common but important disorder observed in children and should be considered in the differential diagnosis in children with the aforementioned clinical presentation. It is important to reassure patients and parents regarding the benign course of BPV.

Symposium Title: The Contribution of Neurophysiology to Migraine: From Basic Mechanisms to the Effects of Novel Treatments

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.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.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.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%).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.

Vestibular Disorders in the Pediatric Age: Retrospective Analysis and Review of the Literature

Vestibular disorders in pediatric patients is still a controversial subject but has gained relevance over the years. In recent studies, its prevalence varied between 0.7% and 15%. Nevertheless, the true prevalence can be underestimated given that its clinical presentation is expressed compared to adults; it can present as rotatory vertigo, but It can also cause vision complaints, headaches, motor delay, and learning disability. Although middle ear effusion is considered the main cause of vestibular dysfunction in this age group, other diagnoses should be considered. The aim of this study was to describe clinical features of the pediatric population referred to a subspecialist Otorhinolaryngology vertigo clinic in a tertiary hospital between 2013 and 2017. We also aimed to compare the results and carry out a literature about the most common causes, diagnostic features and treatment approach. Clinical records of patients referred to a subspecialist Otorhinolaryngology vertigo clinic with suspicion of vestibular dysfunction aged between 0 and 18 years old were reviewed. Patients with middle ear effusion were excluded. Thirty-seven patients met the inclusion criteria. From these, 59% were female, with a mean age of 10.9 years old during the first consultation. The most common reason for referral was rotatory vertigo. Nausea and headache were also frequent complaints in our population. All patients performed audiometry; videonistagmography was performed in 41% of the cases; imaging studies were done in 59% of patients. The most common causes of vestibular dysfunction were vestibular migraine and benign paroxysmal vertigo of childhood (both in 27% of the cases), followed by vestibular neuritis (in 22% of the cases). Although our findings partially concur with the literature, compared with other specialist centers, the range of reasons for referral and of conditions is not as diverse, which may suggest that there is underdiagnosis of vestibular dysfunction in this age group. Vestibular dysfunction in the pediatric age can have several causes; pediatricians, neurologists, physiatrists, family doctors and otorhinolaryngologists must be aware of the different forms of presentation. Referral and evaluation protocols addressing pediatric patients should be created.

Prevalence, clinical profile, and diagnosis of pediatric dizziness in a tertiary care hospital

IntroductionPediatric 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. ObjectivesTo 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. MethodsA 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. ResultsThe 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%). ConclusionsThe 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.

Vestibular and Balance Disorders in Mexican Children and Adolescents: Review of 8-Year Clinical Records

IntroductionVertigo is a seldom studied symptom in the paediatric population, where the prevalence is less than 1%. Vestibular disorders in children are not comparable to those of adults and are often underdiagnosed. Identifying the main causes of these disorders would provide reliable and accurate data of the diseases in certain age groups, improving the diagnostic process. Material and methodsObservational, cross-sectional, and retrospective study. Consecutive records of patients, aged 3–17years, attended due to vestibular, balance and associated symptoms (vertigo, dizziness, hearing loss, balance disorders and headache), attended by the otoneurology service of a tertiary hospital, between September 2010 and September 2018, were included. Descriptive and inferential statistics were used for the analysis. All P-values reported from these analyses were two-tailed with a significance level <.05. Results212 cases were registered from 6444 consultations (3.3%). The proportion between males and females was similar. The mean age of the group was 14.5 (±3.9) years, the median age of onset of symptoms was 11 (IQR 8–14) years and that of the first consultation was 13 (IQR 10–15) years. As a cardinal symptom, 51.9% attended due to vertigo, 25.5% due to dizziness, 9.9% due to gait instability, 7.5% due to hearing loss and 5.2% due to headache. Of the episodes of vertigo, 61.8% were of peripheral origin, 69 32.5% central and 12 5.7% outside the vestibular system. Benign paroxysmal vertigo of childhood, dysfunction and vestibular migraine accounted for more than 65% of cases. No differences were found between the diagnoses regarding the sex and age of the participants (P>.05). ConclusionVestibular and balance disorders are rare in the study population and most of the causes are benign and potentially self-limited disorders.

Vestibular disorders in children: A retrospective analysis of vestibular function test findings

ObjectiveThis study was designed to describe the most common vestibular disorders in children and their associated findings on vestibular function testing. MethodData from 203 children with a mean age of 11.16 ± 3.87 (range, 1–17) years were collected from among 3400 patients who underwent vestibular assessment at a vertigo center in a tertiary hospital over a 3-year period. A retrospective data analysis was performed for 203 children. ResultsVestibular disorders were diagnosed in 78.3% (n = 159) of 203 children among 3400 patients, which revealed a 3-year incidence of 4.67% in our study. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis in our group of children (49%; n = 100), which involved both primary BPPV, and secondary BPPV that was associated with other vestibular pathologies. Vestibular migraine (VM) was the second most common diagnosis (41%; n = 83) followed by benign paroxysmal vertigo of childhood (BPVC; 4.5%, n = 9), vestibular neuritis (VN; 4.5%, n = 9), and psychogenic vertigo (4.5%, n = 9). Our study showed that Meniere's Disease (MD; 1.5%, n = 3) and central vertigo (1.5%, n = 3) were less commonly diagnosed in children. Perilymphatic fistula (PLF) was diagnosed and surgically confirmed in only one child. ConclusionBPPV and VM were the most common pediatric vestibular disorders in our study. Clinicians should be aware of the prevalence, signs, and symptoms of the most common vestibular disorders in children to enable diagnosis, treatment, and rehabilitation. Vestibular function testing with age-appropriate adaptations results in improved differential diagnosis, which guides medical treatment and rehabilitation.

Vertigo during childhood: A disabling clinical entity

The etiology of the vertigo in pediatric age group is often multi-factorial, so clinician should approach a dizzy child with an open mind. Vertigo is not an uncommon symptom in children, though it often unrecognized in clinical practice. The vertigo in children may be acute nonrecurrent spontaneous vertigo, recurrent vertigo and nonvertiginous dizziness or disequilibrium or ataxia. The major causes for vertigo in the pediatric age group are benign paroxysmal vertigo of childhood, vestibular migraine and otitis media. Detailed patient history, routine physical examination, cochlear function tests, vestibular functions tests and imaging are helpful for getting the diagnosis in childhood vertigo. Moreover, the lack of the standard diagnostic protocol for pediatric vestibular examination represents another drawback for effective management of the pediatric vestibular impairment. This review article is a narrative discussion on prevalence, etiopathology, clinical manifestations and current management of the pediatric vertigo. This review article will make a baseline from where further prospective trials for pediatric vestibular disorders can be designed and help as a spur for further research in this clinical entity as there are not many studies in this clinical entity.

Usefulness and practical insights of the pediatric video head impulse test

ObjectiveThe video head impulse test (vHIT) is a diagnostic tool to examine patients experiencing dizziness by assessing the function of the semicircular canals. vHIT has been widely studied in adults but relatively less so in children. The aim of this study was to evaluate the causes of dizziness and the results of vHIT in children. We also identified factors that affect the vHIT results such as artifacts and technical errors. Study designRetrospective review; SettingTertiary care center. PatientsA total of 39 patients who visited our clinic for dizziness from 2014 to 2017. Main outcome measuresThe gain of vestibulo-ocular reflex, refixation saccades, and artifacts were analyzed using vHIT. We analyzed 691 individual vHIT traces and categorized the artifacts into 8 categories. ResultsTwenty-three males and 16 females were included. The mean age was 13.84 ± 2.60 years (range, 7–18). Common causes of dizziness were benign paroxysmal vertigo of childhood (25.6%), vestibular neuritis (20.5%), and vestibular migraine (17.9%). The sensitivity and specificity of vHIT based on the bithermal caloric test results were 40% and 94%, respectively. The analysis of vHIT traces revealed that the children had higher artifact ratios of vHIT than the adults. The main artifacts were high gain and blinking eyes. ConclusionThe vHIT results showed a higher percentage of artifacts in children than in the adults. More careful efforts are required to obtain more accurate results during the test, and it is necessary to check for technical errors while interpreting the results.

Retrospective review of children with vertigo: a 3-year experience

Objectives: To evaluate the age, sex, accompanying symptoms, etiologic factors and laboratory findings in children with vertigo in a tertiary research hospital. Methods: A total of 183 children (65 boys and 118 girls), aged 3-18 (median:14), who presented with complaints of vertigo between November 2016 and September 2019 in the pediatric neurology department were examined retrospectively. Systemic and neurological examination findings, laboratory findings including complete blood count and biochemical tests (fasting blood glucose, electrolytes, liver-kidney function tests), iron, iron-binding capacity, ferritin, vitamin B12 level and thyroid function test results, electroencephalography (EEG) and magnetic resonance imaging findings were examined. Results: The frequency of vertigo complaints were found to be higher in female gender (p = 0.008). The frequency of admission was significantly higher in adolescents (&amp;gt; 12 years) (67%) compared to other age groups (p &amp;lt; 0.001). The most common cause of vertigo was benign paroxysmal vertigo of childhood (BPVC) (23%) and orthostatic hypotension (22%) was the second. When the relationship between the etiology of vertigo and age was examined, the most common cause was BPVC under 12 years of age, where as orthostatic hypotension was significantly more frequent in adolescents (p &amp;lt; 0.001). Headache (41%), syncope (27%) and nausea-vomiting (10%) were the most common accompanying symptoms with vertigo. Epileptiform disorder was detected in 7% of patients who underwent EEG. Of 171 patients who underwent neuroimaging, 85% reported as normal and 10% had non-specific findings. Conclusions: In children presenting with a complaint of vertigo, a detailed history including the age at when the complaint began and the accompanying symptoms, physical examination, blood pressure measurement, laboratory tests, and EEG and neuroimaging (if necessary) should be performed with a multidisciplinary approach.

Trastornos vestibulares y del equilibrio en niños y adolescentes mexicanos: revisión de registros clínicos de 8 años

IntroductionVertigo is a seldom studied symptom in the paediatric population, where the prevalence is less than 1%. Vestibular disorders in children are not comparable to those of adults and are often underdiagnosed. Identifying the main causes of these disorders would provide reliable and accurate data of the diseases in certain age groups, improving the diagnostic process. Material and methodsObservational, cross-sectional, and retrospective study. Consecutive records of patients, aged 3 to 17years, attended due to vestibular, balance and associated symptoms (vertigo, dizziness, hearing loss, balance disorders and headache), attended by the otoneurology service of a tertiary hospital, between September 2010 and September 2018, were included. Descriptive and inferential statistics were used for the analysis. All p-values reported from these analyses were two-tailed with a significance level <.05. Results212 cases were registered from 6,444 consultations (3.3%). The proportion between males and females was similar. The mean age of the group was 14.5 (±3.9) years, the median age of onset of symptoms was 11 (IQR 8-14) years and that of the first consultation was 13 (IQR 10-15) years. As a cardinal symptom, 51.9% attended due to vertigo, 25.5% due to dizziness, 9.9% due to gait instability, 7.5% due to hearing loss and 5.2% due to headache. Of the episodes of vertigo, 61.8% were of peripheral origin, 69 32.5% central and 12 5.7% outside the vestibular system. Benign paroxysmal vertigo of childhood, dysfunction and vestibular migraine accounted for more than 65% of cases. No differences were found between the diagnoses regarding the sex and age of the participants (P>.05). ConclusionVestibular and balance disorders are rare in the study population and most of the causes are benign and potentially self-limited disorders.

Vestibular Syndromes in Childhood and Adolescence.

Introduction The prevalence of vestibular disorders in childhood ranges from 0.4% to 15%; they may be the result of several factors, but most of the time it's an episodic vestibular syndrome related to migraine equivalents. Objective To evaluate the diagnostic and therapeutic aspects of children with vestibular signs and symptoms. Methods The present cross-sectional study evaluated data from the records of patients treated in an outpatient pediatric neurotology clinic over a 10-year period. These data included sociodemographic and clinical variables, results of complementary examinations, the treatment provided, and the clinical evolution. Results The sample was composed of 117 patients, with 54.7% of female subjects with a mean age of 10 years. The most prevalent diagnosis was benign paroxysmal vertigo of childhood (BPVC) (41.9%), followed by vestibular migraine (16.2%). The most prevalent complaint was vertigo (53.9% of the cases). Most patients (66.7%) had inadequate eating habits. Improvement of symptoms was observed in 40.4% of the patients treated with dietary guidance alone. In 80% of the cases, dietary counseling in combination with vestibular rehabilitation therapy achieved therapeutic success without the need of a drug treatment. Conclusion The predominant diagnosis was of BPVC, and its close relationship with the personal and family history of migraine, its benign evolution, and the importance of dietary guidance and vestibular rehabilitation for therapeutic success were observed.