Update in Diagnosis and Treatment of Vertigo in Children
Ramadan Mohamed Tawfik Ali Hat-hout;
Abstract
Vertigo is sensation of spinning of the environment. Dizziness is not ‘typical rotatory vertigo’. It is not just spinning but any illusion of motion.Remember, vertigo is a symptom not a diagnosis.
Vertigo in children is dangerous;
• It interferes with the intellectual and physical development.
• It can cause trauma after fall down in acute attacks.
• It causes difficulties in learning, concentration and behavior.
The prevalence of vertigo in childhood reaches upto 15% of pediatric population.
The differential diagnosis of vertigo in childhood is large and includes diseases more different than in the adult population. Common diseases seen in adulthood, such as BPPV, viral infections of the inner ear, and Ménière’s disease, are rare in children.
The most common causes of Vertigo in childrenare benign paroxysmal vertigo of children 18.7%, vestibular migraine 17.6%, Head trauma 14%, psychogenic vertigo 4.1%, otitis media causing vertigo 3%, BPPV 1.8%, Meniere’s disease 1.5% and orthostatic hypotension 1.2%.
Diagnosis of vertigo in children is difficult due to;
1. Children lack the communication ability, and can’t describe their symptoms.
2. Children infrequently complain of vertigo, theyfear to be considered a clumsy or stupid child.
3. Vertigo and dizziness are rarely seen during childhood.
4. Diseases causing vertigo in children are unique for this population, such as benign paroxysmal vertigoofchildren.
5. There are few published reports regarding vestibular and balance disorders in the pediatric age group.
Diagnosis is still based mainly upon the patient’s history andphysical examination. History from child or his parents or caregivers; it is useful to use a structured questionnaire andAlgorithm. Physical examination as usual starts by general examination, full otorhinolaryngology specially The Ears and neurologic examination. Then bedside Vestibular Tests aiming to examine vestibulo-ocular reflexes (VOR) and vestibulo-spinal reflexes (VSR) are performed.
The best tests to determine whether a child with an otherwise normal neurological system has vestibular hypofunction include. the Head Thrust Test (HTT), the modified Emory Clinical Vestibular Chair Test (m-ECVCT) fixation removed, the Dynamic Visual Acuity test DVA, the Modified Clinical Test of Sensory Interaction on Balance (MCTSIB), and the Sensory Organization Test (SOT) vestibular ratio.
Treatment depends on etiology. The vast majority of vertigo diseases in childhood can be effectively treated by physical therapy or drugs. Physical therapy with posture and gait training is recommended in chronic syndromes (e.g. cerebellar ataxia), surgery rarely necessary.
Vertigo in children is dangerous;
• It interferes with the intellectual and physical development.
• It can cause trauma after fall down in acute attacks.
• It causes difficulties in learning, concentration and behavior.
The prevalence of vertigo in childhood reaches upto 15% of pediatric population.
The differential diagnosis of vertigo in childhood is large and includes diseases more different than in the adult population. Common diseases seen in adulthood, such as BPPV, viral infections of the inner ear, and Ménière’s disease, are rare in children.
The most common causes of Vertigo in childrenare benign paroxysmal vertigo of children 18.7%, vestibular migraine 17.6%, Head trauma 14%, psychogenic vertigo 4.1%, otitis media causing vertigo 3%, BPPV 1.8%, Meniere’s disease 1.5% and orthostatic hypotension 1.2%.
Diagnosis of vertigo in children is difficult due to;
1. Children lack the communication ability, and can’t describe their symptoms.
2. Children infrequently complain of vertigo, theyfear to be considered a clumsy or stupid child.
3. Vertigo and dizziness are rarely seen during childhood.
4. Diseases causing vertigo in children are unique for this population, such as benign paroxysmal vertigoofchildren.
5. There are few published reports regarding vestibular and balance disorders in the pediatric age group.
Diagnosis is still based mainly upon the patient’s history andphysical examination. History from child or his parents or caregivers; it is useful to use a structured questionnaire andAlgorithm. Physical examination as usual starts by general examination, full otorhinolaryngology specially The Ears and neurologic examination. Then bedside Vestibular Tests aiming to examine vestibulo-ocular reflexes (VOR) and vestibulo-spinal reflexes (VSR) are performed.
The best tests to determine whether a child with an otherwise normal neurological system has vestibular hypofunction include. the Head Thrust Test (HTT), the modified Emory Clinical Vestibular Chair Test (m-ECVCT) fixation removed, the Dynamic Visual Acuity test DVA, the Modified Clinical Test of Sensory Interaction on Balance (MCTSIB), and the Sensory Organization Test (SOT) vestibular ratio.
Treatment depends on etiology. The vast majority of vertigo diseases in childhood can be effectively treated by physical therapy or drugs. Physical therapy with posture and gait training is recommended in chronic syndromes (e.g. cerebellar ataxia), surgery rarely necessary.
Other data
| Title | Update in Diagnosis and Treatment of Vertigo in Children | Other Titles | التحديث فى تشخيص وعلاج الدوار فى الأطفال | Authors | Ramadan Mohamed Tawfik Ali Hat-hout | Issue Date | 2015 |
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