Multifactorial Characteristics of Pediatric Dizziness and Imbalance
Alicia Wang BSE
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Search for more papers by this authorGuangwei Zhou ScD
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Harvard Medical School, Boston, Massachusetts, U.S.A.
Search for more papers by this authorSophie Lipson BA
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Tufts School of Medicine, Boston, Massachusetts, U.S.A.
Search for more papers by this authorKosuke Kawai ScD
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Harvard Medical School, Boston, Massachusetts, U.S.A.
Search for more papers by this authorMeghan Corcoran MSN, CPNP
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Search for more papers by this authorCorresponding Author
Jacob R. Brodsky MD
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Harvard Medical School, Boston, Massachusetts, U.S.A.
Send correspondence to Jacob R. Brodsky, MD, 300 Longwood Avenue, Boston, MA 02115. E-mail: [email protected]
Search for more papers by this authorAlicia Wang BSE
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Search for more papers by this authorGuangwei Zhou ScD
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Harvard Medical School, Boston, Massachusetts, U.S.A.
Search for more papers by this authorSophie Lipson BA
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Tufts School of Medicine, Boston, Massachusetts, U.S.A.
Search for more papers by this authorKosuke Kawai ScD
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Harvard Medical School, Boston, Massachusetts, U.S.A.
Search for more papers by this authorMeghan Corcoran MSN, CPNP
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Search for more papers by this authorCorresponding Author
Jacob R. Brodsky MD
Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Harvard Medical School, Boston, Massachusetts, U.S.A.
Send correspondence to Jacob R. Brodsky, MD, 300 Longwood Avenue, Boston, MA 02115. E-mail: [email protected]
Search for more papers by this authorEditor's Note: This Manuscript was accepted for publication on July 21, 2020.
All financial support for this study was provided by the Department of Otolaryngology and Communication Enhancement at Boston Children's Hospital.
The authors have no other funding or conflicts of interest to declare.
The authors would like to acknowledge Talia Shoshany, Karampreet Kaur, and Cassandra Goutos for their help in collecting data for the database that this study examined.
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
Supporting Information
| Filename | Description |
|---|---|
| lary29024-sup-0001-Supinfo.docxWord 2007 document , 16.7 KB | Appendix S1 All assigned diagnoses for vestibular symptoms divided by general category, including number of patients assigned each diagnosis in study sample. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
BIBLOGRAPHY
- 1Brodsky JR, Lipson S, Bhattacharyya N. Prevalence of pediatric dizziness and imbalance in the United States. Otolaryngol Head Neck Surg 2020; 162: 241–247.
- 2Deissler A, Albers L, von Kries R, et al. Health-related quality of life of children/adolescents with vertigo: retrospective study from the German Center of Vertigo and Balance Disorders. Neuropediatrics 2017; 48: 91–97.
- 3Choung YH, Park K, Moon SK, Kim CH, Ryu SJ. Various causes and clinical characteristics in vertigo in children with normal eardrums. Int J Pediatr Otorhinolaryngol 2003; 67: 889–894.
- 4Erbek SH, Erbek SS, Yilmaz I, et al. Vertigo in childhood: a clinical experience. Int J Pediatr Otorhinolaryngol 2006; 70: 1547–1554.
- 5Gioacchini 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: 718–724.
- 6Jahn K. Vertigo and dizziness in children. Handb Clin Neurol 2016; 137: 353–363.
- 7Lee JD, Kim CH, Hong SM, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: a multi-center study. Int J Pediatr Otorhinolaryngol 2017; 94: 36–39.
- 8McCaslin 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.
- 9Niemensivu R, Pyykko I, Wiener-Vacher SR, Kentala E. Vertigo and balance problems in children–an epidemiologic study in Finland. Int J Pediatr Otorhinolaryngol 2006; 70: 259–265.
- 10O'Reilly RC, Greywoode J, Morlet T, et al. Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surg 2011; 144: 142–148.
- 11Ravid S, Bienkowski R, Eviatar L. A simplified diagnostic approach to dizziness in children. Pediatr Neurol 2003; 29: 317–320.
- 12Sommerfleck PA, Gonzalez Macchi ME, Weinschelbaum R, De Bagge MD, Bernaldez P, Carmona S. Balance disorders in childhood: Main etiologies according to age. Usefulness of the video head impulse test. Int J Pediatr Otorhinolaryngol 2016; 87: 148–153.
- 13Wiener-Vacher SR. Vestibular disorders in children. Int J Audiol 2008; 47: 578–583.
- 14Zhu RT, Van Rompaey V, Ward BK, Van de Berg R, Van de Heyning P, Sharon JD. The interrelations between different causes of dizziness: a conceptual framework for understanding vestibular disorders. Ann Otol Rhinol Laryngol 2019; 128: 869–878.
- 15Muelleman T, Shew M, Subbarayan R, et al. Epidemiology of dizzy patient population in a Neurotology clinic and predictors of peripheral etiology. Otol Neurotol 2017; 38: 870–875.
- 16van Leeuwen RB, Colijn C, van Wensen E, Bruintjes TD. The dizzy patient: consider a second diagnosis. Neurologist 2017; 22: 69–71.
- 17Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform 2019; 95: 103208.
- 18Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.
- 19 Headache Classification Committee of the International Headache S. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 629–808.
- 20Journal of Vestibular Research. International classification of vestibular disorders 2019. Available at: https://www.jvr-web.org/ICVD.html. Accessed June 1, 2020.
- 21McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017; 51: 838–847.
- 22O'Reilly RC, Morlet T, Nicholas BD, et al. Prevalence of vestibular and balance disorders in children. Otol Neurotol 2010; 31: 1441–1444.
- 23von Brevern M, Lempert T. Vestibular migraine. Handb Clin Neurol 2016; 137: 301–316.
- 24Lauritsen CG, Marmura MJ. Current treatment options: vestibular migraine. Curr Treat Options Neurol 2017; 19: 38–38.
- 25O'Connell Ferster AP, Priesol AJ, Isildak H. The clinical manifestations of vestibular migraine: a review. Auris Nasus Larynx 2017; 44: 249–252.
- 26Brodsky 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.
- 27Balatsouras DG, Kaberos A, Assimakopoulos D, Katotomichelakis M, Economou NC, Korres SG. Etiology of vertigo in children. Int J Pediatr Otorhinolaryngol 2007; 71: 487–494.
- 28Brodsky JR, Lipson S, Wilber J, Zhou G. Benign paroxysmal positional vertigo (BPPV) in children and adolescents: clinical features and response to therapy in 110 pediatric patients. Otol Neurotol 2018; 39: 344–350.
- 29Brodsky JR, Shoshany TN, Lipson S, Zhou G. Peripheral vestibular disorders in children and adolescents with concussion. Otolaryngol Head Neck Surg 2018; 159: 365–370.
- 30Bittar RS, Lins EM. Clinical characteristics of patients with persistent postural-perceptual dizziness. Braz J Otorhinolaryngol 2015; 81: 276–282.
- 31Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol 2018; 18: 5–13.
- 32Popkirov S, Stone J, Holle-Lee D. Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders. Curr Treat Options Neurol 2018; 20: 50–50.
- 33Staab JP, Ruckenstein MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol 2007; 133: 170–176.
10.1001/archotol.133.2.170 Google Scholar
- 34Meehan WP 3rd, Mannix R. Pediatric concussions in United States emergency departments in the years 2002 to 2006. J Pediatr 2010; 157: 889–893.
- 35Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med 2011; 39: 2311–2318.
- 36Hoffer ME, Gottshall KR, Moore R, Balough BJ, Wester D. Characterizing and treating dizziness after mild head trauma. Otol Neurotol 2004; 25: 135–138.
- 37Scott BR, Uomoto JM, Barry ES. Impact of pre-existing migraine and other co-morbid or co-occurring conditions on presentation and clinical course following deployment-related concussion. Headache 2020; 60: 526–541.
- 38Kontos AP, Elbin RJ, Sufrinko A, Marchetti G, Holland CL, Collins MW. Recovery following sport-related concussion: integrating pre- and Postinjury factors into multidisciplinary care. J Head Trauma Rehabil 2019; 34: 394–401.
- 39Carlson JM, Kangas KJ, Susa TR, Fang L, Moore MT. Sport-related concussion is associated with elevated anxiety, but not attentional bias to threat. Brain Inj 2020; 34: 363–368.
- 40Pan Q, Zhang Y, Long T, et al. Diagnosis of vertigo and dizziness syndromes in a neurological outpatient clinic. Eur Neurol 2018; 79: 287–294.
- 41Hanley K, O' Dowd T. Symptoms of vertigo in general practice: a prospective study of diagnosis. Br J Gen Pract 2002; 52: 809–812.
- 42Türk B, Akpinar M, Kaya KS, Korkut AY, Turgut S. Benign paroxysmal positional vertigo: comparison of idiopathic BPPV and BPPV secondary to vestibular neuritis. Ear Nose Throat J 2019.
10.1177/0145561319871234 Google Scholar
- 43Murofushi T, Tsubota M, Kitao K, Yoshimura E. Simultaneous presentation of definite vestibular migraine and definite Meniere's disease: overlapping syndrome of two diseases. Front Neurol 2018; 9: 749.
- 44Simon NM, Pollack MH, Tuby KS, Stern TA. Dizziness and panic disorder: a review of the association between vestibular dysfunction and anxiety. Ann Clin Psychiatry 1998; 10: 75–80.
- 45Chu C-H, Liu C-J, Lin L-Y, Chen T-J, Wang S-J. Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. J Headache Pain 2015; 16: 62–62.
- 46Faralli M, Cipriani L, Del Zompo MR, Panichi R, Calzolaro L, Ricci G. Benign paroxysmal positional vertigo and migraine: analysis of 186 cases. B-Ent 2014; 10: 133–139.
- 47Teixido M, Baker A, Isildak H. Migraine and benign paroxysmal positional vertigo: a single-institution review. J Laryngol Otol 2017; 131: 508–513.
- 48Uneri A. Migraine and benign paroxysmal positional vertigo: an outcome study of 476 patients. Ear Nose Throat J 2004; 83: 814–815.
- 49Yetiser S, Gokmen MHA. Clinical aspects of benign paroxysmal positional vertigo associated with migraine. Int Tinnitus J 2015; 19: 64–68.
- 50Koo JW, Balaban CD. Serotonin-induced plasma extravasation in the murine inner ear: possible mechanism of migraine-associated inner ear dysfunction. Cephalalgia 2006; 26: 1310–1319.
- 51Best C, Tschan R, Eckhardt-Henn A, Dieterich M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience 2009; 164: 1579–1587.
- 52Edelman S, Mahoney AEJ, Cremer PD. Cognitive behavior therapy for chronic subjective dizziness: a randomized, controlled trial. Am J Otolaryngol 2012; 33: 395–401.
- 53Wang F, Wang J, Cao Y, Xu Z. Serotonin-norepinephrine reuptake inhibitors for the prevention of migraine and vestibular migraine: a systematic review and meta-analysis. Reg Anesth Pain Med 2020; 45: 323–330.
- 54Staab JP, Ruckenstein MJ, Amsterdam JD. A prospective trial of sertraline for chronic subjective dizziness. Laryngoscope 2004; 114: 1637–1641.
- 55Staab JP, Ruckenstein MJ, Solomon D, Shepard NT. Serotonin reuptake inhibitors for dizziness with psychiatric symptoms. Arch Otolaryngol 2002; 128: 554–560.
10.1001/archotol.128.5.554 Google Scholar
- 56Horii A, Mitani K, Kitahara T, Uno A, Takeda N, Kubo T. Paroxetine, a selective serotonin reuptake inhibitor, reduces depressive symptoms and subjective handicaps in patients with dizziness. Otol Neurotol 2004; 25: 536–543.
- 57Sacco S, Ricci S, Degan D, Carolei A. Migraine in women: the role of hormones and their impact on vascular diseases. J Headache Pain 2012; 13: 177–189.
- 58Mattsson P. Hormonal factors in migraine: a population-based study of women aged 40 to 74 years. Headache 2003; 43: 27–35.
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