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Dizziness and Balance Problems in Children

  • Pediatric Neurology (A Yeshokumar, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Dizziness and balance problems in children can be multifactorial. Awareness regarding these disorders is limited. This paper reviews the existing literature in this field to raise the awareness of the discipline that can generate significant morbidity in children. It looks in detail into epidemiology, the aetiology, the diagnostic algorithm and the management of dizziness and balance problems in children.

Recent findings

An accurate history followed by the latest diagnostic algorithm with the latest vestibular test battery that are utilised in adults can be used in children that lead to the diagnosis. The aetiological profile and natural history of different pathologies can be different from that in adults. Most cases can be managed successfully with multidisciplinary cognitive and customised rehabilitation approach.

Summary

Diagnosis and management of dizziness and balance disorders in children require experience and skill to yield the best outcome. Research is needed to study application of individual tests for diagnosis in children and the behaviour of vestibular and central disorders in children.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Li CM, et al. Epidemiology of dizziness and balance problems in children in the United States: a population-based study. J Pediatr. 2016;171:240–7. https://doi.org/10.1016/j.jpeds.2015.12.002. This is the most comprehensive epidemiological study of dizziness and balance problems in children in USA.

    Article  PubMed  Google Scholar 

  2. O’Reilly RC, et al. Prevalence of vestibular and balance disorders in children. Otol Neurotol. 2010;31(9):1441–4. https://doi.org/10.1097/MAO.0b013e3181f20673.

    Article  PubMed  Google Scholar 

  3. Humphriss RL, Hall AJ. Dizziness in 10 year old children: an epidemiological study. Int J Pediatr Otorhinolaryngol. 2011;75(3):395–400. https://doi.org/10.1016/j.ijporl.2010.12.015.

    Article  PubMed  Google Scholar 

  4. • Jahn K. Vertigo and balance in children--diagnostic approach and insights from imaging. Eur J Paediatr Neurol. 2011;15(4):289–94. https://doi.org/10.1016/j.ejpn.2011.04.010. This study is a detailed study to evaluate the diagnostic process involved in assessing paedatric vestibular disorders.

    Article  PubMed  Google Scholar 

  5. McLeod K. Dizziness and syncope in adolescence. Heart. 2001;86:350–4. https://doi.org/10.1136/heart.86.3.350.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. •• Raucci U, et al. Vertigo/dizziness in pediatric emergency department: five years’ experience. Cephalalgia. 2016;36(6):593–8. https://doi.org/10.1177/0333102415606078. Children with acute presentations of dizziness and balance problems are not infrequently observed and this study explores the relative prevalence of different central and vestibular disorders in the casualty setting.

    Article  PubMed  Google Scholar 

  7. Qubty W, Kedia S. Dizziness and orthostatic intolerance in pediatric headache patients. Semin Pediatr Neurol. 2016;23(1):71–8. https://doi.org/10.1016/j.spen.2016.01.004.

    Article  PubMed  Google Scholar 

  8. Emiroglu FN, et al. Assessment of child neurology outpatients with headache, dizziness, and fainting. J Child Neurol. 2004;19(5):332–6.

    Article  Google Scholar 

  9. •• O’Reilly RC, et al. Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surg. 2011;144(2):142–8. https://doi.org/10.1177/0194599810393679. This study is a useful study to evaluate the diagnostic process for managing vestibular disorders in children and observes that the test battery used for adults require to be customised and occasionally modified to test children.

    Article  PubMed  Google Scholar 

  10. •• Lee JD, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: a multi-center study. Int J Pediatr Otorhinolaryngol. 2017;94:36–9. https://doi.org/10.1016/j.ijporl.2017.01.012. A comprehensive epidemiological study in a specific group pf children.

    Article  PubMed  Google Scholar 

  11. • Riina N, et al. Vertigo and imbalance in children: a retrospective study in a Helsinki University Otorhinolaryngology Clinic. Arch Otolaryngol Head Neck Surg. 2005;131(11):996–1000 A snapshot study of vertigo and imbalance in children from a paediatric vestibular department providing useful insights.

    Article  Google Scholar 

  12. •• Wiener-Vacher SR, et al. Epidemiology of vestibular impairments in a pediatric population. Semin Hear. 2018;39(3):229–42. https://doi.org/10.1055/s-0038-1666815 This is the most comprehensive epidemiological study of dizziness and balance problems in children in France.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dasgupta S et al. Paediatric vestibular disorders. Personal series presented at Otometrics Hackathon 2017.

  14. • Dasgupta S, Ratnayake SAB. Functional and objective audiovestibular evaluation of children with apparent semicircular canal dehiscence–a case series in a pediatric vestibular center. Front Neurol. 2019. https://doi.org/10.3389/fneur.2019.00306. A comprehensive study exploring a frequent adult but rare third window condition in children in a paediatric vestibular centre.

  15. Ward BK, Carey JP, Minor LB. Superior canal dehiscence syndrome: lessons from the first 20 years. Front Neurol. 2017;8:177. https://doi.org/10.3389/fneur.2017.00177.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hereditary Hearing Loss Homepage. 2019; https://hereditaryhearingloss.org/ : accessed 01.08.2019 at 16.13 hours.

  17. Raj P, Gupta A. Vestibular dysfunction in children with Sensorineural hearing loss: a cross-sectional study. Indian J Otol. 2017;23(2):74–7.

    Article  Google Scholar 

  18. Pajor A, Jozefowicz-Korczynska M. Prognostic factors for vestibular impairment in sensorineural hearing loss. Eur Arch Otorhinolaryngol. 2008;265(4):403–7.

    Article  Google Scholar 

  19. Bernard S, Wiener-Vacher S, van den Abbeele T, Teissier N. Vestibular disorders in children with congenital cytomegalovirus infection. Pediatrics. 2015;136(4):e887–95. https://doi.org/10.1542/peds.2015-0908.

    Article  PubMed  Google Scholar 

  20. • Gioacchini FM, et al. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol. 2014;78(5):718–24. https://doi.org/10.1016/j.ijporl.2014.02.009. A rather useful overview of epidemiology and diagnosis of vestibular disorders in children with a review of the literature.

    Article  PubMed  Google Scholar 

  21. Brodsdky JR, et al. Benign paroxysmal positional vertigo (BPPV) in children and adolescents: clinical features and response to therapy in 110 pediatric patients. Otol Neurotol. 2018;39(3):344–50. https://doi.org/10.1097/MAO.0000000000001673.

    Article  Google Scholar 

  22. Algarni MA, et al. Association of benign paroxysmal positional vertigo with vitamin D deficiency: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2018;275(11):2705–11. https://doi.org/10.1007/s00405-018-5146-6.

    Article  PubMed  Google Scholar 

  23. Minasyan A, et al. Vestibular dysfunction in vitamin D receptor mutant mice. J Steroid Biochem Mol Biol. 2009 Apr;114(3–5):161–6. https://doi.org/10.1016/j.jsbmb.2009.01.020.

  24. Casani AP, Dallan I, Navari E, Sellari Franceschini S, Cerchiai N. Vertigo in childhood: proposal for a diagnostic algorithm based upon clinical experience. Acta Otorhinolaryngol Ital. 2015;35(3):180–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Strupp M, Mandala M, Escamez JA. Peripheral vestibular disorders: an update. Curr Opin Neurol. 2019;32(1):165–73. https://doi.org/10.1097/WCO.0000000000000649.

    Article  PubMed  Google Scholar 

  26. Wiener-Vacher SR, et al. Vestibular activity and cognitive development in children: perspectives. Front Integr Neurosci. 2013;7:92. https://doi.org/10.3389/fnint.2013.00092.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chetana C, Jayesh R. Subjective visual vertical in various vestibular disorders by using a simple bucket test. Indian J Otolaryngol Head Neck Surg. 2015;67(2):180–4. https://doi.org/10.1007/s12070-014-0760-0.

    Article  PubMed  Google Scholar 

  28. Bonvier R. Head-shaking nystagmus. B-ENT. 2008;4(Supplement 8):9–12.

    Google Scholar 

  29. Ramat S, et al. Translational vestibulo-ocular reflex evoked by a “head heave” stimulus. Ann N Y Acad Sci. 2001;942:95–113.

    Article  CAS  Google Scholar 

  30. Brandt TH, Dieterich M. Different types of skew deviation. J Neurol Neurosurg Psychiatry. 1991;54(6):549–50. https://doi.org/10.1136/jnnp.54.6.549.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Brodsky MC, Donahue SP, Vaphiades M, Brandt T. Skew deviation revisited. Surv Ophthalmol. 2006;51(2):105–28.

    Article  Google Scholar 

  32. Cyr DG. The vestibular system: pediatric considerations. Semin Hear. 1983;4(1):33–45.

    Article  Google Scholar 

  33. Fife TD, Tusa RJ, Furman JM, Zee DS, Frohman E, Baloh RW, et al. Assessment: vestibular testing techniques in adults and children: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2000;55:1431–41.

    Article  CAS  Google Scholar 

  34. Nuti D, Mandala M. Sensitivity and specificity of mastoid vibration test in detection of effects of vestibular neuritis. Acta Otorhinolaryngol Ital. 2005;25(5):271–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Shuman AG, Rizvi SS, Pirouet CW, Heidenreich KD. Hennebert’s sign in superior semicircular canal dehiscence syndrome: a video case report. Laryngoscope. 2012;122(2):412–4. https://doi.org/10.1002/lary.22413.

    Article  PubMed  Google Scholar 

  36. Califano L, Melillo MG, Vassallo A, Mazzone S. Hyperventilation-induced nystagmus in a large series of vestibular patients. Acta Otorhinolaryngol Ital. 2011;31(1):17–26.

    CAS  PubMed  PubMed Central  Google Scholar 

  37. Halmyagi M, et al. The video head impulse test. Front Neurol. 2017;8:258. https://doi.org/10.3389/fneur.2017.00258.

    Article  Google Scholar 

  38. Perez-Fernandez N, Eza-Nunez P. Normal gain of VOR with refixation saccades in patients with unilateral vestibulopathy. J Int Adv Otol. 2015;11(2):133–7. https://doi.org/10.5152/iao.2015.1087.

    Article  PubMed  Google Scholar 

  39. Hulse R, et al. Clinical experience with video head impulse test in children. Int J Pediatr Otorhinolaryngol. 2015;79(8):1288–93. https://doi.org/10.1016/j.ijporl.2015.05.034.

    Article  PubMed  Google Scholar 

  40. Khater AM, Afifif PO. Video head-impulse test (vHIT) in dizzy children with normal caloric responses. Int J Pediatr Otorhinolaryngol. 2016;87:172–7. https://doi.org/10.1016/j.ijporl.2016.06.030.

    Article  PubMed  Google Scholar 

  41. •• Sommerfleck PA, et al. Balance disorders in childhood: main etiologies according to age. Usefulness of the video head impulse test. Int J Pediatr Otorhinolaryngol. 2016;87:148–53. https://doi.org/10.1016/j.ijporl.2016.06.020. A very in depth study exploring the use of the video head impulse test in children and classifying aetiology of vestibular disorders accordingly.

    Article  PubMed  Google Scholar 

  42. Hamilton SS, Zhou G, Brodsky JR. Video head impulse testing (VHIT) in the pediatric population. Int J Pediatr Otorhinolaryngol. 2015;79(8):1283–7. https://doi.org/10.1016/j.ijporl.2015.05.033.

    Article  PubMed  Google Scholar 

  43. Ross LM, Helminski JO. Test-retest and interrater reliability of the video head impulse test in the pediatric population. Otol Neurotol. 2016 Jun;37(5):558–63. https://doi.org/10.1097/MAO.0000000000001040.

  44. Alizadeh S, et al. Normative vestibulo-ocular reflex data in 6-12 year-old children using video head-impulse test. Aud Vestib Res. 2017;26(3):145–50.

    Google Scholar 

  45. Bayram A, et al. Clinical practice of horizontal video head impulse test in healthy children. Kulak Burun Bogaz Ihtis Derg. 2017;27(2):79–83. https://doi.org/10.5606/kbbihtisas.2017.75725.

    Article  Google Scholar 

  46. Renata P, et al. Application of the video head impulse test in the diagnostics of the balance system in children. Pol Otorhino Rev. 2015;4(2):6–11. https://doi.org/10.5604/20845308.1150794.

    Article  Google Scholar 

  47. Dasgupta S. The video head impulse in children – initial experiences in a tertiary centre. J Int Adv Otol. 2015 Supplement;11:7–8.

  48. •• Wiener-Vacher SR, Wiener S. Video head impulse tests with a remote camera system: normative values of semicircular canal vestibulo-ocular reflex gain in infants and children. Front Neurol. 2017;8:434. https://doi.org/10.3389/fneur.2017.00434 This study looks into normative data of vestibulo-ocular reflex gains in children.

    Article  PubMed  PubMed Central  Google Scholar 

  49. •• Bachmann K, et al. Video head impulse testing in a pediatric population: normative findings. J Am Acad Audiol. 2018;29(5):417–26. This study looked into normative data of vestibulo-ocular reflex gains in children.

    Article  Google Scholar 

  50. Rosengren SM, Colebatch JG, Young AS, Govender S, Welgampola MS. Vestibular evoked myogenic potentials in practice: methods, pitfalls and clinical applications. Clin Neurophysiol Pract. 2019;26(4):47–68. https://doi.org/10.1016/j.cnp.2019.01.005.

    Article  Google Scholar 

  51. • El-Danasoury I, et al. Vestibular evoked myogenic potentials (VEMPs) in young children: test parameters and normative data. Egypt J Ear, Nose, Throat Allied Sci. 2015;16(1):81–5. This study looked into normative data of vestibular evoked myogenic potentials in children.

    Article  Google Scholar 

  52. • Pereira AB, et al. Cervical vestibular evoked myogenic potentials in children. Braz J Otorhinolaryngol. 2015;81(4):358–62 This study looks into normative data of vestibular evoked myogenic potentials in children.

    Article  Google Scholar 

  53. Singh S, Gupta RK, Kumar P. Vestibular evoked myogenic potentials in children with sensorineural hearing loss. Int J Pediatr Otorhinolaryngol. 2012;76:1308–11. https://doi.org/10.1016/j.ijporl.2012.05.025.

    Article  PubMed  Google Scholar 

  54. •• Kelsch TA, et al. Vestibular evoked myogenic potentials inyoung children: test parameters and normative data. Laryngoscope. 2006;116:895–900 This study looks into normative data of vestibular evoked myogenic potentials in children.

    Article  Google Scholar 

  55. Rodriguez AI, et al. Air-conducted vestibular evoked myogenic potential testing in children, adolescents, and young adults: thresholds, frequency tuning, and effects of sound exposure. Ear Hear. 2019;40(1):192–203. https://doi.org/10.1097/AUD.0000000000000607.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Zhou G, Kenna MA, Stevens K, Licameli G. Assessment of saccular function in children with sensorineural hearing loss. Arch Otolaryngol Head Neck Surg. 2009;135(1):40–4.

    Article  Google Scholar 

  57. Zhou, G et al. Clinical uses of cervical vestibular-evoked myogenic potential testing in pediatric patients. Medicine 93 (4). doi:https://doi.org/10.1097/MD.0000000000000037

  58. Zhou G, Gopen Q. Characteristics of vestibular evoked myogenic potentials in children with enlarged vestibular aqueduct. Laryngoscope. 2011;121:220–5.

    Article  Google Scholar 

  59. Sheykhelesami K, et al. Vestibular-evoked myogenic potentials in infancy and early childhood. Laryngoscope. 2005;115:1440–4.

    Article  Google Scholar 

  60. Picciotti PM, Fiorita A, di Nardo W, Calò L, Scarano E, Paludetti G. Vestibular evoked myogenic potentials in children. Int J Pediatr Otorhinolaryngol. 2007;71:29–33. https://doi.org/10.1016/j.ijporl.2006.08.021.

    Article  PubMed  Google Scholar 

  61. Erbek S, et al. Clinical application of vestibular evoked myogenic potentials in healthy newborns. Int J Pediatr Otorhinolaryngol. 2007;71:1181–5. https://doi.org/10.1016/j.ijporl.2007.04.007.

    Article  PubMed  Google Scholar 

  62. Young YH, Chen CN, Hsieh WS, Wang SJ. Development of vestibular evoked myogenic potentials in early life. Eur J Paediatr Neurol. 2009;13(3):235–9. https://doi.org/10.1016/j.ejpn.2008.04.008.

    Article  PubMed  Google Scholar 

  63. Chen CN, et al. Vestibular evoked myogenic potentials in newborns. Audiol Neurotol. 2007;12:59–63. https://doi.org/10.1159/000097248.

    Article  CAS  Google Scholar 

  64. Hsu YS, Wang SJ, Young YH. Ocular vestibular-evoked myogenic potentials in children using air conducted sound stimulation. Clin Neurophysiol. 2009;120:1381–5.

    Article  Google Scholar 

  65. Wang SJ, Hsieh WS, Young YH. Development of ocular vestibular-evoked myogenic potentials in small children. Laryngoscope. 2013;123:512–7.

    Article  Google Scholar 

  66. Valente M. Maturational effects of the vestibular system: a study of rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials with children. J Am Acad Audiol. 2007;18:461–81.

    Article  Google Scholar 

  67. Bart O, Bar-Haim Y, Weizman E, Levin M, Sadeh A, Mintz M. Balance treatment ameliorates anxiety and increases self-esteem in children with comorbid anxiety and balance disorder. Res Dev Disabil. 2009;30:486–95. https://doi.org/10.1016/j.ridd.2008.07.008.

    Article  PubMed  Google Scholar 

  68. Langhagen T, Landgraf MN, Huppert D, Heinen F, Jahn K. Vestibular migraine in children and adolescents. Curr Pain Headache Rep. 2016;20:67. https://doi.org/10.1007/s11916-016-0600-x.

    Article  PubMed  Google Scholar 

  69. •• Rinne RM. Vestibular rehabilitation for children. Semin Hear. 2018;39(3):334–44. https://doi.org/10.1055/s-0038-1666822. This study discusses one of the main management modalities for treatment of vestibular disorders in children.

  70. • Christy JB. Considerations for testing and treating children with central vestibular impairments. Semin Hear. 2018;39(3):321–33. https://doi.org/10.1055/s-0038-1666821. Central vestibular impairments are important to be diagnosed and managed often following a different trajectory to peripheral disorders that this paper highlights.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the Department of Audiology, Alder Hey Children’s NHS Foundation Trust.

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Authors and Affiliations

  1. Paediatric Audiovestibular Medicine, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK

    Soumit Dasgupta MBBS, DLO, MS, FRCS, MSc, FIAOHNS, FRCP, Rosa Crunkhorn MBChB, MRCS & Sudhira Ratnayake MBBS, MRCS, DLOHNS, MSc, FRCP

  2. Department of Otolaryngology, University of Siena, Siena, Italy

    Marco Mandala MD, PhD & Lorenzo Salerni MD, PhD

Authors
  1. Soumit Dasgupta MBBS, DLO, MS, FRCS, MSc, FIAOHNS, FRCP
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  2. Marco Mandala MD, PhD
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  3. Lorenzo Salerni MD, PhD
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  4. Rosa Crunkhorn MBChB, MRCS
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  5. Sudhira Ratnayake MBBS, MRCS, DLOHNS, MSc, FRCP
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Correspondence to Marco Mandala MD, PhD.

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Dr. Mandala has nothing to disclose.

Dr. Dasgupta has nothing to disclose.

Dr. Salerni has nothing to disclose.

Dr. Crunkhorn has nothing to disclose.

Dr. Ratnayake has nothing to disclose.

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Dasgupta, S., Mandala, M., Salerni, L. et al. Dizziness and Balance Problems in Children. Curr Treat Options Neurol 22, 8 (2020). https://doi.org/10.1007/s11940-020-0615-9

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