VETIGO IN CHILDREN

• Not an usual complain
• Usually during development, vestibular system is advance of auditory system and thus less vulnerable to environmental insult.
• By 24 weeks there is even a primitive vestibulo-ocular reflex present.
• Bithermal caloric responses can be made in 9 month old babies.
• Vestibular nystagmus in children is of lower frequency and greater amplitude.

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CAUSES OF CHILDHOOD VESTIBULAR SYMPTOMS

WITH HEARING LOSS:

1. OME
2. Cholesteatoma with fistula
3. Temporal bone trauma
4. Barotraumatic perilymphatic fistula
5. Post traumatic vertigo
6. CHARGE syndrome
7. SCC dehiscent
8. Ototoxicity
9. HZ oticus
10. TORCH infection
11. Usher’s syndrome

WITH NORMAL HEARING:

1. Motion sickness
2. BPV of childhood
3. Basilar migraine
4. Seizure disorders
5. BPPV
6. Post-traumatic vertigo
7. Viral labyrynthitis or neuronitis
8. Posterior fossa tumours
9. CNS infection: meningitis

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ASSESSMENT OF THE DIZZY CHILD

• Children are unable to describe what they are experiencing and present with other somatic symptoms :

1. cowering in the corner of cot
2. falling to the ground crying
3. burying their head in their hands
4. vomiting
5. torticollis

HISTORY TAKING:

Nature of dizziness: whether true vertigo or loss of balance or light headed faint feeling

Duration and periodicity

Any head and neck injury

Any associated symptoms like headache, vomiting, hearing loss, otalgia or otorrhoea

Neurological history

Developmental history

Drug history

H/O recent pyrexial illness

Family history: migraine, SNHL or NF2

 

EXAMINATION OF DIZZY CHILD:

1. Otoscopy
2. Facial nerve function
3. Tongue movements
4. Gag reflex
5. Eye movements: nystagmus
6. Clinical balance assessment: Romberg’s test, Unterberger’s stepping test and tandem heel to gait (for fun assessment of child, hoping, kicking a football can be done)
7. Optokinetic nystagmus and marked directional preponderance : watching rotating drum
8. Dix-hallpike positional testing
9. R/O cerebellar ataxia by heel toe tande gait with dysmetria, dyssynergia,  dysrhythmia

 

INVESTIGATION:

• Audiometry is mandatory
• Objective testing with BERA may be indicated
• Tympanometry should be undertaken
• Routine blood tests: exclude blood dyscrasias, infection
• Serology: congenital syphilis and HIV disease
• Depending on the history:

1. Bithermal caloric testing with video-nystagmography or electronystagmography
2. Imaging: MRI and CT scanning: bony labyrinth, temporal bones, enlarged vestibular aqueduct
3. EEG
4. ECG

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CAUSES OF VESTIBULAR SYMPTOMS: