Vestibular Syndromes in Childhood and Adolescence

THIEME Original Research Vestibular Syndromes in Childhood and Adolescence Juliana Antoniolli Duarte1 Elisa Morais Leão1 Daniel Sobral Fragano1 Germana Jardim Marquez1 Anna Paula Batista de Ávila Pires1 Maria Laura Solferini Silva1 Fernando Freitas Ganança1 1 Department of Otorhinolaryngology and Head and Neck Surgery, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil Int Arch Otorhinolaryngol 2020;24(4):e477–e481. Abstract Keywords ► child ► vertigo ► migraine disorders ► dizziness 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. Introduction Balance in the body is comprised of the integration of the visual, vestibular, and somatosensory systems, which is regulated by the central nervous system (CNS) through cerebellum activity. These systems are anatomically developed at birth, but seamless integration between them only occurs at around 8 to 10 years of age. Any conflict between these sensory systems can cause vestibular symptoms (VSs).1 The prevalence of vestibular disorders in childhood ranges from 0.4% to 15%,2,3 and may be underestimated as a result of several factors: vestibular alterations are usually ignored in children; expressions of disrupted bodily balance are usually received August 9, 2019 accepted November 3, 2019 Address for correspondence Juliana Antoniolli Duarte, MSc, Departmento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Rua Pedro de Toledo, 947, Vila Clementino, São Paulo, SP, 04039-002, Brazil (e-mail: ). DOI https://doi.org/ 10.1055/s-0039-3402443. ISSN 1809-9777. attributed to lack of motor coordination or behavioral changes;4 children have difficulty expressing their symptoms;5 and the most prevalent causes of VS differ in adults and children.6 The most prevalent causes of VS in children and adolescents are benign paroxysmal vertigo of childhood (BPVC), serous otitis media (SOM), vestibular migraine (VM), head trauma, malformation of the inner ear, vestibular neuritis, infectious labyrinthitis, visual changes, and tumors of the posterior fossa.2–13 Conventionally, in addition to the clinical examination, vestibular investigation in children includes examinations such as rotary chair testing, caloric testing, and posturography. Other tests to evaluate vestibular function, such as the videohead impulse test (VHIT) and vestibular-evoked myogenic Copyright © 2020 by Thieme Revinter Publicações Ltda, Rio de Janeiro, Brazil 477 478 Vestibular Syndromes in Childhood and Adolescence Duarte et al . potentials (VEMPs), have recently been introduced for use in the pediatric population.1,14 Considering vestibular disorders in childhood and adolescence is essential so they can be recognized early; delays in treatment can affect other aspects of development such as spoken and written language, psychological state, and school performance.2,4 Consequently, the objective of the present study was to analyze the profile of children and adolescents with VS who were cared for in an outpatient pediatric neurotology clinic, including the diagnostic and therapeutic aspects. Materials and Methods The present cross-sectional observational study evaluated all records of patients up to 18 years of age treated in an outpatient pediatric neurotology clinic from 2010 to 2019. Illegible records were excluded. We evaluated the following descriptive factors: gender; age range; clinical diagnosis and associated diagnoses; eating habits; VSs; auditory symptoms; personal history of headache and motion sickness; family history of migraine; time of disease progression; laboratory examinations; caloric tests (performed in children aged 5 years and older); audiometry and immittance audiometry; imaging tests, such as computed tomography (CT) of the skull/temporal bones and magnetic resonance imaging (MRI) of the brain/inner ears; the treatments performed; and the clinical progress. Subsequently, the patients were divided into three groups according to the clinical diagnosis for analytic assessment: group 1 - patients diagnosed with BPVC; group 2 - patients diagnosed with VM; and group 3 - patients with other diagnoses (not BPVC or VM). Associations were made between these groups for three variables: presence or absence of headache, family history of migraine, and motion sickness. The data were stored and analyzed in an Excel (Microsoft Corp., Redmond, WA, US) spreadsheet, and the associations among the data were evaluated using a homogeneous onetailed t-test at a 95% significance level; when differences were found among the three groups, the heterogeneous onetailed t-test was used. Results We assessed a total of 144 patient records, and 117 were considered eligible for inclusion. The included patients were between 2 and 17 years of age, with a mean age of 10 years (standard deviation [SD]: 3.62). Of these, 64 (54.70%) were female. The most prevalent diagnosis was of BPVC, which was found in 49 cases (41.9%); VM was found in 19 patients (16.2%); motion sickness, in 11 (9.50%); metabolic vestibular syndrome (MVS), in 7 (6%); CNS changes (epilepsy, sequelae of meningoencephalitis, and Chiari malformation), in 3 patients (2.50%); Ménière disease in 3 cases (2.50%); dysautonomia in 3 patients (2.50%); benign paroxysmal positional vertigo (BPPV) in 2 cases (1.7%); and labyrinthine concussion in 2 cases (1.70%). Other less prevalent diagnoses were: 1 case of SOM (0.8%); 1 case of superior semicircular ca (...truncated)