Vertigo In Pediatric Age Often Challenge To Clinicians

International Journal of Current Research and Review

Scopus’
DOI: http://dx.doi.org/10.31782/IJCRR.2020.121819

iiaulava@.vailels

: Vertigo in Pediatric Age: Often Challenge to
Clinicians

IJCRR

Section: Healthcare

Santosh Kumar Swain’, Satyabrata Achary, Saurjya Ranjan Das?

Sci. Journal Impact
Factor: 6.1 (2018)
ICV: 90.90 (2018)

Copyright@IJCRR

ABSTRACT

Vertigo or dizziness is perceived to be a common handicapping clinical entity in all the age group of the human being. Vertigo is
an uncommon symptom in pediatric age group and rarity of this clinical entity may be due to unrecognized in children. It is often
associated with a range of otological, neurological and psychiatric diseases. In younger children, benign paroxysmal vertigo is
often seen whereas vestibular migraine is common in adolescent girls. The aetiology of the pediatric vertigo is usually multi-
factorial, so each pediatric patient with vertigo should be approached in an open mind. Thorough history taking is important for
getting a diagnosis of pediatric vertigo. Establishing the diagnosis of vertigo or dizziness is often challenging, especially in the
pediatric age group. This article is a narrative review discussion on prevalence, etiopathology, clinical manifestations and man-
agement of pediatric vertigo. This review article will make a baseline from where further prospective trials can be designed and

‘Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinganagar,
Bhubaneswar-751003, Odisha, India; “Department of Anatomy, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8,
Kalinganagar, Bhubaneswar-751003, Odisha, India.

help as a spur for further research in this clinical entity as there are not many studies of pediatric vertigo.

Key Words: Pediatric age, Vertigo, Vestibular migraine, Benign paroxysmal vertigo, Meniere’s disease, Vestibular neuritis

INTRODUCTION

Vertigo is common complaint posed to a clinician in routine
clinical practice. Vertigo is considered as the most common
causes for referral to neuro physician and Otorhinolaryngol-
ogists in office-based settings and emergency clinics!. Ver-
tigo is described as as a subjective sensation of movement,
typically spinning or turning, in absence of actual movement
of the body’. Vertigo is not an uncommon clinical symptom
in pediatric age group, though it may often unrecognized.
Disorders that cause vertigo in pediatric age vary concern-
ing one another in many ways. Vertigo or dizziness may
be a nonspecific squeal of the several impairments includ-
ing problems in proprioception, vision, vestibular function,
musculoskeletal and autonomic systems’. Proper history tak-
ing is often difficult to obtain because of the pediatric age
and unable to tell their clinical symptoms precisely. There
is an added challenge faced by the clinician in evaluating
and managing pediatric vertigo owing to a lack of the proper
history, practical difficulties during clinical examination and
a lack of standard objective evaluation methods. Here, this
review article discusses the aetiology, prevalence, clinical

presentations, diagnosis and treatment of pediatric vertigo.
This review article aims to give awareness among the read-
ers with the difficult clinical entity such as vertigo, particu-
larly in the pediatric age group.

METHODOLOGY

We conducted an electronic search of the SCOPUS, Medline
and PubMed databases for searching the published articles.
The search terms in the database included vertigo, pediat-
ric age, dizziness and impairment of balance in children.
The abstracts of the published articles are identified by this
search method and other articles were identified manually
from these citations. This review article reviews vertigo in
the pediatric age group including the etiopathology, preva-
lence, presentations, diagnosis and current treatment. This
review article presents a baseline from where further pro-
spective trials can be designed and help as a spur for further
research in this clinical entity where not many studies are
done.

Corresponding Author:

ISSN: 2231-2196 (Print)
Received: 20.06.2020

ISSN: 0975-5241 (Online)
Revised: 22.07.2020

Prof. Santosh Kumar Swain, Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8,
Kalinganagar, Bhubaneswar-751003, Odisha, India; Email: santoshswain@soa.ac.in

Accepted: 24.08.2020 Published: 22.09.2020

Int J Cur Res Rev | Vol 12+ Issue 18 + September 2020

Swain et al.: Vertigo in pediatric age: often challenge to clinicians

prevalence

Dizziness and balance disorders are thought to be uncom-
mon in the pediatric age group. This may be due to poor un-
derstanding of the epidemiology of vertigo or balance prob-
lems in children °. The literature for pediatric vertigo is scant.
Prevalence of vertigo in the pediatric age group ranges from
8% to 15% *. In otolaryngology clinic, the prevalence of the
pediatric vertigo patients constitutes around 0.7% 5. A study
in Scotland with 2165 pediatric patients with an age range
from 5 to 15 years found the one-year prevalence of one epi-
sode of rotary vertigo to be 18% along with the prevalence of
reducing to 5% for minimum three episodes [6]. One study
sampled 1050 children with an age range from 1 to 15 years
in Finland and found the lifetime prevalence of vertigo to
be 8% and that for poor body balance to be 2% *. Episodic
vertigo and dizziness are usually uncommon in pediatric
age group than in the adult population. Valid estimation of
the prevalence of vertigo among pediatric age group must
be determined when someone considers that such clinical
symptoms could have some adverse psychosocial associa-
tions like anxiety and avoidance behaviour, which leads to
child’s educational impairment and poor quality of life ’. It is
also vital that physicians should keep it in mind and aware of
those characteristic features of vertigo or dizziness in pediat-
ric patients, so that appropriate intervention can be provided.

Etiology and types of vertigo in pediatric age
The aetiology of vertigo in children is multi-factorial, so the
management depends on accurate diagnosis. Vertigo in the
children is broadly classified into Acute nonrecurring spon-
taneous vertigo, recurrent vertigo and non-vertiginous diz-
ziness, disequilibrium and ataxia. Vestibular migraine and
benign paroxysmal vertigo are commonly found cause for
vertigo in pediatric age. The common differential diagnosis
of vertigo in the pediatric age group is discussed below.Ta-
ble.1 showing the differential diagnosis in higher than two
thousand pediatric patients with vertigo and dizziness ob-
tained by a group of clinicians ê.

Table 1: Etiological profile of vertigo in children

Serial Diagnosis

number

1 Vestibular migraine

2 Benign paroxysmal vertigo of children
3 Vestibular neuritis

4 Post-traumatic/head trauma
5 Otitis media

6 Meniere’s disease

7 Psychogenic vertigo

8 Epileptic vertigo

9 Unclassified

Vestibular migraine

Majority of the pediatric vertigo is due to vestibular mi-
graine. The patient typically presents with headache, cycli-
cal vomiting, abdominal pain, vertigo, recurrent episodes of
pyrexia or head banging, attacks of pallor and somnolence.
The diagnosis of the vestibular migraine in children needs
awareness where a meticulous history for headache and care-
ful family history towards migraine is an important part of
the diagnosis. However, vestibular migraine remains a diag-
nosis of exclusion. Neuhauser and Lempert (2009) used the
term vestibular migraine as it stresses the vestibular manifes-
tations of migraine °. It is often seen in adolescent girls and
is usually associated with menstrual periods. The vertigo is
associated with a headache which lasts for hours with nau-
sea and vomiting as well as photophobia and phonophobia.
Sensory stimuli like intense smell, bright lights and loud
noise may precipitate the attack. A history of motion sick-
ness is often associated with a family history of migraine.
The otologic, neuro-otologic, general physical and vestibular
examinations are often normal in between the episodes of the
vestibular migraine "°.

Benign paroxysmal vertigo (BPV)

The characteristic features of the BPV in pediatric age are
recurrent brief attacks of vertigo without any warning and
resolving spontaneously in otherwise normal child "!. BPV
is a common cause of vertigo in pediatric patients, showing
with a prevalence of 2.6% '. It is often reported classically
at less than four years of age and uncommon after 8 years of
the age "°. The etiopathology of this clinical entity is still not
known. It appears to occur due to vascular changes which
produce transient hypoxia at the vestibular nuclei and the
vestibular pathways. This type of pathophysiology of BPV is
similar to the pathophysiology of the migraine; so the major-
ity of pediatric patients with BPV will develop migraine in
later part of the life "°. There are no presentations of altered
consciousness, neurological abnormalities and audiovestibu-
lar changes during the attack. The vestibular evoked myo-
genic potential | (VEMP) and caloric test results support the
diagnosis. In the majority of BPV patients, thermal caloric
tests show asymmetry '*. The prognosis of BPV is usually
favourable and tends to disappear spontaneously before ado-
lescence age.

Post-traumatic vertigo

Children having post-traumatic vertigo without any deafness
in the pediatric age could be due to labyrinthine concussion
whiplash syndrome, vertiginous seizures, basilar artery mi-
graine or non-specific dizziness '*. In the case of temporal
bone fracture, inner ear disruption may happen which results
in vestibular dysfunction and leakage of the cerebrospinal
fluid. Temporal bone trauma may lead to perilymphatic fis-
tula which can occur even without evidence of the fracture

137 Int J Cur Res Rev | Vol 12 « Issue 18 + September 2020

Swain et al.: Vertigo in pediatric age: often challenge to clinicians

line in temporal bone and often associated with the fluctuat-
ing type of deafness!®. Surgical closure of the labyrinthine
fistula can reduce the vertiginous symptoms completely but
the deafness may not be recovered !’. After trauma to the
labyrinth, pediatric patients may exhibit abnormal results of
the vestibular tests in approximately half of the cases, even
children are asymptomatic '*. After trivial trauma in case of
children with congenital inner ear anomalies such as Mon-
dini’s dysplasia, enlarged vestibular aqueduct and genetic
disease like CHARGE syndrome are predispose to vertigo
along with hearing loss °. The prognosis of the post-trau-
matic cases with vestibular dysfunction is variable and un-
predictable.

Vestibular neuritis

The aetiology of the vestibular neuritis is somewhat con-
troversial; many authors have suggested that is due to viral
infections although bacterial and other variety of infections
have also been suggested 7°. One study found around 47% of
the upper respiratory tract infection before the onset of the
vestibular neuritis *'. The exact aetiology of vestibular neuri-
tis is controversial, although an association with herpes sim-
plex virus has been found. Pediatric patients suffering from
vestibular neuritis often present with similar symptoms as
their adult counterparts. Vestibular neuritis is rarely found in
children less than 10 years of the age ”!. It presents with sud-
den onset of severe vertigo, nystagmus, nausea and vomiting.
This vertigo is worsened by head movements and children or
patients usually prefer to lie down, often with the affected ear
up. They do not present with hearing loss and tinnitus. Ves-
tibular laboratory investigation shows the unilateral reduced
vestibular response to the thermal caloric test. The clinical
symptoms of the child will resolve within a few days. The
management of this patient includes supportive and symp-
tomatic treatment with early ambulation. A short treatment
with vestibular suppressants such as meclizine (>12 years) or
dimenhydrinate (>2 years) may be prescribed but should be
limited as it often delays central compensation 7”.

Vestibular paroxysmia (VP)

This is an interesting type of the vestibular entity because of
the involvement or compression of the vestibular or eighth
cranial nerve also termed as disabling positional vertigo ”.
In 1994, Brandt and Dieterich coined the term vestibular
paroxysmal ™. Although it is rare in clinical practice, the VP
can cause vertigo in the pediatric patient as well. It usually
presents frequent episodes of vertigo, multiple times in a
day, lasting for seconds to minutes with or without the pres-
ence of postural variation. The attacks of vertigo can be up
to thirty times or more in a day. Magnetic resonance imaging
(MRI) and/or angiography helps demonstrate the neurovas-
cular compression of the vestibulocochlear nerve and also to
rule out cerebellopontine angle tumours ”. In the majority of

the cases, vascular lop by anterior inferior cerebellar artery
is seen to compress the nerve, however posterior inferior cer-
ebellar artery and vertebral artery or vein are rarely involved.
Low dose sodium channel blocker such as carbamazepine is
shown to help control vertigo in pediatric age of VP. Micro-
vascular decompression is an absolute option for relieving
the vestibular symptoms but indicated only in certain cases
such as a failed pharmacotherapy, fear of surgical morbidity
and difficulty in deciding the size of the lesions.

Meniere’s disease (MD)

MD is an uncommon disease among the pediatric age group
and accounts for <3% of all the MD patients *°. Out of all
aetiology for vertigo in the pediatric age group, MD is found
in 1.5-4% of pediatric age 7’. MD or endolymphatic hydrops
(Fig.1) in children present with episodic vertigo, fluctuating
deafness, aural fullness and tinnitus. The pure tone audiom-
etry reveals sensorineural hearing loss with the involvement
of low-frequency sound. But children often unable to com-
municate about aural fullness and tinnitus, so MD should not
be excluded in case of absence of aural fullness and ringing
sound in the ear. The pediatric patients with MD are usually
older than 10 years of the age and very few cases have been
reported in less than 7 years of age °. The pathophysiology
of MD is associated with allergy both in children and adults
and the treatment of the allergy will cure the symptoms of
MD. The management of MD in both adults and pediatric
patients are similar and include labyrinthine sedatives, low
salt diet, intra-tympanic gentamycin and less commonly en-
dolymphatic sac decompression ”.

Figure 1: Distension of the endolymphatic duct in Meniere’s
disease.

Middle ear effusion and otitis media
Pediatric patients with vertigo may occur due to middle ear
effusion and otitis media. °°! As many pediatric patients with

Int J Cur Res Rev | Vol 12 + Issue 18 e September 2020

Swain et al.: Vertigo in pediatric age: often challenge to clinicians

abnormal ventilation of the middle ear cleft do not present
vertigo, the symptoms are often presented by their parents
who say clumsiness, awkwardness and falling. In case of the
middle ear pathologies, the released toxins seen in the mid-
dle ear fluid absorbed into the inner ear fluid and lead to
serious labyrinthitis *°. Others have proposed that alteration
of the pressure in the middle ear cause displacement of the
oval window and round windows which move the inner ear
fluids *!. One study documented a greater chance of sway
in a group of 41 pediatric patients with otitis media in com-
parison to pediatric patients with no ear disease °. Similarly,
one more study documented that body sway was more pro-
nounced in pediatric patients with otitis media in comparison
to the control group. However, the authors also documented
that elimination of these by treating otitis media by myrin-
gotomy and insertion of the grommet *°.

DIAGNOSIS

Despite significant development of the technology in diag-
nostic tools, the diagnosis is still based mainly on proper
history taking and examination findings. However, the di-
agnosis of pediatric vertigo differs from the adult age group
because of the etiologies are often unique to the vertigo of
the children *. Around 90% of the pediatric patients with
vertigo are categorized as “unspecified dizziness”, show-
ing that the diagnostic accuracy and treatment options in
the pediatric age group with vertigo should be improved *.
Getting the exact diagnosis of pediatric vertigo can be dif-
ficult, specifically in very young pediatric patient whose
ability to tell the symptoms is very less. Patience and time
are required for the proper diagnosis of pediatric vertigo. Pa-
tient history and clinical examinations including otological
and neuro-otological examinations help in diagnosis. Patient
history has a vital role in the evaluation of vertigo and the
diagnosis of vertigo. The pediatric patient often unable to
describe the symptoms, so parent’s observation of vertigo
should be taken into consideration for diagnosis. Although
rare, the child may present with vertigo on exposure to loud
noise as in superior semicircular canal dehiscence syndrome
36. Jn the pediatric age group, common etiologies for ver-
tigo are benign paroxysmal vertigo of childhood(BPVC) and
migraine-associated vertigo(MAV), although the frequencies
of occurrence vary between different studies >’. The charac-
teristics of the BPVC are brief and recurrent episodes of ver-
tigo in absence of any warning and resolving spontaneously
in a normal child **. The criteria for diagnosis are at least 5
attacks of vertigo along with minimum one of the follow-
ing: nystagmus, vomiting, ataxia, pallor, fearfulness; in ad-
dition to normal audiometric findings, normal examination
and vestibular functions in between attacks needed. Seizures,
posterior fossa neoplasms and vestibular lesions should be
ruled out °°. BPVC has better prognosis as clinical symptoms

tend to be absent after six to twelve months *’. In addition to
thorough neuro-otologic and systemic examination, vestibu-
lar tests like cervical vestibular evoked myogenic potential
(cVEMP), posturography, electronystagmography (ENG),
rotatory chair test and caloric test. A complete hearing as-
sessment is mandatory in the pediatric patient with vertigo
which includes Otoacoustic emissions (OAEs), hearing test
or behavioural audiometry, brainstem evoked response audi-
ometry (BERA), auditory steady-state response (ASSR) and
impedance audiometry. Magnetic resonance imaging (MRI)
is preferred imaging for assessing vertigo in the pediatric
age group. Clinicians should advice neuro-imaging stud-
ies for children with vertigo who have neurologic signs and
symptoms, risk factors of cerebrovascular lesions or progres-
sive unilateral sensorineural hearing loss or tinnitus *°. MRI
avoids ionizing radiation of computed tomography (CT)
scan and gives a greater sensitivity for posterior fossa and
labyrinthine defects *!. The negative aspects of the MRI are
cost and requirement of sedation in the pediatric patient. His-
tory of head trauma and focal neurological deficit brings up
the indication for MRI. Evaluation of the blood pressure and
electrocardiography (ECG) is useful to rule out a cardiovas-
cular disease like arrhythmia or long QT syndrome. Diseases
of the eye and refractive errors should be ruled out even with
a known cause for vertigo, as these may cause worse symp-
tomatology *.

TREATMENT OF PEDIATRIC VERTIGO

The difficulty and enigma in the treatment of the pediatric
vertigo are because it is not a definite disease but a symptom
which usually diagnosed late in children. The treatment of
vertigo in the pediatric age should be individualized. Based
on the aetiology, the treatment includes medications, physi-
cal therapy, psychiatric treatment and less commonly sur-
gery. There is still a paucity of documentation on the drug
treatment of vertigo even in the current scenario since there
have been no multicentric, well-controlled studies to show
the advantages of treatment over no treatment #. The treat-
ment of the vestibular migraine includes watchful waiting
and education of the children of vertigo and their parents
in addition to stress reduction, encouragement for adequate
sleep, psychological counselling, rehabilitation therapy if
required as well as dietary restrictions of foods own to pro-
voke. Medical treatment of vestibular migraine includes sim-
ple analgesic and/or vestibular suppressant such as meclizine
during the attack. In children with benign paroxysmal ver-
tigo, vestibular suppressants are usually not very useful due
to the very short duration of the attack. In vestibular neuritis,
vestibular rehabilitation and corticosteroids are often help-
ful and facilitate recovery of the disease, particularly when
prescribed initial period of the disease. Ophthalmological
evaluation and correction are also important as visual prob-

139 Int J Cur Res Rev | Vol 12 « Issue 18 + September 2020

Swain et al.: Vertigo in pediatric age: often challenge to clinicians

lems can lead to vertigo or dizziness. Management of the
Meniere’s disease in pediatric age is reassurance and expla-
nations of this condition to the caregivers along with low salt
diet and a diuretic **. The requirement of surgery in pediatric
Meniere’s disease is uncommon.

CONCLUSION

Vertigo in the pediatric age group has myriad of clinical pres-
entations and possible diagnoses. The aetiology of vertigo in
the pediatric age group is often multi-factorial, so a pediatric
patient is approached with an open mind. A thorough evalu-
ation of vertigo in children though difficult is mandatory.
Disorders that cause vertigo in the pediatric age group vary
concerning one another in many ways. The peripheral ves-
tibular disorders rarely cause symptoms lasting more than a
few minutes although Meniere’s disease and vestibular neu-
ritis lasting for hours. Vestibular migraine causes symptoms
lasting for virtually any duration. Vertigo in children can be
highly challenging for evaluation and treatment. Relying on
vestibular tests alone may cause misleading of the diagno-
sis. The physicians must judiciously utilize all the diagnostic
modalities at his/her disposal before dismissing less com-
monly encountered diagnosis.

REFERENCES

1. Moulin T, Sablot D, Vidry E, Belahsen F, Berger E, Lemounaud
P, et al. Impact of emergency room neurologists on patient man-
agement and outcome. Eur Neurol 2003; 50:207-14.

2. Swain SK, Baliarsingh D, Sahu MC. Vertigo among elderly peo-
ple: Our experiences at a tertiary care teaching hospital of east-
ern India. Annals of Indian Academy of Otorhinolaryngology-
Head and Neck Surgery 2018; 2(1):1-5.

3. Swain SK, Behera IC, Das A, Sahu MC. Prevalence of Benign
paroxysmal positional vertigo: Our experiences at a tertiary care
hospital of India. Egyptian Journal of ear, nose, throat and allied
sciences2018;19(3):87-92.

4. Niemensivu R, Pyykkö I, Wiener-Vacher SR, Kentala E. Vertigo

and balance problems in the children-an epidemiologic study

in Finland. International journal of pediatric otorhinolaryngol-
ogy2006;70(2):259-65.

Riina N, limari P, Kentala E. Vertigo and imbalance in children:

a retrospective study in a Helsinki University Otorhinolaryngol-

ogy clinic 2005;131:996-1000.

6. Abu-Arafeh I, Russell G. Paroxysmal vertigo as a migraine

equivalent in children: a population-based study. Cephala-

gial995; 15: 22-5.

Royal College of Physicians, Hearing and balance disorders:

achieving excellence in diagnosis and management. Report of a

Working Party. London, RCP,2008.

8. Weiner-Vacher S. Vestibular disorders in children. Int J Audiol
2008;47:578-83.

9. Neuhauser H, Lempert T. Vestibular migraine.
Clin2009;27:379-91.

10. Cutter FM, Baloh RW.Migraine associated dizziness. Headache
1992;32:300-4.

n

=

Neurol

11.

20.

21.

22,

23,

24.

25:

26.

2T;

28.

29.

Ralli G, Atturo F, de Filippis C. Idiopathic benign paroxysmal
vertigo in children, a migraine precursor. Int J Pediatr Otorhi-
nolaryngol 2009; 73 (1):16-18.

. Balatsouras DG, Kaberos A, Assimakopoulos D, Katotomi-

chelakisc M, Economou NC, Korres SG. Aetiology of vertigo in
children. Int J Pediatr. Otorhinolaryngol2007; 71:487-94.

. McCaslin 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
(2):291-307.

. Koenigsberger MR, A.M. Chutorian AM, Gold AP, Schvey MS.

Benign paroxysmal vertigo of childhood. Neurology1968; 18
(3):301-2.

. Eviatar L, Bergtraum M, Randel RM. Post-traumatic ver-

tigo in children: a diagnostic approach. Pediatric neurolo-
gy1986;2(2):61-6.

. Kim SH, Kazahaya K, Handler SD. Traumatic perilym-

phatic fistulas in children: aetiology, diagnosis and manage-
ment. International journal of pediatric otorhinolaryngolo-
gy2001;60(2):147-53.

. Neuenschwander MC, Deutsch ES, Cornetta A, Willcox TO.

Penetrating middle ear trauma: a report of 2 cases. Ear, nose &
throat journal2005;84(1):32-5.

. Vartiainen E, Karjalainen S, Kärjä J. Vestibular disorders fol-

lowing head injury in children. International journal of pediatric
otorhinolaryngology1985;9(2):135-41.

. Chiarella G, Viola P. The challenge of pediatric vertigo. J Ear

Nose Throat Disord 2017;2(3):1027.

Strupp M, Brandt T. Vestibular neuritis. Semin Neurol2009; 29
(5): 509-19.

Taborelli G, Melagrana A, D’Agostino R, Tarantino V, Calevo
MG. Vestibular neuronitis in children: study of medium and long
term follow-up. International journal of pediatric otorhinolaryn-
gology 2000;54(2-3):117-21.

Li CM, Hoffman HJ, Ward BK, Cohen HS, Rine RM. Epide-
miology of dizziness and balance problems in children in the
United States: a population-based study. The Journal of paediat-
rics 2016;171:240-7.

PJ J. Moller MB. Moller AR: Disabling positional vertigo. N
Engl J Med1984;310:1700-5.

Brandt T, Dieterich M. Vestibular paroxysmal: vascular com-
pression of the eighth nerve?. The Lancet 1994;343(8900):798-
9.

Best C, Gawehn J, Kramer HH, Thömke F, Ibis T, Miiller-Forell
W, et al. MRI and neurophysiology in vestibular paroxysmia:
contradiction and correlation. J Neurol Neurosurg Psychiatry
2013;84(12):1349-56.

Meyerhoff WL, Paparella MM, Shea D. Meniere’s disease in
children. The Laryngoscope. 1978;88(9):1504-11.

Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Re
M. Prevalence and diagnosis of vestibular disorders in children:
a review. International journal of pediatric otorhinolaryngology
2014;78(5):718-24.

Brantberg K, Duan M, Falahat B. Méniére’s disease in children
aged 4-7 years. Acta oto-laryngological. 2012;132(5):505-9.
Meyerhoff WL, Paparella MM, Shea D. Meniere’s disease in
children. The Laryngoscope1978;88(9):1504-11.

. Golz A, Netzer A, Angel-Yeger B, Westerman ST, Gilbert

LM, Joachims HZ. Effects of middle ear effusion on the ves-
tibular system in children. Otolaryngology-Head and Neck Sur-
gery1998;119(6):695-9.

. Suzuki M, Kitano H, Yazawa Y, Kitajima K. Involvement of

round and oval windows in the vestibular response to pressure
changes in the middle ear of guinea pigs. Acta oto-laryngologi-
cal998;118(5):712-6.

Int J Cur Res Rev | Vol 12 + Issue 18 + September 2020

Swain et al.: Vertigo in pediatric age: often challenge to clinicians

. Casselbrant ML, Rubenstein E, Furman JM, Mandel EM. Effect

of otitis media on the vestibular system in children. Annals of
Otology, Rhinology and Laryngology 1995 ;104(8):620-4.

. Jones NS, Prichard AJ, Radomskij P, Snashall SE. Imbalance

and chronic secretory otitis media in children: effect of myrin-
gotomy and insertion of ventilation tubes on body sway. Annals
of Otology, Rhinology & Laryngology1990; 99(6):477-81.
Gruber M, Cohen-Kerem R, Kaminer M, Shupak A. Vertigo in
children and adolescents: characteristics and outcome. The Sci-
entific World Journal 2012;2012.Article ID 109624.

. O’Reilly RC, Morlet T, Nicholas BD, Josephson G, Horlbeck D,

Lundy L, et al. Prevalence of vestibular and balance disorders in
children. Otol Neurotol 2010;31:1441-4.

. Swain SK, Das A, Sahu MC. Superior semicircular canal de-

hiscence syndrome: An uncommon cause of vertigo.Archives of
Medicine and Health Sciences 2018;6(2):262.

. Langenhagen T, Schroeder AS, Rettinger N, Borggraefe I, Jahn

K. migraine-related vertigo and somatoform vertigo frequent-

40.

41.

42.

43.

ly occur in children and are often associated. Neuropediatrics
2013;44(1):55-8.

. Headache Classification Committee of the International Head-

ache Society (IHS). The international classification of headache
disorders, (beta version). Cephalalgia 2013;33(9):629-808.

. Youssef PE, Mack KJ. Episodic and chronic migraine in chil-

dren. Developmental Medicine & Child Neurology 2020
362(1):34-41.

Drachman DA.A 69-year-old man with chronic dizziness.
JAMA1998;280:2111-18.

Loevner LA. Imaging features of posterior fossa neoplasms in
children and adults. Semin Roentgenol 1999;34(2):84-101.
Erbek SH, Erbek SS, Yilmaz I, Topal O, Ozgirgin N, Ozluoglu
LN, et al. Vertigo in childhood: a clinical experience. Int J Pedi-
atr Otorhinolaryngol 2006;70(9):1547-54.

Ruckenstein M, Rutka J, Hawke M.The treatment of Meinere
disease: Torok revisited.Laryngoscope 1991;101:211-14.

Iaa a do GSTS nin Gana a
141 Int J Cur Res Rev | Vol 12+ Issue 18 e September 2020