Epidemiology of Vestibular Impairments in a Pediatric Population

Abstract

The purpose of this study was to report the prevalence of vestibular impairment (VI) in children ( = 2,528) referred for complete vestibular testing because of balance disorders (BD) or hearing loss (H). A VI was shown in 51.5% of the children tested (1,304/2,528). For BD (e.g., vertigo, dizziness, instability, delay in posturomotor development), VI was found in 36.5% ( = 379/1,037). The most frequent causes of BD with VI included inner ear malformation (13.5%), delay in posturomotor development (13.4%), hearing loss revealed with vertigo (3.9%), trauma (3.9%), vestibular neuritis (3.3%), meningitis (2.5%), Meniere-like syndrome (1.1%), BPPV posttrauma (1%), labyrinthitis (0.4%), and unknown etiology (19.6%). Normal responses to the complete battery of tests ( = 658, 63.5%) excluded a vestibular origin to BD, leading to other diagnoses: principally migraine (15.6%), ophthalmological disorders (15.1%), neurological disorders (including delay in posturomotor development; 14.4%), orthostatic hypotension, or somatoform dizziness (<1%). Of the children referred for hearing loss ( = 1,491), 68.5% were tested without cochlear implantation (CI; = 1,022). In this group, 54.5% presented with VI ( = 557). This was mostly found in cytomegalovirus infection, inner ear malformation, and genetic syndromes. Profound hearing loss candidates for cochlear implants had complete bilateral vestibular loss in 20% and delay in posturomotor development, and 80% had partial or normal vestibular function and normal posturomotor development. VI was found after CI in 50% on the side of the implant (partial in 41% and complete in 9%). VI is present in 36.5% of children referred to our center for BDs and 54.5% for hearing loss. Vestibular testing permits ruling out peripheral VI and hence seeking other causes for BDs such as migraine and ophthalmological disorders and also helps lower the risk of inducing bilateral complete vestibular loss in CI protocols.

Dizziness and Convergence Insufficiency in Children: Screening and Management

“…In our pediatric balance evaluation center, vertigo due to vergence disorders is the second more frequent diagnosis after migraine; its prevalence increases every year (from 10% in 2014 to 15% in 2018) (Wiener-Vacher et al, 2018). The American Association of Pediatrics (Swing et al, 2010) recommended limiting children’s exposure to video screens for many reasons.…”

“…We first published evidence that dizziness in children could result from vergence insufficiency VI and dizziness improves when the ophthalmological disorder is treated by orthoptic training, correction of a refractive problem with glasses, or both (Anoh-Tanon et al, 2000). A recent report on a cohort of 1037 vertiginous children found 15% with an ophthalmological disorder as the only cause of dizziness (Wiener-Vacher et al, 2018).…”

“…In our clinic specialized for diagnosing and treating dizzy children, we observed over the past 5 years an increase of the prevalence of oculomotor disorders as the only cause of the dizziness (10–15%) (Wiener-Vacher et al, 2018). We suggest that this increase of symptomatic vergence disorders may be due to the growing use of electronic devices with small video screens that are very demanding for convergence and diverse controlled saccades during long periods of time.…”

Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic

“…Finally, visual impairment is an increasing cause of dizziness/instability and/or headache with the ever-growing popularity of all types of recreational activities based on small video screens (e.g., video games, mobile phones, TV… It is necessary to search for refractive disorders (myopia, hyperopia and astigmatism) and/or vergence dysfunction [31] , [32] .…”

Benign Positional Paroxysmal Vertigo in Children

“…The clinical form was well described by Dix and Hallpike in 1952 [ 2 ] and since then numerous liberatory maneuvers in both adults and children have been proposed for treatment [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. The prevalence of BPPV in the pediatric age is lower than in adults [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. The lower frequency of BPPV in children is due to less common causes of otoconia detachment than in adults (hypertension, metabolic disorders, atherosclerosis) [ 15 ].…”