Dizziness in children

Evaluation of a child with vertigo is very difficult, in part because of the inability to correctly distinguish different diseases that cause vertigo in children. Many factors, such as delay in the onset and progression of the disease and vestibular compensation of congenital vertigo diseases, make the assessment more complicated. In addition, diseases commonly seen in adults are less common in children. Understanding these illnesses and the functional limitations that result from them is important for proper family consultation on child vertigo.
Although very difficult to accurately identify congenital defects of the vestibular system, these defects are rare. Congenital defects may affect the bone labyrinth or cause functional defects of the sensory epithelium. Diseases that affect the sensory epithelium may be identified only in histological studies and cannot be detected by radiography. So they are not very well studied clinically.
The prevalence of dizziness in children has been very variable in different studies. This may be due to differences in studies as well as difficulty in identifying symptoms in this population. A child can never properly express the symptoms of dizziness and vertigo. Diseases that are common in the adult population (BPPV and Menier’s Disease) are uncommon in children. Conversely, some diseases seen in children, such as benign paroxysmal vertigo, are less common in adults.
Clinical evaluation of dizziness and vertigo in children
History taking and physical evaluation
Complete history taking and physical evaluation are critical for the correct diagnosis of pediatric patients with vestibular dysfunction. Younger patients may have difficulty expressing their symptoms. The timing of onset, progression, and timing of symptoms are important features to consider. The specialist should ask questions about the worsening of the vestibular symptoms due to mild blows to the head or loud noises. In addition, vestibular symptoms may be associated with an increase in hearing loss, tinnitus, headaches, epilepsy, and other ear symptoms. Obviously, a child cannot express these symptoms. A vestibular anomaly may be related to the child’s overall inattention and physical disabilities, and thus may completely overshadow the correct diagnosis of the disorder. Vestibular dysfunction can be caused by a variety of infections, so it is important to ask about infections or the use of ototoxic drugs.
Vestibular evaluation of children is difficult due to their age. Depending on the child’s willingness to take the test, the ability to understand the test instructions and his or her general ability to perform tests, they can be evaluated. A neonatal vestibular evaluation requires specific testing methods. Eye movements and gaze-evoked nystagmus can be performed on a small child using a small toy to draw his attention in four directions.
In cases where the child is well-assisted, a series of specialized balance assessments such as the Romberg test can be performed. Children must be able to walk up to 18 months of age and up to five years of age should be able to walk in a straight line with minimal error. Using a foam pad can raise the level of balance testing in children and make it more difficult. Certain physical assessments, such as post-head-shake nystagmus and head-thrust test, can be helpful in detecting vestibular weakness.
Other audiometric and vestibular assessments should also be performed for each child. Age-appropriate audiological evaluation is required in each patient. Although it is difficult to perform vedeonystagmography test even in adults, in some children with good cooperation, it can be used to assess vestibular function. The vestibulo-ocular reflex is visible from birth and continues to develop over the first few years of life. It is possible to perform and interpret a caloric test from 2 months of age but is often not tolerated in the pediatric population. The cervical evoked myogenic potential test (cVEMP) can be used to evaluate saccule function. Despite infants’ inability to maintain muscle contraction and head elevation, cVEMP has been used in infants and children. Posturography can also be used, but it should be noted that the vestibular system does not mature until the age of 12, and therefore there is no normative information in children about this test.
In general, imaging studies should be performed on children with vertigo with other neurological symptoms, unilateral hearing loss, or severe illnesses. The cost of imaging examinations is high and children need anesthesia. Therefore, it is not possible to perform them in all of children with dizziness or vertigo.