How rare is benign paroxysmal positional vertigo in children? A review of 20 cases and their epidemiology

Pediatric Benign Paroxysmal Positional Vertigo: Degree of Nystagmus and Concurrent Dizziness Differs from Adult BPPV

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief, intense episodes of vertigo triggered by abrupt changes in head position. It is generally accepted as being most common in adults, while it is regarded as rare in children. It is necessary to compare the disease between pediatric and adult patients for a better understanding of the disease's characteristics and its natural history. This study aimed to identify the clinical characteristics of BPPV in children and compare them with those of adult BPPV patients. Methods: All children ≤ 18 years old who were diagnosed with BPPV were selected by searching the electronic database of our hospital. Clinical features were identified by medical record review. For adult patients, we collected data from patients > 19 years of age. Results: A total of 30 pediatric (13.65 ± 4.15 years old) and 264 adult patients (60.86 ± 13.74 years old) were included in the study. Among pediatric patients, the lateral canals were involved in 80% and the posterior canals in 16.67%. In adult patients, the lateral and posterior canals were involved similarly (p = 0.007). The degree of nystagmus in pediatric patients was 6.82 ± 12.09, while in adults it was 15.58 ± 20.90 (p < 0.001). The concurrent dizziness disorder was higher in the pediatric group and recurrence was higher in the adult group. In the regression analysis, it was found that adult patients had a stronger nystagmus with a value of 6.206 deg/sec, and the risk of concurrent dizziness disorder was found to be 5.413 times higher in the pediatric group (p < 0.05). Conclusions: BPPV occurs in pediatric patients with lower prevalence, but it cannot be overlooked. In the pediatric group, a relatively high proportion of patients demonstrated lateral canal involvement, weaker nystagmus, and additional dizziness disorder.

Benign paroxysmal positional vertigo in a young child

A girl in her early childhood presented to a regional otolaryngology outpatient clinic with classic signs of benign paroxysmal positional vertigo (BPPV). She reported episodic dizziness when rolling in a supine position. She did not convey any other associated audiovestibular symptoms. A bedside Dix-Hallpike test confirmed geotropic rotational nystagmus indicative of lateral canal BPPV. Due to her young age, limited communicative abilities and concerns for more sinister underlying pathology, a complete neurological examination, MRI and pure tone audiometry were performed. After two sessions of Epley's manoeuvre, she was symptom-free. At her 3-month follow-up, the patient denied any recurrent episodes of vertigo.

Outcome of canalith repositioning manoeuvre in benign paroxysmal positional vertigo in children and adolescents: A systematic review

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is a debilitating condition that has been significantly described in adults. Recent data points out that BPPV occurs in children as well. Canalith repositioning manoeuvre (CRM) has shown promising results amongst adult patients with BPPV.

OBJECTIVE

We reviewed the literature to determine the outcome of CRM in children and adolescents with BPPV.

METHODS

A literature search was conducted over 1 month (March 2022). The primary outcome was defined as the resolution of positional nystagmus and symptoms, and secondary outcomes were determined by the presence of recurrence and the number of attempts of CRM.

RESULTS

Ten articles were selected based on our objective and selection criteria. A total of 242 patients were included, with a mean of 10.9 years. BPPV was diagnosed based on history and positional nystagmus in all patients (100%). CRM was performed in 97.9% of patients, whereby 80.5% recovered following a single attempt of CRM. Recurrence of symptoms was identified in 10% of patients with no reported major complications.

CONCLUSION

CRM has demonstrated promising results in children and adolescents. The quality of evidence is limited until a better-quality study involving randomised controlled studies with a larger sample size is completed.

Comparison of RPM (Re-positioning Maneuver) & Liberatory maneuvers vs Betahistine on BPPV (Benign Paroxysmal Positional Vertigo) for improving functional ability and quality of life

BPPV is a vestibular disease which arises due to positional changes of head. Objective: To compare the efficacy of CRP & Liberatory maneuvers collectively in contrast to Betahistine alone for improving quality of life oof BPPV patients. Methods: After getting the approval from ERC of RIHS (Rawal Institute of Health Sciences) Islamabad, this study was conducted at Rawal General & Dental Hospital Islamabad from 20th September 2022 to 19th Jan 2023. 30 patients between age of 20-50 years with first episode of vertigo were included in this study. Two groups were formulated. Group A patients were given CRP (Epley’s maneuver) & Liberatory maneuver (Semont’s) whereas group B patients were given just Betahistine 16mg. Both techniques were used twice a day for one week. Tools used for assessment were DHI & SF-36. SPSS version 21 was employed for analysis. Results: Mean+SD of age was 32.40+10.91 in group A and 29.93+11.67 in group B. The frequency of age between 20-30 years old patients was 07(46.4%) in group A and 11(73.7%) in group B. The frequency in age group 31-40 & 41-50 was 04(26.8%) & 04(26.8%) in group A whereas in group B it was 04(26.3%) & 0(0%) respectively. within group analysis of both groups showed significant improvement (p<0.05) on. Between groups Analysis revealed insignificant difference (p>0.05). Conclusion: Both maneuvers in combination are equally effective as Betahistine is in improving the quality of life of BPPV patients.

Vestibular dysfunction amongst adolescents: what do we know? A review

BACKGROUND

Vestibular dysfunction in children is a debilitating condition that results in countless pernicious effects, such as motor development delay, poor academic performance and psychosocial impairment. Yet, research pertaining to vestibular and balance disorders amongst adolescents is still lacking and remains an enigma.

METHODS

This paper outlines novel emerging aetiological factors contributing to vestibular dysfunction amongst adolescents by appraising published articles through a narrative review.

RESULTS

Underlying aetiological factors of vestibular dysfunction can be identified among adolescents with thorough evaluation. Proper diagnostic evaluation of vestibular dysfunction is imperative in providing optimal care and guiding appropriate treatment strategies. The available literature demonstrated multifactorial aetiological factors that contribute to vestibular dysfunction in adolescents.

CONCLUSION

Outlining the underlying aetiological factors of vestibular dysfunction is vital to ensure that patients receive appropriate care and treatment.

A Preliminary Study on the Characteristics and Standard Diagnosis and Treatment of Vestibular Dysfunction in Children

OBJECTIVE

To understand the pathogenesis of vestibular dysfunction in children and to provide a reference for the diagnosis and treatment of vestibular dysfunction in children.

METHODS

A retrospective analysis was conducted on 80 children who visited our hospital from June 2011 to July 2020, aged between 4 and 17 years, with a duration of 1 day to 3 years. They were admitted to the hospital for treatment upon vestibular function-related examinations confirmed that there was peripheral vestibular function impairment.

RESULTS

Children aged 6-12 years old who are diagnosed are significantly more than other two age groups (4-6) and (12-17) (X2 = 101.738, P < .001). There was a significant statistical difference (X2 = 91.195, P < .001) in comparison of abnormal rates of vestibular function-related examinations. The Mann test had the highest abnormal rate and the lowest Cervical Vestibular Evoked Myogenic Potential (cVEMP) abnormality rate. Comparison of abnormal consistency rates for quantitative and qualitative examination of vestibular function, the abnormal rates (double temperature test and Mann test) were significantly better than other abnormal consistency rates, and there were statistical differences (X2 = 7.485, P = .024 < .05). Among the children with vestibular dysfunction, the etiology was most common in 58 cases (72.50%) of benign paroxysmal vertigo, 4 cases of vestibular migraine (5.00%), 8 cases (10.00%) of vestibular neuronitis, of which 22 cases (27.50%) were combined with other diseases, and the most common was 15 cases (18.75%) of sinusitis.

CONCLUSION

A limited number of studies were conducted on vestibular dysfunction in children. The current retrospective analysis suggests that age, gender, and side of ear pain have no significant effects, while children aged 6-12 are more likely to suffer from vestibular dysfunction. On children's vestibular dysfunction, more etiology is unclear, and special attention should be paid to differential diagnosis when giving treatment and the child's medical history should be examined in detail and appropriate vestibular function tests should be selected in order to provide timely, effective, and accurate treatment for the child.

The Pharmacological Treatment of Pediatric Vertigo

Vertigo in children is a challenging topic. The lack of dedicated trials, guidelines and papers causes inhomogeneity in the treatment of vertigo in children. Meniere’s disease, migraine equivalents, vestibular neuritis, paroxysmal positional benign vertigo (BPPV), persistent postural-perceptual dizziness (PPPD) and motion sickness may affect children with various degrees of incidence and clinical severity compared to adults. Several drugs are proposed for the management of these conditions, even if their use is subordinated to the child’s age. In this review, we summarize the existing evidence related to the use of drugs for this clinical condition in children as a start point for new trials, stating the urgent need for international guidelines.

Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients

(1) Background: To assess the prevalence and frequency distribution of balance disorders in children and adolescents to delineate the planning of a targeted clinical and instrumental diagnostic work-up; (2) Methods: Retrospective analysis of the clinical documentation of patients under 18 years suffering from balance disorders from 2010 to 2019. Detailed collection of clinical history, accurate clinical examination, including both nystagmus and vestibulospinal signs examinations, and specific instrumental testing were the basis of the diagnostic process. (3) Results: A total of 472 participants were included in the study. Vestibular loss (26.1%) was the most frequent cause of vertigo in children, followed by vestibular migraine (21.2%) and benign paroxysmal positional vertigo (10.2%). In 1.1% of patients, the cause of vertigo remained undefined; (4) Conclusions: The diagnostic process applied was effective in understanding the cause of balance disorders in most cases and prevents more complex and expensive investigations reserved for only a few selected cases.

Benign Positional Paroxysmal Vertigo in Children

The aim of this study was to assess the prevalence and analyze clinical parameters of benign positional paroxysmal vertigo (BPPV) in a pediatric age. A cohort of 423 children under the age of 15 (median age 11. interquartile range 9-13) was submitted to vestibular assessment for balance disorders. Dix-Hallpike and Roll-Supine tests were performed to look for positioning nystagmus using video-infrared goggles. BPPV was found in 43 of 423 children evaluated for balance disorders (10.2%). There were 28 females (65.1%) and 15 (34.9%) males. The posterior canal was involved in 79% of cases and the horizontal canal in 21% of cases. No apogeotropic bilateral or anterior canal form were seen. Thus, BPPV is not an infrequent type of vertigo in children and must be evaluated as soon as possible in order to plan the most appropriate maneuver and restore daily activities as soon as possible, avoiding anxiety and fear.