Ménière's disease and delayed endolymphatic hydrops in children

[Vertigo in children and adolescents. Part 1: Epidemiology and diagnosis of peripheral vestibular disorders]

Migraine equivalents are the most common cause of vertigo in children and adolescents. Vertigo and balance disorders occur frequently in children during the course of otitis media, middle ear effusion and viral infections. If otitis media is associated with reduced hearing and vertigo, labyrinthitis must be considered. Craniocerebral injury is another important cause of vertigo in children. In contrast, spontaneous benign paroxysmal positional vertigo is rare among children. The isolated cases of endolymphatic hydrops that occur in children are usually secondary. Perilymph fistula can have congenital, infectious or trauma-related causes. The following characteristics are useful for differentiating between different vertiginous syndromes: type and duration of vertigo, triggering/aggravating/alleviating factors and accompanying symptoms. A neuro-ophthalmologic examination is essential to rule out central vestibular disorders.

Ménière's disease in children aged 4-7 years

This is a retrospective review of clinical data and audiovestibular test results from four children in whom symptoms suggesting Ménière's disease started at 4-7 years of age. The four patients all had spontaneous recurrent attacks of (spinning) vertigo and fluctuating low frequency sensorineural hearing loss from an early age, suggesting a diagnosis of definite Ménière's disease. Presumably, due to age-related inability to communicate auditory symptoms, the children did not initially meet requirements for a diagnosis of Ménière's disease. However, by 8 years of age, all four children reported tinnitus and/or fullness in the affected ear and, thus, met the AAO criteria for Ménière's disease. Even if information on subjective auditory symptoms is missing, it is reasonable to consider young children with idiopathic spontaneous recurrent attacks of vertigo in whom audiograms reveals fluctuating low frequency hearing loss to have Ménière's disease. This report is a reminder that Ménière's disease may also occur in young children.

[Vestibular examination of children with alterations in balance (II): results by pathologies]

We review the findings of vestibular examinations in children according to disease. Just as in adults, the dizziness can be classified following a physiopathological scheme.

Unusual cases of delayed endolymphatic hydrops

The objective of this report is to emphasize the clinical features of delayed endolymphatic hydrops in comparison with Ménière's disease. Four cases were selected from a series of 16 examined between the years 1993 and 2005, due to their unusual characteristics. A short clinical history and significant tests are presented for each of the four cases. The cases of delayed endolymphatic hydrops discussed in this article suggest that hydrops is the most important underlying pathology that causes the hearing loss and the vestibular symptoms both in the better ear and in the ear with severe hearing loss. They also suggest that this condition probably occurs in patients with congenitally sensitive ears that make them prone to the development of the late hydrops.

Surgical Treatment of Peripheral Vertigo and Vertiginous Diseases

Although our understanding of the mechanisms of vertigo and pathophysiology of vertiginous disorders has increased, diagnosis and treatment of various vertiginous diseases is challenging. The objective for the treatment of a vertiginous disease is to eliminate the underlying pathology either with maneuvers or drugs. In vertiginous diseases, surgery is performed either to eliminate the underlying pathologic event or to create stability in the incoming vestibular signals. It is not always possible to treat the underlying disease. Therefore, surgery is usually performed for the relief of vertigo. There are various surgical approaches used to treat a variety of vertiginous diseases. Selection of the approach depends on the type of vertiginous disease. This review mainly focuses on the current status and outcome of the surgeries used in the treatment of a variety of vertiginous diseases.

Epidemiología de la enfermedad de meniere en cantabria

OBJECTIVES

To know the main epidemiologic characteristics of Meniere's disease in Cantabria.

METHODS

All the patients diagnosed of "definitive" Meniere's disease between 1992 and 2002 in Sierrallana Hospital of Torrelavega (Cantabria, Spain) were reviewed. Incidence, prevalence, presence of bilateral disease, age at diagnosis and gender were recorded.

RESULTS

A total of 75 patients were diagnosed of "definitive" Meniere's" disease" during this time. The incidence was 3/100,000 people/year, the prevalence 75/100,000, male/female ratio was 0.38. Most frequent age at onset was between 40 and 60 years and bilateral cases were 5.3%.

CONCLUSIONS

Meniere's Disease is not uncommon in Cantabria. It is more prevalent among middle aged women. Bilateral cases are rare.