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Zhang J, Zhu Q, Shen J, Chen J, Jin Y, Zhang Q, Duan M, Yang J. Etiological classification and management of dizziness in children: A systematic review and meta-analysis. Front Neurol 2023; 14:1125488. [PMID: 36937528 PMCID: PMC10018681 DOI: 10.3389/fneur.2023.1125488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/24/2023] [Indexed: 03/06/2023] Open
Abstract
Background Dizziness in children, which could not be diagnosed at an early stage in the past, is becoming increasingly clear to a large extent. However, the recognition of the diagnosis and management remains discrepant and controversial due to their complicated and varied etiology. Central and peripheral vestibular disorders, psychogenic and systemic diseases, and genetic pathogeny constitute childhood etiological entities. Further understanding of the etiology and the prevalence of vertigo disorders is of crucial importance and benefit in the diagnosis and management of pediatric patients. Methods This systematic review and meta-analysis were conducted by systematically searching Embase, PubMed, the Cochrane Library, CNIK, the Chinese Wan-Fang database, CBM, the Chinese VIP database, and the Web of Science for literature on childhood vertigo disorders published up to May 2022. The literature was evaluated under strict screening and diagnostic criteria. Their quality was assessed using the Agency for Healthcare and Research Quality (AHRQ) standards. The test for homogeneity was conducted to determine the fixed effects model or random-effect model employed. Results Twenty-three retrospective cross-sectional studies involving 7,647 children with vertigo disorders were finally included, with an AHRQ score >4 (high or moderate quality). Our results demonstrated that peripheral vertigo (52.20%, 95% CI: 42.9-61.4%) was more common in children than central vertigo (28.7%, 95% CI: 20.8-37.4%), psychogenic vertigo (7.0%, 95% CI: 4.8-10.0%), and other systemic vertigo (4.7%, 95% CI: 2.6-8.2%). The five most common etiological diagnoses associated with peripheral vertigo included benign paroxysmal vertigo of childhood (BPVC) (19.50%, 95% CI: 13.5-28.3%), sinusitis-related diseases (10.7%, 95% CI: -11.2-32.6%), vestibular or semicircular canal dysfunction (9.20%, 95% CI: 5.7-15.0%), benign paroxysmal positional vertigo (BPPV)(7.20%, 95% CI: 3.9-11.5%), and orthostatic dysregulation (6.8%, 95% CI: 3.4-13.0%). Vestibular migraine (20.3%, 95% CI: 15.4-25.2%) was the most seen etiological diagnosis associated with central vertigo in children. In addition, we found the sex-based difference influenced the outcome of psychogenic vertigo and vestibular migraine, while there was no significant difference in other categories of the etiology. For the management of vertigo, symptomatical management is the first choice for most types of vertigo disorder in pediatrics. Conclusion Complex etiology and non-specific clinical manifestations of vertigo in pediatrics are challenging for their diagnoses. Reliable diagnosis and effective management depend on the close cooperation of multiple disciplines, combined with comprehensive consideration of the alternative characteristics of vertigo in children with growth and development.
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Affiliation(s)
- Jifang Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Qi Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, Yuyao People's Hospital, Yuyao, Zhejiang, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maoli Duan
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Jun Yang
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Abstract
Vestibular vertigo is most often caused by benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, vestibular migraine or stroke. Features, diagnosis and treatment of vestibular vertigo in patients with these diseases are discussed. The authors analyze common diagnostic errors based on the data of 700 outpatients (205 men and 495 women, aged 25-88 years, mean age 55 years). It is noted that the cause of vertigo is often misdiagnosed with vertebral-basilar insufficiency, discirculatory encephalopathy, cervical spine pathology; at the same time, BPPV, Meniere's disease, vestibular neuritis or vestibular migraine is diagnosed less often. This fact reflects the lack of awareness of physicians about these diseases. BPPV, Meniere's disease and migraine are effectively treated and therefore their diagnosis and adequate treatment are of great importance.
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Affiliation(s)
- L M Antonenko
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Ribeiro KF, Oliveira BS, Freitas RV, Ferreira LM, Deshpande N, Guerra RO. Effectiveness of Otolith Repositioning Maneuvers and Vestibular Rehabilitation exercises in elderly people with Benign Paroxysmal Positional Vertigo: a systematic review. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30102-7. [PMID: 28716503 PMCID: PMC9442809 DOI: 10.1016/j.bjorl.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/20/2017] [Accepted: 06/02/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Benign Paroxysmal Positional Vertigo is highly prevalent in elderly people. This condition is related to vertigo, hearing loss, tinnitus, poor balance, gait disturbance, and an increase in risk of falls, leading to postural changes and quality of life decreasing. OBJECTIVE To evaluate the outcomes obtained by clinical trials on the effectiveness of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises in the treatment of Benign Paroxysmal Positional Vertigo in elderly. METHODS The literature research was performed using PubMed, Scopus, Web of Science and PEDro databases, and included randomized controlled clinical trials in English, Spanish and Portuguese, published during January 2000 to August 2016. The methodological quality of the studies was assessed by PEDro score and the outcomes analysis was done by critical revision of content. RESULTS Six studies were fully reviewed. The average age of participants ranged between 67.2 and 74.5 years. The articles were classified from 2 to 7/10 through the PEDro score. The main outcome measures analyzed were vertigo, positional nystagmus and postural balance. Additionally, the number of maneuvers necessary for remission of the symptoms, the quality of life, and the functionality were also assessed. The majority of the clinical trials used Otolith Repositioning Maneuver (n=5) and 3 articles performed Vestibular Rehabilitation exercises in addition to Otolith Repositioning Maneuver or pharmacotherapy. One study showed that the addition of movement restrictions after maneuver did not influence the outcomes. CONCLUSION There was a trend of improvement in Benign Paroxysmal Positional Vertigo symptomatology in elderly patients who underwent Otolith Repositioning Maneuver. There is sparse evidence from methodologically robust clinical trials that examined the effects of Otolith Repositioning Maneuver and Vestibular Rehabilitation exercises for treating Benign Paroxysmal Positional Vertigo in the elderly. Randomized controlled clinical trials with comprehensive assessment of symptoms, quality of life, function and long-term follow up are warranted.
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Affiliation(s)
- Karyna Figueiredo Ribeiro
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Ciências da Saúde, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Fisioterapia, Natal, RN, Brazil.
| | - Bruna Steffeni Oliveira
- Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Raysa V Freitas
- Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Fisioterapia, Natal, RN, Brazil
| | - Lidiane M Ferreira
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Saúde Pública, Natal, RN, Brazil
| | - Nandini Deshpande
- Queen's University, Faculty of Health Sciences, School of Rehabilitation Therapy, Kingston, Canada
| | - Ricardo O Guerra
- Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Ciências da Saúde, Natal, RN, Brazil; Universidade Federal do Rio Grande do Norte (UFRN), Programa de Pós-Graduação em Fisioterapia, Natal, RN, Brazil
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Vaz DP, Gazzola JM, Lança SM, Dorigueto RS, Kasse CA. Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 2013; 79:150-7. [PMID: 23670318 PMCID: PMC9444521 DOI: 10.5935/1808-8694.20130027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/14/2012] [Indexed: 11/25/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. Objective To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. Method This is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. Results most subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). Conclusion Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.
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Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Front Neurol 2012; 3:169. [PMID: 23226141 PMCID: PMC3508265 DOI: 10.3389/fneur.2012.00169] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/08/2012] [Indexed: 11/13/2022] Open
Abstract
Objective: To identify under-diagnosed neuro-otological disorders and to evaluate whether under-diagnosing depends on the age of the patient. Materials and methods: Retrospective analysis of medical charts from 951 consecutive patients (685 under and 266 above the age of 65 years) who entered diagnostic procedures at the Interdisciplinary Center for Vertigo and Balance Disorders, University Hospital Zurich, Switzerland. Final diagnoses were compared to referral diagnoses. Results: Relative to referral diagnoses, the proportion of patients finally diagnosed with benign paroxysmal positional vertigo (BPPV) almost doubled both in younger (<65 year from 12.7 to 25.1%) and older patients (from 20.7 to 37.6%). Striking relative increases were found for the diagnoses multisensory dizziness in older patients (from 20.7 to 37.6%) and vestibular migraine in younger patients (1.8 to 20.2%). In both age groups, the proportion of patients with undetermined diagnoses was reduced by about 60% (younger: 69.8 to 9.8%; older: 69.2 to 12.4%) by the diagnostic procedures in the vertigo center. These changes were all significant (p < 0.05) in McNemar tests with continuity correction (2 × 2 tables: focused diagnosis vs. other diagnoses, referral vs. final). Conclusion: Significant changes of diagnoses can be expected by a specialized neuro-otological work-up. In particular, BPPV, multisensory dizziness, and vestibular migraine are under-diagnosed by referring physicians. This finding calls for better education of primary care takers in the field of neuro-otology.
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Affiliation(s)
- Rebekka Geser
- Department of Neurology, University Hospital Zurich Zurich, Switzerland
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Mezzasalma MA, Mathias KDV, Nascimento I, Valença AM, Nardi AE. Imipramine on the treatment of chronic dizziness and panic disorder--3 cases report. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:717-8. [PMID: 20307620 DOI: 10.1016/j.pnpbp.2010.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 02/24/2010] [Accepted: 03/09/2010] [Indexed: 11/25/2022]
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Bertoncello D, Sá CDSCD, Calapodópulos AH, Lemos VL. Equilíbrio e retração muscular em jovens estudantes usuárias de calçado de salto alto. FISIOTERAPIA E PESQUISA 2009. [DOI: 10.1590/s1809-29502009000200003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Verifica-se precocidade na utilização de calçado de salto alto, mas não há muitos estudos identificando suas conseqüências. O objetivo deste trabalho foi verificar alterações de equilíbrio e eventual retração muscular em estudantes universitárias habituadas a utilizar salto alto diariamente. Foram avaliadas 30 jovens (média de 20 anos de idade) que anotaram, durante duas semanas, o tempo diário em que permaneciam com o calçado. Foram avaliadas quanto a desvios posturais, quanto às retrações musculares da cadeia posterior, pelo teste de alcance horizontal, e quanto ao equilíbrio, pelo teste de Romberg. Os resultados foram analisados estatisticamente. A média de estatura foi 1,63 m e a de massa corporal, 58,5 kg. O tempo médio de uso dos sapatos de salto alto foi de 34 h por semana. Ao relacionar o alcance horizontal com o tempo semanal de uso do salto alto, verificou-se forte correlação negativa (r=-0,8692; p<0,0001). Não houve correlação entre o alcance horizontal e o tempo de uso de salto alto em anos. O teste de 17 das 30 voluntárias foi positivo para perda de equilíbrio quando descalças, de olhos fechados. A correlação foi negativa com o tempo de uso semanal de salto alto (r=-0,4178; p=0,0216). Foi encontrada correlação positiva moderada entre o alcance horizontal e o tempo de equilíbrio (r=0,6078; p<0,0004). Conclui-se que o uso de calçado de salto alto por mais de 4 horas diárias pode promover alterações de equilíbrio em mulheres jovens, além de retração muscular.
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Mezzasalma MA, Mathias KDV, Nascimento I, Valença AM, Nardi AE. Chronic dizziness presenting in a patient with panic disorder: response to imipramine. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:121-122. [PMID: 19330229 DOI: 10.1590/s0004-282x2009000100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Marco Andre Mezzasalma
- Laboratório de Pânico & Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Abstract
OBJETIVO: realizar o estudo da prova calórica em pacientes idosos com queixa de tontura, acompanhada ou não de zumbido com finalidade de traçar um perfil dos idosos quanto os sintomas vestibulares. MÉTODOS: fizeram parte da amostra 143 pacientes, com faixa etária variando de 60 a 90 anos de idade; todos realizaram o exame otoneurológico. Foram excluídos pacientes idosos com queixa de desequilíbrio e aqueles que apresentaram a queixa de zumbido desacompanhado da tontura. RESULTADOS: o estudo demonstrou que a normorreflexia, em valores absolutos, encontra-se entre 82,3% a 91,2% e os valores relativos são de 93%. Referente aos dados colhidos na anamnese, o que chamou a atenção, foi que do total de pacientes analisados, encontrou-se a tontura acompanhada de zumbido em 69% dos casos e o elevado uso de medicação em pacientes nesta faixa etária. CONCLUSÃO: na população estudada houve um predomínio da tontura acompanhada de zumbido. Em relação à prova calórica, o trabalho demonstrou a alta prevalência de pacientes com valores absolutos e relativos normais.
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Affiliation(s)
| | - Silvana Frota
- CEFAC - Saúde e Educação do Rio de Janeiro; Universidade Federal de São Paulo
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Kanashiro AMK, Pereira CB, Maia FM, Scaff M, Barbosa ER. Avaliação da vertical visual subjetiva em indivíduos brasileiros normais. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:472-5. [PMID: 17665018 DOI: 10.1590/s0004-282x2007000300021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 02/12/2007] [Indexed: 11/22/2022]
Abstract
A função otolítica pode ser avaliada pela Vertical Visual Subjetiva (VVS) que determina a capacidade de um indivíduo julgar se objetos estão na posição vertical na ausência de outras referências visuais. O objetivo deste estudo foi avaliar a VVS em indivíduos brasileiros normais usando um aparelho portátil. As medidas da VVS foram realizadas em 160 indivíduos (16 a 85 anos). O valor médio da VVS foi obtido após dez ajustes. A VVS teve valores médios entre -2,0º e +2,4º (média=0,18º, e DP=0,77º). Não houve diferença entre as médias da VVS em relação à idade (teste de Kruskal-Wallis; p=0,40), mas as faixas etárias maiores tiveram variância maior (teste de Levene; p=0,016). Os valores da VVS encontrados neste estudo foram semelhantes aos registrados na literatura. Não houve diferença nas médias das inclinações da VVS de acordo com a idade, mas foi encontrada maior variância entre indivíduos mais idosos.
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Pavan K, Marangoni BEM, Schmidt KB, Cobe FA, Matuti GS, Nishino LK, Thomaz RB, Mendes MF, Lianza S, Tilbery CP. Reabilitação vestibular em pacientes com esclerose múltipla remitente-recorrente. ARQUIVOS DE NEURO-PSIQUIATRIA 2007; 65:332-5. [PMID: 17607438 DOI: 10.1590/s0004-282x2007000200027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 01/17/2007] [Indexed: 11/22/2022]
Abstract
A esclerose múltipla (EM) é doença desmielinizante, inflamatória, que acomete a substância branca do sistema nervoso central, e sensações vestibulares anormais (vertigem, desequilíbrio) são freqüentes. A reabilitação vestibular (RV) é determinada por mecanismos de adaptações, substituições e compensações neurais. Este estudo avaliou a melhora da vertigem central ou periférica em pacientes com EM remitente-recorrente submetidos à RV (exercícios de Cawthorne-Cooksey), através da escala de Berg e Dizziness Handicap Inventory (DHI). Nesta amostra de 4 casos a RV, realizada em um período de 2 meses, demonstrou a melhora em 3 pacientes avaliados pela escala de Berg e em 2 pacientes quando avaliados pela DHI.
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