Clinical and demographic characteristics of children and adolescents with acute vertigo symptoms: A cross-sectional study

Recurrent dizziness among adolescents in Denmark: Trends 1991-2022 and associations with sociodemographic factors, health, and health behaviours

1) to study time trends in the prevalence of recurrent dizziness among adolescents in Denmark 1991-2022, and 2) to examine how dizziness was associated with sociodemographic factors, mental health related factors, health status, and health behaviours in 2022. The study focused on recurrent dizziness, i.e. episodes of dizziness several times a week during the last six months. Data stem from the Danish arm of the international Health Behaviour in School-aged Children (HBSC) study which included 11-, 13- and 15-year-olds from random samples of schools in nine comparable surveys from 1991 to 2022, n = 40,102. We applied multivariate logistic regression analyses in the 2022 dataset (n = 5,737) to examine how dizziness was associated with other factors. In 2022, the prevalence of recurrent dizziness was 14.3% (boys 8.8%, girls 19.7%), significantly higher than the 7.1% in the surveys 1991-2018. The prevalence in 2022 was significantly higher among girls, older students, and students not living with both parents. Dizziness was significantly elevated among students with short sleep duration, who skipped breakfast, used alcohol and tobacco, felt lonely, had low life satisfaction, low self-esteem, were exposed to bullying at school, felt high schoolwork pressure, low school satisfaction, who were underweight, overweight, had poor self-rated health, chronic illness, injuries in the last year, headache, stomachache, backpain, feeling low, irritability/bad temper, nervousness, difficulties falling asleep, and poor/restless sleep.

CONCLUSION

The study suggested that dizziness is a general indicator of not feeling well, run down, or suffering rather than a sign of specific somatic health problems.

WHAT IS KNOWN

• Recurrent dizziness is common among adolescents and may limit daily activities and harm quality of life. • Recurrent dizziness in adolescence may reflect somatic and mental health problems and is strongly associated with headache.

WHAT IS NEW

• The prevalence of recurrent dizziness among adolescents in Denmark was stable 1991-2018 and increased steeply from 2018 to 2022. • Recurrent dizziness was strongly associated with poor health behaviours, a broad range of somatic and mental health problems, and exposure to stressors.

Characteristics and diagnostic approach of vestibular migraine in children and adolescents: A systematic review

OBJECTIVE

Vestibular migraine (VM) is the most common cause of episodic vertigo afflicts 1% of the general population. The complexity of VM is owing to the migrainous, and vestibular components and much knowledge have been gained in recent years on VM in the adult population. Akin to that, numerous studies focusing on VM in children and adolescent has emerged. We reviewed the literature to understand the characteristics and diagnostic approach of VM in children and adolescents.

METHODS

A literature search was conducted over a period of one month (April 2022).

RESULTS

16 articles were selected based on our objective and selection criteria. A total of patients was included, with a median age of 10.9 years. 11 studies diagnosed VM based on diagnostic criteria. Caloric test and electro/videonystagmography are the most favoured investigation used (50%). Imaging was performed in 56.2% of included studies.

CONCLUSION

Deciphering the ideal diagnostic approach for VM is prudent to ensure children and adolescents suffering from VM are treated earlier. VM can be diagnosed using the established diagnostic criteria, which requires thorough and meticulous history taking. The available oto-neurological examination aims to exclude other disorders as its significance in diagnosing VM is still debatable.

Etiological classification and management of dizziness in children: A systematic review and meta-analysis

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.

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.