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Balance Disorders
Published in Raymond W Clarke, Diseases of the Ear, Nose & Throat in Children, 2023
Take a detailed and thorough history. The duration of symptoms can be of great diagnostic help. ‘Dizziness’ lasting for a few seconds suggests benign paroxysmal positional vertigo (BPPV) but this is rare in children. Episodes lasting a few hours may be due to migraine, or benign paroxysmal vertigo of childhood (BPVC) which is now thought to be a variant of migraine. Vestibular neuronitis and acute labyrinthitis symptoms last for a few days, but compensation in children is much more rapid than in adults. Associated symptoms can help narrow the diagnosis; nausea and vomiting suggest vestibular pathology but may occur in migraine. Neurological features such as seizures or cranial nerve palsies are alarming and warrant urgent investigation to rule out intracranial pathology. Anxiety, depression and eating disorders may be associated with balance dysfunction. ‘Functional’ (or ‘psychogenic’ vertigo as it used to be known) is common, and the rapid hormonal changes of adolescence can often be accompanied by symptoms of ‘dizziness’ caused by postural (orthostatic) hypotension. Adolescence is also a time when young people may be subject to exam pressures, bullying, intense social media activity and sometimes family disharmony, all of which can manifest as somatic symptoms including balance disorders.
Case 47
Published in Simon Lloyd, Manohar Bance, Jayesh Doshi, ENT Medicine and Surgery, 2018
Simon Lloyd, Manohar Bance, Jayesh Doshi
The most likely diagnosis is vestibular neuronitis. There is nystagmus on the ENG and a normal audiogram. Vestibular neuronitis typically causes acute onset of vertigo, sometimes with a preceding upper respiratory tract infection, lasting for days at a time. The hearing is not affected, distinguishing it from sudden sensorineural hearing loss with vertigo (sometimes loosely called viral labyrinthitis); the vertigo is not episodic and is too long in duration for disorders, such as migraine-associated vertigo or Ménière's disease, which typically only last for hours. The following table classifies vertigo by hearing loss and duration. Another entity to consider, particularly in older adults, is a brainstem/cerebellar stroke. In that condition, other neurological signs, such as cranial nerve palsies, spinothalamic sensory signs, oculomotor findings, such as saccadic smooth pursuit and Horner syndrome may be seen.
Balance Disorders in Children
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Louisa Murdin, Gavin A.J. Morrison
Vestibular neuronitis presents as it does in adults, with acute severe vertigo, nausea and often vomiting but normal hearing. Characteristic nystagmus is seen during acute attacks. Children recover more quickly from this disorder than do adults. Half of patients can have repeated episodes, although within a few years attacks become progressively less severe and are likely to cease. Treatment is with vestibular rehabilitation, which in children takes the form of games (ball games, picking up of toys on the floor, and rapid head movements with gaze fixation on fixed targets).19
White Matter Hyperintensities (WMH) and clinical outcome after vestibular neuritis
Published in Neurological Research, 2022
Huimin Fan, Jing Feng, Melissa Wills, Liying Wang, Xiaomeng Chen, Xiaokun Geng, Yuchuan Ding
Vestibular neuritis (VN), often assumed to be tied to viral illness, is a common cause of acute, continuous, nonpositional vertigo[1]. The clinical trajectory of VN is temporally delineated – the first 2 weeks are considered to comprise the acute phase, whereas the subsequent subacute phase can last up to 3 months. Recovery from the symptoms of acute vertigo as a result of vestibular neuritis (VN) is achieved by the rehabilitation of peripheral labyrinthine function as well as through the various patterns of plastic cortical changes in the visual and vestibular systems, known as central compensation[2]. The failure of these mechanisms can lead to persistence of the condition, which can last for years[3]. Indeed, about 20% of patients will continue to experience chronic postural imbalance and vertical oscillopsia, which is known as the syndrome of chronic vestibular insufficiency[4].
Cervicogenic dizziness alleviation after coblation discoplasty: a retrospective study
Published in Annals of Medicine, 2021
Liang-liang He, Ru-jing Lai, Jacqueline Leff, Rong Yuan, Jian-ning Yue, Jia-xiang Ni, Li-qiang Yang
Patients with the following conditions were excluded: peripheral vestibular disorders(such as: benign paroxysmal position vertigo characterized by acute onset, lasting seconds to 1 min, positional, triggered by movement accompanied by nystagmus; Meniere’s disease characterized by general onset, lasting several hours, not positional, hearing loss, tinnitus, fullness; vestibular neuronitis characterized by acute onset, lasting several weeks, central vestibular disorders (such as: posterior circulation infraction characterized by sudden acute onset, ataxia, diplopia, cranial nerve defects, limb weakness; tumours characterized by general onset, brainstem and/or cerebellar dysfunction; vestibular migraine characterized by throbbing headache, vertigo, sensitivity to auditory or visual sensory stimulation, and oculomotor changes, bow hunter’s symptom, whiplash injury, progressive cervical myelopathy, spinal fracture, and coagulopathy.
Caloric test versus video head impulse test in vestibular neuritis patients
Published in Hearing, Balance and Communication, 2021
S. Mekki, W. Mohamed, S. Omar, N. Gad
Vestibular neuritis (VN) is an acute unilateral peripheral vestibular disease without other signs of brain stem involvement. A comprehensive multidisciplinary assessment of VN patients including history and vestibular function tests holds great promise for more effective diagnosis. The caloric test and the video head impulse test (vHIT) are diagnostic tools to examine VN patients through assessing the function of the semicircular canals. Both tests assess the vestibular ocular reflex (VOR) with major differences between them as regards stimulus characteristics, frequency, methodology and function examined. The caloric test is a part of videonystagmography test battery. It is an attempt to discover the degree to which the vestibular system is responsive and how symmetric the responses between the left and right sides are. It is a test of the lateral semi-circular canals alone; it does not assess vertical canal function or otolithic function [1].