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- Title
Unusual vertigo etiologies in pediatric patients.
- Authors
Ionescu, Eugen
- Abstract
In 2015, 110 pediatric vestibular assessments were performed in our tertiary Audiologic & Neurotologic Center of Lyon. Out of these, 50 procedures (45.4%) were related to the systematic evaluation we use to practice before and after Cochlear Implantation surgery. As previously reported, various degree of balance and vestibular impairment is frequent in syndromic and non-syndromic deaf young patients. Migraine or equivalencies such Benign Paroxsymal Vertigo (Childhood Vertigo) was found to be the first cause of imbalance in normal hearing children. On the one hand, these results follow the available statistics considering vertigo etiologies in children. On the other hand, we present a series of cases in which etiologies are very rare or not reported to date in pediatric population. Posttraumatic Endolymphatic Hydrops: 2 cases with clinical signs of hydrops after cohlear implantation surgery (an 8-year unilateral implanted boy and one 17-year bilaterally implanted girl) and 1 case of delayed hydrops after severe head concussion associating extra labyrinthine petrous bone fracture and iterative attacks of vertigo but no hearing loss in a 8 years old boy; Internal Auditory Canal/Meatus stenosis: 2 girls (9 and 17 years old), in both cases the clinical symptoms were bilateral progressive sensorineural hearing loss, imbalance and iterative vertigo. Vestibular paroxysmia: 16-year-old girl presenting a micro vascular compression syndrome of the VIIIth cranial nerve. Method. All patients underwent audio vestibular assessment including: Pure Tone and Vocal Audiometry, Brain Evoked Auditory Responses, VHIT (ICS-Otometrics and/or Synapis Ulmer II), VNG and cervical Vestibular Evoked Myogenic Potentials. In 4 cases of patients presenting severe and repetitive vertigo attacks the patients and their parents were instructed to record eyes movements with a smartphone within crisis period. This method helped us to identify and to characterize the type of nystagmic movements and subsequently the side of the vestibular impairment. All patients were evaluated with cerebral and inner ear 3T RMI sometimes including volumetric studies of the saccular membranous structures. Conclusion. The vestibular assessment is continuously developing. In pediatric population in whom evaluation and positive diagnosis are difficult especially in very young subjects, the clinician must be aware that some vestibular disease thought to be rare at this age may occur. The most difficult diagnosis challenge remains just like for the adults, the iterative vertigo with no auditory symptoms or signs.
- Subjects
VERTIGO; COCHLEAR implants; LABYRINTHINE fluids
- Publication
ORL.ro, 2016, Vol 9, Issue 31, p58
- ISSN
2067-6530
- Publication type
Article