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1.
Laryngoscope ; 2022 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-35524589

RESUMO

OBJECTIVES: This study aimed to determine the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in young children. STUDY DESIGN: Retrospective case review. METHODS: All children <10 years old that have been diagnosed with BPPV at our pediatric vestibular program between December 2012-July 2021 were selected. Clinical features were identified by medical record review, including demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS: A total of 34 children were diagnosed with BPPV with a mean age of 7.9 years old (SD ± 1/7; range 5-9) at the time of diagnosis and a male:female ratio of 1:1. Involved semicircular canals included posterior in 82% (n = 28), horizontal in 41% (n = 14), and superior in 24% (n = 8) of patients, respectively. Comorbid diagnoses included migraine (n = 14), concussion (n = 10), acute vestibular syndrome (n = 4), and persistent postural perceptual dizziness (n = 6). Recurrence with initially confirmed resolution occurred in 10 patients (29%) with a mean of 2.5 recurrences per patient (SD: 2.2; range 1-8). A family history of vertigo or migraine was identified in 11 and 17 patients, respectively. CONCLUSIONS: BPPV is a cause of vertigo in children that may be overlooked. A relatively high proportion of patients demonstrated horizontal or superior canal involvement, recurrence, and additional comorbid causes of dizziness. Thus, providers evaluating young children with dizziness should perform diagnostic maneuvers to evaluate BPPV of all semicircular canals and continue to monitor children after successful treatment for recurrence. LEVEL OF EVIDENCE: 4, Case Series Laryngoscope, 2022.

2.
Laryngoscope ; 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34981837

RESUMO

OBJECTIVES: Idiopathic pain at the cochlear implant (CI) site outside of the immediate postoperative period is an uncommon occurrence but may necessitate device explantation. Our objective was to describe the clinical course for pediatric patients with CI site pain who ultimately required device explantation. STUDY DESIGN: Retrospective chart review. METHODS: We performed a retrospective database review of CIs performed at a tertiary referral center for pediatric cochlear implantation. We specifically evaluated pediatric patients who presented with pain at or near the CI device site and ultimately required explantation. RESULTS: Fifteen patients (16 CIs) had pain at or near the CI site requiring device explantation. Cultures taken during site exploration or device explantation identified bacteria in 86% and 81% of procedures, respectively. Propionibacterium acnes and Staphylococcus non-aureus were the most commonly identified organisms. CONCLUSIONS: The majority of patients with idiopathic pain in this cohort ultimately requiring CI explantation had chronic bacterial colonization. LEVEL OF EVIDENCE: Level 4 (Case series) Laryngoscope, 2022.

3.
Clin J Sport Med ; 32(2): 114-121, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33605602

RESUMO

OBJECTIVE: To describe the collaborative findings across a broad array of subspecialties in children and adolescents with postconcussion syndrome (PCS) in a pediatric multidisciplinary concussion clinic (MDCC) setting. DESIGN: Retrospective analysis. SETTING: Multidisciplinary concussion clinic at a pediatric tertiary-level hospital. PATIENTS: Fifty-seven patients seen in MDCC for evaluation and management of PCS between June 2014 and January 2016. INTERVENTIONS: Clinical evaluation by neurology, sports medicine, otolaryngology, optometry, ophthalmology, physical therapy, and psychology. MAIN OUTCOME MEASURES: Specialty-specific clinical findings and specific, treatable diagnoses relevant to PCS symptoms. RESULTS: A wide variety of treatable, specialty-specific diagnoses were identified as potential contributing factors to patients' postconcussion symptoms. The most common treatable diagnoses included binocular vision dysfunction (76%), anxiety, (57.7%), depression (44.2%), new or change in refractive error (21.7%), myofascial pain syndrome (19.2%), and benign paroxysmal positional vertigo (17.5%). CONCLUSIONS: Patients seen in a MDCC setting receive a high number of treatable diagnoses that are potentially related to patients' PCS symptoms. The MDCC approach may (1) increase access to interventions for PCS-related impairments, such as visual rehabilitation, physical therapy, and psychological counseling; (2) provide patients with coordinated medical care across specialties; and (3) hasten recovery from PCS.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Síndrome Pós-Concussão , Adolescente , Traumatismos em Atletas/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Criança , Humanos , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/psicologia , Síndrome Pós-Concussão/terapia , Estudos Retrospectivos
4.
Front Neurol ; 12: 714543, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744965

RESUMO

Hearing loss (HL) is the most common sensory deficit in humans and is frequently accompanied by peripheral vestibular loss (PVL). While often overlooked, PVL is an important sensory dysfunction that may impair development of motor milestones in children and can have a significant negative impact on quality of life. In addition, many animal and in vitro models of deafness use vestibular hair cells as a proxy to study cochlear hair cells. The extent of vestibular end organ dysfunction associated with genetic pediatric hearing loss is not well-understood. We studied children with a known genetic cause of hearing loss who underwent routine preoperative vestibular testing prior to cochlear implantation between June 2014 and July 2020. Vestibular testing included videonystagmography, rotary chair, video head impulse testing, and/or vestibular evoked myogenic potentials. Etiology of HL was determined through history, physical examination, imaging, laboratory testing, and/or genetic testing. Forty-four children (21 female/23 male) met inclusion criteria; 24 had genetic non-syndromic and 20 had genetic syndromic forms of HL. Mean age at the time of testing was 2.8 ± 3.8 years (range 7 months-17 years). The most common cause of non-syndromic HL was due to mutations in GJB2 (n = 13) followed by MYO15A (3), MYO6 (2), POU3F4 (2), TMPRSS3 (1), CDH23 (1), TMC1 (1), and ESRRB (1). The most common forms of syndromic HL were Usher syndrome (4) and Waardenburg (4), followed by SCID/reticular dysgenesis (3), CHARGE (2), CAPOS (1), Coffin-Siris (1), Jervell and Lange-Nielsen (1), Noonan (1), peroxisome biogenesis disorder (1), Perrault (1), and Trisomy 21 (1). Overall, 23 patients (52%) had PVL. A larger proportion of children with syndromic forms of HL had PVL (12/20, 60%) compared with children with genetic non-syndromic HL (11/24, 46%), though without statistical significant (p = 0.3). The occurrence of PVL varied by affected gene. In conclusion, PVL is a common finding in children with syndromic and non-syndromic genetic HL undergoing vestibular evaluation prior to cochlear implantation. Improved understanding of the molecular physiology of vestibular hair cell dysfunction is important for clinical care as well as research involving vestibular hair cells in model organisms and in vitro models.

5.
Otol Neurotol ; 42(8): e1093-e1100, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34191779

RESUMO

OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) is a recently defined diagnostic syndrome characterized by chronic symptoms of dizziness, unsteadiness, and/or non-spinning vertigo. Although PPPD has been studied in adults, reports in the pediatric population are few. The goal of this study was to describe the presentation and treatment of PPPD in a group of pediatric patients. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: ≤21 years old, who met Bárány Society consensus criteria for a diagnosis of PPPD and were followed for ≥6 months or until symptom resolution. MAIN OUTCOME MEASURESS: Patient demographics, comorbidities, symptom chronicity, and response to treatment(s). RESULTS: Of the 53 patients identified, 44 (83.0%) were women. Mean age at the time of initial evaluation was 14.6 years old. Common diagnoses in addition to PPPD included benign paroxysmal positional vertigo (64.2%), vestibular migraine (56.6%), and anxiety (28.3%). A high proportion of patients (43.4%) reported initially missing school or work due to their symptoms. Eighteen patients (34.0%) reported symptom resolution ranging from 2 to 48 months after diagnosis (median 9 mo). Of these patients, 15 of 18 attended physical therapy (PT), 11 of 18 attended cognitive behavioral therapy (CBT) and/or biofeedback therapy, and 10 of 18 took selective serotonin reuptake inhibitor (SSRI) medications, and 7 of 18 (40%) did a combination of all three therapies. CONCLUSION: PPPD can impact patients at a young age, and prolonged symptoms present a significant burden to children and adolescents, many of whom are unable to attend school. Treatments such as PT, CBT, and SSRI medication may be effective.


Assuntos
Tontura , Transtornos de Enxaqueca , Adolescente , Adulto , Ansiedade , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Criança , Tontura/diagnóstico , Feminino , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
6.
Sports Health ; 13(4): 380-386, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33528343

RESUMO

BACKGROUND: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. PURPOSE: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. RESULTS: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS "balance problems or dizziness" subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). CONCLUSION: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. CLINICAL RELEVANCE: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.


Assuntos
Vertigem Posicional Paroxística Benigna/etiologia , Concussão Encefálica/complicações , Adolescente , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/terapia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Posicionamento do Paciente , Estudos Retrospectivos , Adulto Jovem
7.
Laryngoscope ; 131(4): E1308-E1314, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32809223

RESUMO

OBJECTIVES: To examine the relative prevalence of individual diagnoses in children and adolescents presenting with dizziness and/or imbalance, and to assess the proportion of patients assigned multiple contributing diagnoses. STUDY DESIGN: Retrospective cohort study. METHODS: We retrospectively reviewed our internal database of all patients seen at our pediatric vestibular program between January 2012 and March 2019 to determine the incidence of common diagnoses and groups of diagnoses for patients ages 21 or younger. RESULTS: One thousand twenty-one patients were included with a mean age of 12.5 ± 4.9 years (range: 9 months-21 years). Of this total, 624 patients were female and 397 were male. Common diagnoses included vestibular migraine (VM; 35.0%), benign paroxysmal positional vertigo (BPPV; 21.6%), primary dysautonomia (15.7%), anxiety disorder (13.5%), and persistent postural perceptual dizziness (PPPD; 11.2%). A high proportion of patients (44.4%) received multiple contributing diagnoses. VM was frequently diagnosed with BPPV or PPPD, and 22 patients were diagnosed with all three concurrently. CONCLUSION: The causes of dizziness and imbalance in the pediatric population are diverse, and many patients have multiple diagnoses that are often interrelated. It is important that providers recognize that the causes of vestibular symptoms in children and adolescents may be multifactorial and may span across multiple specialties. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1308-E1314, 2021.


Assuntos
Tontura/etiologia , Equilíbrio Postural/fisiologia , Vestíbulo do Labirinto/fisiopatologia , Adolescente , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/epidemiologia , Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/epidemiologia , Criança , Tontura/diagnóstico , Tontura/epidemiologia , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/epidemiologia , Síndrome Pós-Concussão/complicações , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/epidemiologia , Prevalência , Disautonomias Primárias/complicações , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/epidemiologia , Estudos Retrospectivos
8.
Otolaryngol Head Neck Surg ; 163(6): 1250-1254, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32600124

RESUMO

Auditory complaints are commonly reported following traumatic brain injury (TBI). However, few studies have examined patient-reported auditory symptomatology and quality-of-life metrics in individuals with TBI. We hypothesize that following TBI, individuals can experience auditory symptoms even with hearing thresholds in the normal range. Adult patients with normal auditory thresholds and a history of TBI were evaluated for subjective hearing loss, tinnitus, aural fullness, hyperacusis, and autophony. Hearing Handicap Inventory for Adults, Tinnitus Handicap Inventory, and Hyperacusis Questionnaire were administered. Thirty-one patients were prospectively recruited. Twenty-eight TBI participants (90%) reported ≥1 auditory symptoms at the time of survey intake. Mild to severe handicap in the Hearing Handicap Inventory for Adults and Tinnitus Handicap Inventory was reported in 71.4% and 40% of the participants with hearing loss and tinnitus, respectively. Hyperacusis handicap was considered significant in 41.1% of the participants who complained of hyperacusis and completed the survey. Despite normal hearing thresholds, individuals with TBI experience decrements in auditory quality-of-life metrics. Level of evidence: 3.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Perda Auditiva/etiologia , Hiperacusia/etiologia , Qualidade de Vida , Zumbido/etiologia , Adolescente , Adulto , Audiometria de Tons Puros , Limiar Auditivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
9.
Eur J Paediatr Neurol ; 28: 176-179, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32682672

RESUMO

INTRODUCTION: Susceptibility to severe motion sickness has not been well described in the pediatric population, particularly in very young children. This study aimed to describe and evaluate risk factors and treatment responses in a group of children with severe motion sickness, including infants and toddlers. METHODS: We conducted a retrospective review of patients less than 18 years of age seen in our pediatric vestibular program for evaluation of motion sickness over a 6-year period. RESULTS: A total of 23 patients with motion sickness were identified. Age of onset ranged from 0 to 15 years old, with a mean age of 6.6 ± 4.2 years. Eleven patients (47.8%) were diagnosed with a migraine variant. Vestibular deficits were identified in four out of 17 patients (23.5%) who underwent formal vestibular testing. Other frequent comorbid conditions included recurrent/chronic otitis media (n = 9; 39.1%) and a history of motor delay (n = 7; 30.4%). A high proportion of patients reported symptom improvement when treated with meclizine, ondansetron, cyproheptadine, or vestibular rehabilitation. DISCUSSION: Motion sickness can impact children even in infancy. Common comorbid conditions that may contribute to pediatric motion sickness include migraine disorders, vestibular impairment, otitis media, and motor delay. Treatments such as cyproheptadine and vestibular rehabilitation may be helpful but require further study.


Assuntos
Enjoo devido ao Movimento/epidemiologia , Adolescente , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos de Enxaqueca/epidemiologia , Enjoo devido ao Movimento/terapia , Otite Média/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Doenças Vestibulares/epidemiologia , Doenças Vestibulares/reabilitação
10.
Laryngoscope Investig Otolaryngol ; 5(2): 256-266, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32337357

RESUMO

OBJECTIVE: While cochlear ossification is a common sequalae of meningitic labyrinthitis, less is known about the effects of meningitis on peripheral vestibular end organs. Herein, we investigate histopathologic changes in the peripheral vestibular system and cochlea in patients with a history of meningitic labyrinthitis. METHODS: Temporal bone (TB) specimens from patients with a history of meningitis were evaluated and compared to age-matched controls. Specimens were evaluated by light microscopy and assessed for qualitative changes, including the presence of vestibular and/or cochlear endolymphatic hydrops, presence and location of inflammatory cells, new bone formation, and labyrinthitis ossificans; and quantitative changes, including Scarpa's ganglion neuron (ScGN) and spiral ganglion neuron (SGN) counts. RESULTS: Fifteen TB from 10 individuals met inclusion and exclusion criteria. Presence of inflammatory cells and fibrous tissue was found in 5 TB. Of these, evidence of labyrinthitis ossificans was found in 2 TB. In the peripheral vestibular system, mild to severe degeneration of the vestibular membranous labyrinth was identified in 60% of cases (n = 9 TBs). There was a 21.2% decrease (range, 3%-64%) in the mean total count of ScGN in patients with meningitis, compared to age-matched controls. In the cochlea, there was a 45% decrease (range, 25.3%-80.9%) in the mean total count of SGN compared to age-matched controls (n = 14 TBs). CONCLUSIONS: Otopathologic analysis of TB from patients with a history of meningitic labyrinthitis demonstrated distinct peripheral vestibular changes. Future research may help to delineate potential mechanisms for the observed otopathologic changes following meningitis. LEVEL OF EVIDENCE: N/A.

11.
Int J Pediatr Otorhinolaryngol ; 131: 109862, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31927148

RESUMO

OBJECTIVES: To evaluate the association between torticollis and enlarged vestibular aqueduct (EVA). METHODS: An online/phone survey was administered to parents of 133 children diagnosed with the following disorders: EVA, GJB2 (Connexin 26) mutations associated congenital hearing loss and epistaxis (control). The survey included questions regarding symptoms of torticollis, vertigo, and hearing loss. RESULTS: Patients with EVA had a 10-fold greater odds of having torticollis than controls (31% vs. 4%; OR = 10.6; 95% CI: 2.9, 39.2). No patients with GJB2 had a reported history of torticollis. Torticollis preceded the diagnosis of hearing loss in most (87%) patients with EVA who had a reported history of torticollis. EVA patients were more likely to have reported motor delay than controls (40% vs. 15%; p = 0.002). EVA patients with prior torticollis (80%; 12/15) were more likely to have balance impairment than EVA patients without prior torticollis (12%; 4/33; p < 0.001). Twelve patients had a reported history of paroxysmal torticollis, all of whom had EVA. CONCLUSION: Torticollis in infants may be a marker of EVA. Infants with torticollis should be monitored closely for hearing loss and motor delay, especially when the torticollis is paroxysmal.


Assuntos
Perda Auditiva Neurossensorial/complicações , Perda Auditiva/congênito , Torcicolo/complicações , Aqueduto Vestibular/anormalidades , Estudos de Casos e Controles , Conexina 26 , Conexinas/genética , Feminino , Perda Auditiva/complicações , Humanos , Lactente , Masculino , Mutação , Estudos Retrospectivos , Vertigem/etiologia
12.
Laryngoscope ; 130(3): 752-760, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31074866

RESUMO

OBJECTIVES/HYPOTHESIS: Vestibular symptoms are a common sequela of temporal bone fractures (TBFs). The mechanisms of injury to the peripheral vestibular system following TBF, however, are not well described. Herein, we aimed to investigate the histopathology of the peripheral vestibular system in patients who sustained TBFs. STUDY DESIGN: Retrospective human specimen analysis. METHODS: Specimens from the National Temporal Bone Pathology Registry with (cases) and without (controls) TBFs were evaluated. Specimens were analyzed by light microscopy for vestibular hair cell and/or dendritic degeneration, presence of endolymphatic hydrops, blockage of the endolymphatic duct, and number of Scarpa ganglion cells (ScGCs) in the superior and inferior vestibular nerves. RESULTS: Seven temporal bones (TBs) from five individuals with TBFs, and seven TBs from six age-matched individuals without a history of head injury met inclusion and exclusion criteria. All fractures involved the otic capsule. Severe degeneration of the cristae was identified in the semicircular canals in all TBF cases. The utricular and saccular maculae showed mild to severe degeneration in the TBF cases. Vestibular hydrops (n = 2 TBs) and blockage of the endolymphatic duct (n = 3 TBs) were also present in the TBF cases. There was a decrease of 52.6% in the mean total ScGC count in the TBF cases (n = 3 TBs) compared to age-matched controls (n = 7 TBs, P = .015). There was a mean loss of 53% of the ScGCs in the superior vestibular nerve and a mean loss of 52.3% of the ScGCs in the inferior vestibular nerve compared to age-matched controls (P = .033 and P = .021, respectively). CONCLUSIONS: In a cohort of patients with TBFs, there were distinct peripheral vestibular changes including reduction of ScGCs. LEVEL OF EVIDENCE: NA Laryngoscope, 130:752-760, 2020.


Assuntos
Fraturas Ósseas/complicações , Osso Temporal/lesões , Doenças Vestibulares/etiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/patologia , Humanos , Masculino , Estudos Retrospectivos , Osso Temporal/patologia , Doenças Vestibulares/patologia , Adulto Jovem
13.
Otolaryngol Head Neck Surg ; 162(2): 241-247, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31689154

RESUMO

OBJECTIVES: Understand the prevalence of vestibular symptoms in US children. STUDY DESIGN: Cross-sectional analysis. SETTING: 2016 National Health Interview Survey. SUBJECTS AND METHODS: Responses from the 2016 National Health Interview Survey for children ages 3 to 17 years were examined to determine the prevalence of vestibular symptoms and provider-assigned diagnoses. RESULTS: Dizziness or imbalance was reported in 3.5 (95% confidence interval, 3.1-3.9) million patients (5.6%) with a mean age of 11.5 years. Dizziness was reported in 1.2 million patients (2.0%) with a mean age of 12.7 years and balance impairment in 2.3 million patients (3.7%) with a mean age of 10.6 years. Prevalence of dizziness and imbalance did not vary by sex (P = .6, P = .2). Evaluation by a health professional was reported for 42% of patients with dizziness and 43% of patients with imbalance, with diagnoses reported in 45% and 48% of patients with dizziness and imbalance, respectively. The most common diagnoses reported for dizziness were depression or child psychiatric disorder (12%), side effects from medications (11%), head/neck injury or concussion (8.4%), and developmental motor coordination disorder (8.3%). The most common diagnoses reported for imbalance were blurred vision with head motion, "bouncing" or rapid eye movements (9.1%), depression or child psychiatric disorder (6.2%), head/neck injury or concussion (6.1%), and side effects from medications (5.9%). CONCLUSION: The national prevalence of childhood vestibular symptoms is more common than previously thought. Reported diagnoses varied greatly from the literature, suggesting a need for increased awareness of causes of vestibular symptoms in children.


Assuntos
Tontura/epidemiologia , Equilíbrio Postural/fisiologia , Vertigem/complicações , Vestíbulo do Labirinto/fisiopatologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Tontura/etiologia , Tontura/fisiopatologia , Feminino , Humanos , Masculino , Prevalência , Estados Unidos/epidemiologia , Vertigem/diagnóstico , Vertigem/fisiopatologia
14.
Otolaryngol Head Neck Surg ; 159(2): 365-370, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29685082

RESUMO

Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses. Results Twenty-eight patients (25.7%) were diagnosed with peripheral vestibular disorders. None of these disorders were diagnosed prior to evaluation in our pediatric vestibular clinic or our multidisciplinary concussion clinic, which occurred a mean of 133 days (95% confidence interval, 89.2-177.3) after injury. Benign paroxysmal positioning vertigo was diagnosed in 19 patients, all of whom underwent successful canalith repositioning maneuvers. Other diagnoses included temporal bone fracture (n = 3), labyrinthine concussion (n = 2), perilymphatic fistula (n = 2), and superior semicircular canal dehiscence (n = 2). Both patients with perilymphatic fistula and 1 patient with superior semicircular canal dehiscence underwent successful surgical management, while 1 patient with superior semicircular canal dehiscence was managed nonsurgically. Conclusion Peripheral vestibular disorders may occur in pediatric patients with dizziness following concussion, but these disorders may not be recognized until symptoms have persisted for several weeks. An algorithm is proposed to guide the diagnosis and management of peripheral vestibular disorders in pediatric patients with concussion.


Assuntos
Concussão Encefálica/complicações , Doenças Vestibulares/etiologia , Adolescente , Traumatismos em Atletas/complicações , Tontura/diagnóstico , Tontura/etiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Doenças Vestibulares/diagnóstico , Testes de Função Vestibular
16.
Laryngoscope ; 128(4): 998-1001, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28771798

RESUMO

A 15-year-old boy was diagnosed with a cystic parotid mass, which was initially thought to be a first branchial cleft cyst. The mass was treated with antibiotics and fully resolved on examination and imaging. The mass returned, and a superficial parotidectomy was performed to remove the suspected branchial cleft cyst. Final pathology demonstrated a B-cell lymphoblastic lymphoma. Bilateral bone marrow biopsies and peripheral blood counts were negative for any malignancy. This case demonstrates a rare presentation of primary parotid B-cell lymphoblastic lymphoma that began as a fluctuating cystic parotid mass consistent in appearance with a first branchial cleft cyst. Laryngoscope, 128:998-1001, 2018.


Assuntos
Cistos/diagnóstico , Linfoma/diagnóstico , Imageamento por Ressonância Magnética/métodos , Glândula Parótida/patologia , Neoplasias Parotídeas/diagnóstico , Adolescente , Biópsia por Agulha Fina , Diagnóstico Diferencial , Humanos , Masculino , Recidiva Local de Neoplasia/diagnóstico , Tomografia Computadorizada por Raios X
17.
Otol Neurotol ; 39(3): 344-350, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29287036

RESUMO

OBJECTIVE: This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population. STUDY DESIGN: Retrospective case review. SETTING: Tertiary care center. PATIENTS: One hundred ten patients, aged 5 to 19 years old, diagnosed with BPPV. MAIN OUTCOME MEASURES: Patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS: BPPV was diagnosed in 19.8% of patients seen for dizziness during the study period. Patient age ranged 5 to 19 years old (mean =13.4 ±â€Š3.4 yr). Female:male ratio was 3:2. The most prevalent comorbidities were concussion (n = 42, 38.2%) and migraine disorders (n = 33, 30.0%). Average time to diagnosis from symptom onset was 178.2 ±â€Š190.8 days. The posterior canal was most frequently affected (n = 80, 72.7%), followed by the lateral canal (n = 37, 33.6%) and superior canal (n = 21, 19.1%), and 36.4% (n = 40) of patients had multiple canals affected. Treatment requiring more than or equal to five maneuvers to achieve resolution was observed in 11.8% of cases (n = 13). Recurrence was observed in 18.2% of cases. A logistic regression analysis demonstrated that patients with vestibular migraine or benign paroxysmal vertigo of childhood had five times higher odds of recurrence of BPPV, p = 0.003, 95% [1.735, 15.342], than those who did not have either. CONCLUSIONS: BPPV is a relatively common cause of dizziness in the pediatric population. Children and adolescents with BPPV can be successfully treated with repositioning maneuvers but may be at risk for treatment resistance and recurrence. Increased awareness of BPPV in pediatric patients may reduce delays in identification and treatment.


Assuntos
Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/terapia , Tontura/etiologia , Posicionamento do Paciente/métodos , Adolescente , Criança , Pré-Escolar , Tontura/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Recidiva , Estudos Retrospectivos
18.
Int J Pediatr Otorhinolaryngol ; 97: 66-71, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28483254

RESUMO

OBJECTIVE: To review our institution's experience with the presentation, evaluation, and management of teratoma of the head and neck in the neonatal population. DESIGN: Retrospective case series (November 1970 through September 2011). SETTING: Tertiary care children's hospital. PATIENTS: 14 patients (12 boys and 2 girls). INTERVENTION: Detailed review of presentation, diagnostic approaches, surgical management, and outcomes. MAIN OUTCOME MEASURES: Anatomic sites, use of pre and post-natal imaging, use of EXIT (ex utero intrapartum treatment) procedure, presenting symptoms, surgical approaches, additional therapeutic modalities, and outcomes are reviewed. RESULTS: Seven patients were diagnosed prenatally, while the remaining 7 patients were diagnosed at birth or shortly thereafter. The tumor emanated from the neck in 9 patients, the nasopharynx/oropharynx in 3 patients, the external nose in 1 patient and the face in 1 patient. Nine patients had associated upper airway obstruction. Four underwent an EXIT procedure, with 3 requiring intubation and 1 requiring tracheostomy. All patients underwent surgical resection. One patient demonstrated recurrence at follow-up. CONCLUSIONS: Teratoma of the head and neck, though rare, is an important part of the differential diagnosis of neck masses in children, particularly in the perinatal period. The ability to make this diagnosis prenatally with high-resolution fetal ultrasound and MRI (magnetic resonance imaging) permits planning for airway and tumor management prior to delivery. An EXIT procedure should be considered when airway compromise by tumor compression is suspected. Early surgical excision is the treatment of choice and recurrence is rare when a complete resection is achieved.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Diagnóstico Pré-Natal/métodos , Teratoma/cirurgia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Recidiva Local de Neoplasia/cirurgia , Gravidez , Estudos Retrospectivos , Teratoma/diagnóstico , Teratoma/patologia , Centros de Atenção Terciária
19.
Int J Pediatr Otorhinolaryngol ; 83: 104-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26968063

RESUMO

OBJECTIVE: Describe the clinical presentation and recovery of vestibular neuritis in children and adolescents. STUDY DESIGN: Retrospective case series. SETTING: Pediatric tertiary care center. SUBJECTS AND METHODS: Eleven patients diagnosed with vestibular neuritis were identified from a database of 301 patients evaluated at our pediatric vestibular clinic from January 2012 through January 2015. Medical records were reviewed to determine clinical presentation, vestibular testing results, treatment, and recovery. Incomplete recovery was defined as residual dizziness or imbalance at most recent follow-up >30 days from symptom onset. RESULTS: Patients were 5-19 years old (mean 13.1±5.34) and included 6 boys and 5 girls. All presented with a sudden rotational vertigo, imbalance, and nausea for an average of 10 days without other associated symptoms. Testing included rotary chair (8 of 9 abnormal), caloric (2 of 2 abnormal), video head impulse (5 of 8 abnormal), subjective visual vertical (4 of 8 abnormal), and cervical vestibular evoked myogenic potential (0 of 6 abnormal) tests. All patients with incomplete recovery (n=4; 36%) were ≥15 years old at symptom onset. All patients with incomplete recovery that underwent vestibular rehabilitation (n=2) initiated it ≥90 days from symptom onset, while 3 out of 4 patients with complete recovery that underwent vestibular rehabilitation initiated it ≤14 days from symptom onset. Two patients received oral steroids, neither of whom had incomplete recovery. CONCLUSION: Vestibular neuritis should be considered in pediatric patients with vertigo and may result in longstanding symptoms, particularly in adolescents. The treatment of pediatric vestibular neuritis with rehabilitation and steroids deserves further study.


Assuntos
Vertigem/diagnóstico , Neuronite Vestibular/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária , Vertigem/fisiopatologia , Vertigem/terapia , Testes de Função Vestibular/métodos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/terapia , Vestíbulo do Labirinto/fisiopatologia , Adulto Jovem
20.
Laryngoscope ; 126(3): 727-31, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26014221

RESUMO

OBJECTIVES/HYPOTHESIS: Subjective visual vertical (SVV) is a vestibular test commonly used in adults that has not been well studied in children. In this test, the patient aligns a projected line with the perceived true vertical. Deviation of >2° is usually associated with utricular dysfunction and may also be seen with central vestibular lesions. The goal of this study was to determine the efficacy of SVV in children. STUDY DESIGN: Prospective, controlled study. METHODS: Thirty-three children aged 7 to 18 years with (n = 21) and without (n = 12) dizziness underwent static SVV. History, exam, rotary chair, and caloric testing were used to categorize subjects with dizziness into groups with peripheral vestibular loss (PVL), benign paroxysmal positioning vertigo (BPPV), central vertigo (CV), and nonvestibular dizziness (NVD). RESULTS: Mean SVV deviation was significantly higher in the peripheral vestibular loss group (n = 4; 2.1 ± 1.5) compared to BPPV (n = 5; 0.5 ± 0.3), CV (n = 7; 0.4 ± 0.3), NVD (n = 5; 0.6 ± 0.4), and control (n = 12; 0.7 ± 0.5) groups by one-way analysis of variance (P = .002). SVV deviation >2° demonstrated a sensitivity of 100%, specificity of 75%, positive predictive value of 100%, and negative predictive value of 97% for PVL. CONCLUSIONS: SVV is a simple, noninvasive test that provides a valuable contribution to the assessment of peripheral vestibular function in children. LEVEL OF EVIDENCE: 3b Laryngoscope, 126:727-731, 2016.


Assuntos
Tontura/diagnóstico , Reflexo Vestíbulo-Ocular/fisiologia , Testes de Função Vestibular/métodos , Adolescente , Fatores Etários , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Medição de Risco , Sensibilidade e Especificidade , Vertigem/diagnóstico
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