Characteristics of Benign Paroxysmal Positional Vertigo in Young Children

Abstract

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, 133:694–699, 2023

Evaluation and management of paediatric vertigo

“…Vestibular migraine and early childhood migraine variants are consistently the most common causes of paediatric dizziness, with vestibular migraine typically presenting in adolescence and recurrent vertigo of childhood (RVC) in younger children [1 ▪ ,3,5 ▪ ,6,11 ▪▪ ]. Paediatric vestibular migraine has recently been reclassified as vestibular migraine of childhood (VMC), probable vestibular migraine of childhood (VMC) and RVC [11 ▪▪ ].…”

“…A proportion of children with benign paroxysmal torticollis of infancy (BPTI) also develop either RVC or VMC [12]. In addition, benign paroxysmal positional vertigo (BPPV) is much more common than previously thought, with a higher predilection for horizontal, superior and multiple canal involvement than in adults [1 ▪ ,4 ▪ ]. Persistent postural perceptual dizziness (PPPD) is a relatively newer diagnosis that has been noted to be particularly common in the adolescent age group [13,14,15 ▪ ].…”

“…This test can be performed in children of any age. Diagnostic positional manoeuvres are important in children presenting with vertigo given significant rates of benign paroxysmal positional vertigo and should be performed whenever episodic vertigo is reported that is triggered by head movements [1 ▪ ,32]. Videonystagmography (VNG) or video Frenzel goggles can be particularly helpful in diagnosing BPPV in children and in detecting nystagmus that could indicate an acute vestibulopathy.…”

“…One of the most substantial differences in the management of vertigo over the last decade has been an increased understanding of the most common causes of paediatric dizziness [1 ▪ ,3,7,10]. A nonexhaustive list is presented in Table 1[59–70].…”

“…Our understanding of the evaluation and management of paediatric vertigo has progressed considerably, even within just the last decade. Formation of dedicated paediatric vestibular centres has resulted in robust data on both prevalence and cause of paediatric dizziness [1 ▪ ,2,3,4 ▪ ,5 ▪ ,6,7]. Dizziness and/or imbalance is present in approximately 6% of children in the United States [8,9], leading to a significant impact on the quality of life [10].…”