Peripheral Vestibular Disorders in Children and Adolescents with Concussion

Brodsky, Jacob R.; Shoshany, Talia N.; Lipson, Sophie; Zhou, Guangwei

doi:10.1177/0194599818770618

Cited by 26 publications

(25 citation statements)

References 16 publications

(37 reference statements)

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“…We previously found that 26% of pediatric patients with dizziness in the setting of post-concussion syndrome had evidence of inner ear disorders, with 68% of those having BPPV. 29 Another study found that 28% of adults with dizziness after concussion had BPPV. 36 Additionally, migraine and anxiety can both be triggered by concussion and have been associated with prolonged recovery.…”

Section: Concussionmentioning

confidence: 99%

“…7,10,27 In contrast, we have recently found BPPV to be much more common in pediatric patients than previously thought, though the diagnosis is likely often missed or delayed. 28,29 One reason for this could be the limited awareness of the disorder among pediatric providers. 1 Another factor may be the increased tendency toward horizontal, superior, and/or multiple canal involvement in BPPV among children relative to adults.…”

Section: Bppvmentioning

confidence: 99%

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Multifactorial Characteristics of Pediatric Dizziness and Imbalance

et al. 2020

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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 AE 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.

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Section: Concussionmentioning

confidence: 99%

Section: Bppvmentioning

confidence: 99%

Multifactorial Characteristics of Pediatric Dizziness and Imbalance

et al. 2020

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“…effects on the brain, 1 dysfunction of the peripheral vestibular system in the inner ear may also contribute. 5,10,20 The peripheral vestibular system mainly refers to the balance organs within the inner ear, which consist of 2 linear motion sensors (saccule and utricle) and 3 rotational motion sensors (superior, horizontal, and posterior semicircular canals) on each side of the head (Figure 1). These organs collectively send information to the brain (via the central vestibular system) and subsequently to the eyes and body about head position and movement in order to maintain balance, a sense of equilibrium, and stability of images on the retina.…”

mentioning

confidence: 99%

“…Another recent study found that nearly 1 in 5 pediatric patients with prolonged dizziness after concussion had BPPV, and all of them were successfully treated with repositioning maneuvers. 5 Training in the diagnosis and treatment of BPPV is often limited to specific specialties that regularly manage vestibular disorders, such as otolaryngology. In contrast, providers who routinely manage patients with concussion may have little to no experience with BPPV, which could lead to a significant delay in its management and even prolong overall concussion recovery.…”

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Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion

et al. 2021

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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.

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Vestibular‐Evoked Myogenic Potential Outcomes Associated with Pediatric Sports‐Related Concussion

2021

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Objectives/Hypothesis: To 1) characterize vestibular-evoked myogenic potential responses in children and young adults with sports-related concussion (SRC) histories as compared with a normal healthy control group, and 2) correlate VEMP characteristics to SRC/sport history outcomes.Study Design: Prospective cohort study. Methods: Seventy-six children and young adults with and without a history of SRC received cervical and ocular VEMP testing using a 500 Hz tone burst air conduction stimuli. VEMP response parameters (response rates, peak latencies, and peak-to-peak amplitudes) were assessed. Other clinical vestibular measures were performed. In the SRC group, sport history outcomes including number of SRC sustained over a lifetime, years of playing contact sports, and length of time playing contact sports were collected via in-person questionnaire.Results: Children and young adults with SRC had significantly reduced oVEMP responses and peak-to-peak amplitudes and greater amplitude response asymmetries between left and right ear. There was no effect of group on cVEMP findings. A greater frequency of SRCs sustained throughout a lifetime, a greater number of contact sports played, and a longer duration of playing a contact sport correlated with significantly poorer VEMP response characteristics.Conclusions: Our results suggest that SRC and repeated subclinical head impact events have an effect on oVEMP outcomes. SRC may affect the utricle, superior vestibular nerve, and/or brainstem-mediated vestibular-ocular-reflex pathway. The prevalence of post-concussion-related dizziness is becoming increasingly common in a pediatric-otology clinic, thus performing VEMP testing in youth post-SRC provides an objective, noninvasive, and cost-effective method for monitoring the effects of sports-related impact on the vestibular system and related neural pathways.

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Peripheral Vestibular Disorders in Children and Adolescents with Concussion

Cited by 26 publications

References 16 publications

Multifactorial Characteristics of Pediatric Dizziness and Imbalance

Multifactorial Characteristics of Pediatric Dizziness and Imbalance

Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion

Vestibular‐Evoked Myogenic Potential Outcomes Associated with Pediatric Sports‐Related Concussion

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