Dizziness includes vertigo, imbalance, motion intolerance, light-headedness, unsteadiness, floating or tilting sensations. Vertigo is usually categorized into peripheral or central causes. Central vertigo emanates from a CNS location, and may have other CNS symptoms such as headaches, aura, motor, sensory or visual symptoms such as tinnitus or hearing loss. Symptoms usually last longer and may increase in number, frequency or intensity. Peripheral vertigo emanates from the inner ear-pathology in the vestibular system, a dysfunction of the balance organs of the inner ear.
The most common causes of true vertigo in children are otitis media, migraine headache, and benign paroxysmal vertigo of childhood. Head injury and central nervous system infection are the most frequent life-threatening etiologies
How you keep Balance
Balance and the ability to remain upright are dependent upon three systems, the eyes, joints and the inner ear, all of which give information to the brain.
In the inner ear, or labyrinth, there is cochlea, involved in hearing and semicircular canals, which affect balance. Connecting them is the vestibule (with sensory organs known as the utricle and saccule), which affects balance and equilibrium. When we turn our heads rapidly, the liquid in the semicircular canals moves the tiny hairs lining the cochlea, sending a message (through the vestibulocochlear nerve) to the brain about the movement. In less than a second, the brain sends messages to the muscles needed to maintain balance and help the eyes stay focused.
A disturbance anywhere in the vestibular system may cause patients to have vertigo and associated signs and symptoms such as hearing loss, perceptual changes in vision and nystagmus.
Symptoms
Depending on the type of balance disorder and what’s causing it, symptoms can vary from child to child. Some kids may experience severe symptoms, making it hard for them to function. Others might only have mild symptoms that are barely noticed.
In general, though, kids with balance disorders have symptoms of an unsteady, “woozy” feeling that makes it hard to stand up, walk, turn corners, or climb the stairs without falling, bumping into things, stumbling, or tripping. All of this can make them seem uncoordinated and clumsy.
Balance issues also can impact hearing. Sounds might seem muffled, especially amid background noise. Kids might also have bothersome, distracting ear problems like ear pain, pressure and tinnitus (ringing or other sounds like whirring, humming, or buzzing).
Children who have a family history of hearing or vestibular problems, dizziness, or motion sickness might be more prone to balance disorders, too
Diagnosis
Detecting and diagnosing balance disorders in kids can be tricky. Unfortunately, kids with many common balance problems may be so young that they can’t describe how they’re feeling or respond to certain tests. And to parents, they might just seem clumsy and fussy.
If you think that your child’s balance is affected, you must go and see an ENT surgeon, who will do a physical exam and look at your child’s symptoms and medical history.
Investigations
Specialist investigations can help with the diagnosis, and will generally include hearing tests, blood tests,tests of balance and an MRI scan or CT scan.
Treatment
In general the treatment of vertigo is “symptomatic” with treatment given to control the symptoms without regard to the specific cause of the vertigo.
Treatment also includes treatment of underlying disorders such as seizures, migraine, tumor, IV fluids, vestibular suppressants, and avoiding migraine triggers. Positional maneuvers may be helpful for benign postural positional vertigo. There are specifically targeted exercises to speed up the brain’s natural compensation after inner ear disease. Recovery can be hastened by these exercises.
Vestibular sedatives
The inner ear may be sedated by the use of drugs such as cinnarzine and betahistine. They are not a long term solution, and should be used for as short a time as possible because they prolong the time taken for the body to readjust after the vertigo.
Surgery-rare
If medical treatment proves ineffective, surgical options range from insertion of a grommet to operations which completely destroy the inner ear or divide the nerves leading from the inner ear to the brain.
Case Report
Here an 8 year old boy suffering from vertigo was investigated and found a rare pathology in the semicircular canals as you can see in the 3D CT images.
Semicircular canal pathology – e.g. fistula, stenosis or dehiscence in which there is a gap in the bone overlying the uppermost semicircular canal within the inner ear.
Radiologist Report as:
and Bilateral superior and right posterior semicircular canal focal stenosis.
and Thin to absent bony covering of bilateral superior and left posterior semicircular canal- ? focal dehiscence.
(Dizziness or vertigo are not uncommon in children, and includes vertigo, imbalance, motion sickness, light-headedness, unsteadiness, floating or tilting sensations. Vertigo is usually categorized into peripheral or central causes. They are all symptoms that can result from a peripheral vestibular disorder ie a dysfunction of the balance organs of the inner ear or central vestibular disorder due to dysfunction of one or more parts of the central nervous system that help process balance and spatial information.
Here 8 year old Adithyan suffers from dizziness from an abnormality in the inner ear organ of balance, the semicircular canal .This was detected in 3D CT/HRCT of inner ear.)
