Etiological classification and management of dizziness in children: A systematic review and meta-analysis

Frontiers in Neurology

Neurology

Jiali Shen¹  Jifang Zhang¹  Jianyong Chen¹  Yulian Jin¹  Jun Yang¹  Qing Zhang¹  Qi Zhu²  Maoli Duan³ 

[1] Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China;Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China;Department of Otorhinolaryngology-Head and Neck Surgery, Yuyao People's Hospital, Yuyao, Zhejiang, China;Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden;Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;

关键词: dizziness;    vestibular disorders;    peripheral vertigo;    central vertigo;    etiology;   

DOI  :  10.3389/fneur.2023.1125488

 received in 2022-12-16, accepted in 2023-01-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundDizziness in children, which could not be diagnosed at an early stage in the past, is becoming increasingly clear to a large extent. However, the recognition of the diagnosis and management remains discrepant and controversial due to their complicated and varied etiology. Central and peripheral vestibular disorders, psychogenic and systemic diseases, and genetic pathogeny constitute childhood etiological entities. Further understanding of the etiology and the prevalence of vertigo disorders is of crucial importance and benefit in the diagnosis and management of pediatric patients.MethodsThis systematic review and meta-analysis were conducted by systematically searching Embase, PubMed, the Cochrane Library, CNIK, the Chinese Wan-Fang database, CBM, the Chinese VIP database, and the Web of Science for literature on childhood vertigo disorders published up to May 2022. The literature was evaluated under strict screening and diagnostic criteria. Their quality was assessed using the Agency for Healthcare and Research Quality (AHRQ) standards. The test for homogeneity was conducted to determine the fixed effects model or random-effect model employed.ResultsTwenty-three retrospective cross-sectional studies involving 7,647 children with vertigo disorders were finally included, with an AHRQ score >4 (high or moderate quality). Our results demonstrated that peripheral vertigo (52.20%, 95% CI: 42.9–61.4%) was more common in children than central vertigo (28.7%, 95% CI: 20.8–37.4%), psychogenic vertigo (7.0%, 95% CI: 4.8–10.0%), and other systemic vertigo (4.7%, 95% CI: 2.6–8.2%). The five most common etiological diagnoses associated with peripheral vertigo included benign paroxysmal vertigo of childhood (BPVC) (19.50%, 95% CI: 13.5–28.3%), sinusitis-related diseases (10.7%, 95% CI: −11.2–32.6%), vestibular or semicircular canal dysfunction (9.20%, 95% CI: 5.7–15.0%), benign paroxysmal positional vertigo (BPPV)(7.20%, 95% CI: 3.9–11.5%), and orthostatic dysregulation (6.8%, 95% CI: 3.4–13.0%). Vestibular migraine (20.3%, 95% CI: 15.4–25.2%) was the most seen etiological diagnosis associated with central vertigo in children. In addition, we found the sex-based difference influenced the outcome of psychogenic vertigo and vestibular migraine, while there was no significant difference in other categories of the etiology. For the management of vertigo, symptomatical management is the first choice for most types of vertigo disorder in pediatrics.ConclusionComplex etiology and non-specific clinical manifestations of vertigo in pediatrics are challenging for their diagnoses. Reliable diagnosis and effective management depend on the close cooperation of multiple disciplines, combined with comprehensive consideration of the alternative characteristics of vertigo in children with growth and development.

【 授权许可】

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Copyright © 2023 Zhang, Zhu, Shen, Chen, Jin, Zhang, Duan and Yang.