Epidemiology of childhood vertigo. Bibliographic review and meta-analysis
Abstract Introduction and objective: In the pediatric age group, vertigo is a less common condition compared to adults, likely underreported in prevalence. The aim of our study was to determine the prevalence of pediatric vertigo through literature review and meta-analysis. Method: Systematic searches were conducted in databases including PubMed, WoS, BVS, CARPHA, and EMBASE, following PRISMA guidelines. Epidemiological studies on vertigo in children aged 0 to 14 years were included. Bias risk was assessed using ROBINS-I scale. A qualitative analysis of vertigo causes from literature and a quantitative analysis of pediatric vertigo prevalence using SNS data up to April 2023 were performed. Statistical analysis and meta-analysis were conducted using JAMOVI, employing a 95% confidence interval and a random-effects model. Results: Out of the 29 reviewed articles, 22 were analyzed, revealing a global prevalence of pediatric vertigo at 18.3% (95% CI: 5.1-31.5%). Diagnoses were categorized into three groups, with peripheral vertigo (66.74%) being prominent. Additionally, in Spain's SNS records, vertigo affected 0.72% of children under 14 years, with 4.77% of these cases belonging to the same age group. Discussion: Our study demonstrated that pediatric vertigo has a prevalence of 18.3%, with benign paroxysmal positional vertigo (BPPV) as the most frequent diagnosis. Although some studies show discrepancies in prevalence figures, our research emphasizes the complexity of diagnosing vertigo in children due to the diversity of etiologies. Conclusions: In our study, vertigo affects 18% of children under 14 years old, with peripheral vertigo being the main cause. Conditions like BPPV, Meniere's disease, and migraine are common. Due to study diversity, determining the exact prevalence is complex. These findings set a direction for future research.
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Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Re M. Prevalence and diagnosis of vestibular disorders in children: a review. Int J Pediatr Otorhinolaryngol. 2014;78:718-24. doi: https://doi.org/10.1016/j.ijporl.2014.02.009
Zhang J, Zhu Q, Shen J, Chen J, Jin Y, Zhang Q, et al. Etiological classification and management of dizziness in children: A systematic review and meta-analysis. Front Neurol. 2023;14:1125488. Doi: https://doi.org/10.3389/fneur.2023.1125488
Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am. 2021;54:973-87. Doi: https://doi.org/10.1016/j.otc.2021.06.002
Page M, Moher D, Bossuyt P, Boutron I, Hoffmann T, Cd M, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ [Internet]. 2021 [citado 4 de agosto de 2023];372. Recuperado a partir de: https://pubmed.ncbi.nlm.nih.gov/33781993/
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 36:1-48. Doi: https://doi.org/10.18637/jss.v036.i03
R: A Language and environment for statistical computing. (Version 4.1) [Internet]. 2021. Recuperado a partir de: https://cran.r-project.org. (R packages retrieved from MRAN snapshot 2022-01-01).
Campos MI, Ganança FF, Caovilla HH, Ganança MM. Prevalência de sinais de disfunçäo vestibular em crianças com vertigem e/ou outros tipos de tontura. Rev Bras Med Otorrinolaringol. 1996;165-71.
Ganança MM. Qual a prevalência da vertigem e outras tonturas de origem vestibular de acordo com a faixa etária? Acta AWHO. 2000;170-1.
Henriques IF, Douglas de Oliveira DW, Oliveira-Ferreira F, Andrade PMO. Motion sickness prevalence in school children. Eur J Pediatr. 2014;1473-82. Doi: https://doi.org/10.1007/s00431-014-2351-1.
Herraiz C, Hernández FJ, Tapia MC, De Lucas P, Arroyo R. [Equilibrium disorders in childhood]. Acta Otorrinolaringol Esp. 1998;49:363-8.
Jahn K, Langhagen T, Schroeder AS, Heinen F. Vertigo and dizziness in childhood - update on diagnosis and treatment. Neuropediatrics. 2011;42:129-34. Doi: https://doi.org/10.1055/s-0031-1283158.
Yin M, Ishikawa K, Wong WH, Shibata Y. A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx. 2009;36:30-5. Doi: https://doi.org/10.1016/j.anl.2008.03.006.
Balzanelli C, Spataro D, Redaelli de Zinis LO. Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients. Children. 2021;8:1056. Doi: https://doi.org/10.3390/children8111056.
Božanić Urbančič N, Vozel D, Urbančič J, Battelino S. Unraveling the Etiology of Pediatric Vertigo and Dizziness: A Tertiary Pediatric Center Experience. Medicina (Mex). 2021;57:475. doi: https://doi.org/10.3390/medicina57050475.
Correa U A. Trastornos del equilibrio en los niños. Rev Chil Pediatría. 1980;51:61-2. doi: https://doi.org/10.4067/S0370-41061980000100009.
D'Agostino R, Tarantino V, Melagrana A, Taborelli G. Otoneurologic evaluation of child vertigo. Int J Pediatr Otorhinolaryngol. 1997;40:133-9. Doi: https://doi.org/10.1016/S0165-5876(97)00032-3.
Garone G, Suppiej A, Vanacore N, La Penna F, Parisi P, Calistri L, et al. Characteristics of Acute Nystagmus in the Pediatric Emergency Department. Pediatrics. 2020;146:e20200484. doi: https://doi.org/10.1542/peds.2020-0484.
Grasso A, Poropat F, Kamagni Vodié T, Ghirardo S, Barbi E. How Age Matters in the Assessment of Vertigo in the Pediatric Emergency Department: A 10-Year Age-Stratified Etiology Survey. Pediatr Emerg Care. 2022;38:e43. Doi: https://doi.org/10.1097/PEC.0000000000002242.
Hülse R, Warken C, Biesdorf A, Erhart M, Rotter N, Hörmann K, et al. Prävalenz peripher-vestibulärer Erkrankungen bei Kindern in Deutschland. HNO. 2020;68:360-6. Doi: https://doi.org/10.1007/s00106-019-00747-6.
Hülse R, Biesdorf A, Hörmann K, Stuck B, Erhart M, Hülse M, et al. Peripheral Vestibular Disorders: An Epidemiologic Survey in 70 Million Individuals. Otol Neurotol. 2019;40:88. Doi: https://doi.org/10.1097/MAO.0000000000002013.
Humphriss RL, Hall AJ. Dizziness in 10 year old children: An epidemiological study. Int J Pediatr Otorhinolaryngol. 2011;75:395-400. Doi: https://doi.org/10.1016/j.ijporl.2010.12.015.
Hung C-Y, Young Y-H. Evolution of pediatric vertigo/dizziness during the past two decades. Acta Otolaryngol (Stockh). 2022;142:562-7. Doi: https://doi.org/10.1080/00016489.2022.2106381.
Ishiwara-Niembro K, Pérez-Rodríguez MA, Navarro-Cervantes FA, Jiménez-Pérez JA. Trastornos vestibulares y del equilibrio en niños y adolescentes mexicanos: revisión de registros clínicos de 8 años. Acta Otorrinolaringológica Esp. 2021;72:137-42. Doi: https://doi.org/10.1016/j.otorri.2020.02.011.
Jahn K, Langhagen T, Schroeder AS, Heinen F. Vertigo and Dizziness in Childhood − Update on Diagnosis and Treatment. Neuropediatrics. 2011;42:129-34. Doi: https://doi.org/10.1055/s-0031-1283158.
Ketola S, Niemensivu R, Henttonen A, Appelberg B, Kentala E. Somatoform disorders in vertiginous children and adolescents. Int J Pediatr Otorhinolaryngol. 2009;73:933-6. Doi: https://doi.org/10.1016/j.ijporl.2009.03.010.
Lee JD, Kim C-H, Hong SM, Kim SH, Suh M-W, Kim M-B, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study. Int J Pediatr Otorhinolaryngol. 2017;94:36-9. Doi: https://doi.org/10.1016/j.ijporl.2017.01.012.
Li C-M, Hoffman HJ, Ward BK, Cohen HS, Rine RM. Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. J Pediatr. 2016;171:240-247.e3. Doi: https://doi.org/10.1016/j.jpeds.2015.12.002.
Lüscher M, Theilgaard S, Edholm B. Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. J Laryngol Otol. 2014;128:128-33. Doi: https://doi.org/10.1017/S0022215114000188.
Manrique Lipa RD, Soto Varela A, Santos Pérez S, Manrique Lipa RK, Lorenzo Lorenzo AI, Labella Caballero T. Alteraciones del equilibrio en pacientes menores de 16 años distribuidos por grupos de edad. Acta Otorrinolaringol Esp. 2008;59:455-62. Doi: https://doi.org/10.1016/S0001-6519(08)75118-5.
Niemensivu R, Pyykkö I, Wiener-Vacher SR, Kentala E. Vertigo and balance problems in children-An epidemiologic study in Finland. Int J Pediatr Otorhinolaryngol. 2006;70:259-65. Doi: https://doi.org/10.1016/j.ijporl.2005.06.015.
O'Reilly RC, Morlet T, Nicholas BD, Josephson G, Horlbeck D, Lundy L, et al. Prevalence of Vestibular and Balance Disorders in Children. Otol Neurotol. 2010;31:1441. Doi: https://doi.org/10.1097/MAO.0b013e3181f20673.
Riina N, Ilmari P, Kentala E. Vertigo and Imbalance in Children: A Retrospective Study in a Helsinki University Otorhinolaryngology Clinic. Arch Otolaryngol Neck Surg. 2005;131:996-1000. Doi: https://doi.org/10.1001/archotol.131.11.996.
Wiener-Vacher SR, Quarez J, Priol AL. Epidemiology of Vestibular Impairments in a Pediatric Population. Semin Hear. 2018;39:229-42. Doi: https://doi.org/10.1055/s-0038-1666815.
Yilmaz A, Abseyi S. Clinical and demographic characteristics of children and adolescents with acute vertigosymptoms: A cross-sectional study. Turk J Med Sci. 2020;50:1951-4. Doi: https://doi.org/10.3906/sag-2010-228.
Zhang J, Zhu Q, Shen J, Chen J, Jin Y, Zhang Q, et al. Etiological classification and management of dizziness in children: A systematic review and meta-analysis. Front Neurol. 2023;14:1125488. Doi: https://doi.org/10.3389/fneur.2023.1125488
Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am. 2021;54:973-87. Doi: https://doi.org/10.1016/j.otc.2021.06.002
Page M, Moher D, Bossuyt P, Boutron I, Hoffmann T, Cd M, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ [Internet]. 2021 [citado 4 de agosto de 2023];372. Recuperado a partir de: https://pubmed.ncbi.nlm.nih.gov/33781993/
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw. 36:1-48. Doi: https://doi.org/10.18637/jss.v036.i03
R: A Language and environment for statistical computing. (Version 4.1) [Internet]. 2021. Recuperado a partir de: https://cran.r-project.org. (R packages retrieved from MRAN snapshot 2022-01-01).
Campos MI, Ganança FF, Caovilla HH, Ganança MM. Prevalência de sinais de disfunçäo vestibular em crianças com vertigem e/ou outros tipos de tontura. Rev Bras Med Otorrinolaringol. 1996;165-71.
Ganança MM. Qual a prevalência da vertigem e outras tonturas de origem vestibular de acordo com a faixa etária? Acta AWHO. 2000;170-1.
Henriques IF, Douglas de Oliveira DW, Oliveira-Ferreira F, Andrade PMO. Motion sickness prevalence in school children. Eur J Pediatr. 2014;1473-82. Doi: https://doi.org/10.1007/s00431-014-2351-1.
Herraiz C, Hernández FJ, Tapia MC, De Lucas P, Arroyo R. [Equilibrium disorders in childhood]. Acta Otorrinolaringol Esp. 1998;49:363-8.
Jahn K, Langhagen T, Schroeder AS, Heinen F. Vertigo and dizziness in childhood - update on diagnosis and treatment. Neuropediatrics. 2011;42:129-34. Doi: https://doi.org/10.1055/s-0031-1283158.
Yin M, Ishikawa K, Wong WH, Shibata Y. A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx. 2009;36:30-5. Doi: https://doi.org/10.1016/j.anl.2008.03.006.
Balzanelli C, Spataro D, Redaelli de Zinis LO. Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients. Children. 2021;8:1056. Doi: https://doi.org/10.3390/children8111056.
Božanić Urbančič N, Vozel D, Urbančič J, Battelino S. Unraveling the Etiology of Pediatric Vertigo and Dizziness: A Tertiary Pediatric Center Experience. Medicina (Mex). 2021;57:475. doi: https://doi.org/10.3390/medicina57050475.
Correa U A. Trastornos del equilibrio en los niños. Rev Chil Pediatría. 1980;51:61-2. doi: https://doi.org/10.4067/S0370-41061980000100009.
D'Agostino R, Tarantino V, Melagrana A, Taborelli G. Otoneurologic evaluation of child vertigo. Int J Pediatr Otorhinolaryngol. 1997;40:133-9. Doi: https://doi.org/10.1016/S0165-5876(97)00032-3.
Garone G, Suppiej A, Vanacore N, La Penna F, Parisi P, Calistri L, et al. Characteristics of Acute Nystagmus in the Pediatric Emergency Department. Pediatrics. 2020;146:e20200484. doi: https://doi.org/10.1542/peds.2020-0484.
Grasso A, Poropat F, Kamagni Vodié T, Ghirardo S, Barbi E. How Age Matters in the Assessment of Vertigo in the Pediatric Emergency Department: A 10-Year Age-Stratified Etiology Survey. Pediatr Emerg Care. 2022;38:e43. Doi: https://doi.org/10.1097/PEC.0000000000002242.
Hülse R, Warken C, Biesdorf A, Erhart M, Rotter N, Hörmann K, et al. Prävalenz peripher-vestibulärer Erkrankungen bei Kindern in Deutschland. HNO. 2020;68:360-6. Doi: https://doi.org/10.1007/s00106-019-00747-6.
Hülse R, Biesdorf A, Hörmann K, Stuck B, Erhart M, Hülse M, et al. Peripheral Vestibular Disorders: An Epidemiologic Survey in 70 Million Individuals. Otol Neurotol. 2019;40:88. Doi: https://doi.org/10.1097/MAO.0000000000002013.
Humphriss RL, Hall AJ. Dizziness in 10 year old children: An epidemiological study. Int J Pediatr Otorhinolaryngol. 2011;75:395-400. Doi: https://doi.org/10.1016/j.ijporl.2010.12.015.
Hung C-Y, Young Y-H. Evolution of pediatric vertigo/dizziness during the past two decades. Acta Otolaryngol (Stockh). 2022;142:562-7. Doi: https://doi.org/10.1080/00016489.2022.2106381.
Ishiwara-Niembro K, Pérez-Rodríguez MA, Navarro-Cervantes FA, Jiménez-Pérez JA. Trastornos vestibulares y del equilibrio en niños y adolescentes mexicanos: revisión de registros clínicos de 8 años. Acta Otorrinolaringológica Esp. 2021;72:137-42. Doi: https://doi.org/10.1016/j.otorri.2020.02.011.
Jahn K, Langhagen T, Schroeder AS, Heinen F. Vertigo and Dizziness in Childhood − Update on Diagnosis and Treatment. Neuropediatrics. 2011;42:129-34. Doi: https://doi.org/10.1055/s-0031-1283158.
Ketola S, Niemensivu R, Henttonen A, Appelberg B, Kentala E. Somatoform disorders in vertiginous children and adolescents. Int J Pediatr Otorhinolaryngol. 2009;73:933-6. Doi: https://doi.org/10.1016/j.ijporl.2009.03.010.
Lee JD, Kim C-H, Hong SM, Kim SH, Suh M-W, Kim M-B, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: A multi-center study. Int J Pediatr Otorhinolaryngol. 2017;94:36-9. Doi: https://doi.org/10.1016/j.ijporl.2017.01.012.
Li C-M, Hoffman HJ, Ward BK, Cohen HS, Rine RM. Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based Study. J Pediatr. 2016;171:240-247.e3. Doi: https://doi.org/10.1016/j.jpeds.2015.12.002.
Lüscher M, Theilgaard S, Edholm B. Prevalence and characteristics of diagnostic groups amongst 1034 patients seen in ENT practices for dizziness. J Laryngol Otol. 2014;128:128-33. Doi: https://doi.org/10.1017/S0022215114000188.
Manrique Lipa RD, Soto Varela A, Santos Pérez S, Manrique Lipa RK, Lorenzo Lorenzo AI, Labella Caballero T. Alteraciones del equilibrio en pacientes menores de 16 años distribuidos por grupos de edad. Acta Otorrinolaringol Esp. 2008;59:455-62. Doi: https://doi.org/10.1016/S0001-6519(08)75118-5.
Niemensivu R, Pyykkö I, Wiener-Vacher SR, Kentala E. Vertigo and balance problems in children-An epidemiologic study in Finland. Int J Pediatr Otorhinolaryngol. 2006;70:259-65. Doi: https://doi.org/10.1016/j.ijporl.2005.06.015.
O'Reilly RC, Morlet T, Nicholas BD, Josephson G, Horlbeck D, Lundy L, et al. Prevalence of Vestibular and Balance Disorders in Children. Otol Neurotol. 2010;31:1441. Doi: https://doi.org/10.1097/MAO.0b013e3181f20673.
Riina N, Ilmari P, Kentala E. Vertigo and Imbalance in Children: A Retrospective Study in a Helsinki University Otorhinolaryngology Clinic. Arch Otolaryngol Neck Surg. 2005;131:996-1000. Doi: https://doi.org/10.1001/archotol.131.11.996.
Wiener-Vacher SR, Quarez J, Priol AL. Epidemiology of Vestibular Impairments in a Pediatric Population. Semin Hear. 2018;39:229-42. Doi: https://doi.org/10.1055/s-0038-1666815.
Yilmaz A, Abseyi S. Clinical and demographic characteristics of children and adolescents with acute vertigosymptoms: A cross-sectional study. Turk J Med Sci. 2020;50:1951-4. Doi: https://doi.org/10.3906/sag-2010-228.
Monopoli-Roca, C., Coronel-Touma, G., Almeida-Ayerve, C. N., Marcos-Alonso, S., Batuecas-Caletrío, Ángel, & Pardal-Refoyo, J. L. (2023). Epidemiology of childhood vertigo. Bibliographic review and meta-analysis. Revista ORL, e31756. https://doi.org/10.14201/orl.31756
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