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Peripheral Vestibular Disorders in Children and Adolescents with Concussion.

Abstract

Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses. Results Twenty-eight patients (25.7%) were diagnosed with peripheral vestibular disorders. None of these disorders were diagnosed prior to evaluation in our pediatric vestibular clinic or our multidisciplinary concussion clinic, which occurred a mean of 133 days (95% confidence interval, 89.2-177.3) after injury. Benign paroxysmal positioning vertigo was diagnosed in 19 patients, all of whom underwent successful canalith repositioning maneuvers. Other diagnoses included temporal bone fracture (n = 3), labyrinthine concussion (n = 2), perilymphatic fistula (n = 2), and superior semicircular canal dehiscence (n = 2). Both patients with perilymphatic fistula and 1 patient with superior semicircular canal dehiscence underwent successful surgical management, while 1 patient with superior semicircular canal dehiscence was managed nonsurgically. Conclusion Peripheral vestibular disorders may occur in pediatric patients with dizziness following concussion, but these disorders may not be recognized until symptoms have persisted for several weeks. An algorithm is proposed to guide the diagnosis and management of peripheral vestibular disorders in pediatric patients with concussion.

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  • Authors+Show Affiliations

    ,

    1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA. 2 Harvard Medical School, Boston, Massachusetts, USA.

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    1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA. 2 Harvard Medical School, Boston, Massachusetts, USA.

    ,

    1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA. 2 Harvard Medical School, Boston, Massachusetts, USA.

    1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA. 2 Harvard Medical School, Boston, Massachusetts, USA.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29685082

    Citation

    Brodsky, Jacob R., et al. "Peripheral Vestibular Disorders in Children and Adolescents With Concussion." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 159, no. 2, 2018, pp. 365-370.
    Brodsky JR, Shoshany TN, Lipson S, et al. Peripheral Vestibular Disorders in Children and Adolescents with Concussion. Otolaryngol Head Neck Surg. 2018;159(2):365-370.
    Brodsky, J. R., Shoshany, T. N., Lipson, S., & Zhou, G. (2018). Peripheral Vestibular Disorders in Children and Adolescents with Concussion. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 159(2), pp. 365-370. doi:10.1177/0194599818770618.
    Brodsky JR, et al. Peripheral Vestibular Disorders in Children and Adolescents With Concussion. Otolaryngol Head Neck Surg. 2018;159(2):365-370. PubMed PMID: 29685082.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Peripheral Vestibular Disorders in Children and Adolescents with Concussion. AU - Brodsky,Jacob R, AU - Shoshany,Talia N, AU - Lipson,Sophie, AU - Zhou,Guangwei, Y1 - 2018/04/24/ PY - 2018/4/25/pubmed PY - 2018/4/25/medline PY - 2018/4/25/entrez KW - BPPV KW - benign paroxysmal positional vertigo KW - concussion KW - pediatric KW - postconcussion syndrome KW - vertigo SP - 365 EP - 370 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 159 IS - 2 N2 - Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses. Results Twenty-eight patients (25.7%) were diagnosed with peripheral vestibular disorders. None of these disorders were diagnosed prior to evaluation in our pediatric vestibular clinic or our multidisciplinary concussion clinic, which occurred a mean of 133 days (95% confidence interval, 89.2-177.3) after injury. Benign paroxysmal positioning vertigo was diagnosed in 19 patients, all of whom underwent successful canalith repositioning maneuvers. Other diagnoses included temporal bone fracture (n = 3), labyrinthine concussion (n = 2), perilymphatic fistula (n = 2), and superior semicircular canal dehiscence (n = 2). Both patients with perilymphatic fistula and 1 patient with superior semicircular canal dehiscence underwent successful surgical management, while 1 patient with superior semicircular canal dehiscence was managed nonsurgically. Conclusion Peripheral vestibular disorders may occur in pediatric patients with dizziness following concussion, but these disorders may not be recognized until symptoms have persisted for several weeks. An algorithm is proposed to guide the diagnosis and management of peripheral vestibular disorders in pediatric patients with concussion. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/29685082/Peripheral_Vestibular_Disorders_in_Children_and_Adolescents_with_Concussion L2 - http://journals.sagepub.com/doi/full/10.1177/0194599818770618?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -