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Introduction Introduction
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Clinical vestibular assessment Clinical vestibular assessment
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Clinical oto-neuro-vestibular testing Clinical oto-neuro-vestibular testing
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Significance of the clinical oto-neuro-vestibular assessment Significance of the clinical oto-neuro-vestibular assessment
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Instrumental vestibular assessment Instrumental vestibular assessment
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Aetiologies of dizziness Aetiologies of dizziness
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Headache and vertigo: Migraine equivalent, vestibular migraine Headache and vertigo: Migraine equivalent, vestibular migraine
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Ophthalmologic disorders Ophthalmologic disorders
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Nonpositional benign paroxysmal vertigo (NPBV) Nonpositional benign paroxysmal vertigo (NPBV)
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Posttraumatic vertigo Posttraumatic vertigo
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Malformations of the inner ear Malformations of the inner ear
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Vestibular ‘neuritis’ or acute peripheral unilateral vestibulopathy (PUV) Vestibular ‘neuritis’ or acute peripheral unilateral vestibulopathy (PUV)
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Middle ear pathologies Middle ear pathologies
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Middle ear effusion Middle ear effusion
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Otitis media Otitis media
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Chronic ear infection Chronic ear infection
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Malignant tumour of the temporal bone Malignant tumour of the temporal bone
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Central causes of vertigo Central causes of vertigo
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Other causes of central vertigo in children Other causes of central vertigo in children
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Psychogenic vertigo or somatoform syndrome Psychogenic vertigo or somatoform syndrome
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BPPV BPPV
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Postural hypotension and hypoglycaemia Postural hypotension and hypoglycaemia
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Dizziness related to orthostatic hypotension Dizziness related to orthostatic hypotension
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Hypoglycaemic dizziness (feelings of an empty head or an imminent fall or faint) Hypoglycaemic dizziness (feelings of an empty head or an imminent fall or faint)
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Menière’s syndrome Menière’s syndrome
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Epilepsy and vertigo Epilepsy and vertigo
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Autoimmune disorders (Cogan’s) Autoimmune disorders (Cogan’s)
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Posturo-motor delay syndrome Posturo-motor delay syndrome
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Conclusion Conclusion
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References References
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31 Vertigo and balance disorders in children
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Published:March 2025
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Abstract
The chapter presents a clinical otoneurologic and vestibular examination protocol for differentiating the frequent diagnoses of vestibular disorders in children. With clinical tests the diagnosis and choice of complementary tests can be determined. In the absence of neurologic signs the most useful complementary test is a complete instrumental vestibular assessment to identify a vestibular impairment, or an ophthalmology assessment looking for refraction or vergence disorders. CT or MRI scans are mostly unnecessary. Imaging is required only in case of neurologic signs to diagnose a central tumour (MRI) or a cranial trauma with hearing or vestibular impairment to identify perilymphatic fistulae (air in the inner ear cavities) (CT). Brain imaging should not be rushed in cases of migraine with normal neurologic examination or typical vestibular neuritis. Children presenting with dizziness or vertigo will benefit by a systematic ontologic, neurologic, and vestibular clinical assessment to direct them for further tests and treatments.
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