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Objective Epidemiologic studies have shown Vestibular migraine (VM) to be the most common cause of vertigo in children, but little is known about the typical presentation and response to treatment of this disorder in the pediatric population. The aim of this study was to evaluate the diagnostic features and response to therapy of VM in children managed at a pediatric vestibular clinic. Methods Twenty-eight patients ≤18 years old with a diagnosis of VM were identified from 208 patients seen at the Balance and Vestibular Program at Boston Children's Hospital from July 2012–July 2014, after excluding 12 patients with a history of major otologic or neurologic surgery, recent concussion, or additional vestibular disorders. Patients' electronic medical records and testing results were retrospectively reviewed. Results Patients ranged in age from 9 to 18 years old (mean 14.48). All included patients met criteria for definite (n = 25) or probable (n = 3) VM as defined by the International Classification of Headache Disorders. Rotary chair (n = 17), caloric (n = 8), cervical vestibular evoked myogenic potential (n = 16), and video head impulse (n = 3) tests were normal. Medications effectively reduced reported vestibular symptoms in 88% of those treated with tricyclics (n = 8), 86% of those treated with cyprohepatadine (n = 7), 80% of those treated with topiramate (n = 5), 80% of those treated with triptans (n = 10), and 25% of those treated with gabapentin (n = 4). Conclusions Vestibular migraine is a common cause of vertigo in the pediatric population that is frequently responsive to medical therapy.

Objectives/Hypothesis Subjective visual vertical (SVV) is a vestibular test commonly used in adults that has not been well studied in children. In this test, the patient aligns a projected line with the perceived true vertical. Deviation of >2° is usually associated with utricular dysfunction and may also be seen with central vestibular lesions. The goal of this study was to determine the efficacy of SVV in children. Study Design Prospective, controlled study. Methods Thirty-three children aged 7 to 18 years with (n = 21) and without (n = 12) dizziness underwent static SVV. History, exam, rotary chair, and caloric testing were used to categorize subjects with dizziness into groups with peripheral vestibular loss (PVL), benign paroxysmal positioning vertigo (BPPV), central vertigo (CV), and nonvestibular dizziness (NVD). Results Mean SVV deviation was significantly higher in the peripheral vestibular loss group (n = 4; 2.1 ± 1.5) compared to BPPV (n = 5; 0.5 ± 0.3), CV (n = 7; 0.4 ± 0.3), NVD (n = 5; 0.6 ± 0.4), and control (n = 12; 0.7 ± 0.5) groups by one-way analysis of variance (P = .002). SVV deviation >2° demonstrated a sensitivity of 100%, specificity of 75%, positive predictive value of 100%, and negative predictive value of 97% for PVL. Conclusions SVV is a simple, noninvasive test that provides a valuable contribution to the assessment of peripheral vestibular function in children. Level of Evidence 3b Laryngoscope, 126:727–731, 2016

Objective Describe the clinical presentation and recovery of vestibular neuritis in children and adolescents. Study design Retrospective case series. Setting Pediatric tertiary care center. Subjects and methods Eleven patients diagnosed with vestibular neuritis were identified from a database of 301 patients evaluated at our pediatric vestibular clinic from January 2012 through January 2015. Medical records were reviewed to determine clinical presentation, vestibular testing results, treatment, and recovery. Incomplete recovery was defined as residual dizziness or imbalance at most recent follow-up >30 days from symptom onset. Results Patients were 5–19 years old (mean 13.1 ± 5.34) and included 6 boys and 5 girls. All presented with a sudden rotational vertigo, imbalance, and nausea for an average of 10 days without other associated symptoms. Testing included rotary chair (8 of 9 abnormal), caloric (2 of 2 abnormal), video head impulse (5 of 8 abnormal), subjective visual vertical (4 of 8 abnormal), and cervical vestibular evoked myogenic potential (0 of 6 abnormal) tests. All patients with incomplete recovery (n = 4; 36%) were ≥15 years old at symptom onset. All patients with incomplete recovery that underwent vestibular rehabilitation (n = 2) initiated it ≥90 days from symptom onset, while 3 out of 4 patients with complete recovery that underwent vestibular rehabilitation initiated it ≤14 days from symptom onset. Two patients received oral steroids, neither of whom had incomplete recovery. Conclusion Vestibular neuritis should be considered in pediatric patients with vertigo and may result in longstanding symptoms, particularly in adolescents. The treatment of pediatric vestibular neuritis with rehabilitation and steroids deserves further study.

Introduction Detection of peripheral vestibular loss (PVL) in children with dizziness is an important and challenging task. The static subjective visual vertical (SVV) test can effectively detect PVL, but requires specialized equipment. Objective The goal of this study was to determine the efficacy of a smartphone-based SVV test at detecting PVL in pediatric patients. Methods Thirty-nine patients between 7 and 18 years old (mean = 14.0 ± 2.70) underwent conventional SVV (conv-SVV) and smartphone-based SVV (ip-SVV) testing. Subjects included 6 with PVL (based on clinical history and other vestibular tests), 6 with benign paroxysmal positioning vertigo (BPPV), 11 with central causes of vertigo (CV), 8 with non-vestibular dizziness (NVD), and 8 controls. Results Mean ip-SVV score in the PVL group (2.77 ± 1.45) was significantly higher than in each of the other groups (BPPV = 0.89 ± 0.55; CV = 1.08 ± 0.68; NVD = 1.45 ± 1.19; Control = 1.08 ± 0.73; one-way analysis of variance, p = 0.008), and remained significant after adjusting for age and gender by multiple linear regression analysis. Receiver operating characteristic analysis predicted an optimal ip-SVV cut-off score of >2.13° with a sensitivity of 66.7%, specificity of 97.0%, positive predictive value (PPV) of 80%, and negative predictive value of 94.1% for detecting PVL. Sensitivity and PPV improved to 75% and 100%, respectively, when subjects tested >1 month after symptom onset ( n = 24) were excluded. Conclusion Smartphone-based SVV testing is a simple and useful office-based method for detecting PVL in children with dizziness.

Subjective visual vertical (SVV) is a vestibular test commonly used in adults that has not been well studied in children. In this test, the patient aligns a projected line with the perceived true vertical. Deviation of2° is usually associated with utricular dysfunction and may also be seen with central vestibular lesions. The goal of this study was to determine the efficacy of SVV in children.Prospective, controlled study.Thirty-three children aged 7 to 18 years with (n = 21) and without (n = 12) dizziness underwent static SVV. History, exam, rotary chair, and caloric testing were used to categorize subjects with dizziness into groups with peripheral vestibular loss (PVL), benign paroxysmal positioning vertigo (BPPV), central vertigo (CV), and nonvestibular dizziness (NVD).Mean SVV deviation was significantly higher in the peripheral vestibular loss group (n = 4; 2.1 ± 1.5) compared to BPPV (n = 5; 0.5 ± 0.3), CV (n = 7; 0.4 ± 0.3), NVD (n = 5; 0.6 ± 0.4), and control (n = 12; 0.7 ± 0.5) groups by one-way analysis of variance (P = .002). SVV deviation2° demonstrated a sensitivity of 100%, specificity of 75%, positive predictive value of 100%, and negative predictive value of 97% for PVL.SVV is a simple, noninvasive test that provides a valuable contribution to the assessment of peripheral vestibular function in children.3b Laryngoscope, 126:727-731, 2016.