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Superior Semicircular Canal Dehiscence

Introduction Superior semicircular canal dehiscence (SSCD) can be defined as an anatomic anomaly found (occasionally incidentally) on high-resolution temporal bone computed tomography (CT) scan or at surgical exploration ( Fig. 12.1 ) or as a syndrome, a constellation of symptoms, that frequently accompanies this anatomic deviation. An anatomic dehiscence of bone overlying the superior semicircular canal (SSC) at its interface with the middle cranial fossa dura…

Migraine-Associated Vertigo

Introduction The clinical association of migraine and vertigo or dizziness has been given many names in the literature, including migraine-associated vertigo, migraine-associated dizziness, vestibular migraine, migrainous vertigo, migraine-related vestibulopathy, basilar artery migraine, and others. According to Stewart and associates, 17% of the female population and 6% of males experience severe migraine headaches. Because about one-third of persons with migraine experience dizziness, the prevalence of migraine combined…

Vestibular Neuritis

Case study: L.R. is a 40-year-old female referred by her primary care physician with a chief complaint of acute, severe, room-spinning vertigo. She stated that she awoke at 4 a.m. when the sensation of vertigo came on very suddenly, was quite violent, and was accompanied by nausea and vomiting. She recalled having to crawl on the floor to make it to the bathroom and felt that…

Positional Vertigo: As Occurs Across All Age Groups

Introduction Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders with an estimated lifetime prevalence of 2.4% in the general adult population. Out of the 5.6 million clinic visits in the United States for dizziness per year, it is estimated that 17%–42% of patients with vertigo receive a diagnosis of BPPV. Although this disorder ranges across the lifespan, it tends to disproportionately…

The Video Head Impulse Test

Acknowledgement This work was supported by a Merit Review (F1540-R) and by the Auditory and Vestibular Research Enhancement Award Program (C4339-F), both sponsored by the Rehabilitation Research and Development Service, Department of Veterans Affairs, Washington, D.C. The contents of this chapter do not represent the views of the Department of Veterans Affairs or the United States Government. Introduction Many techniques are available for the assessment of…

Evaluation of Dizziness in the Litigating Patient

Introduction Dizziness is one of the most frequent chief complaints that brings a patient to a physician’s office. Dizziness is also a frequent complaint among litigants who have suffered accidental or job-related injuries. Worker’s compensation, disability claims, and lawsuits are filed for financial compensation because of this complaint. As health care providers, we inevitably become embroiled as either expert witnesses in our patients’ lawsuits or as…

Dizziness and Vertigo in the Adolescent

The Adolescent Brain Adolescence, the developmental transition between the dependency of childhood and the independency of adulthood, encompasses the approximate period between 12 and 18 years of age. Behavior during this developmental stage is frequently characterized by risk taking, impulsivity, and poor choices. The indestructible attitude of the adolescent, which can be met by negative consequences, promotes experimentation of adult practices, development of self-esteem, and eventually…

An Update on the Predominant Forms of Vertigo in Children and Their Associated Findings on Balance Function Testing

Introduction There are many disorders that can cause “dizziness” in the pediatric population. In 1999, Russell and Abu-Arafeh published an epidemiological study showing that in their sample, 15% of school-age children had experienced at least one episode of vertigo in the previous year. In a further effort to describe the prevalence and causes of dizziness in the pediatric population, O’Reilly et al. searched electronic medical records (i.e.,…

Assessment Techniques for Vestibular Evaluation in Pediatric Patients

Introduction Pediatric vestibular evaluation has become more established in audiology and otolaryngology clinics over recent years. Along with early identification of hearing impairment, early identification of vestibular disorders has allowed earlier and perhaps more effective remediation strategies in children complaining of dizziness or balance disorders. Researchers and clinicians have contributed valuable information related to vestibular disorders that may be diagnosed in the pediatric population. There has…

Development of the Vestibular System and of Balance Function: Differential Diagnosis in the Pediatric Population

Clinicians are just beginning to adequately recognize pediatric vestibular disorders as an area of significant importance in the overall well-being of children. Mandates for universal newborn hearing screening have resulted in an early focus on auditory function in infants, facilitating the early identification and management of children with auditory pathology. This has vastly improved outcomes for children with hearing loss and has resulted in a welcomed…

Technological Advances in Testing the Dizzy Patient: The Bedside Examination Is Still the Key to Successful Diagnosis

Acknowledgments The recordings in Figures 2.1–2.9 were performed as part of the AVERT clinical trial (NIH/NIDCD U01 DC013778). We thank the study’s Principal Investigator, Dr. David Newman-Toker and the rest of the AVERT team for providing these resources. Introduction Dizziness is a common complaint across many clinical settings and often an intimidating challenge for physicians to diagnose despite modern advances in medical technology and imaging. Lack…

Dizziness Demographics and Population Health

Dizziness and imbalance are common conditions affecting people of all ages, and particularly the elderly. This chapter begins by defining dizziness, imbalance, and presbyvestibulopathy , or age-related vestibular loss, which is of particular interest to the otolaryngologist, the neurologist, and the primary care physician. Then the epidemiology of dizziness, imbalance, and presbyvestibulopathy will be reviewed. Finally, the impacts of these conditions on population health from the…

Supplemental Material

Section 1: General Chapter 1 : General Considerations In Pediatric Otolaryngology Normal Growth Physiologically, children have a greater ratio of body surface area to volume than adults; as a result they are at greater risk of excessive loss of heat and fluids. Children are more easily affected by medication, toxins, and microorganisms. They also have rapidly dividing cells, which assist in the rate of growth, making…

Pediatric Swallowing, Laryngopharyngeal and Gastroesophageal Reflux Disease, Eosinophilic Esophagitis, and Aspiration

Key Points A stable airway is a prerequisite for oral feeding. Functional and safe swallowing consists of interrelated sequential movements of saliva, liquid, and food through the oral cavity, pharynx, and upper esophagus to the stomach. Dysphagia is defined as impaired swallowing secondary to dysfunction in the oral, pharyngeal, and/or esophageal phase. Gastroesophageal reflux disease (GERD) may play a role in promoting subglottic injury; its treatment…

Aerodigestive Foreign Bodies and Caustic Ingestions

Key Points Most foreign bodies occur in boys under the age of 3. Common airway foreign bodies are peanuts, seeds, and vegetable matter. Most common esophageal foreign bodies are coins and pins. A reliable history and a witnessed aspiration or ingestion are the most important factors in diagnosing an aerodigestive foreign body. Esophageal foreign bodies are twice as common as bronchial foreign bodies, but most of…

Ankyloglossia and Tight Maxillary Frenula

Key Points The frequency of diagnosis and treatment of ankyloglossia (tongue tie) and tight maxillary frenulum (lip tie) has increased dramatically in the last few decades. Ankyloglossia can be categorized into four types, with types I and II describing “anterior” ankyloglossia and types III and IV “posterior” ankyloglossia. Evidence supports lingual frenotomy in the neonatal period for infants with evidence of latching problems caused by ankyloglossia.…

Pediatric Tracheotomy and Decannulation

Key Points Because of the advances in medical care, rates of pediatric tracheotomy have recently declined. The process of obtaining informed consent prior to surgery requires that families understand expectations for tracheostomy management and the potential for decannulation. Prior to discharging a child with a tracheostomy from the hospital, families should have all routine and emergency supplies readily available. Caring for a child with a tracheostomy…

Laryngotracheal Clefts

Key Points The true incidence of laryngeal cleft is difficult to estimate, but it is as high as 7.6% in patients undergoing direct laryngoscopy and bronchoscopy for recurrent respiratory symptoms. A multidisciplinary approach is required to evaluate and manage laryngeal clefts. Early diagnosis is important to prevent potential pulmonary sequelae. Type 1 laryngeal cleft is an anatomic variant, and its functional sequelae should dictate decisions regarding…

Diagnosis and Management of Tracheal Anomalies and Tracheal Stenosis

Key Points Tracheal anomalies in children represent one of the greater challenges in pediatric otolaryngology. In addition to the compromised airway, there is a high prevalence of associated anomalies. Despite surgical and technologic advances, significant morbidity and mortality remain. Advances in molecular biology and development of novel animal models have challenged older theories of foregut development and have allowed increased understanding of the pathophysiology of congenital…

Recurrent Respiratory Papillomatosis

Key Points Recurrent respiratory papillomatosis (RRP) is a devastating, albeit rare, disease in which papillomas of the airway cause hoarseness and airway obstruction. The disease is caused by human papillomavirus 6 and 11, the same subtypes responsible for the development of genital warts and low-risk cervical intraepithelial neoplasia of the genitourinary tract. The age of disease onset and clinical course are highly variable. Surgical therapy for…