Salami Angelo, Dellepiane Massimo, Mora Renzo, Taborelli Giuseppe, Jankowska Barbara
ENT Department, University of Genoa, Genoa, Italy.
Int J Pediatr Otorhinolaryngol. 2006 Jan;70(1):13-8. doi: 10.1016/j.ijporl.2005.05.001. Epub 2005 Jun 17.
Dizziness and imbalance are uncommon in children, but often alarming for their families: a detailed interview and otoneurological examination are important for reaching a specific diagnosis and treatment. Children with vestibular disorders are thought to be difficult to examine: vestibular tests (caloric test, roto-acceleratory test, electronystagmography, opto-kinetic nystagmus, cranio-corpography and posturography) are used less frequently for children than in adult patients. The aim of the study was to determine whether the results of electronystagmography testing improve an emergency physician's diagnosis of dizziness in children.
Patients were selected on the basis of the following inclusion criteria: aged between 2 and 12 years and affected with vertiginous symptoms. All patients underwent the following instrumental examinations: blood tests, audiological screening, electronystagmography of spontaneous nystagmus or provoked by vestibular and optical stimulation and electroencephalogram.
The results underlines an high incidence of central vertigo (83%): 52% of the children presented a prevailing unidirectional nystagmus at labyrinth stimulation and 48% of the children an asymmetry in the response of nystagmus at optical kinetic stimulation with quality alteration of shocks.
Electronystagmography can register and evaluate the qualitative and quantitative characteristics of the nystagmic response and allow to distinguish between central or peripheric vertigo: different degrees and various combinations of the abnormal responses shown in optokinetic central test were the most characteristic of electronystagmography in patients with vestibular central vertigo.
头晕和平衡失调在儿童中并不常见，但往往令其家人担忧：详细的问诊和耳神经学检查对于明确具体诊断和治疗至关重要。患有前庭疾病的儿童被认为难以检查：与成年患者相比，前庭测试（冷热试验、旋转加速试验、眼震电图、视动性眼震、颅-体图和姿势图）在儿童中使用频率较低。本研究的目的是确定眼震电图测试结果是否能改善急诊医生对儿童头晕的诊断。
根据以下纳入标准选择患者：年龄在2至12岁之间且有眩晕症状。所有患者均接受以下器械检查：血液检查、听力筛查、自发性眼震或前庭及光刺激诱发眼震的眼震电图检查以及脑电图检查。
结果显示中枢性眩晕的发生率较高（83%）：52%的儿童在迷路刺激时出现主要为单向眼震，48%的儿童在视动刺激时眼震反应不对称且冲击质量改变。
眼震电图可以记录和评估眼震反应的定性和定量特征，并有助于区分中枢性或周围性眩晕：视动中枢测试中显示的不同程度和各种异常反应组合是前庭中枢性眩晕患者眼震电图最具特征性的表现。
