Hi, I'm Dr. Lauren Bohm and today I'm joined by Dr. Marc Thorne, an Associate Professor and pediatric otolaryngology. We're here today to talk about vestibular disorders in children. Marc what are some potential signs of a vestibular problem in children? Children who are having vestibular issues can have a number of different presenting signs and symptoms. They might complain of dizziness and especially of vertigo and which is a sensation of the room spinning around. Younger children especially will have a harder time articulating their symptoms and so you might see that they are slower in terms of meeting their milestones and that could include walking, include being able to stand on one foot or even riding a bike. They may also have episodes where they will cling to their parent if they're feeling unsteady or having episodes. Those all seem like important things to look for. Are there any particular populations of children that are more at risk of developing a vestibular disorder? Yes there are, so children with hearing loss are at risk of having both hearing loss and vestibular or balance loss because the inner ear provides both of those functions. Another group at risk are children who were exposed to medications that might impact the vestibular system, children with cystic fibrosis and frequent antibiotic exposure would be in that group as well. So for children that present with some of these symptoms when would you consider referral for a vestibular evaluation? I think especially for children in those groups at highest risk, anytime that you have concerns about either symptoms that suggest a vestibular problem or delays and meeting their milestones that would be an appropriate time for referral. If there was one message that you'd like to impart on primary care physicians who take care of children, who may present with these symptoms, what would that be? Well, I think awareness is certainly one big aspect. I would say another is the importance of trying to clarify the history with a patient and what the child and dizziness is one of those terms that's used very differently by different patients and families and so trying to clarify when they say dizziness what they mean. What most will be able to articulate on further questioning if they're traveling for peripheral vestibular issues is a sense of spinning or vertigo. It's as important to differentiate vertigo from other causes of dizziness is that what you're saying? Right. So vertigo would indicate the potential for there to be an issue with the peripheral vestibular system from the ear, other sensations that might be associated with the term dizziness in the lay population might include a sense of unsteadiness or lightheadedness and since that they might pass out and those would typically point you down another path in terms of medical diagnosis. I see. Within the module where we discuss vestibular evaluation more thoroughly, we really tried to emphasize the importance of a multidisciplinary team in the care of these patients. What's been your experience with that team environment? There's no question that having a team is really important in terms of providing optimal care for these patients. No single professional can really do all of the aspects of this care alone. So as a physician, my role is to help to try to establish a medical diagnosis and provide appropriate treatment for that when present, but I rely heavily on my team including the audiologists as well as our physical therapist in terms of additional diagnostic information as well as treatment. I see and do you imply any specific communication techniques or strategies, so that way all the members of the team remain on the same page? Well certainly clear communication across the whole team is very important. It's important that we all understand the condition that we're treating, what we're expecting in terms of outcomes and so I think less important than the specific communication tools imply used, it's important that everybody is communicating clearly and everyone is on the same page. I see. In general do you have any ideas about how we may improve the overall care of children who have dizziness or balance problems? Well, I think evaluating dizziness and vestibular dysfunction in kids is a really exciting area. It's an area that hasn't received a lot of focus from the medical community in the past and so I think there's a lot to learn. I think first we have to become more aware about the prevalence of this condition in kids especially those kids who were at risk because of other medical conditions as we recognize how often this is occurring. I think there's a lot of great opportunities to better our understanding of optimal treatment options and the best way to manage these kids moving forward. Thanks Marc. I really appreciate your insights on this important in emerging topic of pediatric vestibular disorders. Thanks for taking the time to join us today. Absolutely, my pleasure.
