The evaluation of dizziness in children

A child with symptoms that relate to the balance mechanism can be a complex diagnostic problem. Often an adequate history is difficult to obtain because of the child's age and limitation of expression. Psychosomatic illness can frequently present as dizziness in children; however, this should not preclude a thorough evaluation. It is the purpose of this paper to outline these possibilities and the characteristics unique to each. The differential diagnosis can be grouped into central (central nervous system) and peripheral (otologic) categories, with a few miscellaneous conditions. A basic evaluation should include a complete neurotologic examination, audiogram and electronystagmogram. An electroencephalogram is frequently a valuable diagnostic adjunct. Further testing should be decided on the basis of the patient's history, examination and prior results. The records of children admitted to Boston City Hospital over a one-year period were reviewed. Of 2,088 pediatric patients, 238 had discharge diagnoses pertinent to the balance mechanism. Of these, 14 had a presenting symptom of dizziness. These cases are analyzed.