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Visual-vestibular interaction test in the diagnosis of vertigo in children.

Salami A, Dellepiane M, Crippa B, Barettini L, Mora R

ENT Department, University of Genoa, Italy.

OBJECTIVE: The aim of this study has been to test to determine the diagnostic value of a visual-vestibular test with a rotatory cylindrical chamber in the diagnosis of peripheral and central vertigo in children. METHODS: Ten children affected by posttraumatic and migrainous vertigo were enrolled (group A): as a control group 10 healthy children were identified. All the children underwent to electronystagmography (ENG) recording: the children, head blocked, sat on a "Tonnies rotatory chair Pro model", which was placed in the middle of a rotatory cylindrical chamber (2m in diameter and 1.9m in height), and underwent to rotatory vestibular stimulation by Stop test, to optokinetic stimulation and to contemporary rotatory vestibular and optokinetic stimulation (visual-vestibular-ocular-reflex): opening the light on the stop test, by an angular velocity of 90 degrees s(-1) obtained from a chair subliminal acceleration of 0.5 degrees s(-2), and making for 60s the optokinetic stimulation by rotation of the optical contrasts to determinate a nystagmus with a opposite direction to the postrotatory nystagmus and homodirectional to optokinetic nystagmus (in both clockwise and counterclockwise directions). RESULTS: For the analysis of the results we have considered nystagmus mean gain and direction of visual-vestibular-ocular-reflex (VVOR) nystagmus. In group A, all the children presented a VVOR nystagmus homodirectional to vestibular-ocular-reflex (VOR). In control group, all the subjects presented a VVOR nystagmus homodirectional to optokinetic nystagmus. CONCLUSIONS: In the healthy patients, VVOR nystagmus is always homodirectional to optokinetic nystagmus and indicates the optokinetic system prevalence on VOR. The presence of a VVOR nystagmus homodirectional to VOR indicates the absence of the optokinetic system prevalence due to a central nervous system (CNS) modification and highlights a CNS disease. These data show the diagnostic role of our visual-vestibular interaction test in children affected by vertigo.

Published 10 December 2007 in Int J Pediatr Otorhinolaryngol, 72(1): 1-7.
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