Academic journal article Communication Disorders Quarterly

Childhood Vestibular Disorders: A Tutorial

Academic journal article Communication Disorders Quarterly

Childhood Vestibular Disorders: A Tutorial

Article excerpt

There is a growing body of evidence that childhood disorders affecting the vestibular system, although rare, do exist. Describing symptoms associated with the vestibular mechanism for children may be difficult, resulting in misdiagnosing or under-diagnosing these conditions. The pathophysiology, symptoms, and management options of the more common childhood disorders that may affect the vestibular system are addressed in this article. Vestibular problems associated with fetal alcohol syndrome and vestibular deficits in children who are deaf also are discussed. Vestibular deficits can affect not only a child's health but also the child's ability to learn, as well as the child's overall academic achievement. It is important for professionals working with children to recognize signs and symptoms associated with vestibular disorders because appropriate diagnosis and treatment are crucial for positive outcomes.

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Disorders affecting the human vestibular or balance system typically are perceived as problems affecting only adults. A growing body of evidence, however, suggests that childhood vestibular disorders, although rare, do exist (Bower & Cotton, 1995, Eviatar, 1994; Hausler, Toupet, Guidetti, Basseres, & Montandon, 1987; Tusa, 2000a). The incidence of vestibular symptoms associated with childhood disorders reported in the literature ranges from 0.5% (Eviatar & Eviatar, 1974) to 6% (Fried, 1980), depending on the type of population (pediatric, otolaryngology, or neurology clinic patients) under investigation (Bower & Cotton).

Few vestibular studies focus on children. Information regarding vestibular problems in children, therefore, is lacking, as is awareness of the problems. Although disorders affecting the vestibular mechanism are typically not life threatening, they can affect a person's quality of life and future earning potential. Furthermore, there is a high prevalence of psychological disorders, particularly anxiety disorders, associated with patients with vestibular problems (Jacob, 1988; Tusa, 2000b). Timely diagnosis and intervention are crucial for the health and well-being of these children. The purpose of this tutorial is to broaden the knowledge base and promote increased awareness of childhood disorders associated with vestibular symptoms among speech-language pathologists, audiologists, and educators of children who are deaf or hard-of-hearing. The tutorial addresses the pathophysiology, symptoms, and management options of some of the more common childhood disorders that can affect the vestibular system. Differential diagnosis of these disorders is discussed when appropriate because many of these conditions have similar signs and symptoms but quite different implications for treatment and intervention.

ANATOMY AND PHYSIOLOGY OF THE VESTIBULAR SYSTEM

A brief overview of the anatomy and physiology of the human vestibular system will provide a better understanding of various disorders that may disrupt the system. No single system or structure constitutes the vestibular system. It is made up of three primary components: (a) a peripheral sensory apparatus, (b) a central vestibular system, and (c) motor output (Hain, Ramaswamy, & Hillman, 2000).

The peripheral sensory apparatus (also called the vestibular labyrinth), housed in the inner ear, consists of two types of motion sensors: three semicircular canals and the otolith organs. The semicircular canals are sensors for angular motion; for example, when the head is turned from left to right or up and down. The otolith organs include the utricle and saccule, which are sensors for linear acceleration with respect to gravity. Acceleration is sensed by the utricle in the horizontal plane and the saccule in the vertical plane. The utricle and the saccule also sense changes in head motion related to gravity, such as putting the chin on the chest (pitch) or touching the ear to the shoulder (roll). …

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