Dizziness in children is said to be uncommon, occurring at a frequency of about 1/100th that in adults. Until now, the most commonly reported type of dizziness is orthostatic dysregulation (OD). We examined the statistical prevalence of dizziness, and identified four common conditions, designated as VROP, that cannot be treated with knowledge of dizziness in adults alone. VROP comprises VMC (Vestibular Migraine of Childhood), RVC (Recurrent Vertigo of Childhood), OD, and PD (Psychogenic Dizziness). VMC is a pediatric version of vestibular migraine, and its diagnosis and treatment are similar to those of vestibular migraine in adults; RVC is an acute rotatory vertigo attack that occurs most frequently in children under 5 years of age and lasts from a few minutes to several hours; OD is not an otorhinolaryngological disorder, but a pediatric disorder, so collaboration with a pediatrician to manage it is important. Psychogenic gait disturbance is sometimes observed in psychogenic vertigo. This disorder requires to be managed in collaboration with a child psychiatrist. Particularly useful for the diagnosis are diaries of dizziness and headache and video recordings of nystagmus made by a parent or guardian during a vertigo attack.

Using machine learning, we attempted to differentiate between peripheral vestibular disorders (n = 466) and non-peripheral vestibular disorders (n = 254) based on the results of stabilometry. Six algorithms were used for machine learning: random forest, gradient boosting, support vector machine, logistic regression, k-nearest neighbor, and multilayer perceptron. Due to the large difference in the amount of data between the two groups, SMOTE (Synthetic Minority Over-sampling Technique) was used during learning to correct for the amount of data between the two groups.

The results were as follows. (1) The average value and standard deviation of accuracy for the six models were 0.64 and 0.05. Precision and recall were relatively good in the peripheral vestibular disorders group, but poor in the non-peripheral vestibular disorders group. (2) The accuracy rate of prediction of peripheral vestibular disorders by the three algorithms, RF, LR, and KNN, was as high as 90%, whereas their accuracy rate for predicting non-peripheral vestibular disorders was poor (53%).

The insufficient number of cases in the non-peripheral vestibular disease group appeared to have a large influence on the results. Therefore, we would like to collect more cases and repeat the analysis.

Benign paroxysmal vertigo of childhood (BPVC) is one of the most common causes of vertigo attacks in pediatric patients. Some patients with BPVC suffer from migraine in the future, so that the possibility of migraine is an important consideration in children with recurrent vertigo. Recently, novel diagnostic criteria for vestibular migraine and recurrent vertigo of childhood were published for “Vestibular Migraine of Childhood (VMC)”, “probable Vestibular Migraine of Childhood (probable VMC)” and “Recurrent Vertigo of Childhood (RVC)”.

In the present study, we evaluated patients with vertigo or dizziness who were less than 18 years old, focusing particularly on concomitant headaches. The medical records of 69 patients were reviewed retrospectively. The predominant diagnoses were VMC (n = 4) , probable VMC (n = 10) , RVC (n = 22), orthostatic dysregulation (OD; n = 12), central vertigo and vertigo related to infectious disorder (n = 4 each), psychogenic vertigo (n = 3), benign paroxysmal positional vertigo (BPPV; n = 2), Meniere’s disease (n = 1), and other conditions (n = 7).

Of the total, 33 subjects had concomitant headaches and 13 did not, and the presence/absence of headache could not be confirmed in the remaining 23 subjects. Of the 33 patients with concomitant headaches, 13 were diagnosed as having migraine; 4 as having VMC, 3 as having probable VMC, 3 as having OD, and one each as having central vertigo, infectious disorder, and BPPV. Differentiation between migraine and OD is sometimes difficult, because patients with OD also frequently present with headaches, thus indicating the importance of collaborative intervention with a pediatrician.

A significantly larger number of patients reported having concomitant headaches if they were asked about it, as compared with the number among those who were not directly asked the question by the physician. This result indicates the possibility that prompt history taking about the presence/absence of headaches may influence the diagnostic results in pediatric vertigo patients. It is therefore essential to ask pediatric patients with recurrent vertigo if they suffer from headaches or not.

Purpose: In this study, we investigated the effectiveness and feasibility of physical therapist-supervised vestibular rehabilitation (PT-VR) in patients with persistent postural-perceptual dizziness (PPPD) who are unresponsive to medication and/or home-based vestibular rehabilitation (home-VR).

Methods: Seven PPPD patients who exhibited resistance to medication and/or home-VR were enrolled. In conjunction with ongoing home-VR, the patients underwent 7 sessions of PT-VR over a three-month period. Improvement of the symptoms and feasibility of the program were evaluated.

Results: Both the PT-VR and home-VR interventions were completed in all the 7 patients. The Dizziness Handicap Inventory score also showed significant improvement, decreasing from the pre-intervention score of 50.1 ± 12.1 points to 37.7 ± 20.2 at 1 month post-intervention and 26.0 ± 17.5% at 3 months post-intervention (p < 0.001). No adverse events were reported.

Conclusion: For PPPD patients showing inadequate response to initial treatment, the combination of PT-VR and home-VR is an effective therapeutic approach for improving the symptom of dizziness.

In the present study, we attempted to clarify which could be a more effective way of treating Meniere’s disease — treatment carried out only during the attacks (intermittent group) and treatment administered continuously even during periods of remission (continuous group). We enrolled 77 cases of unilateral Meniere’s disease with a history of recurrent vertigo attacks who visited the Vertigo/Dizziness center of Nara Medical University. The patients underwent inner-ear gadolinium-enhanced MRI between June 2014 and March 2022. Of the 77 cases, 73 were divided into the intermittent group (n = 34) and the continuous group (n = 39). Medication included mainly osmotic diuretics, adenosine triphosphate, and vitamin B12, prescribed for oral intake three times per day. The vertigo frequency, modified Dizziness Handicap Inventory (mDHI) score, and hearing level were assessed, and the endolymphatic space (ELS) ratio was calculated on contrast-enhanced MR images for each patient.

The ELS ratios and hearing levels in the affected ear were significantly lower in the intermittent group than in the continuous group, especially in the whole inner ear, cochlea and vestibule. There was no significant difference in the vertigo frequency or mDHI between the intermittent and continuous groups. These results suggest that intermittent treatment just during the vertigo attacks may be more effective to prevent exacerbation of endolymphatic hydrops and preserve the hearing level than continuous treatment. These preliminary findings from the present retrospective study could provide insight for the development of treatment guidelines for Meniere’s disease in the future.