The Scientific World Journal Volume 2012, Article ID 109624, 6 pages doi:10.1100/2012/109624 The cientificWorldJOURNAL Clinical Study Vertigo in Children and Adolescents: Characteristics and Outcome Maayan Gruber, 1 Raanan Cohen-Kerem, 1, 2 Margalit Kaminer, 3 and Avi Shupak 1, 2, 3 1 Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa 34362, Israel 2 The Bruce Rappaport Faculty of Medicine, Israel Institute of Technology (Technion), Haifa 32000, Israel 3 Unit of Otoneurology, Lin Medical Center, Haifa 35152, Israel Correspondence should be addressed to Avi Shupak, shupak@internet-zahav.net Received 14 October 2011; Accepted 22 November 2011 Academic Editors: C. Bosetti and P. A. Schachern Copyright © 2012 Maayan Gruber et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. To describe the characteristics and outcome of vertigo in a pediatric population. Patients. All children and adolescents presenting with vertigo to a tertiary otoneurology clinic between the years 2003–2010 were included in the study. Results. Thirty-seven patients with a mean age of 14 years were evaluated. The most common etiology was migraine-associated vertigo (MAV) followed by acute labyrinthitis/neuritis and psychogenic dizziness. Ten patients (27%) had pathological findings on the otoneurological examination. Abnormal findings were documented in sixteen of the twenty-three (70%) completed electronys- tagmography evaluations. Twenty patients (54%) were referred to treatment by other disciplines than otology/otoneurology. A follow-up questionnaire was filled by twenty six (70%) of the study participants. While all patients diagnosed with MAV had continuous symptoms, most other patients had complete resolution. Conclusions. Various etiologies of vertigo may present with similar symptoms and signs in the pediatric patient. Yet, variable clinical courses should be anticipated, depending on the specific etiology. This is the reason why treatment and follow up should be specifically tailored for each case according to the diagnosis. Close collaboration with other medical disciplines is often required to reach the correct diagnosis and treatment while avoiding unnecessary laboratory examinations. 1. Introduction Vertigo is an uncommon complaint in children and adoles- cents. Surveys of the adult population have reported a one- year prevalence of 23% for unspecified dizziness and 5% for vestibular vertigo [1]. In comparison, a recent review of all ICD-9 codes related to vestibular and balance disorders in more than 560000 distinct pediatric patient encounters during a 4-year period revealed prevalence of only 0.4% for unspecific dizziness, 0.03% for peripheral, and 0.02% for central vestibulopathy [2]. The first reference in the modern scientific literature for pediatric vertigo was published by Harrison [3] in 1962. Despite the most significant technological achievements in the development of diagnostic tools since then, diagnosis is still based mainly upon the patient’s history and physical examination. When a child or an adolescent presents with dizziness, he or she is first being evaluated by the primary physician, usually a pediatrician, and only some are diag- nosed with true vertigo. Dizziness and vertigo might present a considerable pathology, and patients are often referred to additional tests or further evaluation performed by either an otolaryngologist or a neurologist [4–6]. The most important clues to the diagnosis of vertigo are obtained through a careful and pertinent clinical history. However, when a child as the patient is considered this task might be hampered due to lack of communication abilities, narrowed vocabulary, and distractibility. These difficulties sometimes lead to the erroneous impression that the presen- ting symptoms are secondary to lack of coordination or be- havioral problems [7]. Due to these limitations meticulous physical examination and laboratory tests are important stepping stones towards the correct diagnosis. Yet, the pedi- atric patients’ compliance may also be limited in the perfor- mance of a complete otoneurological evaluation. A further challenge is presented by the remarkable ability of most