The evaluation of Vertigo in children: which role for parental-camera recording and telemedicine?

Sir, At this time, the management of pediatric patients affected by vertigo remains a challenge that requires a multidisciplinary approach and the collaboration of many specialists, such as otorhinolaryngologists, audiologists, pediatricians, and neurologists. Vertigo in children is a condition often difficult to assess since the little patients are frequently incapable to provide a complete description of their complaints, and parents can be inaccurate or incomplete, in describing or recognizing crucial clinical signs. Many disorders, including neurological and audio-vestibular diseases, can manifest with vertigo, which in children can occur alone or in association to other symptoms such as visual disturbances, migraine, or learning disabilities. It can severely affect the quality of life of both, children and their families, especially if persisting, enhancing parental concerns and anxieties. A careful collection of medical history, with a detailed description of symptoms, is crucial in the diagnostic process. However, parents/caregivers may omit important data since they are not trained to recognize red flags or specific signs. Thus, during the first consultation, otolaryngologists should alert parents/caregivers for assessing specific vertigo features, in the case of future episodes. Timing, frequency, triggers, and associated manifestations can be helpful details to report. Among specific diagnostic tools, the video Head Impulse Test (vHIT) is a valuable instrument for assessing the vestibular-ocular reflex (VOR), even if it can present a higher percentage of artefacts in children, mainly due to technical issues (i.e., higher gain and blinking eyes). Furthermore, while teenagers can undergo different investigations, including specific vestibular testing, the cooperation of younger children, for a full clinical and instrumental testing, can be tricky. Currently, the use of patients’ self-recorded videos is not common among the audio-vestibular practice. However, according to Gedik-Soyuyuce et al, their application can be valuable for observing children’s behaviors during acute vertigo attacks. Nowadays, smartphone high-definition cameras could be useful for recording the dizzy children during a crisis. Therefore, detailed features (i.e., eyes and body movements) could be documented, as already proposed for the adults affected by Meniere’s disease.