On unexplained childhood dizziness

EOPLE RIDE a merry-go-round outside the Natural History Museum in London last year (photo credit: STEFAN WERMUTH/REUTERS)
EOPLE RIDE a merry-go-round outside the Natural History Museum in London last year
My four-year-old son sometimes complains of dizziness and imbalance, as though he were on a merry-go-round, especially when he has a cold. It passes in a few minutes. His doctor examined him and sent him for tests of various kinds, including his vision, but he didn’t find any problem. What can cause such a condition?
V.A., Ramat Hasharon
Dr. Meirav Sokolov Lasmanovich, an ear-nose-andthroat surgeon and specialist in the otolaryngology department of Schneider Children’s Medical Center in Petah Tikva, deals with this question in a recent issue of Puzzle, the hospital’s newsletter: Dizziness is not a rare complaint in children and teens. It can be caused by a number of things, including a rise in body temperature, dehydration, neurological conditions or vestibular problems. The vestibular system includes the parts of the inner ear and brain that help control balance and eye movements.
Our ears not only enable us to hear but are responsible also for equilibrium and stability, so when there is a problem in the inner ear, it can cause a feeling of dizziness, instability and even occasional falling.
Serous otitis media, better known as middle-ear fluid, is the most common condition causing hearing loss and dizziness in children. Normally, the space behind the eardrum which contains the bones of hearing is filled with air. This allows the normal transmission of sound. This space can become filled with fluid during colds or upper respiratory infection.
Once the cold clears, the fluid will generally drain out of the ear through the Eustachian tube which connects the middle ear to the nose. However, the Eustachian tube does not drain well in children; fluid that has accumulated in the middle ear often remains blocked and can cause dizziness.
While we doctors invest a lot of energy in early diagnosis and treatment of hearing problems in children, the problem of vertigo gets very little attention, due to lack of awareness by doctors, who don’t think about vertigo or balance problems, and among parents.
Also, young children can’t express themselves in words very well about such physical complaints.
Toddlers with balance problems will have difficulty learning to walk or to ride a bicycle, use playground equipment or participate in sports activities such as those involving balls. Often they will be ridiculed as clumsy, which causes anxiety and makes them keep to themselves.
Because of this, various medical centers in the world have establish multidisciplinary clinics that specifically treat children who suffer from dizziness and lack of balance. Medical researchers around the world are also beginning to focus on these problems.
Advanced equipment can today assess vestibular function, diagnose dizziness and imbalance better, and suggest treatment.
We at Schneider have opened such an interdisciplinary clinic – the first of its kind in Israel. Parents are invited to bring children who have such problems for which no explanation has been found.
I am a 79-year-old woman who has been under treatment for CLL (chronic lymphatic leukemia) and observation for over 25 years.
I have been successfully treated, and still am, with ibrutinib for three and a half years. I also have a pacemaker and wet age-related macular degeneration in one eye and had surgery for acute diverticulitis. I am writing because I have been in constant and often excruciating pain, mainly in the area of the stomach and duodenum since I began taking ibrutinib (Imbruvica). A stomach enterological imaging showed nothing one year ago.
The relevant doctors – my oncologist and gastroenterologist – tell me that there is no way I can do a colonoscopy, due to my general condition; no MRI, because of the pacemaker; and no CT, because I have a severe allergy to iodine. Iodine caused me to stop breathing in the past, and an iodine substitute for another CT was violently expelled by my colon before I could drink the full two liters required. There was no successful reading, as a result.
CLL is connected to other cancers within the body. Is there no other method to give a more accurate diagnosis of what is going on, especially in my abdomen, than the manual exam that my oncologist does on me once every three months? I.K., Modi’in
Prof. Nathan Cherny, a senior oncologist and head of palliative medicine, Shaare Zedek Medical Center, answers: Ibrutinib can be an important medication for patients with relapsed CLL. Like many other so-called targeted therapies, it has a range of frequent adverse effects. There are two common ways that ibrutinib can cause abdominal pain. The easiest sort of pain to manage is pain from constipation, which occurs in about a quarter of the patients using ibrutinib regularly.
Constipation can cause painful bowel distension and it must be treated, usually starting with a regular laxative therapy. Some patients develop an abdominal pain syndrome that can affect either the upper or lower abdomen and which does not appear to be related to any form of underlying organ damage.
This sort of pain may need to be treated with a regular analgesic that is tailored to the severity of the pain. It may be worth discussing the possibility of taking a brief break from treatment, to see if the pain resolves. If it does, it could be that the dose of the medication could be reduced.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to [email protected] jpost.com, giving your initials, age and place of residence.