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Balance | Overview


Topic: Vestibular Function in Patients with Usher Syndrome 

Principal Investigator: Dr. Margaret Kenna and Dr. Jacob Brodsky

Summary: Usher syndrome (USH), is the most common genetic cause of deaf-blindness, affecting 20% of infants with bilateral moderate to profound congenital sensorineural hearing loss, 15-30% of patients with retinitis pigmentosa (RP) and 50% of deaf-blind children. Patients with Usher syndrome can also have vestibular dysfunction, manifested by late walking or clumsiness, but onset and degree of this dysfunction is underappreciated and highly variable. The goal of the present study is to characterize vestibular function in patients with Usher Syndrome by prospectively testing these patient in Boston Children’s balance lab. We aim to more clearly define the clinically observable and testable vestibular dysfunction in children with Usher syndrome (USH). Few studies have been conducted on this aspect of USH, however, given its congenital nature, the vestibular dysfunction in children with USH may offer an avenue for earlier diagnosis of USH.

Topic: Vestibular Dysfunction in Post-Concussion Syndrome

Principal Investigator: Dr. Jacob Brodsky

Summary:  It is estimated that 300,000 sports-related concussions occur each year, particularly in teenage athletes. Most athletes with a first concussion will have complete recovery within 1-2 weeks, but many will have persistent symptoms lasting weeks, months, or even years. Vestibular impairments such as dizziness or imbalance may have a particularly important role to play in predicting recovery from concussion. Dizziness is the only on-field symptom of concussion that is predictive of a delayed recovery. There is very little known about the effects of concussion on the vestibular system, despite the apparent role of dizziness and imbalance in predicting delayed recovery and the high prevalence of dizziness and balance-related complaints in patients following concussion. Such symptoms may not only cause significant physical and emotional impairment, but may also greatly delay return to school, work, and sport. Additionally, a specialized type of physical therapy, called vestibular rehabilitation, has been shown to effectively facilitate recovery from many types of vestibular injury, though its indications and efficacy in the setting of post-concussive vestibular dysfunction has not been well established. 

We currently have several active studies on vestibular dysfunction in post-concussion syndrome

• Prospective, multi-institutional study of the role of changes in hearing, vestibular function, and olfaction (smell) in predicting post-concussion syndrome in teen athletes. Other participating institutions are DuPont Hospital for Children in Delaware and Toronto Sick Kids.  

• Retrospective chart review study of patients with dizziness and/or imbalance following concussion resulting from traumatic inner ear dysfunction.

• Prospective database study of vestibular, audiologic, ophthalmologic, and neurologic dysfunction in children and adolescents with post-concussive syndrome evaluated at the Brain Injury Center multidisciplinary concussion clinic in Waltham.

Topic: Video Head Impulse Test (VHIT) in Children and Adolescents

Principal Investigator: Dr. Jacob Brodsky

Summary: Accurately diagnosing vestibular dysfunction is challenging, especially in children who often have difficulty describing their symptoms. Consequently, vestibular testing is important in the evaluation of children with such symptoms, though many vestibular tests are particularly challenging for pediatric patients to perform.  Video Head Impulse Testing (VHIT) is a newly developed test which uses video goggles to quantify the vestibulo-occular reflex (the ability for the eyes to fixate on a target as the head is moving). This test has been shown to accurately detect dysfunction of each of the 3 individual semicircular canals (vestibular organs) on each side of the head. We have already demonstrated the benefits of this device in children with a retrospective study (CITATION). Now we are investigating the use of VHIT in children and adolescents with a prospective study that is comparing VHIT results between control patients without vestibular symptoms and experimental patients with vestibular disorders

Topic: Pediatric Vestibular Migraine Variant Disorders

Principal Investigator: Dr. Jacob Brodsky

Summary: Many migraine-related disorders can cause dizziness and/or imbalance in children and adolescents. Vestibular migraine is the most common cause of dizziness in children. We recently published the first study in the literature describing the effectiveness of medical treatment of vestibular migraine in pediatric patients. We are now developing a randomized, controlled trial of the use of migraine medication to treat vestibular migraine in the pediatric population.

Other less common pediatric vestibular migraine variant disorders include Benign Paroxysmal Vertigo of Childhood and Benign Paroxysmal Torticollis of Infancy (BPTI). BPVC is characterized by recurrent brief episodes of room-spinning vertigo in young children (typically ages 3 – 8 years old). BPTI is characterized by recurrent brief episodes of head tilting in infants and toddlers. We currently have 2 studies underway evaluating the characteristics of these unique disorders and their relationship to migraine.

Topic: Pediatric Vestibular Disorders Database

Principal Investigator: Dr. Jacob Brodsky

Summary: We currently have an ongoing research  database studying the relative incidence of different causes of dizziness and imbalance in pediatric patients. This also includes symptoms and test findings. We are using this database to learn how to more effectively and efficiently diagnose and manage dizziness and imbalance in children and adolescents.