The Impact of Follow-Up on Etiological Classification of Pediatric Vertigo

TL;DR

Long-term follow-up helps identify causes of vertigo in children that were initially unknown, reducing uncertainty from 43% to 10%.

Contribution

The study demonstrates that longitudinal follow-up is a critical diagnostic tool for identifying the causes of pediatric vertigo.

Findings

Extended follow-up reduced unclassified pediatric vertigo cases from 44% to 10%.

Migraine-related vertigo was the most common identifiable cause after reassessment.

Diagnostic tests like cranial computed tomography had low yield in identifying causes.

Abstract

What are the main findings?
Extended longitudinal follow-up dramatically reduced the proportion of pediatric vertigo with initially unknown etiology, from 43% at first evaluation to 10% after diagnostic reassessment.Many cases initially classified as unexplained vertigo evolved into identifiable clinical entities, most commonly migraine-related vertigo, as well as central, hemodynamic, psychogenic, and peripheral vestibular disorders.

Extended longitudinal follow-up dramatically reduced the proportion of pediatric vertigo with initially unknown etiology, from 43% at first evaluation to 10% after diagnostic reassessment.

Many cases initially classified as unexplained vertigo evolved into identifiable clinical entities, most commonly migraine-related vertigo, as well as central, hemodynamic, psychogenic, and peripheral vestibular disorders.

What are the implications of the main findings?
In pediatric vertigo, follow-up should be regarded as an active diagnostic tool, not merely observation, because clinical phenotypes often emerge over time.Early diagnostic uncertainty is common in children with vertigo and should prompt structured longitudinal evaluation rather than premature diagnostic closure.

In pediatric vertigo, follow-up should be regarded as an active diagnostic tool, not merely observation, because clinical phenotypes often emerge over time.

Early diagnostic uncertainty is common in children with vertigo and should prompt structured longitudinal evaluation rather than premature diagnostic closure.

Background: Vertigo and dizziness in children represent diagnostically challenging conditions with heterogeneous etiologies. At initial presentation, a substantial proportion of pediatric patients remain without a definitive etiological diagnosis. Evidence on the impact of longitudinal follow-up on etiological classification in pediatric vertigo is limited. Methods: This observational cohort study uses prospectively collected clinical data. Children aged 1–17 years who presented to a tertiary ENT clinic with vertigo and/or dizziness between 2015 and 2020 were systematically enrolled and followed. The present study represents a retrospective revision of a previously published cohort of 257 children. In 2025, extended follow-up data were reviewed to reassess etiological classification using the same diagnostic categories as in the original analysis. Descriptive statistics were applied to compare etiological distributions at initial evaluation and after follow-up revision. Results: After data revision, the proportion of children with unclassified etiology decreased from 44% to 10%. Central etiologies accounted for 35% of cases, peripheral vestibular disorders for 18%, hemodynamic causes for 16%, psychogenic etiologies for 10%, and other specific causes for 7%. Follow-up duration ranged from 0 to 132 months (mean 17.6 months; median 4.5 months). Diagnostic investigations were frequently performed; however, the etiological yield of certain tests, particularly cranial computed tomography, was low. Conclusions: Extended follow-up significantly improves etiological classification in children with vertigo and dizziness, demonstrating that diagnostic uncertainty at initial presentation often reflects evolving clinical phenotypes rather than the absence of an underlying disorder. A longitudinal, clinically guided, and multidisciplinary approach is essential to enhance diagnostic accuracy and optimize the use of diagnostic investigations in pediatric vertigo.

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