Stories about: Otolaryngology and Communication Enhancement

Clinical Consult: Dizziness, vertigo and balance disorders

dizziness vertigo vestibular disorders

Imagine that you wake up one morning and the world around you is spinning rapidly as if you were on a merry-go-round. You try to walk but the floor seems to be moving and you fall to the ground. You begin to feel nauseous. You lie down hoping the feeling will disappear, but it does not.

It can be a terrifying experience for a child to experience dizziness. Moreover, it can often be very difficult for them to articulate to their parents and doctors exactly what they are experiencing.

Most pediatric health care providers do not learn about the evaluation and management of dizziness in children during the course of their training. A child complaining of dizziness may appear normal and may not have any obvious abnormalities on physical exam, but the differential diagnosis of dizziness in children is expansive, ranging anywhere from simple dehydration to a vestibular or balance disorder to a brain tumor. For these reasons, the evaluation of a child with dizziness can often be an intimidating and time-consuming task. …Read More

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A poor man’s test for vestibular dysfunction

Jacob Brodsky iPhone bucket vestibular dysfunction dizziness

Dizziness is a definite challenge to evaluate in children. “One of the toughest things to figure out is, is it a problem with the vestibular system, or is it part of something else, a heart problem or an eye problem?” says Jacob Brodsky, MD, director of the Balance and Vestibular Program at Boston Children’s Hospital. “Then, the next challenge is determining whether it is an inner ear problem or a problem with the brain.”

A definitive answer often requires fancy equipment that generally isn’t available at pediatric centers. But with an ordinary bucket, an iPhone, an $18 app and some Velcro, Brodsky can quickly get a good indication of whether a child has a vestibular disorder — and specifically an inner ear problem.

The test is quick and simple: patients put their face in the bucket and turn it to “straighten” a vertical line displayed on an iPhone (affixed to the bottom of the bucket). The iPhone then calculates the patient’s subjective visual vertical (SVV), a measure of vestibular function. Brodsky hopes to see pediatricians, neurologists and otolaryngologists adopt this approach to do office-based testing.

Read more the iPhone + bucket test for vestibular dysfunction on our sister blog, Vector.

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Clinical Consult: Tonsils and Adenoids

tonsils adenoids sore throat adenotonsillectomy
(Ilya Andriyanov/Shutterstock)

It’s a common scenario in every pediatrician’s office: A mother brings in her otherwise healthy 7-year-old for a well visit, and you look in the mouth and see markedly enlarged tonsils. Does the child snore? Yes. Does the child mouth breathe? Yes. Does the child experience respiratory pauses? Not sure. But over the last year there have been two episodes of strep-positive tonsillitis, with a few days of missed school. …Read More

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Improving communications with referring providers

referring provider access

As part of an ongoing effort to improve the way we collaborate and communicate with referring providers, Norman Dean, director of Boston Children’s Hospital’s Department Otolaryngology and Communication Enhancement—along with chief marketing and communications officer Margaret Coughlin and medical director of integrated care and strategic partnerships Richard Antonelli, MD, MS—is leading an initiative to enhance accurate, timely identification and communications with primary care and subspecialist referring providers.

The principal goal of this project is to accurately identify the names of all referring primary care providers and subspecialty providers, key members of every patient’s care team. …Read More

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