Persistent postural perceptual dizziness (PPPD) in pediatric patients after COVID-19 infection

Abstract

Background: Patients with long-COVID suffer from symptoms that continue or develop after a COVID-19 or SARS-CoV-2 infection and are present for four or more weeks after the initial infection. This case series describes a group of previously healthy adolescent patients with long-COVID who were seen in a pediatric vestibular clinic for evaluation of severe dizziness and were diagnosed with persistent postural-perceptual dizziness (PPPD). By presenting their symptoms, management and treatment effects, this study aims to provide a diagnostic and therapeutic framework for providers who encounter these patients.

Methods: Patient records were reviewed for past medical history, symptoms, physical exam findings, results of audiometric and vestibular testing, dizziness handicap inventory for patient caregiver (DHI-pc) scores, and treatment recommendations. Parents of patients were contacted for a follow up survey to assess treatment adherence and outcomes including changes in symptoms and return to activity.

Results: A series of 9 adolescent patients were referred from a multidisciplinary long-COVID clinic and diagnosed with PPPD. Recommended treatment included vestibular physical therapy, selective serotonin reuptake inhibitor medication, and cognitive behavioral therapy. The majority of patients experienced an improvement in their symptoms, and all patients had improved activity levels and DHI-pc scores after treatment.

Conclusion: To the best of our knowledge, no previous reports exist discussing PPPD in long-COVID patients. This case series provides insight into symptom evolution and treatment efficacy in this patient population.

Keywords: Adolescent; Long-COVID; Persistent postural-perceptual dizziness; Treatment efficacy.

Fig. 1.

DHI-pc scores. DHI-pc scores are displayed on the Y-axis for three groups (X-axis): patients with PPPD plus long-COVID pre-treatment (closed circle), PPPD plus long-COVID post-treatment (open circle) and for patients seen in a pediatric vestibular clinic with diagnoses other than PPPD, including BPPV, vestibular hypofunction, recurrent vertigo of childhood and other diagnoses (closed square). The symbols represent average DHI-pc scores and the error bars indicate 95 % confidence intervals for the groups listed on the X-axis.

Fig. 2.

Display of percentage of patients who reported a change (Y-axis) in symptoms listed on the X-axis. White bars represent patients who reported improvement in symptoms, black bars represent patients who reported worsening of symptoms, dark grey bars represent patients who reported stable symptoms, and light grey bars represent the proportion of patients who never experienced this symptom.