Maturation of Subjective Visual Vertical in Children

Objective: The attraction of the subjective visual vertical (SVV) to the side of initial rod presentation has already been described in adults. The aim of this study was to evaluate this phenomenon in children and to analyze the effect of sex and maturation in this population. Study Design: Retrospective cross-sectional study. Setting: Tertiary referral center. Patients: Six hundred and one individuals aged between 4 and 19 years. Intervention: All subjects underwent a complete balance workup. SVV was measured by presenting a laser line 12 times in total darkness with a 45 degrees deviation from the vertical alternatively on the left and the right. The patient was seated and asked to replace the bar vertically with a remote control. Results: On average, SVV was tilted to the side of the rod presentation at each iteration. The cumulative tilt to the side of presentation after 12 measures was higher in the 4 to 7 years age group and decreased progressively with age (25 +/- 2.2 degrees in 4-7 years, n = 109 versus 5 +/- 1.4 in 15-19 years, n = 204, p < 0.001, analysis of variance [ANOVA]). The cumulative tilt was higher in girls than in boys in the 15 to 19 years group (8 +/- 2.5 degrees, n = 104 versus 2 +/- 1.2, n = 100, respectively, p < 0.001, ANOVA). This phenomenon appeared independent from the type of vestibular disorder. Conclusion: Young children are highly attracted to the side of rod presentation during SVV measurements. This phenomenon gradually disappears with maturation, faster in boys than in girls.