|SSM Cardinal Glennon Children's Medical Center|
When you think about balance, the role that ears play might not come to mind. But ears are crucial to maintaining balance thanks to their vestibulocochlear nerve. This nerve sends signals to the brain that control hearing (auditory function) and help with balance (vestibular function).
But the ears aren't the only organs that help us balance. Ears, eyes, joints, and muscles work together to keep us steady and upright. When one or more of these systems is out of whack, it can be hard to get around and just function, day to day. The simplest things — like walking, riding a bike, succeeding in school, even playing — can become difficult and frustrating.
Balance disorders are considered uncommon in kids but might be underestimated — kids' symptoms could be misdiagnosed as something else or missed altogether. But resolving kids' balance problems can make a big improvement in their overall quality of life — their ability to play, learn, and feel as happy and healthy as possible.
How Balance Works
To understand balance problems, it's important to understand how balance works normally. Basically, the body relies on three separate systems, each sending nerve impulses to the brain:
If any of these systems isn't working right, it can affect balance.
Depending on the type of balance disorder and what's causing it, symptoms can vary from child to child. Some kids may experience severe symptoms, making it hard for them to function. Others might only have mild symptoms that are barely noticed.
In general, though, kids with balance disorders have symptoms of disequilibrium — an unsteady, "woozy" feeling that makes it hard to stand up, walk, turn corners, or climb the stairs without falling, bumping into things, stumbling, or tripping.
They also might walk with their legs too far apart or be unable to walk without staggering. Walking in the dark or over uneven surfaces can be tricky, too. All of this can make them seem uncoordinated and clumsy.
Another common symptom of a balance problem is vertigo. Most people think of this as a sudden sensation that the room is spinning or whirling or that you're moving when sitting or standing still. But kids may describe it as feeling like they're rocking, floating, or "on a merry-go-round." Kids also might feel dizzy, lightheaded, or disoriented.
Balance disorders can cause vision problems, too. Kids may see images that bounce or look blurry whenever they move their heads. This is called oscillopsia, which can make reading and writing really tough.
Symptoms also can include:
Balance issues also can impact hearing. Sounds might seem muffled, especially amid background noise. Kids might also have bothersome, distracting ear problems like ear pain, pressure or "fullness"in the ears, and tinnitus (ringing or other sounds like whirring, humming, or buzzing).
These kinds of balance-related symptoms can take a real toll on kids — physically and emotionally — and cause other symptoms like:
Of course, symptoms involving kids' movement, sight, hearing — and just how they feel, day to day — can affect their ability to keep up in class, whether in preschool or high school. Balance problems can make it hard to remember things, concentrate, pay attention, and follow directions. Kids might not be able to hear the teacher or focus their eyes on the chalkboard or their books. And they might become frustrated in gym class and with sports.
Some kids with balance disorders might seem like they're being lazy or not paying attention or trying in school. Probably the most aggravating part for them is feeling like they're trying their very best but being unable to do some things they want or need to do — and not knowing why.
Types of Balance Disorders
Although balance disorders aren't common in kids (again, probably because they're so hard to catch), the most frequently diagnosed vestibular conditions are:
Other conditions are far less common; for example, perilymph fistula (PLF) is an abnormality (often a tear or defect) in the connections between the inner ear and middle ear that may cause vertigo, unsteadiness, hearing loss, and ear pressure. And an inner ear disorder called Meniere's disease can bring on tinnitus, hearing loss, ear fullness, and lengthy episodes of vertigo that may last anywhere from 30 minutes to an hour or longer.
Doctors can't always pinpoint the cause of a balance problem. But balance-related symptoms may be brought on by any number of things, such as:
Children who have a family history of hearing or vestibular problems, dizziness, or motion sickness might be more prone to balance disorders, too.
Detecting and diagnosing balance disorders in kids can be tricky. Unfortunately, kids with many common balance problems may be so young that they can't describe how they're feeling or respond to certain tests. And to parents, they might just seem clumsy and fussy.
If you think your child might be having balance problems, call your doctor, who will do a physical exam and look at your child's symptoms and medical history. If the doctor thinks that your child's balance is affected, you might be referred to an audiologist (a hearing specialist), an otolaryngologist (an ear, nose, and throat specialist, or ENT), and/or a neurolotologist (a specialist in ear disorders).
Tests can include:
Kids can just outgrow some balance disorders. For example, both BPV of childhood and benign paroxysmal torticollis of infancy usually go away, without treatment, by the time a child is 5 years old. And vestibular neuronitis and labyrinthitis often disappear on their own, too.
Still, doctors can help manage kids' symptoms and make their lives a little easier with rehabilitation and sometimes medicine or surgery.
Balance therapy (also called vestibular rehabilitation) with a physical or vestibular therapist may include training exercises that help strengthen balance skills and coordination. Exercises might involve things like bending down, standing or walking with eyes open and then with eyes closed, swimming, or walking barefoot on various uneven surfaces. Kids often do very well with vestibular therapy because they're better able to adapt to balance problems than adults.
For kids with BPV of childhood, a therapist can sometimes relieve vertigo and dizziness by gently repositioning the head at different angles to move fluid or the tiny particles floating around in the inner ear (this is known as the canalinth repositioning or Epley maneuver).
And kids with significant hearing loss that's affecting their balance may need one or more of the following:
When to See a Doctor
It's important to remember that although things like dizziness and clumsiness are common signs of a balance disorder, on their own these symptoms aren't necessarily a sign of a balance problem — or any other chronic problem, for that matter. For example, it's perfectly normal for kids to feel woozy if they're dehydrated or they stand up too fast. And lots of kids stumble and fall sometimes, especially toddlers just learning to walk and preschoolers getting used to how their bodies move.
However, if you're seeing a pattern — if you notice one or more possibly balance-related symptoms happening regularly — it's a good idea to call your doctor to find out what's going on. Diagnosing and treating balance disorders can help kids develop more normally, become more steady and coordinated, and just function and feel better physically and emotionally.
Reviewed by: Robert C. O'Reilly, MD