Balance Disorders

Overview

What Is a Balance Disorder?

Our brain, ears, eyes, and skeletal system work together to help us stay steady and upright. If any of them don’t work together properly, it can cause a problem with balance. When there's a problem with balance and equilibrium, it's called a balance disorder.

There are many different types of balance disorders. They can cause dizziness, vertigo (a spinning sensation), and other symptoms that affect a child's daily life and ability to reach growth or learning milestones.

Top Things to Know

• Balance disorders are when there’s a problem with a person’s balance and equilibrium.
• Symptoms include dizziness, loss of balance, nausea, vomiting, or clumsiness while walking, biking, or playing (or a delay in doing these activities).
• Certain conditions can increase the risk of balance problems, including autism spectrum disorder, cerebral palsy, hearing loss, inner ear infections, and head injuries.
• Early diagnosis and treatment are important for addressing a balance problem and related developmental delays. Call your doctor if you are concerned.

What Are the Types of Balance Disorders?

Balance disorders that can affect kids and teens include:

• Benign paroxysmal torticollis of infancy, which usually starts during a child's first 6 months. Kids with this condition tend to keep their heads tilted from feeling so dizzy.
• Benign paroxysmal vertigo of childhood (BPVC), in which vertigo comes on suddenly. Kids may briefly seem unsteady. Doctors will check for other neurologic causes, such as seizures, before making this diagnosis. Episodes are brief and stop on their own. Some kids with BPVC are more likely to have migraines when they are older.
• Benign paroxysmal positional vertigo (BPPV), which happens when small crystals (called otoconia) become displaced and move throughout the semicircular canals in the inner ear. This is rare in kids, but can be seen after head trauma, like a concussion. Kids with BPPV will often report a spinning sensation for a few seconds to minutes with position changes, such as when they turn quickly or roll over in bed.
• Vestibular neuritis, which is caused by a viral infection. The infection causes inflammation of the vestibular nerve. The vestibular nerve sends information about balance from the inner ear to the brainstem. Symptoms can be severe for a few days before slowly getting better over a couple of weeks. Physical therapy may be necessary to help with the recovery.
• Labyrinthitis, which is vestibular neuritis with hearing loss. It is caused by a viral or bacterial infection in the inner ear.
• Post-concussion syndrome, which is when someone still has concussion symptoms (such as dizziness) long after the injury.
• Vestibular migraine, which is when a migraine happens along with vertigo, dizziness, and/or imbalance.

Less often, kids and teens might have:

• Perilymph fistula (PLF), a defect in the connection between the inner ear and middle ear. This can happen after head trauma and may cause both hearing loss and balance symptoms.
• Semicircular canal dehiscence, a defect in one of the balance organs that tells us when we are spinning. This can make someone feel dizzy after hearing loud sounds.
• Meniere's disease, an inner ear problem that can cause vertigo, ear fullness, and fluctuating hearing loss. It's more common in adults than kids and teens.

Signs & Symptoms

What Are the Signs & Symptoms of a Balance Disorder?

Some kids and teens may only have mild signs that are barely noticed while other kids may have more serious symptoms. Very young kids might not be able to describe how they feel. Older kids and teens may complain of feeling dizzy, lightheaded, or disoriented.

Kids and teens with balance disorders might:

• feel like they are unsteady or "woozy" and find it hard to stand up, walk, turn corners, or climb stairs without falling, bumping into things, stumbling, or tripping
• walk with their legs far apart or not be able to walk without holding on to something, especially in the dark or on uneven surfaces
• have the feeling that they, or the things around them, are moving, spinning, or sliding, which is called vertigo

Other signs can include:

• nausea, vomiting, and/or stomach pain
• motion intolerance (car sickness) or frequent falls
• involuntary eye movements or vision problems
• headaches, or migraines
• delayed development
• tiredness and feeling unwell
• depression, fear, anxiety, or panic

People with balance disorders may also have hearing loss or other hearing problems. Sounds might seem muffled, especially when there’s background noise. Kids might also have ear pain, pressure, or "fullness" in the ears, and tinnitus (ringing or other sounds like whirring, humming, or buzzing in the ears).

How Learning May Be Affected

At 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 on the board, screen, or assignments. Balance issues also can make gym class or sports hard for them.

Kids and teens might get frustrated because they feel like they can’t do some things they want or need to do.

When Should I Call the Doctor?

Dizziness and clumsiness can be signs of a balance disorder but also can be caused by many other things. For example, kids can feel woozy if they're dehydrated or they stand up too fast. And lots of kids stumble and fall sometimes, especially toddlers and preschoolers.

But if one or more signs of a balance disorder happen regularly, check in with your doctor to find out what's going on. Diagnosing and treating balance disorders early can help kids become steadier and more coordinated, do the things they like, and feel better.

Causes & Prevention

What Causes Balance Disorders?

Doctors can't always find the exact cause of a balance problem. But symptoms may be brought on by things such as:

• ear, head, or neck injuries
• ototoxicity (medicines that harm the ear) or hearing loss
• migraines
• middle ear infections (otitis media) or cholesteatoma
• other infections (like herpesvirus, chickenpox, colds, the flu, meningitis, measles, mumps, or rubella)
• motion sickness or seizures

If hearing or vestibular (balance) problems, migraines, or motion sickness run in families, children are more likely to get balance disorders.

Can Balance Disorders Be Prevented?

Balance disorders can’t typically be prevented, especially if they run in the family. But there are steps you can take to help protect your child and reduce risks.

• Stay active. Regular exercise can help improve balance and coordination.
• Play fun activities. Swinging and spinning can help your child's balance.
• Eat well. Serve healthy foods with a well-balanced diet.
• Prevent head injuries. Make sure your child wears safety gear like bike helmets.
• Watch for ear problems. If your child pulls on the ear or says it hurts, contact your doctor.
• Make your home safe. Reduce the risk of injuries by creating a safe environment. For example, remove clutter from walkways. 

How Are Balance Disorders Diagnosed?

To look for a balance problem, your doctor will ask about symptoms and do an exam, including watching your child walk, checking for balance, and testing motor skills. Your doctor will also ask about your child’s family medical history.

Your child might be referred to an audiologist (a hearing and balance specialist), an otolaryngologist (an ear, nose, and throat specialist, or ENT), a physical therapist, and/or a neurologist (a brain and nervous system specialist) for more testing.

Exams given to look for a problem may include:

• imaging tests, like an MRI or a CT scan
• hearing tests to check hearing sensitivity and middle ear functioning
• electronystagmograms (ENG) to assess balance using electrodes placed around the eyes while a computer monitors involuntary eye movements
• videonystagmography (VNG), which measures eye movement while a child focuses on various targets while wearing special video recording goggles
• vestibular evoked myogenic potential (VEMP), which uses electrodes on the head and neck to measure muscle contractions (cervical) and eye movements (ocular) in response to loud clicks
• video head impulse test (vHIT), which uses special goggles to check parts of the inner ear as the head is moved in different directions
• rotary chair testing, which uses goggles and a special chair to assess vestibular function for differences between the two ears
• posturography, which measures the ability to balance while standing on a stable or unstable platform
• balance questionnaires for kids who can describe their level of dizziness throughout the day while doing different things

Treatment & Home Care

How Are Balance Disorders Treated?

Some types of balance disorders get better on their own. For others, symptoms may come and go or continue for weeks, months, or longer.

Depending on the cause, medicine or surgery could help some children. Targeted physical therapy can help enhance coordination and strength.

Balance training (also called vestibular rehabilitation or therapy) with a physical therapist or vestibular therapist may include exercises that help strengthen legs and core muscles. It can help kids improve balance and coordination and manage their symptoms.

Treating hearing loss may also help improve balance.

Balance issues play a role in health and well-being, so if you have any concerns about your child’s balance, hearing, developmental milestones, or ear health, contact your doctor right away.