Balance Disorders

Our brain, ears, eyes, joints, and muscles work together to help us stay steady and upright. If any of them don’t work properly, it can cause a problem with balance.

Balance disorders can happen in people of all ages, and symptoms may be missed or blamed on other causes. Kids and teens with balance problems might seem clumsy or uncoordinated. They may have trouble walking, riding a bike, doing schoolwork, or playing.

What Are the Signs & Symptoms of a Balance Disorder?

Some kids and teens may only have mild signs that are barely noticed while others 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.

In general, kids and teens with balance disorders might:

• have problems with equilibrium, like 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
• walk with their legs far apart or not be able to walk without staggering or holding on to something. Walking in the dark or over uneven surfaces can be tricky too.
• have vertigo. Vertigo is a feeling like you or the things around you are moving. Kids may describe it as spinning, swinging, sliding, or feeling like they are on a merry-go-round.

Other signs can include:

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

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).

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're trying their best but can’t do some things they want or need to do, and they don’t know why.

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 scared and 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 may have migraines in the future.
• benign paroxysmal positional vertigo (BPPV), which happens when small crystals (called otoconia) become displaced and move throughout the semicircular canals in the inner ear. 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 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.
• labyrinthitis 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.

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

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

How Are Balance Disorders Diagnosed?

To look for a balance problem, the doctor will ask about symptoms and do an exam, including watching a child walk, checking their balance, and testing their motor skills. They’ll also ask about the child’s and the family’s medical histories.

The doctor might want the child to see 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).

Tests done to look for a problem can include:

• imaging tests, like an MRI or a CT scan
• hearing tests to check hearing sensitivity and middle ear functioning
• electronystagmogram (ENG) to assess balance using electrodes placed around the eyes while a computer monitors involuntary eye movements
• videonystagmography (VNG), in which the child wears special video recording goggles to measure eye movement while they focus on various targets
• 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

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 may help some children. Physical therapy and balance training may also help kids manage their symptoms.

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, and improve balance and coordination.

Treating hearing loss may also help improve balance.

When Should I Call the Doctor?

Dizziness and clumsiness can be signs 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 just learning to walk and preschoolers who are getting used to how their bodies move.

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.