Understanding the balance system

The inner ear plays a key role in helping the body keep its balance. The balance (vestibular) system is located in your inner ears. It senses head and body position and motion. It also works with other parts of the body, such as the eyes and sensors in the muscles and joints in the body.

The body relies on the inner ear for balance signals. Signals from the inner ear, the eyes, and the sensors in the muscles and joints are sent to the brain. This information is used to adjust your muscles, joints, and eyes to keep your balance and vision steady and help the body stay balanced. The balance system is fully mature by the time a child is 6 years old.

A problem in the inner ear can lead to vertigo.

What causes vertigo?

The exact cause of vertigo is not always known. But if there's a problem with the balance system, the brain may not receive enough information for the balance system to work normally. This can lead to vertigo.

Here are the most common causes of inner ear problems in children:

• Things that cause congestion (such as colds, allergies, or sinus infection). This leads to fluid backup through the Eustachian tube, which links the ear to the upper throat and the back of the nasal cavity.

• Glue ear. This happens when the empty middle part of the ear canal fills up with fluid. Your child may complain of ear pain or fullness or pressure in the ears.

• Labyrinthitis. This condition is caused by a viral infection of the labyrinth (a part of the inner ear). It causes dizziness along with other ear-related symptoms, such as hearing loss and tinnitus (noises in the ear).

• Vestibular neuritis. This is inflammation of the vestibular nerve, the nerve in the inner ear that sends messages to the brain. It can cause dizziness. It often goes away over a few weeks.

• Closed head injury. Sometimes children can directly damage their inner ear structures when getting a head injury. This can cause vertigo. Sometimes the inner ear isn't damaged, but a child has a concussion after a head injury. That can cause symptoms like dizziness or vertigo.

• Ménière disease. This happens when the body makes an abnormal amount of fluid in the inner ear. It leads to episodes of vertigo linked with ringing in the ears and hearing loss. It isn't common. But it can occur in children.

• Benign paroxysmal vertigo of childhood. Symptoms include the sudden sensation of spinning, loss of balance, nausea and vomiting, abnormal eye movements, and trouble with balance. Your child may suddenly fall or cling to a person or reach for something for support. Your child may be sensitive to movement, sound, or light. These episodes may occur several times a month for several years. They often go away by age 8.

• Basilar artery migraine. This type of migraine can cause both headache and vertigo. The symptoms of vertigo often go away when the headache does. Your child may describe seeing patterns or flashing lights in their vision.

• Vestibular migraine. It can cause vertigo without a headache. It can last for seconds to days.

• Ototoxicity. Certain medicines (like some antibiotics such as gentamicin and inhaled tobramycin) or chemicals (such as lead, carbon monoxide, mercury, and carbon disulfide) can damage the balance structures in the ear. This can cause vertigo and balance problems. In rare cases, it may also cause loss of hearing.

Vertigo can also be a result of certain vision problems.

How is vertigo diagnosed?

The health care provider will ask about your child’s overall health and symptoms, such as:

• When your child’s symptoms started, how long they lasted, and how often they occurred.

• The potential triggers you may have noticed, like bright lights, loud noise, or flickering lights.

• Any previous history of ear problems, or other systemic infections.

• The medicines your child has taken.

• History of head trauma or a penetrating injury of the ear.

• Any learning or behavioral problems at home or school or on the playground.

This is the main way that vertigo is diagnosed. Your child will also be examined, especially their head and ears. A quick test of your child's vision may also be done. There isn’t a specific test to diagnose vertigo. In some cases, tests like an MRI or a CT scan of the brain may be done to rule out other health problems.

How is vertigo treated?

Often, vertigo will go away on its own without treatment. Treatment is focused on stopping the things that trigger vertigo. If vertigo is caused by an inner ear problem, the health care provider may prescribe medicines as needed. They can help your child’s balance system get back to normal. The most common medicines are:

• Antihistamines to treat inner ear problems.

• Motion sickness medicine (if needed).

• Antibiotics, antivirals, or steroids if it may be an ear infection.

Treatment may include vestibular rehabilitation. This is a type of physical therapy that includes special exercises to improve balance. Your child may be advised to avoid sudden movements or abrupt position and posture changes. Slow movements are preferred. Help your child avoid all known and suspected triggers.

Until vertigo is gone, have your child avoid activities that require balance or coordination. This includes:

• Gymnastics.

• Dancing.

• Skateboarding.

• Riding a bike or scooter.

• Roller skating.

• Driving.

• Hiking and climbing.

When to call the doctor

Call your child’s health care provider right away if your child has:

• Repeated or longer-than-usual episodes of vertigo.

• Severe vertigo. (Your child can't move.)

• Vertigo along with another problem, such as ear ringing, ear pain, headache, ear stuffiness, or hearing loss.

• Confusion or a change in behavior.

• New or abnormal symptoms that concern you.