TürkçeBalance loss in children may result from inner ear disorders, neurological problems, or visual impairments. Detecting it at an early stage is extremely important for preventing permanent problems.
Symptoms of balance loss include frequent falls, difficulty walking, dizziness, and coordination problems. Sudden changes in the child’s movements should be carefully observed.
A detailed ear examination, balance tests, and imaging methods when necessary are used in diagnosis. Once the underlying cause is identified, a treatment plan is prepared.
Vestibular rehabilitation exercises, correction of visual impairments, and appropriate medication treatments may be used. Regular medical follow-up is essential for the child’s healthy development.
How Are Hearing Loss and Balance Problems Connected?
The relationship between hearing loss and balance problems results from the fact that both are directly connected to systems located in the inner ear. The vestibular system consists of mechanisms that maintain body balance and regulate spatial orientation. This system detects the angular and linear movements of the head and transmits information about position and movement to the central nervous system. The structures in the inner ear include:
- Semicircular canals: Detect the angular movements of the head. Each ear contains three semicircular canals representing three planes. These canals correspond to one another in the right and left ears and are specialized organs that measure the child’s orientation in space and the angular movements of the head.
- Otolith organs (Utricle and saccule): Determine the body’s position relative to gravity and are responsible for the linear movements of the head. They function like accelerometers. The cochlea is responsible for hearing. It enables sound to be transmitted to the brain through the auditory nerve. It is the region where neural firing first occurs.
Because the ear is both a hearing and balance organ, any damage or problem occurring in the inner ear may affect both the hearing and balance systems. Vestibular dysfunction is particularly common in children with sensorineural hearing loss. This type of hearing loss may result from congenital disorders or infections and generally also damages the vestibular structures. This condition presents with the following symptoms:
- Delayed motor development
- Imbalance
- Frequent falls
- Dizziness
Children with vestibular dysfunction have difficulty coordinating their movements. Their clumsiness is significantly greater than that of other children. The brain cannot receive the information required to adjust posture in response to gravity and movement. In addition, when impaired vestibular signals are combined with hearing loss, the child’s environmental awareness and navigation skills decrease, and the brain’s ability to use visual or proprioceptive cues becomes limited.
How Common Are Balance Problems in Children with Hearing Impairment?
Balance problems are quite common among children with hearing impairment, particularly those with sensorineural hearing loss (SNHL). Due to the anatomical structure of the inner ear, SNHL may often also be associated with vestibular dysfunction. Therefore, children with hearing loss should be examined very thoroughly, because this condition may cause balance disorders and delays in motor development.
- Rates of vestibular dysfunction among children with hearing loss range from 20% to 70%.
- In children with severe hearing loss, this rate increases to between 35% and 70%.
- Balance problems have been reported less frequently in children with mild hearing loss.
Vestibular dysfunction may cause problems such as difficulty walking, delayed motor skills, and postural instability. This condition may particularly delay motor developmental milestones such as independent walking. Balance disorders in children with hearing loss are not diagnosed adequately worldwide, and this issue is recognized in various regions. Regional studies emphasize the importance of early intervention and the need for early screening of vestibular functions. The potential effects on the vestibular system should be taken into consideration, particularly in children who receive cochlear implants.
Which Diagnostic Tools Are Used to Detect Balance Loss in Children?
Various diagnostic tools are used to detect balance loss in children. These tools identify balance disorders and enable appropriate interventions to be provided.
Videonystagmography (VNG) Test
Videonystagmography (VNG) is the general name given to the device and tests used to investigate the etiology of dizziness by recording eye movements through special goggles equipped with infrared cameras.
Tests performed with VNG are used to distinguish whether dizziness and balance disorders are peripheral or central in origin. In peripheral disorders, they are used to diagnose the specific condition, determine whether vestibular hypofunction is present, and identify whether the vestibular hypofunction is unilateral or bilateral. VNG tests may be grouped as oculomotor tests, static positional tests, dynamic positional tests, and specific diagnostic tests.
VNG prioritizes patient comfort, is painless, and is a non-invasive method that does not disrupt the integrity of the body. Considering its testing techniques and technologies, it is both a reliable and comfortable method for the patient.
v-HIT (Video Head Impulse Test): This is a highly rapid test with strong diagnostic value that allows the individual function of the semicircular canals in the inner ear to be evaluated. v-HIT provides an objective assessment of vestibulo-ocular reflex (VOR) function in response to head movements.
Standardized Inventories
The Pediatric Balance Scale is a scale used to evaluate children’s balance abilities. This scale includes 14 different tasks, each of which tests the child’s balance control under different sensory conditions. The tasks include standing, sitting, and various movement transfers. The child’s performance in each task is carefully examined and scored.
The Modified Clinical Test of Sensory Interaction on Balance evaluates four different conditions:
- Standing on a firm surface with the eyes open
- Standing on a firm surface with the eyes closed
- Standing on a soft foam surface with the eyes open
- Standing on a foam surface with the eyes closed
This test helps determine which sensory systems influence the child’s balance. The functionality of the visual, vestibular, and somatosensory systems is evaluated through this test.
- Romberg Test evaluates the child’s ability to stand with the eyes open and closed. This test assesses the functioning of the vestibular and proprioceptive systems and reveals signs of balance loss.
- Tandem Walking Test (Gait) evaluates whether the child can walk properly along a straight line. During this test, the child’s dynamic balance abilities and visual-vestibular coordination are assessed.
What Happens If Balance Loss in Children Is Left Untreated?
Untreated balance loss in children may lead to many difficulties. Its effects on motor skill development may negatively affect the child’s daily life and long-term health. Balance problems are primarily associated with delays in motor skills, causing a lack of coordination in basic activities such as walking and running. Children’s writing and fine motor skills may also be negatively affected.
- Delayed motor development: It may cause persistent motor difficulties such as developmental coordination disorder, which affects approximately 6% of children.
- Increased risk of falls and injuries: The increased risk of falling during physical activities may lead to injuries and musculoskeletal problems in children.
- Academic difficulties: Difficulty in academic activities requiring coordination, such as writing and drawing, may cause learning problems. This may affect the child’s classroom performance and concentration.
- Social and emotional difficulties: Exclusion from social activities may cause low self-esteem and social withdrawal in children. In the long term, this may lead to psychological effects such as anxiety and behavioral problems.
Frequently Asked Questions
Balance loss in children may be recognized through frequent falls, stumbling while running, difficulty climbing stairs, and coordination problems. Early audiological assessment and appropriate treatment may help support balance development.
Inner ear disorders, infections, vestibular migraine, visual problems, and certain neurological diseases may cause balance loss in children. The underlying cause must be investigated in detail to provide appropriate treatment.
Hearing and balance tests performed by an audiologist allow the vestibular system to be evaluated. Early diagnosis enables a rehabilitation program appropriate for the child’s age and needs to be planned.
Depending on the child’s age and complaints, hearing tests, VEMP, v-HIT, posturography, and other vestibular assessments may be performed. The selection of tests is determined by the specialist according to the clinical findings.
Vestibular rehabilitation consists of specialized exercises designed to improve balance and coordination. When the program prepared by the audiologist is performed regularly, it may contribute to the development of the child’s movement skills and daily activities.
If balance loss is accompanied by sudden hearing loss, altered consciousness, severe headache, vomiting, seizures, or an inability to walk, emergency medical evaluation should be obtained without delay.
Children with balance disorders may experience distractibility, reduced participation in physical activities, and coordination difficulties. Early diagnosis and appropriate rehabilitation may positively support academic and social development.
Creating safe play areas, ensuring that the recommended balance exercises are performed regularly, and encouraging the child’s physical activities may support the treatment process. Exercises must be performed in accordance with the audiologist’s recommendations.
The duration of treatment may vary according to the cause of the balance loss, the child’s age, and adherence to rehabilitation. Regular follow-up and a personalized exercise program may contribute to a more successful recovery process.
In many children, balance problems may improve significantly with early diagnosis, appropriate treatment, and regular vestibular rehabilitation. Success depends on treating the underlying condition and adhering consistently to the rehabilitation program.
Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.
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