Did you know balance can be tested by an audiologist?

An audiologist is a healthcare professional who tests children’s hearing and selects and fits them for devices that help individuals with hearing loss (assistive technology). Some audiologists, including ours here at Children’s Hospital of Philadelphia (CHOP), are experts at evaluating a part of the inner ear that contributes to balance in children called the vestibular system.

What is the vestibular system and how is it related to hearing?

The vestibular system is a set of organs and nerves inside the inner ear that helps your child maintain balance and awareness of where their body is in their space (spatial awareness). It is near to the structures of the inner ear that are responsible for hearing. 

Some children may have trouble with their balance, but vestibular differences are more common in children with hearing loss. Some common causes of vestibular differences in children with hearing loss include: 

• Congenital cytomegalovirus (cCMV)
• A difference in the inner ear structure that affects balance and hearing (enlarged vestibular aqueduct syndrome or EVA)
• An infection that can impact the brain and inner ear (meningitis)
• Differences in the inner ear structure can make it harder for a child to stay steady, move safely, or know where their body is in space (abnormal vestibular anatomy)

What happens during a vestibular evaluation?

If your child needs to have their balance system tested (vestibular evaluation), it may include tests like:

• Hearing Evaluation: If your child has not had a hearing test in the last six months, we may complete a hearing evaluation before vestibular testing to determine their hearing sensitivity.
• Video Head Impulse (vHIT): For this type of test, your child will wear goggles that look like swimming goggles. These goggles hold a camera in place that is used to record eye movements. Your child will be asked to keep their eyes on an object in front of them while their head is moved quickly in different directions.
• Vestibular Evoked Myogenic Potentials (VEMP): We will place small sticker sensors on your child's face and/or neck, then ask them to hold their head and eyes in various positions. We complete this test by recording and measuring vestibular responses as sounds are played through headphones.
• Rotational Chair Testing: For this type of test, your child will wear goggles that look like a scuba mask. These goggles hold a camera in place that is used to record eye movements. Your child will sit in a chair that gently turns. The chair may be in a dark enclosed booth or in an open room with a goggles cap to cover their eyes. We may ask that small children be seated in a car seat or booster seat.
• Videonystagmography (VNG): We will ask your child to follow characters or items on a TV screen with their eyes, while still wearing goggles and holding their head still. We may need to move them or place their head in varying positions. During the final part of VNG testing, we may put warm and cool water or air into your child’s ears to stimulate their inner ear.

Does my child need a vestibular evaluation?

Your child may benefit from vestibular evaluation if they experience any of the following symptoms:

• Delayed motor milestones (like sitting or walking late)
• Imbalance
• Vertigo (dizziness)
• Frequent falls

We highly recommend vestibular evaluation for children with the following medical conditions:

• Congenital cytomegalovirus (cCMV)
• Severe to profound sensorineural hearing loss
• Cochlear implant
• Vestibular neuritis/labyrinthitis
• Syndromes associated with hearing loss and vestibular differences, such as:
  • A rare genetic condition that can affect hearing, balance and other parts of the body called CHARGE 
  • Neurofibromatosis type 2 (NF2)
• Enlarged vestibular aqueduct (EVA)
• Balance and vestibular disorders