Vertigo (Dizziness)

What is vertigo (dizziness)?

Vertigo can be either a sensation of spinning, like the dizzy feeling your child gets after the merry-go-round, or it can be a perception that the world around him is spinning or tilting.

Occasionally, a child can experience vertigo when congestion from a cold or an ear infection presses on his inner ear, which is part of the vestibular system that affects balance. But when a child experiences repeated or prolonged bouts of vertigo, it usually happens in conjunction with other illnesses or conditions.

Overall, vertigo is far less common in children than it is in adults.

Vertigo can be very distressing to a child and can affect children of all ages. Until a child is old enough to express his feelings of vertigo, a parent might notice when the child has a bout and seems clumsy or nauseous, or his eyes might dart back and forth. It is important to seek treatment for vertigo, as it can be a sign of a serious illness and can lead to injuries due to the disruption in balance and coordination.

Cause

Vertigo or dizziness can occur in children either with or without an eardrum problem.

An eardrum problem causes dizziness because the body’s sense of balance is located in the inner ear’s vestibular system. Most eardrum problems that cause vertigo are tied to minor illnesses that, once treated, can eliminate the vertigo.

But other systems in the body can cause vertigo as well. Depending on the disorder causing the symptoms, the bouts of dizziness can be more persistent. In these cases, a change in head position is often a trigger, and your child may experience other symptoms, like nausea and darting eye movements (nystagmus), as well.

The many possible causes of vertigo include:

  • Middle-ear infection or middle-ear “effusion,” in which a thick fluid builds up behind the eardrum, but no infection is present; in either case, your child’s sense of balance, located in the inner ear, is temporarily disrupted from the fluid pressing on the inner ear
  • Inner ear infections, including labyrinthitis and vestibular neuritis
  • Concussion or other head trauma
  • Small bone-like particle(s) floating in the inner ear fluid, residual from a concussion or an infection
  • Migraines, considered a vascular disorder because blood vessels in the brain dilate and produce the throbbing headache; a “motion sickness,” or intolerance, is often the form of vertigo that goes along with migraine
  • Benign paroxysmal positional vertigo (BPPV), which involves sudden attacks of dizziness and often rapid eye movements; in many cases, this disorder appears to be related to an early sign of chronic migraines  
  • Seizures
  • Low blood pressure
  • Autoimmune disorders, such as multiple sclerosis, Type 1 diabetes, and juvenile arthritis
  • Visual dysfunctions, such an excessive difference in prescription between the eyes or a congenital eye movement disorder
  • A brain tumor
  • Meniere’s disease
  • Aspirin and other nonsteroidal anti-inflammatory drugs

Symptoms

Symptoms of vertigo can vary from child to child and depend on the cause and severity of the vertigo. Some common symptoms include:

  • Child complaining of a dizziness, which might feel like a post-merry-go-round sensation, a perception the room is spinning or tilting, or a “motion sickness,” like your child is rocking on a boat and can’t tolerate motion
  • Dizziness triggered by a change in head position — either your child turns his head or stands up from a lying down position. This vertigo usually lasts only seconds or minutes
  • Unusual awkwardness, clumsiness or poor balance
  • Complaint of ear ringing (tinnitus), ear pain or ear stuffiness
  • Hearing loss
  • Fever of more than 100 degrees
  • Migraine
  • Confusion
  • Collapse or blacking-out
  • Nausea
  • Vomiting
  • Sweating
  • Pale complexion
  • Eyes darting back and forth (nystagmus)
  • The desire to lie still
  • Loss of fine or gross motor skills
  • Delayed motor milestones, such as a slowness to hold his head upright, stand or walk

Testing and diagnosis

Your primary care provider will likely refer your child to a pediatric otolaryngologist (ENT specialist) because diagnosing the cause of vertigo can be challenging. Vertigo must be differentiated from other forms of dizziness, and a thorough evaluation of all possible causes may be necessary. An otolaryngologist is best able to perform the comprehensive evaluation and to know when to call on the expertise of other specialists. During the course of the evaluation, a specialist may perform tests such as:

  • Extensive medical history-taking with questions for both you and your child; a family history of migraine may be explored
  • Thorough physical exam, especially of the head and ears
  • Audiometry, or hearing testing
  • Vestibular function tests, such as in a rotational chair
  • Electronystagmography (ENG), which involves electrodes placed above and below your child’s eyes to detect rapid eye movements (nystagmus)
  • Electroencephalography, a test that measures electrical activity in your child’s brain
  • Lab (blood) tests
  • Imaging tests, such as CT scan, X-ray or MRI
  • Vestibular-ocular tests involving games and gaze fixation
  • Dynamic visual acuity, involving your child shaking his head “no” quickly
  • Coordination and gross motor skills, such as hopping, skipping and jumping with eyes open and closed

Treatment

Specific treatment depends on the cause of your child’s vertigo. In many cases, vertigo can be relieved even if the underlying cause persists. An otolaryngologist from The Children’s Hospital of Philadelphia will be able to discuss all of the available treatment options for your child and to customize the plan according to your child’s symptoms and medical history. Possible treatments or therapies might include:

  • Medication, including antibiotics, decongestants or antihistamines for fluid in the ear
  • Motion sickness medicine
  • Seizure or antidepressant medication for migraine-associated vertigo
  • Behavioral modifications and changes in lifestyle, including an avoidance of positions or activities that can induce vertigo or put your child at risk for accidents if he has a bout of vertigo — for instance, if he skateboards or drives a car   
  • Physical therapy techniques, including the Epley or Semont maneuver, which can shift floating bone-like particles to an area of the inner ear where they don’t cause vertigo

Outlook

Most cases of vertigo result from an infection or fluid in the ear; proper treatment of the infection makes the vertigo disappear. When migraines and BPPV are the cause, related episodes of vertigo, along with the migraines themselves, can usually be successfully managed with medication. When more serious disorders cause the vertigo, the vertigo may be controlled through various medicines or therapies, even if the underlying disorder poses treatment challenges. The key is to have your child meet with a specialist for a proper diagnosis and treatment plan.

Follow-up care

If there is an underlying disorder causing your child’s vertigo, the specialist will design an individualized plan to manage your child’s condition and track symptoms and progress. Temporary vertigo, resulting from an infection, can usually be resolved with a course of medication.

Why choose CHOP?

Because of the potential for vertigo to be a sign of a serious condition, it’s important that a child with vertigo is seen by an experienced pediatric specialist. The otolaryngology team at The Children’s Hospital of Philadelphia has the specialized training and expertise to accurately diagnose and successfully manage vertigo in children. When needed, our experts will collaborate with other subspecialists who may need to be involved in your child’s diagnosis and care.