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Balance System Disorders

Underlying causes of balance disorders and resulting symptoms are many and varied, and they include causes related to the vestibular system and causes related to other body systems and conditions. Conditions/events resulting in imbalance and/or dizziness may resolve spontaneously or may become chronic.

Vestibular causes may include the following:

  • Acute injury to the vestibular system
  • Aging vestibular system
  • Autoimmune inner ear disease (AIED)
  • BPPV—cupulolithiasis/canalithiasis
  • Cochlear implant surgery
  • Enlarged vestibular aqueduct syndrome (EVA)
  • Genetic disorders
  • Labyrinthine concussion
  • Medication side effects/ototoxicity
  • Ménière's disease
  • Migraine-associated vertigo/vestibular migraine
  • Otosclerosis
  • Perilymph fistula
  • Space-occupying lesions of the auditory nerve
  • Superior semicircular canal dehiscence
  • Temporal bone fracture
  • Traumatic brain injury
  • Viral/inflammatory process of the inner ear

Other causes may include the following:

  • Alcohol ingestion
  • Anatomic changes of the brain
  • Autoimmune disease
  • Circulatory or cardiovascular conditions
  • Environmental toxins
  • Genetic disorders
  • Infectious disease (viral or bacterial)
  • Mal de debarquement syndrome (rare condition occurring after sustained motion)
  • Medication side effects/ototoxicity
  • Metabolic disorders
  • Musculoskeletal conditions
  • Neurological impairment/event/disease
  • Peripheral neuropathy
  • Psychological disorders
  • Traumatic brain injury


A review of current literature indicates that the most common causes of dizziness in children are otitis media, migraine headache, benign paroxysmal vertigo of childhood (BPVC), trauma, and vestibular neuritis (Gioacchini, Alicandri-Ciufelli, Kaleci, Magliulo, & Re, 2014; O'Reilly et al., 2010). Numerous reports have detailed common disorders that cause vertigo and imbalance in children (Balatsouras et al., 2007; Blayney & Colman, 1984; Jahn, Lahghagen, Schroeder, & Heinen, 2011; McCaslin et al., 2011; Russell & Abu-Arafeh, 1999; Szirmai, 2010; Wiener-Vacher, 2008). Even though these reports originate from different clinics and regions of the world, there is substantial agreement regarding the primary causes of dizziness in the pediatric population. A 2014 systematic review found the causes of vestibular disorders in children to parallel those of adults (Gioacchini et al., 2014). The authors found BPPV (19%) and migraine-associated vertigo (18%) to be the most common causes of vertigo and dizziness in children.

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