Balance Disorders

With its multidisciplinary team of pediatric specialists, the Alfred I. duPont Hospital for Children’s Pediatric Balance Disorders Program provides an effective way to evaluate, diagnose, and care for children with balance and vestibular (inner ear balance) disorders.

A balance disorder may be caused by pathology of the labyrinth (an organ of the body, located in the inner ear, consisting of three semicircular canals and the vestibule), that interacts with the eyes, muscles, and joints to maintain the body’s position. This system, along with the brain and the nervous system, can be the source of balance disorders. For example, balance disorders can be traced to four key areas:

• Peripheral vestibular disorder, a disturbance in the labyrinth.
• Central vestibular disorder, a problem in the brain or its connecting nerves.
• Systemic disorder, a problem of the body other than the head and brain.
• Vascular disorder, or blood flow problems.

Typical Diagnoses/Problems:

• Dizziness or that the "room is spinning" (vertigo) and may not be able to walk without staggering; or may not even be able to arise.
• Falling or feeling of falling
• Lightheadedness or feeling woozy
• Visual blurring
• Disorientation
• Nausea and vomiting
• Diarrhea
• Faintness
• Changes in heart rate and blood pressure
• Fear
• Anxiety
• Panic

Services Available:

Patients can be referred to the program by community audiologists, or from ENT clinics, neurology clinics, ophthalmology clinics, or from developmental pediatrics practices. After a patient is initially assessed, evaluations may be conducted in one or more of the following specialty areas:

• Otolaryngology (Ear, Nose & Throat)
  • Comprehensive neurotologic history and physical examination on primary visit for patients of all ages
  • Scheduling of appropriate tests and examinations and collation of reports/committee recommendations
  • Review of relevant data and initiation of therapeutic plan at final visit based on team meeting recommendations
• Audiology (Hearing)
  • Audiometric and Vestibular Testing
    • Audiogram
    • Immitance Testing
    • Videonystagmography (VNG)
    • Rotational Chair Testing (RVT)
    • Vestibular Evoked Myogenic Potential (VEMP) Thresholds
  • Electrocochleography (ECOG)
    • Fistula Testing
    • Otoacoustics Emissions Testing (OAE) as required
• Physical Medicine and Rehabilitation
  • Augmentative Communication
  • Audiology
  • Neuromuscular Pain Management
  • Neuropsychology/Psychology
  • Physical Therapy
  • Rehabilitation Engineering
  • Speech Pathology
• Physical Therapy
  • Balance Master Evaluation
  • Developmental Assessment And Balance Subtest
  • Lower Extremity Strength And Flexibility Assessment
  • Initiation of Vestibular Rehabilitation Based On Committee Recommendations
• Neurology
  • Neurologic Evaluation
  • Imaging, Special Tests PRN
• Neurosurgery
  • Neurosurgery Evaluation
• Gait & Motion Analysis Laboratory
  • Walking kinematics; patient/in-patients must be able to walk independently
  • Video at any age able to ambulate
  • Static Posturography

A Gait Analysis Laboratory, established in 1993, provides state-of-the-art computer-assisted motion analysis (also referred to as biomechanics) of the gait cycle (the series of movements of the leg and foot between one touch of the heel on the ground and the next time the same heel touches). Detailed information is gathered about the movement of various joints, the patterns of muscle contractions, the associated forces affecting the limbs and the energy demands involved.

Vestibular Testing

Videonystagmography (VNG)
An objective test that helps determine the degree and location of a balance disorder. The patient wears goggles and electrodes are placed on the face. The patient is then asked to follow lights on a bar. The balance system is also gently stimulated by position changes and by cool and warm air introduced into the ears. A computer will automatically analyze the responses. This test takes approximately one hour to complete.

Rotational Chair Testing (RVT)
This test, often done in conjunction with a VNG, evaluates the balance system and whether one or both ears are properly functioning. The patient sits (with a seatbelt) on a computer-controlled rotating chair (or in a parent’s lap) in a dark room while keeping the eyes open. The chair moves to the left and right. This test takes approximately 45 minutes to complete.

Vestibular Evoked Myogenic Potential (VEMP) Thresholds
Seated in a chair, electrodes are placed on the patient’s neck and upper chest; earphones initiate clicking sounds. Patients are asked to turn their heads to contract the sternocleidomastoid muscles (muscles in the neck that act to flex and rotate the head). This test takes approximately 30 minutes to complete.

Electrocochleography (ECOG)
While wearing earphones, the patient hears a series of clicking sounds. A few electrodes placed on the patient’s head send signals back to a computer that analyzes the sounds. This test takes approximately one hour to complete.