Deafness and balance

The inner ear consists of the cochlea, the vestibule and the semicircular canals. The cochlea is the organ of hearing. It looks like a snail’s shell.

The vestibular system includes the vestibule and the semicircular canals. They are filled with fluid and contain small hair cells which detect movement and gravity. As we move, these sense organs send information about our balance to the brain.

As well as the vestibular system in the inner ear, the brain also uses information from two other systems to balance.

• Visual information from the eyes tells the brain where we are in relation to the environment around us.
• Proprioceptors (special pressure receptors in the legs and body) send signals to the brain that tell it about posture, movement, and the surrounding physical environment such as uneven or sloping ground.

Children who are born with permanent deafness are more likely to have a dysfunctional vestibular system, known as vestibular hypofunction. This means that the inner ear isn’t functioning as it should.

Sometimes the vestibular system and the cochlea have been affected by the same problem and so deafness and balance problems can occur together. For example, children with meningitis or enlarged vestibular aqueducts (EVA) may experience deafness and balance problems at the same time.

Sometimes the vestibular system is affected by injury, illness or a long-term condition.

However, not all deaf children will have problems with balance, and not all children with balance disorders are deaf or have hearing loss.

It’s estimated that 60 to 70% of children born with permanent deafness have vestibular dysfunction. The vestibular system could be:

• dysfunctional (not working properly)
• not functioning at all
• hyper functional (working too hard)

Most deaf children who are born with or get vestibular hypofunction early in life will learn to balance naturally, without needing any extra support. They will make up for the difference in their vestibular system by relying more on the other parts of the balance system (eyesight and proprioceptors). Even children born without a vestibular system can learn to balance.

These children are unlikely to feel dizzy or fall over, but you may notice that they are slower to meet motor milestones like sitting unsupported, walking, or riding a bike. Most deaf children will still reach these milestones in their own time!

If you’re worried that your deaf child is not meeting motor milestones, speak to your health visitor, audiologist, GP or other health professional. Make sure the health professionals who work with your child understand the connection between deafness and balance.

Some types of balance problems can cause dizziness or vertigo (the feeling of spinning around, or the feeling of the world spinning). These can happen at any time in childhood. Young children may not understand or be able to describe the concepts of vertigo or feeling unsteady on their feet, so balance problems can be more difficult to detect than with adults and older children.

Signs of dizziness in young children can include:

• being slow or reluctant to walk
• loss of motor skills
• unusual clumsiness
• jerky eye movements
• head tilting or swaying

A temporary change or problem with one part of the vestibular system, such as an inner ear infection or glue ear, can cause temporary dizziness or unsteadiness. However, dizziness can also be caused by a different issue which is not related to the ear, such as migraine. If your child begins to show new signs of dizziness, speak to your audiologist, GP or other healthcare professional.

Dizziness and vertigo are usually temporary and will often go away by themselves. After your child recovers from their dizziness, it’s important that they keep active and move around a lot. Encourage them to relax and feel confident moving about.

The British Association of Audiovestibular Physicians (BAAP) recommends that all children with permanent severe or profound deafness should have their balance tested. However, testing is not available in all areas of the UK. Most children with severe or profound deafness will learn to balance without any extra support.

If a deaf child has delayed motor milestones, or if a child suddenly shows signs of unexplained clumsiness or dizziness which they did not show before, you should speak to your GP, paediatrician, audiologist or other health professional. They may carry out a clinical examination to check your child’s functional balance (how well they can balance). This could include simple activities like walking, marching on the spot, or hopping on one foot.

In very young babies, functional balance can be assessed by observing their head control and muscle tone.

You may also be offered specific tests to see how the vestibular system itself is working.

Vestibular testing

Vestibular testing is painless. Occasionally, testing may make your child feel unsteady, dizzy or nauseous. Most children do not have any problems.

Some tests are carried out in the dark. If your child lip-reads or uses sign language, make sure they understand what will happen before the lights are turned off.

Vestibular tests rely on looking for and recording eye movements. There are different sorts of tests, usually carried out with special goggles.

You should receive information about the tests that will be performed and how long the appointment is likely to take.

It’s unlikely that a balance problem will stop a child from taking part in normal childhood activities. However, children with vestibular hypofunction may find it harder to balance in situations where they cannot use their vision or proprioception, such as in the dark or on uneven surfaces like a sandy beach.

There are some adaptations you can make to support your child’s balance and to keep them safe.

• Keep a night light in the hallway in case your child needs to get up at night.
• Play games which involve planning how to move your body, like Twister and hopscotch.
• Use yoga to develop your child’s proprioceptors. Cosmic Kids Yoga (YouTube) have a playlist of yoga and relaxation videos for children with British Sign Language (BSL).
• Give children extra time and support when learning to ride a bike.
• Closely supervise your child when swimming in case they become disoriented underwater.
• Explain to your child’s teachers or activity leaders that they may have difficulty with balance. [link to personal passports]
• Try not to be overprotective of your child. Encourage them to play and try new things in the same way as you would any other child.

If you feel dizziness or imbalance is affecting your child’s quality of life, or if they are becoming anxious or frustrated, talk to your child’s audiologist, GP or another healthcare provider. If you don't feel your child is getting enough support, contact our Helpline for more advice.