Retrospective Review of a Pediatric Vestibular Program: Pearls and Pitfalls in Clinical Implementation

Background: Pediatric vestibular dysfunction results in motor delays, imbalance, and reduced academic performance. Despite this, pediatric vestibular assessment remains limited, likely because of reduced provider training and awareness of pediatric dizziness, which then results in delayed or missed diagnoses. Establishing an interdisciplinary pediatric vestibular program can improve early identification with timely and targeted rehabilitation. Purpose: The purpose of this review is to describe steps taken to initiate a multidisciplinary pediatric vestibular program and retrospectively review pediatric cases after initiation of the program. Research Design: This is a retrospective review. Study Sample: The study sample included children referred for vestibular evaluation (n = 119) at the Medical University of South Carolina (June 2023 to June 2025). Intervention: A pediatric vestibular program was established. Education and hands-on training were provided to pediatric audiologists, otolaryngologists, and rehabilitation therapists to increase comfort in identifying and managing pediatric vestibular disorders and to form a multidisciplinary network. Vestibular assessment was completed in children at risk for vestibular dysfunction. Testing was expanded from vestibular evoked myogenic potential (VEMP) only to include other vestibular function tests. Data Collection and Analysis: Medical records were reviewed for demographic, case history, audiological, vestibular, imaging, diagnoses, and management data. Results: Over 2 years, 119 children (mean age: 6.3 years, range: 2 months to 18 years) underwent vestibular testing. Most children (85 percent) presented with dizziness and/or balance concerns. Hearing loss was present in 60 percent of patients, and imaging was abnormal in 53 percent of those imaged. Among vestibular function tests, the highest completion rates were noted for cervical VEMPs (96.6 percent) and the video head impulse test (80 percent). Peripheral vestibular dysfunction was identified in 62 percent of ears, with otolith dysfunction (54 percent) more common than semicircular canal dysfunction (26 percent). The most common diagnoses included vestibular migraine/recurrent vertigo of childhood (15 percent) and unilateral peripheral vestibular hypofunction (15 percent). Children were most frequently referred to neurology and/or physical therapy for ongoing management. Conclusions: Developing a pediatric vestibular program is feasible through targeted provider education, expansion of diagnostic tools, and interdisciplinary collaboration, and will provide assessment and rehabilitation to a significant number of children. Clinical Relevance Statement: This model demonstrates an approach for health systems seeking to improve pediatric dizziness care pathways.