Vertigo in children is a challenging complaint for which potentially numerous etiologies exist. The history, often obtained most reliably from the observations of parents or caretakers, contains key information that directs the diagnostic evaluation. Using this information, the clinician may then categorize the complaint of vertigo according to its quality (paroxysmal or unremitting), and its association with the following: hearing loss; loss of consciousness or postural control; or any neurologic symptoms. The differential diagnosis may then be approached in an algorithmic method and narrowed down to isolate the most common disease processes that may account for the specific symptomatology. Current studies support the growing evidence that otitis media is one of the leading causes of imbalance in children.