Fragility and Presbycusis

Aging and the needs of older people: Health strategies for healthy aging

ISBN: 978-84-09-30541-4

Justo Ramón Gómez and Manuel Manrique

Association between age-related hearing loss and balance disorder

Age-related hearing loss tends to take place in the context of degenerative processes affecting the inner ear. These processes may cause changes to the labyrinth, which would give way to a permanent, symptomatic sensorineural hearing loss and/or vestibular disorders, which lead to balance impairment in clinic.

Older people tend to have hearing and balance issues, and they tend to fall1. Identifying modifiable risk factors linked to falls in older people is extremely important for public health. Although hearing has not been usually considered a risk factor for falls in this population, recent reports have proven a strong connection between hearing loss and the incidence of falls2,3. Lin4 points out that hearing loss is distinctly associated with the probability of falls. For every 10 dB increase to the hearing loss, the probability of an individual reporting a fall in the last 12 months increases by 1.4 (95% CI, 1,3-1,5). Other authors have made mention of this probability as well, with remarkably similar ratios6,7. In a systematic review and meta-analysis of the literature, Jiam8 observed that the risk of falling for people with hearing loss is multiplied by 1.69. This association between hearing loss and falls may be accounted for by several mechanisms, such as a concomitant dysfunction of both cochlear and vestibular sensory organs, given their shared location within the labyrinth in the inner ear. Lesser hearing sensitivity could limit space perception directly as well9. Finally, paying attention to posture control takes cognitive resources. Less cognitive resources and attention due to hearing loss may impair the postural balance in real life situations and increase the risk of falling. These two factors suggest a cause-effect connection between the hearing loss and the fall. This raises the question of taking action, as hearing loss is very prevalent, but still largely untreated among older people10,11.

Hearing is important to keep your balance. Traditionally, maintaining postural balance has been described as a process based on the correct interaction of somatosensory, vestibular, and visual systems. The likelihood of impaired balance increases the greater the number of underlying systems affected. The impairment of one of these subsystems tends to be offset by information from the others, hearing included—at least to some extent. Acting on the balance impairment can diminish the risk of falls significantly. Acting on the hearing loss must be a priority to prevent falls and promote the health and wellbeing of older people.

References

  1. Kannus P, Sievämen H, Palvanen T, et al. Prevention of falls and consequent injuries in elderly people. Lancet. 2005;366:1885-1893.
  2. Viljanenn A, Kaprio J, Pyykkö I, et al. Hearing as a predictor of falls and postural balance in older female twins. J Gerontol A Biol Sci Med Sci. 2009;64:312-317.
  3. Lopez D, McCaul KA, Hankey GJ, et al. Falls, injuries from falls, health related quality of life and mortality in older adults with vision and hearing impairment-is there a gender difference? Maturitas. 2011;69:359-364.
  4. Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United Sates. Arch Intern Med. 2012;172:369-371.
  5. Assantachai P, Praditsuwan R, Chatthanawaree W, Pisalsarakij D, Thamlikitkul V. Risk factors for falls in the Thai elderly in an urban community. J Med Assoc Thai. 2003;86(2):124-30.
  6. Kulmala J, Viljanen A, Sipilä S, Pajala S, Pärssinen O, Kauppinen M, Koskenvuo M, Kaprio J, Rantanen T. Poor vision accompanied with other sensory impairments as a predictor of falls in older women. Age Ageing. 2009 Mar;38(2):162-7.
  7. Stam H, van der Horst HE, Smalbrugge M, Maarsingh OR. Chronic dizziness in older people: apply a multifactorial approach. Ned Tijdschr Geneeskd. 2014;159
  8. * Jiam NT-L, Li C, Agrawal Y. Hearing loss and falls: a systematic review and meta-analysis. Laryngoscope. 2016;126: 2587-2596.
  9. Lin FR, Ferrucci L, Metter EJ, An Y, Zonderman AB, Resnick SM. Hearing loss and cognition in the Baltimore longitudinal study of aging. Neuropsychology. 2011;25:763-770.
  10. Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011;171:1851-1852.
  11. Lin FR, Thorpe R, Gordon-Salant S, Ferrucci L. Hearing loss prevalence and risk factors among older adults in the United Sates. J Gerontol A Biol Csi Med Sci. 2011;66:582-590.