The Connection Between Hearing Loss and Balance

By Barry Keate

Hearing loss affects 15% of the world’s population and is one of the most frequently occurring sensory disabilities. It is the most common chronic disorder of the aging population. Hearing loss is closely associated with other dysfunctions such as tinnitus, dementia and depression. A new study from South Korea now finds that hearing loss is also associated with unstable posture, dizziness and falls, one of the most common and serious health problems in older adults. (1)

Hearing loss affects us in many ways. It affects other sensory systems and reduces quality of life. Hearing loss is responsible in 75% to 80% of tinnitus cases.

Uncompensated hearing loss is also responsible for cognitive decline and dementia. With moderate to severe hearing loss the brain actually shrinks and cognitive decline sets in.

This recent study included 3864 participants 40 years and older using data from the 2010 through 2012 Issue of the Korea National Health and Nutrition Examination Survey. The presence of moderate or worse hearing loss was associated with increased odds of postural instability compared to participants with normal hearing.

Pure tone audiometry was used to determine whether there was hearing loss and was conducted on both the left and right sides of the participants. Each ear was classified into 1 of 3 categories; normal hearing, mild hearing loss (26 to 40 dB), and moderate hearing loss (40 dB or worse). Postural instability was defined as the failure to remain standing, with feet 4” apart, for 20 seconds on a 5” foam surface with arms folded, hands cupping the elbows and eyes closed.

Female sex was associated with higher odds of postural instability compared with male sex. The odds of instability also increased with every year increase in age. Mild hearing loss was not associated with an increase in the odds of instability but moderate hearing loss present on at least one side led to an increase in the odds.

Aging, female sex, and having hearing loss were the conditions leading to postural instability in this study. The odds of balance failure were twice as high if a person had moderate hearing loss in one ear compared to no hearing loss. And for every 10 dB in hearing loss there was 1.4-fold increase in odds of the individual reporting a fall over the past 12 months. Better postural stability was found in those using hearing aids.

In a commentary in the same JAMA journal, the author calls for a paradigm shift in clinical treatment of those with hearing loss. It calls for people with hearing loss to also be screened for balance performance and fall risk.

In a recent paper published in JAMA Otolaryngology – Head & Neck Surgery, researchers examined claims for health services for people with and without untreated hearing loss. They found untreated hearing loss was associated with an additional $22,434, or 46% higher, total health care cost over a 10-year period. (2)

It is past time for the US Centers for Medicare and Medicaid Services (CMS) to recognize the dramatic improvement in quality of life and the huge cost savings involved by providing audiology services and hearing aids to those in need of them.

References:

1 – Band SW, Jeon JM, Lee JG, et al. JAMA Otolarygol Head Neck Surg. Published online April 23, 2020.

2 – Reed NS, Alton A, Deal J, et al. Trends in Health Care Costs and utilization Associated with Untreated Hearing Loss Over 10 Years. JAMA Otolaryngol Head Neck Surg. 2019;145(1):27-34.