Background: Hearing impairment (HI) is a very common condition in elderly people and the epidemiology together with hearing-related problems is still poorly investigated. Moreover, the cognitive status may be impaired in relation to hearing function. Objective: The goal of the study was to evaluate: (a) the prevalence of HI in a random sample of elderly people aged 65 and over (n = 1,750) living in Campania, a region of southern Italy; (b) the cross-sectional relationship between hearing function and cognitive status and also depressive symptomatology and disability, and (c) to assess the role of hearing aids on depressive symptomatology. Methods: Cross-sectional study on a random sample of elderly population. Results: The overall participation rate in the study was 74.8% (n = 1,332, mean age was 74.2 ± 6.4 years). The prevalence rate of HI (evaluated by questionnaire) was 27.2%, cognitive impairment prevalence (evaluated by the Mini-Mental State Examination (MMSE)) was 27.9%, mean depressive symptomatology score (evaluated by Geriatric Depression Scale (GDS)) was 11.4 ± 6.6, while disability assessed by Activity of Daily Living (ADL) was present in 7.0% of the whole population. A strong relationship was found between both decreasing hearing function and MMSE decline, independently by the effect of age and education (r = 0.97; p < 0.01). A positive relationship (r = 0.85; p < 0.01) between GDS score and hearing function was also found. Moreover, at an increased level of hearing loss, a lower ADL score was recorded (r = 0.98; p < 0.01). Finally, the use of hearing aids reduced GDS score. In logistic regression analysis, gender, age and educational level indicate that hearing loss risk increased with age (odds ratio 1.60; 95% confidence interval 1.53–1.71), whereas education plays a protective role (odds ratio 0.75; 95% confidence interval 0.72–0.80). Conclusion: HI is very prevalent among elderly people and is associated with either cognitive impairment and/or depression and reduction of functional status. This study suggests that hearing aids may protect against cognitive impairment and disability, improving quality of life of aged people.

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Lateral trunk flexion is a very common clinical observation in patients affected by Parkinson's disease. Postural control is known to depend on vestibular, visual, and somatosensory information. The aim of this study was to investigate whether impairment of vestibular function can account for the postural alterations observed in parkinsonian patients with lateral trunk flexion. We evaluated vestibular function in 11 parkinsonian patients with lateral trunk flexion and in 11 age-, sex-, and disease duration-matched patients without lateral trunk flexion. The following vestibular tests were performed: infrared videonystagmography including fast and slow ocular movements, spontaneous-positional and evoked nystagmus search with and without visual fixation, fast positioning maneuvers, the bithermal caloric test, and the vibration test. A peripheral, unilateral vestibular hypofunction was identified in all patients with lateral trunk flexion. The vestibular hypofunction was ipsilateral to the leaning side and contralateral to the most affected parkinsonian side in all patients. In the control group, 7 subjects had no vestibular signs; 4 subjects had unilateral vestibular hypofunction without clinically evident lateral trunk flexion. Two of the latter patients subsequently developed lateral trunk flexion ipsilateral to the vestibular deficit and contralateral to the side most affected by Parkinson's disease. The processing of vestibular information was impaired in parkinsonian patients affected by lateral trunk flexion. The impairment was at least in part responsible for the patients' postural abnormality. We propose that the acronym PISA (Postural Imbalance Syndrome with vestibular Alterations) be used to describe the specific postural change observed in parkinsonian patients affected by a vestibular defect and lateral trunk flexion.

We provide novel evidence for abnormal thalamic functional response to vestibular stimulation in patients with VM. These functional abnormalities in central vestibular processing may contribute to VM pathophysiology.