Association Between Hearing Loss and Saccular Dysfunction in Older Individuals

Abstract

Objective (1) Describe the association between hearing loss and dysfunction of each of the five vestibular end-organs – the horizontal, superior and posterior semicircular canals, saccule and utricle – in older individuals. (2) Evaluate whether hearing loss and vestibular end-organ deficits share any risk factors. Study design Cross-sectional study. Setting Academic medical center. Patients Fifty-one individuals age ≥70. Interventions Audiometry, head-thrust dynamic visual acuity (htDVA), sound-evoked cervical vestibular-evoked myogenic potential (cVEMP) and tap-evoked ocular VEMP (oVEMP). Main Outcome Measures Audiometric pure-tone averages (PTA), htDVA LogMAR scores as a measure of semicircular canal function in each canal plane, and cVEMP and oVEMP amplitudes as a measure of saccular and utricular function, respectively. Results We observed a significant correlation between hearing loss at high frequencies and reduced cVEMP amplitudes (or reduced saccular function; r = −0.37, p < 0.0001) in subjects age ≥70. In contrast, hearing loss was not associated with oVEMP amplitudes (or utricular function), or htDVA LogMAR scores (or semicircular canal function) in any of the canal planes. Age and noise exposure were significantly associated with measures of both cochlear and saccular dysfunction. Conclusion The concomitant decline in cochlear and saccular function associated with aging may reflect their common embryologic origin in the pars inferior of the labyrinth. Noise exposure appears to be related to both saccular and cochlear dysfunction. These findings suggest a potential benefit of screening individuals with presbycusis – particularly those with significant noise exposure history – for saccular dysfunction, which may contribute to fall risk in the elderly.

Effects of high intensity noise on the vestibular system in rats

“…Nevertheless, because the compensatory mechanisms begins to fail during the process of aging, vestibular dysfunctions may be more common in the NIHL population than in the general population. This view is supported by clinical studies which have demonstrated a strong association between hearing loss and vestibular deficits in the elderly (Zuniga et al, 2012). Vestibular dysfunction, a risk factor for falling, may contribute to increased incidents of falls in the elderly with hearing loss (Viljanen et al, 2009; Lopez et al, 2011; Lin and Ferrucci, 2012).…”

“…It has been reported that some individuals with noise-induced hearing loss (NIHL) also suffer from balance disorders (Oosterveld et al, 1982; Juntunen et al, 1987; Golz et al, 2001). Reduced vestibular caloric response (Manabe et al, 1995; Golz et al, 2001), reduced vestibular-evoked myogenic potentials (VEMP) (Wang et al, 2006; Wang & Young, 2007; Kumar et al, 2010; Akin et al, 2012; Zuniga et al, 2012), nystagmus (Man et al, 1980; Shupak et al, 1994; Oosterveld et al, 1982; Golz et al, 2001), and increased body sway (Ylikoski 1988; Kilburn et al, 1992) have been reported. Despite our understanding of the effect of noise on auditory function, the mechanisms underlying noise-induced vestibular deficiency remain to be elucidated.…”

Association of Hearing Impairment With Incident Frailty and Falls in Older Adults

“…A number of studies have found that HI increases the risk of falling, including a meta-analysis that found a 21% increased odds of falling among those with HI (Deandrea et al, 2010; Kulmala et al, 2009; Pluijm et al, 2006; Tromp, Smit, Deeg, Bouter, & Lips, 1998). There are multiple mechanisms by which HI could influence falls including shared pathological pathways (e.g., co-morbid vestibular dysfunction, cerebrovascular disease; Agrawal, Carey, Della Santina, Schubert, & Minor, 2009; Gates et al, 1993; Zuniga et al, 2012) or through decreased awareness of the auditory environment. Attentional resources are also essential for maintaining postural control and balance (Viljanen, Kaprio, Pyykko, Sorri, Pajala, et al, 2009; Woollacott & Shumway-Cook, 2002), and postural balance in older adults is markedly affected by the performance of concurrent cognitive tasks that utilize attentional resources.…”

Ageing‐related changes in the cortical processing of otolith information in humans

“…Changes in sensory epithelia are accompanied by a reduction in otoconia, mainly in the vertically positioned saccule (Johnsson & Hawkins, 1972). Besides a concurrent decay of saccular, utricular, cochlear and semicircular-canal function as part of the normal overall ageing process, there seems to be an additional association with lifetime noise exposure (Mc & Lawrence, 1958;Kumar et al, 2010;Zuniga et al, 2012).…”