The Effects of Hearing Loss on Balance: A Critical Review

Abstract

Recent epidemiological findings of associations between hearing loss (HL) and poorer mobility and higher falls risk have increased the demand for ecologically valid experimental research to determine the potential mechanisms underlying human hearing-balance relationships. This review provides an overview of the laboratory-based approaches to studying human balance, identifies crucial factors that should be considered to improve the ecological validity of hearing-balance research, and provides a critical review of the scientific literature to date on the effects of HL on balance. Most present studies can be subdivided into those that examine balance changes due to the effects of (1) auditory suppression in individuals with normal hearing, (2) HL with and without hearing aids, and (3) cochlear implants in children and adults. To allow for meaningful comparisons, we based our in-depth critical review on studies that met minimum criteria of having at least one objective kinetic or kinematic measure of standing balance during a two-legged stance with feet side-by-side, for at stance duration of at least 30 sec. With this minimum criterion in place, we found mixed evidence that hearing suppression, HL, or hearing devices affects postural stability, especially when other sensory information is available and/or reliable, and task demands are relatively low. However, hearing may become more important when multiple sensory systems become unreliable, task demands, or cognitive impairments are greater, or when sounds provide important auditory cues to assist with orientation or provide early detection of an impending balance disturbance. However, more research is clearly needed, because there is a wide range of technical and experimental differences and limitations observed across the present literature. To address these gaps, we have provided a number of recommendations and suggested priorities for future research to provide the ecologically valid, reliable, and reproducible evidence needed to uncover any potential relationships between HL, balance, and falls.

Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies

“…208 Combined effect of poor visual acuity, kinaesthetic sense, slow walking speed and potential cognitive impairment are to be blamed for the increased fall risk beyond peripheral neuropathy itself. 209 This adds to the conclusion of previous ample studies on the risk of falling in a general population, in which multiple sensory impairment, that is, vision, peripheral neuropathy and hearing problems 210 were associated with higher probability of falls or balance dysfunction. 211 However, reduced muscle strength in diabetic patients is present before the clinical onset of neuropathy and is characterised by increased fatiguability and reduced muscle twitch amplitude, without major changes in the pattern of motor unit firing, pointing to primary disruption of contractile function.…”

Vestibular Perceptual Thresholds in Older Adults With and Without Age-related Hearing Loss

“…For instance, studies have strategically manipulated the availability of spatially relevant information during standing balance tasks by reducing (e.g., through sound suppression; Gago et al 2015; Vitkovic et al 2016), amplifying (e.g., through hearing aids; Vitkovic et al 2016; Negahban et al 2017; Kowalewski et al 2018), or modifying (e.g., providing or removing auditory landmarks) sound cues in the testing environment (see Carpenter & Campos and Lubetzky et al 2020 for reviews). The results of these studies, however, have been inconsistent with respect to the nature of hearing-balance interactions (see Carpenter & Campos 2020; Lubetzky et al 2020 for reviews).…”

Age-Related Changes to Vestibular Heave and Pitch Perception and Associations with Postural Control

“…Participant Sample. Participants in this study underwent rigorous screening, which allowed us to control for certain age-related factors, including for example, cognitive decline [127]- [132], age-related hearing loss and tinnitus [1], [87], [89], [97], [133], diagnosed vestibular disorders [134], and other serious health conditions. However, these common agerelated conditions are likely to also influence vestibular perception and postural control and, as such, the sample in this study may not be representative of the typical older adult population.…”