Recently we discussed multi-sensory dizziness and imbalance, reviewing how balance is maintained, as well as some of the more common falls risk factors encountered. A common risk factor for falls that was not discussed and is overlooked by many is hearing loss. Hearing loss is prevalent, with around 15% of American adults reporting hearing difficulty. This is even more prevalent than health conditions such as diabetes (10.5% of the U.S. population).
Most people do not think hearing loss could have an impact on balance; however, it has been shown that adults with hearing loss are nearly 3 times as likely to fall as compared to their normal hearing counterparts. This same study showed for every 10 dB decrease in hearing, there was a 1.4 fold increase in the odds of a reported fall.
This demonstrates that with greater degrees of hearing loss, there is an even higher likelihood of one falling.
This observed increase in falls risk was also found to be independent of vestibular (inner ear) balance function, demographic factors such as age, sex, gender, race, as well as cardiovascular factors including diabetes, hypertension, and stroke.
Why would hearing impact balance?
There are likely a number of factors at play that could result in this association. For one, there could be associated vestibular dysfunction associated with the hearing loss. Some conditions that cause hearing loss can also cause vestibular dysfunction.
Secondly, hearing loss may result in reduced environmental awareness. Lastly, it is likely that greater attentional resources are being applied to hearing in individuals with hearing loss and in turn are not directed towards maintaining balance.
Do hearing aids help balance?
At this time, there is minimal data to support that hearing aid use can reduce fall risk. It would seem that if cognitive load and reduced attentional resources are potential contributing factors, then treating hearing loss could reduce cognitive load and increase the number of available attentional resources to be utilized for postural control.
One small scale study showed that elderly hearing aid users saw nearly a doubling in the amount of time that they were able to maintain balance on a foam test pad as well as when standing heel to toe. Interestingly, the individuals in the study did not perceive improved balance performance despite a measurable improvement in their abilities to maintain balance.
At this time, I am not aware of any studies investigating cochlear implant use or bone anchored hearing aid use potentially reducing fall risk; however, as with hearing aids, it seems plausible to think these devices would also reduce the attentional resources applied to hearing and allow for greater resources to be put towards balance maintenance.
Summary
Hearing aid use can reduce the cognitive load associated with hearing loss, which may allow for greater attentional resources to be applied to maintaining balance. This relationship is not fully understood and further research is needed to better understand the association between hearing loss and increased risk of falling, as well as hearing aid use potentially reducing fall risk.
Despite the limited data in this area, we know that appropriately fit hearing aids do help individuals hear better and it appears that there could even be a positive impact on balance.
**Interested readers can view a recent interview by HHTM Editor, Dr. Bob Traynor on the subject of hearing loss and falls here.
