A comprehensive study of over 1,100 patients presenting with dizziness and vertigo has found that specific patterns of hearing loss, or “audiometric phenotypes,” may be indicative of certain balance disorders. Published in Scientific Reports, the findings provide compelling evidence that audiometric profiles—often used to assess hearing ability—may also offer diagnostic value in identifying vestibular pathologies, including bilateral vestibulopathy, benign paroxysmal positional vertigo (BPPV), and Ménière’s disease.
Despite the anatomical proximity of the cochlea and vestibule in the inner ear, the relationship between hearing loss and vertigo has long remained controversial.
This new study, which employed detailed audiometry and vestibular function tests in a large patient cohort, adds weight to the argument that hearing and balance functions are more closely intertwined than previously assumed.
Distinct Hearing Loss Profiles Identified
The study involved 1,115 patients, aged 8 to 98, who sought care at a clinic in Montpellier, France, between 2019 and 2024. Using principal component analysis and hierarchical clustering, the researchers identified six distinct audiometric phenotypes based on patients’ hearing thresholds across frequencies from 250 Hz to 8,000 Hz.
While nearly half of the patients had normal or near-normal hearing, the remaining clusters revealed varying degrees and patterns of hearing loss. High-frequency hearing loss, flat symmetrical loss, and asymmetrical or unilateral hearing loss were all represented. These clusters were then correlated with vestibular test results, including caloric irrigation, rotatory chair testing, and video head impulse testing (vHIT).
Patient grouping based on audiometric patterns.
(A) Principal component analysis (PCA) of audiograms for 1,115 patients, projected onto the first two principal components (PC1 and PC2), derived from pure-tone thresholds in both ears (14 total per patient). PC1 and PC2 account for 92% and 3% of the variance, respectively.
(B) Patient clustering using agglomerative hierarchical clustering based on PC1 and PC2 values. Six audiometric clusters were identified using Euclidean distance and Ward’s method.
(C–H) Median audiograms for the six identified clusters. Open symbols represent the worst-hearing ear; closed symbols represent the best-hearing ear. Shaded areas indicate the interquartile range. Information panels include cluster size, median age (with IQR), and proportion of female patients.
Image and data credit: Nicolas-Puel, C., Bourien, J., Nouvian, R. et al. (2025).
The researchers found that reduced vestibular response measured via caloric irrigation strongly correlated with low-frequency hearing loss in the more affected ear. “Patients with asymmetrical hearing loss at low frequency are likely to have a weaker vestibulo-ocular reflex,” noted the researchers, suggesting the caloric test may be especially useful in those with unilateral hearing loss.
In contrast, the rotatory chair test—which evaluates bilateral vestibular function—showed strong correlation with overall hearing loss across both ears. Similarly, longer-lasting post-rotatory nystagmus (a marker of vestibular dysfunction) was associated with greater degrees of hearing loss and advanced age.
Interestingly, vHIT results showed that lateral and posterior semicircular canal functions declined with age and were also linked to high-frequency hearing loss. However, anterior canal function appeared independent of both age and hearing thresholds, indicating potential resilience to age-related decline.
Diagnoses Reflect Hearing Loss Patterns
When researchers analyzed how the audiometric phenotypes aligned with clinical diagnoses, clear patterns emerged. Vestibular migraine—a condition more common in women and characterized by dizziness without hearing loss—was predominant among patients with normal hearing. Meanwhile, conditions more commonly associated with aging, such as bilateral vestibulopathy and dementia-related balance dysfunction, were more prevalent in older patients with symmetrical or flat hearing loss profiles.
Distribution of clinical diagnoses across six audiometric clusters, shown as a bubble graph. Each patient is represented by a single diagnosis. Bubble radius reflects the proportion of each diagnosis within the corresponding audiometric cluster. Percentages are displayed as white digits on bubbles when the value is 4% or greater.
Image and data credit: Nicolas-Puel, C., Bourien, J., Nouvian, R. et al. (2025).
Ménière’s disease and vestibular neuritis/labyrinthitis were linked to younger patients with unilateral or asymmetrical hearing loss. These findings reinforce the idea that the type and configuration of hearing loss can offer clues to the underlying cause of a patient’s dizziness or vertigo.
“The findings underscore the importance of integrating hearing assessments into the diagnostic evaluation of individuals experiencing balance disorders. Audiometric phenotypes represent valuable tools for refining diagnoses and facilitating personalized management.”
The study also highlighted the diagnostic limitations of traditional vestibular testing. Because caloric irrigation and vHIT assess different frequencies and neural pathways within the vestibular system, the researchers emphasize the value of a multi-modal testing approach, complemented by audiometric data.
In addition to offering diagnostic insights, the research may have implications for understanding age-related changes in balance and hearing. The correlation between hearing loss, especially at high frequencies, and vestibular dysfunction suggests overlapping degenerative processes within the inner ear. The researchers noted that “age-related hearing loss may reflect broader sensory decline that impacts balance function,” opening the door to future investigations on shared pathophysiological mechanisms.
Moving Toward More Integrated Assessments
This study adds to a growing body of evidence suggesting that hearing and balance should not be evaluated in isolation. While the researchers acknowledge the variability in individual responses to vestibular testing, the consistency of correlations across audiometric phenotypes indicates that pure tone audiometry may have a broader role in clinical vestibular diagnostics than previously appreciated.
By incorporating audiometric profiles into the diagnostic process for dizziness and vertigo, clinicians may be better equipped to target their testing, improve diagnostic accuracy, and tailor treatment plans based on a patient’s unique sensory profile.
As the population ages and vestibular disorders become increasingly prevalent, these findings may inform future clinical guidelines and encourage the integration of hearing tests as a routine part of balance assessments.
Reference:
- Nicolas-Puel, C., Bourien, J., Nouvian, R. et al. Audiometry as a predictive proxy for balance dysfunction. Sci Rep 15, 13722 (2025). https://doi.org/10.1038/s41598-025-97995-0
