Hearing Health and Balance: What's the Connection?

by Thomas A. Powers. PhD

September 15, 2021


Age related changes in older adults affect most of the organs and sensory systems in our bodies.  Two of the more common issues are age-related hearing loss (ARHL) and age-related vestibular loss (ARVL).  Most of us are familiar with ARHL, clinically called presbycusis, and have experienced a loved one, perhaps a spouse, parent, grandparent, or friend, that begins to have difficulty following conversations. You may have noticed the volume on devices being louder than normal or a request to repeat a comment more frequently.  In some circumstances, you may also find a loved one withdrawing from social functions as they are not able to participate as they once did.  ARVL, or problems balancing that can lead to falls, may be less familiar.  The National Institute of Deafness and Other Communication Disorders estimates that falls account for over 50% of all accidental deaths in the elderly. A recent analysis calculated the medical costs associated with fatal and non-fatal falls in the USA to be over $19 billion annually.1 The overall prevalence of vestibular issues in American adults aged over 40 is 35.4%, which is around 69 million individuals.2  Both conditions increase the risk of social isolation, cognitive decline.3

Since the auditory and vestibular systems share a common organ, the inner ear, the effect of aging acts on the ability to hear as well as balance, position control and spatial orientation (knowing how close you are to an object and whether you are moving or not). A person experiencing age-related vestibular loss may experience dizziness, have difficulty keeping their balance, or just feel unsteady on their feet. While hearing loss and vestibular loss are related and share the physiology of the inner ear, the diagnostic tests and treatment are very different.

Hearing loss is assessed with pure tone testing as well as speech testing where the patient repeats words or sentences. The current treatment for ARHL is the fitting of hearing aids or a cochlear implant(s) depending on the level of hearing loss.  Properly fitted hearing aids can reduce the effects of hearing loss so that you can rejoin the “conversations” and hear common sounds that were formerly lost to them.  

Assessment of vestibular function involves several tests which could include:

  • Observing eye movements
  • Caloric tests with warm or cold water to induce responses from the inner ear
  • Rapid movement of the patient’s head to test the vestibular organ
  • Blood tests
  • Vision exams
  • Imaging studies

Treatment of vestibular dysfunction may include antibiotics if an infection is present.  Recommended changes to lifestyle include smoking cessation, surgery or balance retaining therapy to alleviate symptoms.

Both ARHL and ARVL can be serious medical issues.  If you or a loved one have been living with hearing loss and/or experiencing dizziness, feeling off-balance, blurred vision or stumbling, we urge you to seek medical assistance as soon as possible. An audiologist is trained and licensed to assess and diagnose both of these issues, so reach out to an audiologist today if you have any questions about your hearing or balance.


Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev (2006) 12(5):290–5.10.1136/ip.2005.011015
2 Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med (2009) 169(10):938–44.
3 Agrawal Y, Smith PF, Rosenberg PB. Vestibular impairment, cognitive decline and Alzheimer's disease: balancing the evidence. Aging Ment Health. 2020 May;24(5):705-708. doi: 10.1080/13607863.2019.1566813. Epub 2019 Jan 29. PMID: 30691295; PMCID: PMC6663651.

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