The Effects of Hearing Loss on Balance in Older Adults: A Systematic Review




Kowalewski, Victoria
Bugnariu, Nicoleta


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Purpose:Falls due to poor postural control are a common problem within the older adult population, leading to many negative outcomes such as fractures, hospitalization, and even death. Traditionally, three sensory inputs – visual, vestibular, and somatosensory – are associated with the control of balance and have been investigated for their potential contribution to increased risk of falls. However, recent epidemiological research has brought attention to the notion that other sensory impairments, such as hearing loss, may affect balance. The purpose of this review is to systematically document the recent evidence linking hearing loss to balance impairments and increased risk for falls in seniors, and to present various hypotheses regarding the mechanisms by which auditory impairments may affect balance. Methods:A literature search was performed using the key terms: hearing loss, auditory impairment, older adults, elderly, balance, falls, hearing aids, hearing devices, gait, locomotion, cognition, and postural control. The databases PubMed, Scopus, CINAHL, Cochrane, ScienceDirect, and Medline were queried for articles published between January 2000 and June 2014. An initial screen was performed based on titles and abstracts. A total of 346 articles were found. A second reviewer who is an expert in the field screened the articles based on the relevance to the topic and narrowed the inclusion number to 72 articles. Literature reviews and articles about pediatrics were excluded from this review, which further narrowed the inclusion number to 47 articles. Results:The evidence from the literature supports a link between hearing loss and balance deficits. Four main theories exist that may explain why and how hearing loss may affect an older adult’s balance: (1) The Physiological Theory; (2) The Social Theory; (3) The Perceptual Theory; (4) The Cognitive Theory. The evidence strongly supports The Cognitive Theory; substantial evidence supports the Social Theory; not enough evidence is currently available in the literature to support or refute the Perceptual Theory and the Physiological Theory. Conclusions:The consequence of hearing loss on a person’s ability to maintain balance has not gained attention until recently and minimal research on the effects of hearing loss on balance exists. This report informs healthcare professionals about potential consequences of hearing loss on an individual’s postural control and the need for further research to be performed.