Evaluating the Association Between Hearing Loss and Falls in Adults With Vestibular Dysfunction or Nonvestibular Dizziness

Abstract

Objectives: Although emerging evidence suggests that hearing loss (HL) is an independent risk factor for falls, it is unclear how HL may impact falls risk in adults with vestibular dysfunction and nonvestibular dizziness. The purpose of this study was to characterize the impact of HL on falls in patients with vestibular dysfunction and nonvestibular dizziness relative to a group of patients without dizziness. In addition, this study aimed to evaluate whether there was an interactive effect between HL and vestibular dysfunction or nonvestibular dizziness on the odds of falling. Design:The authors conducted a retrospective cross-sectional study of 2,750 adult patients with dizziness evaluated at a tertiary care center vestibular clinic between June 1, 2015, and October 7, 2020. Only patients with available self-reported falls status, as extracted from the electronic medical record, were included. Patients were classified into the following diagnostic groups based on rotary chair testing and videonystagmography: benign paroxysmal positional vertigo (BPPV, n = 255), unilateral vestibular hypofunction (UVH, n = 456), bilateral vestibular hypofunction (BVH, n = 38), central dysfunction (n = 208), multiple diagnoses (n = 109), and dizzy, nonvestibular (n = 1,389). A control group of patients without dizziness (n = 295) was identified by a random sample of audiology patients. Degree of HL was characterized by the 4-frequency pure tone average (PTA) (0.5, 1, 2, and 4 kHz) of the better hearing ear. Demographic variables, comorbidities, cognitive impairment status, and falls-associated medications were extracted from the electronic medical record and included as covariates during analysis. Potential associations between PTA and falls status and possible interactions between diagnostic group and PTA were explored using multivariate logistic regression. Results:The BVH and central dysfunction groups had the highest rates of self-reported falls at 26.3% and 26.9%, respectively. The control group had the lowest rate of self-reported falls at 6.4%. With the exception of the multiple diagnoses group, all diagnostic groups had elevated odds of falling compared with the control group, when adjusting for demographics, comorbidities, cognitive impairment status, and fallsassociated medications. There was no significant association between degree of HL and falls status (odds ratio [OR] = 1.02; 95% confidence interval [CI] = 0.93, 1.11; p = 0.713) when adjusting for diagnostic group and all other covariates. Furthermore, there were no significant interactions between diagnostic group and degree of HL on the odds of falling. Conclusions:These results indicate that HL was not associated with falls in patients with vestibular dysfunction or nonvestibular dizziness, while adjusting for demographics, comorbidities, and falls-associated medications. There was no significant interactive effect observed between HL and vestibular dysfunction or nonvestibular dizziness on the odds of falling. As previously reported, vestibular dysfunction and n...

Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis

“…In 13 studies, only BPPV of the posterior canal was included,26,31–38,40,41,43,44 while 8 studies also included the lateral and/or anterior canal 27,29,39,45–48,50. In 4 studies, the affected canal was not specified 28,30,42,49…”

“…Ten studies were assessed with the JBI critical appraisal checklist for case-control studies 28–30,36,37,44. Two studies were classified as high,28,30 6 as moderate,33,36,39,42,44,49 and 2 as low risk29,37 of bias. The 2 studies with a high risk of bias had a cross-sectional design, screening for BPPV in a cohort 28,30.…”

“…27,29,39,[45][46][47][48]50 In 4 studies, the affected canal was not specified. 28,30,42,49 A total of 517 pwBPPV received treatment with PRM. Posterior canal BPPV was treated with the Epley, 26,32,34,40,[46][47][48]50 modified Epley, 27,31,35,38 or Sémont 43 maneuver.…”

“…In 5 studies, pwBPPV and controls were asked whether they experienced falls in a previously defined period. [28][29][30]37,42 With an odds ratio of 2.34, pwBPPV had a significant increased odds of falling compared with controls (P < 0.001; 95% CI 1.46 to 3.75), without heterogeneity (I 2 = 0%) (Figure 10). Exclusion of the studies with a high risk of bias did not affect the significance or odds ratio.…”

“…Of these 219 publications, 25 met the selection criteria. Data extracted from 20 articles [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] could be pooled in meta-analyses, and 5 additional studies [46][47][48][49][50] were only included for descriptive data. An overview of the literature search is shown in Figure 1.…”