Sound can directly affect balance and lead to risk of falling

March 12, 2020

What people hear and do not hear can have a direct effect on their balance, according to new research from the New York Eye and Ear Infirmary of Mount Sinai (NYEE). The research, published in the March 12 issue of JAMA Otolaryngology-Head & Neck Surgery, provides a better understanding of the relationship between hearing loss and why people fall, especially in the elderly population. The findings could lead doctors to screen for hearing loss in patients at high risk for falls, detect hearing loss in its early stages, and treat it quickly.

Falls are the leading cause of deadly injuries in the United States.

"Prior studies have shown that hearing loss is an independent risk factor for falls, even for those who were not dizzy. However, the reason why has never been completely understood, although it is believed to be related to the inner ear. This study found that the sounds we hear affect our balance by giving us important information about the environment. We use sound information to keep ourselves balanced, especially in cases where other senses--such as vision or proprioception--are compromised," said senior author Maura Cosetti, MD, Associate Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai, and Director of the Ear Institute at NYEE. "Balance is complicated and involves the coordination of many different sensory inputs. When people fall, doctors typically focus on vision issues, check for neuropathy in their feet and bone issues, and fully ignore issues related to hearing. This review highlights the importance of hearing for our sense of balance. And because hearing loss is treatable, getting hearing checked is a crucial first step."

In this study, a team of researchers from Mount Sinai and New York University's Steinhardt School of Culture conducted a comprehensive analysis of all published research since inception (PubMed, Cochran Database of Scopus) that investigated the association between sound and standing balance. They looked at 28 medical articles involving more than 700 patients. Many of the studies focused on fields that clinicians who treat falls would not typically encounter, such as sound engineering, computer science, physics, and psychology. The authors combined all of the studies and looked for trends in the data.

The studies analyzed mostly healthy adults, but also looked at patients with congenital blindness, vestibular loss (damage to the inner ear causing balance and eye issues, including vertigo), and different levels of hearing loss. All research examined how sounds affected someone's ability to keep their balance while standing still, often with their eyes closed and when standing on a pliable, squishy surface. They also looked at how wearing noise-canceling headphones (a complete lack of sound) affected balance. Some studies played white noise or static, while others used environmental sounds such as cocktail party chatter or running water. They found that people had more difficulty staying balanced or standing still on an uneven surface when it was quiet, but had better balance while listening to sounds.

The authors found that the type of sound was important when it comes to balance. More specifically, continuous background noise (usually static) was the most helpful for subjects to keep their center of gravity. Some types of sounds actually caused poor balance; for example, some people who listened to sound jumping back and forth through headphones (i.e. beeping that went from left to right) had difficulty standing upright. The authors believe this may be because sound can act as an "auditory anchor." More specifically, people use sounds like white noise to help unconsciously create a mental image of the environment to keep ourselves grounded. The research analysis also showed that sound became more important for balance when the subjects were given difficult balancing tasks (e.g., standing on a moving floor) or if the patients had pre-existing sensory issues. When people with vision loss, hearing loss, or balance problems heard stationary sounds, their posture dramatically improved. This suggests people rely more on hearing when other senses are impaired.

"This research suggests that sounds can have a stabilizing effect on balance--maybe acting as an anchor that patients can lean on when other senses are less reliable--and shows that being unable to hear sounds resulted in poorer balance. Ultimately an inability to hear puts patients at higher risk for instability and falls," adds Dr. Cosetti. "Elderly patients have a number of factors that put them at greater risk of falling, and hearing loss is a significant and under-recognized contributor. Age related hearing loss is prevalent, affecting up to two-thirds of those over the age of 70, and should be considered and checked in those at high risk for falls. Future research will confirm whether treating that hearing loss (with hearing aids or other implants) will also serve as a type of 'balance aid' like a cane, giving access to important information that could be used to improve balance and decrease fall risk."

The analysis highlighted large gaps in research on hearing loss and balance. Future studies are needed that look at different levels of hearing loss, and how hearing aids and cochlear implants affect balance. The researchers added that more studies using everyday sounds like traffic or shopping malls or airports are necessary to understand more about fall risks in people with hearing loss. Also, more studies focused on older adults need to be conducted.
-end-
About the Mount Sinai Health System

The Mount Sinai Health System is New York City's largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care--from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty by U.S. News & World Report.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

The Mount Sinai Hospital / Mount Sinai School of Medicine

Related Hearing Loss Articles from Brightsurf:

Proof-of-concept for a new ultra-low-cost hearing aid for age-related hearing loss
A new ultra-affordable and accessible hearing aid made from open-source electronics could soon be available worldwide, according to a study published September 23, 2020 in the open-access journal PLOS ONE by Soham Sinha from the Georgia Institute of Technology, Georgia, US, and colleagues.

Ultra-low-cost hearing aid could address age-related hearing loss worldwide
Using a device that could be built with a dollar's worth of open-source parts and a 3D-printed case, researchers want to help the hundreds of millions of older people worldwide who can't afford existing hearing aids to address their age-related hearing loss.

Understanding the link between hearing loss and dementia
Scientists have developed a new theory as to how hearing loss may cause dementia and believe that tackling this sensory impairment early may help to prevent the disease.

Study uncovers hair cell loss as underlying cause of age-related hearing loss
In a study of human ear tissues, scientists have demonstrated that age-related hearing loss is mainly caused by damage to hair cells.

Hair cell loss causes age-related hearing loss
Age-related hearing loss has more to do with the death of hair cells than the cellular battery powering them wearing out, according to new research in JNeurosci.

How hearing loss in old age affects the brain
If your hearing deteriorates in old age, the risk of dementia and cognitive decline increases.

Examining associations between hearing loss, balance
About 3,800 adults 40 and older in South Korea participating in a national health survey were included in this analysis that examined associations between hearing loss and a test of their ability to retain balance.

Veterinarians: Dogs, too, can experience hearing loss
Just like humans, dogs are sometimes born with impaired hearing or experience hearing loss as a result of disease, inflammation, aging or exposure to noise.

Victorian child hearing-loss databank to go global
A unique databank that profiles children with hearing loss will help researchers globally understand why some children adapt and thrive, while others struggle.

Hearing loss, dementia risk in population of Taiwan
A population-based study using data from the National Health Insurance Research Database of Taiwan suggests hearing loss is associated with risk of dementia.

Read More: Hearing Loss News and Hearing Loss Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.