A convenient place to tuck stray hair, holders to display chic jewelry, the means of hearing a symphonic orchestra…indeed, our ears serve a multitude of functions! Learn how a sense of balance also requires proper functioning of our ears, and how to address the issue with aging clients.

Auditory Anatomy

The ear in itself is a very complex organ, interpreting sound signals and sending them to the brain for processing. Located deep within the ear canal lies a maze-like structure known as the labyrinth. Tissue and bone combine in this highly complex and delicate wonder, and together with the cochlea (control center for hearing) bears the responsibility for maintaining the body’s sense of balance.

The canals that comprise these inner workings of the ear resemble loops, each with its own set of movement responsibilities. The 3 types of movement required for a stable sense of proprioception are up-and-down, tilting, and side-to-side motion. Fluid is contained within these tube-like structures, which are lined with cilia, or tiny micro-hairs. Any movement on one’s part causes the fluid to flow in one direction or another; the cilia can perceive such dynamics and send appropriate signals to the brain. This process enables the body to sense the occurrence of movement relative to its surroundings, all the while keeping the body upright and “balanced” comfortably.

Hearing and Spatial Sensation

The term proprioception refers to one’s awareness of his body parts and their relation to his surroundings. Some choose to think of this dynamic as one’s positional sense. Working in consort with both the vestibular and visual systems, the human body gains awareness of its position with respect to gravity. In this manner, the brain learns to coordinate these systems, helping to explain the reason we do not experience a continuous blurring of vision as we move through life.

Clearly, if one of these systems malfunctions to any degree, a situation known as a balance disorder occurs. Individuals suffering from such a disorder describe experiencing any or all of the following: feeling dizzy and unsteady, blurred vision, disorientation, confusion, fainting, and even panic or fear.

Understanding Balance Disorders

Considering that the coordination by the brain of multiple organs contributes to our sense of balance, we can understand how any disruption in the inner ear may contribute to a balance disorder. This can result from ear infections, poor blood flow/circulation within the inner ear, Meniere’s Disease, a traumatic head injury, or ototoxicity (chemically-induced inner ear damage due to any of a variety of medications).

Where does the audible process come into play with regard to balance? Some experts feel that hearing loss may in fact contribute significantly to balance problems. Others claim that hearing loss itself may not bear all the blame, but that issues within the ear, as mentioned above, contribute as well. Not all those who experience difficulties with balance suffer from hearing loss; likewise, compromised auditory abilities do not always present with balance disorders. Dr. Nathan Pierce, a head and neck surgeon whose interest lies in diseases of the inner ear and their ramifications, fully endorses this sentiment.

Real-Life Scenarios

A study conducted at the Washington University School of Medicine in St. Louis, MO highlighted how hearing capabilities play a significant role in maintaining equilibrium, or center of balance. The study included 14 participants, all older adults who suffered differing degrees of hearing loss. Interestingly, those subjects who wore hearing aids demonstrated an ability to maintain their balance while on a padded surface for a full 10 seconds longer than their counterparts without hearing aids, many of whom lacked the ability to balance for even 20 seconds. The scientists concluded that better hearing could go a long way towards helping seniors to minimize falls, events which so often pose serious or life-threatening situations.

While a majority of the public accepts the notion that diminished hearing acuity comes naturally as we age, it can present itself separately or as a comorbid situation. Either way, approximately 30% of hearing-impaired individuals suffer some degree of balance problems. A condition known as nerve deafness, or sensorineural hearing loss (often referred to in medical literature as SNHL), constitutes the majority of all hearing loss, and up to 23% of hearing impairment issues experienced by individuals over 65.

As trainers, we may have an opportunity to work with individuals whose age may predispose them for diminished hearing. Not all seniors sport hearing aids, often thinking of such devices as “just for old folks”, a category into which they often struggle to place themselves. We may find the need to speak more slowly to these clients, with greater attention paid to volume and enunciation of words. If you have encountered such situations, an ounce of preparedness can go a long way towards designing exercises to help foster self-efficacy with regard to balance issues.

Caring Safely for Compromised Seniors

Caregivers and personal trainers who regularly interact with senior adults most likely will encounter Benign Paroxysmal Positional Vertigo (BPPV) at some point in time. The National Institutes of Health ranks BPPV among the most common of all balance disorders. Tending to affect individuals over 60 years of age, the major symptom presents as intense vertigo with any movement of the head. Like most inner ear disturbances, BPPV can come on as a result of a basic ear infection.

A study entitled “Hearing Loss and Falls Among Older Adults in the United States” was undertaken in 2017 by Dr. Frank Lin from Johns Hopkins School of Medicine and his partner Luiggi Ferrucci. These scientists enlisted subjects between the ages of 40 and 69. Hearing and vestibular function were both assessed, with note-worthy results: 14.3% of the participants demonstrated hearing loss greater than 25 decibels.

With regard to balance, 4.9% of these subjects reported experiencing at least 1 fall within the past 12 months. Probably the most stunning discovery from this study revealed that those who experienced even a somewhat minor hearing loss tripled the risk of suffering a fall. From this level, the risk increased by 140% for each 10 decibels of hearing loss.

Hearing, Balance, and Cognition

There are three major hypotheses for how hearing loss may exert a negative effect on balance. Individuals suffering with compromised hearing tend to have a decreased sense of awareness of their environs. As such, they may tend not to notice/focus upon other people, animals or even activities occurring around them or possibly in the way of their movement pattern.

Since hearing loss lessens spatial awareness, the ability to gauge one’s body in relation to surrounding obstacles gets challenging, and may point to the reason so many senior adults experience falls more often than younger individuals with more acute hearing. If we consider the amount of brainpower associated with straining to hear and process conversations with others, even those within close proximity, hearing impairment renders less of the brain’s resources available for maintaining balance.

“Gait and balance are things most people take for granted, but they are actually very cognitively demanding,” Dr. Lin says. “If hearing loss imposes a cognitive load, there may be fewer cognitive resources to help with maintaining balance and gait.”

How We Can Help

If you work with, or help care for, senior adults between the ages of 65 and 74, knowing that 33% of them live with some degree of hearing loss increases the need for balance-related exercises in their workout plans. If we couple this with the statistic that among older adults, falls represent the most common cause of trauma-related hospital admissions, we begin to see a very accurate picture emerging…and most importantly, a manner in which we can address these issues and prolong the health and well-being of our ageing clientele.


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  12. www.nidcd.nih.gov/health/hearing-loss-older-adults

Cathleen Kronemer

Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at trainhard@kronemer.com. She welcomes your feedback and your comments!