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Hearing Aids and Balance Improvement

McDaniel, D., Mike, PhD; Motts, Susan, D., PhD; Neeley, Richard, A., PhD, PT

doi: 10.1097/01.HJ.0000532389.67934.64
Editorial
Free

From left, Dr. McDaniel and Dr. Neeley are professors of communication disorders at Arkansas State University (ASU), where Dr. Motts is an associate professor of occupational therapy. Dr. McDaniel is a life member of ASHA. Dr. Mott's research includes brainstem neural circuitry and photobiomodulation. Dr. Neeley served as the program director of ASU's Communication Disorders department for 16 years.

The possibility of using conventional hearing aids and other amplification techniques to enhance the postural integrity and/or balance of people with hearing loss is alluring but, for the present, such claims are potentially misleading. Two recent studies, using similar research designs and relatively small sample sizes, resulted in entirely different conclusions (Laryngoscope. 2015 Mar;125(3):720; Am J Audiol. 2018 Jan 21:1). Results from the Rumalla, et al., study, though failing to reach statistical significance, led the authors to speculate that the use of hearing aids was a novel treatment modality for individuals with hearing impairments and concurrent balance or postural disorders (Laryngoscope. 2015). McDaniel, et al., concluded that hearing aids did nothing to positively (or negatively) affect balance in participants who used them (Am J Audiol. 2018).

Both studies used a within group (i.e., one group of participants) of experienced hearing aid users who were assessed with and without their hearing aids. McDaniel, et al., used balanced testing conditions to guard against order effects. Rumalla, et al., utilized a pseudorandomized set of conditions (aided or unaided) and trials. The primary difference between the two studies was the method by which balance was quantified. Rumalla, et al., utilized the Romberg on Foam test and the Tandem Stance test, both of which are timed screening tools. McDaniel, et al., used computerized posturography (i.e., the Sensory Organization Test) performed on a NeuroCom Balance Master. Both studies share similar limitations concerning convincing sample sizes and criterion for participation selection. Their relatively small sample sizes raise the question of statistical power, thereby increasing the possibility of a type II error. This limitation may have masked a true difference between the aided and unaided conditions. Additionally, the use of only older adults with some hearing aid experience and no diagnosed balance disorders limits the population to which results can be generalized.

There are notable empirical evidence on hearing aid benefit with regard to quality of life and cognitive preservation. Lacerda, et al., observed improvements in the quality of life gained from auto-confidence with auditory prosthetics that reduce the fear of falling (Int Arch Otorhinolaryngol. 2012 Apr; 16(2): 156). Wingfield and Peelle reported that “time-consuming, large-scale, long-term, prospective, longitudinal studies are likely needed to clarify the potential benefit of hearing aids for maintaining cognitive function” (Aging health. 2012 Apr; 8(2): 107).

Research on the potential benefit of hearing aid use in improving balance appears to mirror the research on whether hearing aid use can maintain or improve cognitive function and quality of life.

McDaniel, et al., urged that “…caution should be exercised by hearing aid dispensing clinicians as they counsel potential hearing aid users that amplification (i.e., hearing aids) might improve their balance.” As hearing health care providers, an additional level of caution should be encouraged. Restraint should be exercised, and everyone in the industry should be vigorously encouraged to follow suit. Unfortunately, there is evidence that this restraint is not being fully utilized. One has only to google “hearing aids and balance improvement” to find an array of potentially misleading headlines.

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