Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Division of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
Ear Hear. 2022 May/Jun;43(3):1003-1012. doi: 10.1097/AUD.0000000000001156.
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.
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.
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 falls-associated 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.
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 nonvestibular dizziness were independently associated with falls relative to a group of patients without dizziness. A population-based study utilizing more robust falls data is needed to explore a potential association between HL and falls in those with vestibular dysfunction.
尽管新出现的证据表明听力损失（HL）是跌倒的独立危险因素，但尚不清楚 HL 如何影响前庭功能障碍和非前庭性头晕患者的跌倒风险。本研究的目的是描述 HL 对前庭功能障碍和非前庭性头晕患者跌倒的影响，并与无头晕患者进行比较。此外，本研究旨在评估 HL 与前庭功能障碍或非前庭性头晕之间是否存在交互作用，影响跌倒的几率。
作者对 2015 年 6 月 1 日至 2020 年 10 月 7 日在三级护理中心前庭诊所就诊的 2750 例头晕成年患者进行了回顾性横断面研究。仅纳入了从电子病历中提取的有自我报告跌倒状态的患者。根据转椅测试和视频眼震图，患者被分为以下诊断组：良性阵发性位置性眩晕（BPPV，n=255）、单侧前庭功能低下（UVH，n=456）、双侧前庭功能低下（BVH，n=38）、中枢性功能障碍（n=208）、多种诊断（n=109）和头晕，非前庭性（n=1389）。通过对听力患者的随机抽样，确定了无头晕患者（n=295）的对照组。HL 的程度通过较好耳的 4 个频率纯音平均值（0.5、1、2 和 4 kHz）（PTA）来描述。从电子病历中提取人口统计学变量、合并症、认知障碍状态和与跌倒相关的药物，并在分析中作为协变量。使用多变量逻辑回归探讨 PTA 与跌倒状态之间的潜在关联，以及诊断组与 PTA 之间可能存在的相互作用。
BVH 和中枢性功能障碍组的自我报告跌倒率最高，分别为 26.3%和 26.9%。对照组的自我报告跌倒率最低，为 6.4%。除了多种诊断组，所有诊断组与对照组相比，跌倒的几率都更高，在调整了人口统计学、合并症、认知障碍状态和与跌倒相关的药物后。当调整诊断组和所有其他协变量时，HL 程度与跌倒状态之间没有显著关联（比值比[OR]=1.02；95%置信区间[CI]，0.93~1.11；p=0.713）。此外，在跌倒的几率方面，诊断组和 HL 程度之间没有显著的交互作用。
这些结果表明，在调整了人口统计学、合并症和与跌倒相关的药物后，HL 与前庭功能障碍或非前庭性头晕患者的跌倒无关。HL 与前庭功能障碍或非前庭性头晕之间也没有观察到显著的交互作用对跌倒几率的影响。如前所述，前庭功能障碍和非前庭性头晕与无头晕患者相比，与跌倒独立相关。需要进行一项基于人群的研究，利用更可靠的跌倒数据来探讨 HL 与前庭功能障碍患者跌倒之间的潜在关联。
