Falls constitute one of the most severe but preventable public health conditions around the world. As the population grows older, the problem is even more critical, with significant consequences for the morbidity, mortality, and health-related quality of life of older adults. In a landmark article published in JAMA Otolaryngology–Head & Neck Surgery in March 2025, Dr. Brian Sheng Yep Yeo and colleagues conducted a systematic review and meta-analysis of a vitally underappreciated risk factor—hearing loss (HL)—and its relationship with falls.
A Timely and Complete Inquiry
This systematically conducted research—registered on PROSPERO and according to the PRISMA standards—synthesised data from 27 observational studies, encompassing over 5 million people from Asia, North America, Europe, and Oceania. By confining the analysis to covariate-adjusted estimates, the authors minimized confounding variables, making their results of increased clinical and statistical significance.
Their results were compelling and concerning: individuals with hearing impairment had 51% greater cross-sectional odds and 17% greater longitudinal risk of falls compared with those with normal hearing. Importantly, these associations were still robust after adjustment for the presence of other sensory deficits, namely vision impairment and vestibulopathy—two known fall risk factors.
Methodological Strengths
One of the strongest aspects of this meta-analysis is its methodological robustness. The analysis employed a random-effects model for the purpose of handling clinical heterogeneity and meta-regression and subgroup analysis for the investigation of potential modifiers like age, hearing assessment technique, and geographic location. Publication bias was also handled by the authors with Egger’s test and the trim-and-fill approach, and no distortions were noted.
The inclusion of individuals with validated audiometric testing and individuals with self-reported hearing impairment is especially important because it captures a real-life nuance: most individuals underreport hearing impairment, seeing it as a benign part of aging. The association of HL with falls was, however, significant across testing modalities, emphasizing the insidious and pervasive nature of untreated hearing impairment.
Mechanisms relating hearing and balance
Yeo et al. examine possible biological and behavioral processes underlying the association of HL with falls. Hearing impairment can lower auditory spatial information, which is valuable for keeping track of the surroundings and balance. Second, the cognitive load hypothesis proposes that individuals with HL devote extra cognitive resources to communication, with less available for balance and navigation. Third, HL is also linked with greater brain atrophy, especially of the brain regions involved with balance and coordination.
The authors also identify shared systemic risk factors—such as diabetes, cardiovascular disease, and microvascular damage—that can impact hearing function and balance concurrently. Even after controlling for such comorbidities, however, the relationship of HL with fall risk also remained, suggesting a more direct and potentially modifiable relationship.
Implications for Public Health and Clinical Practice
The authors’ conclusions have important implications. If HL is a modifiable fall risk factor, it would be of greater importance in the assessment of falls in the elderly and prevention of falls. With the estimated burden of untreated HL being greater than 1.5 billion people worldwide, and falls remaining a leading cause of injury-related mortality among the elderly, the incorporation of hearing care into fall prevention is potentially a paradigm shift.
While effective hearing rehabilitation devices such as hearing aids and cochlear implants are available, their usage is low due to stigma, cost, and low levels of awareness. The argument for greater usage and even regular hearing screening for older individuals, particularly those at risk of falling, is strengthened by this work.
Appreciating a landmark contribution
Dr. Yeo and his team of researchers from a number of institutions—Singapore General Hospital and Massachusetts Eye and Ear being two of them—set a new benchmark for multidisciplinary otolaryngologic and geriatric research. Their paper is not only statistically robust and clinically astute, but also deeply relevant for public health globally.
The JAMA Otolaryngology–Head & Neck Surgery editorial board is also to be praised for highlighting this important subject. By publishing this work, they reinforce a message that clinicians, caregivers, and policymakers need to hear: Hearing loss is not just a sensory annoyance—it is a sentinel for other systemic risks, like falls. Looking Forward While the data is strong, the authors rightly call for further randomized, controlled trials testing the hypothesis that hearing interventions can lower the risk of falling. Ethical and practical barriers exist for designing such studies, but their potential for guiding practice and redefining preventive care makes the effort worthwhile. At the same time, this meta-analysis should encourage health systems to integrate hearing health into the core of aging care. Falls can never be completely eliminated, but with improved hearing and improved strategies, we can certainly reduce their frequency—and their impact on human life.
Reference:
Dr. Prahlada N.B
MBBS (JJMMC), MS (PGIMER, Chandigarh).
MBA in Healthcare & Hospital Management (BITS, Pilani),
Postgraduate Certificate in Technology Leadership and Innovation (MIT, USA)
Executive Programme in Strategic Management (IIM, Lucknow)
Senior Management Programme in Healthcare Management (IIM, Kozhikode)
Advanced Certificate in AI for Digital Health and Imaging Program (IISc, Bengaluru).
Senior Professor and former Head,
Department of ENT-Head & Neck Surgery, Skull Base Surgery, Cochlear Implant Surgery.
Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India.
My Vision: I don’t want to be a genius. I want to be a person with a bundle of experience.
My Mission: Help others achieve their life’s objectives in my presence or absence!
My Values: Creating value for others.
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