The Unknown Importance of Hearing Exams

Hearing - or lack of - and inner ear problems impact balance, walking, perception, and thinking, and may require medical treatment.

Helpful Highlights

  • A lot more goes on in the ears than hearing loss.

  • Hearing loss is also more than being unable to hear the TV or conversation. It impacts safety and understanding of body position.

  • Additionally, inner ear problems cause more than hearing loss. They can affect perception and thinking, as well as walking and balance.

  • Older adults are also susceptible to excessive wax build-up and even ear infections.

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Many people believe that they hear just fine, and perhaps they do.  Most do not know, however, that they have actually lost their ability to hear high frequencies, and some come to accept that muffled sound is normal.

Issues in the inner ear also cause balance problems.  Sometimes what we think is a musculoskeletal cause of imbalance (pain or weakness) may be an inner ear disorder.  Finally, modifiable factors that contribute to hearing loss, such as certain medications and environmental factors, can be addressed.

Wax (cerumen) build-up and infection

With age, ear wax (cerumen) tends to become harder and less mobile, making older adults more likely to have problems with too much of it. Excess ear wax can cause a blockage in the ear canal, resulting in itching, pressure, pain, ringing, hearing loss, dizziness, and an increased risk of infection. Some even experience a nagging reflex cough. See a provider and have the wax cleared. Do not stick anything in your loved one's ear to attempt to clear the wax.

Ear infections are also a common issue among older adults, most often infection of the middle ear. Symptoms include an ear or ear canal that is painful, swollen, and tender to the touch, possibly with a thick liquid discharge. The skin of the outer ear, as well as around the ear, may become red and warm until the infection goes away. While some ear infections may resolve on their own, for those lasting more than 2-3 days, it is best to have it evaluated by a provider. Do not use old-time remedies to try and resolve the infection.

Hearing loss

Our ability to hear provides us valuable clues about the world around us, as we receive signals of our location, a sense of direction, and even indications of danger from what we hear. Difficulty hearing certain tones, sounds, or voices increases your loved one's risk of harm or injury. Think of situations like driving or mowing, or while walking in places like intersections, crowded venues, or outdoors.

Natural hearing loss simply from old age is called presbycusis and next to impacted ear wax, it is the most common cause of hearing loss in older adults.

Hearing loss involves more than sound

Hearing loss resulting in sensory, balance, and motor deficits can lead to falls. Even a mild degree of hearing loss triples the risk of an accidental fall. And this risk increases by 140 percent for every additional 10 decibels of hearing loss.

Likewise, hearing loss impacts what's called proprioception (our ability to keep track of where our body parts are in space), and our brain's natural ability to conduct spatial mapping of our surroundings (creating memory maps).

The vestibular system

Researchers and specialists in this area consider the vestibular system to be our true sixth sense because it functions at an almost unconscious level.

The vestibular system aids in hearing, though its primary purpose is to provide our sense of balance by constantly sending information to the brain about our body position. This allows for rapid, reactive body movements (called compensatory movements). Some are so small as to go undetected, such as while casually walking, and others are quite large, such as outstretching our arms when we fall.

When the brain doesn't receive accurate signals about body position, and the ability to make rapid, reactive adjustments - whether large or small - is disrupted, it becomes difficult to keep our footing, stabilize and remain upright if tripped, and prevent stumbling into things or falling.

When the vestibular system is clogged, inflamed, swollen, or damaged - such as with an ear infection - it can also affect our balance and compensatory movements.


Otoconia are tiny calcium crystals that rest in a sensory organ in the inner ear called the utricle. When the crystals are dislodged from the utricle and flow freely in the fluid spaces of the inner ear (the vestibular system), it causes sensitivity to head movements and position changes that don't normally affect us. This creates dizziness and vertigo - the feeling of spinning even when not moving - and puts your loved one at risk for nausea and vomiting, bumps and bruises, and worst of all falls. Dizziness and vertigo can strike at any age, though are more common as we get older.

Hearing exams test for more than hearing

Hearing loss alone is reason enough to encourage your loved one to get a yearly hearing exam, though perhaps more importantly, hearing exams can also detect vestibular system disorders. Both hearing health and vestibular health are essential for your loved one's safety and well-being because, additionally, they can contribute to anxiety and depression, and impact socialization.

Early detection of problems gives your loved one and their healthcare team a better chance to address them and either reduce their effects or, in some cases, reverse them.




Cleveland Clinic

Harvard Medical School

Johns Hopkins Medicine

Li, W., Fend, Z., Sternberg, P.W., & Shawn Xu, X.Z. (2006). A C. elegans stretch receptor neuron revealed by a mechanosensitive TRP channel homologue. Nature, 440(7084), 684-687. DOI: 10.1038/nature04538

Mayo Clinic

University of Michigan. (2006, April 03). The sixth sense--your place in space. Retrieved from:

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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