Hearing Loss and Falls: A Systematic Review and Meta-Analysis

Brian Sheng Yep Yeo; Vanessa Yee Jueen Tan; Jia Hui Ng; Joyce Zhi’en Tang; Brenda Ling Hui Sim; Yu Ling Tay; Anupama Roy Chowdhury; Abel P David; Nicole T Jiam; Elliott D Kozin; Steven D Rauch

doi:10.1001/jamaoto.2025.0056

. 2025 Mar 20;151(5):485–494. doi: 10.1001/jamaoto.2025.0056

Hearing Loss and Falls

A Systematic Review and Meta-Analysis

Brian Sheng Yep Yeo ^1,^✉, Vanessa Yee Jueen Tan ^2,^✉, Jia Hui Ng ², Joyce Zhi’en Tang ², Brenda Ling Hui Sim ², Yu Ling Tay ³, Anupama Roy Chowdhury ³, Abel P David ^4,⁵, Nicole T Jiam ^4,⁵, Elliott D Kozin ⁴, Steven D Rauch ⁴

PMCID: PMC11926736 PMID: 40111358

Key Points

Question

Is hearing loss (HL) associated with falls?

Findings

In this systematic review and meta-analysis of 27 studies and more than 5 million participants, HL was associated with a 51% greater cross-sectional odds and 17% greater longitudinal risk of falls compared with individuals without HL.

Meaning

HL may be a risk factor for falls; physicians and policymakers should be aware of the ramifications of hearing health on aging and explore the potential role of hearing intervention for fall prevention.

This systematic review and meta-analysis evaluates the evidence surrounding the impact of hearing loss on falls.

Abstract

Importance

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.

Objective

To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.

Data Sources

PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.

Study Selection

Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.

Data Extraction and Synthesis

Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.

Main Outcomes and Measures

The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.

Results

A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I² = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I² = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.

Conclusions and Relevance

This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

Introduction

Falls represent a major global public health concern as well as a persistent risk to morbidity and mortality across all ages,¹ ranking as one of the most prevalent causes of disability from injuries globally.² The issue of population aging accentuates concerns about falls, particularly among older adults,³ as epidemiological research suggests that the global burden of falls is most pronounced in this demographic.¹ Falls are defined as an unexpected event where an individual comes to rest on the ground, the floor, or a lower level.⁴ The majority of falls result from a combination of factors that increase an individual’s susceptibility to falling, along with acute mediating factors that create the opportunity for a fall.⁵

Hearing loss (HL) is a highly prevalent condition associated with aging and has emerged as a significant global health concern, particularly due to its link with cognitive impairment and dementia⁶ and its potential role as a modifiable risk factor for various age-related conditions.^7,8 Presently, the relationship between HL and falls is inconclusive. While various studies suggest that HL may be an independent risk factor for falls,^9,10 others contend that it may not significantly influence the propensity to fall or that the risk of falling may be mediated through confounding factors, such as visual impairment, vestibulopathy, and cognitive decline.^11,12 Therefore, a thorough review and synthesis of current evidence may add clarity to preexisting literature.

The objective of this study is to systematically review the preexisting literature and pool their data in a meta-analysis to determine the association of HL with cross-sectional odds and longitudinal risk of falls. Given the considerable public health concern surrounding the morbidity and mortality associated with falls,¹ establishing HL as a potentially modifiable risk factor may further emphasize the importance of addressing hearing health. We hypothesize that HL may be an independent risk factor for falls, and a cohesive summary and analysis of existing literature on this subject is both clinically relevant and timely.

Methods

This systematic review and meta-analysis was registered on PROSPERO (CRD42024534255). This research adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.¹³

Data Sources and Searches

We conducted a comprehensive search of 3 databases (PubMed, Embase, and Cochrane Library) from database inception to April 9, 2024, using search terms pertaining to HL and falls and their relevant synonyms. The full search strategy is provided in eTable 1 in Supplement 1.

Study Selection

The study selection process by titles and abstracts, followed by full-text review, was conducted by 2 of us (B.S.Y.Y. and V.Y.J.T.), with disagreements resolved through the consensus of another independent author (J.H.N., J.Z.T., or B.L.H.S.). Based on the Population, Intervention, Comparators, Outcomes framework,¹⁴ we selected studies that met the following inclusion criteria: (1) adults 18 years older with HL; (2) HL identified using validated clinical methods, such as pure-tone audiometry and International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes, or through self-reported measures such as questionnaires; (3) falls identified either through self-reported measures or hospitalization records; (4) the outcomes of interest being the cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL. We included observational studies published as full-length English-language articles in peer-reviewed journals, reporting covariate-adjusted estimates to minimize confounding.

We excluded studies that did not meet the inclusion criteria, as well as duplicates, case reports, case series, reviews, meta-analyses, letters, conference abstracts, pediatric studies, animal studies, non–English-language studies, studies with incomplete data, and studies lacking a clear definition of HL. In instances where multiple studies satisfying our inclusion criteria used data from the same overarching cohort, we included the study with the largest sample size.

Data Extraction

The data of interest from the included articles were extracted by 2 of us (B.S.Y.Y. and V.Y.J.T.) using a structured template. The details of data extraction were verified by another independent author (J.H.N., J.Z.T., or B.L.H.S.). This includes the information pertaining to study design, baseline population characteristics, method of measuring hearing function, HL criteria, method of evaluating for falls, duration for reporting falls, study outcomes, type of statistical reporting ratio used, covariate-adjusted ratios and their respective 95% CIs, and the list of confounders accounted for.

Data Synthesis and Statistical Analysis

All statistical analyses were performed using R Studio version 4.0.3 (Posit PBC) using the meta and metafor packages.¹⁵ We used a random-effects model to pool covariate-adjusted ratios to account for anticipated clinical heterogeneity.¹⁶ Whenever feasible, generalized linear mixed models with logit-transformed data were used to prevent errors associated with the double-arcsine transformation. Thompson I² values and the Cochran Q test were adopted to assess for heterogeneity, where an I² value of 25%, 50%, and 75% represented low, moderate, and high degrees of heterogeneity, respectively, and a τ² P value of .10 or less was considered significant for heterogeneity.^17,18 To directly quantify heterogeneity, τ² was concurrently estimated, as I² is known to artificially increase with larger sample sizes even when heterogeneity remains constant.¹⁷ Unless otherwise specified, a 2-sided P value less than .05 was considered statistically significant.

Additional prespecified subgroup analyses and sensitivity analyses were conducted to identify potential sources of heterogeneity when sufficient information was available. The subgroup analyses included self-reported vs validated clinical methods of determining HL, the duration for reporting falls, and the geographical continent of study. We also pooled studies that exclusively included community-dwelling individuals as well as those that specifically adjusted for other sensory deficits established as risk factors for falls by the World Falls Guideline,¹⁹ including vision impairment and dizziness or vestibulopathy.

Further leave-1-out influence analyses and cumulative analyses were conducted to examine the effect of individual studies on the overall findings and ascertain the stability of published data over time, respectively. Whenever a minimum of 10 studies were pooled per outcome, meta-regression was performed to account for other potential confounding variables, including age, gender, and follow-up duration. We evaluated for publication bias qualitatively by visually inspecting for funnel plot asymmetry and quantitatively using the Egger regression test.^20,21 The trim-and-fill method was used to input potentially missing studies.²²

Quality Assessment

The risk of bias in observational studies was appraised by 2 independent authors (B.S.Y.Y. and V.Y.J.T.) using the Newcastle-Ottawa Scale (NOS), with differences resolved through the consensus of another independent author (J.H.N., J.Z.T., and B.L.H.S.).²³ Separate NOS scales were used for cross-sectional, cohort, and case-control studies. The studies were categorized as low, moderate, or high risk of bias based on their scores of 8 or more, 5 to 7, and less than 5 points, respectively. The overall quality of pooled evidence at the outcome level was assessed using the Grading of Recommendations, Assessment, Development and Evaluations framework.^24,25

Results

The initial literature search of PubMed, Embase, and Cochrane Library found 3372 studies, of which 270 duplicates were removed. The titles and abstracts of 3102 unique articles were screened, of which 3025 were excluded. Subsequently, the full texts of 77 remaining articles were assessed for eligibility, and 48 articles were further excluded. We included 27 articles comprising 5 071 935 participants. The PRISMA flowchart of study inclusion can be found in Figure 1.

Study Characteristics

Approximately 49.2% of participants were female. Geographically, 14 studies were conducted in Asia,^{11,26,27,28,29,30,31,32,33,34,35,36,37} 7 in North America,^{10,12,38,39,40,41} 3 in Europe,^42,43,44 and 3 in Oceania, represented by Australia.^45,46,47 There were 15 cross-sectional studies, 11 cohort studies, and 1 case-control study. All studies included community-dwelling adults except those by Shen et al³³ and Tiase et al,⁴⁰ which included institutionalized adults. eTable 2 in Supplement 1 presents the key characteristics extracted from the included studies. Based on the NOS, 3 studies had a low risk of bias, 24 studies had a moderate risk of bias, and none had a high risk of bias (eTables 3 to 5 in Supplement 1). The overall quality of evidence per outcome according to the Grading of Recommendations, Assessment, Development and Evaluations framework was low (eTable 6 in Supplement 1).

Assessment of Hearing Function and Ascertainment of Falls

The hearing function of participants was measured using validated clinical methods, such as pure-tone audiometry in 9 studies, while 18 studies used self-reported measures to determine HL, such as patient questionnaires. Separately, the outcome of prevalent falls was investigated in 20 studies, of which 18 relied on self-reported questionnaires, while 2 studies (Shen et al³³ and Tiase et al⁴⁰) used an item of the Morse Fall Scale. The outcome of incident falls was examined by 9 studies, of which those by Deal et al¹⁰ and Tonelli et al⁴⁸ used ICD-9 and ICD-10 codes to identify falls, while the remaining 7 studies used self-reported measures. eTable 2 in Supplement 1 outlines the methods of measuring hearing function and identifying falls in greater detail.

Longitudinal Association of HL and Incident Falls

HL was associated with a 17% greater longitudinal risk of falls compared with individuals without HL (risk ratio, 1.17; 95% CI, 1.06-1.29; I² = 69%; 9 studies) (Figure 2).^{10,11,32,36,37,42,45,46,48} Further meta-regression analyses outlined that age, but not gender and follow-up duration, was a significant moderator of the overall effect size (eTable 7 in Supplement 1). While age did not account for any additional heterogeneity, the pooled effect size increased by a factor of 0.29 (95% CI, 0.02-1.15) per year of increase in the mean age. The leave-1-out influence analysis revealed that the exclusion of any single study did not affect the overall significance of the pooled effect size (eFigure 1 in Supplement 1), and cumulative meta-analysis outlined the stability of the pooled result over time (eFigure 2 in Supplement 1). While visual inspection outlined possible funnel plot asymmetry, there was no evidence of publication bias based on the Egger regression test (intercept = −1.64; P = .14) (eFigures 3 and 4 and eTable 7 in Supplement 1). Additional trim-and-fill analysis did not input any potentially missing studies (eTable 8 in Supplement 1).

Cross-Sectional Association of HL and Prevalent Falls

HL was associated with a 51% greater cross-sectional odds of falls compared with individuals without HL (odds ratio [OR], 1.51; 95% CI, 1.37-1.67; I² = 64%; 20 studies) (Figure 3).^{11,12,26,27,28,29,30,31,33,34,35,38,39,40,43,44,47,49} The cross-sectional odds of falls were greater among studies using validated measures of hearing assessment (OR, 2.01; 95% CI, 1.50-2.69; I² = 58%; 4 studies) than studies that assessed hearing using self-reported measures (OR, 1.43; 95% CI, 1.30-1.57; I² = 56%; 16 studies) (Figure 3). The results also remained robust to other subgroup analyses of duration for reporting falls and geographical continent (eFigures 5 and 6 in Supplement 1). HL was also associated with a greater cross-sectional odds of falls among exclusively community-dwelling adults (eFigure 7 in Supplement 1).

Crucially, HL was still associated with an increased cross-sectional odds of falls in studies that corrected for vision impairment (OR, 1.47; 95% CI, 1.28-1.69; I² = 37%; 11 studies) (Figure 4A)^{11,26,27,30,31,33,34,39,41,47,49} and dizziness or vestibulopathy as a confounder (OR, 1.77; 95% CI, 1.38-2.27; I² = 0%; 3 studies) (Figure 4B).^30,34,39 Importantly, no significant heterogeneity was observed among studies that exclusively adjusted for these sensory impairments.

Using meta-regression, age was identified as a significant effect moderator of the effect size, accounting for 100% of heterogeneity. The pooled OR increased by a factor of 0.13 (95% CI, 0.22-0.74) per year of increase in the mean age. However, gender did not affect the overall observed effect size (eTable 7 in Supplement 1).

Further leave-1-out influence analysis outlined that the omission of any study did not alter the overall significance of the pooled effect size (eFigure 8 in Supplement 1), and cumulative meta-analysis demonstrated stability of the pooled result and narrowing of the 95% CI range over time (eFigure 9 in Supplement 1). There was no funnel plot asymmetry detected by visual inspection or Egger regression test (intercept = 0.54; P = .60) and thus no evidence of publication bias (eFigures 10 and 11 and eTable 8 in Supplement 1). While the trim-and-fill analysis added 2 additional studies, there were no changes to the significance of the overall effect size (OR, 1.46; 95% CI, 1.32-1.61; I² = 69%) (eTable 8 in Supplement 1).

Discussion

This systematic review and meta-analysis of 27 studies and 5 071 935 participants found that HL may be associated with increased cross-sectional odds and longitudinal risk of falls compared with adults without HL. HL may be an independent risk factor for falls after adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline, including visual impairment and dizziness or vestibulopathy. These results remained robust to a variety of subgroup and sensitivity analyses, and no evidence of publication bias was observed. The present study expands on preexisting literature on the relationship between HL and falls and underscores the importance of recognizing HL as a risk factor for falls among other more well-established risk factors.⁵⁰

To our knowledge, this comprehensive evidence-based summary of the literature on the association between HL and falls to date is the first meta-analysis to aggregate the longitudinal relationship between HL and falls. The cross-sectional association between HL and falls was previously pooled in a meta-analysis of 12 studies by Jiam et al⁵¹ in 2016, who found that older adults with HL had 2.39-fold greater odds of falling than older adults with normal hearing. However, the authors acknowledged that their findings were limited by a scarcity of well-adjusted studies, significant heterogeneity, and indications of publication bias. The findings of our study expand on the aforementioned literature by including more than double the number of studies and addressing key limitations identified in previous research. While Jiam et al⁵¹ combined both unadjusted and adjusted studies, we focused solely on studies that provided adjusted estimates to minimize the influence of confounding variables, thereby increasing the reliability of our findings.⁵² Furthermore, our study observed reduced heterogeneity in the pooled associations, likely due to the use of covariate-adjusted estimates. Additionally, our study examined the association of HL with the odds of injury from falls and the longitudinal risk of falls, a comprehensive approach not feasible in the earlier meta-analysis due to limited available literature. With greater availability of literature, further subgroup and sensitivity analyses were conducted, enhancing the robustness of our findings. We also did not identify any publication bias, a key limitation highlighted in the previous meta-analysis. Crucially, we found that the association between HL and falls remained significant even when accounting for concurrent risk factors for falls, such as vision impairment and vestibulopathy, addressing a significant limitation acknowledged in prior research.

Compared with other meta-analyses of observational studies examining the association between sensory impairments and falls, our findings suggest that the magnitude of fall risk associated with HL may be comparable with other well-established sensory-related risk factors, such as vision loss and vestibulopathy. For example, a meta-analysis of observational studies by Deandrea et al⁵ suggested that vision impairment and vestibulopathy increased the odds of falls by 35% and 80%, respectively. While making indirect comparisons between our findings and the results of other meta-analyses should be approached with caution due to potential differences in study variables, our results suggest that HL may warrant attention comparable with that given to other well-established sensory-related risk factors for falls.

There are various plausible mechanisms that may explain the observed association between HL and falls. First, patients with HL may experience increased demands in listening and communication, potentially reducing the attentional resources crucial for balance control.⁵³ The maintenance of balance relies on the brain’s ability to integrate sensorimotor inputs from various parts of the body, which requires intricate neural processing.⁵⁴ Various magnetic resonance imaging studies have demonstrated that individuals with imaging-detected cerebral atrophy experience greater difficulties with balance problems compared with those without structural cerebral changes.⁵⁵ Similarly, HL has been linked to accelerated brain atrophy,⁵⁶ drawing a potential structural link between HL and postural imbalance, which may increase the risk of falling.

Second, HL may also directly restrict an individual’s access to auditory information essential for spatial awareness and maintaining postural balance.⁵⁷ Agmon et al⁵⁸ conducted a systematic review that found that HL may be associated with poorer postural control in older adults. These findings were supported by a meta-analysis by Foster et al,⁵⁹ which further highlighted that older adults with moderate to severe HL may exhibit more postural instability compared with those with normal or mild HL. Importantly, their findings align with previous studies suggesting that HL contributes to slower gait speed,⁶⁰ increased stride length variability,⁶¹ poorer postural control,⁶² and reduced walking endurance.⁶³ These auditory cues may serve as acoustic landmarks that aid in spatial awareness and perception, which may influence postural stability and reactive balance.^64,65 This association between HL and balance difficulties has been linked to an increased risk of falls in both younger and older adults.⁶² These observations suggest that postural imbalance may mediate the relationship between HL and falls.

Third, other shared risk factors and pathophysiological mechanisms between HL and falls may also shed light on their correlation. For example, cardiovascular disease and diabetes have been linked with both HL and falls.^66,67 Individuals with cardiovascular disease and diabetes may develop microangiopathic changes in the cochlea, decreasing microcirculation and potentially causing HL.^66,68,69,70 Similarly, diabetic microangiopathy may also cause peripheral neuropathy and a loss of proprioception, which may affect somatosensory components of posture control.⁷¹ Hence, these shared risk factors may draw an indirect link between HL and falls. Nonetheless, the use of covariate-adjusted estimates robustly accounted for a variety of these shared risk factors.

It is crucial to acknowledge that there are myriad intrinsic and extrinsic risk factors that may increase an individual’s propensity to fall.⁷² The association between HL and falls remained significant in studies that had preadjusted for confounders, suggesting that HL may be an independent risk factor for falls. Various earlier studies have suggested that HL and falls may be mediated by cognitive decline.^73,74 HL is a well-established factor for cognitive impairment and dementia,⁷⁴ and patients with cognitive deficits may have fewer cognitive reserves for executive function and other activities that require neural integration.⁷⁵ Separately, considering the close anatomical proximity of both vestibular and auditory systems,⁷⁶ previous studies have suggested that certain factors that can cause both dizziness and HL, such as age-related degeneration,⁷⁷ ototoxic medications⁷⁸ or otologic conditions like labyrinthitis,⁷⁶ may be partly responsible for the observed association between HL and falls. However, HL was still significantly associated with an increased odds of falling in studies that preadjusted for dizziness or vestibulopathy. Importantly, no heterogeneity was observed in this pooled association. This suggests that the mechanisms behind the association between HL and falls may extend beyond the effects of HL-related vestibular impairments. Nonetheless, future research may provide greater insights into the intricacies of the relationship between HL, vestibulopathy, and falls. Additionally, further studies may add value to the current literature by directly comparing the risk of falling between patients with isolated HL and those with other concomitant risk factors for falls.

We noted a higher odds of falling among patients with HL identified through validated methods of testing compared with those using self-reported questionnaires. We suspect that studies using self-reported measures underestimate the true prevalence of HL because individuals often underestimate their hearing difficulties, attributing them to the natural aging process.⁷⁹ Nonetheless, a significant association between HL and falls was observed in both subgroups, which underscores the need to take caution even among individuals with self-reported claims of HL.

Not surprisingly, meta-regression analysis outlined that age was a significant effect modifier of the association between HL and falls. We observed that an increase in the mean age of participants increased the odds and risk of falling. These observations are supported by previous epidemiological studies.⁸⁰ Salari et al⁸¹ conducted a meta-analysis that identified the pooled global prevalence of falls in older adults to be 26.5%. The risk of falling in older adults may be elevated due to the decline of various neural components necessary for maintaining balance,⁸² the increased likelihood of multimorbidity, and the greater risk of polypharmacy.⁸³ Moreover, poorer functional status in older adults may make it more challenging for them to navigate around environmental hazards, thereby increasing their susceptibility to falls.⁸⁴ Cumulatively, these risk factors contribute to an increase in fall risk with age. Nonetheless, systematically reviewed studies have also shown that HL may be associated with falls in younger adults.

The findings of this study carry significant implications for advancing our understanding of the impact of HL on aging. HL is highly prevalent,⁶ and its effects are potentially treatable with hearing rehabilitative devices, which remain underused.⁸⁵ Although previous studies have proposed potential cognitive and mortality benefits of hearing restorative devices,^7,86 current evidence on the role of hearing intervention in preventing falls is inconclusive among observational studies.^87,88 Additionally, more randomized clinical trials are needed to examine the benefits of treating HL in the context of aging.^8,89 However, conducting randomized studies of this nature may be challenging due to ethical and administrative difficulties in justifying a control group that does not receive any hearing intervention. Hence, this underscores the importance of findings from observational meta-analyses.

The growing body of evidence surrounding the adverse effects of HL in older adults should prompt physicians and policymakers to adopt a more vigilant approach to hearing health. Considering the dire consequences of falls,¹ identifying HL as a potential risk factor for falls may carry significant implications in public health.^90,91 Currently, there is a lack of consensus among recommendation articles regarding the classification of HL as a risk factor for falls. While the World Falls Guideline recommends examining HL as part of a multifactorial falls risk assessment¹⁹ as well as referring individuals with HL to a specialist when appropriate, not all concur.⁹² Crucially, the findings of this study suggest that it may be useful to include HL as a potential risk factor for falls in comprehensive falls risk assessments.

Strengths and Limitations

The strengths of this study include its strict adherence to a prespecified protocol and established guidelines for conducting systematic reviews and meta-analyses. Importantly, by only including studies that used covariate-adjusted estimates, we minimized confounding and achieved a lower degree of heterogeneity. This meta-analysis also examined both cross-sectional and longitudinal outcomes of falls and supported our findings through various subgroup and sensitivity analyses. Additionally, the absence of publication bias further enhances the reliability of our results.

There are some limitations of the present research. First, it is important to note that causal conclusions should not be assumed due to the observational nature of included studies, due to the possibility of residual confounding. Second, we were unable to examine how the severity of HL affected the prevalence and incidence of falls due to insufficient literature. Third, most studies relied on self-reported falls for practical purposes, which may be susceptible to recall bias. Fourth, self-reported measures of hearing and falls may exhibit greater variability compared with validated testing methods. This increased heterogeneity could influence the relationship between HL and falls. Future studies should strive to use validated methods for assessing hearing and identifying falls, which may aid in developing targeted strategies to reduce fall risk among individuals with HL. Nonetheless, our findings remained significant across subgroups using both self-reported and validated measurements of hearing. Fifth, due to insufficient reporting, we were unable to perform a subgroup analysis to investigate whether the association between HL and falls remained significant in adults of different age categories. Given that age was identified as a significant effect size modifier that accentuated the relationship between HL and falls, future studies may consider analyzing how the overall effect size differs between younger and older adults through subgroup stratification.

Conclusions

This systematic review and meta-analysis encompassing 27 studies and 5 071 935 participants suggests that HL may be associated with increased cross-sectional odds and longitudinal risk of falls. Given the significant public health ramifications of falls, physicians should be cognizant of the detrimental consequences of falls and recognize the importance of addressing hearing health as a potential mitigating strategy in fall prevention. The early identification of HL may aid in developing preventive strategies to reduce the incidence of falls.

Supplement 1.

eFigure 1. Leave-1-Out Analysis Showing the Longitudinal Association of Hearing Loss and Incident Falls Compared With Individuals Without Hearing Loss

eFigure 2. Cumulative Analysis Showing the Longitudinal Association of Hearing Loss and Incident Falls Compared With Individuals Without Hearing Loss

eFigure 3. Contour-Enhanced Funnel Plot Showing the Longitudinal Association of Hearing Loss and Incident Falls Compared With Individuals Without Hearing Loss, With Missing Studies Imputed Via the Trim-And-Fill Method

eFigure 4. Linear Plot Showing the Longitudinal Association of Hearing Loss and Incident Falls Compared With Individuals Without Hearing Loss

eFigure 5. Forest Plot Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss, Stratified by Duration for Reporting Falls

eFigure 6. Forest Plot Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss, Stratified by Continent

eFigure 7. Forest Plot Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss, Only Among Individuals in the Community

eFigure 8. Leave-1-Out Analysis Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss

eFigure 9. Cumulative Analysis Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss

eFigure 10. Contour-Enhanced Funnel Plot Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss, With Missing Studies Imputed Via the Trim-And-Fill Method

eFigure 11. Linear Plot Showing the Cross-Sectional Association of Hearing Loss and Falls Compared With Individuals Without Hearing Loss

eTable 1. Search Strategy

eTable 2. Summary of Patient Characteristics

eTable 3. Risk of Bias Assessment of Included Cross-Sectional Studies Using the Newcastle-Ottawa Scale (NOS)

eTable 4. Risk of Bias Assessment of Included Cohort Studies Using the Newcastle-Ottawa Scale (NOS)

eTable 5. Risk of Bias Assessment of Included Case-Control Studies Using the Newcastle-Ottawa Scale (NOS)

eTable 6. Evaluation of Quality of Pooled Evidence Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Framework

eTable 7. Results of the Meta-Regression Analyses

eTable 8. Results of the Publication Bias Analyses

jamaotolaryngolheadnecksurg-e250056-s001.pdf^{(2.1MB, pdf)}

Supplement 2.

Data Sharing Statement

jamaotolaryngolheadnecksurg-e250056-s002.pdf^{(16.7KB, pdf)}

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