Determinants influencing ageing within the vestibular system
Reviewed by Victor Osei-Lah

The observation that ageing affects vestibular function is not new. However, using a whole population survey, the authors set out to evaluate quantitatively factors responsible for the age-related changes in vestibular function. As part of a national survey on health and nutrition, participants undergo video head impulse testing (vHIT) and pure tone audiometry to assess audiovestibular function. After applying a strict inclusion and exclusion criteria, 1270 healthy adults aged from 40 to 80 years of the 2021 National Survey were included in the analysis. Other parameters analysed were income level, level of education, blood pressure (BP), body mass index (BMI), levels of cholesterol (TC), triglycerides (TG), fasting blood sugar, HbA1c, diabetes, smoking and alcohol consumption. The authors found that VOR gain of vHIT decreased with age, but statistically, there was no difference between the age groups, even after restricting the upper age limit to 70 years – the age beyond which previous research reports significant decline in vestibular function. Another vHIT metric analysed was corrective saccades (CS) which, when present, implied abnormal vestibular function. Other interesting findings reaching statistical significance were as follows: the mean VOR gain in the CS group was lower than in those without CS (i.e. normal vestibular function cohort), and were older and male. Subjects in their 40s had normal vestibular function (i.e. no CS), had higher educational level and income. Hearing levels were worse in the normal VOR gain with CS group compared to the normal group for all frequencies. Although health-related variables, such as the presence of hypertension, diabetes mellitus, hypercholesterolemia and hypertriglyceridemia were higher in the normal VOR gain with CS group, they were not statistically significant compared with the group without CS. Using regression analysis, the authors concluded that age, sex, hypertriglyceridemia and hearing levels at 4000 Hz were significantly associated with the presence of corrective saccades (abnormal vestibular function). They rightly questioned the relationship between and relevance of abnormal vestibular function and hearing loss at 4 kHz. Several limitations were addressed, especially the reliance on corrective saccades alone to determine the status of vestibular function. However, they argued that the population-based study offered more insights into factors that affect vestibular function with age.

Which factors influence the deterioration in vestibular function? A nationwide, population-based study with video-head impulse test.
Lee JM, Yoo SG, Lee HJ.
J VESTIB RES
2025;36(1):38–46.