Clinical and otopathologic findings on age-related vestibular loss: state of the art review

Abstract

Age-related vestibular loss is a complex and multifactorial condition, involving several anatomic and functional changes in vision, proprioception and more importantly the inner ear. Vestibular testing and histopathologic reviews have revealed relevant information about those changes; however, little is known about its clinical and otopathologic correlation over the last two decades. We aim to extend the understanding of this process and provide a comprehensive picture of it. Currently available literature was analyzed for understanding the clinical and histopathological correlation of age-related vestibular loss. Age-related vestibular loss articles were reviewed; 467 articles were found on different databases and 33 (9 retrospective chart reviews, 7 cross-sectional, 4 prospective cohorts, 13 histopathology studies) were included in the state of art review. The overall prevalence of age-related vestibular loss is 35.4% in patients older than 40 years. There are other studies that have reported prevalence ranging from 18% to 53% for patients older than 50 years. The most evident is at 75 years of age and vestibular loss is related to people with a lower educational level, less physical activity, smokers and with diabetes or cardiovascular disease. We provide the latest evidence in clinical and histopathologic findings, their relationship, and upcoming challenges in this review. The deepest understanding of these changes would provide better comprehension of this process for primary care physicians, otolaryngologists, neurologists, and neuro-otologists. It will allow better and targeted healthcare attention in elderly patients with balance problems.