12Falls and the Older Recipient
Older recipients sit at the intersection of presbyvestibulopathy, hearing loss and fall risk, and they are more likely than younger patients to lose vestibular function with surgery. Yet much of their post-op disequilibrium reflects slow re-integration of sensory inputs rather than new labyrinthine signs, and it usually recovers with vestibular rehabilitation. The older recipient is a rehabilitation story as much as a surgical one.
FFalls and hearing loss
About 50% of hearing-loss patients in an audiology clinic fell in the prior 12 months, versus about 25% in the general population If falls occur, particularly in the elderly, outcomes can be fatal Caloric testing reveals elevated rates of bilateral vestibular hypofunction and presbyvestibulopathy among older candidates.[2013]
TAge raises surgical vestibular risk
Older patients are more likely to lose vestibular function after implantation, with reported age thresholds variously above 59, 60 or 70 years Vertigo frequency increases with patient age at surgery Older candidates may already have presbyvestibulopathy, so implanting the better ear risks de novo bilateral loss.[2003][2018]
TDisequilibrium without new signs
Older patients commonly have persistent disequilibrium WITHOUT new labyrinthine signs, reflecting a lag in re-integrating visual, vestibular and proprioceptive input They usually recover fully with vestibular rehabilitation exercises Residual imbalance persists 1-2 weeks in under 10% of recipients overall.[2004][2012]
FRehabilitation over suppression
Recovery is driven by central vestibular compensation, the brain rebalancing expected input Vestibular suppressants should be used only for acute vertigo and then withdrawn to permit compensation; persistent symptoms warrant referral to vestibular rehabilitation Vestibular rehabilitation has an established evidence base for unilateral peripheral dysfunction and can recover dynamic visual acuity in bilateral hypofunction.[2007][2007]
What is the most appropriate management?
Compared with the general population, the prevalence of falls among hearing-loss audiology-clinic patients is approximately:
Why should vestibular suppressants be stopped after acute vertigo in an older recipient?