LM301 - Presbyvestibulopathy: Clinical Perspectives on Age-Related Vestibular Loss

Abstract:
The vestibular system experiences decline with age similar to the auditory system. Presbyvestibulopathy, or PVP, is the pathological presentation of an aging vestibular system. PVP leads to increased dizziness, imbalance, and fall risk in elderly patients. However, elderly patients often have multiple comorbidities related to dizziness and balance which can complicate accurate diagnosis and management of care. This talk will focus on the aging vestibular system and its clinical presentation, explore comorbidities related to dizziness and balance, discuss diagnosis criteria for PVP with case studies, and how to manage care in aging patients with vestibular dysfunction and multifactorial balance deficits. 

Summary:
There are many different causes of dizziness and many medical providers do not have the knowledge or resources to properly address the needs of patients with dizziness. Accurate diagnosis and management of dizziness and balance becomes more complicated in an elderly population whose medical history is more complex. Many elderly patients may not be referred for vestibular assessment because their symptoms may be thought of as typical of aging. However, the vestibular system experiences peripheral and central age-related changes much like the auditory system. There is approximately a 25% reduction in otolith organ sensory cell function and a 40% reduction in semicircular canal sensory cell function (Mathesn et al., 1999). There are also declines in the neurons (Lopez et al., 1997) and nerve fibers in the central vestibular system (Park et al., 2001). Presbyvestibulopathy has specific diagnostic criteria as determined by the Barany Society (Agrawal et al. 2019). One of the aforementioned criteria is a diagnosed mild bilateral vestibulopathy which must be documented by objective tests of vestibular function. However, age-related vestibular loss in isolation rarely causes clinically significant balance dysfunction to meet diagnostic criteria for presbyvestibulopathy (Muller et al., 2022). This may be because of central compensation of slow decline in vestibular function and age-related vestibular loss does not become a problem until paired with other sensory or motor balance problems. Jacobson et al. (2008) explored two different fall prevention clinics finding most patients had 4 or more risk factors for falls and most had multisensory balance dysfunction. The vestibular system is only a piece of a complex multisensory system and postural stability is also dependent on vision and proprioception. Postural stability also requires the motor capabilities to respond to those sensory inputs and their environmental interactions. In the aging population, several sensory, motor, and central health-related problems may contribute to dizziness, imbalance, and fall risk. Presbyvestibulopathy, in isolation, is rare but may be more common as part of multifactorial balance dysfunction. Additionally, I will present two case studies that provide a descriptive example of patients with presbyvestiblopathy. Both patients presented with significant dizziness and imbalance and were deemed a fall risk. They have different medical histories but similar dizziness and balance complaints and similar results on tests of vestibular function. These patients’ complaints were previously unaddressed but with a diagnosis of presbyvestibulopathy a multidisciplinary treatment plan was able to be established and executed. The goal of diagnosis and intervention is to prevent falls, reduce dizzy symptoms, and keep elderly patients independent for as long as possible. Audiologists are in a unique position to help identify and diagnose patients with presbyvestibulopathy. We are one of the few disciplines with detailed knowledge of vestibular function and often work with an aging population. Even audiologists who are not performing vestibular diagnostics can be a major referral source for elderly patients if aware of the signs and symptoms. Preventing falls can save lives.