A NEW study has revealed that auditory stimuli, particularly real-world sounds like subway noises, exacerbate balance issues in individuals with unilateral vestibular hypofunction, highlighting an often-overlooked factor in balance assessment and rehabilitation.
The vestibular system in the inner ear, alongside visual and joint input, helps maintain balance by providing the brain with information about head movement and position. While visual effects on balance are well-documented, this study examined the role of sound in balance disruption, especially in noisy environments such as subway stations. Researchers used a virtual reality (VR) subway simulation to investigate this, with the aim of advancing clinical approaches to balance rehabilitation.
The study involved 69 participants, divided into two groups: 41 healthy controls (mean age 52 years) and 28 individuals with unilateral vestibular hypofunction (mean age 61.5 years). Participants stood on foam placed on a force platform to measure their body movement (sway) and wore a VR headset that tracked head movement. During 60-second trials, they experienced static or moving visuals paired with either silence, white noise, or real subway sounds. For the vestibular group, the most sway occurred during dynamic visuals combined with audio stimuli, with real subway sounds inducing the highest instability. Sway was quantified using root mean square velocity, with significant differences observed in head movements (pitch, yaw, roll) and centre-of-pressure sway between the two groups. Healthy controls remained unaffected by sound conditions.
The findings underline the need to integrate auditory stimuli into balance assessments and therapies, particularly for individuals with vestibular hypofunction. This is critical for designing task-specific interventions that reflect real-world environments, such as busy streets or transit stations. Portable VR headsets could serve as an innovative tool to simulate challenging scenarios and improve patient outcomes. Future research should explore how specific sound environments influence balance training and recovery further, refining therapeutic protocols to address these complexities in clinical practice.
Katrina Thornber, EMJ
Reference
Lubetzky AV et al. Real sounds influence postural stability in people with vestibular loss but not in healthy controls. PLoS ONE. 2025;20(1):e0317955.
