Subclinical vestibular pathology in patients with noise-induced hearing loss from intense impulse noise.

Sixty patients with varying degrees of noise-induced hearing loss (NIHL) after long-term exposure to intense impulse noise from firearms, but without manifest clinical symptoms of vestibular pathology, were tested for body sway using a stable platform. The results were compared with those from 115 healthy referents examined in the same way. Subjects with NIHL showed significantly more body sway, estimated as movement of the centre of gravity in the horizontal plane, than did the referents. Subjects with more severe NIHL showed more sway than subjects with milder acoustic trauma. The results show that body sway is increased in patients with NIHL from exposure to impulse noise of high intensity in a way suggesting an exposure-effect relationship. This suggests subclinical disturbances of the vestibular system in these patients. The underlying mechanism may be simultaneous mechanical damage to both the cochlear and vestibular partitions by intense impulse noise.