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A new study published in PLOS ONE has uncovered significant insights into how sound can impact balance in individuals with vestibular hypofunction, a disorder affecting the vestibular system in the inner ear. The vestibular system is responsible for detecting head movements and position, providing crucial information for maintaining balance. While visual cues have long been known to influence balance, this study reveals that auditory stimuli can also play a disruptive role, especially for those with impaired balance.
The research, led by Anat Lubetzky, associate professor of physical therapy at NYU Steinhardt School of Culture, Education, and Human Development, highlights how individuals with vestibular hypofunction struggle with balance in busy environments, such as crowded streets or train stations. These environments are often filled with overwhelming visual stimuli, which can cause anxiety, dizziness, or loss of balance.
“People with vestibular hypofunction have difficulty in places like busy streets or train stations where the overwhelming visual information may cause them to lose balance or be anxious or dizzy,” says Lubetzky. “Sounds are not typically considered during physical therapy, making our findings particularly relevant for future interventions.”
The study involved 69 participants, split into two groups: healthy controls and individuals with unilateral vestibular hypofunction, which affects one ear. Participants wore a virtual reality headset that simulated the sights and sounds of a New York City subway, while their body and head movements were tracked to assess their balance. The study tested different subway scenarios: static or moving visuals paired with either silence, white noise, or recorded subway sounds.
The results showed that participants with vestibular hypofunction experienced the greatest instability when the moving visuals were accompanied by audio—whether white noise or subway sounds. This led to increased body sway, including forward and backward movements, as well as head tilts in various directions. In contrast, the balance of healthy participants was not affected by the audio conditions.
“What we’ve learned is that sound should be included as part of both the assessment of balance and intervention programs,” says Lubetzky. “Because balance training is known to be task-specific, ideally, these should be real sounds related to patients’ typical environments and combined with salient and increasingly challenging visual cues. Portable virtual headsets are a promising tool for both assessing and treating balance problems.”
This groundbreaking study opens the door for new approaches to balance therapy, suggesting that incorporating sound elements into treatment plans could help individuals with vestibular hypofunction regain stability in real-world environments.
Disclaimer: This article is based on the findings of the study “Real Sounds Influence Postural Stability in People with Vestibular Loss but Not in Healthy Controls” published in PLOS ONE in 2025. Results from the study may vary among individuals. Always consult with a healthcare provider for diagnosis and treatment options.
More information can be found in the full study published in PLOS ONE.
