Objectives. The senses of hearing and balance are linked by a close anatomical and physiological relationship. A further pathophysiological interaction is supposed but the detailed mechanism and direction remains elusive. Further insight is required into the prevalence of the audiovestibular symptoms hearing loss, tinnitus and dizziness as only scarce information on the combined occurrence is available so far. Therefore, this was assessed in a population-based sample. Based on this, we studied the influence of risk factors from lifestyle habits as well as cardiovascular and metabolic conditions on the development of audiovestibular symptoms alone and in combination. Design. This analysis evaluated the prevalence of self-reported hearing loss, tinnitus and dizziness in two separate population-based samples from West Pomerania, a rural region of north-eastern Germany. Datasets from 8134 individuals aged 20 to 79 years were available from the baseline investigations of the cohorts START and TREND of the Study of Health in Pomerania (SHIP). Audiovestibular symptoms were assessed by structured questionnaires. The cohorts were comprehensively characterized regarding modifiable lifestyle factors as well as cardiovascular and metabolic disorders, allowing the assessment of the role of those influencing factors. Results. Audiovestibular symptoms were prevalent and overlapping in the investigated population. 2350 individuals (28.9%) reported at least one, 648 (8.1%) two and 111 (1.4%) all three audiovestibular symptoms. Thereby, we observed a weighted prevalence of 14.2% for hearing loss, 9.7% for tinnitus and 13.5% for dizziness in the population. The prevalences increased with age and differed among the sexes. The prevalence of hearing loss as well as tinnitus increased between the two cohorts. A moderate positive correlation was found between hearing loss and tinnitus (phi-coefficient 0.318). In multivariable regression analyses, only smoking was significantly associated with all three symptoms. Less education and several cardiovascular risk factors contributed to both hearing loss and dizziness. Conclusions. Audiovestibular symptoms are highly prevalent in the general population and the occurrence overlaps. A considerable but complex influence of risk factors points towards a relation with neuronal as well as cardiovascular disease processes. Future studies should identify subgroups that are particularly at risk. Additionally, to clarify the underlying mechanisms the interaction between the senses of hearing and balance as well as the mode of action of the risk factors should be evaluated in more detail in the future.

The authors have declared no competing interest.

The Study of Health in Pomerania (SHIP) is part of the Community Medicine Research Network of the University of Greifswald, which is supported by the Ministry of Cultural Affairs as well as the Social Ministry of the German Federal State of Mecklenburg-West Pomerania. SHIP was also funded by the German Federal Ministry of Education and Research (BMBF) with the grant numbers: 01 ZZ 9603, 01 ZZ 0103, 01 ZZ 0403, and 01 ZZ 0701.

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The Institutional Review Board (IRB) of the University Medicine Greifswald, Germany, gave ethical approval for this work (approvals from July 31, 1995 (SHIP-START) and June 06, 2008 (BB 39/08, (SHIP-TREND)).

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