How Your Brain Uses Eyes and Ears to Keep You Upright

Every time you stand or walk, three main systems work together:

• Eyesight (vision): tells your brain where objects, steps, pavements, furniture and people are.
• Inner ears (vestibular system): tiny fluid-filled canals deep in your ears sense movement, rotation and head position.
• Body sense (proprioception): nerves in your muscles and joints tell your brain where your limbs are, even with your eyes closed.

Your brain constantly compares these messages. If one system becomes weaker – for example due to cataracts or hearing loss – the other systems have to work harder. For some people this shows up as:

• Feeling unsteady in dim light or on uneven ground.
• Struggling to find edges of steps or kerbs.
• Feeling disorientated in busy places with lots of noise and movement.
• Increasing reliance on furniture or walls when walking at home.

How Changes in Vision Affect Balance

Vision gives your brain a map of the world. When that map becomes blurred, patchy or distorted, balance becomes harder. Common examples in later life include:

• Cataracts: clouding of the eye’s lens, causing blurry or misty vision and glare.
• Glaucoma: damage to the optic nerve, often leading to loss of side (peripheral) vision.
• Age-related macular degeneration (AMD): damage to the central retina, affecting detailed central vision.
• Poorly corrected short- or long-sightedness: glasses prescription no longer matching your current eyes.

These conditions can make it harder to:

• Spot changes in floor level, kerbs, steps or potholes.
• Judge distances – for example when reaching for a rail on the bus.
• See contrasts between pale carpets and pale walls, or dark mats on dark floors.

Glasses and Falls – Not Just About “Wearing Them”

Many older adults have glasses but avoid wearing them for short trips at home, or find them awkward on stairs. Glasses can affect balance because:

• Bifocals or varifocals change focus as you look down, making steps or kerbs seem closer or further than they really are.
• Wrong prescriptions can make the world look slightly warped or “off”, especially when turning quickly.
• Scratched or dirty lenses reduce contrast and clarity.

Some people are safer on stairs with single-vision distance glasses or no glasses, depending on the advice of their eye specialist. This is one reason to specifically mention balance and falls when you attend eye tests.

Hearing, Inner Ear and Balance

Hearing and balance share the same neighbourhood inside the skull. The inner ear (vestibular system) sends signals about movement and head position, while the cochlea sends sound information. Problems in this area can lead to:

• Vertigo – a spinning sensation, often with head movement.
• Unsteadiness, especially when turning or walking in the dark.
• Loss of confidence and fear of moving quickly.

Conditions affecting the inner ear and hearing include:

• Age-related hearing loss: often gradual, making it harder to judge where sounds come from.
• Earwax blockage: reducing sound input and sometimes altering balance signals.
• Benign paroxysmal positional vertigo (BPPV): brief spinning feelings triggered by head movements.
• Labyrinthitis or vestibular neuritis: inflammation of the inner ear or its nerve, often after infection.
• Menière’s disease: episodes of vertigo, hearing loss, tinnitus and ear fullness.

How Hearing Loss Alone Can Increase Fall Risk

Even without vertigo, hearing loss can quietly increase falls risk because:

• You may not hear approaching people, cyclists or vehicles as clearly.
• You may miss warning sounds (for example behind you) and turn quickly to look, upsetting balance.
• The brain has to work harder to process sound, leaving less “spare” attention for balance – especially in noisy places.

For some people, fitting or adjusting hearing aids improves not only hearing but confidence in moving through the world.

Clues That Vision or Hearing Might Be Affecting Balance

It can be hard to know whether your balance problems come from muscles, joints, blood pressure, nerves, eyes, ears – or a mixture. The following clues suggest that vision or hearing might be playing a part:

• You feel much more unsteady in dim light or at night than in daylight.
• You avoid stairs, escalators or unfamiliar pavements because you “don’t trust what you see”.
• You struggle more in supermarkets or crowded places with lots of noise and movement.
• You have to turn your whole body to hear or see someone, then feel off balance.
• Others have noticed you misjudging doorways, furniture or steps.
• Your falls or near-falls often occur when turning your head, looking up or down, or moving quickly from sitting to standing.

Lighting, Contrast and Sound – Small Adjustments, Big Effects

You cannot control every pavement, but you can usually influence your immediate environment:

• Lighting: ensure good, even lighting in halls, stairs, bathrooms and paths to the toilet at night.
• Contrast: use contrasting colours for stair edges, door frames and key furniture edges.
• Glare: reduce glare from shiny floors or uncovered bulbs, which can make it harder to judge depth.
• Noise: where hearing is affected, reduce background noise (for example turn down the TV) when walking through busy rooms.

Bringing It All Together at Check-Ups

Different professionals each see part of the picture:

• Opticians focus on eyes and glasses.
• Audiologists and ENT teams focus on hearing and inner ear.
• GPs and geriatricians think about whole-person health and medicines.
• Physiotherapists and occupational therapists look at movement, strength, balance and home layout.

You are the only one who lives in your body all day. Sharing the full story of how vision, hearing and balance feel together helps these professionals join up their care.

How PHAT Sessions Support Vision, Hearing and Balance Together

PHAT classes cannot remove cataracts or fit hearing aids, but they can support the whole system in several ways:

• Encouraging you to wear your usual glasses and hearing aids during sessions, so your brain practises moving with them in real life.
• Offering steady, repeated movements that help your brain “re-learn” balance after changes to eyesight or hearing.
• Including options to exercise seated or close to a stable surface if visual or inner-ear problems make standing work difficult.
• Providing a safe space to share worries about falls, vision, hearing and confidence with others who understand.

Over time, many participants report:

• Feeling more aware of where their feet and body are in space.
• Being more confident walking in their homes and local area.
• Feeling better prepared to ask clear questions at health appointments.