Subjective-Objective Concordance in Hearing Loss and Vestibular Dysfunction Among Rural Older Adults

Background: Age-related vestibular and auditory impairments are highly prevalent and frequently comorbid in older adults, particularly in resource-limited rural areas where reliance on subjective symptom reporting may underestimate the true disease burden. This study aimed to (1) quantify the prevalence and comorbidity of objectively measured vestibular and hearing dysfunction, and (2) assess the concordance between self-reported symptoms and objective assessments.Methods: We conducted a cross-sectional study of 670 community-dwelling adults aged 55–65 years in rural Taizhou, China. Vestibular function was objectively evaluated using the video head impulse test (vHIT), and hearing function via pure-tone audiometry (PTA) performed in a sound-treated booth. Concurrently, participants completed an interviewer-administered standardized questionnaire assessing self-reported dizziness, hearing difficulties, tinnitus, and otologic history.Results: Prevalence rates were 71.5% for hearing loss and 8.5% for vestibular dysfunction. Among participants with hearing loss, 10.2% exhibited concurrent vestibular dysfunction. In univariate analyses, symptom patterns involving hearing loss were associated with abnormal vHIT findings. Self-reported dizziness exhibited low sensitivity (7.9%) but high specificity (91.4%) for vestibular dysfunction. Subjective-objective agreement for hearing assessments was poor (κ = 0.173), with 39.7% underestimating their impairment severity.Conclusion: Vestibular and auditory impairments are highly prevalent and frequently comorbid in rural aging populations. Objective testing is essential to overcome limitations of symptom-based screening. Integration of dual-modality sensory screening into rural primary care may optimize early detection and intervention for age-related decline.