Molecular aging of the mammalian vestibular system

• Prevalence of disequilibrium increases with age.
• Degeneration of vestibular neurons.
• Mitochondria play a role in vestibular aging—oxidative stress and apoptosis.
• Hair cell regeneration.
• Therapeutic possibilities to treat imbalance and dizziness.

Dizziness and imbalance frequently affect the elderly and contribute to falls and frailty. In many geriatric patients, clinical testing uncovers a dysfunction of the vestibular system, but no specific etiology can be identified. Neuropathological studies have demonstrated age-related degeneration of peripheral and central vestibular neurons, but the molecular mechanisms are poorly understood. In contrast, recent studies into age-related hearing loss strongly implicate mitochondrial dysfunction, oxidative stress and apoptotic cell death of cochlear hair cells. While some data suggest that analogous biological pathomechanisms may underlie vestibular dysfunction, actual proof is missing. In this review, we summarize the available data on the molecular causes of vestibular dysfunction.