Vestibular function in active professional boxers compared with clinic-recruited non-athletes: a prospective comparative study

Abstract

Boxing exposes athletes to repeated head movements and impact-related forces that may affect vestibular function. This study compared vestibular and oculomotor findings between active professional boxers and clinic-recruited non-athletes. This prospective comparative study included 52 active professional boxers and 52 age- and sex-comparable clinic-recruited non-athletes. All participants underwent neurotologic examination, bedside vestibular testing, Dix–Hallpike testing, vertigo symptom assessment, and video head impulse testing. Composite vestibular dysfunction was defined as at least one abnormal finding in the vestibular assessment battery. Current vertigo symptoms were less frequent in boxers than in clinic-recruited non-athletes (3.8% vs. 19.2%, p = 0.020). Boxers also showed fewer VORS abnormalities (3.8% vs. 19.2%, p = 0.020), VVOR abnormalities (5.8% vs. 23.1%, p = 0.010), abnormal saccades (3.8% vs. 17.3%, p = 0.030), and corrective saccades on vHIT (9.6% vs. 30.8%, p = 0.006). vHIT gains were higher in boxers across all semicircular canals, although values in both groups remained within physiological ranges. Composite vestibular dysfunction was observed in 15.4% of boxers and 42.3% of clinic-recruited non-athletes ( p = 0.002). In multivariable analysis, boxer status was associated with lower odds of composite vestibular dysfunction (adjusted OR 0.24, 95% CI 0.09–0.63, p = 0.004). Active professional boxers showed higher measured vHIT gains and lower observed frequencies of vestibular abnormalities compared with clinic-recruited non-athletes. However, because boxing exposure was not quantified and only active athletes were included, these findings should be interpreted as descriptive associations rather than evidence of boxing-related adaptation, protection, or causal effect.