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In 2001\u20132004 and 2021\u20132023, NHANES included questions about balance, dizziness, and falls in the past 12\u2009months. The modified Romberg test (MRT) was used to examine vestibular balance function. Logistic regression models were used to assess risk factor associations with balance disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 4525 middle\u2010aged adults 40\u201369\u2009years in 2001\u20132004, 21.5% (95% confidence interval [CI]: 19.1%, 23.9%) reported difficulty with balance and dizziness, and 29.7% (27.3%, 32.1%) failed to pass four MRT (MRT\u20104) conditions. Among 3986 middle\u2010aged adults in 2021\u20132023, 36.2% (34.5%, 37.8%) reported specific balance and dizziness problems (BDP), and 25.9% (23.2%, 28.6%) failed the MRT\u20104. An enhanced MRT with a fifth condition (MRT\u20105) increased the discrimination of adults at risk of balance problems and falls. Risk factors for vestibular balance disorders, including age, education, income, cigarette smoking, physical activity, hypertension, diabetes, trouble hearing, and severe headaches\/migraines, remained consistent. Reported functional disabilities (hearing, mobility, and vision) were significantly associated with BDP and MRT. In 2021\u20132023, comparisons of 2084 young adults 20\u201339\u2009years with middle\u2010aged adults showed increased age\u2010specific prevalences of BDP and falls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Middle\u2010age\u2010specific MRT\u20104 results in 2021\u20132023 improved. Balance disorders are associated with other health conditions, increased risk of falls, and need for medical services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.70482","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T01:34:34Z","timestamp":1773452074000},"page":"3577-3593","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Balance Disorders in Young and Middle\u2010Aged Adults:\n                    <scp>NHANES<\/scp>\n                    , 2001\u20132004 and 2021\u20132023"],"prefix":"10.1002","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4105-0808","authenticated-orcid":false,"given":"Howard J.","family":"Hoffman","sequence":"first","affiliation":[{"name":"Epidemiology, Statistics, and Population Sciences Section, National Institute on Deafness and Other Communication Disorders National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana E.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Office of Vision Health and Population Sciences National Eye Institute, National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne E.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Ascension St. John Medical Center  Tulsa Oklahoma USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen S.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head &amp; Neck Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory A.","family":"Flamme","sequence":"additional","affiliation":[{"name":"Stephenson and Stephenson Research and Consulting (SASRAC), LLC  Batavia Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa L.","family":"Themann","sequence":"additional","affiliation":[{"name":"Division of Field Studies and Engineering National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuan\u2010Ming","family":"Li","sequence":"additional","affiliation":[{"name":"Epidemiology, Statistics, and Population Sciences Section, National Institute on Deafness and Other Communication Disorders National Institutes of Health  Bethesda Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan K.","family":"Ward","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles C.","family":"Della Santina","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"1131","article-title":"Prevalence and Presentation of Dizziness in a General Practice Community Sample of Working Age People","volume":"48","author":"Yardley L.","year":"1998","journal-title":"British Journal of General Practice"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000175987.59991.3d"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAO.0000000000000691"},{"key":"e_1_2_11_5_1","first-page":"1","article-title":"Vision, Hearing, Balance, and Sensory Impairment in Americans Aged 70\u2009Years and Over: United States, 1999\u20132006","volume":"31","author":"Dillon C. 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