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You’re on top of your blood pressure and cholesterol, you’re up to date with all vaccines and cancer screenings, and your vision is 20/20 thanks to a new glasses prescription. You think you’re all set, but it turns out there’s one more simple test that could have a huge impact on your overall health and yet most people skip it: a hearing test.
Hearing loss (HL) is more common than most people think, with an estimated 38 million adults in the U.S. affected. What’s compelling is that research over the past two decades has discovered that if you have hearing loss, you may have a greater chance of developing dementia as well as other health issues.
On the other hand, there’s also emerging research that we may be able to reduce risk of cognitive decline by treating hearing loss. “Studies have suggested that hearing loss is the greatest modifiable risk factor in middle age for dementia,” says Sarah A. Sydlowski, Au.D., Ph.D., audiology director of the Hearing Implant Program at Cleveland Clinic and past president of the American Academy of Audiology.
Unfortunately, hearing health is seldom discussed at primary care visits. One survey found that while 80% of health care providers regularly screen blood pressure, cholesterol, and blood glucose levels, only 46% recommend screening for HL. Even more telling is that only 40% of providers asked believe hearing loss is treatable, which may contribute to the lack of discussion, says Sydlowski.
To get to the bottom of this, we reached out to experts. Ahead, here’s what you should know about hearing loss, the link to dementia, and what you can do to protect yourself.
Does hearing loss cause dementia?
The answer is not definitive. “There is a complex relationship between hearing loss and dementia. The risks are correlated and coexist, but it’s hard to say one causes the other,” says Elina Kari, M.D., neurotologist, associate professor and director of the Cochlear Implant Program at the University of California, San Diego. “However, we do know that many factors, including social isolation and sensory deprivation, which can be the results of HL, can contribute to dementia. If you can’t hear well, you may isolate more, so the brain is less engaged and active.”
Besides the social connection piece, your brain also has to work harder with hearing loss because the clarity of the message is affected. “People with hearing loss often say it sounds like the other person is mumbling, so the brain has to work harder to decode the message,” says Jennifer Deal, Ph.D., associate professor of epidemiology and interim director of the Johns Hopkins Cochlear Center for Hearing and Public Health. “Hearing also might impact brain structure and function because we’ve seen that people with hearing loss have faster atrophy, or shrinking of the brain, especially in total brain and central processing. So, multitasking skills and memory may be affected.”
None of this sounds great, but it’s crucial to remember HL is treatable. “What’s key is that if you identify hearing loss early and manage it, it may have a positive impact on your future path and later-life cognitive impairment,” says Sydlowski.
The greater health impact of hearing loss
Alas, dementia isn’t the only health condition that’s linked to HL. “Hearing loss is a significant risk for depression,” says Dr. Kari. “It’s also a safety issue. For example, you may worry about walking alone in a parking lot because you can’t hear your surroundings.”
HL has also been found to be associated with a greater risk of falls and increased hospitalization rates. In addition, hearing loss is prevalent in people with underlying conditions such as heart disease and diabetes, likely due to the tiny blood vessels in the ear through which circulation can be interrupted, says Sydlowski.
Is hearing loss inevitable?
Many factors contribute to hearing loss, including noise from a job, concerts, or fireworks, as well as medications and genetics. “If you use your ears long enough, you’ll likely have hearing loss,” says Sydlowski. “For many, hearing loss starts in middle age and gradually worsens over each decade. By the time you’re in your 80s, about 80% of people have hearing loss.”
But while hearing loss is common, it’s not normal. “We used to think hypertension was just part of aging, but now we know when we treat it, there’s a better outcome,” says Dr. Kari. “Now we also have this awareness that early intervention with hearing loss may have a positive impact.”
It’s also important to know that you can protect your hearing, no matter what your age. “We should not view hearing as outside our control,” says Deal. “Age is a risk factor for hearing loss, but we can be proactive and do things such as wearing hearing protection in noisy environments, like when we’re doing yard work or attending concerts.”
Why do people avoid hearing aids?
You’d get glasses if you had impaired vision. Why does it feel different for hearing loss? “Most people wait years—sometimes more than a decade—between noticing changes in their hearing and actually doing something about it,” says Tammy Lynn Munroe, Au.D., CCC-A, audiologist with Audiologic Solutions.
“For many people, wearing a hearing aid can feel like publicly admitting something they’re not ready to accept: that they’re aging or that something about them has changed,” Munroe says. “That’s often reinforced by the outdated stigma that hearing aids signal frailty or diminished capacity, rather than a tool that’s no different from glasses.”
For others, the changes are so gradual that they simply adjust. “Because nothing about it feels sudden, there’s no clear moment that tells you it’s time to act,” explains Munroe. “Here, the barrier isn’t denial. It’s simply not recognizing what they’ve been missing until they experience better hearing.”
Do over-the-counter hearing aids work well?
For some people, OTC hearing aids are worth trying. “OTC hearing aids can be a good, more affordable entry point for adults with perceived mild to moderate hearing loss, and they’ve lowered the barrier for people who might otherwise never take the first step,” says Munroe. “But more severe hearing loss still requires a prescription device.”
This can be an issue because you can’t identify the degree of hearing loss you actually have on your own. “OTC options are helpful for some people,” says Sydlowski. “But I’ve had OTC wearers with hearing loss that’s completely inappropriate for their OTC aids. These aren’t like ‘cheaters’ you buy at the store for reading. There are different levels of technology, and factors such as the programming, shape and size of your ear canal and the angle of the insertion can affect the quality of the sound.”
One thing to remember is that because there’s little (or no) support when you purchase OTC devices, you may become frustrated if they don’t meet your expectations. “You may need to bump up the level of expertise by seeing an audiologist (AuD), who can fit you properly with a device that’s suitable for your type of hearing loss,” says Dr. Kari. Remember that there are many new devices on the market—many of which are unobtrusive and nearly invisible, if that’s important to you.
One more important note is that there hasn’t been a study evaluating OTC hearing devices for cognitive health. “The major trials behind the hearing-and-cognition research, including the ACHIEVE trial, tested professionally-fitted, audiologist-supported hearing care, not self-fitted OTC devices,” says Munroe. “So while treating hearing loss appears to support brain health, the strongest evidence so far relates to comprehensive, professionally managed care, not the OTC experience specifically.”
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What to do about hearing loss
While it can be daunting, here’s how to begin your hearing health journey:
Don’t ignore subtle signs.
If you’re constantly asking people to repeat themselves or family members notice you often don’t hear them, it’s time to get evaluated, says Dean.
Get a baseline at age 50.
If you’ve never had your hearing tested or hearing health evaluated for underlying medical issues, experts recommend adding this to your list of regular screenings, says Sydlowski.
Find a hearing health provider with whom you feel comfortable.
“If you’re going to make an investment in a device, this is a relationship. This person should be working with you to give you the best possible experience,” says Dr. Kari. “If you don’t like your interactions with the first provider, find another one.”
Understand which hearing health professionals do what.
Many people assume an ear, nose and throat (ENT) doctor will fit you for hearing aids, but that is not generally the case, says Dr. Kari. You’ll often be referred to another professional, such as:
- Licensed hearing aid dispensers are regulated professionals in most states and are legally qualified to test hearing for aid-fitting purposes, select devices, fit them, verify output, and provide follow-up care, says Munroe.
- Audiologists (Au.D.) have a doctoral-level degree, and are the ones who diagnose hearing loss and rule out medical issues. They look at much more than the device itself. “Audiologists provide diagnostic testing to determine whether there are medical concerns and use the in-depth testing diagnostic protocol to guide the selection, fitting, and verification of hearing aids,” says Munroe.
Check with your insurance company.
There’s sometimes coverage for hearing aids, though some plans include only specific brands or models, which may not always be best for your degree and type of loss, says Sydlowski.
Consider OTC hearing devices.
These can be a good solution if you have mild to moderate loss. But you’ll be going it alone and won’t have a hearing professional to make sure it’s a good fit and to make adjustments as needed, says Dr. Kari.
Look for devices that have a trial period.
Many states have a trial period of 30 or more days when you can get at least a partial refund if they don’t work out or you don’t like them, says Sydlowski.
Be persistent.
Sometimes the first (or second) hearing aid isn’t right for you. Don’t give up. “Two people can walk out of two different offices with the exact same hearing aid model and have completely different experiences,” says Munroe. “The device itself is only part of the equation. The rest comes down to the clinician’s ability to measure whether it’s actually working and the clinical experience to know what to change if it isn’t.”
Seek emergency care if you have sudden or rapid hearing loss.
Sudden deafness, or sudden sensorineural hearing loss (SSHL), occurs, often in only one ear, for no apparent reason. It may happen instantly or over a few days. This is a medical emergency, and you should be seen immediately. “The sooner it’s treated, the better the odds of recovery,” says Munroe.
The bottom line
While scientists can’t definitively say that treating hearing loss prevents dementia, it’s worth being evaluated if you’re struggling or have never had a hearing test. “What’s important is that if you recognize HL earlier, you can have a better quality of life,” says Sydlowski. “You won’t stay home or drop out of the workforce early because you’re embarrassed that you don’t know what people are saying. You’ll be able to stay connected, do what you want, and stay independent.”
Eric M. Ascher, D.O. is a board-certified family medicine physician. He completed medical school at the New York College of Osteopathic Medicine, his family medicine residency and fellowship at Northwell Health, and has been working for Northwell Health since. Dr. Ascher practices in New York City and focuses on preventative medicine and healthy lifestyles. He has been recognized annually on The Super Doctor’s List posted in the New York Times and has been recognized by Northwell Health as a Rising Star and Physician of the Year. He hosts a series on YouTube in collaboration with Northwell Health called “Hack Your Health,” where viewers are taught why household items may relieve their ailments. Dr. Ascher is an assistant professor of the Zucker Hillside School of Medicine at Hoftsra Northwell, has been a pioneer for telehealth throughout his career, has been a media expert, and is heavily involved in practice and technology optimization. He appreciates building relationships with his patients and their families to encourage long, happy, and healthy lives.