The overlooked side effects of hearing loss

Whilst hearing loss is typically framed as a sensory impairment and is considered a natural part of aging or as a result of excessive noise exposure*, its broader effects on individual health and quality of life are often underestimated. Clinicians and health professionals increasingly recognise that hearing loss is not a benign condition – it has systemic consequences that extend far beyond the ears.

There is growing evidence that hearing loss can be a marker of cardiovascular health. The relationship between hearing loss and cardiovascular disease is complex and bidirectional with both conditions sharing common risk factors and physiological mechanisms. The inner ear is highly sensitive to changes in blood supply; it requires a rich and consistent flow of oxygenated blood to function properly. The stria vascularis, a part of the cochlea, is especially vulnerable to ischemia as it helps maintain the electrochemical environment necessary for hearing. When cardiovascular health declines due to conditions such as atherosclerosis, hypertension, or diabetes, the blood vessels may become narrow and damaged. This can lead to reduced cochlear blood flow which impairs hearing particularly at higher frequencies including the 4-6 kHz range commonly associated with noise induced hearing loss.

Several large - scale studies have demonstrated associations between hearing loss and cardiovascular disease. The Framingham Heart Study found low frequency hearing loss was significantly associated with cardiovascular events in older adults suggesting that cochlear health reflects systemic vascular integrity. In a cross-sectional study, Friedland et al (2009) reported that audiometric patterns could predict the likelihood of cardiovascular disease with low frequency hearing loss particularly predictive of vascular pathology. Similarly, Bainbridge et al (2008) demonstrated that adults with diabetes, a key cardiovascular risk factor, were twice as likely to experience hearing impairment likely due to microvascular damage.

Emerging evidence has established a strong association between hearing loss and accelerated cognitive decline. A landmark longitudinal study conducted by Johns Hopkins and the National Institute of Aging found that individuals with mild hearing loss were twice as likely to develop dementia compared to those with normal hearing loss. Those with moderate to severe hearing loss had up to a fivefold increase. 

The auditory and vestibular systems are closely linked. Even in cases of isolated sensorineural hearing loss, studies suggest an increased risk of falls. Research from Johns Hopkins found that individuals with mild hearing loss were nearly three times more likely to report falling.  

Hearing loss often imposes a significant cognitive burden, particularly in challenging listening environments. The additional mental effort required to decode degraded speech signals can lead what is known as listening fatigue- a form of cognitive exhaustion that can affect daily functioning, productivity and overall wellbeing.

The assumption that all high-frequency hearing loss stems from noise exposure is no longer tenable. The growing awareness of alternative causes demands a more nuanced approach. Non occupational exposure should be fully considered and claims challenged based on pre-existing or alternative conditions particularly where hearing loss is symmetrical, gradual and in older claimants. I doubt those reading this article would have to venture too far into their claims to find one to meet this description.