Chronic Illness and Hearing Loss: What You Need to Know

Hearing loss is a widespread condition, with one in eight people in the United States aged 12 years or older estimated to have deficits in both ears. For the older population, hearing loss is often simply considered part of the aging process. But did you know hearing loss can also be a complication caused by an underlying chronic health condition?

Disease or disfunction in one part of the body can unexpectedly affect another. For example, if you have a sore knee, you might start walking differently–which could in turn contribute to hip pain. In the same way, various studies about hearing loss have uncovered links to an array of other health conditions. However, it should be noted that, just because research links hearing loss to a chronic disease or health problem, it doesn’t necessarily mean hearing loss causes that problem; it just shows there may be some kind of association between the two conditions.

Here, we explore the connection between some common chronic diseases and hearing loss to help you understand the possible interrelationships and advocate for the best care possible.

How can chronic illness cause or worsen hearing loss?

First, let’s explain what we mean by the term “chronic.” Quite simply, a chronic illness is defined as a health condition that is persistent or long-lasting, generally for more than three months.

As for the connection between chronic illness and hearing loss, says audiologist Kathy Dowd, Executive Director at The Audiology Project (TAP) Inc, of Charlotte, North Carolina. “Chronic diseases change neural [related to a nerve or the nervous system] and vascular [the arteries and veins, that carry fluids such as blood around the body] functions in the body, which can impinge on hearing and vestibular [balance] organs.”

Some common diseases associated with hearing loss include the following:

Cancer, chemotherapy, and radiation treatment

The connection between cancer and hearing loss is attributable to both certain types of cancer, as well as the medications used to treat them. Cancers that grow and press on the Eustachian tubes—the small tubes that run between your middle ears to the back of the nose and throat—can cause pain, fluid, or hearing loss. Tumors that grow into the temporal bone, or the area of the skull above the ear, can also press on nerves and organs that cause hearing loss, dizziness, and facial paralysis.

“The usual treatment for cancer is chemotherapy,” explains Dowd, “which can cause hearing loss.” Chemotherapy side effects such as hearing loss, tinnitus (ringing in the ears), and balance problems are sometimes temporary and resolve after finishing the treatment. In some cases, they are permanent. High doses of radiation therapy and surgery to the head, ear, or brain can also damage the inner ear causing hearing problems.

Learn more: Cancer Chemotherapy Side Effects: Hearing Loss and Tinnitus

Chronic kidney or renal disease and its treatment

Chronic kidney disease (CKD), also known as chronic renal disease, is a condition that causes gradual loss of kidney function. According to the Kidney Foundation, over 54% of people with kidney disease have some form of hearing loss.

“The kidneys are hard-wired to the auditory system and can cause hearing to change,” explains Dowd. Toxins that accumulate during kidney failure—when your kidneys no longer function effectively—can damage the nerves in the inner ear, adversely affecting hearing.”

Certain medications used to treat kidney disease can also cause damage to the ear, resulting in sensorineural hearing loss (SNHL), tinnitus, or balance disorders.

More recently, studies have shown how the kidneys and the cochlea both operate using similar biological structures like cilia (hair-like cells) and rely on the same processes for them to develop. That makes it more likely genetic abnormalities or other factors that affect the cochlea may also affect the kidneys, and vice versa.

Learn more: Hearing Loss and Chronic Kidney Disease (CKD)

Alzheimer’s disease, dementia and cognitive disorders

Hearing loss has also been linked to cognitive-communication disorders, namely forms of dementia such as Alzheimer’s. It’s important to note that the symptoms of cognitive issues and hearing loss may be similar. Dowd told HearingTracker, “If hearing is not tested before a cognitive test is presented, the patient may appear to have Alzheimer’s when there is actually an underlying hearing loss. This is a huge issue in nursing homes, where speech therapists are performing cognitive tests and delivering cognitive treatment without screening for hearing loss and/or referring to audiology. Alzheimer’s may still be present, but communication improves significantly when hearing is assessed and treated.”

While it is unclear whether age-related hearing loss causes Alzheimer’s, there are some theories regarding the connection. Research has shown the brain’s processing centers can change in response to hearing loss and lack of use, exhibiting “neuroplasticity” where unused regions of the brain once used for processing sounds are recruited for other senses like vision. Also, the impact of engaging less in conversation due to social isolation can contribute to cognitive decline. Additionally, the extra energy needed by people with hearing loss to hear in everyday life can also drain the mental capacity (“cognitive load”) needed for memory and thinking, increasing the risk of Alzheimer’s and other cognitive disorders. It is also possible that hearing loss and dementia might share a common cause like a blood flow or neuro-degenerative problem.

Two landmark studies published by the Lancet Commission in 2017 and 2020 showed that hearing loss is the number-one “modifiable risk factor” in middle life, linked to around 8% of worldwide dementia cases. More recently, a 2023 study in The Lancet suggests that people experiencing hearing loss who are not using a hearing aid may have a higher risk of dementia than people without hearing loss; however, the same study indicates using a hearing aid may reduce this risk to the same level as people without hearing loss.

The Lancet Commission and many studies point to the links between hearing loss and cognitive decline. But can treating your hearing loss help? More recently, the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study—a relatively short 3-year randomized trial—showed hearing aids that were professionally fit using best practices cut cognitive decline in half for a group of people who were at greater risk for dementia.

With more research, there will almost certainly be more revealing findings in this area.

Learn more: Dementia and hearing loss

This video, introduced by audiologist Matthew Allsop, features an expert panel that discusses the latest science surrounding the link between hearing loss and dementia and includes researchers involved in the ongoing ACHIEVE and ENHANCE studies.

Loneliness, Social Isolation, and Depression

Research shows that hearing loss can impair the exchange of information, thus significantly impacting everyday life. Hearing loss makes it difficult to communicate with loved ones, perform work tasks, and for people to engage in social situations. Some people may also feel anxiety about missing important information in conversation. All these experiences, together with the lack of auditory stimulation, can lead to feelings of stress, fatigue, or depression.

Often related to depression are social isolation and loneliness—two conditions also impacting chronic mental and physical conditions. Social isolation is a person’s reduced reliance on social networks and the number of people they are connected to. Likewise, loneliness is the perception of the inadequacy of those networks. Unfortunately, there is a common misperception that social withdrawal is a normal product of aging. However, we know social isolation and loneliness are not due to getting older; instead, they are related to one’s desire and ability to engage and communicate with others—which often relies chiefly on the ability to hear well. Research has shown an association between untreated hearing loss and quality of life, social isolation, loneliness, and depression.

Learn more: The Impact of Hearing Loss on Social Engagement, Loneliness, and Depression

Diabetes

Diabetes is a serious medical condition that causes unhealthy levels of glucose (a form of sugar) in the blood, which can lead to long-term and short-term health complications. “In a 2008 study by Kathleen E. Bainbridge to determine whether hearing impairment is more prevalent among U.S. adults with diabetes, incidence of hearing loss in diabetes was approximately 30 percent,” explains Dowd.

High blood sugar levels are believed to have the potential to damage the nerves and small blood vessels throughout the body, including those in the inner ear. Dowd told HearingTracker, “The disruption of small blood vessels and decline of the nervous system affects both hearing and balance organs, the neural pathway, and the brain.”

Learn more: Diabetes and its link to hearing loss, tinnitus, and balance disorders

Heart disease and cardiovascular problems

Heart disease is the leading cause of mortality for men and women in the US, contributing to more than 650,000 deaths per year—that’s 1 in every 4. The most common type of heart disease in the United States is coronary artery disease (CAD), which affects the blood flow to the heart and can cause a heart attack.

The inner ear is often one of the first parts of the body to be affected by heart disease, meaning hearing loss could be a sign of an underlying heart condition. The cochlea—a spiral-shaped organ found within the inner ear that contains delicate hair cells—is one of the smallest and therefore least vasculated organs, and some experts have even likened it to a “canary in a coal mine” for indicating blood-related disorders. Poor blood circulation and insufficient blood flow to the inner ear can cause problems with the functioning of the cochlea. This in turn could lead to hearing loss.

There are even studies suggesting that an ear lobe crease may be a marker for coronary artery disease.

Learn more: How Hearing Loss Is Associated with Hypertension, Heart Disease, and Stroke

Hypothyroidism, hearing loss, and tinnitus

The thyroid is a small, butterfly-shaped gland situated at the base of the front of the neck. The thyroid releases hormones that control metabolism—the way your body uses energy from food. These hormones control vital body functions, including breathing, heart rate, the nervous systems, and body weight, among others.

Hypothyroidism, also known as an underactive thyroid, occurs when the thyroid doesn’t produce enough thyroid hormone to regulate metabolism, causing many of the body’s functions to slow down. This impacts nearly every part of the body, including the ears and is linked to hearing health issues such as sensorineural hearing loss, tinnitus, and/or balance disorders. One study estimated that 25 percent of people with hypothyroidism have evidence of mild to moderate sensorineural hearing loss.

Inflammatory arthritis and pain medications

Inflammatory arthritis (IA) is a condition where instead of attacking germs and viruses, the body's immune system targets the joint tissues, which causes inflammation. People with rheumatoid arthritis (RA)—a form of IA—have a higher risk for developing hearing loss due to damage caused to the body by the condition and the treatment used to treat it.

A serious complication of RA is inflammation of blood vessels (vasculitis), which can damage the parts of the ear responsible for sending information to the auditory nerve and brain. Inflammation can also affect the tiny structures in the ears, impacting hearing.

According to Dowd, “Pain medications for these issues [e.g., non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen] are often ototoxic and can cause hearing loss.”

Learn more: Inflammatory arthritis and its link to hearing loss

Migraine and hearing loss

Research has found a higher incidence of sensorineural hearing loss among individuals with a history of migraines. It is unknown whether one condition leads to the other or if they coexist. It is thought that during a migraine, a sudden constriction of blood vessels can cut off the supply of blood to the auditory system, which is responsible for our sense of hearing. When the oxygen supply to the cochlea is disrupted, it can lead to gradual yet permanent hearing loss.

A study by researchers from Taipei Veterans General Hospital in Taiwan found that people who suffer from migraine are nearly twice as likely to experience sudden sensorineural hearing loss (SSNHL).

Osteoporosis and the middle ear

In the US, an estimated 10 million people aged 50 years and older have osteoporosis, with women being the most affected. Osteoporosis causes low bone density, resulting in weakened, fragile bones that are at increased risk of fractures or breaking.

Research shows that people with osteoporosis are at a greater risk of developing hearing loss. While more studies are needed to truly understand the connection, it is thought that the disease causes damage to the tiny bones inside the middle ear, which play an important role in the processing of sound. If these bones are damaged, it can negatively impact the hearing process. Osteoporosis can also increase the severity of injury during falls for people with vestibular/balance problems (see below).

Learn more: Osteoporosis and Hearing Loss

Stress and blood flow to the cochlea

Stress causes the body to produce too much adrenaline, a hormone that helps us react more quickly in stressful situations. Adrenaline triggers the body's fight-or-flight response, causing our heart rate to quicken. Our bodies respond by rapidly sending blood to our muscles, which may reduce blood flow to the ears.

When stress builds up over time and becomes chronic, the blood flow to the ear can become restricted. Without a continuous supply of blood flow, which provides essential oxygen and nutrients to the cochlea and its hearing hair cells to function, these important structures can become damaged or die. This damage is sometimes permanent, causing sensorineural hearing loss. Furthermore, “Stress contributes to cognitive load, affecting attention and focus,” Dowd told HearingTracker, which can also impact hearing ability. Stress can also heighten tinnitus or ringing in the ears.

Stroke and its impact on hearing and balance

An ischemic stroke occurs when the blood supply to part of the brain is interrupted or reduced. The brain is unable to receive vital oxygen and nutrients, which can cause serious damage.

“Strokes often affect hearing and balance, and they can cause physical impairment on one side of the body,” explains Dowd. “Unilateral hearing loss [hearing loss in one ear] makes it difficult to understand speech in a noisy background even with good hearing on one side.”

Research has identified a correlation between stroke and sudden sensorineural hearing loss (SSNHL)—a rapid loss of hearing in one or both ears, which may occur immediately or over a few days. Stroke patients were found to have a 71% increased risk of SSNHL, compared with patients who have not had a stroke.

Vestibular/balance problems, dizziness, and falls

Hearing loss is associated with increased risk for balance problems, vertigo, dizziness, and falls. The CDC reports falls among adults age 65 and older are very costly: each year about $50 billion is spent on medical costs related to non-fatal fall injuries and $754 million is spent related to fatal falls.

A Johns Hopkins study found that having a hearing loss triples the risk of falling down for people in their 40s and later, and this applied to both moderate and severe hearing losses. A study on postural stability showed that using hearing aids may reduce the risk of falls. One possible explanation is that the brain uses sound for spatial orientation, and can hone in on spatial-orienting landmarks, just as visible objects serve as landmarks to improve stability with sight.

Recent research has been delving into new genetic tests that may help doctors identify the root cause of people's vertigo.

Learn more: Vertigo and Dizziness: Causes, Treatment and Prevention

Minimizing the interaction of chronic disease and hearing loss

The sooner chronic disease is diagnosed, the quicker you can start treatment to help prevent or slow down the progress of the disease. This, in turn, may help to reduce the impact of the condition on other bodily systems such as hearing. Checking in with your healthcare provider annually, as well as when symptoms arise, plays an important role in wellness.

Likewise, if you are worried about your hearing or feel you may have experienced a hearing loss, be sure to make an appointment with a licensed audiologist who can carry out a comprehensive hearing evaluation.

“Only a valid hearing screening or hearing assessment will uncover this invisible handicap for adults,” explains Dowd.

An audiologist can then help you manage your hearing loss—reducing the risk of it impacting your physical or mental health—by determining the best treatment options for your needs.

Meet HearingTracker’s expert

HearingTracker spoke to Kathy Dowd, AuD, Executive Director at The Audiology Project (TAP), Inc, of Charlotte, North Carolina, to understand the relationship between chronic illness and hearing loss. Dr. Dowd has both a clinical and personal interest in this topic. It all began in 2011 when her mother-in-law, who had been living with hearing loss for over 15 years, was diagnosed with diabetes.

As an audiologist, Dowd searched for information related to hearing problems associated with diabetes. “I realized that the Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA) did not know about the link between diabetes and hearing loss,” she explained.

Since then, Dowd has worked to raise awareness of the link between chronic diseases and hearing loss, along with medications that can cause hearing loss (ototoxic drugs). “The non-profit organization TAP was created to organize the audiology associations around this important issue and to include the American Academy of Audiology (AAA), the Academy of Doctors of Audiology (ADA), and the American Speech-Language-Hearing Association (ASHA) in dialogue with CDC,” said Dowd.