How Hearing Loss Is Associated with Hypertension, Heart Disease, and Stroke
According to the Centers for Disease Control (CDC), heart disease is the leading cause of death in both men and women, killing almost 697,000 people in the US during 2020—or about 1 in 5 deaths. But did you know there is evidence to suggest a relationship between heart disease and hearing loss? Researchers have discovered that a healthy cardiovascular system—your heart and blood vessels—is essential to hearing health.
Before we delve deeper into exploring the connections between hearing loss and hypertension, heart disease, and stroke, it’s helpful to take a closer look at the role blood pressure plays in conditions of the heart and brain.
Hypertension is blood pressure that is higher than normal and the condition usually occurs over time. High blood pressure can damage your health in many ways, including hurting important organs like your heart, brain, kidneys, eyes—and ears.
Hypertension, heart disease, and stroke explained
Most heart disease is closely linked to hypertension, also referred to as high blood pressure. Hypertension is a common condition that affects nearly half of adults in the US (47%, or 116 million). Furthermore, about 1 in 3 adults are living with prehypertension—where blood pressure levels are above the normal range, but not high enough to be classified as hypertension. Only half of Americans with hypertension have their condition under control, which is a worrying statistic since having hypertension can lead to a multitude of chronic illnesses and puts them at increased risk for heart disease and stroke.
But what precisely is the effect of hypertension on the body? Quite simply, it’s all about blood flow. If your blood pressure is high, your heart pumps blood through your arteries faster and with more force than usual, which can cause tears to the lining of blood vessel walls. Our bodies repair these tears with scar tissue, but this, in turn, traps plaque (a combination of fat, cholesterol, calcium, and other substances found in the blood). The result: A build-up of plaque, which can lead to blockages, blood clots, and hardened or weakened arteries. Blockages and blood clots limit blood flow to vital organs, and without a sufficient blood supply, the tissue dies.
In hypertension, arteries become constricted, forcing the heart to pump blood with more force.
When the heart doesn’t receive essential oxygen and nutrients, this can lead to coronary heart disease (the most common type of heart disease in the US), which can cause chest pain (known as angina) or shortness of breath and can lead to heart attacks.
Similarly, obstruction of the blood supply to the brain can potentially cause a stroke (sometimes referred to as a “brain attack”). A stroke is a serious life-threatening condition with symptoms including sudden numbness or weakness (especially on one side of the body), dizziness, and difficulty speaking or understanding speech. If a stroke occurs in the areas of the brain responsible for hearing and balance, it can also cause hearing issues, such as difficulty recognizing spoken words, a change in how things sound, dizziness, and problems with balance.
Cardiovascular disease has many causes, including hypertension, and can result in damage to circulation in large arteries and small blood vessels alike. This in turn can damage organs including the heart, kidneys, brain, inner ear, and more.
What is the connection between heart disease and hearing loss?
One of the main ways heart disease and hearing loss are linked is that they share many of the same risk factors—things that increase the chance of developing them—which include:
Heart health and hearing health are closely connected, as good circulation is important in maintaining both.
Disruptions to blood flow due to hypertension may cause an inadequate supply of blood to the inner ear. If the delicate hair cells of the cochlea—the organ responsible for receiving sound—do not receive enough oxygen due to a lack of blood supply, they become damaged or die.
The spiral-shaped cochlea, or inner ear, is responsible for our hearing reception, but is only about 9 mm (1/3 inch) in diameter at its base and 5 mm (1/6 inch) in height—about the size of a pencil eraser. Because of its size, delicacy, and microvasculature, some have postulated that the cochlea is more susceptible to problems associated with other types chronic illnesses, including hypertension.
Dr. Mohan Jagade, Master of Surgery (ENT and Plastic Surgery) and researcher in Mumbai, India, explains, “The outer hair cells are affected first. This affects hearing, and then sensorineural hearing loss (SNHL) and balance problems can ensue.”
It should be emphasized, however, that hearing loss doesn’t affect everyone experiencing high blood pressure—though being aware of this connection can help you maintain your hearing health.
What the research says about the connection between hypertension and hearing loss
Research points to a relationship between hearing loss and hypertension, though this doesn’t necessarily mean that one causes the other; rather there may be some kind of association.
A 2013 study by Dr. Jagade and his team demonstrated a clear link between hypertension and hearing loss. The study included 274 participants between the ages of 45-64 and found that for people with high blood pressure, there was a significant increase in the presence of hearing loss. The researchers surmised that hypertension is an accelerating factor in damage to the auditory system as people age.
Similarly, in an earlier study in 2010, Raymond Hull and Stacy Kerschen reviewed research from the past 60 years on cardiovascular health and its influence on hearing health. They discovered that impaired cardiovascular health negatively affects the auditory system, particularly in older adults.
More recently, in a 2017 analysis of 5,107 Australians, a connection was found between heart disease and risk factors such as hypertension, with an increased risk of hearing loss.
In their 2017 landmark paper that shows how hearing loss is the largest modifiable risk factor for cognitive decline and dementia, Livingston et al. explained that hearing loss may occur as a result of reduced blood flow to both the brain and inner ear (i.e., cardiovascular problems could be a common cause for both hearing loss and cognitive decline).
Tinnitus due to poor circulation
According to Jagade, “Hypertensive patients commonly complain of tinnitus.” Indeed, a recent population study of people with tinnitus ages 20-39 showed they were almost 2.5 times more likely to be diagnosed with hypertension.
Alongside hearing loss, disruptions to blood flow due to the narrowing of blood vessels (caused by the build-up of plaque) can “give rise to the venturi effect—making the blood ‘woosh’ through the vessels,” says Jagade. Those affected may hear a sound with a steady beat that seems in sync with their pulse. This is a rarer type of tinnitus, known as pulsatile tinnitus, which can indicate a more serious condition and should always be evaluated by a physician.
HearingTracker Audiologist Matthew Allsop plays sound files of the most common types of tinnitus and makes recommendations. Closed captions are available on this video. If you are using a mobile phone, please enable captions clicking on the gear icon.
Possible risk of sudden sensorineural hearing loss due to heart disease and stroke
Some evidence suggests a link between untreated heart disease and sudden sensorineural hearing loss (SSNHL)—a sudden or rapid loss of hearing in one or both ears, which can occur immediately or over a few days—especially among patients under 40 years old. Research by the American Heart Association (AHA) found a link between stroke and SSNHL. The study found that people who experienced SSNHL were approximately 150% more likely to experience a stroke within the 2 years after losing their hearing.
The causes of sudden hearing loss / deafness are still poorly understood, but it's thought that one cause could be a lack of blood flow and disruption of oxygen supply in the inner ear or in part(s) of the auditory processing regions of the brain.
If you think you have experienced SSNHL, be sure to seek immediate medical attention, as early treatment can help save your hearing. Sudden hearing loss is one of the few “emergencies of the ear” in which you should seek immediate care from an ENT physician and audiologist.
Ear-damaging medications for heart issues
If you have a heart condition, the medication you use to treat it could be ototoxic (i.e., could potentially cause damage to the ear). Some commonly used ototoxic medications include aspirin, statins, beta-blockers, and ACE inhibitors.
New Jersey audiologist Robert M. DiSogra, AuD, who writes and lectures on a variety of hearing loss topics and is an expert on ototocity explains, “There are 11 categories of cardiac medications. Due to the large number of cardiac medications available, their side effects can vary greatly.”
DiSogra recommends that patients taking medication for a heart condition and are concerned about hearing loss speak with their local pharmacist (or chemist as they are referred to in some countries) about the drug in question and its possible side effects.
Robert DiSogra, AuD
“Vascular-related side effects could cause tinnitus in one or both ears, changes in hearing sensitivity, and vertigo,” he notes. “Side effects will also vary from patient to patient depending on other pre-existing medical conditions, like diabetes, a history of noise exposure, or a pre-existing hearing loss. If there are any concerns about hearing, tinnitus, or balance problems, an audiologist should be consulted.”
Hearing healthcare is a vital part of overall healthcare
Hearing is a significant factor in your overall health. Because untreated hearing loss has been associated with increased risk of falls, as well as feelings of isolation, loneliness, depression, and even dementia, it negatively impacts your physical and mental health, wellbeing, and quality of life. Recent studies also show that untreated hearing loss is associated with a more sedentary lifestyle and reduced physical activity among older adults—which in turn can lead to a cascade of health issues.
If you have hearing loss or suspect a hearing loss, then seeing a primary care provider is essential, particularly if you're over age 40. Some other considerations for better hearing include:
- Choose a healthy lifestyle. Adopting healthy lifestyle habits such as eating a balanced diet and getting regular exercise can go a long way to helping prevent problems with the cardiovascular system.
- Don't smoke. It's well documented that smoking adversely affects both your cardiovascular health and hearing health. Studies indicate that cigarette smokers are 2 to 4 times more likely to have heart disease and about 60% more likely to have high-frequency hearing loss than nonsmokers.
- Protect your ears. Jagade warns of the dangers of listening to music with earphones at volumes that can harm hearing health. To protect your hearing, make sure you avoid extensive exposure to loud noise and wear hearing protection when necessary.
- Have regular blood pressure checks. Due to the connection between cardiovascular health and hearing health, it is important to have regular blood pressure checks and hearing tests. The CDC advises you to have a blood pressure measurement taken at least every two years, and more frequently if you have already been diagnosed with heart disease or other risk factors for heart disease.
People ages 18-40 should get a hearing test at least once every three years, while those older or more at risk for hearing loss should get tested more regularly.
Jagade recommends that patients have regular hearing tests and examinations to monitor hearing levels. If you are between age 18-40, have healthy ears, and are not exposed to hazardous noise, you should get a hearing test every three years. If you older, are regularly exposed to unsafe noise levels, or note that your hearing acuity is declining, you should have a hearing test more regularly (preferably every year).
As always, should you notice a change in your hearing or tinnitus, or notice problems with your balance, speak with your physician and audiologist right away. An audiologist can carry out extensive tests to determine your hearing levels, and also recommend treatment such as hearing aids, assistive devices, or implants, which can significantly improve not only your hearing but your health and quality of life too.