The New England Journal of MedicineAge-Related Hearing Loss

The Progressive Impact of Age-Related Hearing Loss on Cognitive Health and Communication

Age-related hearing loss (ARHL) is a pervasive condition affecting auditory function across the lifespan, with significant implications for cognitive and communicative abilities. This comprehensive review elucidates the pathophysiology of ARHL, its progressive nature, and the intricate relationship between hearing impairment and cognitive decline, while exploring the therapeutic advancements and management strategies that are pivotal in mitigating its impact.

Key Points:

• Epidemiology and Progression: ARHL progressively impairs hearing, with prevalence nearly doubling every decade after 60 years of age, affecting over two-thirds of adults over 60 in the US as of 2019.
• Pathophysiology: The condition primarily involves the loss of sensory hair cells in the inner ear, crucial for sound encoding, which do not regenerate, leading to irreversible hearing decline.
• Risk Factors: Key risk factors include age, lighter skin (indicative of less protective melanin in the cochlea), male sex, and environmental noise exposure, alongside cardiovascular risk factors such as diabetes and hypertension.
• Cognitive Impact: ARHL is notably linked to increased cognitive load, brain atrophy, and social isolation, which are hypothesized to contribute to cognitive decline and heightened dementia risk.
• Management Strategies: Management focuses on using hearing aids and cochlear implants to enhance speech clarity, alongside protective strategies against noise exposure and optimizing communication settings.
• Technological Advances: Recent regulatory changes have facilitated the availability of over-the-counter hearing aids, empowering individuals to manage their hearing health proactively with self-testing and tracking via digital tools like smartphones.
• Clinical Recommendations: For patients presenting with ARHL symptoms, clinicians are advised to conduct a thorough evaluation to rule out treatable causes and consider referral to specialists or audiologists for advanced management options.
• Research and Future Directions: Ongoing research is exploring the potential of pharmacologic and genetic interventions to slow ARHL progression, though no effective restoration therapies have been confirmed effective to date.

Among adults ages 70 and older with hearing loss who could benefit from hearing aids, fewer than 1 in 3 (30%) has ever used them. Even fewer adults ages 20-69 (approximately 16%) who could benefit from wearing hearing aids have ever used them. (NIH)

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