From the Guidelines
Unilateral sensorineural hearing loss (SNHL) is likely to increase the risk of cognitive decline, as evidenced by recent studies suggesting a link between hearing loss and cognitive impairment. The exact mechanisms are not fully understood, but it is thought that hearing loss may contribute to cognitive decline through social isolation, structural changes in the brain, and depletion of cognitive reserve 1. When one ear has impaired function, the brain must work harder to process auditory information, potentially diverting cognitive resources from other tasks, which may accelerate cognitive aging over time.
Key Findings
- The relationship between hearing loss and cognitive decline appears to follow a dose-response pattern, with greater hearing loss severity associated with greater cognitive risk 1.
- Early intervention with appropriate hearing aids or other hearing assistive devices for unilateral hearing loss may help mitigate these cognitive risks by reducing listening effort and supporting continued social engagement.
- Regular hearing assessments are recommended, especially for adults over 50, to identify and address hearing loss promptly.
- A recent RCT, the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, found that appropriately fit amplification and associated auditory rehabilitation appears to reduce cognitive loss within 3 years for those at-risk of cognitive decline 1.
Clinical Implications
- Clinicians and older adults with hearing loss must consider the type of technology and/or delivery approach that is best suited to the individual's needs and priorities.
- The pathway of care will be dependent on the severity and complexity of the hearing loss, the individual's ability to self-manage care, and the communication goals of the individual.
- Cost and insurance coverage are also considerations when navigating available options, where state-based Medicaid programs provide variable coverage and federal-level Medicare currently provides no coverage for hearing aids. Therefore, it is essential to prioritize early intervention and regular hearing assessments to mitigate the risk of cognitive decline associated with unilateral SNHL.
From the Research
Unilateral Sensorineural Hearing Loss and Cognitive Decline
- The relationship between unilateral sensorineural hearing loss (SNHL) and cognitive decline is not directly addressed in the provided studies, which primarily focus on the effects of hearing loss in general on cognitive function 2, 3, 4, 5, 6.
- However, it is established that hearing loss is a significant modifiable risk factor for cognitive decline and dementia, accounting for up to 9% of the overall modifiable risk 2.
- Studies suggest that hearing rehabilitation, including hearing aids and other interventions, can play a crucial role in preventing or slowing the rate of cognitive decline in individuals with hearing loss 2, 3, 6.
- The impact of hearing loss on cognitive function is thought to be related to factors such as social isolation, loneliness, and depression, as well as the increased cognitive load associated with effortful listening 4, 5.
- Longitudinal studies have found that auditory and cognitive functioning influence each other's trajectories over time, even when controlling for metabolic risk factors 5.
- Experts recommend that hearing care practitioners be knowledgeable about cognitive decline and its management, and that person-centered hearing care be provided to older adults to maximize successful hearing intervention and overall well-being 6.