Heart disease is known to be one of the most prevalent causes of death in the United States. According to the Centers for Disease Control and Prevention (CDC), heart disease kills about 610,000 people in the U.S. every year making it the cause of roughly one in four deaths.

A healthy heart plays a significant role in keeping hearing abilities intact. Your heart is responsible for pumping blood and bringing oxygen and other nutrients throughout your body. With cardiovascular diseases, such as a build-up of plaque in the arteries, the heart has to work much harder to do this. More specifically when the blood supply to the inner ear is affected, this can lead to hearing loss.

How heart disease influences hearing loss

Hearing loss in elderly persons is a public health concern that is of increasing importance as the global population ages. It is estimated to affect more than half of the adults older than 75 years in the United States, a population that is expected to double over the next 40 years. The inner ear and cochlea is a small yet extremely powerful organ.

This makes it sensitive to changes in blood flow. An abnormally functioning cardiovascular system may inhibit blood flow to the inner ear, causing long-term hearing loss. In addition, a study conducted by Harvard University identified a significant correlation between heart disease and hearing loss, finding that hearing loss was 54 percent more common in people with heart disease.

According to a 2010 American Journal of Audiology report, impaired cardiovascular health can affect both the peripheral (outer, middle, and inner ear) and central auditory systems, particularly, among older people. The nerves in the cochlea play an important role in translating noise in your ears to electrical impulses in your brain. As a result of heart disease, poor circulation can reduce sufficient oxygen from reaching the brain.

This can then cause damage or destroy the nerve cells causing permanent hearing loss. Many researchers suggest that the inner ear is often the first organ in the body to be affected by heart disease. A 2017 study confirmed that heart conditions such as arterial disease and a history of cardiovascular disease may indicate a higher risk of developing hearing loss.

High blood pressure causes the heart to work extra hard to pump blood to the various organs in the body. Furthermore, hypertension may be related to atherosclerotic disease, in which there is a thickening of the wall lining of the blood vessels, and this may lead to a poorer blood supply in the inner ear. Research has also shown hearing loss as a sign of circulatory instability.

The inner ear is considered a sensorineural organ that is sensitive to systemic pathology such as cardio-metabolic, autoimmune, or inflammatory conditions. A multidisciplinary approach to managing hearing loss is required, and medications targeting the cardiovascular system may have a future role in preventing hearing loss. Hearing loss may become an early marker for cardiovascular disorders if future studies demonstrate that hearing loss precedes the onset of cardiovascular events.

Shared risk factors

There is a significant link between hearing loss and heart disease. In addition, there are several other shared risk factors for hearing loss and heart disease which increases the chances of the person being diagnosed with one or both. The risk factors include:

• High blood pressure
• High cholesterol
• Diabetes
• Poor diet
• Inactivity
• Excessive alcohol use

Both cardiovascular and cardio-metabolic diseases often result from lifestyle patterns, including poor nutrition, lack of exercise, smoking, and stress. These lifestyle patterns have been evident in hearing loss in older adults as well. To make matters worse, the research shows that 75 percent of older adults with heart failure have hearing loss, but in this population, only 16.3 percent of those wear hearing aids.

This adds to the burden of the disease as heart failure management requires that patients hear and understand physician recommendations. This is not surprising as other studies of older adults have found similar findings that many people who have hearing loss do not use hearing aids. The reasons for this are multifactorial but the most common challenges that include accessibility and costs. Untreated hearing loss leads to

diminished quality of life and has been associated with overall morbidity and mortality, as well as greater cognitive decline. As with heart disease, if left untreated, the person is at an increased risk of death amongst a decline in general lifestyle functioning.

What is the way forward?

From an Audiology perspective, it is important that the person has his/her hearing tested, to begin with. Research findings have indicated that persons with cardiovascular disease and heart problems often present with similar types of audiometric patterns, specifically low-frequency (sloping) and flat losses. Research performed by Friedland et.al, 2009 reported that patients with low-frequency hearing loss should be regarded as “at-risk” for cardiovascular events, and appropriate medical referrals should be considered.

Lifestyle changes

Restoration of blood supply to the cochlea through better cardiovascular fitness, reversing modifiable cardiovascular risk factors, or treating the cardiovascular disease earlier may protect against hearing loss. Early intervention to cardiovascular disease by addressing risk factors may be beneficial to persons with an increased predisposition to hearing loss due to positive family history or lifestyle events. An active lifestyle can play a big part in a healthy cardiovascular system, including regular physical activity, maintaining a healthy diet, and keeping blood pressure in a healthy range.

In summary

A healthy heart can lead to healthy hearing. Increasing physical activity can increase blood flow to the ears, which may decrease your risk of hearing loss. This type of hearing loss can also be managed with the help of an audiologist, who can provide a comprehensive hearing evaluation as well as amplification as a treatment option.

The key message is that some heart diseases and some types of hearing loss are related. If you have heart disease, you should have your hearing evaluated. If you have a moderate, or greater, low-frequency, inner-ear hearing loss, you should have your cardiovascular system evaluated.