Senior Wellness: Age-Related Hearing Loss
By Carrie Dennett, MPH, RDN
Today’s Dietitian
Vol. 24 No. 8 P. 12
Can a healthful eating pattern reduce the risk?
Dietitians know that nutrition plays a direct or indirect role in countless health conditions, but is it associated with hearing loss? Research suggests that eating patterns over time, and possibly intake of specific nutrients, can influence risk of developing hearing loss, for better or for worse.
According to the World Health Organization, 35% of adults globally older than age 65 suffer from disabling hearing loss, which has been ranked as a leading cause of years lived with disability.1,2 Data from 2014 in the National Health Interview Study found that the prevalence of perceived hearing loss increased with age—5.5% of adults aged 18 to 39, 19% of adults aged 40 to 69, and 43% of adults aged 70 or older.3
Sensorineural hearing loss, caused by damage to the inner ear or auditory nerve, usually is permanent and managed with hearing aids, cochlear implants, or alternative communication techniques such as lip reading or sign language. Loud noise is a common cause, as well as genetics, chronic diseases such as diabetes or high blood pressure, chronic ear infections, smoking, and certain “ototoxic” medications.4,5 Numerous randomized clinical trials for drugs that may help prevent or treat hearing loss are underway, but it’s also important to know that diet and nutrition also may play a role in decreasing the risk of hearing loss in seniors—starting before birth.
Eating Patterns and Hearing
It’s well-established that an overall healthful eating pattern can help reduce the risk of many chronic diseases, and age-related hearing loss may be no different. The Conservation of Hearing Study (CHEARS) looked at risk factors for hearing loss among a subset of more than 70,000 female participants in the Nurses’ Health Study II by monitoring their dietary intake and hearing for 22 years.6 Researchers measured adherence to three healthful eating patterns: Alternate Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and Alternative Healthy Eating Index-2010 (AHEI-2010).
• AMED is based on fruits, vegetables, nuts, whole grains, legumes, and olive oil. It encourages eating fish and drinking only a moderate amount of alcohol. It differs from the traditional Mediterranean diet in that it doesn’t include dairy and “penalizes” for only red and processed meats, rather than all meats.
• DASH encourages fruits, vegetables, nuts, lean meats, fish, and low-fat dairy and limits sodium, sugar, and fat.
• AHEI-2010 encourages vegetables, fruits, whole grains and limits sugar, salt, and animal fat.
The women ranged in age from 27 to 44 at the beginning of the study. Those with dietary patterns matching the AMED, DASH, or AHEI-2010 were less likely to report new onset of moderate-or-worse hearing loss during follow-up. Women with the greatest adherence to the AMED or DASH diets had an approximately 30% lower risk, while women closely following an AHEI-2010 pattern showed a 21% lower risk. The authors say no food or food group appeared to contribute more strongly to the observed associations and that the overall dietary pattern likely is key. Because a more healthful diet promotes a more healthful blood lipid profile, better endothelial function, lower blood pressure, and reduced inflammation, this, in turn, protects blood vessels, and the authors say this may prevent insufficient blood supply to the cochlea, the part of the inner ear involved in hearing. Reduced cochlear blood flow deprives the cochlea of oxygen, which can damage cells and nerves, leading to hearing loss.
A 2021 scoping review of 22 studies examining the relationship between nutrition, dietary habits, and hearing loss found that diets rich in saturated fats and cholesterol may increase risk of hearing loss, while higher consumption of fruit, vegetables, omega-3 polyunsaturated fatty acids, and antioxidant vitamins A, C, and E may reduce risk. The authors noted that eating patterns with vegetables, fruits, whole grains, and an adequate quantity of fish as primary components usually are associated with a decrease in systemic inflammation, which could help maintain normal hearing.7
Nutrition-Related Health Conditions and Hearing
While nutrient-rich, balanced eating patterns may reduce risk of adult hearing loss, malnutrition and certain chronic health conditions, including type 2 diabetes, may increase the risk of hearing loss.
A follow-up of 2,193 individuals aged 16 to 23 in Nepal who had previously participated in a randomized vitamin A supplementation trial at around 5 years of age found that children who had experienced malnutrition were significantly more likely than their well-nourished peers to suffer early adult hearing loss, abnormalities in the middle ear, or both. The researchers noted that children who experience malnutrition in the period from conception to early childhood—a malnourished woman may pass on any nutrient deficiencies during pregnancy and lactation and may have babies that are small for gestational age—can suffer stunted anatomical development, including inner ear development.8 Participants of the Nurses’ Health Study II who reported a birth weight of less than 5.5 lbs were 14% more likely to also report adult-onset hearing loss. Interestingly, participants who had a gestational age of 42 weeks or more at birth were 33% more likely to report adult-onset hearing loss.9
Individuals with type 2 diabetes are twice as likely to experience hearing loss than people without diabetes, and those with prediabetes have a 30% higher rate of hearing loss. The sensory and support cells of the cochlea have insulin receptors, glucose transporters, and insulin signaling components, which can make both hearing and balance vulnerable to the effects of impaired glucose utilization. Nerve and blood vessel damage related to diabetes also can affect the nerves and blood vessels of the inner ear.10
Micronutrients and Hearing
Some research into the potential association between nutrition and hearing loss has focused on the possible effects of inadequate dietary intake of nutrients known to play a role in inner ear function. A 2014 analysis of data from the 2001–2004 National Health and Nutrition Examination Survey (NHANES) found an association between higher intakes of beta-carotene, vitamin C, and magnesium—from food, supplements, or both—and a lower risk of hearing loss. In addition to dietary supplements, beta-carotene is found in many yellow and orange vegetables. Citrus fruit is a rich source of vitamin C, and magnesium is commonly found in green leafy vegetables, legumes, nuts, and whole grains.11
Conversely, data from 18 years of follow up of 65,521 women from the Nurses’ Health Study II found that higher vitamin C intake from supplements was associated with higher risk of hearing loss, while higher intakes of beta-carotene, beta-cryptoxanthin, and folate, from supplements and/or the diet, were associated with lower risk. The authors noted that antioxidants and carotenoids may protect hearing by reducing cell and tissue damage due to oxidative stress, while folate may influence cochlear blood flow via its beneficial effects on endothelial function. 12 An examination of 1,149 men and women aged 20 to 69 who participated in NHANES found a U-shaped association between red blood cell levels of folate—a measurement that’s less sensitive to short-term dietary effects than serum folate levels—and hearing loss. Subjects with moderate folate levels were 32% less likely to have hearing loss.13 Foods high in folic acid include dark green vegetables, beans, whole grains, and fortified foods.
A 2021 systematic review of studies evaluating the protective effects of vitamins and antioxidants on occupational noise-induced hearing loss found that vitamin B12, folic acid, and N-acetylcysteine (NAC) have a considerable protective effect and that findings on vitamins A, C, and E are inconsistent.14 Potassium—found most abundantly in leafy greens, avocados, sweet and regular potatoes, bananas, and beans—plays a large role in the way the inner ear functions.15,16
Counseling Patients
The potential role of nutrition in age-related hearing loss demonstrates the importance of nutrition across the lifespan.
• Dietitians working in prenatal or pediatric care help pregnant or lactating mothers and young children meet dietary recommendations and may be helping to prevent hearing loss in the near and far terms.
• RDs working with patients with diabetes know that good diabetes management can help prevent a number of health complications—now they can add hearing loss to the list.
• Dietitians working with older patients who are undergoing life transitions—empty nest, retirement, downsizing, death of a spouse—can be alert for indications of impaired nutrition status, especially in those experiencing taste changes or problems with dentition.
Regardless of the demographic to which patients belong, providing education and support as needed to facilitate eating a balanced diet with adequate fruits and vegetables in accordance with their lifestyle can reduce the risk of age-related hearing loss as well as other chronic health conditions that increase in prevalence with age.
— Carrie Dennett, MPH, RDN, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy for Your Life: A Holistic Guide to Optimal Wellness.
References
1. Deafness and Hearing Loss. World Health Organization website. http://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss. Published April 1, 2021.
2. Wilson BS, Tucci DL, Merson MH, O'Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017;390(10111):2503-2515.
3. National Center for Health Statistics. Self-reported hearing trouble in adults aged 18 and over: United States, 2014. https://www.cdc.gov/nchs/data/databriefs/db214.pdf. Published 2015.
4. US Preventive Services Task Force, Krist AH, Davidson KW, et al. Screening for hearing loss in older adults: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(12):1196–1201.
5. Hearing loss: a common problem for older adults. National Institute on Aging. https://www.nia.nih.gov/health/hearing-loss-common-problem-older-adults. Updated November 20, 2018.
6. Curhan SG, Wang M, Eavey RD, Stampfer MJ, Curhan GC. Adherence to healthful dietary patterns is associated with lower risk of hearing loss in women. J Nutr. 2018;148(6):944-951.
7. Rodrigo L, Campos-Asensio C, Rodríguez MÁ, Crespo I, Olmedillas H. Role of nutrition in the development and prevention of age-related hearing loss: a scoping review. J Formos Med Assoc. 2021;120(1 Pt 1):107-120.
8. Emmett SD, Schmitz J, Karna SL, et al. Early childhood undernutrition increases risk of hearing loss in young adulthood in rural Nepal. Am J Clin Nutr. 2018;107(2):268-277.
9. Gupta S, Wang M, Hong B, Curhan SG, Curhan GC. Birth weight and adult-onset hearing loss. Ear Hear. 2020;41(5):1208-1214.
10. Samocha-Bonet D, Wu B, Ryugo DK. Diabetes mellitus and hearing loss: a review. Ageing Res Rev. 2021;71:101423.
11. Choi YH, Miller JM, Tucker KL, Hu H, Park SK. Antioxidant vitamins and magnesium and the risk of hearing loss in the US general population. Am J Clin Nutr. 2014;99(1):148-155.
12. Curhan SG, Stankovic KM, Eavey RD, Wang M, Stampfer MJ, Curhan GC. Carotenoids, vitamin A, vitamin C, vitamin E, and folate and risk of self-reported hearing loss in women. Am J Clin Nutr. 2015;102(5):1167-1175.
13. Kabagambe EK, Lipworth L, Labadie RF, Hood LJ, Francis DO. Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003-2004 National Health And Nutrition Examination Survey (NHANES). Eur J Clin Nutr. 2018;72(5):720-727.
14. Abbasi M, Pourrajab B, Tokhi MO. Protective effects of vitamins/antioxidants on occupational noise-induced hearing loss: a systematic review. J Occup Health. 2021;63(1):e12217.
15. Peixoto Pinheiro B, Vona B, Löwenheim H, Rüttiger L, Knipper M, Adel Y. Age-related hearing loss pertaining to potassium ion channels in the cochlea and auditory pathway. Pflugers Arch. 2021;473(5):823-840.
16. Ciorba A, Corazzi V, Bianchini C, et al. Sudden sensorineural hearing loss: is there a connection with inner ear electrolytic disorders? A literature review. Int J Immunopathol Pharmacol. 2016;29(4):595-602.