Sound vs. perception

A sound, on its own, is just a series of vibrations moving through the air. Your ears can take that in. But it takes a connection to the brain to identify your spouse’s voice or distinguish between a robin’s or a cardinal’s song. When there’s damage or even changed capacity in the brain, it can alter your ability to make those distinctions and perceptions. “Let’s say the hearing pathway is normal but the brain is undergoing changes,” Tedeschi says. “Then you’re going to have some perception problems.”

He adds that a stroke is a fitting example. “A person who has a stroke may be able to hear very clearly … but they have what we call receptive aphasia. Sound comes in, but their brain can’t process it because of the damage done by the stroke … and they have no idea what you’re saying.”

While a stroke is an extreme example, Tedeschi illustrates how changes in the brain (even the standard shrinkage that comes with age) affect the process we understand as hearing—not just receiving the sound but understanding what it means.

Hearing loss happens with age

When you think about what your ears do all day every day, age-related hearing loss makes sense. The mechanical energy that Dr. Tedeschi mentioned is part of a physical chain reaction inside the ear every time you hear a noise: Sound bounces off the eardrum and triggers the movement of tiny bones. This then causes the hair cells of the inner ear to flex and wave, producing electrical energy²  that goes to the brain. Now multiply that process by the number of sounds you hear daily over the course of 60 or 70 years—it’s easy to see how wear and tear happens.

Plus, there are other factors that can add to the effects:

Increased burden on the brain

The brain is a very adaptable organ. As problems arise in certain areas, it works to compensate in other ways. Tedeschi points out that, consciously or not, people who are starting to struggle with hearing also start to watch and read people’s lips. The portion of the brain that handles visual information starts helping with hearing. “And then we start to see other areas of the brain working to help us hear,” Tedeschi says.

Changes can be hard to detect

Most age-related hearing loss is gradual, and your adaptable brain helps you adjust, bit by bit, so that everything feels fairly normal. This makes it harder for people to perceive their own hearing loss. “The individual with the hearing loss is the last person to realize they have it,” Tedeschi says. “Family members and people around them will always notice it first.”

It often takes a long time for people with hearing loss to be convinced that they would benefit from help. But in that time, their hearing loss is gradually worsening. Tedeschi says that by the time many people come in for a hearing check, they may have mild, moderate or even severe hearing loss. When they wear hearing aids for the first time, it’s a shock. “Their reaction is ‘Oh, wow, things are way too loud.’ Well, it’s not that they’re not way too loud, it’s just that that’s how much your hearing has changed.

“I [often] tell people, ‘The amount of hearing loss that you have right now, if it would have happened overnight, you would have been in the emergency room or at your family doctor saying, ‘Something’s happened!’”

Support your hearing and your brain

The flip side to all this is that there are ways you can support your hearing and your brain simultaneously. Tedeschi stresses that the most important advice is to simply “do something.” That means getting a hearing test either regularly or at the prompting of a loved one.

Getting tested and finding hearing loss early makes it more likely that you’ll be able to find a solution that meets your expectations. “As we lose our hearing over time, without amplification, we see our ability to understand—our discrimination ability—[decrease],” Tedeschi says. “When that happens, it becomes more difficult to restore … that discrimination ability. That’s why we try to tell people that it’s better to get into hearing aids earlier than later. We cannot recover what’s been lost in the brain over time. But if we catch it early enough, we can prevent it from getting worse."

How hearing aids help

Once hearing loss starts, there are limited options for treating it—especially for the majority of people with mild to moderate hearing loss, for whom invasive options like surgery don’t make sense. Hearing aids are not only widely available—they are the most effective solution for people who need hearing support. And as more studies show, their benefits extend to the brain.

“What we see is that, when people start to wear hearing aids, that auditory cortex begins to function more,” Tedeschi says. “In some of the studies that we’ve seen, over six months to a year, in people wearing hearing aids who hadn’t before, the auditory cortex starts to take the sound energy in again and the other areas of the brain that were helping now don’t have to help.”

That reduced demand on the brain may help mitigate cognitive decline ⁴ but hearing aids also help with other problems associated with dementia. “We know that in cognitive decline, there are a number of comorbidities that are amplified with hearing loss,” Tedeschi says. “We see more falls, we see more social isolation—due to hearing loss. By utilizing hearing aids and by going through hearing remediation, we aren’t saying that we can prevent these things from happening, but we can slow it down. We can actually help an individual live a more sustainable life, a more enjoyable life. And that’s why the use of hearing aids is so important.”