Your ears get most of the credit for hearing, but your brain is an equal partner in the process. Working together, the ears and the brain convert energy waves traveling through the air into words you understand and sounds you recognize. With age, natural changes happen in your ears and your brain—often unavoidably—that affect how you hear.
With expert help from Dr. Thomas Tedeschi, Chief Audiologist (who holds doctorates in both audiology and neuroscience) at Miracle-Ear, we’ll explore what you can expect as a normal part of aging and how you can protect and support your hearing and your brain for the long term.
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Hearing is a complex process, but Tedeschi breaks it down. "When we hear, sound comes into the ear, going through the middle ear into the inner ear. The inner ear is a transducer that turns mechanical energy into electrical energy and sends it up to the brain. Then it goes to the auditory cortex of the brain and the auditory cortex is what deciphers all the signals that are coming in."
The quality of that process changes over our lifetime. Natural, age-related hearing loss — known as presbycusis — is extremely common: as much as 80% of people over 70 experience it to some degree.¹ Presbycusis is one of the most significant ways that aging and hearing loss intersect, sending progressively weaker signals to the brain over time.
At the same time, the brain itself undergoes natural changes. "As we get older, a couple things start to happen," Tedeschi says. "Our brain starts to get a little smaller and, [because of that], our cognitive function is not as sharp as it used to be."
Brain shrinkage with age is a normal part of the brain aging process — but combined with the weaker auditory signals caused by hearing loss, it creates a compounding effect. With less processing power in the aging brain and reduced input from the ears, it becomes increasingly harder to comprehend speech and identify sounds in the environment.
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. This is where brain aging becomes directly relevant to hearing: when the brain undergoes changes — even the gradual shrinkage that comes with age — it can alter the 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 affect the process we understand as hearing — not just receiving the sound but understanding what it means. This distinction between sound and perception is central to understanding how aging affects the brain and hearing simultaneously.
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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:
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.
Many older adults also adapt—without even knowing it—by using their lifetime repository of knowledge about how people speak.
They can make educated guesses, using the limited things they're hearing, the context of the conversation and their natural understanding of speech, to get the gist of what someone is saying.
This is called "auditory closure." It's another way that the brain compensates, dialing up activity in one area when it's not working so well in another. "So now we have a lot of cognitive areas [of the brain] that are trying to help us hear better, which leads to getting tired and fatigued," Tedeschi says. "That's why you'll see that sometimes older people get tired of listening. They'll...go away where it's quiet because their brain gets overloaded."
This kind of listening fatigue — also referred to as auditory fatigue — is more than just feeling tired. It becomes a matter of overuse and underuse, and both affect long-term brain health. With less input from the ears, the auditory cortex doesn't receive enough stimulation and, like a muscle with no exercise, gradually loses its ability to function.
Meanwhile, other areas of the brain are working overtime to compensate, leaving the person mentally exhausted and increasingly likely to withdraw from social interaction. This cognitive load, sustained over time, is one of the key mechanisms linking hearing loss and dementia — and one of the clearest illustrations of how age-related cognitive decline can be accelerated by untreated hearing loss.
Most age-related hearing loss is gradual, and the adaptable brain helps you adjust bit by bit — so that everything feels fairly normal for longer than it should. This is one of the reasons cognitive aging linked to hearing loss often goes unaddressed for years. "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!'""
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The flip side to all this is that there are ways you can support your hearing and your brain simultaneously — and the most important step is early action. 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.
How to keep your brain sharp as you age starts with protecting your hearing. "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."
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 a growing body of research shows, the benefits of hearing aids extend well beyond improved sound.
"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." This is one of the most significant findings in the relationship between hearing aids and dementia research.
The landmark ACHIEVE study — a randomized controlled trial conducted by Johns Hopkins University — found that hearing aids reduced the rate of cognitive decline by nearly 48% in older adults at higher risk of dementia.
For those managing age-related hearing loss, this represents a meaningful and accessible intervention. That reduced demand on the brain helps mitigate cognitive decline, but the benefits of hearing aids go further. "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."
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