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Original Investigation
July 2018

Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old

Author Affiliations
  • 1Yale School of Medicine, New Haven, Connecticut
  • 2Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
  • 3Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania
  • 4Boston Consulting Group, New York, New York
  • 5Department of Otolaryngology, Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York
  • 6New York Presbyterian, Columbia University Medical Center, New York, New York
JAMA Otolaryngol Head Neck Surg. 2018;144(7):623-629. doi:10.1001/jamaoto.2018.0643
Key Points

Question  How is cardiovascular disease associated with hearing in elderly persons?

Findings  In this cohort study that reviewed the records of 433 patients aged 80 years or older, cardiovascular disease was primarily associated with worsened low-frequency hearing and with accelerated hearing loss. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies.

Meaning  Treating underlying cardiovascular disease may prevent or slow the progression of hearing loss, and conversely, hearing loss may suggest underlying cardiovascular disease.


Importance  In the United States, the population of individuals older than 80 years is expected to double in the next 40 years. Cardiovascular comorbidities are prevalent in this older old population, and their relationship with hearing loss has not been well characterized.

Objective  To investigate the association of cardiovascular disease (CVD)-related risk factors with auditory function among the older old (>80 years).

Design, Setting, and Participants  Audiological data and medical records from 2001 through 2014 of 433 patients aged 80 to 106 years at an academic medical center were analyzed in 2017.

Main Outcomes and Measures  The degree of low- and high-frequency hearing loss of participants with coronary artery disease, diabetes, hypertension, history of cerebrovascular accident, and smoking status was compared with that of disease-free individuals. Rate of hearing loss was also determined.

Results  Among the 433 patients (67% female; mean [SD] age, 89 [5.8] years), the presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Among the 96 patients with 2 audiograms performed at age 80 years or older from which the rate of hearing loss could be calculated, 32 patients had CVD or related risk factors and 64 were healthy controls. Those with at least 1 disease had accelerated hearing loss. Patients with cardiovascular morbidity experienced a faster mean (SD) decline in LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies tested and with poor word recognition score. Hearing loss was more strongly associated with CVD risk factors in men than in women.

Conclusions and Relevance  In this study of the older old, cardiovascular risk factors and disease were associated with worse hearing and a greater rate of hearing deterioration. Hearing loss in women was less associated with the presence of CVD, possibly owing to the cardioprotective effects of estrogen. The association of hearing with CVD severity and management remains to be determined.