Editorial Published on December 26, 2025
Hearing Rehabilitation as Dementia Prevention: Redefining the Otolaryngologist’s Role in Managing Presbycusis
Paul Samuel1
1. Chief Editor KJENTHNS; Senior Consultant in ENT, Cosmopolitan Hospital Thiruvananthapuram*
Corresponding Author: Dr. Paul Samuel, Chief Editor KJENTHNS
Senior Consultant in ENT, Cosmopolitan Hospital Thiruvananthapuram
Email: drpaulsamuel@cosmopolitanhospitals.in
The practice of otolaryngology has long focused on restoring auditory function and improving quality of life in patients with presbycusis. However, emerging high-level evidence demands a fundamental reconceptualization of our clinical mandate. Hearing rehabilitation is no longer merely symptomatic treatment; it represents a potentially disease-modifying intervention for cognitive decline and dementia. This paradigm shift carries profound implications for how we screen, counsel, treat, and follow our elderly patients with hearing impairment.
The landmark ACHIEVE randomized controlled trial has provided Level 1 evidence demonstrating that hearing intervention reduces 3-year cognitive decline by 48% in older adults at increased risk for cognitive impairment.1 This finding, combined with the 2020 Lancet Commission’s identification of mid-life hearing loss as the largest modifiable risk factor for dementia, positions otolaryngology at the forefront of dementia prevention strategies.2 With 65% of adults over 60 years experiencing hearing impairment, the public health implications are staggering.
The neurobiological mechanisms linking auditory deprivation to cognitive decline are increasingly well-characterized. Chronic hearing loss triggers cortical reorganization with demonstrable gray matter atrophy in temporal and frontal regions.3 At the molecular level, animal models reveal accelerated tau phosphorylation in hippocampal neurons following auditory deprivation, suggesting direct pathological links to Alzheimer’s disease.4 Additionally, the cognitive load imposed by degraded auditory signals diverts neural resources from higher-order functions including memory consolidation and executive processing. These converging mechanisms underscore that presbycusis is not a benign sensory deficit but rather a neurological risk factor demanding aggressive intervention.
However, the neuroprotective benefits of hearing aids depend entirely on sustained compliance; an area where clinical practice often falls short. Patients diagnosed with dementia demonstrate 54% reduced odds of persistent hearing aid use compared to cognitively intact individuals, creating a therapeutic paradox wherein those with greatest potential benefit show poorest adherence.5 Critically, baseline cognitive function strongly predicts future hearing aid compliance, with comprehensive neurocognitive assessments providing superior predictive value compared to screening instruments.6 This evidence highlights a narrow therapeutic window: intervention must occur while cognitive function remains sufficiently preserved to enable successful device adoption and habitual use.
These findings necessitate substantive changes in clinical practice.
First, patient counselling must explicitly frame hearing rehabilitation as dementia prevention rather than merely communication enhancement. This recontextualization transforms hearing aids from optional quality-of-life devices to essential preventive medicine, potentially improving patient motivation and adherence.
Second, hearing aid fittings must incorporate evidence-based compliance strategies from inception. Mandatory caregiver involvement, establishment of daily usage routines with explicit targets (minimum 6-8 hours), simplified device interfaces with automated usage monitoring, and scheduled reinforcement appointments should constitute standard protocols, not optional enhancements.7 Passive device dispensation without structured follow-up virtually guarantees suboptimal outcomes.
Third, interdisciplinary collaboration should become routine. Patients presenting to geriatric or neurology clinics with mild cognitive impairment warrant immediate audiometric evaluation. Conversely, elderly patients in our clinics with moderate-to-severe presbycusis should undergo cognitive screening. Establishing bidirectional referral pathways with geriatricians and neurologists maximizes our preventive impact and ensures comprehensive patient care.
In conclusion, the evidence compels otolaryngology to embrace an expanded clinical mandate. Every untreated presbycusis patient represents not merely impaired communication but increased dementia risk. Every poorly adherent hearing aid user represents unrealized neuroprotective potential. Since we possess the diagnostic tools, therapeutic interventions, and now the evidence base to meaningfully impact the dementia epidemic, we must actively address the issue for our elderly patients.
END NOTE
Author information
Financial Support: Nil
Conflict of Interest: None declared
References