Cathy B.* doesn’t remember a time when she could hear well. The 58-year-old says by the time she was in her late forties, her hearing had become a big issue — at home, at work and, even with her friends. “My doctor didn’t recommend a test. But, everyone around me was pushing me to get my hearing tested because [it] was really turning into a problem, socially. Then, a friend died after a horrible battle with cancer and I thought, ‘My issue is fixable, I need to do something.’”

At 47, she went to an audiologist who recommended hearing aids. Once the doctor told her about the link between hearing loss and cognitive health, she says, “The decision to get hearing aids was a no brainer.”

Understanding how hearing works

“The brain hears, not the ears,” says Hal Freed, doctor of audiology in New York and Miracle-Ear expert. The ears, he says, are merely messengers on an intricate assembly line to the brain. Over the past few decades, research has helped doctors better understand that the process of hearing includes a series of channels in the auditory system.

The inner ear, or cochlea, is filled with fluid and lined with about 16,000 to 30,000 nerve fibers or hair cells, which are sensory receptors. Sound vibrations cause the fluid in the cochlea to form a wave which, in turn, causes chemicals to rush into the hair cells. Those cells then create an electrical signal that’s carried from the auditory nerves to the brain. It’s the brain that turns the electrical signal into recognizable sounds that we understand.

When those hair cells in the ears break down and die, as a result of the natural aging process, noise damage, medication, or illness, our brain begins to have trouble recognizing sounds, which is defined as hearing loss. “It’s a one shot deal. Once [the hair cells] die or break, there is no repairing them,” Freed says.

Why is this important to understand? Hearing loss can affect more than just your conversations. Being proactive about hearing health should be part of everyone’s general health plan, says Freed. In fact, “check up from the neck up” is the slogan used by the nonprofit Us Against Alzheimer’s which encourages individuals and providers to make brain health a routine part of clinical care. “Hearing loss is no longer grandma or grandpa’s issue or an older person’s issue. We’re seeing younger and younger and younger. Why? We are in a world where everyone is using more stimulation to the ears, cell phones, air pods, all kinds of headphones,” says Freed. “With better hearing aid technology, we don’t have to wait until the person is moderately impaired before we can help them,” he says.

“Hearing loss is no longer grandma or grandpa’s issue or an older person’s issue. We’re seeing younger and younger and younger. Why? We are in a world where everyone is using more stimulation to the ears, cell phones, air pods, all kinds of headphones.” — Dr. Hal Freed

The following are three major ways preventative measures for hearing can help:

1. Reducing the risk of cognitive decline

In the same way an injured leg needs to be used so it doesn’t atrophy, the brain needs to be stimulated. It’s all about cognitive processing, says Freed, who often uses the children’s game “Telephone” to explain how poor hearing can change the meaning of a sentence or an entire conversation.

Good hearing is about keeping the brain active, says Victoria A. Zambrano, a doctor of audiology, who has worked as a Miracle-Ear expert for more than 20 years. As hearing loss worsens and nerves start to weaken, hearing aids can provide needed auditory stimulation. “Without that stimulation, over time, that neurological connection just starts to deteriorate and the brain starts to go into an atrophy, where it’s just not getting enough information. Therefore, our brain just kind of says, ‘Well, why do I have to do anything’ and begins to shut down,” she says, “the hearing aid or aids, [give] auditory nerves a purpose. And through that purpose, the brain comes back to life.”

That’s because hearing aids can reshape what a person is hearing — making sounds sharper and clearer.

Clarity was definitely missing for Cathy B. As a teacher, she says before getting hearing aids, she developed a method to help her hear her students. “I often made up reasons for them to write things down so I could read what they had to say since I couldn’t hear what they were telling me.”

Zambrano says visual crutches like Cathy’s are a common go-to for those with hearing loss. A lot of patients tell her, “‘If I put my glasses on, I’ll hear you better.’ They’re not actually hearing, they’re just reading someone’s lips,” says Zambrano who adds, often this hearing-gap fix works only until a person can no longer rely on their vision. So, she spends time teaching her patients the difference between hearing — an umbrella term that we associate with the ear — and understanding. “When the brain isn’t getting the information from the ear, then it’s not able to understand. And that’s what we’re focusing on. … With hearing stimulation we can sustain hearing. I can’t fix it. Once it’s gone, it’s gone. But we can sustain what function they have with the right fitting hearing aid,” says Zambrano.

“When the brain isn’t getting the information from the ear, then it’s not able to understand. And that’s what we’re focusing on. … With hearing stimulation we can sustain hearing. I can’t fix it. Once it’s gone, it’s gone. But we can sustain what function they have with the right fitting hearing aid.” — Dr. Victoria Zambrano.

2. Defending against dementia with hearing health

New research supports previous studies which suggest a strong link between dementia and hearing health. Published in the medical journal Lancet, the study suggests that the simple use of hearing aids may be an easy, safe, and non-invasive way to lower the risk of dementia in vulnerable populations. Those individuals in the study with an increased risk for dementia who were given hearing aids showed a nearly 50 percent reduction in the rate of cognitive decline over a three year period.

“From all the studies we see, those with hearing loss that goes untreated, even mild hearing loss… compared [to] their peers with no hearing loss have a higher incidence (and the percentage goes up) with memory issues,” says Freed. But he cautions not to make the leap that, “If you don’t wear hearing aids you’ll have dementia. That is certainly not true.”

The takeaway is that “hearing stimulates the brain and stimulating the brain is never a bad thing,” says Freed who tells the story of a 99-year-old patient with Alzheimer’s. Her family told Freed their mother hadn’t spoken in years. They thought it was related to her dementia. The first thing Freed did upon meeting the patient was to give her a hearing test; he immediately determined that she had hearing loss then fitted her with some demonstration hearing aids. “And I said, ‘Ma’am where are you from?’ And she said, ‘I was born in South Carolina, in the early 1900s.’ And now she’s talking and stimulating and, I kid you not, the daughters are crying. They thought the mother was so far gone with cognitive impairment. And, she may have had some degree of Alzheimer’s, but no one thought at that point up to then to have her hearing tested.”

Freed says the hearing aids made her almost a new person.  “A small device can make a great change in a person’s life,” he says.

“A small device can make a great change in a person’s life.” — Dr. Hal Freed

3. Promoting physical and emotional health

Individuals with good hearing foster strong social connections, and being social can reduce the risk of loneliness and depression. The ability to engage in social activities can lead to an overall improved quality of life. “We know people with hearing aids fatigue less, they don’t have to strain to hear, are less embarrassed, are more confident, [and] are more actively social,” Freed says.

Addressing hearing loss through preventative care not only contributes to social and emotional well-being, but also enhances physical safety. “It seems to be, from the research, [people with good hearing are] having less issues with falls,” Freed says, because hearing and balance are also connected. Hearing is also crucial for situational awareness, allowing individuals to be alert to potential dangers in their environment.

Navigating preventative solutions

As for Cathy B. who believes a childhood illness may have caused her hearing loss, though it’s never been confirmed, she remains a huge fan of the hearing aids she got when her kids were six and eight. She wears them without fail all day, every day and goes to the audiologist infrequently — about two or three times over the last decade when she needed the devices tweaked.

The hearing aids she uses are designed specifically for her, which is what Zambrano recommends — a better choice, she says, than the over-the-counter variety. “A prescriptive hearing aid, like what Miracle-Ear and others provide, is going to take into account all of an individual’s specific levels and needs. Not only how they tolerate soft sounds, but loud sounds, how their comfort is in noise versus their comfort in quiet, their individual ‘miss’ is built into that hearing device. And that’s what Miracle-Ear really hones and focuses on. It’s not a one-size-fits-all, it’s individuality.”

*Name changed for privacy