Summary: Can a relatively simple ear procedure help protect your memory? A major new study suggests it can.
Analyzing data from the NIH’s All of Us Research Program, researchers examined records from hundreds of thousands of participants and found that two treatable middle ear conditions—tympanic membrane (eardrum) perforations and cholesteatoma (an abnormal skin growth in the middle ear)—are associated with substantially higher odds of dementia. Importantly, when these conditions were treated with surgery or when hearing aids were used, the increased dementia risk diminished significantly or disappeared.
Key Findings
- The Associated Risk: People with a perforated eardrum had about double the odds of dementia, while those with cholesteatoma had nearly twice the odds compared with individuals without these conditions.
- Surgery Reduces Risk: For cholesteatoma, surgical treatment removed the statistically significant association with dementia, effectively returning the risk to levels similar to those without the condition.
- Hearing Aids Help: Use of hearing aids reduced the dementia association for both conditions, supporting the view that preserving auditory input helps maintain cognitive function.
- Not All Middle-Ear Issues Behave the Same: Otosclerosis, a bone-related disorder of the middle ear, was not significantly linked to dementia in this analysis, indicating that different conductive pathologies may affect cognition differently.
Source: AAO
A new study published in Otolaryngology–Head and Neck Surgery, the peer-reviewed journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), reports that two common, treatable causes of conductive hearing loss—tympanic membrane perforation and cholesteatoma—are associated with higher odds of dementia.
The research also shows that treating these conditions, either surgically or with hearing aids, is linked to a reduced risk of dementia. These findings were first presented at the AAO-HNSF 2025 Annual Meeting & OTO EXPO in Indianapolis and contribute to a growing body of evidence that untreated hearing loss can accelerate cognitive decline. The study raises an important clinical question: when the cause of hearing loss is correctable, can addressing it protect cognitive health?
“We have known that untreated hearing loss is related to poorer cognition in adults. This study shows that specific forms of surgically treatable hearing loss are also associated with worse cognitive outcomes,” said Justin S. Golub, MD, MS, corresponding author from Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian/Columbia University Irving Medical Center. “What is most encouraging is that routine surgical treatment may both restore hearing and potentially reduce dementia risk.”
Researchers from Columbia University and the University of Utah analyzed records from more than 363,000 participants drawn from the All of Us Research Program, a diverse national health dataset sponsored by the National Institutes of Health. In the study’s methods section, participant counts are reported as n = 396,194 for those aged 18 and older.
After adjusting for age, sex, education, race, and ethnicity, the investigators found that tympanic membrane perforation carried about twice the odds of dementia and cholesteatoma carried nearly double the odds as well. Otosclerosis did not show a significant association with dementia in this cohort. When the analysis accounted for surgical treatment, the link between cholesteatoma and dementia was no longer statistically significant. Use of hearing aids also reduced the dementia association for both conductive conditions, suggesting that restoring auditory input—by surgery or amplification—may help lower cognitive risk.
Key Questions Answered:
A: Conductive hearing loss forces the brain to expend extra effort decoding sounds, increasing cognitive load and diverting resources from memory and other functions. In addition, reduced hearing can lead to social withdrawal, which is associated with reduced cognitive stimulation and brain atrophy over time.
A: The study found that surgical treatment of cholesteatoma eliminated the statistical association with dementia, though this does not guarantee absolute protection. Restoring the physical pathway for sound appears to be one of the most effective ways observed so far to reduce the elevated dementia risk linked to these conditions.
A: Hearing aids were also associated with a lower dementia risk in the study. Whether through surgery or amplification, the key seems to be maintaining sound input to the brain to reduce the cognitive consequences of sensory deprivation.
Editorial Notes:
- Article edited by a Neuroscience News editor.
- The journal paper was reviewed in full by the editorial team.
- Additional context was added by staff writers.
About this dementia and auditory neuroscience research news
Author: Tina Maggio
Source: AAO
Contact: Tina Maggio – AAO
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“Conductive Hearing Loss Pathologies are Associated With Dementia in the All of Us Research Program” by Powell, S.D., Weinstein, H.N.W., Tucker, L.H., Denham, M.W., Gurgel, R.K. and Golub, J.S., Otolaryngology – Head and Neck Surgery.
DOI: 10.1002/ohn.70152
Abstract
Conductive Hearing Loss Pathologies are Associated With Dementia in the All of Us Research Program
Objective
Large cohort studies have linked conductive hearing loss (CHL) to dementia, but the disease-specific relationships have been unclear. This study examines whether particular CHL pathologies—cholesteatoma, tympanic membrane perforation, and otosclerosis—are associated with dementia in a large national cohort.
Study Design
Cross-sectional epidemiologic analysis.
Setting
Data were drawn from the NIH All of Us Research Program.
Methods
Participants aged 18 and older were included (n = 396,194). CHL pathologies were identified by ICD-10 codes: cholesteatoma (H71.X), tympanic membrane perforation (H72.X), and otosclerosis (H80.X). The outcome was all-cause dementia defined by ICD-10 codes (F01, F03, G30-32). Multivariable regression assessed the odds of dementia in individuals with and without CHL pathologies, adjusting for age, sex, education, race, and ethnicity. Additional analyses incorporated treatment variables, including surgical intervention and hearing aid use.
Results
The mean participant age was 55 years (±17). After adjusting for covariates, cholesteatoma was associated with 1.77 times the odds of dementia (95% CI 1.08–2.73; P = .015) and tympanic membrane perforation with 2.09 times the odds (95% CI 1.68–2.59; P < .001). Otosclerosis did not show a significant association. When surgical treatment was included in the models, the odds for cholesteatoma fell to 1.40 (95% CI 0.82–2.27; P = .198), losing statistical significance, while tympanic membrane perforation remained associated with increased odds (OR 2.01; 95% CI 1.60–2.50; P < .001).
Conclusions
Cholesteatoma and tympanic membrane perforation were associated with higher odds of dementia in this large national cohort, and these relationships were attenuated by treatment. Given that dementia is unlikely to cause these specific conductive pathologies, reverse causation is an unlikely explanation. These results support the broader evidence that sensory deprivation affects cognition and highlight that correctable conductive hearing loss may represent an actionable target for lowering dementia risk.