Summary: Can a relatively simple ear operation help protect your memory? A large new study suggests that treating specific middle ear problems may substantially reduce the risk of dementia.
Researchers examined data from a large national health dataset and found that two treatable causes of conductive hearing loss—tympanic membrane (eardrum) perforations and cholesteatoma (abnormal skin growth in the middle ear)—are linked to significantly higher odds of dementia. Importantly, when these conditions were treated surgically or when hearing aids were used, the elevated risk of dementia decreased or disappeared in the analysis.
Key Findings
- Increased dementia odds: Eardrum perforations were associated with roughly twice the odds of all‑cause dementia; cholesteatoma was associated with nearly double the odds compared with participants without these conditions.
- Treatment reduces risk: Surgical treatment for cholesteatoma removed the statistically significant association with dementia, effectively aligning the risk with that of people without the condition.
- Hearing aids help: Use of hearing aids reduced the association between these conductive pathologies and dementia, supporting the idea that preserving auditory input protects cognitive health.
- Not all middle ear disease behaves the same: Otosclerosis, a bone-related middle ear disorder, was not significantly linked to dementia in this study, suggesting different pathologies may affect the brain in different ways.
Source: AAO
A new peer-reviewed study published in Otolaryngology–Head and Neck Surgery, the journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation, analyzed specific conductive hearing loss pathologies and their association with dementia. The research focuses on correctable middle ear conditions and whether treatment—through surgery or amplification—modifies dementia risk.
The findings, first presented at the AAO-HNSF 2025 Annual Meeting & OTO EXPO, add to a growing body of evidence linking hearing impairment and cognitive decline and raise an important clinical question: when the cause of hearing loss is correctable, can treating it also protect cognitive function?
“We have known for some time that untreated hearing loss is related to worse cognition in adults. This study shows that specific forms of surgically addressable hearing loss are also adversely related to cognition. But what is most exciting is that treatment with routine surgery may improve both the hearing and possibly reduce the risk of dementia,” said Justin S. Golub, MD, MS, corresponding author from the Department of Otolaryngology–Head and Neck Surgery at Columbia University.
Investigators from Columbia University and the University of Utah examined data from the NIH All of Us Research Program. The dataset allowed the team to evaluate associations between diagnostic codes for conductive hearing loss pathologies and ICD-10 codes for all‑cause dementia while controlling for age, sex, education, race, and ethnicity.
After adjusting for these covariates, the analysis showed that cholesteatoma and tympanic membrane perforation were associated with higher odds of dementia. When the researchers included surgical treatment in the models, the strength of the association for cholesteatoma decreased to a point that was no longer statistically significant. Use of hearing aids also attenuated the associations for both conditions, supporting the idea that restoring auditory input—either by correcting the conductive pathway or by amplification—may reduce dementia risk.
Key Questions Answered:
A: Conductive hearing loss forces the brain to work harder to decode sounds, a phenomenon known as increased cognitive load. That extra effort can divert resources from memory and other cognitive processes. In addition, hearing loss can lead to social isolation and reduced sensory stimulation, which are associated with cognitive decline.
A: For cholesteatoma, the study found that surgical treatment rendered the statistical association with dementia nonsignificant. While this does not guarantee prevention for every individual, the results indicate that restoring the physical pathway for sound is among the most effective ways identified to reduce the biological risk associated with these conductive hearing losses.
A: The study also found that hearing aids were associated with a reduced dementia link for both cholesteatoma and tympanic membrane perforation. Restoring auditory input—whether surgically or with devices—appears to be the critical factor.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by the editorial team.
- Additional context was added by staff to clarify clinical implications.
About this dementia and auditory neuroscience research news
Author: Tina Maggio ([email protected])
Source: AAO (American Academy of Otolaryngology–Head and Neck Surgery)
Contact: Tina Maggio – AAO
Image: Image 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., published in 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
Prior work has linked overall conductive hearing loss (CHL) with dementia in large cohorts, but disease‑specific associations were unclear. This study examines whether particular CHL pathologies are associated with dementia within a large national cohort.
Study Design
Cross‑sectional epidemiologic analysis.
Setting
NIH All of Us Research Program.
Methods
Adults aged 18 and older were included (n = 396,194). Exposures were CHL pathologies 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–G32). Multivariable regression assessed odds of dementia while adjusting for age, sex, education, race, and ethnicity. Additional models evaluated the impact of surgical treatment and hearing aid use.
Results
Mean age was 55 years (±17). After adjusting for covariates, cholesteatoma was associated with 1.77 times higher odds of dementia (95% CI 1.08–2.73; P = .015) and tympanic membrane perforation with 2.09 times higher odds (95% CI 1.68–2.59; P < .001). Otosclerosis was not significantly associated. When surgical treatment was included, the odds for cholesteatoma dropped to 1.40 (95% CI 0.82–2.27; P = .198), while the association for TM perforation remained elevated at 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 treatment attenuated these relationships. Because it is unlikely that dementia causes these specific conductive lesions, reverse causation is an unlikely explanation. The findings strengthen evidence that sensory deprivation affects cognition and extend that observation to correctable conductive causes of hearing loss, highlighting the potential cognitive benefit of timely diagnosis and treatment.