- Design
- cross-sectional analysis with multivariable linear regression adjusted for covariates
- Population
- 223 late middle-aged adults, mean age 65.6 years (SD 3.8), mean pure-tone average 21.0 dB
- Primary outcome
- whole-brain and regional amyloid standardised uptake value ratio on positron emission tomography
- Effect
- word recognition: global β 0.064 per 10% worsening (P = 0.005); pure-tone average: left temporal 0.024 per 10 dB (P = 0.048)
Two hundred and twenty-three adults with a mean age of 65.6 years underwent amyloid positron emission tomography alongside audiometry, with pure-tone average and word recognition score in the better ear as exposures and regional standardised uptake value ratios as outcomes, adjusted for relevant covariates.
The two hearing measures behaved differently. Pure-tone average reached significance in only one region — the left temporal, 0.024 higher uptake per 10 dB worsening (P = 0.048) — although the authors note associations were similar in direction and magnitude elsewhere. Word recognition was associated with higher amyloid much more broadly: left and right temporal, left and right parietal, left and right cingulate, right frontal, and globally (β 0.064 per 10% worsening, P = 0.005).
That split is the interesting part. Pure-tone average measures the ear; word recognition measures what the brain does with what the ear delivers. If the association sits with the measure that depends on central processing, the finding is at least as consistent with early neurodegeneration degrading speech understanding as with hearing loss driving amyloid deposition. The authors say the direction requires further investigation, and note the associations appeared driven by those with the most hearing loss and the most amyloid.
Nothing changes in clinic. This is cross-sectional, the effect sizes are small, and no one should be ordering amyloid imaging on the basis of an audiogram, or offering hearing aids as amyloid prevention. What it does add is a reason to take poor word recognition out of proportion to the pure-tone average seriously as a finding in its own right, rather than as an audiometric curiosity.
- Note word recognition that is disproportionately poor for the pure-tone average as a finding worth recording, not an artefact
- Do not order amyloid imaging or cognitive investigation on the basis of an audiogram alone
- Do not tell patients that hearing aids prevent amyloid deposition; this study cannot support that
- Report both pure-tone average and word recognition; they carried different information here
- Where word recognition is poor and declining, consider whether cognitive assessment is separately indicated on clinical grounds
Why it matters
The association sat with the measure that depends on central processing, which points the causal arrow the opposite way from the usual telling.
Don't overread it
Cross-sectional data with small effect sizes cannot show that hearing loss causes amyloid deposition, or that treating hearing changes it.
The statistics, in plain English
These are regression coefficients on a standardised uptake ratio, a scale on which 0.064 is a small difference — statistically detectable in 223 people but not a clinically interpretable quantity. Several regions were tested for each exposure without an explicit correction for multiple comparisons, so a P value of 0.048 in one region, as for pure-tone average, is weak evidence on its own. Everything here is cross-sectional: hearing and amyloid were measured at the same time, so nothing establishes which came first.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for ent & head and neck surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free