How Hearing Loss and Tinnitus “Intertwine” with Cognitive Decline, Diabetes (Hyperinsulinemia), Heart Disease, Diet, Exercise and Noise Excess…An Interview with Kirsten McWilliams, Au.D.

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Early Screening, Ear Protection, Reducing the Total Volume, Cardiovascular and Diabetes Prevention and Treatment with Whole Food Diets and Exercise Along with Allergy Control in the Sinuses…

Kirsten McWilliams, Au.D.
Doctor of Audiology
The Hearing Solution
725 University Ave.
Sacramento, CA 95825
(916) 646-2471 office / (916) 646-2472 fax
kirsten@thehearingsolution.com
TheHearingSolution.com

Interview Summary

(Interview transcript below summarized by AI. Reviewed and edited by Kirk Hamilton PA)

In this interview with Kirk Hamilton, PA, Kirsten McWilliams, Au.D., Doctor of Audiology, explains that audiology involves much more than dispensing hearing aids; a Doctor of Audiology completes a four-year clinical doctorate with training in diagnosis and treatment of hearing and balance disorders, hearing technology, prevention, and patient counseling. She emphasizes that hearing care should begin with prevention through baseline testing (generally by age 60 or earlier with risk factors), protection from loud environments, safe listening habits, and early treatment because untreated hearing loss can negatively affect health, communication, relationships, and quality of life. Dr. McWilliams explains that hearing loss is becoming more common due to longer lifespans and increased noise exposure from headphones, loud workplaces, and modern environments. She stresses that headphone-related injury depends more on the “dose” of sound—the volume and duration—rather than the type of device, noting that sound above approximately 85 decibels increases risk, while over-ear noise-canceling headphones may help people listen at lower volumes. She discusses increasing hearing concerns in younger people, including teenagers and young adults exposed to unsafe personal audio devices and loud music settings, and notes that adult hearing loss is expected to rise due to aging and noise exposure. A focus of the discussion is the relationship between hearing loss and cognitive decline: Dr. McWilliams describes this as a possible two-way relationship where hearing loss can strain brain processing and reduce social engagement, while cognitive decline can affect neural pathways that effect hearing. Although treating hearing loss does not reverse cognitive decline, she states that hearing aids and improving hearing may reduce listening effort, improve communication, and help individuals remain socially and mentally engaged. She highlights lifestyle factors that support hearing health, including regular exercise to improve blood flow to the inner ear, a diet rich in leafy greens, berries, fish, nuts, and magnesium-containing foods, and limiting processed foods, excess sugar, and salt because cardiovascular health affects the delicate blood vessels of the inner ear. She explains that diabetes and prediabetes increase the risk of hearing loss through damage to small blood vessels and nerves and that cardiovascular disease and vision disorders such as macular degeneration overlap with hearing concerns because they share dependence on healthy circulation. She also discusses temporary hearing changes from allergies and sinus problems due to middle ear fluid and pressure, and warns that more than 200 medications can be ototoxic, including certain antibiotics, chemotherapy drugs, loop diuretics, and high doses of aspirin and ibuprofen, recommending a discussion with one’s health care provider before stopping medications. Regarding tinnitus, she explains that tinnitus occurs in the brain rather than the ear and recommends evaluation by a tinnitus specialist; her clinic uses Tinnitus Retraining Therapy, combining sound therapy and counseling to help the brain habituate to tinnitus, while hearing aids may help when hearing loss is also present. She notes there is no strong, consistent evidence that supplements prevent hearing loss or treat tinnitus and instead emphasizes maintaining vascular health and blood sugar control through nutrition, blood pressure control, and physical activity. Her overall message is that hearing health should be treated proactively: prevention should begin before symptoms appear, screening should not be delayed, and early treatment with modern hearing technology can help protect physical, emotional, social, and cognitive well-being.

Kirk Hamilton: What does it entail to become a “Doctor of Audiology”? What does that allow you to do in the professional and public world?

Kirsten McWilliams: Becoming a Doctor of Audiology requires earning a clinical doctorate (Au.D.) in four years and involves completing coursework, supervised patient care and a full-time externship. Professionally, the clinical doctorate prepares you to diagnose and treat hearing and balance disorders, fit hearing technology and counsel patients from a holistic, medically based perspective, rather than just sell them hearing aids. In the community, the Doctor of Audiology degree positions you as a go-to expert for hearing health and hearing loss prevention.

KH: First, in an ideal audiologist’s world, how do you provide “health maintenance” for the individual? When should an individual seek an audiologist for prevention…and treatment?

KW: In an ideal world, hearing care starts early with baseline hearing testing and ongoing monitoring. I encourage adults to get their hearing checked by age 60, or sooner if they’re exposed to loud noise frequently or are exhibiting any symptoms of hearing loss. Hearing protection is the best way to prevent hearing loss—the earlier you start doing it, the better—and an audiologist will likely have custom-fit options for you to choose from. Hearing loss treatment isn’t something you want to put off either, as living with untreated hearing loss can impact your health, relationships and quality of life.

KH: Is hearing loss in general becoming more of a problem? What are some lifestyle and environmental risk factors?

KW: Hearing loss is more visible now, and a few factors are driving that. People are living longer, which naturally increases risk, and daily noise exposure has become constant—headphone overuse, loud jobs and busy environments all contribute to the problem. Many individuals don’t connect lifestyle habits to long-term hearing damage until their communication with others starts to suffer.

KH: Can you elaborate for a moment on “headphone overuse”? How do you define that? Everyone has some type of hearing device, from complete ear-covering headphones to earbuds to devices that just transmit the sound through bone without getting placed in the ears. I realize earphones are probably a discussion in themselves. Can you say which kind is the least harmful to hearing? Or is it just the “loudness” and duration of their use?

KW: When I talk about “headphone overuse” with my patients, I keep it simple: It’s not the device—it’s the dose of sound your ears are getting. That means how loud it is and how long you listen. You can listen safely for long periods at low volumes, or you can cause damage in minutes if the volume is high enough. Once you get above about 85 decibels, the risk rises quickly, and at very high levels—around what some headphones can produce—damage can happen in a short time. I usually tell patients that if they notice ringing, fullness or muffled hearing afterward, that’s their body telling them they’ve overdone it.

As for which headphones are “least harmful,” there’s no completely safe type at high volumes, but some designs make it easier to listen safely. Over-ear, especially noise-canceling headphones, tend to be a better choice because they block background noise and help you keep the volume lower. Earbuds sit right in the ear canal and often lead people to turn things up more, especially in noisy environments. So in reality, it comes down less to the device and more to your habits—lower volume and regular breaks are what protect your hearing.

KH: Are younger individuals or children having more problems with hearing impairment or hearing loss? If so, what are the causes?

KW: Yes, younger patients are having more problems with hearing loss, primarily due to noise exposure. Globally, over one billion teenagers and young adults are at risk of hearing loss due to listening to personal audio devices at unsafe volumes and attending loud music venues. In the U.S., an estimated 12.5% of kids and teens—more than 5.2 million—have permanent damage to their hearing because of excessive exposure to noise.

KH: In adults, are hearing loss or impairment issues increasing?

KW: Yes, the number of adults with hearing loss is expected to double by 2060, according to a 2017 Johns Hopkins study. The reasons why include the growing aging population and frequent noise exposure. I recommend a baseline screening by age 60, or earlier if you have risk factors. Regular follow-up evaluations can help catch gradual hearing changes earlier so you can start treatment as soon as possible.

KH: When did you become aware that cognitive decline might be associated with hearing loss? Is it something you read about, or was it just obvious in seeing patients every day that those who have hearing loss seem to have cognitive decline more frequently or progressively?

KW: The correlation between hearing loss and cognitive decline was first established through research, but it became more real to me through my firsthand experience with patients. Over time, I noticed that some patients with untreated hearing loss had more difficulty staying engaged in conversation and processing information. My clinical experience mirrors what some studies have shown.

KH: Is it the “chicken or the egg” or “both”? Does hearing loss result in physiologic events that increase the pathophysiology leading to dementia, or does having dementia or cognitive decline increase hearing loss issues?

KW: It may be more of a two-way relationship. Hearing loss can increase the strain on the brain and reduce social interaction, both of which are thought to contribute to cognitive issues. At the same time, cognitive decline can damage the neural pathways in the brain, leading the brain to slow down its processing speed, which can make it harder for an individual to interpret sounds.

KH: Are there things that you can do from an audiologist’s perspective that will actually improve a patient’s cognitive decline?

KW: While hearing loss treatment won’t reverse decline, studies have found that it may help reduce the risk or slow the progression of cognitive decline in some individuals. Hearing aids can improve access to sound and reduce listening effort for users. When patients hear more clearly, they tend to stay socially active and mentally engaged, both of which support cognitive health.

KH: What are the standard preventive things people should do to maintain their hearing?

KW: Daily habits matter. Everyone should use hearing protection in loud environments, keep headphone volume at safe levels and give their ears regular breaks. They should also get routine hearing checkups and try to stay as healthy as possible to help maintain their hearing ability.

KH: Does exercise improve hearing in general?

KW: Regular exercise increases healthy blood flow to the inner ear, and good blood flow helps deliver oxygen and nutrients to the delicate structures involved in hearing. Exercise won’t prevent hearing loss, but it does contribute to overall ear health. One study found that individuals over 50 who have moderate or high cardiovascular fitness levels maintain hearing sensitivity comparable to people in their 30s, which is pretty remarkable.

KH: What common drugs are known to have adverse effects on hearing?

KW: There are over 200 drugs (prescription and over the counter) that are ototoxic, which means they can harm hearing or cause tinnitus. They include certain antibiotics, chemotherapy drugs, loop diuretics and high doses of aspirin and ibuprofen. It’s important for your followers to know that this doesn’t mean that they should abruptly stop taking these medications—but they should review the risks with their doctor and schedule a hearing check with an audiologist.

KH: Do you know of any dietary factors that you feel affect hearing positively or negatively?

KW: Diet can directly influence hearing by affecting blood flow, inflammation and nerve health in the inner ear. Diets rich in leafy greens, berries, fish and nuts support circulation and provide antioxidants that help protect delicate hearing structures; foods high in magnesium—like bananas, spinach and avocados—may help the ear recover from noise exposure. On the flip side, consuming foods that are high in sugar, high in salt or artificially processed can impact hearing over time by contributing to heart disease, which can affect the ear’s small blood vessels and nerve function.

KH: How important is blood sugar control (not being diabetic or prediabetic) in maintaining hearing?

KW: Very! People with diabetes are twice as likely to experience hearing loss compared to those with normal hearing, and people with prediabetes have a 30% higher rate of hearing loss than those without the condition. Blood sugar that’s too high can damage small blood vessels and nerves in the inner ear, while low blood sugar can harm how nerve signals move from the inner ear to the brain, leading to hearing loss. Keeping glucose levels stable helps protect those structures over time.

KH: Do people with cardiovascular diseases or visual diseases like macular degeneration have more hearing issues and possible cognitive impairment?

KW: There’s a strong overlap between hearing, vision and cardiovascular health, as conditions that affect blood flow, such as heart disease, can impact multiple senses—the ear and the retina rely on proper blood flow to function. Patients with heart disease or vision changes should be especially proactive about keeping up with their hearing care, as they are at a higher-than-normal risk of developing hearing loss.

KH: Do people with allergies in the sinuses and upper airways have more hearing loss?

KW: Yes, but the good news is that their hearing loss is usually temporary. When allergies and sinus issues affect the middle ear, they can lead to fluid buildup and temporary hearing changes, as well as pressure that can muffle sound or create a sense of fullness. However, treating allergies helps reduce the fluid buildup and pressure, restoring one’s hearing to normal.

KH: Any “clinical pearls” and hope for tinnitus sufferers? Any thoughts on prevention and treatment?

KW: Tinnitus occurs in the brain, not the ear- so my biggest recommendation is that your patients see a tinnitus specialist to get accurate information about the condition. There is a lot of misinformation out there and breaking the cycle sooner than later helps the most. We use Tinnitus Retraining Therapy a structured program combining sound therapy with counseling to help your brain naturally habituate to the tinnitus. If someone has hearing loss, hearing aids can be surprisingly helpful because they restore external sounds and reduce the perception of the tinnitus.

Prevention tips include protecting your ears in loud environments to prevent hearing loss to begin with.

KH: Any comments on nutritional supplements that can benefit hearing?

KW: When it comes to supplements, I’m very honest with patients: There isn’t strong, consistent evidence that supplements can prevent hearing loss or treat tinnitus. Some are marketed heavily, but nothing is evidence-based. That said, good overall vascular health does matter for the inner ear. So I usually shift the conversation slightly and emphasize a heart-healthy lifestyle—things like a balanced diet, managing blood pressure and staying active—because the cochlea in the ear depends on good blood flow to function.

KH: What recommendations can you make for screening and treatment?

KW: If there’s one takeaway I want your followers to remember from this interview, it’s that it’s never too early to start caring for your hearing health, even if you aren’t experiencing signs of hearing loss or tinnitus. Hearing loss happens so gradually that it can be easy for you to miss, so I always recommend everyone get a baseline hearing screening at age 60. However, if you have other risk factors, such as if you work a noisy job in construction or at a factory, you should get a screening much earlier.

As far as treatment for hearing loss goes, that’s another thing that’s better dealt with sooner rather than later, as leaving it untreated can have serious consequences for your physical, mental and emotional health. I know many people don’t want to wear hearing aids because they think they’re too big and obvious, but today’s devices are so small and discreet that no one will notice you’re wearing them. They’re also packed with advanced technology—such as automatically amplifying speech from a speaker in front of you while minimizing background noise—so they make hearing better incredibly easy.

KH: Thank you, Dr. McWilliams, for taking the time to answer these questions!

Related References…Partial List

ALLERGY/INTOLERANCE
A systematic review of the clinical evidence for an association between type I hypersensitivity and inner ear disorders
Immune-Mediated Association Between Celiac Disease and Sensorineural Hearing Loss: A Systematic Narrative Review
CARDIOVASCULAR DISEASE
Cardiocerebrovascular risk in sensorineural hearing loss: results from the National Health and Nutrition Examination Survey 2015 to 2018
COGNITION/DEMENIA
Hearing Loss, Hearing Aid Use, and Risk of Dementia in Older Adults
DIABETES (HYPERINSULINEMIA)
The Effects of Hyperinsulinemia on Cochlear Functions
DIET
Adherence to Healthful Dietary Patterns Is Associated with Lower Risk of Hearing Loss in Women
Associations between dietary indices and hearing status among middle-older aged adults – results from the Baltimore Longitudinal Study of Aging
Effects of Occupational Noise Exposure on Hearing Loss: Regulatory Effect of Mediterranean Diet
Inflammatory diet, gut microbiota and sensorineural hearing loss: a cross-sectional and Mendelian randomization study
Relationship between Inflammatory Food Consumption and Age-Related Hearing Loss in a Prospective Observational Cohort: Results from the Salus in Apulia Study
Protective effects of dietary nutrients on hearing loss: a systematic review and meta-analysis

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Kirk Hamilton PA-C
Health Associates Medical Group
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.StayingHealthyToday.com
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www.KwikerMedical.com

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