Hearing loss isn’t just an inconvenience of aging — it’s increasingly seen as a key factor in brain health, potentially accelerating the risk of dementia. At Johns Hopkins, otolaryngologist Carrie Nieman is exploring the overlap between these two conditions and how practical, accessible solutions may help improve outcomes for both.

“There’s still much we don’t fully understand, but we know hearing loss appears to be a risk factor for dementia,” says Nieman, a core faculty member at the Cochlear Center for Hearing and Public Health. “The exciting part is that hearing is something we can address, making it a potentially modifiable risk factor.”

Nieman’s work underscores the effectiveness of simple interventions for hearing loss, including early detection, community education and affordable, over-the-counter hearing aids.

In a study recently published in JAMA Open Network, Nieman and colleagues at Johns Hopkins found that hearing loss affected nearly 80% of people with Alzheimer’s disease and related dementias (ADRD), with prevalence rising to 94% in those over age 85. However, only 22% of those affected used hearing aids, suggesting a glaring need for hearing care in patients with dementia.

Policy changes are also critical for making hearing-loss interventions a cornerstone of care for older adults, Nieman and colleagues write in a recent opinion article for the Alzheimer’s Association. They call for expanded Medicare coverage and legislative efforts to make hearing aids more accessible and affordable, and they advocate for more inclusive research practices.

Nieman focuses especially on health equity, with evidence showing that people from lower income and underrepresented groups are less likely to get help for hearing. She previously led the Baltimore HEARS (Hearing Equality Through Accessible Research & Solutions) study, one of the largest U.S. trials of hearing-care interventions targeting Black and low income older adults. Through the program, community health workers trained patients how to select and use over-the-counter hearing devices. Results were promising, with participants showing improvements in communication similar in impact to that from hearing aids fitted by audiologists.

Hearing loss can be insidious, Nieman says, because it so often goes unnoticed for a long time.

“It usually progresses gradually, and most people don’t realize it until it’s severe,” she says. “Because of that, many people don’t seek help, even though treatments like hearing aids are more accessible than ever.”

To refer a patient, call 443-997-6467.