Carotid Artery Disease and Hearing Loss

The carotid arteries, the major blood vessels in your neck, do more than supply blood to the brain. A new review of 25 clinical and mechanistic studies indicates that dysfunction in these vessels is consistently linked to hearing loss, suggesting a vascular component to auditory health.

How the Review Connected Carotid Health to Hearing

Researchers Gulruh Shodmonkulova, Gavkhar Khaydarova, and Abdurasul Yulbarisov conducted a narrative literature review to examine the role of vascular endothelial dysfunction in hearing loss related to carotid artery stenosis. They searched four major scientific databases—PubMed, Google Scholar, Web of Science, and Scopus—for studies published in English up to January 2026.

From an initial pool of 197 records, they selected 25 studies for qualitative synthesis. This final set included epidemiological work, investigations into biological mechanisms, clinical reports, and a small number of interventional studies. The goal was to synthesize evidence across these different types of research to build a coherent picture of the relationship.

Carotid Disease Predicts Poorer Hearing Outcomes

The compiled evidence points to a clear association. Studies found that increased carotid intima-media thickness (a measure of arterial wall thickening) and greater plaque burden were linked to worse hearing thresholds. Individuals with carotid atherosclerosis also faced a higher risk of both progressive and sudden sensorineural hearing loss.

This relationship held across different study designs, strengthening the argument that the link is real and not a coincidence. The hearing loss observed is typically sensorineural, meaning it originates in the inner ear or auditory nerve, rather than being a conductive problem in the middle ear.

The Proposed Mechanism: A Starved Cochlea

The review authors propose that endothelial dysfunction is the key intermediary. The endothelium is the thin layer of cells lining blood vessels. When it functions properly, it regulates blood flow by releasing substances like nitric oxide, which keeps vessels relaxed and open.

In carotid atherosclerosis, this system breaks down. Endothelial dysfunction is characterized by reduced nitric oxide, increased oxidative stress, and inflammation. For the cochlea—the spiral-shaped organ of hearing—this is a critical problem. Its intricate hair cells and neural structures demand a rich, constant blood supply. The review suggests that impaired microcirculation due to endothelial failure can lead to ischemic injury, slowly starving the delicate auditory structures of oxygen and nutrients, ultimately causing hearing loss. This vascular perspective complements other research on auditory health, such as studies into tinnitus and cerebral blood flow.

From Subtle Decline to Sudden Loss: Clinical Presentations

The auditory symptoms of carotid-related vascular issues are not uniform. The review notes a spectrum of clinical manifestations. For some, the impact is a slow, subclinical decline in hearing sensitivity that might only be detected on an audiogram. For others, it can manifest as sudden sensorineural hearing loss, a medical emergency.

Another potential symptom is pulsatile tinnitus, a rhythmic whooshing or thumping sound in the ear that often syncs with the heartbeat. This type of tinnitus is frequently linked to vascular abnormalities and underscores the direct connection between blood flow and auditory perception. Understanding these varied presentations helps differentiate them from conditions with different origins, such as the sound intolerance seen in misophonia or hyperacusis.

Does Fixing the Artery Fix the Hearing?

A critical question for patients and clinicians is whether treating carotid stenosis can improve hearing. The review found the evidence here is limited and not yet conclusive. Reports of hearing improvement following carotid revascularization procedures (like endarterectomy or stenting) exist, but they are primarily based on small case series.

This lack of strong interventional data means a direct causal link is not definitively proven. It remains possible that carotid disease and hearing loss are parallel consequences of a shared underlying process, like systemic inflammation or aging. The authors stress that more prospective and controlled interventional studies are necessary to determine if vascular treatments can reliably preserve or restore auditory function.

Practical Implications for Integrated Patient Care

Despite open questions about causality, the consistent association has immediate practical implications. For audiologists and hearing specialists, a patient presenting with unexplained sensorineural hearing loss, especially if accompanied by cardiovascular risk factors, may warrant a conversation about vascular health. Conversely, cardiologists and vascular surgeons treating carotid disease should consider inquiring about hearing status and possibly recommending a baseline hearing test.

This integrated approach supports earlier diagnosis and a more holistic management strategy. It aligns with a broader view of hearing health that considers whole-body wellness. For instance, managing cardiovascular risk factors like hypertension and diabetes may have the secondary benefit of protecting hearing, similar to how acupuncture has been studied for both blood pressure and hearing health.

“Vascular endothelial dysfunction may represent an important mechanism linking carotid artery stenosis to hearing loss,” the authors conclude. While more research is needed to clarify therapeutic paths, recognizing this connection is a step toward better, more preventive care for both the heart and the ears.

Source: Shodmonkulova, G., Khaydarova, G., & Yulbarisov, A. (2026). The role of vascular endothelial dysfunction in hearing loss associated with carotid artery stenosis: a narrative review. DOI: 10.1186/s43163-026-01092-6.