Carotid Artery Stenosis and Hearing Loss

Carotid artery stenosis is associated with a higher risk of both sudden and progressive sensorineural hearing loss. A new review by researchers Gulruh Shodmonkulova, Gavkhar Khaydarova, and Abdurasul Yulbarisov proposes that vascular endothelial dysfunction—a problem with the inner lining of blood vessels—is the likely mechanism connecting these conditions. Their analysis, synthesizing evidence from 25 relevant studies, suggests that impaired blood flow to the cochlea due to this dysfunction may be a previously underappreciated cause of auditory damage.

How Researchers Investigated the Heart-Hearing Link

The team conducted a narrative review of the existing scientific literature to assess the evidence. They searched major databases including PubMed, Google Scholar, Web of Science, and Scopus for studies published in English up to January 2026. Their search terms focused on the intersection of carotid atherosclerosis, endothelial dysfunction, and hearing loss.

From an initial pool of 197 records, the authors screened for relevance and quality. They ultimately included 25 epidemiological, mechanistic, clinical, and interventional studies in their final qualitative synthesis. This approach allowed them to build a multi-faceted picture of the potential relationship, examining everything from population-level associations to proposed biological pathways. You can read the full review, “The role of vascular endothelial dysfunction in hearing loss associated with carotid artery stenosis: a narrative review”.

Carotid Artery Disease Correlates with Poorer Hearing

The compiled evidence points to a clear association. Studies consistently found that individuals with carotid atherosclerosis—measured by increased carotid intima-media thickness (CIMT) and greater plaque burden—had worse hearing thresholds. They also faced a higher risk of both progressive, age-related hearing loss and sudden sensorineural hearing loss (SSNHL).

This connection is not just a statistical link in older populations. The review indicates it may be a contributing factor to hearing decline that often gets attributed solely to aging or noise exposure. The findings reinforce the importance of a holistic health view, where the state of the cardiovascular system directly impacts sensory organs. For more on this specific link, see our related article, Carotid Artery Disease and Hearing Loss.

Endothelial Dysfunction: A Proposed Biological Mechanism

The core of the review’s argument is a specific mechanism: vascular endothelial dysfunction. The endothelium is the thin layer of cells lining blood vessels. When healthy, it regulates blood flow by producing nitric oxide, a compound that relaxes vessels. In atherosclerosis, this system breaks down.

“Endothelial dysfunction—characterized by reduced nitric oxide bioavailability, oxidative stress, and inflammatory activation—may contribute to impaired cochlear microcirculation and ischemic injury,” the authors write. In simpler terms, a diseased carotid artery may not deliver enough oxygen-rich blood to the delicate, high-energy-demand hair cells of the inner ear. This chronic, low-grade ischemia could lead to cell damage and death, resulting in hearing loss. This vascular model aligns with other research exploring blood flow issues in hearing disorders, such as studies on Tinnitus and Cerebral Blood Flow.

From Subtle Decline to Sudden Hearing Loss

The clinical manifestations of this vascular link are varied. For many, the effect may be a slow, subclinical decline in hearing sensitivity that worsens over years. For others, it can present more acutely as sudden sensorineural hearing loss, a medical emergency often with an unknown cause that this review suggests may sometimes be vascular.

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 its presence alongside hearing changes could be a red flag pointing toward carotid or other vascular issues.

Does Fixing the Artery Fix the Hearing?

A critical question is whether treating carotid stenosis through revascularization procedures like stenting or endarterectomy can improve hearing. The review finds the current evidence here is limited and not conclusive. Reports of hearing improvement exist, but they are primarily based on small case series and anecdotal observations.

The lack of strong interventional data means causality—proving that the artery disease directly causes the hearing loss—is not yet definitively established. It remains possible that both conditions are parallel results of the same systemic inflammatory and aging processes. This gap highlights a major need for prospective, controlled studies that measure hearing outcomes before and after vascular interventions.

Practical Implications for Patients and Clinicians

This research has immediate practical value. It supports a more integrated approach to diagnosis and management. For audiologists and hearing specialists, a patient’s cardiovascular risk profile—including history of stroke, hypertension, or heart disease—should be part of the clinical picture. Unexplained or asymmetrical hearing loss, especially with pulsatile tinnitus, may warrant a referral for vascular screening.

Conversely, cardiologists and vascular surgeons should be aware that carotid artery disease may have an auditory component. Informing patients about the potential for hearing issues and considering baseline hearing tests could be part of comprehensive care. For those diagnosed with hearing loss of a suspected vascular origin, management strategies used for other auditory conditions may still apply, such as the use of hearing aids to improve listening abilities and communication.

The work by Shodmonkulova and colleagues connects two major fields of health. It argues that hearing health is not isolated and that vascular endothelial health may be a key piece in preventing and understanding certain types of hearing impairment. Further research is needed to confirm the mechanism and explore treatments, but the message for now is clear: what’s good for your heart is likely good for your ears.