Hearing Loss and Carotid Artery Disease Link

Carotid artery stenosis, a narrowing of the major blood vessels in the neck, is consistently associated with sensorineural hearing loss according to a new review of 25 studies. The research, led by Gulruh Shodmonkulova, Gavkhar Khaydarova, and Abdurasul Yulbarisov, points to vascular endothelial dysfunction as the likely mechanism connecting cardiovascular disease to auditory impairment.

How the Review Connected Heart and Hearing Data

Shodmonkulova and colleagues conducted a narrative literature review, searching databases including PubMed and Scopus for studies published up to January 2026. They used terms related to carotid atherosclerosis, endothelial dysfunction, and hearing loss. From an initial 197 records, they selected 25 epidemiological, clinical, and mechanistic studies for qualitative synthesis. This approach allowed them to build a coherent picture from different types of evidence, from population-based links to proposed biological pathways.

The Consistent Link Between Artery Health and Hearing

The findings show a clear pattern. Measures of carotid atherosclerosis, specifically increased intima-media thickness and greater plaque burden, correlate with worse hearing thresholds. Individuals with these vascular issues face a higher risk of both progressive, age-related hearing decline and sudden sensorineural hearing loss. This suggests that compromised blood supply to the inner ear, or cochlea, has a measurable effect on auditory function.

The review notes that this auditory decline is not always dramatic. It often begins with subclinical changes, particularly in the higher frequencies, which might go unnoticed without formal testing. In other cases, the presentation is acute, such as sudden hearing loss, or includes pulsatile tinnitus—a rhythmic whooshing sound synchronized with the heartbeat. This type of tinnitus directly points to a vascular origin, distinguishing it from the more common constant ringing associated with other mechanisms explored in articles on the dorsal cochlear nucleus’s role in tinnitus and hyperacusis.

Endothelial Dysfunction: The Proposed Biological Pathway

The researchers identify vascular endothelial dysfunction as the central mechanism likely explaining the association. The endothelium is the thin layer of cells lining blood vessels, responsible for regulating blood flow. When dysfunctional, it produces less nitric oxide, a compound vital for vasodilation, and promotes oxidative stress and inflammation.

In the context of the cochlea, this is particularly damaging. The inner ear’s hair cells are metabolically demanding and exquisitely sensitive to even brief reductions in oxygen and nutrient delivery. Endothelial dysfunction in the tiny arteries supplying the cochlea could lead to chronic hypoperfusion (low blood flow) or micro-infarcts (tiny strokes), resulting in permanent sensorineural damage. This vascular model adds a significant systemic component to understanding hearing loss, complementing research into other diagnostic tools like fMRI advances for hearing disorders.

Limited Evidence for Hearing Recovery After Revascularization

A critical question for patients and clinicians is whether treating the carotid stenosis improves hearing. The review finds the evidence here is sparse and inconclusive. Reports of hearing improvement following surgical (endarterectomy) or stent-based revascularization are primarily based on small, uncontrolled case series. This lack of strong interventional data means a causal link between carotid disease and hearing loss, while strongly suggested, is not yet definitively proven.

The authors state that large, prospective studies are needed to determine if restoring blood flow can stabilize or reverse auditory decline. This gap highlights the importance of prevention and early detection within an integrated care model.

Practical Implications for Patient Care and Future Research

This review has immediate implications for clinical practice. It argues for greater awareness of hearing as a potential marker of cardiovascular health. An unexplained sensorineural hearing loss, especially if sudden or accompanied by pulsatile tinnitus, could warrant assessment of carotid and overall vascular health. Conversely, patients diagnosed with significant carotid atherosclerosis may benefit from a baseline audiological evaluation and monitoring.

This integrated approach aligns with broader trends in managing complex auditory conditions, where multidisciplinary understanding is key. For instance, managing the distress of conditions like misophonia often requires a nuanced approach, as discussed in parent insights on raising a child with misophonia.

For researchers, the path forward requires targeted studies. Prospective cohort studies can track hearing changes in patients with carotid disease over time. Controlled interventional trials are needed to test if revascularization improves auditory outcomes. Further mechanistic research should explore the specific inflammatory and oxidative pathways in the cochlear vasculature.

The work by Shodmonkulova and colleagues consolidates existing evidence and provides a clear vascular hypothesis for a subset of hearing loss cases. Recognizing the ear as an end-organ for vascular disease could lead to earlier interventions and better long-term outcomes for both hearing and heart health.

The source review, “Vascular endothelial dysfunction in hearing loss associated with carotid artery stenosis: a narrative review,” by Gulruh Shodmonkulova et al., is available via DOI: 10.1186/s43163-026-01092-6.