A new meta-analysis challenges the view that treating age-related hearing loss can help preserve cognitive function.
Despite finding a statistically significant improvement of about 4% in cognitive scores after people with presbycusis received hearing aids or cochlear implants, the review found little convincing evidence of a protective effect when robust comparisons were applied.
The study in Audiology Research on 30 April 2026 systematically reviewed 22 clinical trials and cohort studies examining whether hearing interventions improve cognitive outcomes in older adults with presbycusis.
Researchers from China searched major databases including PubMed, EMBASE and Web of Science up to June 2025, focusing on studies that used standardised cognitive assessments.
Of 22 studies identified, 19 were included in the quantitative analysis, covering more than 1,562 patients. Seven studies examined hearing aid use while 12 focused on cochlear implantation.
When the researchers pooled results from 17 studies using pre–post comparisons where participants served as their own controls, they found a modest but statistically significant improvement in cognitive scores after intervention.
On average, cognitive test performance increased by about 4% after treatment.
The researchers said that when the analysis was restricted to four higher-quality studies that included an untreated control group comprising 815 individuals who received hearing interventions and more than 7,400 controls, there was no statistically significant difference in cognitive outcomes between those who received treatment and those who did not.
The authors said this discrepancy highlighted the limitations of uncontrolled study designs, which may overestimate benefits due to practice effects, regression to the mean, or other confounding factors.
“While pre–post analyses suggest a small cognitive improvement, controlled evidence does not support a causal relationship between hearing intervention and cognitive preservation,” the researchers concluded.
“The hypothesis that hearing intervention preserves or enhances cognitive function in older adults with presbycusis remains unsubstantiated by current controlled evidence.”
The authors suggested that observed improvements may be attributable to non-specific influences particularly practice effects rather than a specific causal effect of hearing restoration.
They noted that differences in follow-up duration, cognitive measures, and patient characteristics may influence outcomes and said longer-term studies may be needed to detect more subtle or delayed cognitive effects.
While observational studies had consistently shown an association between untreated hearing loss and poorer cognitive outcomes, establishing whether intervention alters this trajectory had proven more difficult, they said.
“Large-scale, long-term randomised controlled trials with active control conditions and blinded outcome assessment are urgently needed to isolate the true cognitive effects of hearing devices from non-specific influences,” they wrote.
Experts argue that hearing care should still form part of a holistic approach to healthy ageing. Addressing hearing loss may help reduce social isolation, depression, and cognitive load during listening, all of which are thought to play a role in cognitive health.
