Hearing loss is more common and more severe in survivors of stroke than in the general population says Dr Kelly Miles, a hearing scientist and stroke survivor. 

By Dr Kelly Miles

With one in four Australians predicted to have hearing loss by 2050 – and one in four also expected to have a stroke in their lifetime – the intersection of these two conditions demands attention.  Urgent action is needed to understand what this overlap means for stroke survivors and their rehabilitation, and how it challenges conventional approaches to hearing health.

Stroke and hearing loss often coexist, yet their combined impact remains poorly understood and under-recognised. Research shows a bidirectional relationship: sudden sensorineural hearing loss can increase the risk of stroke [1], while stroke has also been shown to lead to sudden sensorineural hearing loss [2]. Hearing loss is also reported to be more common and more severe among survivors of stroke compared to the general population [3, 4].

Auditory processing affected

Beyond the audiogram, stroke also affects central auditory processing [5]. Standard hearing assessments may not detect hearing difficulties as they typically focus on peripheral hearing loss. However, central auditory processing difficulties can significantly impact everyday communication, particularly in noisy environments. For example, Koohi and colleagues [6] found that 55% of stroke survivors in their study aged 61–80 exhibited a combination of peripheral hearing loss and auditory processing disorder, while 40% of younger survivors (aged 18–60) presented with auditory processing disorder.

Cognitive changes are common following stroke, further complicating hearing and communication challenges. Up to 70% of survivors of stroke experience difficulties with information processing speed [7], around half encounter difficulties with attention [8], and most will experience changes in cognitive functioning to some extent [9]. Crucially, these changes may impact auditory processing – particularly in noisy environments – where maintaining attention and separating speech from background sounds is crucial [10].

Difficulties listening in noise

Anecdotal accounts show that many survivors of stroke experience increased difficulty and stress when trying to communicate in noisy environments [11, 12]. They often report that background noise makes it challenging to stay engaged in social interactions, leading to withdrawal and reluctance to socialise [13, 14]. They also describe how difficulties communicating in noise can act as a barrier to returning to work after a stroke [15] and participating effectively in day-to-day tasks in the workplace [16].

Empirical studies support these claims, demonstrating that survivors of stroke are particularly prone to difficulties listening in noise when the target speech and background noise share similar acoustic properties [5, 17]; for example, the challenge of trying to follow a conversation in a café where multiple people are talking simultaneously. These difficulties have been linked to cognitive function in stroke survivors, with those experiencing attention difficulties more likely to have problems with background noise that contains informational speech [18].

While more research is essential to fully understand the relationship between stroke and hearing difficulties, hearing practitioners can take several practical steps right now:

•  Broader screening: Incorporate speech-in-noise testing, auditory processing screens, and actively listen for red flags like, “I just get tired of listening,” or “I avoid noisy places now”.

•  Collaboration with stroke teams: Foster relationships with local rehabilitation clinics, neurologists, and speech-language pathologists. You may be the only hearing specialist involved in a patient’s care.

•  Tailored interventions: Hearing aids may help, but assistive technology, communication strategies, and environmental modifications may also support better outcomes.

•  Evidence-based interventions: Advocate for interventions supported by empirical evidence. Stay informed of emerging research and incorporate proven strategies into practice.

•  Family involvement: Educating carers and families about post-stroke hearing and listening challenges may enhance communication success at home and reduce frustration.

•  Elevate the voices of stroke survivors: Amplify the experiences and perspectives of stroke survivors and advocate for unmet hearing needs.

The intersection of stroke and hearing loss is common yet often overlooked. As our population ages, more individuals will live with both conditions, underscoring the urgent need for stronger care pathways, more research into post-stroke hearing needs, and better integration of audiology into stroke recovery.

Stroke teams must recognise that hearing is not just an added consideration – it is fundamental to rehabilitation, reconnecting with loved ones, and regaining independence. Proactively addressing the hearing needs of stroke survivors is crucial to enhancing their recovery and quality of life.

ABOUT THE AUTHOR

Dr Kelly Miles is a hearing scientist at the ECHO Lab, Macquarie University Research Centre, where her work focuses on listening and communication in complex auditory environments. As a stroke survivor, Dr Miles recognised the lack of research at the intersection of stroke and hearing. Her team published a scoping review protocol which aims to map the breadth of research on listening-in-noise difficulties following stroke, and has recently launched a survey to better understand the hearing and listening profiles of stroke survivors. Dr Miles welcomes insights from hearing professionals about their experiences in supporting stroke survivors’ hearing health. She can be contacted at kelly.miles@mq.edu.au

Location: Sydney, Australia

Years in industry: 10

References:

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