Hearing Health

Hearing Health: A Nutritional and Natural-Health Reference

1. Definition and Overview

Hearing loss is the most common sensory deficit worldwide, affecting approximately 5% of the world population and exacting a significant personal and societal cost. In the context of nutrition and natural health, "hearing health" refers to the integrity of the auditory system — from the outer ear through the cochlea, auditory nerve, and central auditory pathways — and the degree to which dietary, metabolic, and lifestyle factors influence its preservation or decline.

Disabling hearing loss is defined by the World Health Organization (WHO) as hearing thresholds greater than 30 dB for children and greater than 40 dB for adults. Hearing impairment is commonly classified along three main axes: type (conductive, sensorineural, or mixed), degree (mild through profound), and onset (prelingual or postlingual). Hearing loss that occurs in the cochlea or beyond — that is, in the eighth nerve or higher-level neural centers — is considered sensorineural hearing loss.

An estimated 1.57 billion people globally had hearing loss in 2019, accounting for one in five people (20.3%). Of these, 403 million people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use. Of all people with a hearing impairment, 62.1% were older than 50 years. By 2050, a projected 2.45 billion people will have hearing loss, a 56.1% increase from 2019, despite stable age-standardised prevalence.

2. Anatomy and Body Systems Involved

The outer, middle, and inner ears along with the auditory nerve make up the peripheral auditory system, and the brainstem and brain constitute the central auditory nervous system.

The outer ear serves as the initial receiver of environmental sounds and aids in localization in the vertical plane as well as differentiation between sound sources in the front and back of the listener. The middle ear and its three ossicles — malleus, incus, and stapes — is chiefly responsible for delivering sound to the cochlea and overcoming the impedance mismatch between the external auditory canal (air-filled) and the cochlea (fluid-filled).

The ultimate goal of the cochlea is to transform complex airborne vibrations into auditory neural impulses. The tonotopic map created by the cochlea's spiral enables individuals to simultaneously interpret a vast array of sounds through vibrations carried from the perilymph to the endolymph in the cochlear duct. The anatomy of the cochlea enables it to efficiently transmit vibrations, which are ultimately converted into electrical impulses and interpreted by the brain's auditory cortex.

Low-level stimuli are detectable because they are amplified in the cochlea via a process called cochlear amplification, in which outer hair cells are involved; traveling waves on the basilar membrane push hair bundles toward the tallest stereocilia and hair cells are depolarized (excited). Inner hair cells are connected to afferent nerve fibers and upon stimulation, glutamate is released and signals are transmitted to the brain.

The primary centers in the auditory brainstem, in order of anatomical location from the cochlea to the cortex, are: the cochlear nucleus, olivary complex, lateral lemniscus, inferior colliculus, and medial geniculate.

2.1 The Stria Vascularis and Cochlear Blood Supply

A critically important but often overlooked structure in hearing health is the stria vascularis — the highly vascular epithelium lining the lateral wall of the cochlea. Common cardiovascular risk factors may play an important role in the pathogenesis of age-related hearing loss by affecting the cochlear microvasculature. Specifically, the vascular nature of the stria vascularis may make it especially vulnerable to vascular compromise. Loop diuretics can be ototoxic as they inhibit the Na/K/2Cl cotransporter in the stria vascularis, inducing pathological changes including the formation of edematous spaces in the stria vascularis epithelium, leading to decreased cochlear electrical potential and, with long-term use, temporary or permanent sensorineural hearing loss.

3. Types of Hearing Loss

• Sensorineural hearing loss (SNHL): Sensorineural hearing loss, which results from damage to the hair cells in the inner ear, is more frequently considered as the major pathway to permanent hearing impairment.
• Age-related hearing loss (presbycusis): Age-related hearing loss, or presbycusis, is a common cause of hearing loss in elderly people worldwide. It typically presents as progressive, irreversible, and usually affects the high frequencies of hearing, with a tremendous impact on the quality of life.
• Noise-induced hearing loss (NIHL): Exposure to intense sound or noise can result in purely temporary threshold shift (TTS), or leave a residual permanent threshold shift (PTS) along with alterations in growth functions of auditory nerve output. The principal cause of NIHL is damage to cochlear hair cells and associated synaptopathy.
• Sudden sensorineural hearing loss (SSNHL): Sudden sensorineural hearing loss is usually defined by acute onset of hearing loss in one or both ears of 30 dB or more on at least three contiguous audiometric frequencies within 3 days or less.
• Congenital hearing loss: Morphological and physiological variations within the auditory system are typically congenital. Most cases (approximately 80%) are caused by membranous malformations involving inner ear hair cells, resulting in sensorineural hearing loss.

4. Contributing and Associated Factors

4.1 Aging and Oxidative Stress

Ageing is the biggest risk factor for age-related hearing loss and is characterised by a state of chronic oxidative stress and inflammation. Although degenerative changes within the cochlea arise as a consequence of cellular aging, they also reflect the cumulative effects of additional extrinsic factors throughout the life of the individual. As such, age-related hearing loss is considered a multifactorial disorder with underlying risk factors divided into several categories: biological age, gender, ethnicity, environment (e.g., noise exposure, ototoxic medications), lifestyle (e.g., smoking, drinking, diet), health comorbidities (e.g., hypertension, diabetes), and genetic predisposition.

In addition to genetic factors, oxidative stress has been identified as a common mechanism underlying several cochlear pathologies, including noise-induced, ototoxic drug-induced, and age-related hearing loss. Because mitochondria are a major source of intracellular reactive oxygen species (ROS), the link between aging and ROS has been the focus of mitochondrial research.

4.2 Noise Exposure

Noise-induced hearing loss is associated with multiple cochlear damages, including mechanical damage to inner ear structures, oxidative stress with increased free radical production, damage to mitochondria, vascular injury, and alteration of ionic concentration in the cochlear fluids. Reactive Oxygen Species (ROS), as well as Reactive Nitrogen Species (RNS), have been identified as key factors in NIHL pathogenesis, considering that they play a crucial role in triggering apoptotic and necrotic pathways, leading to hair cell death after noise exposure and, consequently, causing sensorineural hearing loss.

ROS have been detected in cochlear tissue immediately after noise exposure, indicating that free radical accumulation is an early event in the hair cell damage process. Free radicals are observed within hair cells well before any morphological signs of damage are obvious, further supporting a role in damage initiation. The amount, distribution, and time course of free radical formation have been defined, including a clinically significant late formation 7–10 days following noise exposure.

Hair cells in the cochlea are particularly vulnerable to oxidative stress damage because they have a high metabolic rate, high oxygen consumption, high lipid content, abundant mitochondria, and high energy requirements. Following noise exposure, mitochondria increase aerobic respiration, using a large amount of oxygen. This leads to a great increase of free radicals, including superoxide, singlet oxygen, and hydrogen peroxide.

4.3 Cardiovascular and Metabolic Disease

Hearing loss frequently coexists with several chronic conditions, including cardiovascular disease, diabetes, stroke, and depression. Hypertension, diabetes, hyperlipidemia, and hyperuricemia are confirmed risk factors for age-related hearing loss. A diet low in saturated fat may help slow hearing loss. Maintaining a healthy, active lifestyle is a logical form of risk reduction in light of the fact that hearing loss is associated with stroke, myocardial ischemia, hypertension, hyperlipidemia, and diabetes.

A mouse model of diabetes and dyslipidemia showed higher hearing impairment and degeneration of the cochlear spiral ganglion and stria vascularis. Some studies have found mitochondrial dysfunction occurs in both metabolic diseases and presbycusis, and research suggests that metabolic diseases may increase susceptibility to presbycusis by causing mitochondrial dysfunction.

4.4 Smoking and Lifestyle

Lifestyle effects on hearing are diverse, with studies showing that both smoking and passive smoking increase the risk of hearing loss, while moderate alcohol consumption has a protective effect on hearing. Modifiable factors include exposure to noise and ototoxic chemicals, smoking, an unhealthy diet, a lack of regular exercise, and the presence of chronic lifestyle diseases such as obesity, diabetes, and other cardiovascular health issues. Research literature suggests that the likely mechanism of action is related to oxidative damage and inflammation, and healthy lifestyle behaviours such as safe listening, smoking cessation, a healthy diet, and regular physical activity have been shown to reduce the risk and progression of age-related hearing loss.

4.5 Genetics

Approximately half of hearing loss cases have a genetic etiology. SOX2 is an important transcription factor that plays a key role in cochlear development; mutations in SOX2 have been associated with sensorineural hearing loss.

4.6 Dementia and Cognitive Decline

Multiple epidemiological studies have shown an association between hearing loss and dementia in older adults. Research indicates that age-related hearing loss is linked to the onset of serious mental health conditions, falls, cognitive impairment and Alzheimer's disease.

5. Nutrients Studied in Relation to Hearing Health

Dietary antioxidants, vitamins, and minerals may protect the auditory system by reducing free radical production and maintaining cochlear health. Specific dietary factors and nutrients, such as antioxidants, anti-inflammatory components, vitamins, and minerals, may play key roles in protecting the inner ear and maintaining auditory function.

Several studies have evaluated the association between nutrition and hearing, finding that the incidence of hearing loss was increased with the lack of single micro-nutrients such as vitamins A, B, C, D and E, and zinc, magnesium, selenium, iron, and iodine.

5.1 Antioxidant Vitamins (A, C, and E)

Traditional Use

Vitamins A, C, and E have long been recognized in traditional nutritional and herbal medicine as protective agents derived from plant-rich diets. Vitamin C, abundant in citrus fruits, was historically associated with overall vitality and tissue health. Vitamin E, found in nuts, seeds, and leafy greens, has been used as a general cellular protectant. Vitamin A, obtained from animal liver and colorful vegetables, was considered essential for sensory organ function across multiple traditional healing systems, including Ayurvedic and Chinese medicine, though historical use specifically targeting hearing was not systematically recorded.

Scientific Evidence

Antioxidant nutrients such as vitamins A, C, and E are believed to protect inner ear cells by neutralizing free radicals and reducing oxidative stress, thereby slowing the progression of age-related hearing loss. Free radical scavengers such as vitamins A, C, and E appear to act in synergy with magnesium to reduce changes in hearing thresholds more reliably than treatment with any single agent.

In contrast, diets high in sugar and fat may increase the risk of hearing loss by promoting inflammatory responses and oxidative stress.

A 2025 systematic review and meta-analysis published in Frontiers in Nutrition (PMC) found that the intake of minerals, carbohydrates, vitamins A, C, and E, carotene, tea, coffee, alcohol, and sugar did not show statistically significant associations with hearing loss in meta-analysis. These results suggest that while dietary habits may be linked to hearing health, the effects of different nutrients may vary depending on their biological functions and intake levels. Evidence for individual antioxidant vitamins as protective agents in hearing therefore remains preliminary and largely observational, with findings from food-frequency questionnaire studies not consistently confirmed by controlled trials.

5.2 Carotenoids (Beta-Carotene, Lutein, Zeaxanthin)

Traditional Use

Carotenoid-rich foods — including carrots, sweet potatoes, and leafy greens — have been prized across many traditional dietary systems for their broad health-protective qualities. However, targeted traditional use for hearing is not documented in the historical herbal literature.

Scientific Evidence

Carotenoids are plant pigments with antioxidant activity, widely present in plant-based foods, including β-carotene, β-cryptoxanthin, lutein, and zeaxanthin. Prolonged exposure to noise and other environmental stressors leads to the generation of excessive free radicals within the cochlea. The proposed mechanism is that carotenoids can quench these reactive species before they damage hair cell membranes.

The 2025 systematic review and meta-analysis (PMC) found carotenoid intake did not reach statistical significance in pooled analyses, acknowledging that evidence remains preliminary. An earlier observational cohort study (Curhan et al., published in the American Journal of Clinical Nutrition, 2015) examined carotenoid intake in relation to self-reported hearing loss in women but its findings were observational in nature and subject to recall and confounding biases.

5.3 Magnesium

Traditional Use

Magnesium was not traditionally applied to hearing-specific complaints in classical herbal or nutritional medicine; its role in the auditory system is an entirely modern discovery arising from basic science and clinical investigation.

Scientific Evidence

Magnesium has been reported to reduce hearing loss through synergistic effects with vitamins. Free radical scavengers such as vitamins A, C, and E appear to act in synergy with magnesium to reduce changes in hearing thresholds more reliably than treatment with any single agent, suggesting that higher intake of antioxidants and/or magnesium may be associated with a lower risk of hearing loss.

A randomized controlled trial in cochlear implant recipients (cited in multiple PMC reviews) administered a daily combination of 315 mg magnesium plus beta-carotene, vitamin C, and vitamin E, or placebo, for 106 days. Those who received magnesium plus antioxidants were found to have better hearing preservation over a three-month period than those who received placebo, with the difference amounting to an 8 decibel (dB) hearing loss reduction. An observational study in nearly 2,600 participants aged 20–69 years found greater intakes of magnesium, beta-carotene, vitamin C, and vitamin E were each associated with better hearing of speech and high frequencies.

Magnesium's proposed mechanisms include neuroprotective and vasodilatory effects, as reduced blood flow and free radical formation in the cochlea play essential roles in noise-induced hearing loss. Evidence is promising but largely derived from small trials and observational studies. Larger, rigorously designed RCTs in human populations are needed to confirm the effect size and optimal intake levels.

5.4 Zinc

Traditional Use

Zinc-rich foods — oysters, red meats, legumes, and pumpkin seeds — have been dietary staples associated with vitality and immune strength in diverse traditional cultures. Zinc's specific application to tinnitus or hearing is a modern application not found in pre-20th century pharmacopeias or herbal traditions.

Scientific Evidence

Studies have found that the incidence of hearing loss was increased with the lack of zinc, among other micronutrients. In a study reviewed by PMC (Yeh et al.), subjects with noise-induced hearing loss-associated tinnitus took 40 mg/day zinc gluconate for 2 months. The results demonstrated that there were no statistically significant differences in hearing thresholds, speech reception thresholds, or tinnitus frequency and loudness before and after treatment, but following zinc treatment, Tinnitus Handicap Inventory (THI) scores improved significantly in patients with NIHL-associated tinnitus.

The overall evidence for zinc supplementation specifically improving audiometric hearing thresholds in humans with sensorineural hearing loss remains mixed. Benefits in reducing subjective tinnitus burden have been more consistently reported in some trials, but study populations have been small and methodological heterogeneity limits firm conclusions.

5.5 Vitamin D

Traditional Use

Vitamin D, obtained through sun exposure and oily fish consumption, was historically recognized in nutritional traditions for bone health and immune function, not for auditory applications. Its specific role in cochlear physiology is a product of modern biological investigation.

Scientific Evidence

Vitamin D regulates cochlear calcium homeostasis, mitigates oxidative stress via antioxidant enzyme activation, and modulates inflammatory responses, while Vitamin D deficiency contributes to inner ear damage.

The role of Vitamin D in the human auditory system has been extensively studied, with research indicating that Vitamin D deficiency is linked to both bilateral hearing impairment and bilateral sensorineural hearing loss in older adults. A prospective cohort study (PMC, 2025) found that serum 25(OH)D levels in sudden sensorineural hearing loss patients (24.1 ± 9.5 ng/mL) were significantly lower than those in healthy controls (32.6 ± 11.0 ng/mL, p = 0.012), with 73.7% of patients presenting with Vitamin D insufficiency or deficiency — a prevalence 1.8 times higher than in the control population. These findings identify low Vitamin D status as a preventable nutritional contributor to sudden sensorineural hearing loss.

A 2025 randomized controlled trial (PMC) enrolled 101 patients with sudden sensorineural hearing loss and vitamin D deficiency, randomizing them to conventional therapy alone or conventional therapy plus Vitamin D3. Evidence from this and similar small trials is encouraging but requires replication in larger, longer-duration studies before firm clinical conclusions can be drawn. Evidence strength is currently classified as preliminary.

5.6 B Vitamins: Folate and Vitamin B12

Traditional Use

Foods rich in folate (leafy greens, legumes) and vitamin B12 (animal products, fermented foods) have been fundamental to traditional diets across most cultures, recognized for supporting energy and nervous system health. Their explicit application to hearing health was not documented in traditional herbal or nutritional medicine.

Scientific Evidence

Studies based on food frequency questionnaires suggest that folate and vitamin B12 intake could protect against hearing loss. A cross-sectional analysis of the 2003–2004 NHANES dataset (n = 1,149 participants aged 20–69) found that erythrocyte folate levels showed a U-shaped relationship with hearing loss, suggesting a need to evaluate whether optimizing blood folate levels could prevent hearing loss. Although inverse associations between vitamin B12 and hearing loss were observed, these associations were not statistically significant (P > 0.05).

Fully adjusted models confirmed an inverse association between folate intake and hearing loss consistent with previous food frequency questionnaire studies and results from a clinical trial in the Netherlands. The finding of an inverse relationship in the general U.S. population shows that the benefits of folate on hearing observed in elderly populations are also evident in younger people.

A study of elderly individuals found that serum folate was significantly lower among elderly persons with age-related hearing loss, and trials on nutritional supplementation may substantiate the role of serum folate in age-related hearing loss.

The proposed mechanism involves folate and vitamin B12 being necessary for normal function of cells throughout the body, including nerve cells, and these vitamins helping to reduce levels of homocysteine, a potentially toxic compound that builds up in the body when B12, folate, and other nutrient levels are low. Elevated homocysteine is associated with impaired cochlear microvascular function. Overall, evidence quality is moderate-observational, with some RCT support; definitive dose-response relationships have not been established for hearing-specific endpoints.

5.7 Riboflavin (Vitamin B2)

Scientific Evidence

Vitamin B2 (riboflavin) acts as a crucial coenzyme in the body, participating in energy metabolism and the antioxidant defense system. Its role in the inner ear may be associated with hearing loss through two pathways. First, riboflavin supports antioxidant defense, serving as a coenzyme for glutathione reductase and helping to maintain the activity of glutathione, which neutralizes free radicals and reduces oxidative damage to cochlear hair cells. Oxidative stress is closely related to the pathological processes of hearing loss, and riboflavin deficiency may increase lipid peroxidation. As an essential vitamin for mitochondrial function, its deficiency may lead to disruptions in cellular energy metabolism, impairing the normal function and survival of cochlear hair cells and increasing the risk of noise-induced hearing loss. Evidence is currently largely mechanistic and pre-clinical.

5.8 Omega-3 Fatty Acids

Traditional Use

Consumption of fatty fish (salmon, mackerel, herring, sardines) has been integral to the traditional diets of Nordic, Japanese, Mediterranean, and coastal Indigenous communities, where it was associated with cardiovascular health and general vitality. No traditional text-based record specifically links omega-3 consumption to auditory preservation.

Scientific Evidence

Higher carbohydrate, fat, and cholesterol intake, or lower protein intake, corresponded to poorer hearing status. Higher consumption of polyunsaturated fatty acids corresponded to better hearing status in studied subjects.

A prospective cohort study tracked more than 65,000 women over 18 years (published in the American Journal of Clinical Nutrition). Researchers found that women who consumed two or more fish servings weekly were at a reduced risk of hearing loss compared to women who rarely consumed fish. This observational finding is consistent with omega-3 fatty acids' anti-inflammatory and vascular-protective properties. However, evidence from RCTs specifically targeting hearing outcomes with omega-3 supplementation remains limited, and current evidence is classified as preliminary–observational.

6. Herbs and Natural Ingredients Studied in Relation to Hearing Health

6.1 Ginkgo biloba

Traditional Use

Ginkgo biloba leaf extracts have been used in traditional Chinese medicine for thousands of years, primarily for conditions related to memory, vertigo, and circulation. Chinese pharmacopoeia texts referenced the seeds of the Ginkgo tree (Bai Guo) for respiratory conditions, while the leaves came into medicinal prominence in 20th-century Europe. The extract is used in medicine and is prescribed for cognitive dysfunctions including dementia, cerebrovascular insufficiency, recent memory loss, headache, vertigo, and tinnitus, in addition to emotional instability accompanied by anxiety.

Scientific Evidence

The Ginkgo biloba leaf is rich in flavones and glycosylated flavonoids, terpenes, lactones, and other constituents, which are responsible for the pharmacological properties of the extract. Preparations containing Ginkgo biloba increase blood flow, with the resulting improvement of oxygen supply to the cells, and protect tissues from the damage resulting from lack of oxygen. Furthermore, an inhibition of platelet aggregation has been found, being recommended in cases of deficit in the cerebral blood flow. Studies have shown that terpene lactones such as ginkgolide B and bilobalide are the constituents of the extract responsible for these properties.

A systematic review of randomized, placebo-controlled clinical trials published in PMC (2011) concluded that there is evidence of efficacy for the standardized extract EGb 761® in the treatment of tinnitus from three trials in patients in whom tinnitus was the primary complaint. Supportive evidence comes from a further five trials in patients with age-associated cognitive impairment or dementia in whom tinnitus was present as a concomitant symptom. As yet, the efficacy of other ginkgo preparations has not been proven, which does not necessarily indicate ineffectiveness, but may be due to flawed clinical trials.

A 2022 Cochrane review on Ginkgo biloba for tinnitus identified multiple included studies; one three-arm trial compared Ginkgo biloba, hearing aids, and Ginkgo biloba with hearing aids, and another four-arm trial compared Ginkgo biloba, alpha-lipoic acid plus vitamin C, papaverine hydrochloride plus vitamin E, and placebo. The total sample size for all included studies was 1,915 participants (range 22 to 978). Evidence supports a benefit specifically for the standardized EGb 761 formulation; generalizability to other preparations is not established. Evidence for reducing tinnitus severity is rated as low-to-moderate quality from this body of trials.

6.2 N-Acetylcysteine (NAC)

Traditional Use

NAC is a synthetic derivative of the amino acid cysteine and has no traditional herbal use. Its inclusion here reflects its status as a naturally-occurring precursor compound studied in the natural-health context of cochlear antioxidant defense.

Scientific Evidence

Endogenous antioxidant enzymes — including glutathione, glutathione peroxidase and reductase, superoxide dismutase, and catalase — work to reduce oxidative stress and reestablish redox balance by neutralizing ROS. NAC acts as a precursor to glutathione, the cochlea's primary endogenous antioxidant.

A 2022 systematic review and meta-analysis published in PMC analyzed multiple RCTs examining NAC for prevention of noise-induced hearing loss. The review and meta-analysis found that NAC showed a direction of benefit for noise-induced hearing loss. Nonetheless, larger randomized controlled trials are required for further investigation and verification. A meta-analysis of NAC in sensorineural hearing loss (PMC, 2022) synthesized evidence from both NIHL-prevention and sudden SNHL contexts, finding a signal of benefit but noting that internal validity varied and study sizes were generally small. Overall evidence is rated as preliminary, with the strongest signals coming from pre-clinical animal models and small human trials.

6.3 Alpha-Lipoic Acid (ALA)

Traditional Use

Alpha-lipoic acid is an endogenous compound with no traditional herbal use; its study in hearing health is entirely a product of modern biochemical and clinical research.

Scientific Evidence

Alpha-lipoic acid (ALA), an essential cofactor in mitochondrial enzymes, is a novel biological antioxidant and a potent free radical scavenger. In animal models, ALA has been shown to protect from both age-induced and cisplatin-induced hearing loss.

A systematic review of vitamin/antioxidant protection against occupational NIHL (PMC, 2019) found that ALA consuming 600 mg for 10 consecutive days could significantly protect from temporary hearing loss induced by exposure to 90 dB pure tone of high frequency, and that temporary threshold shift and Transient Evoked Otoacoustic Emissions amplitude change after noise exposure were lower after 10 days of oral ingestion of ALA. A human preliminary study of ALA on temporary threshold shift (PMC, 2013) examined 30 volunteers in a randomized design. Evidence remains preliminary, with a need for larger, longer-duration RCTs. Animal-model data are robust; human translation is in early stages.

6.4 Coenzyme Q10 (CoQ10)

Traditional Use

Coenzyme Q10 is an endogenously synthesized compound found in organ meats and some fish; it has no documented traditional herbal use for hearing complaints.

Scientific Evidence

Coenzyme Q10 is crucial for mitochondrial bioenergetics and redox balance and has been studied in hearing disorders. Its clinical use ranges from genetic mitochondrial deafness to acquired hearing loss associated with oxidative stress. Coenzyme Q10 (ubiquinol) delayed the progression of hearing loss in patients with a specific genetic defect (7445A→G mitochondrial mutation).

A 2026 scoping review published in MDPI identified 14 human clinical studies meeting inclusion criteria, including RCTs, non-randomized clinical studies, case series, and case reports. Fourteen studies met the inclusion criteria. Internal validity varied across studies: most evidence for replacement therapy was derived from observational designs, and antioxidant applications were mainly supported by small studies. Evidence is currently rated as low-to-moderate quality overall, with the most compelling signal for mitochondrial-related hereditary hearing conditions.

7. Dietary Patterns and Lifestyle Factors

7.1 Overall Diet Quality

Some cross-sectional studies and longitudinal cohort studies have provided preliminary evidence suggesting that healthy dietary patterns may contribute to hearing preservation, while others have failed to find significant associations. Higher carbohydrate, fat, and cholesterol intake, or lower protein intake, by individuals corresponded to poorer hearing status. Higher consumption of polyunsaturated fatty acids corresponded to better hearing status. In addition to malnutrition, obesity was reported as a risk factor for hearing loss.

7.2 Saturated Fat and Dietary Lipids

A diet low in saturated fat may help slow hearing loss. This recommendation is grounded in the established vascular mechanism: dietary lipids influence arterial health, and the stria vascularis is particularly susceptible to vascular insufficiency. Atherosclerotic changes affecting the small vessels supplying the cochlea may reduce oxygen and nutrient delivery, accelerating hair cell degeneration.

7.3 Physical Exercise

Exercise is beneficial for health as it improves cardiovascular function, physical fitness, and psychosocial health. Regular exercise can also reduce multiple cardiovascular risk factors, such as correcting lipoprotein profiles and lowering fat mass and blood pressure. Diet and exercise may also play a role in aging and hearing. The mechanism by which physical activity may support hearing health is thought to relate primarily to improved cochlear perfusion and reduced systemic inflammation and oxidative stress.

7.4 Body Weight and Obesity

In two cohort studies in Europe and Korea, high BMI and low BMI were found to be associated with hearing loss, respectively. Obesity was reported as a risk factor for hearing loss. The relationship between body weight and auditory function is thought to be mediated partly by shared metabolic pathways (inflammation, dyslipidemia, insulin resistance) that affect cochlear vascularity.

7.5 Noise Protection as a Lifestyle Factor

As extrinsic factors are thought to have a role in the progression of presbycusis, wearing earplugs or earmuffs to attenuate sounds may be helpful if the patient needs to be exposed to loud noises. Given the increasing prevalence of noise-induced hearing loss owing to occupational noise exposure and personal audio device use, addressing this issue is a pressing public health challenge.

7.6 Smoking

Hearing loss, tinnitus, and vertigo are associated with smoking, high blood pressure, diabetes mellitus, lifestyle, age, health history, leisure activities, and exposure to occupational noise. The ototoxic effect of smoking is thought to involve both direct cochlear vasoconstriction (reducing oxygen supply) and the systemic induction of oxidative stress.

8. Summary of Evidence Levels

• Magnesium + antioxidant vitamins (combined): Moderate evidence from a small RCT and observational data; synergistic effects on hearing thresholds suggested.
• Ginkgo biloba EGb 761 (standardized extract): Low-to-moderate evidence from multiple RCTs, specifically for tinnitus; other preparations lack adequate trial data.
• Folate: Moderate observational evidence; one Dutch RCT; U-shaped dose relationship observed in NHANES data; further RCTs needed.
• Vitamin D: Preliminary-to-moderate observational and cohort evidence; small RCTs support benefit in deficient patients with SSNHL.
• N-Acetylcysteine (NAC): Preliminary evidence from small RCTs; signal of benefit for NIHL prevention; larger trials required.
• Alpha-lipoic acid: Strong animal-model evidence; one small human RCT showing protection against temporary threshold shift; preliminary in humans.
• Coenzyme Q10: Low-to-moderate evidence; strongest signal for mitochondrial hereditary deafness; preliminary for acquired SNHL.
• Omega-3 fatty acids: Preliminary; large observational cohort data; no large dedicated RCTs for hearing outcomes.
• Vitamins A, C, E (individually): Preliminary; observational associations; not confirmed by meta-analysis of intervention studies.
• Zinc: Mixed; may reduce subjective tinnitus burden in some patients; no consistent effect on audiometric thresholds in RCTs.
• Riboflavin (B2): Mechanistic/pre-clinical; insufficient human trial data to characterize evidence level.

References

• NCBI StatPearls: Neuroanatomy, Auditory Pathway
• NCBI Bookshelf: Basics of Sound, the Ear, and Hearing
• PMC: Clinical Measures of Auditory Function: The Cochlea and Beyond
• NCBI StatPearls: Physiology, Cochlear Function
• PMC / Bulletin of the WHO: Hearing loss: rising prevalence and impact
• PMC: The Epidemiology of Deafness
• PMC / The Lancet: Hearing loss prevalence and years lived with disability, 1990–2019: GBD Study 2019
• Scientific Reports: The global burden of hearing loss and its comorbidity with chronic diseases, 1990–2021
• PMC / Frontiers in Nutrition: Protective effects of dietary nutrients on hearing loss: a systematic review and meta-analysis (2025)
• PMC: Protective effects of vitamins/antioxidants on occupational noise-induced hearing loss: A systematic review
• PMC: Association of Nutritional Factors with Hearing Loss
• PMC: Cellular mechanisms of noise-induced hearing loss
• PMC: Mechanisms of Noise-Induced Hearing Loss Indicate Multiple Methods of Prevention
• PMC: Redox homeostasis dysregulation in noise-induced hearing loss: oxidative stress and antioxidant treatment
• PMC: Antioxidant Therapy as an Effective Strategy against Noise-Induced Hearing Loss: From Experimental Models to Clinic
• PMC: Role of Oxidative Stress in Sensorineural Hearing Loss
• PMC: Pathogenesis and New Pharmacological Approaches to Noise-Induced Hearing Loss: A Systematic Review
• PMC: Erythrocyte folate, serum vitamin B12, and hearing loss in the 2003–2004 NHANES
• PubMed: Age-related hearing loss, vitamin B12, and folate in the elderly
• PMC: Ginkgo biloba extract in the treatment of tinnitus: a systematic review
• PMC: Clinical randomized trial study of hearing aids effectiveness in association with Ginkgo biloba extract (EGb 761) on tinnitus improvement
• Cochrane Library: Ginkgo biloba for tinnitus (2022)
• PMC: Age-Related Hearing Loss
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• PMC: Age-related hearing loss in older adults: etiology and rehabilitation strategies
• PMC: Probable Association of Hearing Loss, Hypertension and Diabetes Mellitus in the Elderly
• PMC: The effect of alpha-lipoic acid on temporary threshold shift in humans: a preliminary study
• PMC: Effect of N-acetyl-cysteine in prevention of noise-induced hearing loss: a systematic review and meta-analysis of RCTs
• PMC: Effect of N-acetyl-cysteine treatment on sensorineural hearing loss: a meta-analysis
• MDPI Audiology Research: Coenzyme Q10 in Hearing Disorders
• PMC: Vitamin D Deficiency as a Risk Factor for Onset and Recurrence of Sudden Sensorineural Hearing Loss
• PMC: Association between Serum Vitamin D Levels and Risk of Sudden Sensorineural Hearing Loss
• PMC: Clinical efficacy of vitamin D combined with conventional therapy for sudden sensorineural hearing loss in patients with vitamin D deficiency: a randomized controlled trial
• PMC: Evaluation of Intratympanic Alpha-Lipoic Acid and Diltiazem as Alternatives to Dexamethasone in Noise-Induced Hearing Loss