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Hearing loss is something we associate with older age, but it is increasingly affecting younger people, too.
Analysis published this year in the BMJ Global Health journal found that worldwide more than a billion teens and young people are at risk of hearing loss because of their use of phones or headphones and exposure to loud noise at concerts.
While you can't reverse hearing loss, recent research has uncovered ways that you can improve hearing sensitivity and prevent further decline.
One crucial step is to boost your speech-in-noise perception. This is the ability to identify words when there's background noise such as other people talking — a problem with speech-in-noise perception is often the first sign of hearing loss.
More than a billion teenagers and young people are thought to be at risk of hearing loss due to use of their phones and headphones
Singing is proven to help because it 'improves our ability to detect subtle pitch and timing differences or melody recognition and prediction — and these skills are also important for speech recognition, particularly in noisy environments,' says Doris-Eva Bamiou, a professor in neuroaudiology at University College London.
A 2019 study in the journal Frontiers of Neuroscience, with more than 50 people aged 54 to 79, found that those who took part in weekly two-hour group choral sessions for ten weeks experienced a 10 to 20 per cent improvement in speech intelligibility compared with a control group who did nothing.
And it doesn't have to be in a choir — singing to yourself in the car or in the shower may help as it 'involves speech production and speech monitoring in a rhythm,' says Professor Bamiou.
'Rhythm acts like a scaffold for the brain,' she says, 'and this helps skills such as speech perception in noise'.
Musical training also improves brain function and this in turn appears to lead to bigger areas within the auditory cortex, the area of the brain that deciphers sound, she adds.
If you don't use the auditory cortex, it can get lazy, so give it a workout by listening to something intently. 'There is evidence that passive listening to a story, such as an audiobook, could improve speech perception,' says Professor Bamiou.
Michael Marchant, an audiologist and head of professional services at Hidden Hearing, adds: 'Another good exercise is to play a piece of music and try to isolate the different instruments being played or the words being sung, rather than listening passively.
'You can even try it from a different room or play it quietly so that your ears have to strain to hear it.'
You need to do the training consistently a few times a week and over several weeks to benefit, adds Professor Bamiou.
Cardiovascular exercise promotes healthy blood flow to the inner ear, which is crucial for healthy hearing.
In fact, regular workouts may slow age-related hearing loss reported a 2016 study on mice in the Journal of Neuroscience.
'The inner ear is a network of tiny blood vessels and they rely on the oxygen and nutrients that come with good blood flow,' says Michael Marchant.
'It doesn't need to be vigorous — anything that gets your heart rate up will do, such as fast walking. It's not only protective against hearing loss, but may help to prevent further deterioration if you already have it.'
'We are more likely to be able to listen well when we don't try to do other things at the same time — as our attention is a finite resource,' says Professor Bamiou. 'When we are present in the moment and not subconsciously worried that we may mishear, we hear better. So mindfulness could help.'
A large study — the Conservation of Hearing Study — followed 71,000 women aged 27 to 44 over two decades.
It found that those whose dietary patterns most resembled the AMED (alternate Mediterranean diet score) or DASH (dietary approaches to stop hypertension) approaches had about a 30 per cent lower risk of hearing loss than women whose diets least resembled them.
The DASH diet emphasises fruit, vegetables and low-fat dairy, with wholegrains, fish, nuts and poultry, with little red meat or sugar.
One way to improve hearing sensitivity is to boost your speech-in-noise perception, which is the ability to identify words when there's background noise
The AMED diet emphasises fruits, vegetables, fish, nuts and olive oil and lower consumption of animal products and saturated fat.
The researchers said these diet approaches help by reducing cholesterol levels, blood pressure and inflammation.
'High cholesterol and high blood pressure can damage blood vessels and reduce the delivery of blood and oxygen to the cochlea [the fluid-filled area in the inner ear that plays a vital role in hearing],' says lead researcher Professor Sharon Curhan, a physician and epidemiologist at Mass General Brigham in the U.S.
'Lower cholesterol and healthy blood pressure can help preserve healthy vascular function and ensure the delivery of blood and oxygen to hearing structures,' she told Good Health.
'As for inflammation, too much can directly damage the cells responsible for hearing and reduce blood flow to the cochlea.'
Hearing loss is twice as common in people who have diabetes, and those with prediabetes (where blood sugar levels are higher than normal) have a 30 per cent higher rate of hearing loss.
'Research is ongoing into the exact mechanisms but it's known that diabetes causes micro-angiopathy [damage to the smallest blood vessels] in the ear and disrupts the chemical state of the fluids in the inner ear,' says Kathy Dowd, an audiologist and director of The Audiology Project, which raises awareness of the link between diabetes and hearing loss.
'It's also known that high blood sugar levels in diabetes can damage the protective covering around a nerve that transports both hearing and vestibular [i.e. balance system] signals to the brain.'
Micro-angiopathy from diabetes also occurs in the brain, which can affect cognition and processing of what you hear.
'People with diabetes should keep their blood sugar and blood pressure as close to normal as possible to prevent further decline,' says Kathy Dowd.
Lastly, get your hearing checked. 'If we pick up problems early, you have a much better chance of preserving what's left and warding off the cognitive decline that's associated with hearing loss,' says Michael Marchant.
'It's a case of use it or lose it — the brain is resourceful and if an area isn't being used, it can start to redirect itself and use it for other purposes.
'People over 50 should be screened once a year, but go earlier if you have any symptoms.'