Eardrum perforations and cholesteatoma linked to higher odds of dementia

A new study published in Otolaryngology–Head and Neck Surgery, the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), finds that two common and treatable causes of conductive hearing loss-eardrum perforations and cholesteatoma, a type of abnormal skin growth in the middle ear-are associated with higher odds of dementia. Notably, the study also found that treatment, whether through surgery or hearing aids, was associated with a reduction in that elevated risk.

The findings, first presented at the AAO-HNSF 2025 Annual Meeting & OTO EXPO in Indianapolis, Indiana, add to a growing body of evidence linking hearing loss to cognitive decline and raise an important question: if the underlying cause of hearing loss is treatable, could treating it help protect the brain?

We have known for some time that untreated hearing loss is related to worse cognition in adults. This study shows that specific forms of surgically addressable hearing loss are also adversely related to cognition. But what is most exciting is that treatment with routine surgery may improve both the hearing and possibly reduce the risk of dementia."

Justin S. Golub, MD, MS, corresponding author on the paper from the Department of Otolaryngology–Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center

Researchers at Columbia University and the University of Utah analyzed data from more than 363,000 participants in the All of Us Research Program, a large and diverse national health dataset sponsored by the National Institutes of Health. They found that participants with eardrum perforations had more than twice the odds of dementia compared to those without, and those with cholesteatoma had nearly twice the odds. Otosclerosis, a condition affecting the bones of the middle ear, was not significantly associated with dementia in this study.

Importantly, when surgical treatment was accounted for in the analysis, the association between cholesteatoma and dementia became nonsignificant. Treatment with hearing aids also reduced the association for both conditions, suggesting that restoring hearing, whether through surgery or devices, may play a meaningful role in lowering dementia risk.