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LONGEVITY LATEST ISSUE 33 · 21 OCTOBER 2026
LONGEVITY LATEST
The Evidence-Based Edge on Living Longer and Better
Issue 33 · What Your Ears Are Worth · 21 October 2026
Welcome
If conversation in a busy restaurant has started to feel like work, you’ve probably read that hearing loss raises dementia risk. It sits joint top of the Lancet Commission’s list of modifiable risk factors. Treat it, the logic goes, and you protect the brain. ACHIEVE, the largest trial to test that, gave 977 people in their seventies and early eighties hearing aids or health-education classes. Three years later, their thinking had declined by the same amount.
The details are more interesting. Participants at higher risk did better with hearing aids, and the hearing-aid group reported fewer falls. CHOICE, a second trial published last month, also missed its main target while hinting at something else. Whether aids help some people’s brains more than others is now the live question: a hypothesis, not yet a rule.
The short version. If you struggle to follow conversation in a busy room, check your hearing this week; it takes three minutes online. If you’re offered hearing aids, wear them most of the day: the evidence is strong for hearing and everyday life, unsettled for balance and the brain. Sudden hearing loss in one or both ears is different: ask for an urgent GP appointment or call NHS 111. And leave the “hearing support” supplements on the shelf.
SPOTLIGHT
One trial, five answers
What ACHIEVE measured | What hearing aids changed | How much weight it bears |
Thinking (all 977) | No difference in three-year cognitive decline (0.002 SD; p = 0.96). | The primary outcome, and the headline. |
Thinking (238 at higher risk) | 48% slower decline. A 2025 risk-model reanalysis: 62% slower in the highest-risk quarter. | Prespecified, but a subgroup. |
Hearing (daily-life handicap) | Handicap score halved, 15.7 to 7.8; controls drifted from 14.9 to 16.2. | Secondary and self-reported, but it’s what aids are for. |
Falls (self-reported) | 1.45 vs 1.98 falls per person over three years, 27% fewer; injurious falls 0.49 vs 0.81. | Exploratory, in an unmasked trial. |
Connection (network, loneliness) | About one more person kept in the social network; loneliness change too small to matter. | Exploratory. |
My reading: the further from the trial’s main question, the better hearing aids look and the softer the evidence gets. The row I’d most like tested properly is falls. Nobody fits a hearing aid to keep someone upright.
Lin et al. ACHIEVE. Lancet (2023) · Pike et al. Alzheimers Dement (2025) · Goman et al. Lancet Public Health (2025) · Reed et al. JAMA Intern Med (2025)
No, then maybe. The main result came up empty; nearly everything around it leaned the right way.
THIS WEEK’S ANALYSIS
Top 3 Interventions Under the Microscope
Each grade judges the evidence for the outcome in its heading, not hearing care in general.
Hearing-evidence grades: A = randomised trials show a clear benefit, at least moderate certainty; B = positive randomised evidence, but few or small trials, short follow-up or imprecise results; C = no benefit or mixed results in the trials that matter, however good the observational data; D = claims outrun the data.
1. Hearing aids, for hearing and everyday life | Grade A
The least surprising result in this issue, and the most useful. If you have hearing loss, they work for what they’re for.
The evidence. Cochrane updated its review this August: 16 studies, 2,261 adults with mild to moderate loss. Hearing aids probably bring a large improvement in everyday participation (8 studies, 1,683 people) and in listening to other people, both at moderate certainty. Any lift in general well-being may be small, and loneliness may not change at all, both at lower certainty. Obvious? To audiologists. The uptake figures suggest the rest of us haven’t noticed.
The gap. RNID estimates that around 8 million UK adults could benefit from hearing aids; about 3 million use them. NHS aids are free. The evidence isn’t the problem. The delay is.
2. Self-fitted hearing aids, including AirPods | Grade B
A reasonable option for mild to moderate loss, on a short evidence trail. Far better than nothing; not yet shown equal to a professional fitting over the long run.
The trial. One randomised trial compared self-fitted Lexie aids with audiologist-fitted ones in 64 adults with mild to moderate loss. At six weeks, benefit was statistically indistinguishable. At eight months, 44 of the 64 were followed up, and the groups still looked similar. One device, one small sample, nearly a third missing from the long-term check: that’s what makes it a B. Worth knowing, though it doesn’t change the grade: hearX, Lexie’s parent company, funded the trial, and several authors reported payments from it.
Apple’s version: trust the test, not yet the hearing aid. On AirPods Pro 2, 86.5% of the hearing test’s thresholds landed within 10 dB of a sound-booth test in 25 people (the Pro 3 wasn’t tested). The hearing aid feature hasn’t shown a benefit. In a separate 25-person study, it mostly amplified less than prescription targets and didn’t improve speech in noise straight after setup. Participants had reported their hearing loss rather than had it measured, so that study can’t settle the question either way.
Think of it like reading glasses off a chemist’s rack: fine for a simple, even problem, wrong for anything else, and no substitute for the eye test. I’d call AirPods a decent first step and a poor last one: use the test to find out, and see an audiologist if the loss is in one ear or beyond moderate.
De Sousa et al. JAMA Otolaryngol (2023) · De Sousa et al. JAMA Otolaryngol (2024) · Kruger et al. Otolaryngol Head Neck Surg (2026) · Apple OTC feature study. Am J Audiol (2026)
3. Hearing aids, to protect thinking | Grade C
Plausible and promising, but the trial support so far comes from a subgroup and a secondary outcome. Wear them for your hearing; count any benefit to your brain as a bonus.
The case for. The cohorts point the same way. In Australia’s ASPREE study, 2,777 people over 70 with moderate hearing loss, those prescribed aids had a third lower dementia risk over seven years. Yet their cognitive test scores were no better, and the authors say confounding may explain the gap: healthier, wealthier people are likelier to get aids and wear them.
The trials, so far. ACHIEVE measured cognitive decline and found no difference overall. CHOICE measured something else, progression to dementia-level impairment, in 703 people in Shanghai who already had mild cognitive impairment: 3.1% with hearing aids against 4.7% with education over two years, not a significant difference. Its secondary result is the one I keep rereading. On the dementia rating scale, 15% of the hearing-aid group moved back to normal, against 2% of controls. The assessors didn’t know who had been fitted, which makes that harder to wave away. The authors still call it exploratory, and so do I.
Why C? Graded on headlines, this would be an A. Neither trial hit its main target, and the encouraging signals come from a subgroup and a secondary outcome. C, leaning up. The companion explains why the trials keep half-answering.
HYPE CHECK
“Natural hearing and tinnitus relief”
The claim. “Hearing support” supplements promise inner-ear circulation and relief from ringing. Cortexi, promoted through advertiser-written “reviews” on local US newspaper sites, costs $69 a bottle or $294 for six months. Lipo-Flavonoid, sold in mainstream pharmacies, calls itself the “#1 doctor-recommended supplement for ear ringing”: about $26 for 100 caplets, at six a day for at least 60 days, so roughly $100 a course.
The evidence is thin to absent. The best Lipo-Flavonoid trial I could find, from the University of Iowa, used it as the comparison arm rather than testing it against placebo. Of the 16 people who finished six months on it, two said the ringing seemed quieter; none improved on the tinnitus questionnaires. Ginkgo, common in these blends, has a 2022 Cochrane review: 12 trials, 1,915 people, little or no difference from placebo, at very low certainty. US ear, nose and throat guidelines, last issued in 2014, say supplements should not be recommended for tinnitus.
Of 16 people who finished six months on Lipo-Flavonoid Plus, none improved on the tinnitus questionnaires.
Why it misleads. Age-related hearing loss is largely the loss of sensory hair cells and their nerve connections in the inner ear, and in humans they don’t grow back. “Circulation” is doing a lot of work in that pitch. The bigger cost is delay: a year on supplements is a year of untreated hearing.
Cortexi sponsored listing (2026) · H-E-B. Lipo-Flavonoid listing (2026) · Rojas-Roncancio et al. J Am Acad Audiol (2016) · Sereda et al. Cochrane (2022)
Our verdict. Skip them. Six months of Cortexi costs $294; an NHS hearing assessment and hearing aids cost nothing. For tinnitus, the same guideline backs a hearing assessment where hearing is affected, and cognitive behavioural therapy once it has bothered you for six months.
IN BRIEF
A hearing aid only helps if it helps. A pooled analysis of seven cohorts across 33 countries, published in Cell Reports Medicine in June, followed 61,089 adults over 55 with hearing loss for 6.5 years on average. Any hearing aid use went with 9% lower risk of probable dementia: 14% among people who said their aids improved their hearing well, and no clear reduction among those who said they helped poorly. Observational and self-reported, but a fair nudge to go back for adjustments.
THIS WEEK’S DEEP DIVE
Listening Is Hard Work
In the Baltimore Longitudinal Study of Aging, people with hearing loss lost more than a cubic centimetre of extra brain tissue a year, mostly in the regions that handle sound and speech.
This is where the explaining happens. The companion sets out four reasons ears and brains might be linked, what each would mean for hearing aids, and three questions for reading the next “hearing aids cut dementia risk” headline.
BIOHACKING CORNER · THE PLAN LIVES HERE
This week: the three-minute check. RNID’s free online check plays digits over background noise; use headphones, somewhere quiet. If you have AirPods Pro 2, Apple’s hearing test also performed well against a booth test. Both are screens, not diagnoses. If either flags a problem, or the family keep turning the television down, ask for an NHS hearing assessment through your GP, or refer yourself where your area allows it.
If you get hearing aids, wear them from breakfast to bedtime; ACHIEVE participants averaged 7.2 hours a day three years in. The first fortnight feels strange, with your own voice, the fridge and rustling paper suddenly loud. Go back for adjustments rather than retiring them to a drawer.
Protect what’s left. The WHO-ITU safe-listening standard sets an adult weekly allowance of 80 dB for 40 hours; louder means less time. Many phones can track headphone exposure against it, so turn that on. My rule, a judgement rather than a finding: from 60, a hearing check goes in the diary every year, next to the blood pressure check.
RNID. Online hearing check · Kruger et al. (2026) · WHO-ITU. Safe listening standard (2019) · NHS. Hearing loss
READER PULSE
Last week’s balance-training poll is still open, so the results, and the decision on the step-by-step progression plan, come in Issue 34.
This week, one quick question: when did you last have your hearing tested? In the past year, one to five years ago, longer, or never?
CLOSING
Treat the hearing, and keep watching the brain
Hearing aids already earn their place for what they were built to do. Whether they also protect thinking is still open; ACHIEVE’s long-term follow-up is under way. I wouldn’t wait for it.
Next week: eyes. Untreated vision loss made the Lancet Commission’s list too, and cataract surgery has some of the most intriguing observational data in dementia research. Whether it survives a trial is another matter.
Stay curious and stay healthy!
Christian Thomsen, Editor
Longevity Latest is published weekly by FrontWave Media Ltd. Educational content, not personal medical advice. Sudden hearing loss in one or both ears needs an urgent GP appointment or NHS 111. Ear pain or discharge, dizziness, or tinnitus that pulses with your heartbeat needs medical assessment, not a self-fitted device. Check with your doctor or pharmacist before taking supplements alongside prescribed medicines.
Sources and reading notes
Evidence checked through 16 October 2026. Cochrane figures are from the August 2026 update’s summary of findings. ACHIEVE’s falls, social and risk-model results are secondary or exploratory analyses. CHOICE was open-label with blinded cognitive assessors and statistician; its improvement finding is an exploratory secondary outcome. The self-fitting trial’s eight-month follow-up covered 44 of 64 participants. Apple’s hearing test was validated on AirPods Pro 2; the hearing aid feature study recruited on self-reported loss. ASPREE and the 33-country analysis are observational. Supplement prices are US retail or advertiser listings, October 2026.
H-E-B. Lipo-Flavonoid ear ringing caplets, 100 count, listing and directions (accessed October 2026)
© 2026 FrontWave Media Ltd · Longevity Latest