Change in hearing loss and its association with general health in a community-based longitudinal study of middle-aged individuals: The Busselton healthy ageing study.
Over six years, hearing thresholds significantly declined in middle-aged Western Australians, with greater deterioration in men and at higher frequencies, and hearing loss progression was shaped not only by age and sex but also by broader metabolic and environmental health profiles.
Key Findings
Results
The prevalence of mild-or-greater hearing loss increased substantially over six years of follow-up.
Prevalence of mild-or-greater hearing loss based on 4FPTA increased from 14% to 26% over six years.
Prevalence based on HFPTA (4 & 8 kHz) increased from 53% to 71% over six years.
3596 participants with reliable audiometry at both baseline and follow-up were included.
Mean baseline age was 57.9 years, and 55% of participants were female.
Baseline data collection occurred between 2010 and 2015 with a six-year follow-up.
Results
Hearing thresholds worsened across all age categories, with greater deterioration observed in men and at higher frequencies.
Deterioration was observed across all age categories present in the cohort (45–70 years at baseline).
Men experienced greater hearing threshold deterioration than women.
Higher frequencies (4 & 8 kHz) showed greater deterioration than the standard speech-frequency range (0.5–4 kHz).
Both the better-ear 4FPTA and HFPTA metrics were used to assess change.
Results
Older age and male sex were significantly associated with faster hearing decline in univariate models.
Both older age and male sex were identified as significant determinants of hearing threshold progression.
These associations were found in univariate models with adjustments for age and sex.
Age and sex are described as 'established determinants' of hearing loss in this population.
Results
Higher BMI was significantly associated with faster hearing decline after adjustments for age and sex.
Higher BMI was identified in univariate models as significantly associated with faster hearing decline.
The association was present after adjustments for age and sex.
BMI was categorized among general health factors in the analysis.
Results
Smoking was significantly associated with faster hearing decline after adjustments for age and sex.
Smoking was identified in univariate models as a significant factor associated with faster hearing threshold deterioration.
The association remained after adjustments for age and sex.
Smoking was categorized as a general health and environmental factor in the analysis.
Results
Tinnitus and chronic ear infection were significantly associated with faster hearing decline.
Both tinnitus and chronic ear infection were identified as significant ear-related factors associated with faster hearing decline.
Associations were found in univariate models after adjustments for age and sex.
These were categorized as ear-related factors in the analytical framework.
Results
Noisy workplace exposure, particularly with inconsistent or absent hearing protection, was significantly associated with faster hearing decline.
Noisy workplace exposure was a significant environmental factor associated with faster hearing threshold deterioration.
The association was particularly strong for those with inconsistent or absent use of hearing protection.
This factor was assessed after adjustments for age and sex in univariate models.
Results
Hypertension and pre-diabetes were significantly associated with faster hearing decline after adjustments for age and sex.
Both hypertension and pre-diabetes were identified as significant metabolic health factors associated with faster hearing threshold deterioration.
Associations were found in univariate models after adjustments for age and sex.
These findings are described as highlighting 'the complex interplay between metabolic health, environmental exposures, and hearing outcomes.'
Methods
Linear mixed models were used to analyze the association of demographic, ear-related, general health, and environmental factors with change in hearing thresholds.
The study used data from the Busselton Healthy Ageing Study (BHAS), a population-based cohort in Western Australia.
Adults aged 45–70 years at baseline underwent audiometric testing and comprehensive health assessments.
Better-ear four-frequency Pure Tone Averages for 0.5–4 kHz (4FPTA) and for high frequencies at 4 & 8 kHz (HFPTA) were calculated.
Hearing loss was classified according to WHO criteria.
Factors analyzed included demographic, ear-related, general health, and environmental variables.
What This Means
This research followed nearly 3,600 middle-aged adults in Western Australia for six years, testing their hearing at the start and end of the study period. The results showed a striking increase in hearing loss over this time: the proportion of people with at least mild hearing loss nearly doubled (from 14% to 26%) when measured across standard speech frequencies, and increased from 53% to 71% when measuring higher-pitched sounds, which are typically the first frequencies affected by damage. Men lost more hearing than women, and high-frequency hearing declined more than lower-frequency hearing across all age groups in the study.
Beyond age and sex, the study found that several health and lifestyle factors were linked to faster hearing deterioration. These included higher body weight (BMI), smoking, tinnitus, chronic ear infections, and exposure to loud noise at work—especially when hearing protection was not consistently used. Notably, metabolic health conditions such as hypertension (high blood pressure) and pre-diabetes were also associated with faster hearing decline, suggesting that cardiovascular and blood sugar health may play a role in how quickly hearing worsens during middle age.
This research suggests that hearing loss in midlife is not simply an inevitable consequence of getting older, but is also shaped by a person's broader health profile and environmental exposures. The findings point to the potential importance of managing metabolic conditions, reducing noise exposure, and using hearing protection consistently as factors that may be relevant to hearing health. The authors call for future research to better understand how these different factors interact and contribute to hearing loss progression.
Smit A, Eikelboom R, Mao Y, Hunter M, Atlas M, Swanepoel D, et al.. (2026). Change in hearing loss and its association with general health in a community-based longitudinal study of middle-aged individuals: The Busselton healthy ageing study.. PloS one. https://doi.org/10.1371/journal.pone.0360651