Hearing Loss and the Brain: Why the Expectations We Hold Change Everything

By Kim Fishman, Audiologist | Hears Hearing & Hearables  |  Hears to U Clinic, Hopkins, Minnesota

I heard a podcast a few years ago that I haven’t been able to stop thinking about since. A man who had been blind from birth described how he navigated the world independently, not with a cane or a guide dog, but with click-tones. He would make a clicking sound with his mouth and use the echo that returned to map his surroundings, much like a bat uses echolocation. He walked through cities, rode bikes, and played basketball.

What made his story even more remarkable was this: his mother had refused to lower her expectations of him. She didn’t make the world smaller so he could move through it more safely. She taught him to navigate the world as it actually was, and his brain, given that expectation, adapted to meet it.

I’ve spent a lot of my career thinking about that story in the context of hearing loss. What happens to the brain when hearing declines? What happens when the people around someone with hearing loss, and the person themselves, lower their expectations of what’s possible? And what happens when they don’t?

Why an Audiologist Is Writing About Brain Science

Early in my career, I pursued doctoral-level research at the University of Minnesota, focusing specifically on how people with hearing loss learn to read, and what brain imaging tells us about the relationship between language, sensory deprivation, and cognitive adaptation. I didn’t complete the program, but the research shaped how I think about hearing care in ways that have never left me.

I still read the research regularly. And the more I read, the more convinced I become that the clinical conversation about hearing loss is too focused on the ear, and not focused enough on the brain. The ear is the hardware. The brain is where hearing actually happens. And the brain is far more adaptable than most people realize.

The Brain Is More Adaptable Than You Think

One of the most striking findings from neuroimaging research is that the brain doesn’t simply accept sensory loss; it reorganizes around it.

Studies using fMRI have shown that individuals who use sign language activate their auditory cortex when processing signed language, the same brain region associated with hearing in people with normal hearing. Meanwhile, people who are blind and have learned spatial navigation activate their visual cortex during non-visual tasks. The brain recruits available territory for new functions when the original input is missing or reduced.

This phenomenon, called cross-modal neuroplasticity, demonstrates that the brain’s architecture is not fixed. It responds to experience, to learning, and to the demands placed on it. Sensory deprivation doesn’t shut regions of the brain down. It reassigns them.

For people with hearing loss, this has profound implications. The auditory cortex doesn’t simply go quiet when hearing declines. It remains available for language processing through other modalities, for cognitive engagement through hearing aids and other assistive technology, and for rehabilitation and adaptation. But it requires stimulation to do so. It requires expectations.

Why Language Proficiency Changes Brain Activity

One of the clearest findings from decades of brain research is this: people with more developed language skills show more extensive, more nuanced brain activity than those with limited language development. This holds across modalities, spoken language, signed language, and written language.

In the context of deaf individuals, research has consistently shown that those who are proficient in American Sign Language from an early age demonstrate:

• Enhanced visual-spatial processing skills, the brain develops a stronger capacity in the regions that handle spatial reasoning and visual attention
• Greater orthographic processing, the visual-phonological system of ASL supports reading in written English in ways that aren’t immediately obvious
• Increased cognitive flexibility, bilingualism in any form, including ASL-English bilingualism, strengthens the executive function systems of the brain
• Higher reading proficiency in English, counter to what some might assume, a strong ASL foundation correlates with stronger English literacy

The reason matters. Language, any well-developed language, builds neural scaffolding. It creates connections. It trains the brain to process complexity, hold meaning in working memory, and navigate the subtle relationships between words, ideas, and syntax. A brain that has been well-exercised by language is more capable in almost every domain.

How Expectations Shape What the Brain Actually Does

Here is where the research gets personal to me, and where I think it has the most direct relevance to the people I work with every day.

Expectations function as cognitive demands. When a person is held to a high expectation, when the people around them and the systems they navigate assume they are capable, the brain is given a problem to solve. It rises to that problem through increased synaptic activity, neural pathway reinforcement, and what researchers call cognitive engagement.

The reverse is also true. When expectations are lowered, when a person with hearing loss is talked over rather than talked to, when communication strategies are abandoned because it seems easier, when the assumption becomes ‘they can’t keep up’, the brain receives a different signal. There is less demand. Less engagement. And over time, less capacity.

The brain optimizes for what is expected of it. High expectations are not just motivational; they are neurologically significant.

This is part of why untreated hearing loss is consistently associated in research with accelerated cognitive decline. It’s not only that the auditory cortex receives less stimulation. It’s that social withdrawal, reduced communication, and the cognitive disengagement that follows from hearing loss all reduce the brain’s overall load, and a brain with reduced load does less well over time.

What High Expectations Look Like for People With Hearing Loss

I’ve had the privilege of working with patients who refused to let hearing loss define what they could do. They are not outliers. They are people who held high expectations of themselves and found the tools and strategies to meet those expectations.

In practice, high-expectation individuals with hearing loss tend to:

• Seek treatment rather than accept decline; they don’t wait until hearing loss is severe before addressing it
• Use technology actively, hearing aids, remote microphones, Bluetooth streaming, and telecoil-equipped devices in looped venues, rather than avoiding them
• Advocate for themselves, asserting their ADA rights, asking for accommodations, choosing environments and communication partners who support them
• Stay socially and cognitively engaged, continuing to participate in conversations, events, and activities that challenge them
• Maintain positivity about what’s possible, not denial about the reality of their hearing loss, but a genuine belief that adapting is worth doing

None of this requires perfect hearing. It requires high expectations of themselves and of the hearing care system they work with. That’s where I believe hearing professionals have a responsibility that goes beyond selling devices.

What This Means for Hearing Care Professionals and Why It Shapes How We Work

When I think about what a hearing care professional actually owes a patient, I don’t think it begins and ends with programming a hearing aid correctly. It includes helping the patient understand what’s possible. Setting expectations that are high, realistic, and honest. Helping them see their hearing loss not as a ceiling on what they can experience, but as a challenge that the brain, given the right tools and the right support, can adapt to meet.

This is part of why I’m skeptical of hearing care that treats hearing aids as a transaction. Buy the device, set it up, and send the patient home. That model misses the cognitive and emotional dimensions of what hearing loss actually involves and what recovery and adaptation actually require.

At Hears Hearing & Hearables and at our Hears to U clinic, we try to practice something closer to what the research suggests: that what we expect of patients shapes what they achieve. That counseling on realistic but ambitious expectations is as important as the technical fitting. That follow-up matters because adaptation takes time, and the brain needs support through that process.

Back to the Click-Tones and What They Mean for You

The man who navigated the world with click-tones wasn’t doing something supernatural. He was doing something the brain is designed to do when expectations demand it: find a way.

His mother’s refusal to lower her expectations of him wasn’t cruelty. It was the deepest kind of belief that he was capable of more than the world assumed, and that the path to that ‘more’ was through challenge, not protection from it.

I think about that story often when I sit with a patient who has been told by other providers, by family, by their own internal voice that they’re too old to bother with hearing aids, that their hearing loss isn’t bad enough to matter, that they should just speak up and manage. Each of those messages is a lowered expectation. Each of them tells the brain: don’t bother.

The evidence suggests something different. The brain, given stimulation and demand, adapts. Hearing aids that restore acoustic input give the auditory cortex something to work with. Communication strategies that keep patients in conversation keep the language systems engaged. High expectations from professionals, from family, and from patients themselves keep the brain oriented toward what’s possible rather than what’s lost.

Taking Your Hearing and Your Brain Seriously

If you’ve been putting off addressing your hearing loss because it doesn’t seem bad enough, or because you’re not sure it’s worth it, or because you’ve absorbed the message that decline is just what happens, I’d invite you to consider the research differently.

The brain you have today is not the brain you’re stuck with. It adapts. It reorganizes. It responds to what you ask of it. What you ask of it starts with what you expect of your hearing, of your hearing care, and of yourself.

We’re here to help you set those expectations high and find the tools to meet them, whether that’s an OTC hearing aid, a prescription fitting, a telehealth consultation, or a conversation about what’s actually possible for your specific hearing situation. 

— Kim Fishman, Audiologist | Hears Hearing & Hearables  |  Hears to U, Hopkins, Minnesota

Just what makes that little ole ant think he can move a rubber tree plant! 

He’s Got High Hopes!

Frequently Asked Questions: Hearing Loss and the Brain

Does untreated hearing loss affect the brain?

Yes. Research consistently links untreated hearing loss with accelerated cognitive decline, social withdrawal, and reduced brain stimulation in the auditory cortex. When the brain receives less acoustic input, the auditory regions can be recruited for other functions, but the overall cognitive engagement that comes from active listening, conversation, and social participation also decreases. This is one of the strongest arguments for addressing hearing loss earlier rather than later.

Can the brain adapt to hearing loss?

Yes, and it already does, whether we direct that adaptation or not. Cross-modal neuroplasticity research shows that when one sensory channel is reduced, the brain reorganizes to use available neural territory for new purposes. Hearing aids, assistive technology, and communication strategies can direct this adaptation productively. Without intervention, the brain still adapts, but in ways that may not serve the person well long-term.

What is neuroplasticity, and why does it matter for hearing loss?

Neuroplasticity is the brain’s ability to reorganize itself by forming new neural connections throughout life. It means the brain is not fixed; it changes in response to experience, learning, and demand. For people with hearing loss, this means the auditory cortex remains available for stimulation and adaptation. Hearing aids that restore acoustic input give the brain something to work with, which is part of why earlier intervention tends to produce better long-term outcomes than waiting until hearing loss is severe.

Why does ASL proficiency improve reading in deaf individuals?

American Sign Language is a fully developed language with its own grammar, syntax, and phonological system, expressed visually and spatially rather than acoustically. Proficiency in ASL builds the same neural scaffolding that any well-developed language builds: working memory for language structures, cognitive flexibility, and the ability to process complex meaning. These skills transfer to reading in English. Research consistently shows that a strong ASL foundation correlates with higher English literacy in deaf individuals, counterintuitive but well-documented.

How does hearing aid use affect the brain?

Hearing aids restore acoustic input to the auditory cortex, which helps maintain the neural pathways associated with speech and language processing. Research suggests that consistent hearing aid use is associated with slower rates of cognitive decline in people with hearing loss. The mechanism is not fully understood, but the cognitive engagement that comes from active listening, conversation, and social participation, all of which hearing aids support, appears to be protective for brain health.

What does it mean to have high expectations with hearing loss?

High expectations in the context of hearing loss mean refusing to accept avoidance and withdrawal as the default response. It means seeking treatment, using available technology, advocating for accommodations, staying socially engaged, and maintaining the belief that adaptation is possible and worth doing. Research on expectations and cognitive outcomes suggests this orientation is not just motivational; it has neurological significance because the demands placed on the brain shape what the brain does.