The Future of Hearing Medicine: Why We Need a Better Ruler to Measure Change

The world of medical research moves incredibly fast. Picture therapies that can correct genetic flaws or drugs that can halt chronic disease. These are real breakthroughs, but they all share one critical challenge: How do we accurately and affordably measure if they actually work?

For hearing health and correlated conditions like dementia, diabetes, cardiovascular and circulatory diseases, this measurement gap is especially clear. We know people rarely check their hearing currently, so as new, complex treatments emerge, we need a simple, scalable tool to track patient progress over time. At eargym, we deliver that longitudinal measurement, AND we focus on how your brain processes sound, as part of your overall hearing capacity.

Breakthroughs Demand Better Metrics

Consider the cutting edge of hearing research: gene therapy.

A 2025 study by Pan et al. detailed an incredible process of gene editing to treat progressive hearing loss in mice (1). The therapy used microscopic bubbles called Extracellular Vesicles (EVs) to deliver gene-editing tools directly into the inner ear, a huge leap forward for fixing the source of hearing loss.

To confirm success, the researchers relied on a gold-standard clinic test called the Auditory Brainstem Response (ABR). ABR is objective, but it’s expensive, requires specialised equipment, and is not practical for frequent, widespread monitoring.

This highlights the problem: A groundbreaking treatment is only as useful as our ability to measure its effect. We need a metric that is standardised and sensitive, yet easy to access.

The Power of Functional Hearing: Speech-in-Noise Testing

Traditional hearing tests (pure-tone audiometry) only measure the quietest sound you can detect. This tells you about the health of your ear, but very little about how your brain is managing sound in the real world.

The key to functional measurement is the Speech-in-Noise (SiN) test.

SiN testing measures your ability to pick out words when there’s confusing background noise. This task is difficult because it forces your central auditory system (the brain’s sound-processing center) and your cognitive resources (attention and memory) to work overtime.

• The SiN test measures functional listening: It tells you how well you communicate in a busy restaurant, not just a quiet booth. This is known as ecological validity, a measure’s relevance to daily life.

• The SiN test tracks cognitive effort: A poor SiN score doesn't just mean your hearing is weak; it often means your brain is working too hard to compensate, a concept researchers call auditory cognitive load.

  
  

eargym’s SiN test is a powerful tool. It’s a medical-grade metric that can be accessed simply and affordably, making it ideal for tracking subtle, meaningful changes before and after an intervention.

The SiN test: Measuring Change Across the Body

The need for a scalable measurement like SiN extends far beyond the ear. We now know that difficulty hearing in noise is often an early warning sign or a key risk factor for other chronic conditions.

1. Diabetes and Circulation

For people with Type 2 Diabetes, hearing loss is common and often severe (2). This is because high blood sugar levels damage the tiny blood vessels and nerves of the inner ear, a problem called microvascular damage.

• The Measurement Opportunity: SiN testing can act as an accessible biomarker for microvascular health. If a patient starts a treatment plan to improve their blood sugar control (measured by HbA1c), a stable or improving the SiN score suggests the intervention is successfully protecting the sensitive inner ear, offering a non-invasive way to track systemic health.

2. Dementia and Brain Health

Research confirms that difficulty understanding speech in noise is strongly linked to a faster decline in cognitive function and an increased risk of dementia (3, 4). This connection is primarily due to the intense mental effort required for listening in noise, which diverts resources away from memory and executive function.

• The Measurement Opportunity: When a person starts a new cognitive training program or is prescribed a new drug designed to slow memory decline, changes in their SiN scores can be a sensitive indicator of success. A better SiN score means the brain is processing sound more efficiently, lowering the auditory cognitive load.

3. Depression and Mental Well-being

Depression and hearing loss often occur together, and they can worsen each other (5, 6). Individuals with depression may find it harder to focus and filter out distracting sounds, which severely impairs their SiN performance.

• The Measurement Opportunity: SiN testing can provide an objective metric for evaluating the success of mental health treatments. As depression lifts and focus improves, the brain’s ability to handle competing sounds often recovers. An improving SiN score can demonstrate the functional, real-world benefit of mental health care and integrated auditory support.

Measurement Drives Progress

From verifying the success of cutting-edge gene editing to providing accessible monitoring for chronic diseases like diabetes and dementia, the need for an accurate, scalable metric is paramount.

eargym’s digital SiN testing is helping to close this measurement gap, offering researchers, clinicians, and individuals the precise, functional data needed to validate interventions, measure changes, and drive progress in the future of medicine.

References

1. Pan, X., Huang, P., Ali, S. S., Renslo, B., Greenberg, Z., Erwin, N., Li, Y., Ding, Z., Hutchinson, T. E., & He, M. (2025). Extracellular vesicle–mediated gene editing for the treatment of nonsyndromic progressive hearing loss in adult mice. Science Translational Medicine, 17(824). $10.1126/scitranslmed.adn3993$

2. Caballero-Borrego, M., & Andujar-Lara, I. (2025). Type 2 diabetes mellitus and hearing loss: A Prisma systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery, 173(5), 1041–1053. $10.1002/ohn.1346$

3. Dawes, P., Fortnum, H., Moore, D. R., Emsley, R., & Norman, P. (2014). Relation between speech-in-noise threshold, hearing loss and cognition from 40–69 years of age. PLoS One, 9(9), e107720. $10.1371/journal.pone.0107720$

4. Zhang, S., Li, H., & Xu, Z. (2022). Speech perception in noise is associated with different cognitive abilities in Chinese-speaking older adults with and without hearing aids. Frontiers in Psychology, 12, 640300. $10.3389/fpsyg.2021.640300$

5. de Carvalho, L. M., Gonsalez, E. C., & Iorio, M. C. (2017). Speech perception in noise in the elderly: interactions between cognitive performance, depressive symptoms, and education. Brazilian Journal of Otorhinolaryngology, 83(1), 101–107. $10.1016/j.bjorl.2016.03.003$

6. Xie, Z., Zinszer, B. D., Riggs, M., Beevers, C. G., & Chandrasekaran, B. (2019). Impact of depression on speech perception in noise. PLoS One, 14(8), e0220928. $10.1371/journal.pone.0220928$