Objectives/Hypothesis To analyze the association between early audiometric age‐related hearing loss and brain β‐amyloid, the pathologic hallmark of Alzheimer's disease (AD). Study Design Cross‐sectional analysis of a prospective cohort study. Methods A cross‐sectional analysis was performed on 98 participants in a cohort study of hearing and brain biomarkers of AD. The primary outcome was whole brain β‐amyloid standardized uptake value ratio (SUVR) on positron emission tomography (PET). The exposure was hearing, as measured by either pure‐tone average or word recognition score in the better ear. Covariates included age, gender, education, cardiovascular disease, and hearing aid use. Linear regression was performed to analyze the association between β‐amyloid and hearing, adjusting for potentially confounding covariates. Results The mean age ± standard deviation was 64.6 ± 3.5 years. In multivariable regression, adjusting for demographics, education, cardiovascular disease, and hearing aid use, whole brain β‐amyloid SUVR increased by 0.029 (95% confidence interval [CI]: 0.003‐0.056) for every 10 dB increase in pure‐tone average (P = .030). Similarly, whole brain β‐amyloid SUVR increased by 0.061 (95% CI: 0.009‐0.112) for every 10% increase in word recognition score (P = .012). Conclusions Worsening hearing was associated with higher β‐amyloid burden, a pathologic hallmark of AD, measured in vivo with PET scans. Level of Evidence 3 Laryngoscope, 131:633–638, 2021

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