Hypothesis
Progressive presbycusis does not merely reflect peripheral damage; it actively remodels the gut microenvironment through a vagal‑mediated anti‑inflammatory pathway. We hypothesize that chronic auditory deprivation reduces afferent signaling to the nucleus tractus solitarius (NTS), diminishing efferent vagal output to the gut. This loss of cholinergic tone lowers acetylcholine release in the intestinal mucosa, decreasing expression of tight‑junction proteins (claudin‑1, occludin) and increasing intestinal permeability. The resulting translocation of microbial lipopolysaccharide (LPS) fuels systemic inflammation, which re‑enters the cochlea via a compromised blood‑labyrinth barrier, exacerbating stria vascularis atrophy and spiral ganglion neuron (SGN) loss. Thus, hearing loss initiates a vicious gut‑cochlea cycle that accelerates age‑related sensory decline.
Mechanistic Insight
Recent work shows that gut‑derived metabolites can set the brain's homeostatic baseline (see seed idea). We extend this by proposing that the direction of influence is context‑dependent: when sensory input wanes, the brain's autonomic output to the gut wanes in parallel, flipping the axis from bottom‑up to top‑down loss of regulation. The cholinergic anti‑inflammatory pathway, mediated by α7‑nicotinic acetylcholine receptors on macrophages, is a well‑established link between vagal activity and gut barrier integrity (Tracey, 2020). Auditory‑driven NTS activation is known to sustain vagal efferent firing ([Zheng et al., 2021](https://doi.





























