The body functions because of dozens of smaller processes that work together, and when one of those processes isn’t working the way it should, you can usually feel it. Though this may not be entirely true for hearing health — you may not know something is wrong until you’re confronted with evidence in an auditory exam — in many ways, hearing health is a window into overall health. It has been linked to a number of bodily processes, such as memory, heart function, blood health, and even stress or anxiety.

For example, cardiovascular disease can be detected by measuring mild hearing losses in the inner ear. Cardiovascular disease contributes to a hardening of the arteries, restricting blood flow to the damaged areas. The inner ear houses some of the tiniest arteries in the body, and these arteries are among the first to be affected by cardiovascular disease. When blood flow to the inner ear is affected, the delicate hair cells suffer damage or death because they receive little or no oxygen. This mild hearing loss as a result of damaged hair cells may offer insight into how at risk an individual is for serious heart complications down the road.

The brain can also face serious complications as a result of hearing loss. Typically, this damage appears later in life, when it may be too late to reverse life-threatening conditions, making it all the more insidious. In multiple studies, untreated hearing loss was linked to cognitive disease and loss of brain mass, typically in older populations. Though there is no absolute proof that hearing loss leads to dementia or Alzheimer’s disease, some studies have reported that the average onset of cognitive decline occurred many years later in patients who used hearing aids, most likely because of continued stimulation of the areas of the brain responsible for processing sound, memory, and balance.

Yet another study showed that the brain shrank at a greater rate in those whose hearing loss was left untreated—one additional cubic centimeter per year, on average — in the areas of the brain responsible for processing sound, memory, and balance. And there’s a growing belief by some neuroscientists that tinnitus and some forms of hearing loss may be more brain related than ear related; stress and anxiety are often cited as “triggers” for tinnitus symptoms because they act as vasoconstrictors, squeezing the blood vessels and restricting blood and oxygen flow to all areas of the body.

Diabetics and those with sickle-cell anemia typically have impaired blood flow as well, which, again, can cause damage to the inner ear. Incidence of hearing loss in diabetics is about twice that of the general population, making treatment for these two diseases all the more important to your health.

Though hearing loss may not be the root of every health problem, overall hearing health has become a fantastic indicator of overall bodily health — and that should be kept in mind when the time comes for yearly overall health checkups.