July 21, 2018
Hands Inserting A Hearing Aid Into A Man

Hearing Loss: Don't Suffer in Silence

by Berkeley Wellness

If you have trouble hearing conversations, miss dialogue at the movies, find yourself boosting the volume on your cell phone or blasting the TV—or just tend to say “what?” or “huh?” a lot—you may already know (or suspect) that you have some hearing loss. According to the CDC, nearly 20 percent of adults ages 40 to 69, and 43 percent of those over 70, have some degree of hearing loss, attributed to aging (presbycusis), long-term noise exposure, or, less frequently, injuries, congenital disorders, or other conditions. Age-related hearing loss typically starts with a loss in ability to hear high-frequency sounds and may be accompanied by tinnitus (ringing in the ears).

Yet most people resist wearing a hearing aid, often because of unawareness (the loss is usually very gradual), denial of the problem, the high cost of the devices (typically $2,500 or more, not covered by most insurance or Medicare), or the stigma associated with them. It’s estimated that among people over 50 with hearing loss in the U.S., only one in seven use hearing aids.

Why treatment is critical

Hearing loss is often viewed as an inconsequential part of aging. But it’s not just an “ear issue.” Studies have linked significant hearing impairment to profound physical, psychological, and social consequences, including isolation, loneliness, depression, anxiety, falls and other accidents, and increased mortality rate. It can take its toll on relationships and overall quality of life. And it’s associated with accelerated cognitive decline and dementia. A large study in the Journal of the American Geriatrics Society (JAGS) in 2015, for example, found that people with hearing loss had lower levels of cognitive functioning both at baseline and over 25 years of follow-up, compared to those without hearing loss, independent of factors such as age and education.

What’s the connection between hearing loss and impaired cognition? One theory involves cognitive load, in which hearing loss compromises cognitive processes, such as working memory, because so much more effort is needed to process auditory information. Hearing loss may also increase social isolation, which is a risk factor for cognitive decline and dementia, presumably due to reduced stimulation. Even if someone with hearing loss maintains social connections, not being able to hear well can lead to feelings of isolation. It’s also possible that hearing loss and cognitive decline share some of the same underlying physiological mechanisms, which would impair both at the same time.

Does treating hearing loss mitigate the adverse effects? That has not been well studied, but some research suggests that wearing a hearing aid has benefits that go far beyond just hearing better—including improvements in social interactions, reduced depression, and better general health. According to a survey of several thousand people with hearing loss and their families, conducted by the National Council on Aging, hearing aids improved relationships and social life, sense of safety and independence, physical health, the ability to play sports, sexual satisfaction, and more. An older analysis of 16 studies, published in the Journal of the American Academy of Audiology, found that hearing aids improved health-related quality of life “by reducing the psychological, social, and emotional effects” of hearing loss.

Improving hearing may also help cognitively. In the JAGS study mentioned above, people with hearing loss who wore hearing aids had less cognitive decline over the years than those not using the devices, and rates of decline similar to those without hearing impairment. And in a 2016 study of 100 people (ages 80 to 99) with hearing loss, in the American Journal of Geriatric Psychiatry, those who used a hearing aid did better on a cognitive screening test than non-users.

Can a Healthy Diet Slow Hearing Loss?

Can a healthy diet prevent or slow age-related hearing loss? Though most studies have been observational and have sometimes produced conflicting results, research overall suggests that balanced nutrition throughout life is good for your ears.

Tests and devices for hearing loss

If you think you have hearing loss, get tested. You can start with your primary care doctor, who may do a simple screening or refer you to an otolaryngologist, audiologist, or other hearing specialist for further evaluation and, if indicated, to be fitted for a hearing aid. Your doctor should determine if there are any underlying causes for the hearing loss that can be treated or managed, such as a chronic disease that affects the blood supply (like hypertension, coronary artery disease, or diabetes) or certain medications you may be taking (including NSAIDs like aspirin and certain diuretics, antibiotics, and cancer drugs). An ear infection (which typically causes more sudden hearing loss) or something as simple as a buildup of earwax (cerumen) may also be to blame.

Hearing aids are difficult to get accustomed to and don’t function well in all situations, which is why many people who have them don’t use them regularly or at all. Today’s models, mostly digital, are smaller, less conspicuous, and more comfortable—and they perform better—though they also are not problem-free. A good audiologist or other hearing specialist will work with you to get your hearing aid optimally adjusted and can teach you other ways to manage hearing loss. Cochlear implants—surgically implanted electronic devices that directly stimulate the auditory nerve to provide a sense of sound—are an option in some cases of profound hearing loss, though they carry some risk and are expensive, and extensive rehabilitation is needed afterwards.

Assisted listening devices (ALDs) are worth considering, too, especially if you can’t afford or tolerate a hearing aid or if the device is not enough. These “binoculars for the ears”—which use a microphone, transmission technology, and a device to receive the signal and sound in the ear—amplify sounds and eliminate background noise. Hearing loops, one type of ALD system, are being installed in more public spaces, and you can set one up at home as well. Personal ALDs connect to your phone, TV, or other audio devices and work with or without a hearing aid. Because of the variety of devices and systems available—some more complex than others—an audiologist or other hearing specialist can help you select and manage them; some may require professional installation. Good starter resources are at the National Association of the Deaf, the Rehabilitation Engineering Research Center on Hearing Enhancement, and the National Institute on Deafness and Other Communication Disorders.

Earlier treatment, better outcomes

The earlier hearing loss is diagnosed and addressed, the better the long-term outcomes, experts now believe. As baby boomers age—meaning that more people than ever are facing hearing loss—there has been a push by government agencies and advisory councils to make hearing aids more affordable and accessible, including trying to change regulations that bar Medicare from covering them, a throwback to the days when hearing loss was not considered a major disability or significant public health concern.

For more information, the National Institute on Deafness and Other Communication Disorders has a short survey to assess your hearing, plus guidance about ALDs and other tips to improve hearing. The Hearing Loss Association of America provides resources about the consequences of hearing loss, where to find support groups, and more. Want to test your hearing now? You can do it here on your computer.