More than Meets the Ears

Most have experienced it – being frustrated with someone who refuses to take steps to improve their hearing. Or perhaps you’re that someone. Whether due to financial constraints, vanity or simple stubbornness, people sometimes do not want to use a hearing aid.

But the repercussions of hearing loss may extend much further than the obvious problems, like not being able to effectively engage in conversations, difficulty enjoying simple pleasures such as movies and television, and constantly asking others to repeat themselves. Research has shown that hearing loss can lead to increased anger, depression, anxiety and loneliness, as well as decreased cognitive function. In addition, it might exacerbate the aging process, and there have even been potential links established between hearing loss and Alzheimer’s disease.

LEND ME YOUR EAR

It has long been established that hearing loss negatively impacts mental health and cognitive functions.

During the 1980s to ’90s, Shlomo Silman conducted a number of sensory deprivation studies that observed people with hearing loss in both ears who wore only one hearing aid. According to Christine Eubanks, Ph.D., CCC-A, director of audiology at Virginia Commonwealth University (VCU) Health, over a five-year period, the study found that there was a decrease in the word recognition scores of the unaided ear compared with the aided ear (after removing hearing threshold effects). When researchers provided a hearing aid for the unaided ear, the scores increased. “That suggests that not receiving adequate auditory stimulation can result in adult-onset auditory deprivation” – i.e., a diminished ability to recognize speech.

CAUSE & EFFECT

Aaron Moberly, M.D. and assistant professor of otolaryngology at The Ohio State University’s Wexner Medical Center, agrees that there appears to be a link between hearing loss and decreased cognitive function, but the direction of that link is unclear. He lists these four main theories:

1. Hearing loss causes cognitive decline: This decline is either permanent or potentially remediable, but cognitive decline occurs because of a shift of cognitive resources to enable the listener to compensate for the hearing loss.
2. Cognitive load theory: Cognitive decline reduces an individual’s cognitive resources available for use in auditory perception (i.e., decreased resources available for listening tasks).
3. Common cause theory: Some other underlying factor contributes to both hearing loss and cognitive decline.
4. Social isolation: This theory suggests that hearing loss leads to social isolation which leads to cognitive decline. (This is not necessarily mutually exclusive from the other theories.)

TURNING A DEAF EAR TO THE PROBLEM

Several other studies have also shown that uncorrected hearing loss gives rise to poorer quality of life. “This appears to be related to social withdrawal and isolation, reduced social activity and a feeling of being excluded – leading to an increased prevalence of symptoms of depression in patients with hearing loss,” Moberly notes.

“Although greater hearing loss is independently associated with higher levels of loneliness in older adults presenting to clinic for hearing loss treatment, further studies are needed to determine whether hearing treatment can reduce loneliness in older adults,” he adds.

Exactly how hearing loss affects one’s mental health depends on the individual. Eubanks explains that personality characteristics determine how people respond to any disability.

“In other words, personality affects who is going to isolate themselves and stop going to church, meetings, social events, [and so forth] because it is too difficult to communicate, or because they are embarrassed.”

She notes that other people, even though they misunderstand a lot, may appear to have cognitive problems when in fact they only misheard. “But the effect is the same – hearing-impaired people who don’t get treatment are treated as though they are less functional because their conversation partners are frustrated by those glitches in communication.”

Moberly believes psychosocial interventions that teach skills related to hearing-loss advocacy for both individuals and their families could provide a powerful tool to boost participation in social, vocational and leisure activities.

“A reduction in cognitive impairment might be observed following psychological or psychosocial intervention. Interventions aimed at increasing everyday independence after hearing loss may also ameliorate age-related cognitive declines.”

CHICKEN OR EGG?

According to Eubanks, multiple studies have shown an association between hearing loss, various dementias (including Alzheimer’s disease) and other cognitive dysfunctions. But she notes that the mechanisms and/or causal relationships of hearing loss and Alzheimer’s disease specifically remain unknown. For example, lack of oxygen can impact both vascular dementia and hearing loss, so those might be causally related.

“Many of the risk factors for dementia are higher in elderly people, who are also statistically more likely to have hearing loss – so cause and effect is difficult to determine,” she adds.

Moberly agrees that although there is growing evidence to suggest hearing loss is associated with cognitive decline and dementia, the direction of this association is still unclear.

“Between 2011 and 2013, The Lin Research Group of the Johns Hopkins Cochlear Center for Hearing and Public Health has done much work investigating this relationship and have found between a 7 and 24 percent increase in dementia for every 10 decibels of untreated hearing loss.” More recent research (2015) by Francesco Panza, Vincenzo Solfrizzi and Giancarlo Logroscino found that age-related hearing loss was a significant factor in Alzheimer’s disease.

POTENTIAL ANTIDOTES

Today there is a much broader consideration of the effects of hearing loss in older adults on the whole individual, including quality of life, social interactions, mental health and cognitive health, as well as self-efficacy.

“We are beginning to see studies that suggest that use of amplification [hearing aids] or cochlear implants for patients with severe hearing loss potentially results in improvements in cognitive functions. It is also plausible, though unproven, that earlier intervention for people with hearing loss may stall cognitive declines, and ongoing studies are investigating this,” Moberly concludes.

Hearing loss is usually treatable through a number of medical options, so many of these potential risks can possibly be reduced, delayed or even avoided. If you are experiencing hearing loss, consult with a physician – and sooner is always better than later!

A FREE RESOURCE FOR VIRGINIANS

Virginia Relay, a free public service administered by the Virginia Department for the Deaf and Hard of Hearing (VDDHH), enables people in Virginia with hearing loss to place and receive telephone calls.

In addition, VDDHH also oversees an equipment distribution program (Virginia Technology Assistance Program, TAP) that helps people in Virginia who are deaf, hard of hearing, deafblind or who have difficulty speaking obtain assistive equipment.

Any Virginia veteran with hearing or speech loss is also qualified to apply for equipment through TAP. 

Christopher Cussat is a freelance writer whose features have appeared in dozens of regional and national publications. His second collection of poetry, Consequences of Being, anthologizes over two decades of his poetic work and will be published this year by Shade Seekers Press. Christopher is also an adjunct professor of English for American Public University and American Military University. Read more of his work at Cussat.com.