More than 5% of the world's population have a hearing loss with thresholds of 40 dBHL and more. Hearing loss often comes slowly and subtly, thus affected persons delay seeking help for up to ten years. There is no known cure for a permanent hearing impairment, but there are technologies such as hearing aids and hearing implants that can alleviate hearing and communication problems.
Untreated hearing loss is associated with other health problems
Doing something about hearing loss is an essential step towards hearing health. Hearing loss is not an isolated health issue but is associated with many other health problems. Comorbidities linked with hearing loss include accelerated cognitive decline, an increased risk of dementia and falls, social isolation, depression and even premature death. Untreated hearing loss that leads to reduced communication may have social implications, like loneliness and loss of autonomy. Therefore, hearing loss treatment does not only affect communication but health in general.
According to the World Health Organisation, cardiovascular diseases (CVD) are the number 1 cause of death globally. In 2016, 31% of all global deaths were due to heart attacks, strokes and other CVDs. Many of these diseases could be prevented by eliminating well-known risk factors such as smoking, obesity or stress. But one contributing factor to a healthy heart often goes unnoticed: our hearing.
A large study conducted in the USA found that hearing loss is much more common in people with heart disease. This link is due to anatomical parallels between the ear and the heart. Like the heart, the inner ear is very sensitive to blood and oxygen flow. Poor blood supply to the inner ear may result in the damage of its sensory cells and consequently to a permanent hearing impairment.
Heart diseases and hearing loss share many risk factors: excessive noise over a long period of time often leads to poor hearing, but it also increases stress levels, thus affecting heart health as well. The same holds true for smoking, which reduces the flow of oxygen to the heart as well as to the inner ear; and for high blood pressure that causes plaque formation; for inactivity, often a consequence of social isolation that comes with hearing loss; and many more. Reducing stress, eating a healthy diet, quitting smoking and doing physical exercise will not only affect your heart, but also your hearing.
Cognitive Decline & Dementia
The association between hearing loss and cognitive decline/dementia has been widely researched in the past decades. Numerous studies have concluded that hearing loss is a possible biomarker for cognitive decline and dementia. Scientists have noted that greater hearing loss is significantly associated with lower scores on certain cognitive tests.
Explanations on the reasons for this association touch upon decreased auditory stimulation for the brain, reduced social contacts and mobility, all of them inherent risk factors of untreated hearing loss. A 2018 Lancet review stated that up to 35% of dementia cases may be preventable and that 9% of dementia cases may be attributable to hearing loss in midlife.
Hearing loss is regarded as a modifiable risk factor. It is not yet proven whether treating hearing loss will remedy cognitive decline or dementia, however, recent research points in this direction. A particularly long-running study, with a follow-up after 25 years, found an increased risk of dementia for participants with untreated hearing loss, which was not seen in those using hearing aids. Similarly, a 2018 study on cochlear implant users showed improved cognitive skills in adults aged 50+ years.
In light of other risk factors linked to hearing loss such as social isolation or depression, it seems worthwhile to treat hearing loss with appropriate technologies such as hearing aids or implants.
Both diabetes and hearing loss are widespread health concerns in developed countries. For many years, the association between these two has been debated, as there is an obvious overlap. A large study showed that hearing loss is twice as common in people with diabetes compared to people who don’t have this condition. But what are the parallels? Scientists don’t know for sure but assume that they are due to the high levels of blood glucose in diabetes patients. These damage the small blood vessels in the inner ear. However, the inner ear, being a very sensitive organ, relies on stable levels of blood supply to fully maintain its function, particularly that of its sensory cells.
What can diabetics do to protect their hearing? While the following recommendations are truly important for people suffering from diabetes, they apply to everybody:
- Protect your ears by using hearing protection equipment in very noisy surroundings, or even avoid excessive noise, turn down the volume of your personal electronic device, your radio or your television.
- Exercise regularly. Diabetics as well as hard-of-hearing people often lack mobility. Moderate physical exercise improves blood circulation, benefitting not only your ears, but your whole body.
- Watch your weight. Overweight increases blood pressure, a leading cause of cardiovascular diseases. Again, high blood pressure negatively affects the blood supply to the inner ear. Keeping a healthy diet and consequently an appropriate weight means keeping your body and your ears healthy.
If you or a loved one have diabetes, we recommend getting your hearing checked regularly. Hearing loss often develops slowly, and it may take years to notice it. Do a baseline hearing test and see your ENT doctor or audiologist once a year for follow-up checks to make sure you don’t miss out on the sounds you love.
Hearing loss is very common among older adults. However, not everybody is willing to do something against their poor hearing. As communication skills decrease, ignoring a hearing loss may have serious emotional and social consequences. Older people in particular have higher odds of suffering from depression if they accept their diminished hearing as an inevitable and harmless part of ageing. Because it is not. Numerous studies have shown that hearing troubles, even self-reported, are associated with an increased risk of depression. Why is that?
Poor hearing often leads to misunderstandings and emotional distress. Feelings of anxiety and insecurity make people withdraw from social life. Their circle of friends gets smaller, and at a certain point using the telephone or listening to the radio is no longer possible. The feeling of loneliness often culminates in depressions. Poor hearing is not only strenuous for the person affected, but also for their partners. “We have never had so many arguments in the past 50 years of our marriage”, is a sentence many spouses of hearing impaired admit to say.
Studies have not only researched the connection between hearing loss and social isolation or depression but have also looked at possible solutions. A long-term study in France concluded that older adults using hearing aids were less at risk of suffering from depression. Similarly, a US study observed significant improvements in depressive symptoms after their patients had received cochlear implants.
Treating hearing loss paves the way back for many hearing-impaired individuals to a more active social life. Better communication dissolves many misunderstandings. “After my cochlear implantation we got on much better again”, is a common statement. Hearing loss can be treated with hearing aids or hearing implants. It is important to assess your hearing and do something early enough to avoid misunderstandings, social withdrawal and ultimately depression.
Hearing loss is linked to a variety of comorbidities that are widely known, such as social isolation and depression. One side-effect of hearing loss that is scarcely known is a higher risk of falling. Researchers from the renowned John Hopkins University in Baltimore, USA, conducted a large study on this topic and found out that adults, particularly older ones, with untreated hearing loss are more prone to falls. This risk triples with a mild hearing loss that is not remedied with a hearing aid. The poorer the hearing thresholds, the higher the risk of tripping.
What are the underlying causes? First of all, people with impaired hearing may not perceive their environment as well as those with normal hearing. Secondly, although balance and gait are usually automated, they require cognitive resources. In people with hearing loss these resources are often bound by their focus on hearing. These resources are missing when it comes to maintaining balance and gait, thus resulting in a higher risk of falls, expert Barbara Weinstein, audiologist and professor at the City University of New York explains.
Can the risk of falls be reduced? The good news is that the Baltimore researchers did not observe this higher risk of tripping when people used hearing aids. This may be a good indicator that treating hearing loss diminishes falls and all the consequences that come with them. Our recommendation: get your hearing tested and treated if necessary. There are plenty of highly effective hearing technologies such as hearing aids and hearing implants that help you stay fully aware of your environment and keep your balance and gait.
Is hearing loss associated with more frequent hospitalisation for older people? This question was in the focus of studies carried out in the USA by an international research team. The short answer: yes, it is. On average, they observed that individuals with mild and moderate-or-greater hearing impairment had a 17–19% higher annual rate of hospitalization compared to individuals with normal hearing. On top, there seems to be a trend towards a longer duration of hospital stays for hearing impaired people too.
Hearing loss is very common among older people, it is treatable, yet severely undertreated. Many people who are in need of a hearing solution are not willing to be treated with hearing aids or hearing implants or lack access to hearing solutions.
This may not only lead to communication problems and everything that comes with them, but also to negative health-effects, such as cognitive or social problems. The economic implications are considerable. Higher rates of hospitalisation incur significantly higher costs for healthcare funding.
What is the connection between hearing loss and hospitalisation? Social isolation and cognitive decline often come with poor hearing. Possibly, even cardiovascular diseases, which are linked to hearing loss, may contribute to the odds of hospitalisation. Furthermore, researchers point out that the ability to talk to and orally communicate with physicians is reduced in hearing impaired individuals. Many delay seeing a doctor because of their reduced communication skills. And when they do, their condition may have progressed to a point that requires a hospital stay.
It is not yet clear whether hearing aids or hearing implants could potentially mitigate the risk of hospitalisation in older adults. Further studies are required to answer this question with scientific significance. Self-reports from hearing aid users indeed show a trend towards a shorter length of hospitalisation. Regular hearing checks and considering a hearing solutions, depending on the severity of hearing loss, can definitely help to improve communication, with family, friends and doctors!
Chronic Kidney Disease
The number of people with chronic kidney disease has increased significantly in the past few years. This is closely linked to a rise in diabetes mellitus and hypertension, two major risk factors for kidney disease. Patients with chronic kidney disease are prone to yet another side-effect: hearing loss. Scientifically proven, patients with chronic kidney disease, especially older ones, have a higher incidence of sensorineural hearing loss.
What are the implications? The reasons for the above association have not yet been clearly established, but hypertension, electrolyte disturbances and ototoxic drugs seem to be among the underlying causes. Ototoxic drugs may damage the inner ear, thus leading to sensorineural hearing loss. For certain conditions such as chronic kidney disease ototoxicity is a possible, yet accepted side-effect of medication.
Haemodialysis has also been reported to contribute to hearing loss in chronic kidney disease patients. Interestingly, studies showing the effects of haemodyalisis on hearing have yielded contradictory results. Some state that it plays no role in hearing loss, others claim that every second or third patient on haemodialysis experiences some degree of hearing impairment. More and larger studies are necessary to research the consequences of haemodialysis on hearing.
Patients with chronic kidney disease who regularly have their hearing screened can detect deteriorating hearing abilities at an early stage. Consequently, appropriate measures such as hearing aids or hearing implants can be considered without losing valuable time.
A 2015 study links hearing loss to premature death, notably before the age of 75. Researchers found that the percentage of deaths among people living without a partner was higher for those with hearing loss. Other studies were contradictory in nature, with some finding no differences in mortality rates while others stating higher rates among the hearing impaired.
A recent study from Columbia University (US) looked at premature death numbers from a different angle. It showed that normal hearing partners had a positive effect on the life expectancy of their hearing-impaired spouses. This can be attributed to more social activity, support in daily life, the partner serving as the eyes and ears, avoiding dangerous situations by warning in time; as a motivation for physical exercise, thus benefitting overall health, including cardiovascular.
Hearing solutions certainly are no substitute for a loving partner, but they serve a similar purpose. They allow people with hearing loss to communicate better, lead an active social life, motivate to go out and meet people, increase self-esteem, independence and mobility. And they foster partnerships. Spouses who face no communication challenges get on better with each other.
No matter what scientists ultimately conclude, one thing is certain: good hearing improves the quality of life. Whether ones hearing is naturally good or thanks to hearing aids or hearing implants, does not matter.