Hearing loss effects on cognition and mental health for Tampa Bay residents.

The Facts:

  • About 20% of adults in the United States, approximately 48 million, report some degree of hearing loss.
  • By age 65, one out of three people has a hearing loss.
  • About 2% of adults aged 45 to 54 have disabling hearing loss. The rate increases to 8.5% for adults aged 55 to 64. Nearly 25% of those aged 65 to 74 and 50% of those who are 75 and older have disabling hearing loss.
  • Hearing loss is a major public health issue and is the third most common physical condition after arthritis and heart disease.

While it is widely known that hearing loss, treated with hearing aids, has had a positive effect on an individual’s overall quality of life; i.e: Relationships at home and work, social interactions and overall self-esteem, did you know hearing loss has been more recently linked to cognition/dementia/mental health, falling and hospitalizations, kidney disease, including diabetes, mortality and cardiovascular disease?

To better understand the effects, we will review each area over the next several weeks.

“This study debunks the myth that untreated hearing loss in older persons is a harmless condition,” said James Firman, EdD, president and CEO of The National Council on the Aging. A separate survey of 2,300 hearing impaired adults age 50 and older found, through the NCOA back in 1999, found that those with untreated hearing loss were more likely to report depression, anxiety, and paranoia and were less likely to participate in organized social activities, compared to those who wear hearing aids.

The survey found that significantly more seniors with untreated hearing loss reported feelings of sadness or depression that lasted two or more weeks during the previous years. Among respondents with more severe hearing loss, 30% of non-users of hearing aids reported these sad feelings, compared to 22% of hearing aid users.

Because social isolation is a serious problem for some older people, the study also examined social behavior and found that people who don’t use hearing aids are considerably less likely to participate in social activities. Among respondents with more severe hearing loss, 42% of hearing aid users participate regularly in social activities compared to just 32% of non-users.

Another Johns Hopkins study found that older adults with hearing loss were 57% more likely to have deep episodes of stress, depression or bad mood than their peers with normal hearing. Another study showed that hearing loss is associated with an increased risk of depression in adults of all ages, but is most pronounced in 18 to 69 year olds. A different study, conducted in Italy, looked at working adults—35 to 55 years of age—with untreated mild to moderate age-related hearing loss and found that they were more prone to depression, anxiety, and interpersonal sensitivity than those with no hearing problems.

Falling and Hospitalizations:
Frank Lin, PhD, at Johns Hopkins University School of Medicine and the university’s Bloomberg School of Public Health completed a study with the National Institutes on Aging and found that people with a mild hearing loss (25-decibel) were nearly three times more likely to have a history of falling. Every additional 10-decibels of hearing loss increased the chances of falling 1.4 fold.

Lin, an otologist and epidemiologist, says among the possible explanations for the link is that people who can’t hear well might not have good awareness of their overall environment, making tripping and falling more likely. Another reason hearing loss might increase the risk of falls, Lin adds, is cognitive load, in which the brain is overwhelmed with demands on its limited resources. “Gait and balance are things most people take for granted, but they are actually very cognitively demanding,” Lin says. “If hearing loss imposes a cognitive load, there may be fewer cognitive resources to help with maintaining balance and gait.”

Lin and his Johns Hopkins team completed an analysis of health survey data from 1,140 men and women aged 70 and older with hearing loss found that those with hearing deficits were 32 percent more likely to have been admitted to a hospital than 529 older men and women with normal hearing.

Another of the study’s key findings was that older adults with hearing loss were 36 percent more likely to have prolonged stretches of illness or injury (lasting more than 10 days). Lin says social isolation resulting from hearing loss may explain the physical and mental declines – as well as the cognitive deficits – that afflict older adults. This, in turn, may lead to more illness and hospitalization.

Kidney Disease/Diabetes:
Research shows that people with uncontrolled type 1 or type 2 diabetes are twice as likely as others to experience hearing loss. In a large study of people ages 20–69, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases found a connection between diabetes and hearing problems, as early as age 30.

A recent study from Henry Ford Hospital in Detroit reached much the same conclusion. Researchers found that in women younger than 60, hearing was worse among those with type 1 or type 2 diabetes compared to women without diabetes. According to study coauthor Kathleen Yaremchuk, M.D., women between the ages 60–75 with poorly controlled diabetes had significantly worse hearing than those whose diabetes was considered well-controlled.

“When you think about complications of diabetes, this is not what you think about,” says Joanne Rinker, RD, CDE, with the North Carolina Diabetes Prevention and Control Branch. “But one in three people with diabetes will have trouble with their hearing because of complications from their elevated blood glucose.”

Diabetes seems to affect hearing in several ways. When blood sugar rises, “there is a breakdown of nerves in the ears — the same kind of nerve damage that causes tingling and other symptoms in the fingertips and toes,” Rinker says. The blood vessels in the ears are very small. “When blood sugar is high, blood running through the veins is like syrup,” she says. “Imagine how hard it is to get into the tiny capillaries of the cochlea.”

In addition, “our hearing mechanisms rely on specialized cells called hair cells,” says Elizabeth A. Dinces, M.D., at Montefiore Medical Center in Bronx, New York. “They are very fragile and susceptible to changes in the environment, including the effect of increased glucose in blood.”

A recent study in the American Journal of Kidney Diseases, indicates that older people who suffer from moderate chronic kidney disease (CKD) may require screening and treatment for hearing loss. Australian researchers examined the medical records of 2,564 people aged 50 and over, 513 of whom had moderate chronic kidney disease. Some 54.4% of all the patients with chronic kidney disease had some degree of hearing loss, as compared to 28.3% of those who had no kidney problems. Severe hearing loss affected nearly 30% of the CKD patients, compared to only 10% of the others.

So what is the correlation between the CKD and hearing loss? Researchers believe “The link can be explained by structural and functional similarities between tissues in the inner ear and in the kidney. Additionally, toxins that accumulate in kidney failure can damage nerves, including those in the inner ear.”

Some treatments for kidney ailments may also affect hearing.

Researchers from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), working with researchers in Iceland, found that hearing impairment and dual sensory impairment (vision and hearing impairment combined) in older men are associated with increased mortality from cardiovascular disease (CVD) and other causes. The research was published in the August 30th online edition of Age and Ageing reports the potential importance of hearing loss, especially among men, in predicting mortality.

The study found that women who were hearing impaired had only slightly higher rates of mortality than women without any sensory impairment.

The researchers observed that men and women who used hearing aids had significantly lower mortality risk compared with hearing impaired men and women who did not use hearing aids. This reduced risk occurred despite increased age and more severe hearing loss in the hearing aid group.

For men or women who had vision impairment alone, there was no increased risk of mortality.

Cardiovascular Disease:
As mentioned previously, inadequate blood flow and trauma to the blood vessels of the inner ear can contribute to hearing loss.

David R. Friedland, MD, PhD at the Medical College of Wisconsin in Milwaukee, has been studying the relationship between cardiovascular and hearing health for years. He offers up this response: “The inner ear is so sensitive to blood flow that it is possible that abnormalities in the cardiovascular system could be noted here earlier than in other less sensitive parts of the body.”

In one study, published in The Laryngoscope, Dr. Friedland and fellow researchers found that audiogram pattern correlated strongly with cerebrovascular and peripheral arterial disease and may represent a screening test for those at risk. They also found that patients with low-frequency (pitch) hearing loss should be regarded as at risk for cardiovascular events, and appropriate referrals should be considered. When controlling for age, hypertension, diabetes, smoking, and hyperlipidemia, low-frequency presbycusis (age related hearing loss) was significantly associated with intracranial vascular pathology such as stroke and transient ischemic attacks. Significant associations were also seen with peripheral vascular disease, coronary artery disease, and a history of myocardial infarction.

As seen in these recent posts, hearing loss can be the “window” into so many aspects of our health. Hearing loss should no longer simply be thought of as “something that happens when you get older”, it could be your body indicating something else, potentially serious, is going on within. We need to encourage our Primary Care Physicians to refer for hearing evaluations when concerns of cognition/dementia/mental health, falls or hospitalizations, kidney disease, including diabetes, and cardiovascular disease are brought up by the patient and/or family or in test results. Doing so may lead to amplification and re-engaging the individual, and potentially slowing of health concerns. Likewise, we as Audiologist, based on hearing test results and patient case history, should refer to Primary Care Physicians to ensure best health of our patients.

Here at Gardner Audiology, we take your hearing health seriously.

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