Hearing loss is an invisible impairment that affects millions of people across the country and around the world. While it often goes undetected or untreated, it can have significant effects on quality of life, posing risks to physical safety, cognitive abilities, psychological health, family and social and relationships, and economic and occupational status.
About 48 million Americans have some degree of hearing loss, according to the Hearing Health Foundation. That number doubled from 2000 to 2015 and is projected to reach 73 million by 2060. Globally, the incidence has increased 44%, and hearing loss is the second most common health issue in the world.
One potential reason for the rising rate is increased longevity: Hearing loss is more common among older adults. About 1 in 3 people between 65 and 75 have hearing loss, and 2 in 3 people over the age of 75 are have impaired hearing. But hearing loss occurs even in children, and about 26 million people between the ages of 20 and 69 have hearing deficits.
Causes of hearing loss include noise pollution from loud music and urban or industrial environments, misuse of headphones and earbuds, certain medical conditions, and even certain medications. Hearing loss is a potential side effect of over 200 prescription and over-the-counter medications. Tinnitus, a disorder marked by ringing in the ears that frequently results in hearing loss, is noted as a potential side effect of 450 medications.
Despite the frequency of hearing loss, most physicians don't routinely screen for it, and only 15% to 20% of people who would benefit from a hearing aid actually obtain one. This may be due to out-of-date misconceptions about hearing aids, as newer devices are smaller and more comfortable. They also use digital rather than analog technology, which makes them Bluetooth compatible and allows them to adjust to different sound environments. Although the stigma may be an impediment for some people, they may be underestimating the very real negative effects of missing out on essential conversations in family, social, and work settings.
Effects on Physical Health and Safety
While hearing loss itself is a concern, it is associated with other important health and safety risks, as well. For example, hearing loss can result in impaired balance and increased risk of falls. The sensing and orienting functions performed by the ears provide essential information for navigating one's environment. Recent research is also exploring the possibility that hearing loss results in structural changes to the area of the brain responsible for balance.
People with hearing loss are also put in danger if they fail to notice important sounds like honking horns, emergency sirens, and the noise of oncoming traffic. A study published in the journal Ear and Hearing suggests that less than half of older people with impaired hearing will be awakened by a typical fire alarm. The frequencies of standard fire alarms, between 3,000 and 4,000 hertz, are often imperceptible to people with hearing loss. The research found that subjects with impaired hearing were seven times more likely to respond to fire and smoke alarms in the 520-hertz range. (LifeTone Technologies and the Darrow Company make these lower-frequency models.)
Hearing impairments are associated with high blood pressure, heart disease, and diabetes, because the structures in the ear are affected by variations in blood flow. A Harvard University study found that hearing loss was 54% more likely in people with cardiac disorders. For these patients and people with other medical conditions, there's a risk of mishearing instructions from physicians or pharmacists.
A Major Cognitive Effect
Current research is exploring the link between untreated hearing loss and dementia. Dementia refers to a form of cognitive decline in which one or more mental processes become impaired to a significant degree. These processes include short- and long-term memory, learning ability, speech and language comprehension, judgment, planning, the ability to focus and sustain attention, motor skills, and the ability to perform everyday tasks such as shopping.
A study published in 2011 followed 639 people with no cognitive impairment and assessed them at regular intervals for 12 to 18 years. The research subjects with normal hearing were less likely to have symptoms of dementia, and those who tested as hearing impaired were significantly more likely to have dementia. The risk of developing dementia was nearly double for those with mild hearing loss, triple for those with moderate levels of impairment, and five times more likely for those with severe hearing loss.
A second study by the same lead researcher in 2013 confirmed this relationship. The cognitive abilities of 1,984 older adults were assessed and followed over six years. Those with hearing loss experienced a 30% to 40% accelerated rate of cognitive deterioration and were more likely to develop dementia.
There are several possible reasons for this link between hearing loss and dementia. One possibility is that hearing loss actually changes the structure and functionality of the brain, as brain tissue shrinks when it is not provided with adequate stimulation in the form of sound. A second possibility is that some unidentified physiological pathway produces both hearing loss and dementia, although the known and likely culprits, such as high blood pressure, were accounted for in the studies. A third possible explanation is that the social isolation that often results from hearing loss accelerates the progression of dementia. A fourth hypothesis posits that, if the brain is tasked with intense focus on listening, it may have less capacity for memory processing and other functions. The chronic stress of this "cognitive load" may compromise functioning over time. A new study exploring these possibilities is underway.
When the onset of hearing loss or tinnitus is sudden — for example, due to medical conditions, medication side effects, injuries, and industrial or military incidents — there are often significant symptoms of distress. These can include sleep loss, anxiety, depression, and feelings of helplessness and hopelessness. There may also be changes in self-concept and perceptions of personal effectiveness, including feelings of being damaged, deficient, or incompetent.
Age-related hearing loss tends to be gradual, progressing from milder to greater impairment, and comes with different psychological risks. With gradual onset, the problem is adaptation and failure to recognize and respond to the hearing impairment. The average delay in getting needed hearing aids is 10 years, and much damage to a person's self-concept, social connectedness, and communication skills occurs in that time.
A number of studies have found increased risk of clinical depression in people with impaired hearing, particularly women. Anxiety was also identified at a significantly higher rate in people with impaired hearing than individuals with no hearing loss. Finally, rates of substance abuse, including alcohol and prescription opiates, are higher in hearing-impaired populations than people with normal hearing.
Effects on Relationships
Untreated hearing loss can have a significant effect on relationships with loved ones and friends, as well as daily interactions in the community. There can be a reduction in attunement and awareness of subtle social cues. With impaired hearing, it's easier to misunderstand others and misinterpret intentions. Sometimes people who have hearing loss believe that others are mumbling or have poor enunciation. When listening becomes an experience of frustration or embarrassment, social withdrawal frequently follows.
Loved ones, family members, and friends also may retreat when communication becomes difficult. They may become frustrated if the person with hearing loss is resistant to addressing the problem. People with impaired hearing are sometimes perceived as obstinate, arrogant, or incompetent in situations where the actual issue is unheard information or instructions.
As a result, untreated hearing loss often leads to limited social engagements and changes in routine. People with impaired hearing are likely to find themselves on fewer phone calls, less interested in things like concerts and lectures, and avoiding previously loved places due to loud background noise.
Economic and Occupational Effects
An estimated 60% of people with impaired hearing are below retirement age, and untreated hearing loss can have negative effects on workplace performance. Many aspects of work life, such as group meetings, video-conferencing, and telephoning, as well as the need to follow instructions from supervisors, can be affected by hearing loss. Though illegal, workplace discrimination has been documented, as employers may be unwilling to provide adaptive technologies.
Ironically, hearing loss is often caused by the work environment. According to the Hearing Health Foundation, active service members and veterans rank hearing loss and tinnitus as their top two health concerns, and 30 million U.S. workers are exposed to hazardous noise levels in their jobs.
This can result in fewer opportunities for promotion or limited options for changing jobs, which affects earning potential. One estimate is that people with untreated hearing loss average between 50% to 70% less in lifetime earnings than their peers with normal hearing, and hearing loss may cost as much as $12,000 per year in average household earnings.
Reducing the Harm
The risks of hearing loss to health and safety, cognitive processes, psychological functioning, family and social relationships, and work life can be prevented by wearing hearing aids or, in some cases, cochlear implants.
For example, the risk of dementia associated with hearing loss can be averted or even reversed based on the results of two studies published in 2015. In one, 3,670 people aged 65 or older with hearing loss were followed for 25 years. The subjects who used hearing aids had no cognitive decline compared with their same-age cohorts, while those who did not use hearing aids experienced significant declines in mental processes. The same study also found a reduction in depressive symptoms for the hearing aid users.
The second study, conducted in France, found that corrected hearing can result in actual improvement in cognitive functioning and speech perception. It evaluated 94 subjects between the ages of 65 and 85 who had profound deafness in at least one ear. After cochlear implants and auditory therapy, 80% of those with the lowest cognitive scores showed improvement one year later. While these results are preliminary, this rate of improvement is double that shown with current medications used to treat dementia.
In addition to cognitive benefits, research has shown that psychological health also improved following the introduction of hearing aids. In one study, 34 older patients were tested before and three months after the use of hearing aids. The results indicated significant psychological benefits, as well as improvements to participants' relationships.
With respect to the workplace, it's been shown that hearing aids almost completely mitigate the risk of reduced earnings for those with mild hearing loss, and reduce it as much as 65% to 77% for those with moderate and severe hearing loss.
To prevent hearing loss:
- Treat ear infections promptly.
- Use recommended methods to keep your ears clean.
- See a doctor if you have a high fever, severe headaches, dizziness or spinning sensations, or other unusual symptoms.
- Listen to music at moderate volume.
- Use highly rated earplugs or headphones when using loud equipment or firing weapons.
- Wear earplugs to concerts and sporting events, on airplanes, and in loud subway or train stations.
- Avoid sitting directly in front of speakers.
- Review your current medications to ensure you're not exposing yourself to unnecessary risk.
- If you notice side effects such as tinnitus, dizziness, or hearing loss, discuss the benefits, health risks, and alternative medication options with your physician and pharmacist.
- Get your hearing tested to establish a baseline and then periodically retest over time.
- Make lifestyle changes to reduce the risk of heart disease, diabetes, and hypertension.
If you already are already concerned about a decline in your hearing:
- Don't procrastinate on seeking intervention.
- Make an appointment to get tested by a board-certified professional and get recommendations for improved hearing.
- If hearing aids are recommended, learn about all the options, not just the least expensive.
- Get fitted by a professional.
- Consider wearing more than one device if it improves your hearing.
- Expect your hearing perception to be compromised at first and give yourself time to adjust.
- Wear your hearing aid regularly (even at home alone) to help your brain accommodate more quickly.
- Discuss your fears and concerns with loved ones, friends, and health-care providers to ensure you get the support you need.
If you are experiencing tinnitus:
- Consult a physician to determine likely causes and recommended interventions.
- Recognize that your anxiety levels may be temporarily higher and use mindfulness meditation strategies to redirect your attention away from the ringing/tones.
- Consider cognitive-behavioral therapy if you are struggling with unmanageable levels of anxiety or depression.