Hear Ye! Hear Ye!
The social and cognitive importance of hearing well
By Heidi Lading Kiec
Our hearing, they say, is the first thing to go as we age. And it seems to be something we don’t care much about.
“Typically, people think, ‘Oh, Grandma can’t hear. She needs a hearing aid, but she’s stubborn and won’t get one. So be it,’” says Sam Marzo, MD, chairman of the Otolaryngology Department at Loyola University Health System.
Only 20 percent of people who could benefit from hearing aids actually use them, and among hearing aid users, most lived with hearing loss as long as 10 years before seeking treatment. By then, their impairment had progressed to moderate-to-severe levels.
But hearing loss is not an inconsequential part of aging; rather it’s a serious, long-term issue impacting healthy brain functioning, according to studies by Frank Lin, MD, PhD, associate professor of otolaryngology and geriatric medicine at Johns Hopkins University.
One study found that older adults with hearing loss experienced a 30 to 40 percent faster decline in their ability to think and remember compared to older adults whose hearing was normal. The level of cognitive decline was directly related to the severity of hearing loss.
In another of Lin’s studies, participants underwent yearly magnetic resonance imaging (MRI). Participants whose hearing was impaired at the start of the study experienced accelerated rates of brain atrophy compared to participants with normal hearing.
Lin and his colleagues also discovered that adults with mild, moderate and severe hearing loss ran the risk of developing dementia over time, twofold, threefold and fivefold, respectively.
“We’re at a point of [determining] which came first, hearing loss or cognitive decline, and if you treat the loss, can you reverse the decline?” Marzo says. “But, it’s all clearly related. If you treat a patient’s hearing loss, you’re getting more stimulation to the brain.”
The social link to hearing
Social isolation, a known risk factor for depression, dementia and other cognitive disorders, is a common by-product of untreated hearing loss.
Audiologist Phyllis Stern-Weisman of North Suburban Hearing Services says, “If you’re not hearing, you’re withdrawing from certain situations. I’ve always seen this happening, and [Lin] did the research to finally prove it.”
Debra Flandro, a 57-year-old senior-level credit manager, experienced an unexplained sudden and severe hearing loss in both ears, attributed to an autoimmune issue.
“It was quite scary to not be able to hear anything. I couldn’t hear loud noises. I couldn’t understand what anyone was saying,” she says. “Hearing loss is not just having people talk louder and amplifying things so you can hear better.”
Flandro had work calls forwarded to a staff member, and urgent messages were transcribed and emailed to her. But she became embarrassed when people tried to accommodate for her hearing loss during meetings, and she withdrew from her social life for months. She noticed the toll that speech reading (the practice of watching a person’s lips, facial expressions and gestures to understand conversation) took on her physically.
“Struggling to hear every day, I would go home exhausted,” Flandro says. “Sometimes I would eat dinner and sometimes not, and I would be in bed by 6:30 and sleep until 5:30 in the morning.”
Flandro tried oral steroids, steroid injections and hearing aids, but nothing helped her word discrimination. Then she received a cochlear implant, a surgically implanted electronic device that bypasses damaged portions of the ear and directly stimulates the auditory nerve, which allowed her to understand words in one ear. The hearing in her other ear eventually stabilized.
“When my hearing rebounded, I felt like myself again.”
Hearing aid and implants link to brain health
Cochlear implants benefit the profoundly deaf and severely hard-of-hearing, but less extreme hearing loss is often aided with a variety of new advancements in hearing technology.
A 25-year study, published in October 2015 in the Journal of the American Geriatrics Society, was the first to show that wearing hearing aids reduces the cognitive decline associated with hearing loss.
Both Marzo and Stern-Weisman admit that the stigma associated with hearing devices means patient coaching is usually required.
“As physicians, we need to counsel these patients on some of the other issues associated with or related to hearing loss such as falls, depression and cognitive decline,” Marzo says. “If these patients decline hearing aids on that visit—that is OK. I am not going to force the patient to get a hearing aid or give up on that patient. I am going to encourage them to come back to me in six months or so, so that I can clean the ears and see if anything has changed.”
“The stigma of wearing hearing aids is changing. People who are younger are not willing to sit on the sidelines and will wear hearing aids,” says Stern-Weisman. “The choices now are much more cosmetically appealing compared to yesteryear, but people still need to choose what they are willing to wear. An audiologist needs to answer questions and ask questions about lifestyle to be able to suggest what type of amplification is most appropriate as well as cosmetically acceptable.”
It helps that devices are getting smaller, more powerful and infinitely cooler. Lyric is a hearing aid that is unseen and worn even while sleeping and showering. Some hearing aids and implants connect to cell phones, mp3 players and televisions via Bluetooth. And the FDA approved the EarLens Contact Hearing Device, the first hearing aid to use light to transmit sound.
Flandro now tells people to be proactive with their loss of hearing. With the mounds of definitive research and viable solutions for hearing loss available today, that sounds like great advice.
Originally published in the Spring 2016 print edition.
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