Jan. 24, 2024 – Sight, smell, touch, taste, hearing. Which of these five senses are you most afraid of losing? More often than not, hearing ranks last, even though an estimated 60 million Americans have some form of hearing loss, 44 million of whom are people 20 and older.
Only 16% of 20- to 60-year-olds and 30% of people over age 70 have ever used a hearing aid. Most people over the age of 50 have not had their hearing tested. What’s more, recent survey findings suggest that primary care doctors consider hearing loss low on the totem pole of most important health conditions to manage, and fewer than 50% also recommend that their patients have their hearing tested at least once yearly. Other research shows that the same percentage believe that nothing can be done about it.
This perfect storm of widespread hearing loss, combined with lack of prioritization by providers, puts the onus on individuals to ask about screening. Oftentimes, people are not aware that they have hearing loss, nor do they consider the long-term health consequences that could be prevented or slowed by hearing interventions.
“Hearing has always been thought about like a binary – you either have normal hearing or all of a sudden you have hearing loss and you have to do something about it,” said Frank Lin, MD, PhD, an otolaryngologist (ear, nose, and throat doctor) and director of the Cochlear Center for Hearing and Public Health at Johns Hopkins Bloomberg School of Public Health in Baltimore. “If you actually checked your hearing every year, you would find that it slowly and gradually diminishes bit by bit, literally over your entire life starting at puberty.”
It’s time to change the way that we think about hearing, he said.
Severed Connections, Interrupted Stimulation
Hearing relies on the ability of the inner ear – especially the fluid-filled cavity (cochlea) – to convert sound waves into electrical signals for the brain to interpret. Over time, the cochlea becomes damaged by a lifetime exposure to noise. Other things that affect hearing include your genes, certain prescription drugs, and medical conditions like high blood pressure and diabetes.
“Most people who notice hearing loss will notice it when they are in background noise because it tends to be a more challenging listening environment," said Bria Collins AuD, CCC-A, associate director of audiology practices at the American Speech-Language-Hearing Association (ASHA) in Rockville, MD. “But it’s pretty much anytime that you’re not hearing the speech signal reliably.”
A hard time hearing is only one part of the equation. Health risks are another.
“Hearing loss has been consistently related to the risk of cognitive decline or dementia over time,” said Lin. He explained that it’s possible that cochlear damage makes the brain work harder to decode electrical signals, which, he said, “comes at the expense of our thinking memory abilities.” He noted that another theory suggests that “hearing loss itself changes the brain’s structural integrity, leading to faster rates of atrophy [when the brain loses brain cells and neurons], which is not good for brain function.” Social isolation and depression are also possibly at play; both result in fewer chances to take part in activities that stimulate brain function.
For now, this cognitive conundrum does not have a cure, but there is a solution that might help ease hearing loss before it becomes so severe that dementia sets in: the stigma-carrying hearing aid.
Dementia, Death, and Hearing
Lin is co-principal investigator of ACHIEVE, a study that examined if counseling by an audiologist and hearing aids could reduce dementia risk in mentally healthy older adults with mild to moderate hearing loss.
He explained that over 3 years, the hearing intervention reduced further mental declines by half in at-risk people, compared to those with hearing loss but no cognitive risks.
Studies have also linked hearing loss to an increased risk of dying. Janet Choi, MD, MPH, an ear, nose, and throat doctor with Keck Medicine of USC in Los Angeles and lead researcher of a newly published study, explained that she and her colleagues found that among the almost 10,000 adults who were examined, “those with hearing loss who regularly used hearing aids had a 24% lower risk than those who never wore hearing aids.” The study also showed that this benefit was maintained over time in regular hearing aid users, but not in occasional or never users, despite things like the degree of hearing loss (mild to severe), age, income, and medical history.
The challenge is that many adults don’t want to admit that their hearing is not as clear as it used to be.
“In my personal experience, patients don’t bring this up to their doctors, and will suffer with it for years before saying anything,” said Leah Ross, MD, a geriatrician at Penn State Health in Hershey, PA. At the same time, “practitioners don’t always make the connection between hearing loss and impairment and the effects down the road, even though we see it all the time. It’s the third most common chronic medical condition in older adults.”
By 2050, an estimated 2.5 billion people worldwide will have some degree of hearing loss. One in 10 (700 million people) will have disabling hearing loss. Although neither hearing screening rates nor recommendations have caught up with this future reality, there are simple steps that can be taken now.
Avoid excessive noise. “We might not be able to control genetics but we can control our noise exposure,” said Collins.
Damage to hearing can occur when decibel levels are too high, if a person constantly listens to music at loud levels over time, or if they consistently use a higher volume setting when using earbuds. Noise-related hearing loss is the only type of hearing loss that is completely preventable. Avoiding regular and prolonged exposure to loud sounds, turning down the volume on listening devices, and using hearing protection (such as earmuffs, ear plugs, and noise-canceling earphones) are advisable.
Use high-tech help, and talk up close. Many people have access to smart technology on phones and televisions. Lin said that he uses closed captioning when watching films and shows.
“When you have visual information on the screen, it allows the brain to fuse it with the auditory information without having to catch up.” Having deliberately close (within 3 feet) face-to-face conversations, which also gives the brain a break, provides visual clues and prevents any sort of noise distortion, he said.
- Know your baseline hearing number. The hearing number is snapshot of your hearing at any given time. Because regular hearing screenings are in the menu that primary care doctors rely on, you can take things into your own hands. There are several downloadable apps (such as Apple’s Mimi or the World Health Organization’s HearWHO) that give you a baseline and track hearing over time so consumers can see an audiologist if the numbers are worrisome. Johns Hopkins also offers more hearing number information on its website.
Consider an over-the-counter hearing aid.
“I always recommend that patients get their hearing tested first, just so they know the type of severity of their hearing loss," said Choi.
Fortunately, significant technological advances in hearing devices over the past decade mean that options are numerous. Hearing aids are smaller, some are invisible, and some look like Bluetooth devices. And for people who are seeking options that cut background noise, assistive devices like ClearCast might be preferable. Regardless of what you ultimately choose, just be sure that they are FDA-approved, and follow up with your doctor for the right fit.