“What?” – Untreated Hearing Loss and Cognitive Decline


The dreaded question that infiltrates the natural flow of conversation, forcing you to pause to repeat your last sentence or phrase. Did you hear this question frequently over the holiday season with family members or friends? Did you hear it from your spouse or kids today? Yes, some of the time it is asked due to inattention or distraction. Other times, it may come from an elderly relative who physically did not hear you clearly due the softness of your voice, the amount of background noise present or the inability to see your face for visual cues. Could this question be asked because the listener could not remember what you just said? In the last 3-4 years, a lot of research in the field of audiology has been devoted to studying the risk of untreated hearing loss on advancing cognitive decline.

Before we delve into what is causing this decline in those individuals with hearing loss who aren’t wearing hearing aids, let’s look at some facts:

  • Hearing loss affects more than 9 million Americans over the age of 65 years old.
  • Another 10 million Americans between the ages of 45 to 64 years old have hearing loss.
  • About half of individuals over the age of 75 years old have hearing loss.
  • Only about 20% of people who need to wear hearing aids are wearing them.
  • On average, individuals wait 7-10 years after their initial diagnosis of hearing aids to buy/wear hearing aids.

When comparing the number of individuals affected by hearing loss versus the number of individuals wearing hearing aids, it is shocking that there are any successful conversations over the holiday season!

Why aren’t people wearing hearing aids if they know they have hearing loss and are struggling in daily conversations with family or collegues?

There are many reasons or combinations of reasons that prevent patients from investing in their auditory health:

  • First reason, and for many the most debilitating, is cost. Hearing aids are pricy little computers that sit behind your ears. Unfortunately, most insurance companies are not helpful in footing the bill either. A lower budget option is for the individual to naturally develop their own compensatory strategies such as, turning up the television louder, saying “What?” more often, or not participating in dinner conversations.
  • Second, many people are in denial about their hearing loss. It’s so often that a spouse will blame his wife for being “too soft spoken” or blame the teenager for “talking too fast”. These claims may be true (especially with younger generations talking quickly) but it’s also possible that the listener may have experienced some age-related or noise-induced hearing loss.
  • Third, there is still (unfortunately) a stigma related to hearing aids. Eligible users fight they are not “old enough” for hearing aids or that it makes them look weak to use an aid. If the person’s experience with hearing aids is generally good (“friend wears them and likes them”), the person is more likely to adopt hearing aid use. If it is generally negative (“grandpa John used to wear those big, squealing things in his ears”), it may be harder to counter the stigma.
  • Lastly, especially with older patients, the anti-hearing aids campaign is based on cosmetic appeal. Previous generations of hearing aids were huge and bulky, filling the entire ear and squealing frequently (see #3 with grandpa John). New devices do not have this reputation and for most patients, there are a variety of style options adequate to fit the hearing loss properly.

What’s the risk of not getting hearing aids if I think or know I have a hearing loss?

Photo Credit: Starkey Hearing Technologies

Again, let me turn you to the facts, this time about untreated (untreated=not wearing hearing aids) hearing loss:

  • Adults with untreated hearing loss develop cognitive impairment 3.2 years sooner than normal hearing cohort (Lin et al, 2011, 2013).
  • Untreated hearing loss is correlated to a 36% increase in the rate of cognitive decline versus the normal hearing cohort (Lin, 2013).
  • Individuals with hearing loss experience a loss of memory and thinking capabilities 40% faster than those without hearing loss (Lin, 1997).
  • Mild hearing loss doubles the risk of dementia, with moderate hearing loss leading to three times the risk, and severe hearing loss five times the risk (Breckell).
  • Individuals with untreated hearing loss report higher incidence of depression, paranoia and anxiety.

A recent study by Dr. Helen Amieva (researcher from Neuropsychology and Epidemiology of Aging at the University of Bordeaux, France) showed similar results to the facts above. Titled “Self-Reported Hearing Loss: Hearing Aids and Cognitive Decline in Elderly Adults: A 25-year Study”, the study evaluated over 3500 adults ages 65 years and older, some using hearing aids and others not. She found that there was no difference in the rate of cognitive decline between the control group (no hearing loss present) and people who were wearing hearing aids for their hearing loss. In contrast, the untreated hearing loss group (not wearing hearing aids) was significantly associated with lower baseline scores on the Mini-Mental State Examination (MMSE). The MMSE is frequently used in studies to evaluate the degree of cognitive impairment.

How come individuals with hearing loss who aren’t wearing hearing aids are experiencing faster cognitive decline than their normal hearing or hearing aid wearing cohort?

A study by Campbell and Sharma (University of Colorado) in 2014 focused on this verey question! What is happening in the brain when one sense is deprived or lost? They found that there are neuroplastic changes in the brain which allow for one well-functioning/normal sensory system (let’s say, visual) can recruit brain regions of the deprived sensory system (let’s say, auditory). They took brain recordings (CVEP-cortical visual-evoked potentials) from adults with mild-moderating hearing loss and found there was increased activity in the auditory regions in response to a visual stimulus! The visual system was stealing some of the untouched auditory system’s resources. The recruitment and plasticity of the brain could make it harder for someone to understand speech when background noise is present.

These cortical changes can negatively impact working memory and executive function, therefore contributing to cognitive decline. Not using hearing aids means that there is less auditory input or stimuli for the auditory cortex. Not stimulating parts of brain causes atrophy, a degeneration of cells.

“It’s not just about hearing well today, it’s about the long-term effects of untreated hearing loss.”

Why bother getting hearing aids if you’re making it by in daily life, turning up the radio a little louder and avoiding phone calls, when possible?

Dr. Donald Schum, the Vice President for Audiology and Professional Relations at Oticon, Inc stated, “Improved communication made possible by hearing aids resulted in improved mood, social interactions and cognitively stimulating abilities and is the most likely underlying reason for the decreased cognitive decline reported in the study.” Hearing allows you to be connected to the world around you. It allows you to feel safer and socially involved. Hearing aids are directly correlated to an overall better quality of life, combatting the loneliness, anxiety, depression and social isolation that accompanies hearing loss.

If you’re one of the individuals, waiting 7-10 years before diving into the world of hearing aids, don’t wait any longer! As Schum stated, “It’s not just about hearing well today, it’s about the long-term effects of untreated hearing loss.”


Sources and Articles:


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