ArticlePDF AvailableLiterature Review

Negative consequences of uncorrected hearing loss - A review

Authors:

Abstract

Hearing loss gives rise to a number of disabilities. Problems in recognizing speech, especially in difficult environments, give rise to the largest number of complaints. Other kinds of disabilities may concern the reduced ability to detect, identify and localize sounds quickly and reliably. Such sounds may be warning or alarm signals, as well as music and birds singing. The communicative disability affects both hearing-impaired people and other people in their environment--family members, fellow workers, etc. Hearing-impaired people are not always aware of all the consequences of the impairment; they do not always know what they are missing. Several studies have shown that uncorrected hearing loss gives rise to poorer quality of life, related to isolation, reduced social activity, and a feeling of being excluded, leading to an increased prevalence of symptoms of depression. These findings indicate the importance of early identification of hearing loss and offers of rehabilitative support, where the fitting of hearing aids is usually an important component. Several studies also point to a significant correlation between hearing loss and loss of cognitive functions. Most of these studies show such a correlation without being able to show whether the hearing loss caused the reduction in cognitive performance or if both the hearing loss and the cognitive decline are parts of a common, general age-related degeneration. A couple of these studies, however, indicate that the uncorrected hearing loss may be the cause of cognitive decline. Whichever alternative is true, the correlation should be seen as a clear indication for early hearing aid fitting for those needing it. Monaural hearing aid fitting in subjects with bilateral hearing loss may give rise to a reduced ability to recognize speech presented to the unaided ear, the so-called late-onset auditory deprivation effect. This functional decline is reversible in some but not all subjects after fitting of a hearing aid also on the previously unaided ear.
Stig Arlinger
Department of Audiology,
University Hospital,
S-581 85 Linköping, Sweden
E-mail:
Disability and handicap
Hearing loss is an often underestimated disturbance of a sensory
function. It has been shown to negatively affect physical,
cognitive, behavioural and social functions, as well as general
quality of life, and is clearly related to depression and dementia.
It is estimated that approximately 10% of the population in
many Western countries suffer from a hearing loss of a such
a degree that it affects ordinary daily life. The prevalence of
hearing loss is strongly related to age (Davis, 1995; Rosenhall et
al, 1999).
A lesion in the auditory sense organ can give rise to various
forms of impairment, most commonly hearing loss, tinnitus, or
hyperacusis. In this review, the focus is on hearing loss and the
possibilities of overcoming at least some of its effects by means
of hearing aids.
The kind of lesion that dominates in the developed countries
is the sensorineural lesion, primarily involving the cochlea, with
loss of hair cell function. This kind of lesion gives rise to both
quantitative and qualitative effects, both attenuation and dis-
tortion (Plomp, 1978).
A hearing loss gives rise to disabilities of various kinds, e.g.
loss of ability to detect sounds, to recognize speech, especially
in adverse conditions, and to localize sound sources. In response
to questions about problems in understanding speech in back-
ground noise or reverberation, young normal-hearing people
typically answer ‘rarely’ (Cox, 1996), while people with slight-
to-moderate hearing loss, on average, answer ‘often’ (Cox &
Alexander, 1995). In order for hearing-impaired people to pick
up as much as possible of the acoustical world, they have to
concentrate much more than normal-hearing people. The fatigue
caused by this extra concentration is an additional component
among the consequences of uncorrected hearing loss. The
reduced ability to detect sounds may affect sounds such as those
of doorbells or telephones, traffic sounds that may signal
immediate danger, and sounds of importance for quality of life,
such as music or bird song.
Disability may in turn give rise to handicap or, in other
terminology, affect the hearing-impaired persons participation
in interactions with other people. Increasing difficulties in
recognizing the spoken messages of others, having to ask for
repetition too often, and still not being sure about having
understood correctly, often lead to withdrawal from social
activities, rejection of invitations to parties, and no more visits
to theatres, cinemas, churches, lectures, etc. This, in turn, leads
to reduced intellectual and cultural stimulation, and an in-
creasingly passive and isolated social citizen.
In a German study (Kiessling et al, 1996), a group of 99
subjects of various ages with slight-to-moderate hearing loss
were asked to fill in a questionnaire, the Gothenburg Profile,
which assesses both disability and handicap caused by the
Original Article
International Journal of Audiology 2003; 42:2 S17–2 S20
Negative consequences of uncorrected
hearing loss––a review
Stig Arlinger
Department of Audiology,
University Hospital,
Linköping, Sweden
Key Words
Hearing loss
Speech communication
Quality of life
Depression
Cognitive functions
Auditory deprivation
?
Abstract
Hearing loss gives rise to a number of disabilities. Problems in recognizing speech, especially in difficult
environments, give rise to the largest number of complaints. Other kinds of disabilities may concern the
reduced ability to detect, identify and localize sounds quickly and reliably. Such sounds may be warning
or alarm signals, as well as music and birds singing. The communicative disability affects both hearing-
impaired people and other people in their environment—family members, fellow workers, etc. Hearing-
impaired people are not always aware of all the consequences of the impairment; they do not always
know what they are missing. Several studies have shown that uncorrected hearing loss gives rise to
poorer quality of life, related to isolation, reduced social activity, and a feeling of being excluded,
leading to an increased prevalence of symptoms of depression. These findings indicate the importance
of early identification of hearing loss and offers of rehabilitative support, where the fitting of hearing
aids is usually an important component. Several studies also point to a significant correlation between
hearing loss and loss of cognitive functions. Most of these studies show such a correlation without being
able to show whether the hearing loss caused the reduction in cognitive performance or if both the
hearing loss and the cognitive decline are parts of a common, general age-related degeneration. A
couple of these studies, however, indicate that the uncorrected hearing loss may be the cause of cognitive
decline. Whichever alternative is true, the correlation should be seen as a clear indication for early
hearing aid fitting for those needing it. Monaural hearing aid fitting in subjects with bilateral hearing
loss may give rise to a reduced ability to recognize speech presented to the unaided ear, the so-called
late-onset auditory deprivation effect. This functional decline is reversible in some but not all subjects
after fitting of a hearing aid also on the previously unaided ear.
2S18
International Journal of Audiology, Volume 42 Supplement 2
hearing loss. To questions regarding the degree of problems in
recognizing speech, the average response was ‘half the time’. To
questions regarding handicap, focusing on how the hearing loss
affects social interactions with other people, or behaviour and
reactions in various situations, the average answer was ‘now and
then’.
In the USA, Ventry & Weinstein (1982) administered a 25-
item questionnaire to 100 persons above 65 years of age with
varying degrees of hearing loss, from none at all to profound.
The questions concerned two categories—emotional conse-
quences of hearing impairment, and problems and reactions
related to specific situations. On a scale running from 0 to 100,
the subjects with hearing thresholds within normal range scored,
on average, 9.9, those with mild hearing loss scored 23.7, those
with moderate hearing loss scored 42.7, and those with severe-
to-profound hearing loss scored 76.0.
A hearing loss affects communication with other people. Thus,
the effects concern not only hearing-impaired people, but also, to
a high degree, people around them—family, fellow workers, etc.
Also, these people have to put more effort into communication
with the hearing-impaired person: they need to speak more slowly
and with better articulation, turn their face towards the hearing-
impaired person to allow lipreading, and move closer rather than
talking from a distance or from a neighbouring room. As a
consequence of these increased demands, there is a high risk that
people will make less contact with the hearing-impaired person,
who will become still more isolated.
Often, the hearing-impaired person is not clearly aware of all
the consequences of the hearing loss. This may be due to the
slow progress of the loss, which is the typical pattern, as well as
to the fact that the hearing-impaired person does not think of
the existence of all the sounds that have become inaudible. This
is clearly illustrated by the finding often reported by people after
having been fitted with their first hearing aids of rediscovering
sounds the existence of which they had long since forgotten.
Wellbeing and quality of life
As pointed out above, longstanding uncorrected hearing loss
in the elderly often results in withdrawal from a variety of social
activities, which in turn may affect quality of life as well as
mental health and wellbeing. Reduced auditory and intellectual
stimulation may give rise to changes in the central nervous
system, and may affect the development of dementia.
The National Council on the Aging in the USA (Seniors
Research Group, 1999) organized a study in which 2304 elderly
hearing-impaired persons, hearing aid users as well as non-users,
answered a questionnaire. In addition, 2090 significant others of
hearing-impaired people answered another questionnaire. The
results showed that hearing-impaired people who did not use
hearing aids more often stated that they felt sad or depressed,
were worried, showed paranoid tendencies, took part in less
social activity, and experienced more emotional turmoil. Both
the affected people and their significant others reported benefits
from hearing aid use in terms of better relationships at home,
more confidence, and better relationships with others. Family
members reported such benefits more often than the hearing-
impaired people themselves. The most common reasons for not
using hearing aids in this group were that they felt that their
hearing was not bad enough or that they got along without one.
Scherer & Frisina (1998) at the Veterans Administration in
the USA compared two groups, each with 20 subjects in the age
range 60–81 years; one group had normal hearing (average
hearing threshold levels at 1, 2 and 4 kHz 11 dB, range 5–16
dB), while the other group had slight-to-moderate hearing loss
(average 25 dB, range 13–41 dB). Both groups showed normal
cognitive functions. Although the groups were small, the results
showed that even a slight hearing loss gives rise to increased
problems of speech recognition in noise and reduced feeling of
wellbeing.
Cognitive functions
A research group in Berlin, Germany, has reported a series of
studies concerning the correlation between changes in sensory
function with age and intellectual and cognitive functions.
Lindenberger & Baltes (1994) reported on a study of 156
persons in the age range 70–103 years (mean age 85 years). In
the age range 70–84 years, the mean hearing loss (five-frequency
average 0.5–4 kHz) was 50 dB for the men and 44 dB for the
women. In the group above 85 years of age, the corresponding
values were 59 dB and 58 dB, respectively. Only about 17% of
the subjects had access to hearing aids. In addition to hearing
thresholds, visual acuity was tested, and cognitive functions
were assessed by a series of tests. Taken together, the results
from the visual and auditory tests explained close to half of the
total variance and 93% of the age-related variance in the
cognitive tests. The authors interpret these results as support for
a model in which age-related differences in cognitive functions
represent an indirect consequence of age-related differences
in vision and hearing. Sensory function is seen as a strong
predictor in late life of individual differences in intellectual
function. The authors admit, however, that the results may be
interpreted as visual and auditory acuity being very sensitive to
negative age changes in cognitive functions such as attention
and discrimination. Unfortunately, the subgroup that had access
to hearing aids was not compared with those who did not.
A later report from the same authors (Lindenberger & Baltes,
1997) presented the results from an extended group of 516
persons in the same age range, with 16% of the subjects using
hearing aids. The results here essentially confirmed the results
from the previous study: sensory function is significantly cor-
related with cognitive function in elderly persons. The model
that they present suggests that the relationship between age,
sensory function and cognitive function implies that age-related
differences in cognitive functions are so strongly related to
sensory–sensorimotor function (vision, hearing, balance) that
age in itself has no significant effect on cognitive functions after
control for sensory–sensorimotor function.
A third report from the same group (Baltes & Lindenberger,
1997) concerned 687 subjects over the wider age range from 25
to 103 years by complementing the 516 from the previous study
with 171 younger subjects in the age range 25–69 years. None of
the younger subjects used hearing aids. The results showed that
sensory function was a good predictor of age-related differences
in cognitive function, and that the relationship between sensory
function and cognitive function increased with age. The authors
conclude that the mechanisms behind age-related changes in
sensory function are also behind age-related changes in cognitive
function. However, their results still do not allow an interpre-
2S19
Arlinger
Negative consequences of uncorrected
hearing loss––a review
tation in terms of cause and effect, i.e. that reduced sensory
function gives rise to reduced cognitive function through sensory
deprivation.
An Italian study (Appolonio et al, 1996) involved 1192
subjects in the age range 70–75 years in northern Italy. Both
cross-sectional and longitudinal data obtained over a 6-year
period were presented. The subjects were divided into three
groups according to auditory and visual function. Group A (275
subjects) were considered to have normal auditory and visual
acuity, while group B (673 subjects) had reduced visual and/or
auditory acuity with access to correction by glasses and/or
hearing aids. The third group C (244 subjects) had reduced
visual and/or auditory acuity without access to any correction.
Of these, 20 were affected in both vision and hearing, 106 had
hearing loss but normal vision, and 118 had normal hearing but
reduced visual acuity. Socio-economic status, quality of life and
cognitive functions were assessed by means of questionnaires.
Health state was assessed in terms of use of medical care, and
mortality was recorded during the 6-year study period. The
statistical analysis showed significant differences between the
groups. Group C showed significantly poorer outcome than
groups A and B in quality of life and cognitive function. When
controlling for differences in socio-economic factors, significant
differences remained in quality of life between groups B and C
and between groups A and B. The analysis of mortality during
the 6-year period showed a significantly higher mortality rate
among men in group C than among men in group A and group
B after correction for differences in socio-economic status and
general state of health. No differences were found for women.
The conclusion drawn by the authors is that poor health as such
cannot alone explain the differences in mortality between the
men in the three groups in the study, but that auditory and
visual function play an indirect role through their effects on
general physical health and on social relations. They consider
the results as strongly supporting the need to check visual and
auditory functions among the elderly, and to encourage them to
use sensory aids when these functions are reduced.
Cacciatore et al (1999) studied 1332 persons older than
65 years (mean age 74 years) in southern Italy. They assessed
hearing loss, cognitive function, depression and quality of life
by means of questionnaires. Hearing loss was reported by 27%
of the subjects. Use of hearing aids was recorded. A strong
correlation was found between hearing loss and reduced cognitive
function, independent of age and educational level. Also, the
correlation between hearing loss and depression was statistically
significant. Use of hearing aids reduced the symptoms of
depression. Greater hearing loss was associated with reduced
quality of life. The conclusion drawn by the authors is that the
use of hearing aids may have a protective effect against reduced
cognitive function and provide better quality of life for elderly
people.
Similarly, a Japanese study has shown a significant cor-
relation between hearing loss, cognitive function and depression,
based on 747 subjects in the age range 65–98 years (Naramura et
al, 1999). The authors could not draw any conclusions about
cause and effect, however, but suggested that regular checks of
hearing for early detection of hearing loss may contribute to the
preservation of good quality of life among the elderly.
Uhlmann et al (1989), in the USA, investigated a group of 100
elderly (above 65 years) subjects with dementia, and a control
group of equal size, matched for age, gender, and educational
level. Hearing acuity was measured (0.5–3 kHz), and cognitive
function and depression were assessed by means of validated
questionnaires. Hearing aids were used by 17 subjects in the
dementia group and 13 in the control group. Hearing loss was
significantly more common in the test group than in the control
group. The probability of dementia was significantly higher in a
subgroup where hearing loss exceeded 40 dB. The degree of
hearing loss showed a significant correlation with reduced
cognitive function in both the test group and the control group.
This significant correlation remained after control for differences
in age, level of education, gender, medication, and depression.
The authors concluded that their results support the hypothesis
of hearing loss contributing to reduced cognitive function in the
elderly. This, in turn, may increase the symptoms of dementia
and result in reduced functionality. Correcting the hearing loss
by the use of hearing aids cannot be expected to prevent
dementia, but may reduce the consequences of the disease.
A common finding among the reports reviewed above is a
significant correlation between hearing loss and reduced cognitive
function. This makes a study from The Netherlands interesting
(Smits et al, 1999); this showed cognitive function to be signi-
ficantly correlated with the probability of surviving a 5-year
period in a group of 2380 subjects, randomly selected in the age
range 55–85 years. Speed of information processing was the
specific cognitive function that showed the strongest correlation
with mortality. The authors assume a general biological decline
to be the most likely hypothesis to explain the predictive ability
of the cognitive functions.
Mulrow et al (1990) reported on a study concerning 188
elderly persons with hearing loss, in which half of the subjects
were randomly selected for hearing aid fitting, and the other half
were placed on a waiting list for hearing aids. The groups were
comparable with regard to demographic and clinical variables
and degree of hearing loss. Quality of life, depression and
cognitive functions were assessed initially, as well as after
6 weeks and 4 months. Changes over the 4-month period differed
significantly between the two groups. The hearing aid group
reported significant improvements in social, emotional and
communicative functions, as well as in cognitive function and
depression. Also, assessment by significant others regarding
social and communicative function agreed with this.
A later report (Mulrow et al, 1992) concerned 192 elderly
(mean age 72 years) hearing-impaired people over a period of
12 months after the fitting of hearing aids. Using standardized
questionnaires for quality of life, depression and cognitive
function, they found a significantly improved quality of life and
reduced degree of depression; this effect was stable over the
observation period. Cognitive functions showed only small
changes, which returned to baseline after 12 months; however,
only two of the subjects showed significantly reduced cognitive
function.
Late-onset auditory deprivation
A special aspect of untreated hearing loss concerns the auditory
deprivation effect, which may occur in people with bilateral,
essentially symmetrical, hearing loss with only monaural hearing
aid fitting (Arlinger et al, 1996). The effect appears as a reduced
ability to recognize speech presented to the ear that has not been
2S20
International Journal of Audiology, Volume 42 Supplement 2
fitted with a hearing aid and which has therefore been exposed
to significantly less auditory input than the aided ear for a long
time; both ears show essentially identical unchanged pure-tone
hearing thresholds. The first report came from the USA (Silman
et al, 1984). The effect typically appears after one or a few years
of monaural hearing aid use, and has been shown in both
children and adults (Gelfand & Silman, 1993; Hattori, 1993).
After changing to binaural hearing aid fitting, the effect may
disappear completely or partially, but in some cases the effect
may remain despite this. A follow-up study reported on six adult
patients showing the effect but with rather different recovery
patterns after they started using binaural fittings for at least
8 h/day (Gelfand, 1995). Two of the cases showed complete
recovery after 1 year of binaural use. Two other cases showed
partial recovery with remaining asymmetry even after 2 and
5 years of binaural use, respectively. The two remaining cases
showed no recovery even after 5 or 6 years of reported binaural
hearing aid use. No obvious factors could predict the different
recovery patterns. None of the studies reported on binaural
speech recognition in sound fields, and thus it is not known
whether the effect also involves reduced ability to make use of
binaural integration.
Conclusions
Uncorrected hearing loss represents an auditory disability
involving reduced speech recognition ability, especially in difficult
environments, and reduced ability to detect, identify and localize
sounds. This affects the lives of both the hearing-impaired person
and significant others. The hearing-impaired person is not always
aware of all the consequences.
Uncorrected hearing loss gives rise to a poorer quality of life,
related to isolation, reduced social activity, a feeling of being
excluded, and increased symptoms of depression. There is a
significant correlation between uncorrected hearing loss and
reduced cognitive functions. There is no clear proof that hearing
loss is the cause of the reduced cognitive function, but indirect
evidence from some studies supports this hypothesis. If the
hearing loss is indeed a cause of cognitive decline, this is a very
strong argument for early detection of hearing loss and fitting of
hearing aids. However, hearing loss and cognitive decline having
a common cause is also a good reason for early detection and
fitting of hearing aids: The cognitive decline will exacerbate the
consequences of missed information due to the hearing loss. The
more auditory information that is available, the easier it will be
for the impaired cognitive system to process it successfully.
Monaural hearing aid fitting in subjects with bilateral hearing
loss may give rise to a late-onset auditory deprivation effect,
appearing as a reduced ability to recognize speech presented to
the ear that has been deprived of significant auditory stimula-
tion. The effect may or may not be reversible. This is considered
a strong argument for bilateral fitting being the standard
procedure in hearing aid dispensing (Arlinger et al, 1996).
References
Appolonio, I., Carabellese, C., Frattola, L. & Trabucchi, M. 1996.
Effects of sensory aids on the quality of life and mortality of elderly
people: a multivariate analysis. Age Aging, 25, 89–96.
Arlinger, S., Gatehouse, S., Bentler, R.A., Byrne, D., Cox, R.M., et al.
1996. Report of the Eriksholm Workshop on auditory deprivation
and acclimatization. Ear Hear, 17, 87S–98S.
Baltes, P.B. & Lindenberger, U. 1997. Emergence of a powerful con-
nection between sensory and cognitive functions across adult life
span: a new window to the study of cognitive aging? Psychology and
Aging 1997; 12:12–21.
Cacciatore, F., Napoli, C., Abete, P., Marciano, E., Triassi, M., et al.
1999. Quality of life determinants and hearing function in an
elderly population: Osservatorio Geriatrico Campano Study Group.
Gerontology, 45, 323–328.
Cox, R.M. 1996. The Abbreviated Profile of Hearing Aid Benefit
(APHAB)—Administration and Application. Phonak Focus No. 21.
Stäfa: Phonak.
Cox, R.M. & Alexander, G.C. 1995. The Abbreviated Profile of Hearing
Aid Benefit. Ear Hear, 16, 176–186.
Davis, A. 1995. Hearing in Adults. London: Whurr Publishers.
Gelfand, S.A. 1995. Long-term recovery and no recovery from the
auditory deprivation effect with binaural amplification: six cases.
J Am Acad Audiol, 6, 141–149.
Gelfand, S.A. & Silman, S. 1993. Apparent auditory deprivation in
children: implications of monaural versus binaural hearing. J Am
Acad Audiol, 4, 313–318.
Hattori, H. 1993. Ear dominance for nonsense-syllable recognition
ability in sensorineural hearing-impaired children: monaural versus
binaural amplification. J Am Acad Audiol, 4, 319–330.
Kiessling, J., Bachmann, J. & Margolf-Hacki, S. 1996. Computer-
unterstützte Erfassung der Subjektiv empfundenen Hörstörung und
des daraus resultierenden Handicaps mit Hilfe von Frageninventaren.
Audiologische Akustik, 35, 110–123.
Lindenberger, U. & Baltes, P.B. 1994. Sensory functioning and intelli-
gence in old age: a strong connection. Psychology Aging, 9, 339–355.
Lindenberger, U. & Baltes, P.B. 1997. Intellectual functioning in old and
very old age: cross-sectional results from the Berlin aging study.
Psychology Aging, 12, 410–432.
Mulrow, C.D., Aguilar, C., Endicott, J.E., Tuley, M.R., Velez, R., et al.
1990. Quality-of-life changes and hearing impairment. Ann Intern
Med, 113, 188–194.
Mulrow, C.D., Tuley, M.R. & Aguilar, C. 1992. Sustained benefits of
hearing aids. J Speech Hear Res, 35, 1402–1405.
Naramura, H., Nakanishi, N., Tatara, K., Ishiyama, M., Shiraishi, H.,
et al. 1999. Physical and mental correlates of hearing impairment in
the elderly in Japan. Audiology, 38, 24–29.
Plomp, R. 1978. Auditory handicap of hearing impairment and the
limited benefit of hearing aids. J Acoust Soc Am, 63, 533–549.
Rosenhall, U., Jönsson, R. & Söderlind, O. 1999. Self-assessed hearing
problems in Sweden: a demographic study. Audiology, 38, 328–334.
Scherer, M.J. & Frisina, R. 1998. Characteristics associated with marginal
hearing loss and subjective well-being among a sample of older
adults. J Rehab Res Dev, 35, 420–426.
Seniors Research Group. 1999. The Consequences of Untreated Hearing
Loss in Older Persons. Washington, DC: The National Council on
the Aging.
Silman, S., Gelfand, S.A. & Silverman, C.A. 1984. Late-onset auditory
deprivation: effects of monaural versus binaural hearing aids.
J Acoust Soc Am, 76, 1357–1362.
Smits, C.H.M., Deeg, D.J.H., Kriegsman, D.M.W. & Schmand, B. 1999.
Cognitive functioning and health as determinants of mortality in an
older population. Am J Epidemiol, 150, 978–986.
Uhlmann, R.F., Larson, E.B., Rees, T.S., Koepsell, T.D. & Duckert,
L.G. 1989. Relationship of hearing impairment to dementia and
cognitive dysfunction in older adults. JAMA, 261, 1916–1919.
Ventry, I.M. & Weinstein, B.E. 1982. The Hearing Handicap Inventory
for the Elderly: a new tool. Ear Hear, 3, 128–134.
... The age-standardized prevalence rate of hearing loss varies considerably among countries and is still increasing (Li et al. 2022). Tinnitus and hearing impairment are chronic conditions, which can significantly compromise patients' quality of life (Arlinger 2003;Li et al. 2022;GBD 2019Hearing Loss Collaborators 2021Trochidis et al. 2021;World Health Organization 2021), and the currently available treatments come at a high cost, leading to public health issues (GBD 2019 Hearing Loss Collaborators 2021; World Health Organization 2021; Trochidis et al. 2021). ...
... A cohort study based on data from the Longitudinal Health Insurance Database 2005 of Taiwan illustrated that individuals with non-migraine headaches have considerably higher risks of experiencing sensorineural hearing loss, tinnitus, and sudden deafness than subjects without chronic headaches (Chen et al. 2019). Significant or disabling hearing loss increases difficulties in detecting sounds, the ability to recognise speech, and identifying the spoken messages of others, leading to reduced intellectual stimulation and social isolation (Arlinger 2003). People with impaired hearing are also predisposed to developing dementia (Arlinger 2003). ...
... Significant or disabling hearing loss increases difficulties in detecting sounds, the ability to recognise speech, and identifying the spoken messages of others, leading to reduced intellectual stimulation and social isolation (Arlinger 2003). People with impaired hearing are also predisposed to developing dementia (Arlinger 2003). Therefore, further research is required to develop new treatments in this field. ...
Article
Objective To describe evidence of migraine-associated tinnitus and hearing loss. Design This study was registered in PROSPERO and followed the PRISMA guidelines. The inclusion criteria were observational studies with subjects aged ≥18 years, in which the association between migraine and tinnitus and/or hearing loss was evaluated. Reviews, case reports, commentaries, letters to the editor, and studies that included individuals with some diseases were excluded. Study sample The search yielded 698 articles from electronic databases. Six studies were eligible for this review with 26,166 participants. Results Most studies have shown an association between migraine and tinnitus, and between migraine and hearing loss. Studies have concluded that migraine presented high odds ratio, and hazard ratio for tinnitus. Another study found a strong association between these conditions (p < 0.001), and two investigations detected the presence of migraine in 10.1 and 22.5% of tinnitus patients. Migraine presented high odds ratio and hazard ratio for hearing loss. Additionally, the studies included were of good quality, adhering to most of the requirements on the JBI Critical Appraisal Checklist. However, a limitation of this review is the small number of studies included. Conclusions Associations between migraine, tinnitus, and hearing loss were observed in the included studies.
... Reduced auditory and intellectual stimulation may give rise to changes in the central nervous system and it may affect the development of cognitive decline and dementia [11]. Literature review on hearing loss or poor speech recognition score has been found associated with overall wellbeing [12]. Significant decline in feeling of loneliness and isolation has been reported within 4 to 6 weeks of hearing aid uses in older person with moderate to severe hearing loss [1,13]. ...
Article
Background and objectives: Severe to profound hearing loss impacts the capacity for verbal communication as well as the social, emotional, and overall quality of life; however, the association between socio-emotional rehabilitation and post-hearing aid use is not widely explored. This study aimed to investigate the socio-emotional change in post-hearing aid fitted individuals with severe to profound hearing loss. Materials and. Methods: A total of 60 individuals comprised of 15 females and 45 males with severe to profound hearing loss within the age range of 40-60 years (mean age and standard deviation of 53.4±6.1), participated in this study. Participants were divided into two categories with a 10-year age interval i.e., 40-50 and 51-60 years. These participants were equally divided into hearing aid user (HAU) and non-hearing aid user (NHAU) groups. The hearing handicapped inventory for the adults-short version (HHIA-S) adapted from Weinstein & Ventry (1983) was used in this study. Results: The mean social score of all the participants was significantly higher than the mean emotional score. However, no such advantage was observed between the HAU and NHAU groups. The mean social score of females in the HAU category was significantly higher than males. The mean social and emotional scores were also compared across two age categories in the age range of 40-50 and 51-60 years and revealed no significant difference between mean social and emotional score across the age categories (p=0.026). Conclusions: In individuals with severe to profound hearing loss, social rehabilitation occurs quicker than emotional. In the HAU group, socialization occurred faster in females than males. These findings suggest that a customized counselling should be developed for the social and emotional wellbeing as these two parameters improve distinctly.
... The selection and prescription of hearing aids is often a key component of audiological rehabilitation in hearing healthcare, and hearing aids are commonly recommended as a first-line treatment to prevent the negative consequences of untreated hearing loss. A person's ability to detect, identify, and localize sounds, as well as to recognize speech sounds, are reduced by uncorrected hearing loss (Arlinger, 2003). These auditory deficits are related to various challenges for them such as poorer quality of life (Chia et al., 2007), social isolation (Ramage-Morin, 2016), depression (Mener et al., 2013), functional and cognitive impairments (Williams et al., 2020), and to burden for significant others (Scarinci et al., 2012). ...
Article
Full-text available
There is increasing evidence to suggest that the implementation of family-centered care practices in clinical audiology yields positive patient outcomes. Previous work showed that significant-other attendance at audiology appointments, a recommended practice consistent with family-centered care, was associated with greater odds of hearing aid adoption and increased satisfaction with hearing aids. The primary goal of this retrospective explorative study was to investigate the unexplored question of whether an association exists between the type of significant other (SO) in attendance at appointments and hearing aid adoption. The study sample consisted of adult patients from a chain of private clinics in the United Kingdom who either attended their audiology appointment with a SO (n = 10,015) or alone (n = 37,152). Six SO types were identified and classified: partner (n = 6,608), parent (n = 76), child (n = 2,577), sibling (n = 208), friend (n = 518), and carer (n = 28). In addition to replicating previous findings which showed that significant-other attendance at audiology appointments was positively associated with hearing aid adoption, results from the current paper also revealed that the odds of hearing aid adoption were greater if the SO was of a stronger relationship tie (i.e., partners, parents, children, and siblings) and not a weaker relationship tie (i.e., friends, carers). These findings suggest that an extension of the non-audiological factor of significant-other attendance during the hearing rehabilitation process should be considered: the relationship type patients have with their significant others.
... Exposure to noise in recreation areas increases the risk of developing hearing loss by 7%, for every 5 years [5]. Noise induced hearing loss ranks among the leading causes of occupational illness among industrial workers [6,7] which subsequently results in unemployment [2,8]. Early detection and prevention of noise induced hearing loss is critical in addressing this occupational hazard. ...
Article
Full-text available
Background Industrial workers are at a high risk of acquiring noise induced hearing loss, yet there is minimal hearing loss screening of such groups of people. Pure Tone Audiometry (PTA), the gold standard for hearing loss screening, is expensive, and not readily available at health sites. Mobile audiometry can bridge this gap. However, there is limited knowledge on its acceptability in low-income countries like Uganda. We aimed to assess the acceptability of using the Wulira App, a validated mobile phone app, in assessing hearing loss among industrial workers in Kampala. Methods We carried out a qualitative study in a steel and iron manufacturing industry in Kampala, in April 2021. Four Focus group discussions (FGDs) with 8 participants per FGD, and 12 In-depth Interviews (IDI), were conducted on the industrial workers. The industrial workers were first tested for hearing loss, then enrolled for the FGDs and IDI. A semi-structured interview guide was used. Audio recordings were transcribed verbatim. Themes were derived using thematic content analysis, borrowing from Sekhon’s model of Acceptability of Health Interventions. Results Industrial workers found the Wulira App user friendly, cheap, time saving, and an effective hearing loss assessment tool. However, barriers such as lack of smart phones, difficulty in navigating the app, and fear of getting bad news hindered the App’s acceptability, as a hearing assessment tool. Conclusion Hearing loss assessment using Wulira App was acceptable to the industry workers. There is need of informing industrial workers on the essence of carrying out regular hearing loss screening, such that barriers like fear of getting screened are overcome.
... The higher direct outpatient costs may be due to more frequent outpatient services utilization by people with hearing loss (Green & Pope 2001). Previous studies have found that hearing loss is associated with physical pain (Arlinger 2003), cognitive status (Lin et al. 2013), and reduced physical function (Dalton et al. 2003). In addition, hearing loss also inevitably leads to communication disorders, so people with hearing loss are more likely to fall into depression, sadness, despair, and helplessness (Knutson & Lansing 1990). ...
Article
Objectives: To our knowledge, hearing loss has been proved by a few studies from developed countries to bring a high economic burden of disease, but there is no relevant cost estimate in China. The purpose of our study was to measure the direct costs attributable to hearing loss among middle-aged and older people aged 45 and above in China in 2011, 2013, and 2015. Design: On the basis of data from the China Health and Retirement Longitudinal Study and the China Statistical Yearbook, an econometric model was used to obtain the hearing-attributable fraction, and then the direct costs attributable to hearing loss of middle-aged and older people aged 45 and above in China in 2011, 2013, and 2015 were calculated. Results: In 2011, 2013, and 2015, the direct costs attributable to hearing loss of middle-aged and older people aged 45 and above in China were $50.699 billion, $81.783 billion, and $106.777 billion, accounting for 3.43, 4.54, and 5.54% of the overall healthcare costs in the same year, respectively. Among the direct costs attributable to hearing loss, direct outpatient costs accounted for 75.75 to 81.13%, and direct inpatient costs accounted for 18.87 to 24.25%. Conclusions: The direct costs attributable to hearing loss for Chinese adults aged 45 and above have placed a heavy burden on Chinese society. The government should give priority and take effective measures to the prevention and treatment of hearing loss.
... Besides the auditory deficits related to deafness described earlier, deafness in older adults may be associated with multiple negative consequences, such as loneliness, isolation, reduced social activity and a feeling of being excluded, which leads to an increase in the prevalence of depression (Arlinger, 2003;Strawbridge et al., 2000). These challenges may be compounded by experiences of dependence, frustration, anxiety, anger, embarrassment, and even guilt (Ciorba et al.,2012). ...
Article
Full-text available
South Africa has experienced considerable international outward migration in the last half century, which has had a severe psychological impact on members of families affected by this phenomenon. Older parents who remain behind may experience feelings of loss and isolation. Information Communication Technologies (ICTs) are useful in maintaining relationships between family members separated by migration and increasingly allow migrant families to experience a virtual co-presence despite geographical separation. However, the process may be challenging, especially for older people with hearing difficulties. This article reports on a qualitative study exploring the perceptions of a group of older adults who have difficulty hearing and who live in a residential care home about using ICTs to communicate with family abroad. Interview data were analysed using thematic analysis. Most of the participants used either a fixed line telephone or a mobile phone. They reported challenges in communicating with family members abroad arising from their deafness, as well as difficulties using technological devices together with their hearing aids. These challenges resulted in feelings of helplessness and frustration. Although the data collection took place prior to the COVID-19 pandemic, these findings may be of particular relevance to situations such as those during the pandemic when many older adults became more reliant on technology to communicate with family members because of restrictions on direct contact. Accordingly, suggestions are made to address challenges in communication between older adults and loved ones who are geographically separated.
... As a matter of fact, the models tested were not acceptable by the structural equation model criteria used. What is also true of the above two data sets is that the hearing losses were only of the mild to moderate kinds (assessed by the pure tone audiogram in Rönnberg et al., 2011, and by the digit triplets test in Rönnberg et al., 2014), suggesting that early prevention with hearing aids should be employed (Arlinger, 2003), although the data for treatment by hearing aids is relatively meager when it comes to dementia. ...
Article
Full-text available
The review gives an introductory description of the successive development of data patterns based on comparisons between hearing-impaired and normal hearing participants’ speech understanding skills, later prompting the formulation of the Ease of Language Understanding (ELU) model. The model builds on the interaction between an input buffer (RAMBPHO, Rapid Automatic Multimodal Binding of PHOnology) and three memory systems: working memory (WM), semantic long-term memory (SLTM), and episodic long-term memory (ELTM). RAMBPHO input may either match or mismatch multimodal SLTM representations. Given a match, lexical access is accomplished rapidly and implicitly within approximately 100–400 ms. Given a mismatch, the prediction is that WM is engaged explicitly to repair the meaning of the input – in interaction with SLTM and ELTM – taking seconds rather than milliseconds. The multimodal and multilevel nature of representations held in WM and LTM are at the center of the review, being integral parts of the prediction and postdiction components of language understanding. Finally, some hypotheses based on a selective use-disuse of memory systems mechanism are described in relation to mild cognitive impairment and dementia. Alternative speech perception and WM models are evaluated, and recent developments and generalisations, ELU model tests, and boundaries are discussed.
Article
Full-text available
Purpose: Ototoxicity is considered a dose-limiting side effect of some chemotherapies. Hearing loss, in particular, can have significant implications for the quality of life for cancer survivors. Here, we review therapeutic approaches to mitigating ototoxicity related to chemotherapy. Methods: Literature review. Conclusions: Numerous otoprotection strategies are undergoing active investigation. However, numerous challenges exist to confer adequate protection while retaining the anti-cancer efficacy of the chemotherapy. Implications for cancer survivors: Ototoxicity can have significant implications for cancer survivors, notably those receiving cisplatin. Clinical translation of multiple otoprotection approaches will aid in limiting these consequences.
Article
Background: Individuals with Down syndrome are known to have high rates of hearing loss, but it is unclear how this impacts their ability to communicate and function in real-world environments. Methods: Sixteen English-speaking and Spanish-speaking mothers of individuals with Down syndrome ages 6-40 years participated in individual, semi-structured interviews using a videoconferencing platform. Session transcripts were analysed using applied thematic analysis. Results: Mothers described listening environments, the impact of hearing on daily life, barriers to successful listening, and strategies to overcome communication barriers for their children with Down syndrome. Conclusions: Hearing was largely discussed in terms of challenges and detriments, suggesting that hearing experiences are predominately considered to negatively impact the functional abilities of individuals with Down syndrome. Background noise and hearing loss were sources of communication difficulties. Parent-reported barriers and strategies can inform ecologically valid research priorities aimed at improving outcomes for individuals with Down syndrome.
Article
Purpose The purpose of this study was to explore the perspectives of audiologists to provide input into development of a smartphone application (app) to document the real-life listening difficulties and the listening environment of hearing aid candidates and users. Method Two focus groups were conducted. Facilitators utilized a topic guide to generate participants' input and perspectives. The focus groups were audio-recorded and transcribed verbatim. The transcripts were then qualitatively analyzed using content analysis. Study Sample The study samples were 10 audiologists (seven females) with 2- to 10-plus years of hearing aid fitting experience. Results Three main categories were identified: (a) The mobile device app could provide meaningful information to help audiologists to counsel their clients, (b) the app could give clients an insight into their hearing difficulties, and (c) the app could help clients to self-manage their hearing condition. Conclusion These findings suggest that audiologists may better understand their clients' real-life listening difficulties through the use of a mobile device app; however, further research is required to harness the benefits of such an app.
Article
Full-text available
Relations among age, sensory functioning (i.e., visual and auditory acuity), and intelligence were examined in a heterogeneous, age-stratified sample of old and very old individuals (N = 156, M age = 84.9 years, age range = 70-103). Intelligence was assessed with 14 tests measuring 5 cognitive abilities (speed, reasoning, memory, knowledge, and fluency). Together, visual and auditory acuity accounted for 49.2% of the total and 93.1% of the age-related reliable variance in intelligence. The data were consistent with structural models in which age differences in intelligence, including speed, are completely mediated by differences in vision and hearing. Results suggest that sensory functioning is a strong late-life predictor of individual differences in intellectual functioning. Explanations are discussed, including the possibility that visual and sensory acuity are indicators of the physiological integrity of the aging brain (common cause hypothesis).
Article
Full-text available
: The terminology used in studies documenting changes in auditory performance following fitting of hearing aids has been diverse. Definitions for the auditory deprivation effect and auditory acclimatization are offered as a first step in rationalization. Two statements summarize current knowledge concerning auditory deprivation effects and auditory acclimatization, as well as considering the potential implications for research, field trial and clinical practice applications. Potential areas for future research are identified. (Ear & Hearing 1996;17;87S-98S) (C) Williams & Wilkins 1996. All Rights Reserved.
Article
We conducted a case-control study in 100 cases who had Alzheimer's-type dementia and 100 age-, sex-, and education-matched, nondemented controls to evaluate the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. The prevalence of a hearing loss of 30 dB or greater was significantly higher in cases than in controls (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.4), even when adjusted for potentially confounding variables. In addition, we observed a dose-response relationship in which greater hearing loss was associated with a higher adjusted relative odds of having dementia. Hearing loss was also significantly and independently correlated with the severity of cognitive dysfunction, as measured by the Mini-Mental State Examination, in nondemented as well as demented patients. These results demonstrate an association between hearing impairment and dementia and lend support to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. (JAMA. 1989;261:1916-1919)
Article
The aim of this article is to promote a better understanding of hearing impairment as a communicative handicap, primarily in noisy environments, and to explain by means of a quantitative model the essentially limited applicability of hearing aids. After data on the prevalence of hearing impairment and of auditory handicap have been reviewed, it is explained that every hearing loss for speech can be interpreted as the sum of a loss class A (attenuation), characterized by a reduction of the levels of both speech signal and noise, and a loss D (distortion), comparable with a decrease in speech-to-noise ratio. On the average, the hearing loss of class D (hearing loss in noise) appears to be about one-third (in decibels) of the total hearing loss (A + D, hearing loss in quiet). A hearing aid can compensate for class-A-hearing losses, giving difficulties primarily in quiet, but not for class-D hearing losses, giving difficulties primarily in noise. The latter class represents the first stage of auditory handicap, beginning at an average hearing loss of about 24 dB.
Article
This study was designed to evaluate long-term benefits of hearing aids in elderly individuals with hearing loss. A primary care cohort of 192 elderly, hearing-impaired veterans (mean age 72 +/- 6, 97% White, 94% retired) were assessed at baseline and at 4, 8, and 12 months after hearing aid fitting. Drop-out rates at 4, 8, and 12 months were 5%, 13%, and 16%, respectively. Outcome assessments included several quality-of-life scales: Hearing Handicap Inventory in the Elderly (HHIE), Quantified Denver Scale of Communication Function (QDS), Geriatric Depression Scale (GDS), and the Short Portable Mental Status Questionnaire (SPMSQ). All quality-of-life areas improved significantly from baseline to 4-month post-hearing aid fittings (p < 0.05). Social and emotional (HHIE), communication (QDS), and depression (GDS) benefits were sustained at 8 and 12 months, whereas cognitive changes (SPMSQ) reverted to baseline at 12 months. We conclude that hearing aids provide sustained benefits for at least a year in these elderly individuals with hearing impairment.
Article
To assess whether hearing aids improve the quality of life of elderly persons with hearing loss. Primary care clinics at a Bureau of Veterans Affairs hospital. One hundred and ninety-four elderly veterans who were identified as being hearing impaired from a screening survey involving 771 consecutive clinic patients. Of the original 194, 188 (97%) completed the trial. Subjects were randomly assigned to either receive a hearing aid (n = 95) or join a waiting list (n = 99). MAIN ENDPOINTS: A comprehensive battery of disease-specific and generic quality-of-life measures were administered at baseline, 6 weeks, and 4 months. Persons assigned to the two groups were similar in age, ethnicity, education, marital status, occupation, and comorbid diseases. At baseline, 82% of subjects reported adverse effects on quality of life due to hearing impairment, and 24% were depressed. At follow-up, a significant change in score improvements for social and emotional function (34.0; 95% CI, 27.3 to 40.8; P less than 0.0001), communication function (24.2; CI, 17.2 to 31.2; P less than 0.0001), cognitive function (0.28; CI, 0.08 to 0.48; P = 0.008), and depression (0.80; CI, 0.09 to 1.51; P = 0.03) was seen in subjects who received hearing aids compared with those assigned to the waiting list. Six drop-outs (three per group), no crossovers, and no significant changes in cointerventions were seen. Average, self-reported, daily aid use in the hearing aid group was 8 hours. Hearing loss is associated with important adverse effects on the quality of life of elderly persons, effects which are reversible with hearing aids.
Article
We conducted a case-control study in 100 cases who had Alzheimer's-type dementia and 100 age-, sex-, and education-matched, nondemented controls to evaluate the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. The prevalence of a hearing loss of 30 dB or greater was significantly higher in cases than in controls (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.4), even when adjusted for potentially confounding variables. In addition, we observed a dose-response relationship in which greater hearing loss was associated with a higher adjusted relative odds of having dementia. Hearing loss was also significantly and independently correlated with the severity of cognitive dysfunction, as measured by the Mini-Mental State Examination, in nondemented as well as demented patients. These results demonstrate an association between hearing impairment and dementia and lend support to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults.
Article
Performance on tests of pure-tone thresholds, speech-recognition thresholds, and speech-recognition scores for the two ears of each subject were evaluated in two groups of adults with bilateral hearing losses. One group was composed of individuals fitted with binaural hearing aids, and the other group included persons with monaural hearing aids. Performance prior to the use of hearing aids was compared to performance after 4-5 years of hearing aid use in order to determine whether the unaided ear would show effects of auditory deprivation. There were no differences over time for pure-tone thresholds or speech-recognition thresholds for both ears of both groups. Nevertheless, the results revealed that the speech-recognition difference scores of the binaurally fitted subjects remained stable over time whereas they increased for the monaurally fitted subjects. The findings reveal an auditory deprivation effect for the unfitted ears of the subjects with monaural hearing aids.
Article
This report describes the development and standardization of the Hearing Handicap Inventory for the Elderly (HHIE). This self-assessment tool is designed to assess the effects of hearing impairment on the emotional and social adjustment of elderly people. The inventory is comprised of two subscales: a 13-item subscale explores the emotional consequences of hearing impairment; a 12-item subscale explores both social and situational effects. The inventory was administered to 100 elderly subjects (mean age = 75 years) with hearing threshold levels in the better ear ranging from normal to severe. The reliability of the HHIE was evaluated by assessing its internal consistency through the computation of Chronbach's alpha. Alpha values ranged from 0.88 (social/situational subscale) to 0.95 for the entire inventory. Split-half reliabilities were equally high. The validity of the HHIE was not directly evaluated. Certain aspects of the data, however, support the construct validity of the instrument, while analysis of the questions themselves appears to attest to its content validity. Possible uses of the inventory were described and suggestions were made regarding future research on the instrument. The reliability and validity of the HHIE as well as its brevity, simplicity, and ease of administration and interpretation all recommend its use in assessing hearing handicap in the elderly.