Consequences of Mild to Moderate Hearing loss in Adults

It is well known among auditory scientists and clinicians that hearing loss from any cause, including ototoxicity, has substantial psychosocial consequences on adults, such as communication difficulties, social isolation, social stigmatization, cognitive impairment, lower wages, higher unemployment, and depression (Heffernan et al., 2016; Sprinzl et al., 2010). However, even in medical and scientific literature, there is often an assumption that these effects apply mostly to elderly adults, usually with more severe forms of hearing loss (Monzani et al., 2008). In fact, hearing loss has equally significant consequences on adults of all ages, and can potentially effect mental health and well-being among younger patients (age less than 65 years) more profoundly than older individuals (Tambs, 2004).

It is tempting to conclude that adults with mild to moderate hearing loss should have minimal deterioration of quality of life because they still have meaningful capacity to hear relative to those who are severely hearing impaired or deaf. In reality, adults with mild and moderate hearing loss report primarily negative consequences of this handicap, including poor identity (feeling old and unintelligent), decreased participation in social activities, communication and relationship difficulties, fewer community and professional activities, and more loneliness (Heffernan et al., 2016). Below, the effects of mild and moderate hearing loss on cognitive ability, social engagement, and psychological health are examined in greater detail. Cognitive Decline

Hearing loss in older adults is known to be an independently associated risk factor for poor cognitive function and early onset of dementia (Fortunato et al., 2016), and this association is true when specifically considering adults with mild and moderate hearing loss. For example, cognitive testing scores (including assessment of orientation, concentration, language, praxis, memory, and executive function) have been shown to decline 30-40% faster in individuals with hearing loss beginning with only a 25 dB threshold shift (defined as mild hearing loss), and increase in direct proportion with the severity of an individual’s baseline hearing loss (Lin et al., 2013).

Dementia (memory loss) is also more prevalent among adults with mild or moderate hearing impairment. The increased risk of dementia becomes evident for hearing loss of only 25 dB, and increases in a significant log-linear relationship with each incremental 10 dB threshold shift beyond this (Lin et al., 2011). In this same study, the rate of dementia incidence was almost twice as high for patients with mild hearing loss and three times as high for patients with moderate hearing loss compared to normal hearing individuals.

Social and Professional Engagement Hearing impairment can understandably lead to frustration and decreased participation in social and professional activities, but these restrictions are not limited to older or more severely hearing-impaired individuals. For example, among a cohort of men and women with a mean age of 46 years and mild or moderate hearing loss (mean hearing threshold of 40 dB), participation in social activities was significantly reduced, relational problems with family and

friends were increased, and emotional difficulties at work were higher than matched controls with no hearing loss (Monzani et al., 2008). Younger individuals with hearing loss are also more likely to seek early retirement. Two separate cross-sectional studies showed that working men age 31-45 years were approximately 1.5x more likely to seek early retirement for each 10 dB hearing loss compared to normal hearing workers (Helvik et al., 2012). This effect was more pronounced than in older workers (age 46-65 years), who showed only a 1.2x increased likelihood of seeking early retirement with each 10 dB loss of hearing.

Psychological Health and Quality of Life Mild to moderate hearing loss has been demonstrated to reduce quality of life and increase rates of depression. For example, among a cohort of 472 individuals of whom 106 had mild to moderate hearing loss (thresholds of 27-55 dB), quality of life (defined by emotional, social, and communication function) was significantly reduced in those with hearing loss, and this handicap was perceived as severe by those affected (Mulrow et al., 1990). A separate cross-sectional study of 1,328 participants age 60 years and above found that mild hearing loss (thresholds of 25-40 dB) was associated with a significantly (1.83x) higher risk of depressive symptoms compared to normal hearing individuals (Gopinath et al., 2009). Among younger, working individuals, mild and moderate hearing impairment was associated with significantly worse psychological well-being than normal hearing subjects, especially if their professions involved high-stress work (Monzani et al., 2008).

Conclusion Hearing impairment does not need to be severe to have a significantly detrimental effect on the lives of adults. It is therefore clear that any effective measures to prevent hearing loss would be beneficial to cognitive function, social participation, workplace success, psychosocial health, and other measures of quality of life. Ototoxicity is one potential cause of hearing loss, and could be prevented or minimized by improved understanding and awareness. Such prevention would begin with routine screening of drugs for ototoxic effects. Given the various consequences of even mild and moderate hearing loss on adults, routine ototoxicity screening should be a logical priority for drug manufacturers and regulators.

References Fortunato, S., Forli, F., Guglielmi, V., de Corso, E., Paludetti, G., Berrettini, S., & Fetoni, A.R. (2016). A review of new insights on the association between hearing loss and cognitive decline in ageing. Acta Otorhinolaryngologica Italica 36, 155-166.

Gopinath, B., Wang, J.J., Schneider, J., Burlutsky, G., Snowdon, J., McMahon, C.M., Leeder, S., & Mitchell, P. (2009). Depressive symptoms in older adults with hearing impairment: the Blue Mountains Study. J Am Gereatr Soc 57(7), 1306-1308.

Heffernan E., Coulson, N.S., Henshaw, H., Barry, J.G., & Ferguson, M.A. (2016). Understanding the psychosocial experiences of adults with mild-moderate hearing loss: an application of Leventhals’s self-regulatory model. Int J Audiol 55(Suppl 3), S3-S12.

Helvik, A-S., Krokstad, S., & Tambs, K. (2012). Hearing loss and risk of early retirement. The HUNT study. Eur J Pub Health 23(4), 617-622.

Lin, F.R., Metter, E.J., O’Brien, R.J., Resnick, S.M., Zonderman, A.B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Arch Neurol 68(2), 214-220.

Lin, F.R., Yaffe, K., Xia, J., Xue, Q-L., Harris, T.B., Purchase-Helzner, E., et al. (2013). Hearing loss and cognitive decline among older adults. JAMA Intern Med 173(4), 1-14.

Monzani, D., Galeazzi, G.M., Genovese, E., Marrara, A., & Martini, A. (2008). Psychological profile and social behaviour of working adults with mild or moderate hearing loss. Acta Otorhinolaryngologica Italica 28, 61-66.

Mulrow, C.D., Aguilar, C., Endicott, J.E., Velez, R., Tuley, M.R., Charlip, W.S., & Hill, J.A. (1990).

Association between hearing impairment and the quality of life of elderly individuals. J Am Geriatr Soc 38(1), 45-50.

Sprinzl, G.M., & Riechelmann, H. (2010). Current trends in treating hearing loss in elderly people: a review of the technology and treatment options – a mini-review. Gerontology 56, 351-358.

Tambs, K. (2004). Moderate effects of hearing loss on mental health and subjective well-being: results from the Nord-Trondelag Hearing loss study. Psychosom Med 66, 776-82.

Authors David Hicks, M.D.: Dr. Hicks directs business development at Turner Scientific, and has significant training and experience in clinical treatment of ear disorders. Contact: dhicks@turnerscientific.com

Jeremy Turner, Ph.D.: Dr. Turner is the founder and Chief Scientific Officer at Turner Scientific. He completed his Ph.D. in auditory neuroscience, and has more than 22 years’ experience in preclinical hearing loss, tinnitus, and ototoxicity research. Contact: jturner@turnerscientific.com

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