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Hearing Loss and Cognitive Decline

Senior woman suffering from tinnitus or ringing in her ears.

A man was convinced his wife was losing her hearing, so one day he decided to run a little test.  While his wife was at the kitchen sink with her back to him, he stepped just inside the kitchen and called her name in a normal tone.

No response.

He stepped closer and repeated the process.

No response.

Finally, he stepped directly behind her and called her name again.

She turned around and said, “What are you doing?  I’ve answered you twice.  What do you want?”

An old expression about one’s brain rusting may not land well with folks who are experiencing hearing loss, but studies conducted by some pre-eminent experts in the field at Johns Hopkins conclude that hearing loss is linked to developing problems thinking and remembering in older adults.

Some may need strong encouragement, others just a gentle nudge to transition to using hearing aids, but we can all agree, friends and family suffer when these devices stay in the drawer.

Simply put; you hear with your brain, your ears make electricity that is carried to your brain through the hearing nerves.   Here’s how we interpret sound:

The Outer Ear

The auricle (pinna) is the visible portion of the outer ear. It collects sound waves and channels them into the ear canal (external auditory meatus), where the sound is amplified. The sound waves then travel toward a flexible, oval membrane at the end of the ear canal called the tympanic membrane or eardrum. Sound waves cause the eardrum to vibrate.

The Middle Ear

The vibrations from the eardrum set the ossicles- the smallest bones in the human body, into motion. These three bones are named after their shapes: the malleus (hammer), incus (anvil) and stapes (stirrup). The ossicles further amplify the sound.   Within the Middle ear we find the Eustachian tube, a canal that links the middle ear with the back of the nose.  This tube is responsible for equalizing pressure and transferring sound waves between the outer ear and the middle ear.

The Inner Ear

Sound waves enter the inner ear and then into the cochlea, a snail-shaped organ. The cochlea is filled with a fluid that moves in response to the vibrations from the oval window. As the fluid moves, 25,000 nerve endings are set into motion. These nerve endings transform the vibrations into electrical impulses that then travel along the eighth cranial nerve (auditory nerve) to the brain.

The brain then interprets these signals, and this is how we hear.

Signs of Hearing Loss

Underlying health issues can be signaled by hearing loss.  One may not necessarily connect hearing function with diabetes or cardiovascular issues, but poor circulation, often a symptoms of the later, is also indicative of poor hearing. Listen to your ears! A simple hearing test should be added to your healthcare routine to stay vital and aware of your overall health. Consider that on average people wait four years before acting on their hearing loss once accepting there is an issue, precious time is lost that would be better spent protecting brain function.

The following symptoms may indicate that a hearing check is in order:-

  • Occasionally thinking others are mumbling or speaking too softly
  • Difficulty hearing phone conversations
  • Inappropriately responding to others after misunderstanding what was said
  • Frequently being told that your TV or radio is too loud
  • Constant roaring, ringing, or hissing in your ears
  • Difficulty hearing or understanding conversations with more than two people
  • Needing others to repeat themselves regularly
  • Avoiding crowded places and restaurants because of difficulty hearing

Bringing it home – hearing loss and cognitive decline

In a study that tracked 639 adults for nearly 12 years, Johns Hopkins expert Frank Lin, M.D., Ph. D., and his colleagues found that mild hearing loss doubled dementia risk. Moderate loss tripled risk, and people with a severe hearing impairment were five times more likely to develop dementia.

In the study, volunteers with hearing loss, participated in repeated cognition tests over six years, had cognitive abilities that declined some 30 percent to 40 percent faster than in those whose hearing was normal. Levels of declining brain function were directly related to the amount of hearing loss, the researchers say. On average, older adults with hearing loss developed a significant impairment in their cognitive abilities 3.2 years sooner than those with normal hearing.

The findings, reported in the JAMA Internal Medicine, are among the first to emerge from a larger, ongoing study monitoring the health of older blacks and whites in Memphis, Tenn., and Pittsburgh, Pa. Known as the Health, Aging and Body Composition, or Health ABC study, the latest report on older adults involved a subset of 1,984 men and women between the ages of 75 and 84, and is believed to be the first to gauge the impact of hearing loss on higher brain functions over the long term. According to senior study investigator and Johns Hopkins otologist and epidemiologist Frank Lin MD PhD,  all study participants had normal brain function when the study began in 2001, and were initially tested for hearing loss, which hearing specialists define as recognizing only those sounds louder than 25 decibels.

“Our results show that hearing loss should not be considered an inconsequential part of aging, because it may come with some serious long-term consequences to healthy brain functioning,” says Lin, an assistant professor at the Johns Hopkins University School of Medicine and the university’s Bloomberg School of Public Health.

“Our findings emphasize just how important it is for physicians to discuss hearing with their patients and to be proactive in addressing any hearing declines over time,” says Lin. He estimates that as many as 27 million Americans over age 50, including two-thirds of men and women aged 70 years and older, suffer from some form of hearing loss. More worrisome, he says, only 15 percent of those who need a hearing aid get one, leaving much of the problem and its consequences untreated.

But, help, and hope is on the way.

Reasons folks balk at the idea of hearing aids include:

  1. Denial of the problem – my hearing’s not that bad
  2. Not wanted to appear old- devices are smaller and sleeker these days
  3. Cost not covered by Medicare or insurance plans – OTC purchasing is now a reality.
  4. Worried about what others might think and perceived social stigma.

Medicare doesn’t cover the cost of hearing aids which can easily cost about $4700 which, for most Americans

is the third largest purchase they will make, house – car- hearing aids.  However, in October the Food and Drug Administration cleared the way for over the counter purchasing for hearing aids. Online and retail stores will be offering the devices on the low end at about $200 up to $800 – a far cry from the nearly $5000 investment needed prior to this life changing initiative for many suffering from mild to moderate hearing loss.

The take away is to encourage loved ones to get their hearing tested to avoid the self-imposed isolation that often happens when hearing is a challenge.