What Is the Cost of Hearing Loss? 


Barbara Reynolds, Audiologist

Many people ask how much hearing aids cost, but very few people ask what the cost of the hearing loss is.  When deciding whether to address a hearing loss with the intervention of hearing aids, we also need to understand the other side of the equation . . . that of doing nothing at all. Is there a cost to doing nothing?  The answer is yes.

Old and new research has shown that the costs of an untreated hearing loss are many.  For many years audiology, psychology and related fields have researched the social and psychological impacts of hearing loss.  And for years we have known that a hearing loss leaves a person more prone to depression, apathy, social withdrawal and reduced ability to understand speech.  But research starting in 1986, started looking at the other costs.  What could they be?

In 1986, Richard Ulhmann and others began an initial study looking at the rates of hearing loss and dementia.  From this first study which indicated a possible link, they performed a second study in 1989 which included more of the standard hearing tests we use in a clinic every day with cognitive and memory testing that matched more of the guidelines for psychology.  This 1989 study was the first one to quantify a risk between hearing loss and memory loss and the risk of dementia or mental decline.

 Since that study was released, there have been at least 2 dozen studies that also show the real risk of a hearing loss is not the social aspects,  but decreases in mental or cognitive abilities.  In 2011, Frank Lin and colleagues, released a study out of the Johns Hopkins Institute that replicated the results closely with the 1989 article from Ulhmann, et.al..  The results showed that for even a mild hearing loss, the risk of dementia or cognitive decline doubles.  For moderate hearing losses, the risk is 3 times what it is for a normal hearing person within the same age group. And for severe hearing losses, the risk of developing memory problems if 5 times what it is for normal hearing.  And the risk of developing Alzheimer’s disease increases with every 10 dB decrease in hearing.

Additionally, in January of 2013, Dr. Lin reported a follow up study where people with and without hearing loss were followed for 6 years with periodic cognitive testing.  Those patients with hearing loss showed progressive decline that was 30-40% faster than those with normal hearing.  The levels of decline were directly related to the degree of hearing loss.  In fact, on average, hearing loss produced adecline in cognition 3.2 years sooner than if they would have had normal hearing.


How much hearing does it take?

One of the most surprising findings from the 2011 study was that when given memory tests and 2 other cognitive tests to 2 groups of people, those who had very normal hearing between 0-15dB and those who had what has been traditionally deemed the low end of normal at 25dB, those with the levels of 25dB showed a mental aging affect of almost 7 years compared to those with very normal hearing.  Yet, only 3% of people with mild hearing loss (25-40dB) are wearing amplification to correct for the loss.  That means 97% of people with mild hearing loss are potentially aging faster than necessary because of lack of education about the true costs of their hearing loss.

As with most findings in medical science, these findings do not guarantee a loss of mental functioning due to the hearing loss, but the risks are significantly higher, especially with a greater hearing loss. In fact, that correlation or connection becomes statistically significant at 40dB which indicates the beginning of a moderate loss. 

Dr. Lin, an otologist and epidemiologist from Johns Hopkins University School of Medicine states “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. (www.sciencedaily.com Jan 21 2013).  In Plasticity of the Auditory System by Springer Handbook of Auditory Research (2008 page. 264) it states as well that “the aging population is going to have to come to terms with the fact that in order to maintain cell integrity, it requires acoustic input”.

The research supports that the cost of the hearing loss is far more serious than the costs of intervention. 

Please seek help by contacting your family doctor, an otolaryngologist or an audiologist or hearing instrument specialist for an initial assessment of your hearing.  Early intervention is critical to maintaining healthier and more robust brain functioning in perceiving sound and preserving the nerves that respond to sound in your memory, attention and emotional networks as well.


 References

“Uhlmann, R.F.; Larson, E.B. & Koepsell, T.D.: Hearing impairment and cognitive decline in senile dementia of the Alzheimer’s Type.  J Am Geriatr Soc 1986:34: 207-210

“Uhlmann, R.F.; et.al.: Relationship of Hearing Impairment to Dementia and Cognitive Dysfunction in Older Adults.  JAMA 1989;261: 1916-1919

Lin, Frank, et.al.: Hearing Loss and Incident Dementia Arch Neurol. 2011;68(2):214-220

www.sciencedaily.com:  Jan. 21, 2013: Hearing Loss Accelerates Brain Function Decline in Older Adults. (Full article online JAMA Internal Medicine by Frank Lin – Johns Hopkins University.

Andersson, U. & Lyxell, B.: Phonological deterioration in adults with an acquired severe hearing impairment.  A deterioration in long-term memory or working memory?  Scand Audiol 1999;28: 241-247

McCoy, S.L., et.al.:  Hearing loss and perceptual effort:  downstream effects on older adults’ memory for speech  Q J Exp Psychol A 2005;58(1):22-33

van Boxtel, M.P.; et.al.: Mild Hearing Impairment Can Reduce Verbal Memory Performance in a Healthy Adult Population.  J Clin Exp Neuropsychol 2000;22: 147-154

Sciencedaily.com:  Musical Experience Offsets Some Aging Effects:  Older Musicians Excel in Memory and Hearing Speech in Noise compred to Non-Musicians  May 12 2011

Gold, M.; Lightfoot, L.A. & Hnath-Chisolm, T: Hearing Loss in a Memory Disorders Clinic: A Specially Vulnerable Population.  Arch Neurol 1996;53: 922-928

Gates, G.A.; et.al.:  Central Auditory Dysfunction May Precede the Onset of Clinical Dementia in People With Probable Alzheimer’s Disease  J Am Geriatr Soc 2002;50: 482-488

Gates, G.A.; et.al.: Central Auditory Dysfunction, Cognitive Dysfunction and Dementia in Older People Arch Otolaryngol Head Neck Surg. 1996;122: 161-167

Valentijn, S.A., et.al.: Change is sensory functioning predicts change in cognitive functioning: results from a 6-year follow-up in the Maastricht aging study  JAGS 2005;53(3):374-380

Weinstein & Amsel Hearing impairment and cognitive function in Alzheimer’s disease. J Am Geriatr Soc. 1987 Mar;35(3):273-5

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