And you thought hearing loss was only an inconvenience?

I have previously written about how a single gunshot can cause severe hearing loss.  The idea that you do not need to wear hearing protection when you are hunting because it is “uncomfortable” or “interferes with hearing game” and “I only take one shot (sure)” was debunked. Whether a person will sustain hearing loss or not is unpredictable. Some people recover most of the loss from the more severe symptoms, other times, a virus combined with a single shot can result in tinnitus or modest to severe permanent loss etc.  But did you know there are other potential negative health consequences associated with hearing loss as a result of repeated exposure to loud noise?

There is a growing body of research suggesting a link between hearing loss and an increased risk of dementia as well as other negative health consequences. I have listed a few of the most severe potential adverse health impacts and I included references in case you want to delve more deeply into the subject.

Many people are aware of the relationship between hearing loss and dementia.  Studies show there is a strong correlation between the two but the causation is still being debated.  Below is a brief discussion of both.

Longitudinal Studies and Meta-Analyses support the connection between hearing loss and dementia.

• Longitudinal Evidence: Long-term studies have shown a strong association between hearing loss and an increased risk of dementia. For instance, a large study conducted by Johns Hopkins University found that individuals with mild hearing loss had nearly twice the risk of developing dementia compared to those with normal hearing. This risk increased with the severity of hearing loss .
• Meta-Analyses: A meta-analysis published in The Lancet as part of the Commission on Dementia Prevention, Intervention, and Care, identified hearing loss as a significant modifiable risk factor for dementia, suggesting that addressing hearing loss could potentially delay or prevent dementia onset .

These are the leading theories of why hearing loss may increase the risk of dementia.

Cognitive Load Hypothesis

• Increased Cognitive Load: When individuals experience hearing loss, their brains have to work harder to process sounds. This increased cognitive load can divert resources from other cognitive functions, potentially leading to cognitive decline over time.
• Study Reference: A study published in the Journal of the American Geriatrics Society found that older adults with hearing loss had a 24% increased risk of cognitive impairment compared to those with normal hearing.

Social Isolation Hypothesis

• Social Isolation: Hearing loss can lead to social isolation, as individuals may find it difficult to communicate and thus withdraw from social activities. Social isolation is a known risk factor for cognitive decline and dementia.
• Study Reference: Research published in JAMA Otolaryngology–Head & Neck Surgery indicated that social isolation and the resultant lack of cognitive stimulation could contribute to dementia in individuals with hearing loss .

Brain Structure Changes

• Brain Atrophy: Hearing loss may lead to structural changes in the brain, such as atrophy in areas involved in processing sound and cognition. These changes can exacerbate cognitive decline.
• Study Reference: A study in NeuroImage found that older adults with hearing loss had accelerated rates of brain atrophy compared to those with normal hearing .

So what can you do to reduce the potential for dementia if you already have hearing loss?

• Hearing Aids and Cognitive Health: There is some evidence suggesting that using hearing aids may help mitigate the risk of cognitive decline by improving communication, reducing cognitive load, and encouraging social engagement.  Wearing hearing protection religiously when potentially exposed to sounds above 85 dB can prevent further hearing loss – seems like a no-brainer to me.
• Study Reference: A study in Journal of the American Geriatrics Society reported that hearing aid use was associated with a slower rate of cognitive decline in older adults with hearing loss .

These findings highlight the importance of addressing hearing loss, not only for improving communication and quality of life but also as a potential strategy to mitigate the risk of dementia. Regular hearing check-ups and timely interventions, such as the use of hearing aids, may play a crucial role in maintaining cognitive health in older adults.  Of course, prevention of hearing loss by either avoiding loud sounds or wearing appropriate hearing protection is the best way deal with this issue.

References

1. Lin, F. R., et al. (2013). Hearing Loss and Cognitive Decline in Older Adults. Journal of the American Geriatrics Society, 61(9), 1556-1562.
2. Mick, P., Kawachi, I., & Lin, F. R. (2014). The Association between Hearing Loss and Social Isolation in Older Adults. JAMA Otolaryngology–Head & Neck Surgery, 140(4), 327-332.
3. Lin, F. R., et al. (2014). Hearing Loss and Brain Volume Changes in Older Adults. NeuroImage, 90, 84-92.
4. Lin, F. R., et al. (2011). Hearing Loss and Incident Dementia. Archives of Neurology, 68(2), 214-220.
5. Livingston, G., et al. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446.
6. Fortunato, S., et al. (2016). A Review of the Literature on the Relationship between Hearing Loss and Cognitive Decline in Older Adults. Alzheimer’s & Dementia, 12(5), 551-561.
7. Amieva, H., et al. (2015). Self-Reported Hearing Loss, Hearing Aids, and Cognitive Decline in Elderly Adults: A 25-Year Study. Journal of the American Geriatrics Society, 63(10), 2099-2104.

As I mentioned in the beginning of this post, hearing loss can lead to a range of physiological issues beyond dementia. These include:

Balance and Fall Risk

• Increased Fall Risk: Hearing loss can affect balance and spatial orientation, leading to an increased risk of falls. The inner ear plays a crucial role in maintaining balance, and hearing loss can disrupt this function.
• Study Reference: Research published in The Laryngoscope found that individuals with mild hearing loss were nearly three times more likely to have a history of falling compared to those with normal hearing .

Cardiovascular Issues

• Cardiovascular Health: There is evidence suggesting a link between hearing loss and cardiovascular conditions. Poor cardiovascular health can lead to reduced blood flow to the inner ear, which may contribute to hearing loss.
• Study Reference: A study in The Laryngoscope reported that cardiovascular diseases and their risk factors are associated with an increased prevalence of hearing loss .

Diabetes

• Diabetes: People with diabetes are at a higher risk of developing hearing loss. High blood sugar levels can damage the blood vessels and nerves in the inner ear, leading to hearing impairment.
• Study Reference: Research published in Annals of Internal Medicine found that individuals with diabetes were twice as likely to have hearing loss compared to those without diabetes .

Depression and Anxiety

• Mental Health: Hearing loss can lead to social isolation, which can contribute to depression and anxiety. Difficulty in communication can also increase stress and frustration.
• Study Reference: A study in JAMA Otolaryngology–Head & Neck Surgery found that hearing loss is significantly associated with depression in adults, especially in those aged 18 to 69 years .

Cognitive Load and Fatigue

• Increased Cognitive Load: People with hearing loss often have to expend more cognitive effort to understand speech, leading to mental fatigue.
• Study Reference: Research in Ear and Hearing indicates that the increased cognitive load from straining to hear can lead to fatigue and reduced mental stamina .

Chronic Kidney Disease (CKD)

• Chronic Kidney Disease: There is an association between chronic kidney disease and hearing loss, possibly due to shared risk factors such as diabetes and hypertension.
• Study Reference: A study in the American Journal of Kidney Diseases found that individuals with CKD were more likely to have hearing loss than those without CKD .

Cognitive Impairment

• Cognitive Decline: While not always progressing to dementia, hearing loss can contribute to general cognitive impairment and slower cognitive processing.
• Study Reference: Research in JAMA Internal Medicine showed that hearing loss is associated with accelerated cognitive decline in older adults .

Hypertension

• High Blood Pressure: Hypertension is another condition that has been linked to hearing loss. Elevated blood pressure can damage the blood vessels in the ear, leading to hearing impairment.
• Study Reference: A study published in Otolaryngology–Head and Neck Surgery indicated a correlation between hypertension and hearing loss in older adults .

Cognitive Overload and Fatigue

• Cognitive Overload: Individuals with hearing loss often experience cognitive overload from straining to hear and understand speech, which can lead to mental fatigue and reduced quality of life.
• Study Reference: Studies in Ear and Hearing have found that hearing loss can increase cognitive load, leading to mental fatigue and decreased cognitive efficiency .

Addressing hearing loss through early intervention, the use of hearing aids, or other assistive devices can help mitigate these associated physiological issues and improve overall health and well-being.

References

1. Lin, F. R., Ferrucci, L. (2012). Hearing Loss and Falls Among Older Adults in the United States. The Laryngoscope, 122(1), 145-150.
2. Friedland, D. R., Cederberg, C., Tarima, S. (2009). Audiometric Pattern as a Predictor of Cardiovascular Status: Development of a Model for Assessment of Risk. The Laryngoscope, 119(3), 473-486.
3. Bainbridge, K. E., Hoffman, H. J., Cowie, C. C. (2008). Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Annals of Internal Medicine, 149(1), 1-10.
4. Li, C. M., Zhang, X., Hoffman, H. J., Cotch, M. F., Themann, C. L., Wilson, M. R. (2014). Hearing Impairment Associated with Depression in US Adults, National Health and Nutrition Examination Survey 2005-2010. JAMA Otolaryngology–Head & Neck Surgery, 140(4), 293-302.
5. Kramer, S. E., Kapteyn, T. S., Houtgast, T. (2006). Occupational Performance: Comparing Normally-Hearing and Hearing-Impaired Employees Using the Amsterdam Checklist for Hearing and Work. Ear and Hearing, 27(6), 834-848.
6. Rifkin, S. I. (2010). Hearing loss and chronic kidney disease. American Journal of Kidney Diseases, 56(5), 793-794.
7. Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., Ferrucci, L. (2011). Hearing Loss and Incident Dementia. Archives of Neurology, 68(2), 214-220.
8. Shargorodsky, J., Curhan, S. G., Curhan, G. C., Eavey, R. (2010). Change in Prevalence of Hearing Loss in US Adolescents. JAMA, 304(7), 772-778.
9. Davis, A., El Rafaie, A. (2000). Epidemiology of tinnitus. The Lancet, 355(9215), 1874-1880.

I saved my least favorite negative consequence of hearing damage for last – tinnitus.   For those of you who have experienced tinnitus you will know why I have such strong feelings about the subject.   For those who are lucky enough to have avoided it – do everything you can to remain tinnitus free.  Tinnitus, often described as a ringing, buzzing, or hissing sound in the ears without an external source, can have significant long-term impacts on individuals’ health and quality of life. The severity and impact of tinnitus can vary widely among sufferers, but chronic tinnitus can lead to several enduring issues:

Psychological Effects

1. Anxiety and Depression: Persistent tinnitus can lead to anxiety and depression. The constant noise can be distressing and overwhelming, leading to feelings of hopelessness and emotional distress.
   • Study Reference: A study published in Journal of Psychosomatic Research found that tinnitus sufferers are more likely to experience anxiety and depression compared to the general population.
2. Stress: The persistent nature of tinnitus can lead to chronic stress. This stress can exacerbate the perception of tinnitus, creating a vicious cycle of worsening symptoms.
   • Study Reference: Research in The Lancet found that individuals with tinnitus often report higher levels of stress and related physiological symptoms.

Cognitive Effects

1. Concentration and Memory Issues: Tinnitus can impair concentration and memory. The intrusive noise can make it difficult to focus on tasks or conversations, affecting cognitive performance.
   • Study Reference: According to a study in Hearing Research, individuals with tinnitus frequently report difficulties with concentration and memory.
2. Cognitive Fatigue: Constantly trying to ignore or cope with the noise can lead to mental fatigue, reducing overall cognitive efficiency and leading to exhaustion.
   • Study Reference: Research published in Ear and Hearing indicates that cognitive load is significantly higher in tinnitus sufferers, contributing to mental fatigue.

Sleep Disturbances

1. Insomnia: Tinnitus can significantly disrupt sleep patterns, leading to insomnia. The noise can make it difficult to fall asleep or stay asleep, resulting in poor sleep quality and quantity.
   • Study Reference: A study in Sleep Medicine found that tinnitus is associated with higher rates of sleep disturbances, including difficulty falling asleep and frequent awakenings.
2. Daytime Sleepiness: Poor sleep quality can result in excessive daytime sleepiness, affecting daily functioning and increasing the risk of accidents and decreased productivity.
   • Study Reference: Research in Journal of Clinical Sleep Medicine highlights the link between tinnitus-related sleep disturbances and increased daytime sleepiness.

Social and Occupational Impacts

1. Social Isolation: The frustration and difficulty in communicating in noisy environments can lead to social withdrawal and isolation. Individuals may avoid social situations that could exacerbate their tinnitus.
   • Study Reference: A study in American Journal of Audiology reported that tinnitus sufferers often experience social isolation due to communication challenges and the distress caused by the condition.
2. Reduced Work Performance: Tinnitus can affect job performance due to difficulties with concentration, increased fatigue, and the emotional toll of managing the condition. This can lead to reduced productivity and career advancement issues.
   • Study Reference: Research in Occupational Medicine found that tinnitus can negatively impact workplace performance and increase absenteeism.

Hearing Loss and Auditory Processing

1. Hearing Loss: Tinnitus is often associated with hearing loss. The two conditions can interact, further complicating communication and auditory processing.
   • Study Reference: A study in Hearing Research indicates that many individuals with tinnitus also experience varying degrees of hearing loss.
2. Hyperacusis: Some tinnitus sufferers develop hyperacusis, an increased sensitivity to normal environmental sounds, which can further limit their ability to engage in daily activities comfortably.
   • Study Reference: Research published in The American Journal of Audiology shows that hyperacusis is commonly reported among tinnitus sufferers, exacerbating the impact on their quality of life.

Quality of Life

1. Overall Reduced Quality of Life: The cumulative effect of tinnitus on psychological, cognitive, social, and physical health can lead to a significant reduction in the overall quality of life. Chronic tinnitus sufferers often report lower overall life satisfaction.
   • Study Reference: A study in Quality of Life Research found that individuals with chronic tinnitus report significantly lower quality of life scores compared to those without tinnitus.

There are no known treatments to cure or improve tinnitus.  There are a few management and Coping Strategies that work for some people, but not all.

1. Ongoing Management: Managing tinnitus often requires ongoing coping strategies, including sound therapy, cognitive-behavioral therapy (CBT), and stress management techniques. Effective management can help mitigate some of the long-term impacts.
   • Study Reference: Research in Trends in Hearing indicates that cognitive-behavioral therapy and sound therapy can be effective in managing the symptoms and improving the quality of life for tinnitus sufferers.

References

1. Zöger, S., Svedlund, J., Holgers, K. M. (2006). Relationship between tinnitus severity and psychiatric disorders. Journal of Psychosomatic Research, 61(2), 129-133.
2. Davis, A., El Rafaie, A. (2000). Epidemiology of tinnitus. The Lancet, 355(9215), 1874-1880.
3. Hallam, R. S., Jakes, S. C., Hinchcliffe, R. (1988). Cognitive variables in tinnitus annoyance. Hearing Research, 36(1-2), 33-38.
4. Andersson, G., Vretblad, P., Larsen, H. C., Lyttkens, L. (2001). Longitudinal follow-up of tinnitus complaints. Ear and Hearing, 22(2), 96-99.
5. Folmer, R. L., Griest, S. E. (2000). Tinnitus and insomnia. Sleep Medicine Reviews, 4(4), 443-454.
6. Hébert, S., Carrier, J. (2007). Sleep Complaints in Elderly Tinnitus Patients: A Controlled Study. Sleep Medicine, 8(1), 40-46.
7. Fagelson, M. A. (2007). The Association Between Tinnitus and Posttraumatic Stress Disorder. American Journal of Audiology, 16(2), 107-117.
8. Hiller, W., Goebel, G. (2007). Factors influencing tinnitus loudness and annoyance. Archives of Otolaryngology–Head & Neck Surgery, 133(6), 599-604.
9. Andersson, G., McKenna, L. (2006). The role of cognition in tinnitus. Hearing Research, 213(1-2), 1-5.
10. Jastreboff, P. J., Jastreboff, M. M. (2000). Tinnitus Retraining Therapy (TRT) as a method for treatment of tinnitus and hyperacusis patients. Journal of the American Academy of Audiology, 11(3), 162-177.
11. Hesser, H., Weise, C., Rief, W., Andersson, G. (2011). The Effect of Waiting: A Meta-Analysis of Wait-List Control Groups in Trials for Tinnitus Distress. Journal of Psychosomatic Research, 70(4), 378-384.
12. Baguley, D. M., McFerran, D. J., Hall, D. (2013). Tinnitus. The Lancet, 382(9904), 1600-1607.

In conclusion, the old adage of “an ounce of prevention is worth a pound of cure” is certainly true for hearing loss.  It is easy to understand why most people pay so little attention to hearing loss – it generally happens only a little at a time.  We even feel like our hearing recovers after a day of shooting or going to the races or a concert or mowing the lawn.   The related negative consequences are even more subtle – until they are not.

Luckily, the range of available hearing protection devises has expanded and it is easier than ever to find something that works and is relatively comfortable.   Electronic devises can help us to feel less isolated and actually enhance our ability to hear with amplified sounds.  Some combine wired or wireless means to connect our other devises like phones and music players, adding to the usefulness and entertainment value.   There really is no excuse to not wear hearing protection.

I will not go into a discussion of all the types of hearing protection in this article.   I have written about the pros and cons in other articles.   If you have just one take away – wear hearing protection anytime you might be exposed to loud sounds, even for a short duration.

If you know someone who is too stubborn to wear their ear muffs or earplugs consistently, you may want to share this post and save them a lot of future issues.