Comorbidities of Hearing Loss

Comorbidities of Hearing Loss
It is not uncommon to see hearing loss co-occur with other health or mental health conditions. First, it is important to note that the term comorbidity refers to “the simultaneous presence of two chronic diseases or conditions in a patient.1” We will take a look at some compelling research, but it is important to differentiate that correlation does not necessarily equate to causation.  For example, the number of swimmer’s ear incidences may be correlated with amount of ice cream consumed, but one would not necessarily suggest that eating ice cream causes swimmer’s ear. Be cautious of those using phrases such as “hearing loss causes dementia,” because that is not a scientifically based statement. Rather, it is more accurately stated that dementia occurs at a higher rate in those with hearing loss as compared to those without hearing loss. Okay, enough of the technicalities, I’ll step off my soapbox. In short, the purpose of this post is to explore comorbidities to look for in oneself or loved ones that may have suspected hearing loss or those who already wear hearing aids. We want to encourage you to be involved in your healthcare and be aware of conditions to look for.
·         Social isolation and loneliness
o   In a study by Sung & colleagues (2016) greater hearing loss was associated with increased self-reported loneliness.2
·         Depression & Anxiety
o   Mener & colleagues found that those with hearing loss were 1.63 times more likely to report depression than those with normal hearing in a 2013 study.3 They found that people were 1.5x more likely to report depression per every increased 25dB of hearing loss (e.g. those with more hearing loss were more likely to report depression).
o   A study by Jayakody & colleagues (2018) revealed those with hearing loss were more likely to report depression, anxiety, and stress  than those with normal hearing.4
·         Falls
o   Lin & Ferrucci (2012) found for every 10 dB increase in hearing loss, there was a 1.4 fold increase in odds of an individual reporting a fall.5
o   A 2017 review of the literature found links between hearing loss and reduced postural control in older adults. 6
·         Cardiovascular disease
o   A 2009 study found evidence that low-frequency hearing loss can be related to cardiovascular disease.7 They even recommended cardiovascular disease and risk factors assessment for those with bilateral low-frequency hearing loss.
·         Diabetes
o   Patients with diabetes are at a greater risk to develop hearing loss. A 2014 study showed incidence of hearing loss with those with Type 2 diabetes ranging from 44-69%.8 The study found that the self-reported hearing difficulties is 1.9 fold higher in those with diabetes as compared to the normal population. In this article the authors recommended that those with diabetes have their hearing assessed.
·         Cognitive impairment/dementia
o   There have been several studies that have indicated that those with hearing loss had higher risks for developing dementia than those without hearing loss. One study showed the risk of developing dementia increased with every 10 dB in hearing loss.9 A 2014 study also showed that those with hearing loss develop dementia at a faster rate than those with normal hearing. 10
Exploring potential comorbidities of hearing loss makes it obvious that hearing loss is not just a nonthreatening consequence of aging. I hear many patients say “I have some difficulties hearing, but isn’t that just a normal part of aging?” While the chances of developing hearing loss increase with age, experiencing potential side effects of hearing loss (e.g. frustration, loneliness, social isolation, depression, etc.) should not be expected or accepted as a “normal part of aging.” We actively treat vision loss, depression, cardiovascular issues, so why should hearing be any different? Shouldn’t we expect the best for our ability to communicate and to stay connected and involved in life? The good news is that while hearing aids obviously cannot reduce the risk of or cure diabetes, research has shown they may help improve some other comorbidities noted on our list above. Abram (2017) reviews studies indicating that the use of hearing aids may help decrease the risk of falls, may help decrease the perception of loneliness, and may help even lower the feelings of depression. 11
In all, keep an eye out for these comorbidities that may be associated with hearing loss. For you or loved ones that are experiencing these symptoms, or signs of hearing loss, schedule an appointment to get hearing assessed. At the very least, it is good to have a baseline assessment for hearing. If necessary, intervention with hearing aids can help keep those with hearing loss connected to the world around them.
2.       Sung, Y., Li, L., Blake, C., Betz, J., & Lin, F. (2016). Association of hearing loss and loneliness in older adults. Journal of Aging and Health. 28(6), 979-994.
3.       Mener, D., Betz, J., Genther, D., Chen, D., & Lin, R. (2013). Hearing loss and depression in older adults. Journal of American Geriatric Society, 61(9), 1627-1629.
4.       Jayakody, et al. (2018). Association between speech and high-frequency hearing loss and depression, anxiety, and stress in older adults. Maturitas, 110, 86-91.
5.       Lin, F., Ferrucci, L. (2012). Hearing loss and falls among older adults in the United States. Achieves of International Medicine, 172(4), 369-370.
6.       Agmon, M., Lavie, L., & Doumas, M. (2017). The association between hearing loss, postural control, and mobility in older adults: A systematic review. Journal of the American Academy of Audiology, 28, 575-588.
7.       Friedland, D., Cederberg, C., & Tarima, S. (2009). Audiometric pattern as a predictor of cardiovascular status: Development of a model for assessment of risk. The Laryngoscope, 119, 473-486.
8.       Morrison, C., Morar, P., Morrison, G., Purewal, T., & Weston P. (2013). Hearing loss and type 2 diabetes: Is there a link? Practical Diabetes, 31(9), 366-369.
9.       Lin, F. R., Metter, E. J., O’Brien, R., Resnick, S., Zondermna, A., & Ferrucci, L. (2011). Hearing loss and incident dementia. Arch Neurolo, 68(2), 241-220.
10.   Gurgel, R., Ward, D., Schwartz, S., Norton, M., Foster, N., & Tschanz, J. (2014). Relationship of hearing loss and dementia: A prospective, population-based study. Otology & Neurotology, 35(5), 775-781.
11.   Abrams, H. (2017). Hearing loss and associate comorbidities: What do we know? Hearing review. 
LeAnn Clements, Au.D, CCC-A Clinical Audiologist at Hill Country Ear, Nose & Throat

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