Hearing loss is an important public health problem


Hearing loss can be a real pain in the back. In addition to its embarrassment for friends and loved ones, it can pose a significant health problem. For example, there is growing evidence linking hearing loss to dementia.

Yes, hearing loss can lead to dementia, which is impaired cognition. Cognition is the mental process of acquiring knowledge and understanding through thought. This is the function of the intellect, the ability to think. It is the mind’s ability to rationalize, solve problems, and draw correct conclusions about experiences and perceptions. It encompasses memory, comprehension, reasoning, use of logic, calculation, problem solving and judgment. It requires input into the brain from the outside world via the five senses (vision, hearing, touch, smell, and taste).

Dementia is a decline or loss of cognitive function. Mental processes are impaired. Symptoms include memory problems, impaired reasoning, difficulty making decisions and problem solving, reduced ability to communicate, and impaired comprehension (difficulty understanding what is being communicated).

Human speech and communication are vital for normal cognitive function. It requires good hearing. Sensory input from the ear travels via nerves to the speech and language centers of the brain (for more on the inner ear and sound, see Hearing and How the Ear Processes Speech). his). From there, the brain processes the sound input to make sense of it. This enables the individual to make the right decisions and take the appropriate actions.

Age-related hearing loss, called presbycusis, is a natural phenomenon of aging. It is rather widespread; most people over 70 have hearing loss. Yet it is largely undiagnosed and undertreated. In contrast, most people with visual impairment are treated early, for example with corrective lenses.

Hearing loss causes problems detecting speech sounds and reduced word recognition. This leads to reduced comprehension, reduced ability to understand the spoken word, or misunderstanding of what is being communicated. This leads to problems processing the auditory input since the input is unclear or muddled. People with hearing loss spend more effort and energy processing this unclear and confusing information to the detriment of other cognitive functions, thus depleting their cognitive reserve. In other words, cognitive functions such as memory, reasoning, problem solving, etc., may be sacrificed to pay more attention to processing suboptimal sensory input from the ears. These cognitive functions can deteriorate due to underuse.

Sound perception and speech understanding are worsened when there are other distractions such as background noise, for example, in group settings such as restaurants, meetings or gatherings with several people conversing in same time. Impaired communication and understanding can lead to an inability to engage with other people. If a person cannot meaningfully engage with others, it can lead to withdrawal from social activities; and social isolation is another risk factor for dementia.

Improving sensory inputs such as hearing can prevent or reduce the risk of dementia or slow its progression. The most common way is amplification with properly fitted and programmed hearing aids. Naturally, this requires a hearing test (audiometric test) by a qualified audiologist. If an unusual finding on the test is found, an evaluation by an ENT doctor is required.

The federal government and some insurers recognize hearing loss as an important public health problem, affecting a large segment of the population, and requiring detection and treatment. Hopefully, in the future, more insurance companies will provide coverage for hearing tests (Medicare does, if ordered by a doctor) and cover the cost of hearing aids (which can be quite expensive) for their insureds.

Randall S. Fong is an otolaryngologist and can be contacted on his eponymous site, Randall S. Fong, as well as on his blog.

Image credit: Shutterstock.com



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