Hearing loss, an underreported condition, may lead to cognitive decline

Jan. 24, 2013, 4:09 p.m.

Hearing aids can help alleviate hearing loss, but are often prohibitively expensive. (Matthijs/Flickr Creative Commons)

A loss of hearing may be related to a loss of brainpower – and the latter isn't fixable with a hearing aid.

New research appearing in JAMA Internal Medicine looked at more than 1,100 people with hearing loss and tested their cognitive function (e.g., their ability to plan, pay attention, problem-solve, remember). The study's authors discovered that, over six years, scores among folks who were hard of hearing declined at a significantly greater rate than it did among people with normal hearing.

Researchers determined that meant that people with hearing loss had a risk of cognitive impairment that was 24 percent greater than normal.

That means becoming hard of hearing may mean more than having to put a little amplifier inside your ear.

Hearing loss: An underreported condition

According to the Hearing Health Foundation, 20 percent of Americans have hearing loss in at least one ear. Additionally, 20 percent of children 12 and older have hearing problems that are severe enough to impact their communication skills.

But it's likely that those numbers don't really reflect the reality of hearing loss, in part because it's such an underreported condition.

A lot of times, that's because people experiencing hearing loss "kind of figure as they get older, they'll just start to lose their hearing a bit," said Dr. Paula Rodgers, an otolaryngologist (ear, nose and throat specialist) at Kaiser Permanente Baldwin Park Medical Center. "Therefore it's just accepted."

Rodgers said most folks "don't think there's much that can be done." But that's not necessarily the case. Sometimes it's nerve damage, but some cases are as simple as a buildup of wax – that is to say, easily remedied. But pride plays a role in people's decision to not seek a doctor's attention.

"For some people it's just a reinforcement that they are getting older," she said. "They don't want to admit that they are having problems with their hearing or vision." Certain cultures, too, frown upon the notion of admitting there's something wrong, she added.

Underreporting happens "across the board," said Rodgers, but it's especially true among people with a low socioeconomic status.

"There's a strong thought that they want to not necessarily show any weakness or signs of getting older, so therefore they just won't check their hearing," she said. "I think in more affluent communities, they are so in tune to any changes in their body and so will try to get treatment for their changes."

The cost can be prohibitive. People with insurance will likely be able to get testing for hearing loss covered pretty easily. But only a small number of people are covered when it comes to amplification – hearing aids – which can cost up to $8,000 for a pair.

As for the uninsured, even getting tested can be a challenge.

Which is a problem, since Rodgers says letting hearing loss go unchecked can have a drastic impact on a person's quality of life – one that goes beyond being hard of hearing.

"I think it's so important for middle-aged or elderly people to stay connected with their community because there are definite social cues that help them retain their cognitive ability," she said. "And if they don't have these triggers or these little verbal cues that help them to stay connected, I think that they become somewhat to themselves – very isolated, not very communicative, they stop learning, their verbal skills start to go down."

In other words, she said, they disconnect.

When children having hearing problems

When it comes to children, it's not underreporting that's the problem – it's a lack of awareness and, all too often, misdiagnosis.

"Less than 1 percent of children entering kindergarten have hearing loss," said Jill Muhs, the vice president of programs for John Tracy Clinic. The mission of the clinic, which has a location in South L.A. on Adams Boulevard, is to provide diagnoses and education to families of young children with hearing loss. Muhs called condition in children a "low-incident handicap."

"People don't look for it, including pediatricians," she said. "A pediatrician can have their entire career and never see a child with hearing loss."

Muhs explained that as certain children develop, their bodies will have a potassium imbalance that ultimately results in the loss of hearing.

"It's when the child gets to be three years old, missing social cues, not having a developed language system – which they should by then – not really understanding what's being said, much less saying it," said Muhs. That's often people's first clue that something is off – and usually it's chalked up to autism.

It's not that the technology to detect hearing loss in infants and children isn't there, she said. It's that certain lifestyles make it easy to miss something like this.

"If you just moved from Mexico, or just came from another state, or you move around a lot, these things can be missed," said Muhs. "You don't have a consensus of people watching the child develop, other than the parents."

In South L.A., another problem is that most people aren't seen by the same doctor consistently, making it unlikely a health provider will detect any long-term patterns.

Muhs says the newborn hearing screening has "massively changed this field," but doctors are "still identifying kids late – at three, four, five years old."

"The immediacy and the need for a child is very different for an adult," she said, adding that that's in part because children who are that young haven't developed their language system yet.

John Tracy Clinic has guidelines to help determine whether a child may be experiencing hearing loss.

While the U.S. Preventive Services Task Force says there's not enough evidence to recommend hearing tests for anyone 50 or older, Dr. Rodgers recommends that everyone gets tested once they turn 50 – and even earlier than that if they have a family history of hearing loss or spend a lot of time in loud environments.

Photo by Matthijs via Flickr Creative Commons.

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