March 7, 2014
News Review From Harvard Medical School -- Hearing Loss May Increase Depression Risk
People who lose their hearing are more likely than others to become depressed, a new study suggests. Researchers looked at data from a U.S. government health survey of 18,000 adults. Those who were 70 and older received hearing tests. The others were asked about their hearing and any problems with it. Everyone also filled out a questionnaire designed to show if they were depressed. About 5% of those with no hearing problems and 11% of those with some degree of hearing loss were depressed. Depression with hearing loss was most common among those under age 70. Women had higher rates of depression than men. Depression was also more likely as hearing loss grew worse. But those who were totally deaf were not more likely to be depressed. Researchers said they may have become used to coping with a lack of hearing. The journal JAMA Otolaryngology -- Head & Neck Surgery published the study. HealthDay News wrote about it March 6.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
My aging father-in-law doesn't have much of his hearing left. After I hung up the phone from an especially loud conversation, I joked with my husband.
"Your dad wanted me to tell you something," I said to him.
"What's that?" my husband asked.
I grinned and shouted, "He said, 'SAY HELLO TO DAVID!'"
David didn't think my joke was all that funny. And that's fair. His father had not been happy lately, and his hearing loss must have a lot to do with it. This is true for many people.
Hearing loss tends to cut us off from other people. It has a large impact on our social life and quality of life. We have known this is true for older adults, but it is also true for young adults.
A new study has also found a strong link between hearing loss and depression. The connection was particularly strong for women. The journal JAMA Otolaryngology -- Head & Neck Surgery published the study.
Researchers surveyed almost 20,000 people. They found moderate to severe depression in 4.9% of people with excellent hearing and in 7.1% of people who reported good hearing.
But among adults who reported any hearing loss short of deafness, 11.4% had moderate to severe depression. Another 19.1% had mild depression.
The study researchers looked further than surveys for the 1,535 older (70 or older) patients. They received formal hearing tests. Researchers also used a careful questionnaire (called the PHQ-9) that can diagnose depression. In women age 70 or older, there was a clear connection between the degree of hearing loss and the likelihood of depression. For men, this study did not show such a connection.
There was an interesting exception. People who were completely deaf did not seem to have a higher likelihood of depression. Presumably, they had developed ways to accept and function with their disability. By contrast, many people who have reduced hearing (but are not deaf) have not sought out help.
The National Health and Nutritional Examination Surveys (NHANES) found that only 1 out of 7 of those over 50 who had hearing loss actually owned a hearing aid. Also, many people who do own hearing aids often don't use them.
What Changes Can I Make Now?
If you have depression or if you notice it in a family member, perhaps hearing loss is contributing to the problem. This can be easily checked if your doctor orders a hearing test (audiogram).
Hearing loss is especially common in people over age 60. Aside from its connection to depression, hearing loss can be wrongly diagnosed as early dementia.
Age-related hearing loss causes these symptoms:
- Difficulty understanding words, even if you can hear that words are being spoken. This comes from trouble hearing higher-pitched sounds, which include many consonants in the alphabet.
- Difficulty hearing female voices.
- Difficulty hearing conversations when there is loud background noise. For example, it can be hard to hear at a party.
- Sensitivity to loud noises or shouting. If you are straining your ears to hear higher tones, loud shouting will be uncomfortable.
- Ringing in the ears.
- Unsteadiness on your feet. This is a common problem that can develop along with hearing loss. Using a hearing aid does not help this problem.
Age-related hearing loss can't be changed. But there are many ways to compensate if you have hearing loss:
- Hearing aids -- These are expensive (sometimes more than $1,000). However, most retailers will let you test the device for a trial period and will refund payment if you are not satisfied. Hearing aids that are very small or hidden inside the ear canal tend to amplify less well than standard hearing aids. Some modern hearing aids are programmed to cancel out noises such as wind.
- Other amplification devices -- These devices make specific sounds louder. You can buy devices for telephones, and headsets that broadcast from a TV or a church microphone. A relatively low-cost device, the wireless "Pocketalker," is a headset with a small portable microphone. To use it, you place the microphone close to the person who is talking and listen through a headset.
- Cochlear implant -- Most people are helped by a hearing aid. For people who do not get enough help that way, a small electronic device can be threaded into the inner ear. This is called a cochlear implant. It looks similar to a hearing aid because a piece of the device rests above and behind the ear, but it is much more powerful.
What Can I Expect Looking to the Future?
New hearing aids are being tested that are not visible outside of the ear. One device (the "Esteem") is implanted by surgery in the middle ear. Another device (called "Lyric") is placed onto the eardrum by a nonsurgical procedure. It is replaced several times per year.
Other devices being developed can amplify sounds coming from specific directions. This technology can increase the volume only for a conversation, as opposed to background noise.