The Silent Threat to Health and Longevity: Hearing Loss

Stigma and high costs deter people of all ages from getting hearing aids, dramatically affecting mood, ability to think clearly, even lifespan

Hearing loss, like graying hair, may occur so gradually it initially goes undetected. But constantly interrupting conversations with What did you say? or What? has health consequences extending far beyond FOMO (fear of missing out).

Poor hearing affects cognition, mood, balance, and a sense of well-being and is even associated with a shorter lifespan, studies have shown. This effect is broad-reaching: Though 28.8 million American adults have hearing loss, only 16% of people aged of 20 to 69 who require hearing aids wear them, according to the National Institute for Deafness. That means one in six Americans are unknowingly harming their mental and physical health.

Concerned about the increased mortality with hearing loss, Janet Choi, MD, an otolaryngologist at Keck Medicine of USC, wondered about the opposite narrative: Would wearing a hearing aid prolong life? Until now, little research has examined whether hearing aids extend lifespan.

Choi’s new study found that routine use of hearing aids reduced the risk of premature death by 24% compared to subjects with hearing loss that never wore them. Those who do not use hearing aids but should may want to reconsider.

“These results are exciting because they suggest that hearing aids may play a protective role in people’s health and prevent early death,” Choi, the study’s lead researcher, said in a statement.

Her results illustrate how correcting one easily modifiable factor, like wearing a hearing aid, provides immediate health and well-being benefits, as well as enhances overall longevity.

The researchers identified 1863 adults aged 20 and older with hearing loss and divided them into three groups:

• 237 were regular users of hearing aids (worn five hours a week).
• 143 were non-regular users (worn once a month or less).
• 1,483 of the subjects were never-users. All groups were followed for ten years.

The researchers used statistics from the National Health and Nutrition Examination Survey collected between 1999–2012.

The study found that the 24% difference in death risk between regular hearing aid users and never-users remained steady, regardless of age, ethnicity, income, degree of hearing loss, education, and medical history.

There was no difference in death risk between adults who used hearing aids occasionally and those who never wore them.

Choi and her team were surprised by how strong the link was between regular hearing aid use and longevity, especially considering that “regular” users included those who wore them for as little as five hours weekly.

The association between hearing loss and shortened lifespan is not fully understood. A recent line of research has linked hearing loss with structural brain changes, including atrophy — a decrease and loss of tissue — particularly in regions involved in processing sound and language. If you don’t use it, you lose it seems to apply to auditory centers. This decrease in brain volume may then affect other functions like cognition.

“The question we really don’t know is when you use hearing aids, does that have a protective impact, or does it actually restore any of these brain structures?” Choi says. Further studies may answer these questions. In the meantime, by realizing the enormous benefits of hearing aids, hopefully, more people will wear them.

You are more likely to fall if you can’t hear

Other adverse effects of poor hearing may account for the decrease in lifespan. The NIH lists several health issues due to reduced hearing in aging, including:

Dementia: Up to 40% of dementia cases could be delayed or avoided by taking care of contributing factors, including hearing loss, a major cause, according to the CDC. A decrease in hearing is one of the most controllable risk factors for adult dementia, a study published in The Lancet revealed.

Falls: People with mild hearing loss, classified as a loss of 25 decibels, were nearly three times more likely to have a history of falling, according to a study published in Johns Hopkins Medicine. The chances of falling increased by 1.4-fold for every additional 10-decibel loss. A total of 2,017 subjects ages 40 to 69 with tested hearing loss answered questions about whether they had fallen the prior year.

Depression: Hearing loss (compared to no hearing loss) was associated with a four percent increase in onset of depression, considered significant, by a group of scientists that examined comorbidities related to hearing loss published in JAMA Network. Health records for 200,000 participants with hearing loss were followed for reports of depression for two, five, or ten years.

Substance abuse: Especially among those younger than aged 49, hearing loss is associated with substance use disorders. In those aged 18–34, opioid prescriptions were most commonly abused, and for those aged 35–49, both alcohol and a prescription opioid use disorder were linked with hearing loss, according to a study published in The Journal of Preventive Medicine. Two years of National Survey data on Drug Use and Health were reviewed to compile the type of substance use disorders among adults with and without self-reported hearing loss.

“Social isolation, depression, anxiety, and dementia have all been associated with hearing loss,” Choi says. While these factors have also been tied to mortality, the specific way they add to the burden of hearing loss isn’t as well understood. More studies are needed.

Your wallet will take a hit

The stigma of needing hearing assistance, appearance, and high cost are why people don’t use hearing aids. The average price of $4,000 isn’t exactly chump change.

Most health insurance policies will not cover the fee. Hearing aids typically last three to seven years, making the cost slightly more palatable. Some hearing centers offer financing, with payments spread over many months.

Medicare A and B do not pay for hearing aids, but part B will cover the hearing exam. Some Medicare C (Medicare Advantage) include coverage for hearing aids, but policies differ.

Only five states in the US mandate that health insurance pay for hearing aids for adults who need them, according to the National Council on Aging, and include Arkansas, Connecticut, Illinois, New Hampshire, and Rhode Island. So, for most Americans living in the remaining 45 states, you’re on your own.

In October 2022, the FDA created a new category of over-the-counter (OTC) hearing aids for those 18 years and older with perceived moderate to mild hearing loss to allow easier access to hearing aids and their benefits. So, hearing aids can now be purchased without a medical exam, prescription, or fitting by an audiologist or licensed expert.

If you choose the OTC route, some resources, such as Hearing Tracker, can help you find the best deals. Also, Costco, a lead provider of hearing aids, offers several varieties at a lower price than most retailers, and some Costco hearing centers have a licensed audiologist on staff. Several hearing aid companies offering OTC brands might also be helpful with finding a reasonably priced pair.

However, given the complexity of hearing loss and the many types and different features of hearing aids, expert assistance is important.

Why you need to be tested and professionally fitted

Though signs of hearing loss are different for everyone the most common indicator is difficulty hearing what others say, or misunderstanding what was said, especially in a noisy setting. Frequently asking others to repeat themselves, turning the TV or radio volume louder than anyone else needs, and problems hearing on the phone are other red flags.

The professional visit: An audiologist first determines the degree and frequency of your hearing loss, which impacts your hearing aid choice. Severity is measured according to decibel loss with seven categories ranging from normal (-10 to 15 dB) to profound (91+ dB).

There are three common types of hearing loss: sensorineural, conductive, and mixed. Conductive hearing loss occurs from damage to the middle or outer ear and impacts low-frequency sounds, while sensorineural loss results from injury to the inner ear and causes high-frequency sound loss. The most common hearing loss is in the high frequencies — you might hear deep voices just fine, but miss things said by someone with a high-pitched voice, for example.

The audiologist also helps you select from the three common hearing aid styles: behind the ear (BTE), in the ear (ITE), and in the canal (ITC), depending on your specific hearing loss and your lifestyle and activity level. Each style has benefits and drawbacks. If an in-the-ear device is chosen, a custom mold of your ears might be done to fit the device perfectly.

Programming: Your chosen hearing aids are next programmed using specialist software to precisely fit your range of hearing loss. This Manual programming is completed by a professional using a computer and is considered the gold standard. It is incredibly accurate and gives the user more control over their hearing aid settings. It is also more time-consuming and contributes to the higher cost when purchasing through a professional. Typically, your settings can be automatically updated every three months as part of your service.

Those who self-purchase hearing aids must use Automatic programming completed with a remote control or a smartphone app. This programming is faster but less precise and less successful.

The fitting: Once programmed, you’ll return to the office to have the hearing aids fitted so they are comfortable. A complicated sound test is performed to ensure the hearing aids perform correctly, during which a thin tube is placed near your eardrum. Your response to soft and loud sounds is observed to balance the amplification precisely. Finally, instructions are given on how to insert and remove, clean and maintain, and change the batteries of your hearing aids and how to program them to different sound levels.

Given that hearing aids may decrease mortality as well as improve quality of life, the investment seems worth it. And the sooner, the better. Putting off getting hearing aids can reduce the degree to which hearing can be restored, some studies suggest. Your brain’s ability to process auditory information will change the longer it is deprived of sound. If you constantly interrupt a conversation with a What did you say? it’s time to make that audiology appointment.