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Hearing Loss and Dementia: The Silent Connection

Hearing loss and dementia are more common as you get older. The latest research shows that’s no coincidence. The two are linked. Scientists are finding more and more evidence that trouble with hearing makes you more likely to go on to have dementia, a condition marked by memory loss and trouble with thinking, problem-solving, and other mental tasks.

That doesn’t mean that people with hearing loss (about two-thirds of adults over 70) are guaranteed to have dementia -- simply that the odds are higher. There may be things you can do to lower your chances for mental decline, even if you start to have trouble hearing.

What’s the Link?

Scientists have found that a person’s chances for mental decline seem to go up the worse their hearing problems are. In one study, mild, moderate, and severe hearing loss made the odds of dementia 2, 3, and 5 times higher over the following 10-plus years.

And it seems to happen faster. Studies of older adults who had lost some hearing found that they had mental decline 30%-40% faster, on average. Looked at another way, they had the same mental decline in 7.7 years, on average, as someone with normal hearing showed in 10.9 years.

Researchers don’t know for sure how the two conditions are connected. Frank Lin, MD, PhD, of Johns Hopkins University, says three things may be involved:

People with hearing loss tend to feel isolated, since it’s hard to join in conversations or be social with others when you can’t hear. Some research has shown a link between feeling lonely or isolated and dementia. So hearing loss may make mental decline happen faster than it would otherwise.
Your brain has to work harder to process sound if you don’t hear well. That may take away resources that it could use for other important activities.
If your ears can no longer pick up on as many sounds, your hearing nerves will send fewer signals to your brain. As a result, the brain declines.

“It’s likely a combination of all three,” says Lin, who has done much of the research on the connection between the conditions.

What Can You Do?

If you want try to lower your chances of hearing loss as you age, try to keep your heart healthy, protect your hearing from loud noises, and don’t smoke.

“Smoking is a big risk factor for sensory loss -- vision and hearing,” says Heather Whitson, MD, at Duke Health.

Even when they take precautions, some people are simply more likely to get hearing loss in older age. In those cases, can using hearing aids protect you from dementia?

“That’s the billion-dollar question,” Lin says.

Lin is leading a 5-year clinical trial studying 850 people to see if hearing aids can cut dementia.

Even without the proof, Lin says there’s no downside to using hearing aids. In fact, there’s often a big upside to getting help for your hearing loss.

“With a very simple intervention, we could make a big difference improving quality of life,” Lin said.

In a pilot study, people with dementia started wearing inexpensive, over-the-counter devices to boost their hearing. A month later, their caregivers reported improved communication, more laughter, and more storytelling.

“If you’re an older adult with hearing loss, it would make sense to treat that hearing loss,” says Richard Gurgel, MD, of the University of Utah.

If you think your hearing has gotten worse with age, Gurgel recommends a hearing screening. The relatively quick, painless test can help you notice how your hearing changes as you get older and if a hearing aid would help you. https://www.webmd.com/healthy-aging/features/hearing-loss-dementia#2

Tinnitus

Tinnitus, commonly referred to as ringing in the ears, is the perception of sound in one or both ears. These sounds can include high or low pitched ringing, buzzing, hissing, roaring, and clicking, with a pulsing (beating) or steady pattern; and can range in severity. The sounds can also be constant or intermittent.

What Causes Tinnitus?

Tinnitus is often caused by damage to the tiny hair cells within the inner ear. The cells can be damaged due to aging, or damage can occur after exposure to very loud noise, certain medications, injury, or disease. Sometimes the damage is not permanent, however, the sound is. Tinnitus can also be a result of problems not related to the hearing system. It may originate in some areas of the brain, or the brainstem. Occasionally, tinnitus can also result from disorders of the jaw joint, such as temperomandibular joint (TMJ), neck injuries, and severe anxiety.

IT IS IMPORTANT TO NOTE THAT ALTHOUGH TINNITUS CAN BE ANNOYING, IT IS NOT USUALLY A SIGN OF A SERIOUS HEALTH PROBLEM. THERE IS ONLY POSSIBLE CAUSE FOR CONCERN IF YOUR HEALTH PRACTITIONER DISCOVERS ACCOMPANYING SYMPTOMS ALONG WITH THE TINNITUS THAT MAY POINT TO A PARTICULAR DIAGNOSIS.

Tinnitus Diagnosis

While tinnitus is not usually a sign of a serious health problem, it is important that any patient experiencing these symptoms be evaluated, to ensure that there is not another, more serious underlying problem. A hearing test will be performed and can provide more information on the potential cause of the tinnitus (i.e. if it might be related to hearing loss). Other tests such as magnetic resonance imaging (MRI) or computed tomography (CT) scans may be needed if the audiological tests point to possible or suspected brain-related causes, and/or if the information from the medical history and physical examination indicate a need for further investigation.

Tinnitus Management

There is no cure for tinnitus. In some cases it may be eliminated if a known underlying cause can be resolved. Hearing aids may improve tinnitus symptoms in people with hearing loss, by making the tinnitus sound less noticeable. Cochlear implants may help relieve tinnitus in some cases, however, they are only recommended in patients who have severe to profound hearing losses that do not receive benefit from hearing aids, and who are medically cleared by a physician to receive the implant. Patients who have damage to their auditory system due to medication may see improvement of their tinnitus and prevent hearing loss from worsening when they stop their medication. Patients must consult with a healthcare provider before starting or stopping any medications. In many instances, the cause of the tinnitus is not known, so the best approach is to help the patient manage the condition. We provide tinnitus retraining therapy (TRT), and cognitive behavioral therapy (CBT) to help patients manage their tinnitus. TRT involves retraining the subconscious part of the auditory system to accept the sounds associated with tinnitus as normal, natural sounds rather than annoying sounds. CBT teaches patients to manage their psychological responses to tinnitus, by using coping strategies, distraction skills, and relaxation techniques. These options can be discussed with you once we complete your evaluation.

Vestibular assessments, or balance assessments, are recommended for people who have dizziness, vertigo, imbalance, and other related symptoms, because the vestibular portion of the inner ear contributes largely to our ability to stay upright. Visual input, somatosensory input and the central nervous system also contribute to our balance. Vestibular assessments are usually done by an audiologist. Because several body systems contribute to our balance, a patient who has dizziness may also be evaluated via clinical exam with an otologist or neurotologist or with imaging and blood work.

What happens during a Vestibular Assessment or Balance Test?

A comprehensive balance test has several parts, including a recent hearing evaluation. Because the inner ears of hearing and balance are closely grouped, a vestibular problem may also affect one’s hearing in large ways, or in small ways that a patient may not perceive.
GANS Sensory Organization Performance testing tells the audiologist about which senses a patient depends on most to maintain balance. The test involves standing with the eyes open and closed in a few different stances, on the floor and on a foam pad.
Videonystagmography (VNG) testing is an important part of the vestibular assessment. VNG testing involves wearing a pair of goggles and completing a battery of eye movement tests called ocular motility tests. Eye movements that we use in everyday life are assessed, and the goggles allow the audiologist to examine these eye movements up close. Also included in the VNG testing are different positional and positioning tests where the patient is guided through different head and body positions and the eyes are assessed for involuntary movements called “nystagmus.” Finally, we use the VNG goggles to complete caloric testing. Caloric testing involves flowing warm and cool air into the ear canals and measuring nystagmus from the eyes. This test is important in diagnosing a weakness in function of one or both of the inner ears of balance. (Why is so much emphasis placed on the eyes, when we’re looking for information about the inner ears of balance? Well, the eyes and inner ears of balance are connected by an important reflex, so the eyes can tell us a lot about the inner ears.)
Vestibular Evoked Myogenic Potentials (VEMPs) and electrocochleography (EcochG) are additional tests which may be completed if requested by your doctor. These tests may further inform your care team about certain inner ear of balance problems. These tests involve the placement of gel electrode stickers on different places on the face, head or neck, and listening to clicking sounds.

What is a cochlear implant?
Source: NIH/NIDCD

A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see figure). An implant has the following parts:

A microphone, which picks up sound from the environment.
A speech processor, which selects and arranges sounds picked up by the microphone.
A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses.
An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve.

An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech.

How does a cochlear implant work?

A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and understand speech in person or over the telephone.

Who gets cochlear implants?

Children and adults who are deaf or severely hard-of-hearing can be fitted for cochlear implants. As of December 2012, approximately 324,200 registered devices have been implanted worldwide. In the United States, roughly 58,000 devices have been implanted in adults and 38,000 in children. (Estimates provided by the U.S. Food and Drug Administration [FDA], as reported by cochlear implant manufacturers.)

The FDA first approved cochlear implants in the mid-1980s to treat hearing loss in adults. Since 2000, cochlear implants have been FDA-approved for use in eligible children beginning at 12 months of age. For young children who are deaf or severely hard-of-hearing, using a cochlear implant while they are young exposes them to sounds during an optimal period to develop speech and language skills. Research has shown that when these children receive a cochlear implant followed by intensive therapy before they are 18 months old, they are better able to hear, comprehend sound and music, and speak than their peers who receive implants when they are older. Studies have also shown that eligible children who receive a cochlear implant before 18 months of age develop language skills at a rate comparable to children with normal hearing, and many succeed in mainstream classrooms.

Some adults who have lost all or most of their hearing later in life can also benefit from cochlear implants. They learn to associate the signals from the implant with sounds they remember, including speech, without requiring any visual cues such as those provided by lipreading or sign language.

How does someone receive a cochlear implant?

Use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing. Not everyone performs at the same level with this device. The decision to receive an implant should involve discussions with medical specialists, including an experienced cochlear-implant surgeon. The process can be expensive. For example, a person’s health insurance may cover the expense, but not always. Some individuals may choose not to have a cochlear implant for a variety of personal reasons. Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery. An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Speech-language pathologists and audiologists are frequently involved in this learning process. Prior to implantation, all of these factors need to be considered.

Tinnitus/PR

Vestib/PR