It’s time to think differently about hearing loss. Once thought of as an “old person’s issue”, we know now that hearing loss begins earlier than old age. Hearing loss often occurs gradually. Combine that with it being an invisible and painless issue and it’s no wonder most physicians don’t have it higher on their radar screen.

Initially, hearing loss may present as difficulty hearing well in background noise such as a restaurant or religious service. It may seem like certain people mumble or don’t enunciate clearly, one may find themselves unable to follow a group conversation easily, or have been accused of, “you hear only what you want to hear!” Early hearing loss is not going to be readily apparent speaking one-on-one to a patient in a quiet exam room.

Why should identifying hearing loss be a priority? The most important reason to identify and treat hearing loss early is that we hear with our ears and our brain. While hearing loss may originate in the ear, the reduction of sound to the brain has an impact on cognition and rate of brain atrophy.

Even a mild loss impacts cognitive load if it is not treated. The extra effort expended to hear and understand what is being said diverts resources that would normally go into storing that information in memory. Expending effort to hear well also takes more energy and can lead to chronic fatigue.

Frank Lin, M.D., Ph.D. and his colleagues compared annual MRI studies of participants in the Baltimore Longitudinal Study of Aging with normal hearing and those with hearing loss. Those with impaired hearing lost more than an additional cubic centimeter of brain tissue each year compared with those with normal hearing. Those with impaired hearing also had significantly more shrinkage in particular regions, including the superior, middle and inferior temporal gyri (brain structures responsible for processing sound and speech). The researchers pointed out that these brain structures also play roles in memory and sensory integration and have been shown to be involved in the early stages of mild cognitive impairment and Alzheimer’s disease.

From an emotional standpoint, not hearing well can be very frustrating. Even people with mild hearing loss may find it easier to stay home rather than go out to a noisy restaurant with friends. This social isolation can lead to depression.

Which patients need a hearing screening? Ideally, every patient age 50 years or older should have a baseline hearing screening. Patients with diabetes and cardiovascular disease are at a higher risk of hearing loss and should be evaluated annually. There are simple 10 question screening forms a patient can fill out while waiting for the physician which can help identify those that need to be seen by an audiologist with a minimal (less than 2 minutes) time investment.

Finding an excellent audiologist to help support your practice in this effort is important. Audiologists are the professionals who identify and treat hearing loss. At my practice, hearing aids are only one part of treating hearing loss. Aural rehabilitation – training the brain to listen more effectively – is an important piece of bringing the sounds of life back to people with hearing loss and the reason our patient satisfaction rate is so high.

If you would like a copy of the hearing screening questionnaires or to schedule a time to discuss how to incorporate hearing care in your practice, please reach out.

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