While it has been established that hearing loss is a key risk factor of dementia, the potential impact of hearing loss interventions for this patient population has not been well-understood. Recently published findings demonstrated that managing hearing loss may reduce or delay cognitive decline.
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“Hearing loss has always been considered a consequence of aging that we just have to live with,” says Sarah Sydlowski, AuD, PhD, MBA, Associate Chief Improvement Officer and Audiology Director of the Hearing Implant Program at Cleveland Clinic. “This research is one of several emerging studies that elevate the importance of hearing health. The main takeaway from this study is that number one, hearing has a direct impact on cognitive health. And number two, managing hearing loss appropriately has the ability to impact more successful outcomes in terms of cognitive health.”
These findings come as no surprise to Dr. Sydlowski or other audiologists who dedicate their careers to optimizing hearing health. “As an audiologist, I’ve seen evidence on a daily basis of how much better an individual’s quality of life is as well as how much sharper and more connected they are when their hearing loss is managed appropriately,” she says. “I have also witnessed the negative consequences when people wait too long or aren’t using the appropriate technology. I am so glad that we are finally seeing this evidence in the literature.”
This systematic review and meta-analysis evaluated the connection between hearing loss interventions and cognitive decline and dementia. The researchers reviewed 3,243 studies and 31—with 137,484 participants—were included. Of these, 19 were a part of the quantitative analyses.
The study authors reported that the use of hearing restorative devices was associated with a 19% decrease in the hazard of long-term cognitive decline among individuals with hearing loss. Additionally, they also observed a 3% improvement in cognitive test scores in the short term. Based on these findings the researchers emphasized the need for randomized trials to further explore this connection. Most importantly, they urged physicians to strongly encourage their patients with hearing loss to use appropriate hearing devices.
This direct message that prioritizing hearing loss management has a direct impact on cognitive health should be a wake-up call for all healthcare providers.
When discussing the significance of this research, Dr. Sydlowski notes that these findings highlight a direct link between hearing and cognition. “If hearing loss is not managed appropriately, the odds of cognitive decline increase,” she says. “Managing hearing loss can help reverse that trend. This evidence suggests that hearing needs to be a health priority and intervention is necessary to improve other health outcomes.”
Implications for practice
These findings, which add to a growing body of research highlighting the importance of hearing health, have the power to prompt a change in how hearing loss is approached, suggests Dr. Sydlowski.
“If leveraged correctly, this evidence can inform physicians and, I hope, inspire them to make hearing loss a priority,” she says, while acknowledging that this can be a challenge, especially in primary care where providers are managing various aspects of a patient’s health. “This is why having compelling evidence is so valuable. It will force people to take notice and change the way that physicians have conversations with their patients.”
This research also has the potential to impact patient behavior. As discussed above, hearing loss is an anticipated and accepted part of aging, and patients may not address this issue the same way they would other health concerns, says Dr. Sydlowski. “However, people do not want cognitive issues. Patients may be more inclined to take action if they know that something as simple as managing their hearing can help avoid a negative cognitive consequence.”
Overall, she believes that the benefit of this study, and studies like it, will be to shift our perception of hearing loss and to help individuals recognize that it is within their control to significantly change their quality of life as they age.
At Cleveland Clinic, Dr. Sydlowski and colleagues are committed to communicating this message broadly. This includes building partnerships with other disciplines, such as geriatric medicine and primary care as well as different research efforts.
“We’re doing a lot of work to explore the best ways to help our primary care partners make hearing a priority and this includes educating them about these results,” she says. “Our goal, ultimately, is to increase the number of patients whose hearing is screened and whose hearing loss is identified. And secondly, to increase their access to audiology care so that their hearing loss can be managed appropriately.”
The audiologist’s role
These findings also underscore the critical role audiologists have in a patient’s overall health. The introduction of over-the-counter hearing aids is positive and has the potential to increase access for individuals who might otherwise find it difficult to get this technology, according to Dr. Sydlowski. Additionally, the support from regulators and legislators to expand access to this technology highlights the importance hearing has for public health. However, she notes, the introduction of OTC hearing aids does not eliminate the need for audiologists. It’s likely that it’s not just the use of a hearing device that has the most positive impact on cognitive health. Which device is used, how appropriately it’s programmed, and how fully it addresses the changes to the hearing system hearing loss causes are all key factors to the effectiveness of the intervention.
“The connection to cognition really should be a compelling reason to invest in your hearing. Cognitive health is not something to shortchange yourself on,” she says. “ The role of the audiologist is to determine the type and degree of hearing loss and then to provide recommendations for appropriate intervention. This could be an over-the-counter device, but it might need to be a prescription device or a cochlear implant.”
No one else can fill this role, she emphasizes. “This is what an audiologist does. This evidence just reinforces why it is imperative that we don’t skip this step. It isn’t just a patient’s hearing we are talking about. It’s their quality of life. It’s their future cognitive capability. Taking the time to have a hearing test and to have this conversation is far more important than just picking a device.”
If nothing else, Dr. Sydlowski hopes this research motivates health care providers to make sure their patients get a hearing test, which is covered by nearly all insurances, including Medicare. “It is important that they realize that hearing loss covers a very broad spectrum and the care that we can provide starts from prevention of hearing loss and it goes all the way through cochlear implantation and everything in between.”