Depression and Hearing loss

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Depression and Hearing Loss

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By kind permission of The hearing review:

Depression and its connection to hearing loss seems pretty logical and self-evident, especially if you’re a dispensing professional who experiences daily the difference that amplification can make in a person’s life. In fact, many clinicians find themselves explaining the connection as follows: a person’s hearing loss and related communication problems can lead to gaffes and social faux pas; leading to embarrassment, anxiety, and loss of self-esteem; leading to gradual withdrawal from social situations and physical activity; leading to social isolation and loneliness; and eventually bringing them down the path to depression.

Karl Strom_photo

While this is probably an adequate description for some cases, a recent webinar1 by Victor Bray, PhD, associate professor and former dean of Salus University’s Osborne College of Audiology, points to more recent scientific literature that paints a far more complex picture of hearing loss and its association with depression—one we all should be aware of. The utility of hearing aids, cochlear implants, and assistive devices is made no less important by this complexity; however, it’s vital to understand who might be most at risk for depression in your patient population, how best to administer simple screening tools (ie, the PHQ-2 or PHQ-9), and why it’s important to refer patients to a medical doctor or psychologist, when indicated. 

Depression, also known as major depressive disorder (MDD), is present in 5-10% of the general population (up to 40% in some groups), and is a serious medical illness that negatively affects feelings, thoughts, and actions. The primary risk factors for depression are co-morbid chronic medical conditions (hearing loss is a pervasive chronic condition, especially among seniors) and recent stressful events. And, as with cognitive decline and dementia—the subject of my editorial last month—the stakes in treating depression are high for society and healthcare professionals. As Hsu and colleagues (2016) pointed out:

Depression is a common mental disorder, which affects 350 million people in the world. Unipolar depressive disorders and adult-onset hearing loss, the most common neuropsychiatric conditions, and sense organ disorder, respectively, are the first and second leading nonfatal causes of year loss due to disability among adults in high-income countries.2

Several of the studies reviewed by Dr Bray tend to suggest that the odds ratio for acquiring depression increases by a factor of about two if you have untreated hearing loss. However, a lot of the studies also show that a variety of chronic illnesses—ranging from cirrhosis to diabetes mellitus—can be associated with depression, so there could be some underlying neurophysiological common cause in hearing loss and other health problems that hasn’t been discovered yet. Dr Bray also looks at some very intriguing research about how dual-sensory loss (ie, hearing and vision loss) and sudden sensorineural hearing loss (particularly among young people) can greatly increase the risk for depression, as well as studies that are shedding light on how treated hearing loss might positively affect those suffering from anxiety, loneliness, and depression. 

As Dr Bray explains, the linkage of hearing loss to depression could come from both a social (downstream) effect, as described at the beginning of this article, and a biological/neurological (upstream) effect, as proposed in a model by Rutherford et al.3 If that were the case, an effective treatment plan could involve therapy and/or medication from a psychologist, in coordination with a hearing device and/or auditory and cognitive retraining from a hearing care professional. 

Dr Bray’s webinar was sponsored by Hamilton CapTel, and the company also sponsored an exceptionally interesting and well-viewed webinar last year about hearing loss and associated co-morbidities (including depression) by Harvey Abrams, PhD.4,5 When viewed together, they put an exclamation point on the fact that hearing loss isn’t just about the ears, it’s about health, the brain, quality of life, healthy aging, and so much more—while underscoring the crucial role of the hearing care professional in general healthcare.

To see Dr Bray’s webinar, visit https://bit.ly/2Lpt4AW. 

Citation for this article: Strom KE. Depression and hearing loss. Hearing Review. 2018;25(8):6.

References

1. Bray V. Depression, hearing loss, and treatment with hearing aids [Webinar]. July 13, 2018. Available at: http://www.hearingreview.com/2018/07/new-webinar-depression-hearing-loss-treatment-hearing-aids

2. Hsu W-T, Hsu C-C, Wen M-H, et al. Increased risk of depression in patients with acquired sensory hearing loss: A 12-year follow-up study. Medicine. 2016;95(44):e5312.

3. Rutherford BR, Brewster K, Golub JS, Kim AH, Roose SP. Sensation and psychiatry: Linking age-related hearing loss to late-life depression and cognitive decline. Am J Psychiatry. 2017;175(3):215-224.

4. Abrams H. Hearing loss and associated comorbidities: What do we know [Webinar]? May 31, 2017. Available at: http://www.hearingreview.com/2017/05/new-webinar-hearing-loss-associated-comorbidities-know/

5. Abrams H. Hearing loss and associated comorbidities: What do we know? Hearing Review. 2017;24(12):32-35. Available at: http://www.hearingreview.com/2017/11/hearing-loss-associated-comorbidities-know/

BBC news reader now wears a hearing aid.

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Newsreader Lewis Vaughan Jones makes debut wearing hearing aid

Honiton hearing News:

This post is from the original BBC news item.

 “It was crowded and loud on air”

A newsreader who suddenly lost the hearing in his left ear, has received messages of support after his first appearance on air with a hearing aid.

Lewis Vaughan Jones, 37, feared his career presenting the news on the BBC and ITN was over after doctors told him the hearing loss was permanent.

“That was the darkest moment,” he told BBC Radio 5 live.

He also spoke of his embarrassment in social situations and the difficulties of coming to terms with a hearing aid.

Vaughan Jones had good hearing all his life until he got a cold several months ago and couldn’t hear in one ear.

Doctors found his left eardrum was no longer working and the nerve which takes sound to the brain had given up, he told BBC Breakfast.

When they told him the sudden hearing loss and the tinnitus were permanent, he walked out of hospital “completely bamboozled”, he added.

The charity Action on Hearing Loss says about 11m people in the UK have some form of hearing loss, and 2m use hearing aids. It estimates that there are about 6.7m people who could benefit from hearing aids.

Before being fitted with a hearing aid, Vaughan Jones said his situation had left him frustrated and embarrassed.

“There’s only so many times you can interrupt. You feel embarrassed so you withdraw,” he said.

He also described how he would smile and nod along when spending time with friends and family, feeling unable to engage and as though he was missing out.

His hearing aid, he said, has been a massive help, allowing him to return to work.

His return to screen, however, was a noisy one as he can hear the director and correspondents through an earpiece in his right ear and an amplified, distorted version of his own voice through the hearing aid in his left.

The brain should learn to quieten down that distortion, he said.

Getting used to wearing a hearing aid has not come easy.

“I was self-conscious about it. My hair is slightly longer so that’s a reflection that I might have been trying to hide it,” he adds.

Now back on air, he wants to show everyone he is wearing one.

“There’s no logical reason why I shouldn’t wear my hearing aid on air and feel good about it,” he said.

Some took to Twitter to agree.

Robbie M said he started wearing two hearing aids five years ago after finding he was unable to hear in meetings. He advised Vaughan Jones to “wear them with pride,” adding: “Quality of life over people’s thoughts every time.”

Nikki Magrath said: “Great to hear you talk about SSHL [Sudden Sensorineural Hearing Loss] today. I know just how it feels. Has happened twice – once with full recovery.”

Heading a football could create Balance issues

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Heading a Football May Be Linked to Increase in Balance Problems

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Soccer players who head the ball more often may be more likely to have balance problems than players who do not head the ball as often, according to a preliminary study released today that will be presented at the American Academy of Neurology’s (AAN) Sports’ Concussion Conference in Indianapolis July 20 to 22, 2018, the AAN announced on its website.

“Soccer headers are repetitive subconcussive head impacts that may be associated with problems with thinking and memory skills and structural changes in the white matter of the brain,” said study author John Jeka, PhD, of the University of Delaware in Newark, Del. “But the effect of headers on balance control has not been studied.”

For the study, 20 soccer players recruited from the community in Newark took a balance test where they walked along a foam walkway with their eyes closed under two conditions: with galvanic vestibular stimulation (GVS) and without GVS. For GVS, electrodes placed behind each ear stimulate the nerves that send messages from the balance system in the inner ear to the brain. So the stimulator can make you feel like you are moving when you are not. In this case, it made participants feel like they were falling sideways.

The soccer players, who had an average age of 22, also completed questionnaires about how many times they had headed the ball during the past year. The number of headers over a year for each participant ranged from 16 to 2,100, with an average of 451 headers. Those numbers were calculated by asking participants for the average number of headers during a practice and game, the average number of practices and games per week, and the average number of months per year that the player participated.

The study found that the players with the largest number of headers had the largest balance responses to GVS in both foot placement and hip adduction during the walking test, which indicated that they had vestibular processing and balance recovery problems. Researchers found for every 500 headers, foot placement response increased about 9 millimeters and hip adduction response increased about 0.2 degrees.

“Soccer players must have good balance to play the game well, yet our research suggests that headers may be undermining balance, which is key to all movement, and yet another problem now linked to headers,” said study author Fernando V. Santos, PT, of the University of Delaware. “It is important that additional research be done to look more closely at this possible link with balance and to confirm our findings in larger groups of people.”

A limitation of the study was that participants relied on memory when reporting how many times they headed the ball. The study was supported by the National Institutes of Health (NIH).

Learn more about concussion at www.BrainandLife.org, the American Academy of Neurology’s free patient and caregiver magazine and website focused on the intersection of neurologic disease and brain health. Follow Brain & Life on Facebook, Twitter, and Instagram.

To learn more about the AAN’s Sports Concussion Guideline and access resources, visit https://www.aan.com/concussion.

Original Paper: Santos FV, Caccese JB, Gongora M, et al. Greater exposure to repetitive subconcussive head impacts is associated with vestibular dysfunction and balance impairments during walking. Paper presented at: 2018 AAN Sports Concussion Conference; Indianapolis, IN. https://www.aan.com/PressRoom/Home/GetDigitalAsset/12757

Source: AAN

Image: © Macleoddesigns | Dreamstime.com

Tinnitus therapy Devon

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An international study from 2012 found that 15% of the global population experience permanent tinnitus but many more are affected by temporary tinnitus. A Danish study, also from 2012, with 14,000 participants found that 27% of those in the study experienced either temporary or permanent tinnitus. In other words, more than one quarter of the Danish population are affected tinnitus.

But despite a lot of research on the topic, there is still a lot to learn about tinnitus. According to Chief Physician Ture Andersen at Odense University Hospital in Denmark, tinnitus is often a symptom of damage to the inner ear. Tinnitus is not a disease, but can be a symptom of a disease or an impaired auditory system. It is defined as the perception of noise or ringing in the ears when no external sound is actually present. The sounds are most commonly described as ringing, whistling, wheezing, buzzing or humming, but can be described in many other ways. A large Swedish study showed that excessive noise at work and in other environments results in fatigue, headaches and ultimately impaired hearing or tinnitus. Another study, from France, shows that only one in 123 people with tinnitus do not have a hearing impairment.

 

Eva’s history

Eva Jensen, who lives in Greve, Denmark, fits in well to these statistics. With a moderate to severe hearing loss, Eva can’t hear much without her hearing aids and she experiences tinnitus.
“What does your tinnitus sound like?” I asked Eva. She explained that it is a constant buzzing sound, which lies somewhere in the middle of the pitch spectrum. “I think it developed at my work where there was a lot of noise,” says Eva. In 2006 she stopped working as an Educational Assistant in a nursery because of a back injury and since then she has suffered from constant back pain.
“It was only when I stopped working that I started thinking about my tinnitus. My husband was still working so I was at home alone where it was completely quiet and I became more aware of the ringing in my ears.” She experiences it all day, especially when she takes off her hearing aids in the evening. “Since my injury I have the TV on constantly – it helps me think of something other than my back pain,” says Eva.

Eva’s experience with Relief app

“It’s really great to be able to use the app when my tinnitus is driving me crazy. If you are strongly affected by tinnitus, I would definitely recommend this app. There are so many possibilities with creating your own soundscapes, you can always find a sound that’s comfortable. There is no doubt that I’m going to keep it on my phone, so I can get help when my tinnitus it really bothering me,” says Eva with a smile.

ReSound Relief

The idea of helping people focus on something other than the pain, or in this case tinnitus, is the basic concept of a new app made by the hearing aid manufacturer GN Hearing. The free app is called ReSound Relief and offers a combination of audio therapy and relaxation exercises. My editorial team and I tested the app, which offers some new and unique features compared to other apps we have tried. One very smart feature of the app is that it allows you to create your own soundscapes.

Relief allows you to combine a variety of familiar sounds such as birdsong or bubbling water with music and other therapeutic nature sounds. The ability to combine sounds, offers an almost endless amount of possibilities. This sound mixing feature allows you to mix five different sounds and you can individually adjust the volume of each sound.

After downloading the app, you can listen to music on your smartphone as usual, and if you use wireless hearing aids or headphones, you can stream directly through them. The ReSound Relief app also contains a feature called MyRelief that keeps a record of how you use the app and which sounds you have used the most. It creates a personalized plan and allows you to track your progress, much like an exercise app. “When we were developing the concept of this app, we analyzed the market for other tinnitus apps and found that mostof them just use sounds as a distraction. Very few actually guide the user through the tinnitus management process. Tinnitus management for many is more than just playing a sound.

The idea of MyRelief is that you can use it as part of the treatment provided by a Hearing Care Professional. Because MyRelief keeps a record of your use, it provides useful information that a Hearing Care professional can use as part of tinnitus counseling” says Michael Piskosz, Senior Audiologist at GN Hearing.

Article taken from a press release by GnResound May 2018

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Tinnitus therapy in Devon. The Honiton hearing centre.

For more information on Tinnitus read our Tinnitus page here.

New Study Examines Inequality in Treatment for Hearing Loss

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New Study Examines Inequality in Treatment for Hearing Loss

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By Kara Gavin, Lead Public Relations Representative

Hearing loss seems like one of the great equalizers of old age, striking people of all kinds as their ears gradually lose the ability to pick out sounds or hear certain pitches.

But a new national study reveals major gaps in whether Americans over age 55 get help for their hearing loss—gaps that vary greatly by age, race, education, and income, according to an article published on the Michigan Medicine website.

In all, just over a third of older adults who say they have hearing loss are using a hearing aid to correct it, the study finds. But those who are non-Hispanic white, college educated, or have incomes in the top 25% were about twice as likely as those of other races, education levels, or income ranges to have a hearing aid.

The cost of hearing aids is most to blame, say the researchers from the University of Michigan who published the study in The Gerontologist. They presented it this week at the annual research meeting of the AcademyHealth professional society for health care researchers.

Hearing aids can cost thousands of dollars out of a patient’s pocket because most health insurance programs, including Medicare, don’t cover them.

In fact, the study finds that the only factor that leveled the playing field for hearing aid use was having insurance through the Department of Veterans Affairs, which covers hearing aids in many cases. Hearing-impaired veterans ages 55 to 64 were more than twice as likely as their nonveteran peers to use a hearing aid, even after the researchers corrected for other differences. The gap between veterans and nonveterans was also significant for those over 65.

But the detailed interviews conducted for the study also show that personal concerns about hearing aid use, and lack of engagement with health providers, play a role.

“Hearing aids are not easy for many to obtain due to their costs,” says Michael McKee, MD, MPH, the U-M family medicine physician and assistant professor who led the analysis.

Michael McKee, MD, MPH

Michael McKee, MD, MPH

“However, there are a number of additional issues that place at-risk groups at an even larger disadvantage to achieving good hearing health. Many of these issues are beyond the financial aspects, including racial/ethnicity and sociocultural elements, for instance stigma and vanity.”

National survey and local interviews

McKee, who uses a cochlear implant to overcome his own hearing loss, worked on the study with Helen Levy, PhD, a health economist and professor at the U-M Institute for Social Research, and other colleagues. The authors are members of the U-M Institute for Healthcare Policy and Innovation.

They used survey data from the nationally representative Health and Retirement Study, which is based on interviews conducted by the Institute for Social Research with funding from the National Institutes of Health.

The analysis included data from more than 35,500 people nationwide over age 55 who said they had hearing loss. In addition, McKee and colleagues conducted in-depth interviews with 21 other older adults with hearing loss in the communities surrounding the university.

The authors conclude that the Centers for Medicare & Medicaid Servicesshould consider covering hearing aids for Medicare participants and those in Medicaid plans for lower-income adults of any age. Some state Medicaid plans do cover hearing aids, but it is not required.

“Many people may not realize that Medicare does not cover hearing aids,” says Levy. “But it doesn’t, so cost can be a significant obstacle preventing older adults with hearing loss from getting the help that they need.”

More findings from the study:

  • The percentage of older adults with hearing loss who used a hearing aid rose with age, from about 15% of those in their late 50’s to more than 57% of those in their late 80s.
  • Forty percent of non-Hispanic white adults with hearing loss used a hearing aid, compared with 18.4% of non-Hispanic black and 21.1% of Hispanic adults with hearing loss.
  • Nearly 46% of hearing-impaired older adults who had gone to college reported that they used a hearing aid, compared with just under 29% of those who hadn’t graduated from high school.
  • Nearly half of those with incomes in the top 25% wore a hearing aid, compared with about one-quarter of those in the bottom 25%.
  • There were no significant differences in hearing aid use based on the size of the community where the person lived, nor their level of health literacy as measured on a standard test.
  • Interviews showed that cost, lack of insurance coverage (or knowledge about insurance coverage), vanity, and stigma were common reasons for not using hearing aids. Participants also cited a lack of attention to hearing loss by their primary care provider and worries about finding an audiologist they could trust.
  • Many interview participants who used a hearing aid mentioned efforts that hearing-related professionals made to connect them to discounts and insurance programs.

More about hearing loss

Estimates of hearing loss incidence place it at 29% of people in their 50s, 45% of those in their 60s, 68% of those in their 70s, and 89% of those in their 80s.

Previous studies have shown that untreated hearing loss reduces older adults’ ability to carry out everyday tasks, reduces their quality of life, and is linked to social isolation, lower income, reduced cognitive function, and poorer physical and psychological health.

A recent study led by McKee’s colleague Elham Mahmoudi, PhD, found that having a hearing aid was associated with a lower chance of being hospitalized or visiting an emergency room in the past year. That study focused on people over 65 who had severe hearing loss, and it used data from a federal database.

McKee leads the Health Info Lab, which is researching health information use and literacy among deaf and hard-of-hearing individuals.

This article is copyrighted by the University of Michigan and used with permission.

Original Paper: McKee MM, Choi H, Wilson S, DeJonckheere MJ, Zazove P, Levy H. Determinants of hearing aid use among older Americans with hearing loss. The Gerontologist. 2018. Available at: https://academic.oup.com/gerontologist/advance-article-abstract/doi/10.1093/geront/gny051/5000029?redirectedFrom=fulltext

Source: Michigan Medicine/University of Michigan, The Gerontologist

Image: University of Michigan

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