Hearing Loss and Mental Health

The effects of hearing loss on mental health

Does it ever seem like everyone around you is mumbling? Or do you strain to hear the television? You might have impaired hearing. Hearing loss is a normal part of aging, but certain lifestyle choices can either accelerate it or slow it down.

Even if you're confident that your hearing is still sharp, it’s important to protect this vital sense. After all, hearing loss doesn’t just affect your ability to listen to your favorite song or join in conversations. It can also play a pivotal role in your mental health and well-being.

Hearing loss can come with a variety of emotional struggles. Maybe you feel frustrated that you have to keep asking family members to repeat themselves. Or perhaps you feel as though you're missing out on intimate phone conversations with distant friends. You may even feel the urge to withdraw from social situations due to feelings of embarrassment at your poor hearing.

It's important not to discount these emotions. Impaired hearing and the feelings of isolation and helplessness that often come with it can contribute to mental health problems such as:

Anxiety. Research shows that people with hearing loss tend to experience more anxiety. You might worry about how quickly your hearing loss will worsen or whether current treatments can salvage your hearing. In social situations, you might worry about miscommunication or being judged.

Depression. People with hearing loss are at a higher risk of developing depression and experiencing suicidal thoughts. You might grieve the loss of hearing certain sounds or wrestle with feelings of isolation. Perhaps you feel that hearing loss also restricts your ability to be autonomous, which can affect your sense of self-worth.

Cognitive decline and dementia. Hearing loss can speed up cognitive decline in older adults, raising the risk for conditions such as Alzheimer's disease. Several theories may explain the link between hearing loss and cognitive decline:

• The brain is working harder to interpret the world without sounds, which reduces its ability to perform other tasks.
• Loss of hearing may discourage you from being social. This isolation then speeds up cognitive decline.
• Parts of your brain may shrink as they receive and interpret fewer signals.

[Read: Dementia Symptoms, Types, and Causes]

Psychosis. Hearing loss can be a risk factor for psychosis, a condition that can include symptoms such as hallucinations and delusions. Auditory hallucinations, such as voices and music, can be particularly common in people with impaired hearing. This may be due to feelings of loneliness or disruptions to the way the brain recalls and perceives information.

Sleep problems. Impaired hearing can affect the quality of your sleep. This, in turn, puts you at risk of other conditions, ranging from depression to high blood pressure to diabetes. One study found that tinnitus can be a main factor in disrupted sleep.

Causes of hearing loss

Many factors can lead to hearing loss, and understanding those factors is the first step in protecting your hearing. The major types of hearing loss are age-related impairments and noise-induced impairments.

Age-related hearing loss

Age-related hearing loss typically affects both ears, and its gradual nature can often make it hard for you to even notice the impairment.

As you age, your inner ear, middle ear, and nerve pathways change, diminishing your hearing over time. In rarer cases, abnormalities in your outer ear can also dull your hearing. Other factors, such as high blood pressure, medications that kill off sensory receptors, and years of noise exposure, accelerate the issue.

In the United States, for example, roughly one out every three seniors between 65 and 74 years old has some degree of hearing loss. And almost half of seniors over 75 have trouble hearing.

Noise-induced hearing loss

In most cases, noise-induced hearing loss (NIHL) is caused by damage to sensory cells. Your ears use sensory hair cells to detect sounds. Loud noises ranging from the sudden crack of a firework to the lengthy roar of construction equipment can damage those cells. Once damaged, the cells won’t regenerate.

No matter your age, you can experience NIHL. The damage can occur in one ear or both, and, depending on the severity, you may notice gradual or sudden hearing loss.

According to research, nearly 24 percent of U.S. adults may have NIHL, and it's more common in men. Additionally, around 17 percent of teens may also struggle with impaired hearing as the result of noise damage.

Conductive hearing loss

Conductive hearing loss occurs when sound is blocked from traveling through the outer or middle ear to the inner ear. If you're experiencing this type of hearing loss, noises may sound muffled in one or both ears.

Fluid, earwax, foreign debris, or even a benign tumor can cause a blockage in the ear. An infection could also be the cause of the issue. Some people are born with conductive hearing loss due to a deformed ear canal. Depending on what’s behind the hearing loss, treatment might include surgery or medication.

Signs of impaired hearing

Some people have a hard time noticing that their hearing has deteriorated, while a sense of denial may lead others to ignore symptoms of hearing loss. Here are a few signs that you should schedule an appointment with a hearing specialist.

Difficulty understanding conversations. Do you have a hard time understanding friends, family members, or coworkers in your daily interactions? You may find yourself constantly asking them to repeat what they said or experience frequent miscommunication. Whether you're on the phone or trying to engage with people around the dinner table, it might seem like their words are muffled.

Difficulty hearing specific sounds. Do you often miss the sound of a phone or doorbell ringing? Hearing loss can reduce your ability to detect high-pitched noises. In other cases, you might have trouble distinguishing consonants, such as “s” and “f,” when someone is talking. Some people with hearing loss also experience hypersensitivity to specific noises, leading to pain.

Trouble hearing the television. Do you find yourself turning up the speakers even when everyone else says the volume is loud enough? You might even have trouble hearing in movie theaters. This might make you feel restricted in situations where you're enjoying media with others.

Assessing your risk factors

When assessing potential hearing loss, you should also consider your risk factors.

• Does your job regularly expose you to loud noises? People such as factory workers, construction workers, mechanics, and concert stage crew often have to work in noisy environments.
• Do your hobbies involve loud noises? For example, do you visit a shooting range, play an instrument, or ride a motorcycle?
• Have you suffered ear injuries at any point in your life? Serious injuries can lead to lasting damage.
• Do other members of your family deal with hearing loss? Research shows that sometimes hearing loss can be hereditary.
• Do you have a chronic condition that's associated with hearing loss? There is a link between diabetes and hearing loss, for example. Hearing loss is also associated with high blood pressure as well as
  sleep apnea.
• Do you smoke? Smoking can have a negative effect on your sense of hearing.

What is tinnitus?

If you experience a constant or reoccurring ringing sound in your ears with no external source, you may have tinnitus. Tinnitus can be short-term or chronic, and is often the result of exposure to loud noise. Conditions like ear and sinus infections, earwax buildup, blood vessel damage, and temporomandibular joint (TMJ) dysfunction can also cause tinnitus.

Even when tinnitus is temporary, it can cause a lot of distress. It's often described as a ringing sound, but it can also sound like a hiss, screech, roar, buzz, or other unpleasant noise. It can disrupt your concentration or even your sleep.

People with tinnitus may also suffer from depression, anxiety, irritability, and mood swings due to the constant noise. Research shows that people with severe tinnitus are at increased risk of suicide attempts.

Tinnitus in young people

Roughly one in 10 U.S. adults experience tinnitus. While it's typically more common in older individuals, a 2016 study of adolescents found that more than half of participants had experienced tinnitus at least once. About 28 percent of participants showed signs of chronic tinnitus.

Likely causes of tinnitus in teenagers include listening to loud music through earbuds or going to loud concerts, parties, or raves.

Managing tinnitus

Certain factors can worsen tinnitus, so avoiding them can help you manage the condition. These factors include:

• Stress.
• Lack of sleep.
• Noisy areas.
• Quiet spaces.
• Certain foods or drinks, such as those that contain caffeine.

While there's no way to cure tinnitus, there are tools and strategies can help you better cope with the problem:

General wellness habits, such as exercising, socializing, and practicing relaxation techniques to manage stress can help to reduce the volume and the impact of the noise.

Masking devices and sleep apps use external sounds to help cover the sound of tinnitus.

Antidepressant or anti-anxiety medications may be useful in helping you manage the effects of severe tinnitus, at least in the short term.

Behavioral therapy can help you develop better coping techniques for tinnitus.

Acupuncture may also be useful in reducing the severity of your tinnitus.

Experimental therapies, such as repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS), may also prove useful in the future. In the meantime, be on the lookout for scammers who promise cures in the form of supplements or other gadgets. While no products can reverse tinnitus, the above strategies can help you feel more in control.

4 steps to protect your hearing

Since it’s an inevitable part of the aging process, you can't completely prevent age-related hearing loss. However, you can take steps to protect your hearing, minimize noise-induced damage, and enjoy years of excellent hearing.

These steps include:

1. Identifying damaging sounds.
2. Wearing protective accessories.
3. Limiting exposure to loud noises.
4. Using relaxation techniques.

Step 1: Identify damaging sounds

The first step to protecting your ears is knowing which noises are hazardous.

Sound is measured in decibels (dB). Noises that are over 85 dB can cause damage to your ears. The amount of damage depends on the loudness of the noise as well as your distance to the source and length of exposure.

Common noises and average sound level

Step 2: Wear protective accessories

When you know you'll be exposed to loud sounds, wear earplugs or earmuffs to protect your hearing. You can even pair these protective equipment pieces together for increased safety.

Earplugs fit directly into your ear canal. Their discrete design makes them suitable for events like concerts, but they can also be easy to lose. Earplugs can reduce sound by 15 to 30 decibels and are available in various sizes and shapes. You can also ask an audiologist to create a pair to specifically fit your ears.

Earmuffs fit over your ears. Depending on how snug they fit, they can offer similar noise reduction benefits as earplugs. They have a less discrete design than earplugs, but they're adjustable, so most people won't need a customized product. They're commonly used at shooting ranges and at worksites with loud noises.

Step 3: Limit exposure

Whether you're at home, in the workplace, or out with friends, be mindful of the noise level around you. The following tips can come in handy, especially if you don't have earmuffs or earplugs on hand:

Limit the amount of time you spend in loud environments. For example, step out of the concert venue every once in a while to enjoy some quiet. If you can’t leave the area, try to put distance between you and the source of the sound. Don’t sit near speakers at bars or stand near them at concerts. Try to move away from loud machinery in factories and other places.

If the noise volume can be adjusted, be vocal about your discomfort. If you're in a bar and the music is so loud that you can't follow a conversation, ask an employee to turn it down. If they can't accommodate you, think about relocating to a different bar or restaurant.

Anticipate and dampen impulse noise. Impulse noise is any sharp but short sound, such as the sound of a firecracker or passing ambulance siren. Use your fingers to plug your ears and dampen the sound.

Reduce household noise. At home, you have more control over your environment. When shopping for items like dishwashers, air conditioners, vacuum cleaners, and power tools, look for products that emphasize quiet operation. Turn off the TV, music, and other appliances when you aren't actively using them.

Step 4: Practice relaxation techniques

Hearing loss can contribute to anxiety, but the reverse can also be true. Hypertension can accelerate age-related hearing loss, so learning to manage stress can benefit your hearing. Even if you're already experiencing substantial hearing loss, relaxation techniques may help reduce your risk of mental health issues like anxiety.

The following relaxation techniques can help put you in a restful state, lowering your blood pressure, and slowing your heart rate.

Deep breathing exercises are easy to learn and can offer quick anxiety relief. Sit with your back straight and slowly inhale through your nose and exhale through your mouth. The goal is to breathe from your abdomen. So, to measure the depth of each breath, keep one hand on your chest and the other on your stomach. During the exercise, the hand on your stomach should rise and fall, but the one on your chest should remain fairly steady.

[Listen: Deep Breathing Meditation]

Progressive muscle relaxation involves tensing and relaxing the muscles in your body. It’s a gradual process, so you concentrate on one muscle group at a time. For example, you can start with one of your feet. Focus on squeezing the muscles tightly for 10 seconds. Relax the foot and focus your attention on the release of tension. Repeat the same process for other muscle groups.

Body scan meditation is similar to progressive muscle relaxation in that you focus on one body part at a time. Instead of tensing your body, just note how each part feels. Ask yourself, “What sensations am I experiencing here?” Resist the urge to label them “bad” or “good.” The goal is to become more aware and accepting of sensory experiences, but relaxation is a common effect of this practice as well.

[Read: Relaxation Techniques for Stress Relief]

Professional treatment for hearing loss

Professional treatment for hearing loss typically begins with a hearing test conducted by an audiologist or otolaryngologist. If tests reveal a hearing impairment, the health care provider can point you toward treatment options.

Early detection of hearing loss is important. The sooner you know the extent of the damage and the potential causes, the sooner you can take steps to slow down further impairment. For example, you might discover that medications you are taking are accelerating your hearing loss.

Hearing tests

Hearing tests allow an audiologist to assess your hearing loss and come up with potential solutions. A test might involve putting on a pair of headphones and listening for beeps or repeating words that you hear.

Before scheduling a hearing test with a professional, you can take an online assessment. Although it's not a substitute for a professional evaluation, an online screening may offer some insight into your current level of hearing.

• Heuser Hearing Institute offers a free online hearing test.
• The WHO offers a free app to test your hearing.

Hearing aids

Hearing aids use a microphone, amplifier, and speaker to amplify sound waves. This makes it possible for your remaining hair cells to detect the sound.

Despite the usefulness of hearing aids, some people hesitate to wear them due to social stigma. Maybe you’re worried that the devices will make you look “old.” Or perhaps you think people will take pity on you or treat you differently.

It's important to consider that modern hearing aids can be very discreet. You can find models that sit deep within the ear canal, making them hard to notice. In other models, a microphone sits behind the ear and connects via wire to a speaker within the ear canal. Flesh-colored designs are also available.

On the other hand, you can fight against the social stigma by choosing to embrace your decision to use a hearing aid. Some people choose to decorate their hearing devices, adding removable covers and jewelry for a touch of flair. It's a way to express yourself while enjoying the benefits of improved hearing.

Another way to overcome the stigma is to shift your focus away from what other people might think and instead focus on the mental health advantages. If hearing loss can contribute to conditions like anxiety and depression, it makes sense that wearing hearing aids can have the opposite effect. In fact, one 2020 study found that regular hearing aid use decreased the risk of psychological distress.

These devices can help you feel less isolated and more connected with those around you. Conversations become easier, so you might be more likely to seek out social interactions with friends and family members. You won’t have to wrestle with the embarrassment or frustration that comes with frequent miscommunication.

Prescription vs over-the-counter (OTC) hearing aids

Prescription hearing aids are only available by visiting a hearing specialist. Initially, it was only possible to receive a hearing aid this way. However, in 2022, the United States’ Food and Drug Administration (FDA) authorized the sale of over-the-counter (OTC) hearing aids.

OTC models tend to be more affordable and accessible. You can find these models in stores and online without visiting an audiologist. However, OTC hearing aids are only suitable for mild to moderate hearing loss. If you have severe hearing loss or are under 18, you should seek specialized care and a prescription hearing aid from a doctor.

Cochlear implants

Cochlear implants also improve hearing but work differently than hearing aids. The implants feature an external part that sits behind the ear and an internal part that is surgically inserted under the skin. Rather than amplifying sound waves for hair cells to pick up, implants convert sounds into electrical signals that stimulate the auditory nerve. This results in a sensation of hearing. Implants can be expensive and require surgery, so they’re typically only an option for severe or profound hearing loss.

If you're experiencing hearing loss, any of these devices can help you improve your mental health, regain a sense of normalcy, and better engage with the world around you, including the people you love most.