Let’s begin this blog by defining the word comorbidity so that there is no confusion as to what we mean.
- A comorbidity is the simultaneous presence of two or more diseases or disabling medical conditions in a patient. These may include such condition as cognitive decline and Alzheimer’s disease, diabetes, clinical depression, falls among the elderly, heart disease, and many other chronic conditions.
In recent years several studies have brought to light that hearing loss may be associated with many of these comorbidities and defined as chronic illnesses…a health condition that lasts for more than three months. If we define chronic conditions this way, then certainly hearing loss qualifies as a chronic condition.
In a recent webinar presented by Dr. Harvey Abrams, PhD, he focused his attention on the research surrounding seven comorbid conditions associated with hearing loss—social isolation and loneliness, depression, balance problems and falls, cardiovascular disease, diabetes, dementia and even mortality…. And similar to some other comorbidities such as diabetes in the early stages, hearing loss can be “invisible’, progressive, painless, and treatable.1
He also points out that there are numerous other comorbidities linked to hearing loss, including fibromyalgia, anemia, psoriasis, rheumatoid arthritis, kidney disease and sleep apnea.
- Hearing loss, to some extent, affects 20 percent of all Americans, or 48 million people, according to the Hearing Loss Association of America. Hearing loss is the third most prevalent chronic health condition facing older adults.
- 26 million people in U.S. between ages 20-69 have a hearing loss, according to the National Institute on Aging, approximately one in three people between the ages of 65 and 74 has a hearing loss, and nearly half of those older than 75 has difficulty hearing.2
Interestingly hearing loss has been on the increase in the past decade. The main reasons for this are the increase in exposure to loud sounds in work places, recreational activities such as “rock” concerts, the advent of ear buds or other personal listening devices being used improperly, and the aging population of baby boomers.3
Attending to hearing loss as early as possible is so important because it can lead to other psychosocial consequences and cause a person to become isolated, depressed, socially withdrawn, and suffer from other quality of life issues.
More importantly, hearing loss – especially once it becomes profound – can result in difficulty communicating, comprehension of language, misunderstanding of instructions, and personal embarrassment leading to social withdrawal.
Important Comorbidities to Be Aware Of:
Certain comorbidities seem to be more highly linked to hearing loss and the impacts they can have including:
In a 2009 study by DR Friedland and colleagues published in Laryngoscope4 it showed that the audiometric patterns—particularly low-frequency (sloping) and flat (strial) losses—were strongly correlated with cardiovascular disease. In fact, the researchers reported that patients with low-frequency hearing loss should be regarded as “at risk” for cardiovascular events, and appropriate medical referrals should be considered. One chart in the study suggests that about 85% of diagnosed strokes were associated with individuals who had flat or low-frequency sloping losses.
An extremely interesting population study looking at the association between hearing loss and diabetes was conducted by Kathleen Bainbridge and colleagues, published in the July 2008 edition of the Annals of Internal Medicine.5 These researchers looked at 5,140 adult National Health and Nutrition Examination Survey (NHANES) participants from 1999-2004. The researchers report that hearing impairment was found to be more prevalent among those participants with diabetes. Following analyses, they found that people with diabetes had significantly increased odds of hearing impairment in worse and better ears at all severity levels and frequencies.
In 2016 MB Kim et al6 published a prospective study of over 253,000 adults with baseline normal hearing who were followed from 2002-2014. The authors posit that the vascular effects of diabetes damage the blood supply to the cochlea leading to sensorineural hearing loss. Specifically, high blood glucose levels may damage the vessels in the stria vascularis and nerves impacting the biochemistry and neural innervation of the cochlea.
Falls are the leading cause of fatal and non-fatal injuries among the elderly. Falls often lead to fatal outcomes within the first 12 months of a fall with injury in the senior population. Lin and Ferrucci7 examined the association between falls and hearing loss among 2,017 people ages 40-69 in NHANES participants from 2001-2004. They found a significant association, with a 1.4-fold increased odds of reporting a fall in the previous year for every 10 dB of hearing loss. Adjusting for demographic, cardiovascular, and vestibular balance function did not substantially change the magnitude or significance of this association.
Many of the studies mentioned here as well as others, found that fitting the patient with a hearing aid contributed to positive results rather quickly as far as depression, isolation, falls and dementia were concerned.
What does all this mean for today’s hearing healthcare professionals? It is suggested that clinicians should consider discussing with their senior patients social and cognitive disorders, as well as some of these other health-related conditions, and if appropriate, refer them to their geriatric or primary care physician for further evaluation. It also makes sense for professionals to build a network of specialists to whom they can refer their patients and their advocates—including primary care physicians, psychologists, gerontologists, neuropsychologists, etc.
From the studies done over the past 20 years, it appears that age related hearing loss may be a significant contributing factor to various comorbidities particularly in the senior population.
How e3 Diagnostics Can Help You Better Serve Your Patient Population
e3 Diagnostics is the leading provider of audiology equipment sales and service solutions in the United States. With over 30 offices nationwide, staffed with teams of highly-experienced hearing and balance instrument experts, our local approach allows us to be your most responsive and optimal choice when looking for solutions to help you provide the highest quality patient care. Our purpose is to keep you informed about how best to respond to the problems associated with untreated hearing loss and vestibular/balance issues, and to be aware of how other comorbidities affect a patient’s well-being.
For more information contact your local e3 Diagnostics office.
1 Harvey Abrams, PhD, a webinar—courtesy of Hamilton CapTel—that looks at seven chronic conditions linked to hearing loss.
4 Friedland DR, Cederberg C, Tarima S. Audiometric pattern as a predictor of cardiovascular status: Development of a model for assessment of risk. Laryngoscope. 2009;119:473–486.
5 Bainbridge KE, Hoffman HJ, Cowie CC. Diabetes and hearing impairment in the United States: Audiometric evidence from the National Health and Nutrition Examination Survey, 1999-2004. Ann Intern Med. 2008;149(1):1-10.
6 Kim MB, Zhang Y, Chang Y, Ryu S, Choi Y, Kwon MJ, Moon IJ, Deal JA, Lin FR, Guallar E, Chung EC, Hong SH, Ban JH, Shin H, Cho J. Diabetes mellitus and the incidence of hearing loss: A cohort study. Int J Epidemiol. 2016 Nov 6. pii: dyw243. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27818377
7 Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med. 2012 Feb 27;172(4):369-71. doi: 10.1001/archinternmed.2011.728. PMID: 22371929; PMCID: PMC3518403. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518403/