Understanding the connection between hearing loss and mental health

The United Nations states that over 1.5 billion people worldwide are experiencing hearing loss. According to recent estimations, this could rise to more than 2.5 billion individuals by 2030.¹

Image Credit: Amplivox UK

When it comes to building healthy relationships and positive emotions, communication becomes vital. In addition to the diagnosis of hearing loss, it is pertinent for healthcare professionals to consider the mental health impact of the patients.

What is the connection between hearing and mental health?

Communication is a critical aspect of being human. Our life experience and ability to develop fulfilling relationships are based on easy communication with others. 

Losing the ability to hear and understand things clearly affects our ability to connect with others and can make an individual withdraw from the rest of the world. This imposed isolation results in a significant increase in the risk of developing mental health problems. Our ability to communicate is therefore intrinsically linked to our mental health.

What effects can hearing loss have on our mental health?

Communication, defined as ‘the imparting or exchanging of information,’ is affected by hearing disabilities. The person with hearing loss may struggle to react or respond appropriately.

The inability to be completely engaged in communication may cause embarrassment, rage, disappointment, or frustration for someone with hearing loss. Certain people may experience feelings of paranoia and suspect that others are talking about them, behave in socially inappropriate ways, or simply cease communicating entirely.²

Children and adults facing hearing difficulties can sometimes experience mental fatigue, which could lead them to start restraining from large gatherings that take place in noisy environments. Although this self-imposed isolation feels easier at the start, it could result in long-term feelings of loneliness and depression.²

Individuals suffering from hearing loss may feel like an outsider within their own family, observing rather than feeling involved in things. On the other hand, environmental noise can also harm the physical and mental well-being of those with sound hearing:

“Environmental noise is a pervasive pollutant that is one of the greatest environmental threats to mental, physiological, and psychological well-being and has a significant global health burden associated with it.”³ 

Noise pollution can lead to stress, anxiety, and depression. It can even affect a child’s cognitive development. As a result, investigations into the role of hearing in mental health have increased. 

We are now more aware of the link between hearing disorders and the development of dementia, and the positive influence of early intervention.⁴

What is the impact of untreated hearing loss on mental health?

Untreated or inadequately treated hearing loss can cause serious implications for the patient: 

• Individuals with untreated hearing loss may avoid social interactions because they find it difficult to cope with complex sound environments. Mishearing and misunderstandings can become a source of anxiety and worry, which leads to feelings of social exclusion and loneliness.
• Loss of hearing signifies a serious loss. Like any loss, there is a grieving period associated with emotions of anger, resentment, and sorrow. This can lead to the development of depression. 

The loss of some or all of our hearing has negative implications on the hearing nerve and auditory pathway system. This reorganized brain functionality has been connected to faster cognitive decline, affecting our brain’s ability to remember, learn, concentrate, and make decisions.⁵

The robust link between hearing loss, dementia, and Alzheimer’s disease is also known. The probability of dementia is double in people with mild hearing loss, and triple in people with moderate hearing loss.⁴ 

Strategies for coping with hearing loss

Hearing loss does not have to define a person's identity or prevent them from living a fulfilling and joyful life. Significant progress has been recently made in diagnosis and treatment options. As such, hearing loss can now be effectively treated and managed in ways that were not possible just a few years ago.

Like almost everything, early intervention is critical as hearing loss left untreated can get worse. Unfortunately, there is still a stigma around the use of hearing aids, resulting in many people delaying getting help.

A 2020 study conducted by the National Council of Aging⁶ found that the use of hearing aids decreases the risk of psychological distress associated with hearing loss, so it is vital we try and change these negative perceptions.

There are numerous approaches to help a person experiencing hearing loss feel empowered and proactive about their personal limitations and available options. Depending upon the type of hearing loss, treatments can include: 

• Assistive listening devices
• Hearing aids or systems
• Auditory training
• Medication 
• Surgery

Hearing therapists are increasingly collaborating with doctors and audiologists to help people identify the issues associated with living with hearing loss. Counseling is also suggested to individuals dealing with the grief of hearing loss, helping them to develop healthy coping skills and strategies.

Hearing loss education and support

Early intervention is critical for diagnosing hearing loss and identifying mental health issues. A loss of hearing does not need to define a person. Therapeutic intervention, coupled with support for the individual’s mental health and well-being, can enable them to live a full and joyful life. 

It is important for individuals dealing with hearing issues to understand that they are not alone. Several organizations are committed to advancing hearing loss education and awareness through knowledge and support. Here is a list of recommendations:

• Audiologyonline
• Ida Institute
• RNI:D

References and further reading

1. United Nations, UN News. (2022) Over one billion people at risk of hearing loss: WHO. Accessed at: https://news.un.org/en/story/2022/03/1113182
2. Bess F, Hornsby B. National Library of Medicine. (2017) Commentary: Listening Can Be Exhausting—Fatigue in Children and Adults With Hearing Loss. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603232/
3. Liu CM, Lee CT. Association of Hearing Loss With Dementia. JAMA Netw Open. 2019 Jul 3;2(7):e198112. doi: 10.1001/jamanetworkopen.2019.8112. PMID: 31365110; PMCID: PMC6669778.
4. Robin T. Bigelow, MD. (2020) Association of Hearing Loss With Psychological Distress and Utilization of Mental Health Services Among Adults in the United States. JAMA Netw Open. Accessed at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768374
5. SCIE. (2020) Dementia and sensory loss: hearing loss. Accessed at: https://www.scie.org.uk/dementia/living-with-dementia/sensory-loss/hearing-loss.asp 
6. National Council of Aging. (2021) Can Hearing Loss Affect Mental Health in Older Adults?. Accessed at: https://www.ncoa.org/article/can-hearing-loss-affect-mental-health-in-older-adults

Wider reading

• Narozny W, Tretiakow D, Skorek A. National Library of Medicine. (Jun 2021) Tinnitus in COVID-19 Pandemic. Ear Nose Throat J. 2021 Jun;100(3_suppl):197S-198S. doi: 10.1177/0145561320988364. Epub 2021 Jan 20. PMID: 33470830. Accessed at: https://pubmed.ncbi.nlm.nih.gov/33470830/ 
• Morgan-Jones RA. (2001) Hearing Differently: The Impact of Hearing Impairment on Family Life. London and Philadelphia: Whurr Publishers, 2001
• Evans M, Fisher EB. National Library of Medicine. (Jan 2022) Social Isolation and Mental Health: The Role of Nondirective and Directive Social Support. Community Ment Health J. 2022 Jan;58(1):20-40. doi: 10.1007/s10597-021-00787-9. Epub 2021 Mar 3. PMID: 33660137. Accessed at: https://pubmed.ncbi.nlm.nih.gov/33660137/ 
• Robb CE, de Jager CA, Ahmadi-Abhari S, Giannakopoulou P, Udeh-Momoh C, McKeand J, Price G, Car J, Majeed A, Ward H, Middleton L. Front Psychiatry. (Sept 2020) Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK. 2020 Sep 17;11:591120. doi: 10.3389/fpsyt.2020.591120. PMID: 33132942; PMCID: PMC7566017. Accessed at: https://www.frontiersin.org/articles/10.3389/fpsyt.2020.591120/full 
• Tai SY, Shen CT, Wang LF, Chien CY. BMC Neurol. (Feb 2021) Association of sudden sensorineural hearing loss with dementia: a nationwide cohort study. 2021 Feb 25;21(1):88. doi: 10.1186/s12883-021-02106-x. PMID: 33627087; PMCID: PMC7904508. Accessed at: https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-021-02106-x
• Loughrey DG, Kelly ME, Kelley GA, Brennan S, Lawlor BA. JAMA Otolaryngol Head Neck Surg. Association of Age-Related Hearing Loss With Cognitive Function, Cognitive Impairment, and Dementia: A Systematic Review and Meta-analysis. 2018 Feb 1;144(2):115-126. doi: 10.1001/jamaoto.2017.2513. 2018 Feb 1;144(2):176. PMID: 29222544; PMCID: PMC5824986. Accessed at: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2665726 
• Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. JAMA Neurology. (Feb 2011) Hearing loss and incident dementia. Arch Neurol. 2011 Feb;68(2):214-20. doi: 10.1001/archneurol.2010.362. PMID: 21320988; PMCID: PMC3277836. Accessed at: https://jamanetwork.com/journals/jamaneurology/fullarticle/802291 
• Thomas W. Weickert. National Library of Medicine. (2014) The Role of Dopamine in Schizophrenia from a Neurobiological and Evolutionary Perspective: Old Fashioned, but Still in Vogue. Accessed at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032934/ 
• M. Burry. Healthy Hearing. (2020) Understanding auditory deprivation: Why untreated hearing loss is bad for your brain (2020). Assessed at: https://www.healthyhearing.com/report/46306-Hearing-loss-auditory-deprivation 
• Hearing Link Services. (2022) Hearing loss and counselling. Accessed at: https://www.hearinglink.org/living/adjusting-to-hearing-loss/hearing-loss-and-counselling/

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