Cognitive decline seen in people with hearing loss

Yearly eye exams are normal. People routinely visit their dentist every six months.

But the audiologist generally is the appointment that’s put off, many times until it’s too late.

Dr. Audra Branham, an audiologist with Hearing Innovations of Liberty and Boardman, said new research shows that’s simply not a good plan.

“Untreated hearing loss contributes to other health conditions, like cognitive decline,” Branham said. “If we can keep the ear healthy, we can keep other parts of the body healthy.”

The age of technology is enhancing the process, from more exacting examinations to hearing aids packed with as much artificial intelligence as Alexa or a Fitbit.

“Technology has gone from zero to 100,” Branham said. “We have a lot of options now.”


Hypertension, diabetes, heart disease, eye health, depression — many seemingly unrelated conditions have connections to hearing loss, Branham said. Researchers are continuing to research what the links may be, but there are a few clues.

According to the Hearing Health Foundation, 360 million people worldwide suffer from hearing loss. In the United States, the number of people with hearing loss doubled from 2000 to 2015.

As hearing declines, people tend to become less engaged with others. They feel disconnected from family and friends because they can’t engage as fully in conversation as they once did. Simple pleasures like listening to music or hearing birds chirp can be difficult.

People with hearing loss can withdraw into self-imposed isolation, and feel loneliness or anger. This, in turn, affects other parts of the body’s systems.

In an article titled “The Hidden Risks of Hearing Loss” published by Johns Hopkins Medicine, a 12-year study at Johns Hopkins showed links between hearing loss and walking problems, falls and even dementia.

“Brain scans show us that hearing loss may contribute to a faster rate of atrophy in the brain,” Frank Lin, M.D., Ph.D, said in the published report. “Hearing loss also contributes to social isolation. You may not want to be with people as much, and when you are alone, you may not engage in conversation as much. These factors may contribute to dementia.”

When people walk, the ears pick up cues that help with balance. Without them, the brain works harder to process sounds and that can interfere with other mental processing needed to walk safely, Lin said.

A report by the Mayo Clinic states, “The mechanism of interaction between hearing loss, cognitive impairment, depression and isolation is being actively studied. Initial research suggests that treating hearing loss can have a positive effect on cognitive performance, especially memory.”

Branham said that’s why audiologists are making efforts at educating the general population to check their hearing.

“We want them to understand there are other things that can happen if you don’t treat it.”


If there are no other problems beforehand, people should schedule their first hearing exam when they are about 50 to 55 years old to establish a baseline, Branham said. It gives the audiologist a place to start when measuring hearing decline over the years.

“It’s painless. The whole process takes about a half hour. A lot of insurances cover the tests. It makes sense to get it done every couple of years after age 50,” she said.

The exam includes a tiny camera that goes into the ear canal. Both patient and doctor can watch the monitor to see what’s there, she said.

In the Johns Hopkins study, Lin said hearing aid users wait an average 10 years before getting help. That’s 10 additional years of hearing loss that can’t be recovered.

Research also shows that only one in seven of Americans who have hearing loss use a hearing aid. A common excuse: “My hearing’s not that bad.”

Branham said that’s what her office has found out as well — people often don’t call until they notice a problem. If it’s mild, patients will return every two to five years to measure the rate of decline. Mild decline generally doesn’t require therapy or treatment.

Sometimes, it’s something as simple as a wax buildup, Branham said. Clear the impacted wax and hearing is back to normal.

When hearing loss moves into moderate to severe loss, treatments such as hearing aids will be explored.

The important thing is not to wait too long for that first visit, she said.

“If loss is bad enough, there is a point that as it drops, the more physical damage is done inside the ear, so there’s less hearing in there for me to use. I can only give you back so much,” she said. “No matter how great technology is, if we let it go too far, those won’t come back.”


Not long ago, hearing aids were analog devices. Tiny screws were used to make adjustments.

When digital hearing aids came on the scene, audiologists could make better tweaks with computer programs. Even that has given way to better methods, Branham said.

A number of audiology offices, including theirs, have invested in real ear verification testing technology. A tiny microphone is placed between the ear drum and the hearing aid. That allows the audiologist to see on a computer screen exactly what sounds the ear is receiving and how it is processing them.

“We can make adjustments not just on our tests but on the individual shape of the ear,” she said.

Ears are different from person to person, and individual acoustics are not the same. That’s why in the past, even on digital hearing aids, there still could be some ringing or feedback even after adjustment. Real ear verification shows on a display screen exactly what’s happening.

“Before, I had to ask you what do you think. Now I don’t need you to tell me what you are hearing. I can see it myself and adjust. The results are instant,” Branham said.

“We didn’t have that here even five years ago,” she said. “That has been a complete change.”


Hearing aids themselves continue to improve while prices have stayed the same, Branham said.

They also aren’t the big, bulky, noisy things that they used to be.

Nationally,the average price for a hearing aid is $1,675 per ear for equipment, fittings and evaluations, according to the Johns Hopkins study.

Branham said one of the most helpful innovations is a rechargeable battery. Users plug their hearing aids in at night and don’t have to bother with carrying around replacement batteries.

Another innovation is a direct connection to smartphones. Phone calls can be transmitted directly through the hearing aid.

Last fall, artificial intelligence components began being built into hearing aids, Branham said. That has opened up a full world of differences and healthful enhancements.

With AI technology, hearing aids will know when a person falls and alert emergency contacts.

Hearing aids monitor things like heart rates and movement, much like a fitness tracker. They keep daily brain and body scores of everything from how often a person moves each hour to how engaged he or she is socially to promote active listening and changes of environment. Body and brain goals can be set individually.

Coming soon, hearing aids will be able to be programmed like virtual assistants such as Alexa. “You can say, ‘Hey, remind me at 3 o’clock to pick up the car,’ and at 3 o’clock, it reminds you,” Branham said.

“We’ve kind of moved to this age of the whole-body health, not just hearing.”