PHOTOS BY JULI LEONARD - jleonard@newsobserver.com
For people with impaired hearing, being fitted with the right kind of hearing aid is important in preventing social isolation.
Hearing loss, a disability currently untreated in about 85 percent of those affected, may be the nation's most damaging and costly sensory handicap. It is a hidden disability, often not obvious to others or even to those who have it.
Its onset is usually insidious, gradually worsening over years and thus easily ignored.
Most of those affected can still hear sounds and think the real problem is that people aren't speaking clearly. They often ask others to speak up, repeat what was said or speak more slowly. Or they pretend they can hear, but their conversations may be filled with non sequiturs.
As hearing worsens, they are likely to become increasingly frustrated and socially isolated. Unable to hear well in social settings, they gradually stop going to the theater, movies, places of worship, senior centers or parties or out to restaurants with friends or family.
Social isolation, in turn, has been linked to depression and an increased risk of death from conditions like heart disease.
And now there is another major risk associated with hearing problems: dementia and Alzheimer's disease.
This finding alone should prompt more people to get their hearing tested and, if found impaired, get properly fitted with aids that can help to keep them cognitively engaged.
Medicare does not pay for hearing aids, and many older people cannot afford the thousands of dollars that aids and auditory training can cost.
For the fewer than 15 percent of hearing-impaired people who have hearing aids, the devices are not an adequate solution. Hearing aids work best when the distance between the sound and the listener is less than six feet and when background noise is minimal, which can preclude clear communication in theaters, airports, restaurants and many other social settings.
Although hearing impairment was first linked in major medical journals to dementia and cognitive dysfunction more than two decades ago, not until last year did researchers demonstrate an independent association with dementia over time.
"People are most likely to notice communication problems when their hearing loss exceeds 25 decibels," said researcher Dr. Frank R. Lin, an otolaryngologist at Johns Hopkins Medicine. "It's not that they can't hear, but they can't understand. Hearing loss at this level affects the clarity of words."
How, then, might this lead to cognitive deficits?
"The brain dedicates a lot of resources to hearing," Lin said. "When the clarity of words is garbled, the brain gets a garbled message. It has to reallocate resources to hear at the expense of other brain functions."
How proper aids help
Rose Marie Jewett, 83, of Janesville, Wis., who had experienced progressively worsening hearing loss for 40 years, had all but given up hope of hearing others speak or ever again enjoying music.
She said she could understand how hearing loss could lead to dementia, because she was "forgetful" when she did not hear what she should have.
It's not that she forgot things; she had never heard them to begin with, and the strain of constantly trying to piece things together was taking its toll.
"When you can't hear anybody, you don't pay attention," Jewett said. "You shut yourself off from the world, you don't think very well, your memory gets bad and you get kind of dull."
A new world
Now it's a whole new world for Jewett. Linda Remensnyder, founder of Hearing Associates in Illinois, taught her how to hear clearly in social settings. She fitted Jewett with the right kind of hearing aids and with devices that allow her to hear clearly on the telephone, when watching television and in public settings with a hearing loop.
Neither Lin nor Remensnyder can yet say whether improving auditory signals for the hearing-impaired will diminish or delay the development of dementia. Meanwhile, Remensnyder said, it can "revolutionize" the lives of people with hearing difficulties, a virtue in itself.
