Hearing loss points to higher risk of death, dementia: Experts

---

SINGAPORE - It can be a strain to communicate with others, given muffled voices and a lack of facial cues as a result of mask-wearing during the Covid-19 pandemic. It gets worse for people with hearing loss.

 

Not only does hearing loss impair communication, but it is also associated with a 13 per cent increased risk of death from any cause, according to a recent study by local researchers.

 

In addition, hearing loss affects the quality of life and is an established risk factor for dementia, say other experts, so addressing hearing loss should be a priority for an ageing society.

 

Doing so can offer people a new lease on life at any age.

 

Ms Sharon Khoo, 75, is the recipient of a cochlear implant that returned hearing to her right ear after decades of silence.

 

Her hearing started to deteriorate in her teens from unknown causes. She failed oral examinations at school and lost several jobs because of her inability to hear. Despite having a successful career in quality assurance, working in factories, she was often excluded from conversations, even though she could lip-read.

 

She says that in her youth, there was little medical or social support for the deaf and hard of hearing. Even hospitals "couldn't help and I was told to adapt and adjust my life".

 

In the late 1990s, when cochlear implant surgery became available in Singapore, she was advised to receive an implant. However, she felt then that the surgery was too expensive for a single mother supporting a daughter. Most of the cost would have to come from her pocket.

 

In 2019, however, when she was in her 70s, she went for an implant surgery that was mostly covered by government subsidies.

 

Since then, she has been able to join weekly dance exercise sessions in her Boon Lay neighbourhood and communicate regularly with her two granddaughters in Australia.

 

"My quality of life is very much better. I've got back my self-esteem and self-worth," says the retiree.

 

"Without the implant, I would be still living a life with defective hearing as an introvert, not participating much in conversations or communicating much with others, for fear of answering wrongly."

 

Hearing loss can lead to people with the condition being excluded or retreating inwards. There are also other implications for health and mortality.

 

A study published in December and conducted by student researchers from the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine) found that hearing loss is associated with 13 per cent increased risk of death from any cause (all-cause mortality) and 28 per cent increased risk of death from cardiovascular causes.

 

The study published in international scientific journal Jama Otolaryngology - Head & Neck Surgery, also found that people with hearing loss and vision loss had 40 per cent increased risk of all-cause death and 86 per cent increased risk of cardiovascular death.

 

The NUS Medicine team noted that hearing loss has been given less priority than vision loss because it can be hard for patients and their family to detect the decline in hearing. Other experts The Straits Times spoke to agreed.

 

Hearing loss can be hard to identify

 

People with hearing loss may not get themselves tested early because they can hear some sounds, if not others.

 

Ms Koh Si Hui, a clinical audiologist and trainer at hearing healthcare service provider Hearing Partners, fits people with hearing aids and educates them on the use of these devices.

 

She says some of her clients deny their reduced ability to hear because some sounds are still audible.

 

"People with hearing loss often do fairly well in quiet face-to-face situations," she says. "Hearing changes often do not result in an overall loss of volume. Some sounds remain as audible as they always were, yet others become harder to hear, and some conversations require more attentiveness."

 

Otologist and cochlear implant surgeon Rebecca Heywood at private clinic Advanced ENT Centre says any sudden hearing loss should be investigated immediately. It could be a by-product of a viral infection and sometimes a sign of nasopharyngeal cancer.

 

Dr Barrie Tan, senior consultant and ENT (ear, nose and throat) specialist surgeon at Gleneagles Hospital, says there are different types of hearing loss.

 

Conductive hearing loss affects the conduction of sound through the ear canal and could be due to physical causes such as impacted ear wax, fluid build-up in Eustachian tube or obstructions.

 

Sensorineural hearing loss affects the sensory organs in the inner ear or auditory nerve and is most seen in elderly patients as the organs degenerate with age.

 

Mixed hearing loss is a combination of both types of hearing loss.

 

Dr Liu Jiaying, consultant ENT surgeon at private clinic Aurion ENT & Hearing Centre, says age-related hearing loss is the primary cause of hearing loss in Singapore.

 

According to a 2017 study, nearly half a million older Singaporeans have hearing loss and, among them, about 16 per cent have disabling hearing loss which requires hearing aids or implants.

 

Dr Heywood says: "A hearing aid can be used to treat the majority of sensorineural hearing loss by amplifying sounds. In some cases, however, the inner ear hearing is too bad to benefit from a hearing aid and then a cochlear implant can be used."

 

These implants directly stimulate the auditory nerve, bypassing the inner ear organs and allowing sound signals to be transmitted to the brain.

 

Dangers of hearing loss

 

Dr Liu notes that hearing loss is a major risk factor for dementia for several reasons.

 

The lack of auditory stimulation leads the brain to shrink irreversibly. Second, listening takes so much effort that energy is shunted away from higher order cognitive functions such as planning or thinking.

 

Third, she adds: "People with untreated hearing loss tend to withdraw themselves from social activity due to impaired communication with others. The lack of social stimulation results in reduced brain activity setting the stage for cognitive decline seen in dementia."

 

Madam Ong Eng Lian, 67, began worrying that her husband Andy Lee would develop dementia when his hearing loss led him to reduce conversations with the family over the years. After dinner, he would busy himself with his hobbies such as playing with aircraft models.

 

Mr Lee, 71, admits: "I couldn't hear what you were saying, it was a waste of time so I went off on my own."

 

The retired maintenance controller lost his hearing after years working on an airbase with planes flying overhead - he did not always use noise-cancelling safety equipment.

 

He began using hearing aids in 2009 but those became less useful as time went on. In July last year he received a cochlear implant and started therapy to help him improve his speech and understanding. Now he participates actively in family gatherings, playing regularly with his six grandchildren, and has also returned to playing the guitar.

 

He says: "I can now be more involved in the lives of each member in my family and meeting up with friends and ex-colleagues. I am a much happier person now."

 

Dr Tan says that Singapore has a universal hearing test for newborns. Loss of hearing can lead to poorer outcomes in school and the workplace, because of social exclusion or difficulty doing collaborative projects.

 

Ms Nicolette Koh Shi Jing, 21, lost hearing in both ears around age three for reasons unknown, which made it difficult to understand teachers when her back was turned, or to socialise with classmates.

 

She had cochlear implants fitted in her left ear at age four and right ear at age 10.

 

She recalls being excluded from the "cool kids" group on the school bus and says: "In school it was hard to form a social circle until I got the implant and I could hear more clearly and understand what was going on."

 

She has completed a diploma in pharmaceutical science at Ngee Ann Polytechnic and is planning to do a degree in pharmacy. During her time at Ngee Ann Poly, she co-founded a project to provide additional support for special education needs students and shared her past experiences online as well.

 

Not as easy as wearing glasses

 

While hearing loss can be treated, Ms Koh, the audiologist, says that wearing a hearing aid is not as simple as putting on a pair of spectacles. Users need to be trained on how to use the aids.

 

She says: "From the user's perspective, initially, they might notice that they are hearing speech and other sounds that they may not have heard for a long time. Their brain may need a little time to adjust in order to focus on the sounds that are important and filter out the rest."

 

Similarly, recipients of cochlear implants may need rehab to help them redevelop the skills of processing and understanding sounds, says Dr Tan. The surgery has been available in Singapore since 1997, and takes about 21/2 hours under general anaesthesia. The implant is switched on after three weeks to a month, and then rehab can start.

 

Being able to communicate with loved ones is perhaps the best motivation for people to address hearing loss, says Dr Tan. His oldest patient for cochlear implant surgery was an 86-year-old grandmother, who received the implant so that she could go see her grand-daughter graduate from a university in the United States.

 

"Now, not only is she able to speak on the phone but she can make video calls," he says. "The whole family is amazed that grandma, who used to sit quietly by the side, is engaging with the family."

 

Addressing hearing loss gives older people a better quality of life and more independence, which is important to an ageing Singapore, he adds. "We have to ensure that seniors have access to all the necessary senses because that keeps them safe and allows them to enjoy life."

 

He thinks that hearing loss should not be seen as only an individual patient problem but as a social issue. He points to how addressing hearing loss improves family relationships and social interactions.

 

"When a family is happy and healthy, society is happy and healthy."

 

Tips for communication

 

Madam Ho Ah Hin, 85, has been using hearing aids since she was in her 50s and says the devices are essential to her daily life.

 

When she is between devices - such as when a hearing aid goes for repair or she is being fitted for a new one - her family uses several communication strategies to include her in conversations.

 

Her daughter Chan Lai Yoke, 62, says: "We will talk very slowly, facing her. It takes patience."

 

Clinical audiologist Koh Si Hui recommends similar strategies when communicating with loved ones who are hard of hearing: have conversations in quieter and well-lit places; speak clearly and enunciate consonants rather than swallowing words or running words together; and speak at an appropriate pace that is not too fast.

 

Ms Judy Lim, executive director of The Singapore Association for The Deaf (SADeaf), says when it comes to communication, flexibility and accommodation are key.

 

She recommends finding out and catering to the mode of communication preferred by the person who is deaf or hard of hearing. He or she might prefer speaking and listening, or writing and typing, or using sign language.

 

"A person who is deaf may prefer to communicate via writing on paper or typing on phone screens. However, when requested to communicate by writing, some people refuse to do so, instead repeating what they say, or speaking louder or slower," she says.

 

"These may not help, especially with face masks being mandatory in many settings, making it difficult to speech-read."

 

Reading facial cues remains important to communication.

 

A study of 150 people whose loved ones have hearing loss was conducted by data analytics firm Kantar in November and December last year.

 

The study commissioned by hearing healthcare service provider Hearing Partners found that wearing masks during the pandemic has affected communication.

 

Among the respondents, 45 per cent said the inability to read facial cues has made interactions with their loved ones harder, and 51 per cent said muffled voices make communication more difficult.

 

Assistive technology such as hearing aids can allow users to stream audio from computers, televisions and speakers, but there is still the danger that a person may be isolated socially and psychologically.

 

Ms Lim says people who are deaf or hard of hearing may still be left out of conversations, miss information that is transmitted verbally or not receive auditory alerts and alarms.

 

"Empathy and patience are much needed from loved ones as well as the general public," she says. "As deafness is an invisible disability, the impact tends to be overlooked or downplayed. But it adversely affects one's quality of life if not addressed properly."

 

SADeaf conducts sign-language classes and awareness programmes. Find out more at this website.

 

Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.

---

ALL views, content, information and/or materials expressed / presented by any third party apart from Council For Third Age, belong strictly to such third party. Any such third party views, content, information and/or materials provided herein are for convenience and/or general information purposes only. Council For Third Age shall not be responsible nor liable for any injury, loss or damage whatsoever arising directly or indirectly howsoever in connection with or as a result of any person accessing or acting on any such views, content, information and/or materials. Such third party views, content, information and/or materials do not imply and shall not be construed as a representation, warranty, endorsement and/or verification by Council For Third Age in respect of such views, content, information and/or materials.