Reduce Mental Fatigue in Hearing Loss Patients by 30%

Hearing loss is not just a sensory impairment. Individuals with hearing loss often also are hampered by significant blows to their psychological health, cognitive abilities, and social relationships. The resulting impact can comprise social isolation, anxiety, and depression from struggling to remain engaged in conversations and social settings.1

Mental fatigue is another common consequence, with research showing a compounded effect of cognitive and emotional strain from listening fatigue and a near constant endeavor to interpret sound—a burden that can diminish overall quality of life.2 Barriers to treatment, such as stigma around hearing aids, financial costs, and limited access to hearing care, according to experts, further deepen emotional distress and contribute to health disparities. These effects can extend beyond the individual affected to strain family dynamics and social relationships through miscommunication, frustration, and withdrawal. Among the various psychological impacts, social anxiety holds a particularly significant place, undermining communication function and amplifying feelings of loneliness and negative affect, including depression and anger.3-5

Recognizing these interconnected challenges underscores the need for holistic approaches to hearing health that address both auditory and emotional well-being.

The Global and Aging Burden of Hearing Loss

According to the World Health Organization, by 2050 alone, more than 700 million people worldwide could require some form of hearing rehabilitation—the present total is 430 million—and 2.5 billion are likely to have some form of hearing impairment.6

“Epidemiological data have shown higher rates of both anxiety and depression in people with hearing loss compared to peers with normal hearing. We also see increased levels of loneliness and social isolation,” Kate McClannahan, AuD, PhD, CCC-A, audiologist/speech and hearing scientist, assistant professor of otolaryngology, and director of undergraduate studies in the Program in Audiology and Communication Science, Washington University in St. Louis, explained in an interview with The American Journal of Managed Care® (AJMC®). “People with hearing loss often report that they are less likely to participate in social activities that have been a big part of their lives, like religious services, eating at restaurants, and going to the movies or theater.”

This effect is often amplified in older individuals, among whom the prevalence of hearing loss increases with age, due to the cumulative effects of both years lived with disability and disability-adjusted life-years.6

For example, one analysis that utilized data from the US National Health and Nutrition Examination Survey showed that although there was an overall decrease in hearing loss prevalence among adults aged 20 to 69 years, age remained the strongest predictor of hearing loss, with individuals aged 60 to 69 years having the highest rate of speech-frequency hearing impairment.7 Also, compared with adults aged 45 to 54 years, the rate of disabling hearing loss has been shown to be 2 times, 4 times, and more than 10 times greater in persons aged 55 to 64 years, 65 to 74 years, and 75 years and older, respectively, at 5% vs 10%, 22%, and 55%.8

“In the research, we see strong links between hearing loss in older adults and mental health concerns, such as social isolation and loneliness, depression, and anxiety. An overarching factor is sensory loss accessibility in the built environment, which makes it harder for individuals with sensory loss to engage and participate,” Alison Huang, PhD, MPH, epidemiologist and assistant program director at NYU Langone Health supporting the Aging and Cognitive Health Evaluation in Elders Study (NCT03243422), noted in an interview with AJMC. “Thus, older adults with hearing loss may be less likely to participate in certain social activities, particularly activities that rely on hearing and have limited accessibility.”

The Hidden Toll of Listening Fatigue

Huang also echoed concerns about the link between increased cognitive effort to hear and understand speech among those with hearing loss and how it can be tiring, leading to withdrawal and feelings of loneliness despite being surrounded by loved ones. She spoke of her grandmother who had hearing loss and who often found it difficult to keep up with conversations.

“For individuals with hearing loss, speech and sound is heard as garbled. Extra mental and cognitive effort is then needed for discerning speech and sound,” she said. “This can take away from other cognitive processes, like executive function and memory, and can be tiring, leading to fatigue.”

McClannahan concurred. “If the auditory signal is degraded in some way, whether that is due to background noise or a person’s hearing loss, that speech processing becomes more effortful. More cognitive resources need to be involved in listening and understanding when that speech signal is not fully audible (loud enough) or clear of distortion.”

It is because of these hearing-related difficulties—not only hearing loss but tinnitus as well9—that higher rates of many mental health difficulties are seen among affected individuals. These include depression and anxiety, according to Huang and McClannahan; difficulty with daily activities8; and reduced quality of life.10

Drilling down, there is also social anxiety, McClannahan explained. With verbal communication being inherently social in that it requires at least 1 speaker and 1 listener, there are unique challenges associated with hearing loss in social situations. Just the anticipation of miscommunication can exacerbate social anxiety in particular and anxiety in general.

“Adding the need to expend more effort on speech processing and a higher likelihood of misunderstanding the speaker because of a hearing loss means you have an even more challenging social situation,” she said. “For someone more predisposed to fears of negative evaluation by peers, embarrassment, or humiliation in social interactions and hearing loss, that social communication may be doubly challenging.”

Beyond strained social interactions, personal, familial, and caregiver relationships can also suffer, Huang noted. Hearing loss can put a strain on these connections, frustrating both the individuals who have the hearing loss and their loved ones. Coupled with the hearing loss itself and the potential for miscommunication, there are also the emotional effects of hearing loss, which encompass broken emotional connections, decreased satisfaction, hopelessness, lack of intimacy, loneliness, and social withdrawal.11

Barriers to Care and Opportunities for Support

To effectively and holistically address the mental health challenges that accompany hearing loss, including improving individuals’ quality of life, overall, it's important to address these difficulties as early as possible and to expand potential solutions beyond hearing aids.

Although hearing aids are an effective treatment for most kinds of hearing loss—thanks in part to the wide variety of types, features, and technologies12—stigma, cost, and accessibility can throw up major barriers, with prices ranging from $1000 to $10,000.13-15 In addition, neither hearing aids nor exams for fitting hearing aids are covered by Medicare—and have been excluded from coverage since 1965—under Part A or Part B plans16; only some Medicare Part C plans offer this coverage option.17 In 2022, the FDA did establish a category of over-the-counter hearing aids, but these are only approved for use in adults 18 years or older and for mild to moderate hearing loss.18