Hearing loss and dementia

Gentle Reader,

I can’t hear you!  Will you please speak up?

I can't hear you!
I can’t hear you!

I noticed I was the only one asking for increased volume.

I arrived early for yoga so I could put my mat right in front of the instructor.  Otherwise, I missed her instructions.  The meditation went right by me.

I cupped a hand behind first one ear and then the other to hear the reader in our foursome at Louisa’s where several groups of four were taking turns reading aloud what we had written in the previous forty-five minutes.

One particular daughter speaks so softly that I missed half of what she said.  Since she has the belief that I have not listened to her much of her life, this is particularly serious.  I can’t be asking her “What did you say?” over and over. She might believe that I don’t hear her because I don’t listen.

At my annual physical this past October, I asked my doctor about this matter of missing things and straining to hear in certain settings.  He referred me to the Polyclinic’s audiologist. Sure enough, I tested below 20—the line of perfect hearing—in both ears, the left one more severe than the right.  A follow up visit with the ear/nose/throat specialist determined that the hard-of-hearing diagnosis is age related and not caused by anything that could be fixed with an operation. Surgery?  Yikes.  That had never crossed my mind.  I had the closing conference with the audiologist.  “Here is what we have to offer you for the best and most nuanced hearing enhancement.” Price tag, $6000.

I nearly fell out of my chair and watched my fall trip to Europe disappear into the realm of Never-Never.  I became an observer of ears and noticed a lot of people have spent $6000 to hear better.  Or have they?  I talked to many and discovered there is an alternative. Costco. Suspicious of a quality discrepancy between private and warehouse medicine, I made an appointment to check it out.  This required joining Costco.  I am not a Costco shopper.

Luckily, for me, my audiology person at Costco had worked in the private sector before moving to Costco.  She explained the difference—and it was not about quality.  Sale of hearing aids is lucrative in private practice.  The mark-up is unregulated.  Medicare and Medicaid pay nothing for hearing aids. (I wonder if that will change when the results of several studies catch the public eye.  More about that in a minute.) Doctors and clinics in the private sector of medicine are happy to have big-ticket items to sell and hearing aids are among them.

Costco on the other hand is all about volume and a low margin of profit, 5% in the case of hearing aids according to my specialist.  They just cut a deal with the top of the line, Phonak, which angers the private practice audiologists.  The batteries sell for $.23.  And when you join, the Costco/Amex card charges the minimum monthly payment and no APR for 6 months, giving one a chance to space out the cost with no interest.  To read an interesting discussion of Costco’s decision to sell Phonak and the industries reaction, click here. The ones I chose are the most nuanced as far as being able to move the volume up and down without taking the hearing aids out of your ears.  The price?  $3000, half the price for a better product.

I walked out of Costco on Christmas Eve with hearing aids and greeted 20 people for a stand up oyster stew and cocktails party a few hours later.  I found it easy to turn the volume up and down as needed just by pushing a tiny button on the right (increase) and on the left (decrease).  The apparatus is the size of a kidney bean and rests behind the ear attaching by a thin transparent wire to a tiny nub that fits snugly into the ear.  I got the feel for inserting the nub with minimal practice. Later on Christmas Eve, the tympani, trumpets and organ needed quieting down.  When my stepdaughter leaned in to whisper something during the service, I turned it up, adjusting quickly to meet the situation.  In the past, I would not have heard her.  Period.  Now I could.  On Christmas Day, twenty family members and friends sat around a massive table and I could hear every word, even the words not directed at me.

Since my hearing loss is not severe, why bother?  Why not wait until it gets much worse? The audiologist told me that there is evidence that untreated hearing loss and dementia may be connected.  The problem of a dramatic increase in the prevalence of dementia—doubling every 20 years—and the fact that preventing or delaying dementia is easier than reversing it, gave rise to a study of 635 people from the Baltimore Longitudinal Study of Aging.

The conclusion drawn from this careful study (2011) is that “Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.”  If you are interested, I recommend you read the abstract which can be found here.  They don’t know cause and effect, but the coincidence is there.

An earlier review (2003) of unattended hearing loss and quality of life studies came to this conclusion:

Uncorrected hearing loss gives rise to a poorer quality of life, related to isolation, reduced social activity, a feeling of being excluded, and increased symptoms of depression. There is a significant correlation between uncorrected hearing loss and reduced cognitive functions. There is no clear proof that hearing loss is the cause of the reduced cognitive function, but indirect evidence from some studies supports this hypothesis. If the hearing loss is indeed a cause of cognitive decline, this is a very strong argument for early detection of hearing loss and fitting of hearing aids. However, hearing loss and cognitive decline having a common cause is also a good reason for early detection and fitting of hearing aids: The cognitive decline will exacerbate the consequences of missed information due to the hearing loss. The more auditory information that is available, the easier it will be for the impaired cognitive system to process it successfully. Stig Arlinger, Department of Audiology, University Hospital,

Linköping, Sweden Negative consequences of uncorrected hearing loss––a review


No one is coming right out and saying, “Get hearing aids and avoid dementia.”  Here, however, is an argument no one will disagree with, as remembered by my friend who wears hearing aids.  It is posted on her audiologist’s wall.


The background is faint picture of a grandpa walking with his young grandson. The content goes something like this:
How much did my hearing aids cost? Let’s see–at least three good friendships, a lot of aggravation with my loving spouse, a regular bridge game, my grand children thinking I didn’t care about them, and many other activities that I used to hold dear like group gatherings, singing and going to the movies. The actual aids were really inexpensive! 


If you have a little—or a lot—of trouble hearing, and haven’t taken any action to address this problem, why wait any longer?  Whether you want to avoid dementia or increase your capacity to connect with people you care about, either reason is a valid push toward making that appointment.  I am so glad I did.


Be well, Do well and Keep moving.  Betsy


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