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Rethinking the Future of Hearing Health

Tremblay, Kelly L., PhD

doi: 10.1097/01.HJ.0000542420.93431.6d
Journal Club

Dr. Tremblay is a professor at the University of Washington in Seattle. She has a 30-year history of serving and advocating for people with hearing loss. She studies the effects of hearing loss and hearing prostheses on the brain, and the public health benefits of intervention for our aging society.

The recent regulatory and technological changes in hearing health care have paved the way for new opportunities and priorities that are shaping the future of the field. Notably, three studies are expanding the current views on hearing health care in ways that can influence government policies and leadership by emphasizing the socioeconomic cost of hearing loss and the preventative benefits of intervention.

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THE SOCIOECONOMIC PICTURE

First, we now have a better understanding of the global impact of hearing loss. According to Wilson, et al., hearing loss is the fourth leading contributor to years lived with a disability, affecting nearly 500 million people worldwide (Lancet. 2017 Dec 2;390(10111):2503). They estimated the social and economic costs of hearing loss to be more than $750 billion per year globally. Among the many underlying reasons for these socioeconomic costs is that people now live longer and thus need to stay employed longer to meet their financial needs. Given the high prevalence of age-related hearing loss, an older person's ability to stay in the workforce can be challenging as hearing loss is associated with low workability and fatigue (Int J Audiol. 2018 Apr 27:1). The stigma of hearing loss and the threat of unfair hiring practices may also prevent someone with hearing loss from getting hired or retained over time. Adults with hearing loss are more likely to be unemployed and earn significantly less than adults without hearing loss (Otol Neurotol. 2015 Mar;36(3):545); Ann Otol Rhinol Laryngol. 2012 Dec;121(12):771). Thus, a person's contribution to society through spending behaviors, employment taxes, and reliance on government benefits is significant. By highlighting the socioeconomic costs to society and the individual, Wilson and colleagues made clear connections between hearing health, human rights, social justice, and economics. They showed how hearing health care is important to the world economy, and suggested initiatives that can be a sample model for hearing loss, such as VISION 2020, which involves efficient local and global leadership.

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THE LIFE COURSE PERSPECTIVE

Russ and colleagues have suggested that hearing health be viewed from a life course perspective (In: Halfon, et al. (eds). Handbook of Life Course Health Development, 2018). They showed how life course theory can influence how we understand and approach hearing health. Traditionally, childhood hearing loss has been regarded as a separate issue from adult hearing loss. However, the life course health development (LCHD) model views health as an emergent capacity that develops over time in response to multiple nested and ever-changing genetic, biological, behavioral, social, and economic contexts. In this respect, the early years of a person's life (e.g., childhood hearing loss) becomes “embedded” into emerging biological systems and alters a person's health trajectory. Multiple risk and protective factors (genetics, gene-environment interactions and epigenetics, environmental) are acknowledged to play a role at different points in the lifespan, even throughout adulthood. Critical periods are known to exist within the context of brain development in the early years. However, the LCHD model also acknowledges critical timing decisions throughout the lifespan. For example, young adults with hearing loss might find their need for hearing assistive technology and support increase as they progress through the educational system and on to higher education. Older adults might experience challenging work and/or social environments as they age. Without support in place, these unmet needs could result in otherwise preventable withdrawal from education or employment. These examples are especially relevant given that hearing disability is associated with multiple consequences that affect a person's quality of life, including accelerated cognitive decline and social withdrawal (Gerontologist. 2016 Apr;56 Suppl 2:S256).

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PREVENTION PATHWAYS

Topics such as cognitive decline and social withdrawal serve as a good segue into the third publication. The Lancet Commission on dementia prevention and intervention recently identified hearing loss in mid-life, as well as low social contact later in life, as modifiable risk factors for dementia (Lancet. 2017 Dec 16;390(10113):2673). The commission arrived at this recommendation after reviewing the published literature and reporting the population attributable fractions (PAFs), which are proportion estimates of a certain outcome (e.g., dementia) that could be avoided if exposure to a specific risk factor is eliminated (e.g., dementia cases that may be prevented if a risk factor like hearing loss did not exist). The commission proposed a new life course model of risk by identifying opportunities for dementia prevention. Livingston, et al., estimated that one in three cases of dementia might be attributable to nine potentially modifiable risk factors at different stages of life. For example, increasing education (in early life), reducing hearing loss (in mid-life), and breaking smoking habits (in later life) might help prevent dementia.

The assumption here is that dementia is not an inevitable consequence of aging, and thus, like in the life course perspective, a person's health trajectory might be altered if risk factors present early in life are eliminated. If dementia is viewed as a problem to address later in life, many potential pathways to prevention may be missed.

These recent studies show how hearing loss is a global public health issue with critical socioeconomic and health consequences. Armed with these evidence-based reports, decision makers in private and public sectors can better appreciate the benefits of hearing loss prevention, intervention, and management.

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