Dementia & Hearing Loss

Dementia Awareness Week
17th-23rd May 2021

In this blog we highlight the relationship between dementia and hearing loss, and the importance of early action once a hearing loss is identified, to reduce the risk of declining brain function.

The Global Dementia Challenge

With improving healthcare, the average life expectancy in developed countries like the UK has risen steadily for years. However, an improved life expectancy does not necessarily mean good health, and there is a particular challenge around making sure that we maintain good brain health into older age.

One of the most difficult conditions to manage in older age is dementia, an illness associated with a decline in brain function which can affect an individual’s ability to communicate and remember people and places, amongst other vital functions.  Dementia is a particular challenge because until very recently we have had a limited understanding of the factors that contribute to developing the condition, and this has meant as a society we have struggled for ways in which to prevent and treat the disease.

The health and emotional burden of dementia on an individual and their family is clear, but there is also a financial burden to the family (and wider society) with the costs involved in providing care for someone with advanced dementia.

Dementia predominantly affects older adults, and the rate of hearing loss in the general population also increases with age, so it should come as no surprise that many people with dementia also have hearing loss. However recent research has suggested that in fact hearing loss is significantly more common in those with dementia than in those of a similar age without dementia.

Cause or Effect?

The exact reason that hearing loss in mid-life increases the risk of developing dementia is unclear. It may be that there is a common underlying process, i.e. whatever process causes hearing loss in mid-life, might also cause the onset of dementia. However, it may also be that changes in the brain as a result of hearing loss cause the onset of dementia. It has been well established that hearing loss causes social isolation and this lack of stimulation, or “sensory deprivation”, could be the factor that links hearing loss with dementia. The less we are able to hear, the more disengaged we are with our surroundings, our family, and our friends, and the less we exercise our brain. It has been proven that good brain health relies on continually stimulating the brain, especially in ways that promote positive emotions.

‘Modifiable’ Risk

A recent extensive and high quality research paper published in the Lancet scientific journal divided factors that increase the risk of developing dementia into two categories:

  1. Risk factors that are unknown, and possibly down to luck or genetics (60% of the overall risk)
  2. Risk factors that can be reduced, or modified, by changes in lifestyle (40% of the overall risk)

Of the modifiable category of risk factors, hearing loss accounts for over 20% (over 8% of the overall risk). Not only this, but social isolation and depression account for a further 10% of the modifiable risk (4% of the overall risk) each. Older adults with hearing loss are up to 3.5 times more likely to be socially isolated and depressed than those without hearing loss, and so when we add this all together, an untreated hearing loss could contribute to increasing your risk of developing dementia by up to 15%.

What Should I Do?

Public health bodies often encourage us to make lifestyle decisions to reduce our risk of developing serious long-term health conditions. We are told to eat healthily to avoid developing cardiovascular disease or diabetes, to limit alcohol consumption to lower the risk of liver disease, and to limit sun exposure to reduce the chance of developing skin cancer. However up until now there has been no concrete advice offered on how we might reduce our risk of developing dementia. Given that it is possible that treating hearing loss may reduce an individual’s risk of developing dementia by over 15%, it is now more important than ever to seek advice if you are concerned about your own hearing, or that of a friend or family member. Doing so may increase your chances of being able to lead an active and fulfilling life into older age.

If you are concerned that you or someone you know has dementia, contact your GP or visit www.alzheimers.org.uk.

If you think you or a loved one may have a hearing loss, contact us to find out how we can help.

Understanding Noise & Hearing Protection

28th April 2021 is International Noise Awareness Day. In this blog we discuss the importance of protecting your ears so that you are able to enjoy your hearing into later life.

Why Is Noise A Problem?

Microscopic hair cells detect the sound waves entering the inner ear, and turn this into an electrical signal to send to the brain. Excessive noise exposure causes physical damage to these hair cells, affecting their function and sometimes even destroying them completely, or damaging the quality of their connection with the hearing nerves. Because of the way that sounds are naturally amplified by the shape of the human ear, noise-induced hearing loss tends to affect high-frequency hearing; causing hearing difficulties in a number of social and workplace situations. Another common side-effect of noise exposure is persistent tinnitus; the perception of a phantom sound in the ears or head. Tinnitus can be a distressing sensation for some, affecting sleep and mood amongst other negative effects on quality of life. Once this damage has been caused, there is no going back. Although drug treatments for hair cell damage are on the distant horizon, there is currently no treatment that can restore hearing lost, or tinnitus caused, through noise damage.

You could be forgiven for thinking that hearing damage due to noise is largely a thing of the past; consigned to history with the closure of the coal mines and gradual winding up of the UK steel industry. With Noise At Work Regulations having been in place since 1989, and made more stringent in 2005, employers have been at pains to avoid the eye-watering claims for industrial hearing loss which have been commonplace over the last few decades. However, preventing such large-scale industrial hearing loss is only part of the picture. Read on to find out why…

Noise Exposure In The 21st Century

Modern life is becoming an increasingly noisy soundscape, particularly for those of us living in towns and cities. Road noise, electronic equipment, fans or air conditioning; the louder the background noise in our environment is, the louder we need the TV, music, or conversation to be in order to hear it clearly. Sound sources compete with each other, raising the overall noise level. When we live our lives in such noisy environments on a daily basis, determining when noise levels have reached a potentially harmful level is a difficult judgement. To further complicate matters, depending on the volume of the noise, the time we can safely spend in an excessively noisy environment before being at risk of hearing damage can vary from many hours, to just a few minutes.

Whilst employers are bound by law to have their workplace noise levels assessed and provide adequate hearing protection to their employees, as individuals we are not in the habit of assessing our own personal listening environments. We are therefore unlikely to be aware of which situations we are placing ourselves in that contain potentially harmful noise levels, and how long we can safely spend in the situation before we risk permanent hearing damage.

Who Is At Risk?

Here, we explore five of the most common occupations and hobbies putting you at risk of developing noise-induced hearing loss or tinnitus.

Self-employed tradespeople or gardeners

Use of power tools such as drills or saws on a repeated basis, day-after-day, can cause gradual permanent damage to hearing. Self-employed tradespeople are unlikely to include hearing protection in their toolbox, and will often work longer days and longer weeks compared to those employed by larger companies, increasing the risk of long-term hearing loss and tinnitus.

Lawnmowers give out noise which is well in excess of safe listening levels, and so gardeners using this equipment for hours on end may also be at risk of hearing damage.

DIY enthusiasts

For the same reasons, home DIY enthusiasts are at similar risk of hearing damage. Even those regularly using sewing machines to craft their own textiles can be at a similar risk of hearing damage as the factory-based machinists of the 20th century.

Noise levels by decibels chart

 

Musicians and gig-goers

Many of you will have attended a gig and left with ears ringing, your friends having to shout  to make themselves heard. Depending on the type and volume of music, and proximity to the speakers, musicians and audience members can all experience a temporary threshold shift in their hearing during the gig and for some time afterwards. With repeated exposure to these environments hearing will increasingly struggle to bounce back to normal afterwards.

Because musicians and audience members are not employees of the venue, the venue-owners are not required to protect the hearing of those at the gig, so use of personal hearing protection is vital. Awareness of the problem is growing thanks to films such as the recent remake of the classic A Star Is Born, and the Oscar-winning Sound of Metal. Both films follow the struggles of professional musicians with noise-induced hearing loss and tinnitus. The rock and heavy metal magazine Kerrang recently ran this feature discussing the problem.

 

Headphone users

Almost everybody owns a pair of headphones or earphones these days, and although some devices do provide an option for limiting the playback volume, research suggests this option is rarely used. The noisier the environment the headphones are used in, the higher the volume is likely to be, in order to make the music audible above the background noise. This is also true of car stereos; think of the difference in volume of your car stereo when driving on quiet residential roads compared to on a busy motorway.

 

Recreational shooters

High-impulse noises such as gunshots can cause instant acoustic trauma. Whilst this can cause hearing damage to both ears, shooting tends to deal a more severe blow to the left ear, as most shooters are right-handed and the head shields the right ear, slightly decreasing the noise exposure to this side. The type of gun used can also affect the exposure; shotguns being louder than rifles for example. Those shooting regularly with others can also be at risk of more gradual and cumulative damage from the gunfire of others close by.

Man shooting rifle

What Can I Do?
  1. Educate yourself on safe listening practices. Try a website such as Listen Up! Protect Your Hearing. (cdc.gov).
  2. Download a sound level meter for your smartphone, such as Decibel Meter for iPhone or Sound Meter for Android, to make yourself aware of potentially harmful environments.
  3. Turn down the volume. Don’t listen to your headphones at anything louder than 60% of the maximum volume.
  4. Reduce the time that you are exposed to excessive noise, by taking regular breaks.
  5. Wear appropriate hearing protection. Not all hearing protection is created equal, and using hearing protection suitable for the activity is key to ensuring adequate protection for your ears. Read on to find out more…

Hearing Protection
  • Foam Earplugs

Whilst these cheap disposable plugs do reduce exposure to harmful levels of noise they are generally uncomfortable to wear for long periods and are likely to frequently slip out of the ear. They are also designed to be single use and, as the material they are made from can harbour bacteria, they can increase the risk of developing ear infections if the same pair is used repeatedly.

  • Reusable plugs

These are generally more comfortable for shorter time periods than the foam earplugs, but are still liable to become uncomfortable after long time periods and can still slip out of the ear frequently if your ears are not the average shape or size. Some come with disposable tips to prevent potential problems with infection.

  • Custom fit hearing protection

This form of hearing protection is most expensive, but is tailor made to fit the individual’s ear and so is comfortable to wear for extended periods of time, and remains in place without the need for frequent adjustment. They are also typically manufactured from anti-bacterial materials and can last up to 6 years if well cared for. Custom fit hearing protection can be fitted with filters specific to the type of environmental noise the wearer is exposed to, so that the quality of other sounds in the environment is not affected unnecessarily.

  • Active hearing protection

Some activities, such as shooting, require hearing protection that responds to sounds in the environment to allow the wearer to hear conversation clearly during quiet periods, but then suppress sudden loud noises. Such technology does mean an extra cost, but is invaluable in safeguarding the wearer’s hearing.

Read more about different types of hearing protection here. To talk to us about your risk of noise exposure and to find out if you might benefit from hearing protection, please contact us.

Noise induced hearing loss though preventable is permanent image

World Hearing Day 2021

World Hearing Day logo

Each year the World Health Organization designates a day as World Hearing Day, which it uses to raise awareness on how to prevent hearing loss, and to promote ear and hearing care across the world. In 2021, World Hearing Day is the 3rd March.

 

We take many things in life for granted, until we start to lose it; hearing is one of those things. From our first moments as a baby when we are soothed by the sound of our parents’ voices, to our later years talking and sharing memories with our close family and friends, hearing is an essential part of our lives.

With advances in healthcare, life expectancy is increasing. In the UK we can now reasonably expect to live into our 80s. However, with a larger proportion of our lives spent in older age it is becoming more and more likely that most of us will develop hearing loss and live with it for many years. Even if we do not develop hearing loss ourselves, a close friend or family member will. At present there are estimated to be 12 million adults in the UK with a hearing loss; that’s one in five. As life expectancy increases this is predicted to rise to 14.2 million by 2035 [Royal National Institute for the Deaf estimates using Office for National Statistics population data].

Communication

Whilst our communication needs change throughout our lifetime, from the classroom, to the nightclub, to the office, and into older age, there is rarely a time in our lives when hearing well is unimportant to us.

Although they change for everyone over time, our communication needs at a given point in time are very individual too. Two people who share the same working environment, who both have a partner and two children, and both live on a quiet street, might appear on the face of it to have identical communication needs. However, this does not take into account the myriad of factors that can influence our ability to hear in individual situations, from the acoustics of the different listening environments, to the clarity of the speaker’s voice. Hearing healthcare professionals have a duty to use patient-centred care to understand those individual communication needs in order to provide the most effective help and advice.

Hearing Loss and Mental Health

The increased listening effort required if someone has a hearing loss can lead to mental fatigue, which can then adversely impact on other aspects of their life. Even with this increased effort they might not always be able to determine what is being said and if this occurs repeatedly can lead to the person becoming socially withdrawn and isolated. In some cases this can develop into depression.

As we hear, the ears are continually passing sound up to the brain for it to analyse. There is increasing evidence that the reduction in sound information passed to the brain that occurs with hearing loss is associated with a greater risk of developing dementia. As well as the obvious human cost of this, investing in hearing care earlier in life may also help avoid financial outlay on dementia care later in life.

Prevention

Exposure to a single extremely loud noise (such as an explosion) can irreparably damage hearing instantly, but moderately loud noise, such as that experienced in some occupations on the factory floor, or using power tools can slowly damage hearing over time. Increasingly, recreational noise exposure is becoming a widespread cause of hearing loss with repeated exposure to high volumes in live music venues or nightclubs, and use of headphones at high levels.

Recognising situations that put us at risk of hearing loss and taking steps to limit our exposure, by taking regular breaks or by wearing appropriate ear protection, is an essential first step towards prevention of early-onset hearing loss.

Diagnosis

Those at risk of developing hearing loss should have their hearing checked regularly by a hearing healthcare professional.

On average in the UK, it takes a person with hearing loss 10 years before seeking help or advice. However research is increasingly highlighting the importance of accessing help for hearing loss as soon as difficulties are noticed. As well as reducing the mental fatigue and social isolation that come hand-in-hand with hearing loss, the risk of dementia due to hearing loss can be reduced by use of hearing devices.

Early identification of hearing loss may also provide opportunities to tackle the underlying factors contributing to its cause. For example, medication or poorly managed health conditions which can contribute to worsening hearing can be addressed.

Management

Identification of a hearing loss is only part of the story. The first hearing aids were developed in the mid-20th century to help those soldiers who had developed hearing loss due to noise exposure in the Second World War. Since then, advances in hearing healthcare have been huge, and there has never been such an array of technologically advanced hearing devices available to help those with hearing loss. Many hearing aids now are able to communicate directly with smartphones so that phone calls and music can be streamed directly into the ears, with adjustments made to take into account any hearing loss. There are devices that can similarly link the TV to hearing aids, there are handheld remote controls so that those with poor dexterity can operate their hearing aids, and invisible hearing aids for those who wish to keep their hearing loss private. Cochlear implants help those whose hearing loss has progressed to be severe or profound in severity, and bone-anchored hearing devices are available for those whose hearing loss is due to poor sound transmission to the inner ear. In short, there are solutions to suit all types and degrees of hearing loss, and most importantly, to suit everyone’s individual communication needs.

If you are concerned about your hearing and want to find out more, please contact us.

Tinnitus Awareness Week

tinnitus

noun

tin·​ni·​tus 

A sensation of hearing a sound in the absence of any external sound

With over 1 in every 8 people in the UK reporting persistent tinnitus, almost everyone reading this Tinnitus Awareness Week blog is likely to have a friend, family member, or work colleague with tinnitus.

For many it is not a particularly intrusive sensation, and although they are aware of it, it does not affect their quality of life. Even if someone finds their tinnitus very noticeable at first, the brain will act to gradually reduce the sensation over time. However, for some there are factors that can contribute to tinnitus that can be rather more persistent and the impact is more significant; affecting concentration, hearing, sleep, and mood, amongst other aspects of their life.

How can I get help?

Sadly, many who seek help from their GP for persistent tinnitus are told that nothing can be done and that they must “learn to live with” the condition. Fortunately this is simply not true. Whilst there is no “cure” for tinnitus there are lots of effective management strategies that can lessen the impact that tinnitus has on someone’s life. Audiologists and Hearing Therapists are trained to offer support and interventions to help those struggling with persistent tinnitus.

At North East Hearing & Balance we support the British Tinnitus Association as corporate members. To mark Tinnitus Awareness Week, which this year runs from 1st-7th February, the BTA have released a short film about the impact of persistent tinnitus which you can watch here. The BTA are a fantastic source of support for people with tinnitus and the professionals who support them.

How Can I Avoid Persistent Tinnitus?

Tinnitus is often, although not always, associated with hearing loss; particularly hearing loss caused by excessive noise exposure. Noise exposure can come from a variety of sources, both occupational and recreational. Taking care of your hearing through protecting against exposure to noise will reduce the risk of causing persistent tinnitus.

Another common cause of tinnitus is ear wax. This can block the ear canal or restrict movement of the ear drum, causing temporary hearing loss and tinnitus. Sometimes this can be relieved by ear drops but, if this is not successful, may require removal by an Audiologist or Ear Nose & Throat doctor.

Hearing loss and tinnitus are also more common in those who have diabetes (which can cause damage to nerve endings in the ear) and conditions which cause poor circulation (which can restrict blood flow to the inner ear). Therefore taking steps in terms of diet and exercise to reduce your risk of acquiring diabetes and cardiovascular disease will also help to reduce your chances of developing persistent tinnitus.

If you are having problems with tinnitus and would like to talk to us to discuss how we can help, please contact us.

6 Myths about Ear Wax

Ear wax: we all have it. But what are the most common myths about this “sticky” subject?

Myth 1: Having wax means your ears are dirty

With its yellowish-brown appearance, you could be forgiven for mistaking wax for dirt, but wax is your friend!

Wax is produced to capture bacteria, dust and other airborne particles and then carry these out of the ear. In short, wax does the cleaning of your ears for you, and wiping the wax away from the outside of your ear with a tissue, cotton wool pad, or wet flannel is all that is required!

Myth 2: Cotton buds are the best ‘at home’ method of wax removal

It seems logical, right? Cotton is soft and couldn’t possibly do any harm if I give it a gentle wipe around the inside of my ear canal… Wrong! If you want to know the quickest way to fall out with your Audiologist or ENT doctor then use cotton buds!

Whilst using a cotton bud might pick up some of the wax from your ear canal walls, it is likely to force the majority of the wax deep into the ear, making it harder to migrate out of the ear naturally. Using cotton buds regularly can cause the wax to build up into a wall deep in the ear, making it more likely to block up the ear entirely and cause hearing loss.

Additionally, although cotton is generally quite gentle, the skin that lines the ear canal is particularly sensitive to abrasion even from cotton fibres. Abrasion of the skin can make the ear more prone to infection, which can cause pain, discharge, and hearing loss.

I have also personally seen several cotton bud tips which have become lodged deep in the ear, either through over-zealous “cleaning” or through faulty product manufacture.

Myth 3: Hopi ear candles are good for wax removal

Amazingly, putting a hollow tube of wax into the ear canal entrance and lighting it has been proven to do little to help remove wax from the ear! In fact, it has been shown that ear candles are more likely to deposit more wax into the ear canal; wax that is hot and can risk damaging the skin both inside and outside the ear.

Myth 4: Wax build-up only affects hearing

Although hearing loss is the most common side-effect of wax build up, wax can also cause tinnitus (a phantom sound in the ear, such as a ringing, buzzing, or humming), or sensations of pressure in the ear.

If the wax is very deep, and comes into contact with the eardrum, it can cause discomfort, pain, and even dizziness.

Myth 5: I should use drops every day to keep my ears clear

There are a multitude of different drops available at the pharmacy marketed for wax removal. Many of these drops contain active ingredients included to help break up the wax. However, in some drops the active ingredient is hydrogen peroxide (think bleaching your hair or teeth!), and so it is not surprising that long-term use risks damaging the sensitive skin in the ear canal. In fact long-term use of any ear drops is not advisable.

Myth 6: Using olive oil will get rid of my wax

Whilst olive oil is the safest product to use in your ears, and can be helpful in softening hard wax, it does not have any properties that break up the wax itself. However it can be a good idea to put a drop of oil in your ears once a week to keep the wax soft and prevent build up of dry wax.

Using a little oil before a professional wax removal procedure can make the process easier and more comfortable, but using too much can cause the wax to turn into a runny mess making removal very tricky! Repeatedly putting too much oil in one ear before bed and then lying on the opposite side can cause the wax to run deeper into your ear and collect near the eardrum, resulting in a higher risk of blockage and more difficult removal. It’s important to follow your hearing healthcare professional’s advice on olive oil use before wax removal.

If you think you have a problem with ear wax and would like to discuss this further, please contact us.

World Mental Health Day – 10th Oct 2020

Hearing Loss and Mental Health

Hearing is one of our five main senses, and losing it results in an enormous tax on our mental capacity. As a result of this, an untreated hearing problem can lead to serious issues with mental health; including:

  • Fatigue
  • Stress
  • Anxiety
  • Depression
  • Fear of social situations
  • Dementia

Hearing loss and tinnitus can create anxiety in everyday situations. They can cause individuals to feel frustrated and stressed, which can make the perceived hearing loss and tinnitus worse. Isolation can be a devastating effect of reduced hearing, affecting relationships with family, friends and colleagues.  Untreated hearing loss can also lead to cognitive decline as the auditory part of the brain is not being used as effectively. 

So what can we do?

Protect your hearing and look after your mental health.

The sooner someone seeks help for their hearing loss, the better. Treatment may include hearing devices but individuals may also benefit from communication tactics, information and support. Simply addressing the needs of the individual can have a huge impact on quality of life.

Collaborative working between Audiology practices, mental health services and GPs can ensure that effective and holistic support is provided.

We need to remove the barriers faced by those who are hard of hearing, and encourage support networks to protect against hearing loss and mental health problems.

Look out for your family, friends and loved ones.  If you believe they are suffering from the effects of hearing loss, encourage and support them to seek help.

If you want more information on how to take care of your mental well-being, Mind can offer advice and support.

Contact us if you have any questions or want to discuss how we can help.