Hearing loss and depression: What's the connection?

Do you find yourself asking others to repeat themselves, or turning up the volume on your television so you can hear? You're not alone.

Most people will eventually develop some level of age-related hearing loss, or presbycusis. In fact, in the United States, about 2% of adults between 45 and 54 report that they have significant, or “disabling” hearing loss. That rate jumps to 25% for those between 65 and 74 and surges to 50% for those age 75 and older, according to the National Institute on Deafness and Other Communication Disorders.

Age-related hearing loss tends to occur gradually, over time. Many people might not even realize it's happening. Yet although it's common, the condition isn't harmless and should be addressed.

If you're not able to hear well, you might find it easier to avoid conversations with family and friends than to struggle with deciphering muffled words. You might avoid social situations and phone calls. Meanwhile, hearing loss can be particularly worrisome if you find it harder to follow the instructions of your healthcare providers or to hear important everyday sounds, such as doorbells, car horns and other alarms.

If left untreated, this struggle to communicate and interact with others may also increase the risk for depression, according to Justin Douglas, MD, MS, an otolaryngologist with LewisGale Hospital Alleghany in Low Moor, Virginia.

“A link between hearing loss and depression seems to exist,” Dr. Douglas says. “Even if the clinical diagnosis of depression is not reached, hearing loss definitely affects quality of life, especially as you age.”

Surprisingly, those with moderate hearing loss may be at higher risk for depression than those with more profound hearing impairment since those on the cusp may not seek out and receive adequate treatment.

In many cases, depression likely sets in when people with hearing loss begin to avoid social interactions, according to Douglas. “Instead of caring for their hearing loss, people withdraw—they quit doing the things they enjoy because they can't hear their friends and participate in conversations,” he explains.

Be proactive about your hearing

When it comes to addressing hearing loss-related depression, prevention is the best approach, Douglas advises.

The American Speech-Language-Hearing Association recommends getting your hearing checked at least once every 10 years until age 50. From that point on, you should start undergoing regular hearing screenings every three years. Your primary care physician (PCP) can perform these screenings.

Knowing the risk factors and warning signs of hearing loss can also help ensure you address the issue early on—before it takes a greater toll on your health and overall quality of life.

Aside from age-related wear and tear, hearing loss can result from a number of other factors, according to Douglas. This include:

• Exposure to loud noises, both recreational and occupational
• Blockage from earwax or fluid buildup
• Injury or illness, including chronic ear infections or a punctured eardrum
• Health conditions like diabetes, high blood pressure, heart disease, stroke and a brain injury or tumor
• Certain medications, such as “ototoxic” drugs that are known to cause inner ear damage
• Family history of hearing loss

If you're experiencing warning signs or symptoms of hearing loss, it's important to bring it up with your doctor. “The biggest sign is if you're having a lot of ringing in your ears,” Douglas points out. “If that ringing is persistent, visit your doctor.”

Other red flags include:

• Sounds or speech seem muffled
• Trouble hearing high-pitched sounds or consonants
• Needing to turn up the volume on the television or radio
• Trouble with phone conversations
• More difficulty having conversations when there is background noise
• Having to ask others to repeat themselves or speak more loudly or slowly
• Withdrawing from conversations due to problems with hearing

“If you're out at a restaurant with your friends or loved one, and there's a lot of background noise, and you're having to ask people to repeat themselves, or you're missing words—and it's become bothersome to both you and the people you're speaking to—then this should be discussed with your physician,” Douglas says.

Treating hearing loss can help

One of the best ways to avoid or ease hearing loss-related depression is to address—not ignore—hearing problems.

“If we can detect and treat hearing loss in the elderly quicker, we may be able to prevent some of the withdrawal from society that most of them experience, which likely leads to depression,” Douglas explains. “The more we can detect early, the more we can prevent people from falling into that downward spiral of social withdrawal, decreased quality of life and possibly depression.”

Your PCP can perform an initial evaluation and, if necessary, refer you to an ear, nose and throat (ENT) specialist, called an otolaryngologist, or an audiologist—a hearing health professional who performs tests to determine the type and severity of hearing loss.

An otolaryngologist can help determine if there is a simple explanation or treatable cause for your hearing loss, Douglas says. If your hearing is tested by an audiologist, the results of these tests should be reviewed by your otolaryngologist, Douglas points out. Based on your hearing test, your otolaryngologist will determine if you may benefit from hearing aids, bone-anchored hearing aids or even cochlear implants or surgery, he adds.

Meanwhile, it's important to take other steps to cope with hearing loss and avoid isolation:

• Be open with your friends and loved ones about your concerns or trouble hearing. If they know you have hearing loss, they may make an effort to speak up, speak more slowly or otherwise accommodate you during conversation.
• Use assistive devices that can help amplify certain sounds, particularly when there is a lot of background noise. Other tools that can help include voice recognition software and devices that connect to doorbells, phones or alarms that produce loud sounds or blinking lights.
• Wear hearing aids, if needed. They may help lower the risk of hearing loss-related depression and improve your social interactions and sense of independence. Worth noting: of the 28.8 million Americans with hearing loss who would benefit from hearing aids, fewer than 16% have ever tried using one. These people are more likely to feel ongoing sadness and depression than those who do wear hearing aids.

Recognize signs of depression

People who are struggling with the loss of their hearing and independence and feel isolated or lonely are at greater risk for depression. They are also more prone to other health issues or unhealthy habits, such as smoking, being more sedentary, not following a healthy diet and not getting quality sleep. They may experience signs of depression, such as withdrawing and not being as social or talkative, and they may stop engaging in the activities they once enjoyed or develop changes in their usual eating or sleeping patterns.

Someone with depression may also experience one or more of the following symptoms:

• Feeling sad, hopeless or “empty” for a prolonged period of time
• Feeling guilty, worthless or helpless
• Loss of energy or fatigue
• Moving less quickly or talking more slowly
• Memory problems
• Difficulty concentrating or making decisions

If you start to recognize any of these behaviors, it's important to reach out for help.

“Be sure to discuss how you're feeling with your primary care physician,” Douglas advises. In addition to treating the underlying hearing loss, your doctor can steer you to a mental health professional who can help you manage your depression with a combination of cognitive therapy and medication.

Medically reviewed in October 2019.

Sources:
National Institute on Aging. “Hearing Loss: A Common Problem for Older Adults.”
Mayo Clinic. “Hearing Loss.”
American Academy of Audiology. “Untreated Hearing Loss Linked to Depression, Social Isolation in Seniors.”
National Institute on Deafness and Other Communication Disorders. “Age-Related Hearing Loss.”
The American Speech-Language-Hearing Association. “Hearing Screening.”
World Health Organization. “Deafness and hearing loss.”
National Institute on Deafness and Other Communication Disorders. “Noise-Induced Hearing Loss.”
Centers for Disease Control and Prevention. “How Do I Know if I Have Hearing Loss Caused by Loud Noise?”
National Institute on Deafness and Other Communication Disorders. “Hearing Aids.”
National Institute on Deafness and Other Communication Disorders. “Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders.”
Elham Mahmoudi, PhD, Tanima Basu MS, et al. Journal of the American Geriatrics Society. “Can Hearing Aids Delay Time to Diagnosis of Dementia, Depression, or Falls in Older Adults?” September 4, 2019.
Johns Hopkins Medicine. “The Hidden Risks of Hearing Loss.”
National Institute of Mental Health. “Depression.”