Hearing Loss and Depression

Robin Williams taking his life was a recent event that was surrounded by great sadness. This event highlighted an issue that plagues us with perhaps no soul left untouched by the disease that is mental illness and specifically depression. To some degree we each have our times of feeling down and sad wishing to withdraw from others on very healthy and normal terms and yet it feels lousy. Depression as an illness is obviously magnified to a far greater extent even to the point where one considers taking their life as a solution.

In my Audiology practice I have many patients that are open about their mental illness and depression. Over the years I have become acutely aware of the connection between depression and hearing loss. It only makes sense that when your hearing deteriorates without intervention one becomes less able to function in groups, having conversations in a background of noise and even on a one on one basis. When this degree of difficulty starts to effect the functionality of ones ability to communicate often that individual will start to avoid those situations that they find difficult moving in the direction of self isolation. For those whose life has been one where human interaction is common and important this self-inflicted isolation can lead to depression that spirals downward.

Recently I was running an earwax (cerumen) removal clinic and encountered a male in his thirties that had impacted wax. The patient reported that they had been plugged for a few months now and really wanted the wax removed. Typically when this is the case and I remove the wax occlusion my patients are amazed at the difference as being plugged and therefore hearing impaired had become a normal part of their life. That feeling of being able to hear again is like turning the light on for someone who was blind only moments ago and there is a degree of overwhelming hearing for a time. In this particular case when I removed the wax my patient had a far more honest insightful self-revelation as he told me that he instantly felt happier. What this patient told me in our conversation following the wax removal was that while he does not suffer from depression not being able to hear well was really bringing him down. Being plugged with wax had created inefficiency in a major sense that left him very tired at the end of the day from working so hard to simply hear. This man reported times where he did withdraw himself from social situations because as he put it “it was too hard”. Indeed to have one of your primary senses impaired makes one feel less like themselves.

There are now studies that verify and quantify this phenomenon that we as Audiologists have witnessed in our clinical practices for some time.

“In the new study, as hearing declined, the percentage of depressed adults increased -- from about 5 percent in those who had no hearing problems to more than 11 percent in those who did.

"We found a significant association between hearing impairment and moderate to severe depression," said study author Dr. Chuan-Ming Li, a researcher at the U.S. National Institute on Deafness and Other Communication Disorders. "The cause-and-effect relationship is unknown," Li said, citing a need for further studies.

The study was published online March 6 in JAMA Otolaryngology--Head & Neck Surgery.

The new findings make sense, according to two experts in the field who reviewed the study conclusions.

"It is not surprising to me that they would be more likely to be depressed," said James Firman, president and CEO of the National Council on Aging. "People with hearing loss, especially those who don't use hearing aids, find it more difficult to communicate with other people, whether in family situations, social gatherings or at work."

Experts who care for those with hearing loss have long noticed the link, said Robert Frisina, director of the Global Center for Hearing & Speech Research at the University of South Florida, in Tampa. "When they come in [to see about their hearing], they mention this," he said.”

“For the new study, the researchers looked at data from the U.S. National Health and Nutrition Examination Survey, including more than 18,000 adults aged 18 and older. The younger people self-reported on their hearing status, while hearing tests were given to those 70 and older. All participants filled out a questionnaire designed to reveal depression.

As hearing loss became worse, the depression did, too, except among those who were deaf. These adults, Frisina said, may be accustomed to coping with the loss.

Hearing loss was linked with an increased risk of depression in adults of all ages, but was most pronounced in the respondents aged 18 to 69, the investigators found. Women had higher rates of depression than men did.

Among those 70 and older, no link was found between self-reported hearing loss and depression. However, a link was found for women in this age group if the hearing test found a hearing loss.”

SOURCES: Chuan-Ming Li, M.D., Ph.D., researcher, U.S. National Institute on Deafness and Other Communication Disorders; Robert Frisina, Ph.D., director, Global Center for Hearing and Speech Research, and professor of chemical and biomedical engineering and communication sciences and disorders, University of South Florida, Tampa; James Firman, Ed.D., president and CEO, National Council on Aging; March 6, 2014, JAMA Otolaryngology--Head & Neck Surgery, online

http://consumer.healthday.com/senior-citizen-information-31/misc-aging-news-10/hearing-loss-linked-with-depression-study-685523.html

This kind of information is extremely important as it allows us to focus in on the preventable in health care. Seeing an Audiologist is typically seen to be just about hearing ability as opposed to being about healthy living. Depression is as real a health issue as is heart disease or cancer. We have become far more knowledgeable regarding our own health and well being than we have ever been before as a society yet here is an area that we perhaps do not give much thought to.

On the day after Robin Williams took his life I had a very painful conversation with a friend that was in a fight for his teenage sons life as his young son was enrolled in a program of intervention to help him cope with his own thoughts of ending his life. Mental illness is perhaps an even worse stigma than hearing loss and a struggle that is even harder to talk about than hearing loss. There is great societal reticence to accept treatment for depression as there is some resistance to accepting the reality of the diminishing of our sense of hearing and an even greater unwillingness to explore the solutions that may be readily available.

Eyes, Ears, Teeth

Those embarrassing purple teeth! Remember when the health nurse used to come to our school and give us those purple pills that when chewed would reveal the plaque in your teeth? It was back in those days that we went through dental screenings, vision screenings, and hearing screenings. There was a real effort made to educate the young as to healthy habits and the importance of good vision, dental health and hearing. I can still picture the oversized set of teeth and gums and the giant toothbrush that was used to teach us the right way to brush our teeth and the vision chart that we still use as well as what I now know as a screening Audiometer. I remember so well the room that our school provided for the screenings to be done and worrying about pass or failure.

Over the years it has become common practice for us to have our vision tested to see where we stand, we check our children’s vision and have ours checked periodically as adults. The dentist is now visited regularly to check dental work and to prevent decay through cleanings.

Hearing is a major and important sense that should be checked pre-emptively to be educated as to where we stand with this ability. We would not wait till we had lost significant vision before having vision testing or till several teeth had fallen out before we thought a dentist might be a good idea.

Each of us should have our hearing baseline tested in order to reference change in the future. Knowing that you have a mild hearing loss allows you to take action early and with great potential to optimize function.

Eyes ears teeth all need to be kept as healthy as possible with screenings and testing a necessary part of the process.

What is an Audiologist ?

     As I grew up my parents had an expectation that higher learning (graduate school and beyond) was simply a given. We were imigrants in 1970 comming to North America to achieve, audiology was a word I had probably never had a connection to. I doubt that audiology was a word that was part of my vocabulary until I was in University.
      In todays world there are many professions that did not exist 20 years ago, specializations in areas that seemed improbable in the past. In our education system students are supposed to know what they want to do for the rest of their lives as 18 year olds before they even have an inkling of all that is out there.
     As an Audiologist I posses a Bachelors degree in Communicative Disorders from Andrews University in Michigan, a Master of Science degree from The George Washington University and clinical Doctorate from Salus University in Pennsylvania.
     Audiologists through their years of education are trained in hearing and hearing disorders including vestibular and balance disorders as well as the remediation that might be appropriate. Remediation may be Hearing aids, Cochlear implants, Aural rehabilitation, Tinnitus management and vestibular rehabilitation to name a few areas of practice.
      A few years ago a young woman that I have watched grow up from the time she was a little girl asked to come to my office to find out what an Audiologist does. When a student comes to me to ask for advice or profesional direction this is what I have to offer, "you may not know exactly what you want to do professionally but you should have an idea of what kind of work you want". Do you want to work with people? Do you prefer working with equipment, computers, your hands? Do you want to work with others or by yourself?
     I just attended the 2014 Audiology Now conference which is a convention hosted by the Americam Academy of Audiology and was overjoyed to catch up with this same young woman, now a second year Doctoral student who had the honour of having a poster session at the conference. Lachelle has gone down this professional path and is enthusiastic about her future in her profession.
      Until you walk in our door at "The ear Company" you may not know what an Audiologist is and so I write this post for those of you that are in need of anything related to better hearing or balance. This is that little known profession that almost every one of us will one day need to utilize.

This link describes the profession od Audiology in a little more depth.
http://www.audiologist.org/ada-students/careers-in-audiology

Airport Audiologist

I was recently travelling back from an Audiology convention and was standing in a security checkpoint line at the Orlando airport. I actually love airports, I love seeing all the people and often try to imagine what their "story" is. I tend to be very visual anyway and notice much about my surroundings. This was the end of the U.S. Spring break and a Sunday and as such the airport was busy and bustling. As security lines go mine was moving nicely when next to me I noticed and older couple travelling and yes I couldn't help but notice his ears and his hearing aids. Right away I could tell what manufacturer they were and rather obviously I could see that his earmolds (the pieces in the ear) were not in correctly. Within moments I surmised that these were new earmolds as they looked new with new tubing.  I turned to my travel partner and pointed out this inefficiency. In my office I would have no problem walking up to my patient and helping them fix the hearing aid insertion. I felt compelled to just reach over and fix it but that of course would be weird and I would have probably ended up swarmed my the many security officers at that checkpoint. As much as knew what I wanted to do I resisted the urge to do so. As we passed through security my friend asked if I was going to go over and say something to this man as the hearing aids looked like they were going to fall out of his ears. As outgoing as I can be in my own office I am sometimes more inclined to blend into the woodwork in public places. I just didn't feel comfortable helping this man hear better in this context. We had some time to wait for our flight and being a large and busy airport filled with thousands of people at any given time I had many stories to put together about those that I saw travelling.

As I was boarding the plane I looked at my boarding pass to check my seat number and there in what I suspected was my row was the very same man with the ill fitting hearing aids. I felt a little like Jonah to use a Bible analogy being called and compelled to do my  work as an Audiologist.  I leaned over to this gentleman and asked him if I could help him with his hearing aids and explained that I was actually an Audiologist (luckily he know what that was) . In a couple of seconds this man was hearing again and we proceeded to have a nice conversations through our trip. I gave this an a little advice along the way regarding his hearing aids and am certain that his Audiologist will take good care of him now that he has returned home.

While at the Orlando airport I saw a Disney store that had the sign EarPort and the Disney logo meaning this was a place to get mouse ears. I couldn't help but think that in more ways than one Orlando really was an EarPort that day.

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Resolutions and Doughnuts

Making  New Years resolutions are a part of the change in the year for many. It is often the case that people make resolutions for self improvement, losing weight seems to be the most common resolution,  or maybe it is to eat healthier or excercise more. It struck me today as I was sitting down to write this article that much of what we resolve has do has to do with self. I suppose that when it comes to making resolutions the one thing that we should have some control over is ourself. Well what about other types of resolutions that may be moving away from self just a little? What about resolving to spend more time being a better listener?  This particular resolution may be one that revolves around our relationships and how we function within them.

Too many times we live life becomming self absorbed, self obsessed and fail to make the connections in life that are right in front of us. Often I hear my children talking away to me but sometimes fail to really listen to them. Yes my youngest two tend to talk incessantly and I tend to tune them out at times but maybe I should resolve to actually try to listen more often, maybe I should resolve to communicate better on a one on one basis, invite that friend out to coffee to just talk, spend time with just one of my parents at a time to listen to them and hear them. What is more important in life than the relationships we have?

If relationships are so important then why do we take them for granted and focus on things further down the scale of importance like weight loss when it comes to New Years resolutions. As an Audiologist I get to think about communication and how to improve it on a daily basis so perhaps this is a topic that is at the forefront of my conciousness for that reason. At Christmas time I wrote an article about taking the time to consider how best to communicate with that hearing impaired loved one during the holidays, perhaps this is also a valid consideration in every day. Life is so fast paced and hurried that we forget to slow it down from time to time and have that slow fulfilling conversation with that friend, co-worker, family member or aquaintance, to truly listen allowing that person to feel listened to and heard.

It takes some degree of skill and awareness to be able to have a converation with someone and verify that your message is getting across while also affirming that their message has been understood and feeling good about it. We talk about relationships and communication but these just become buzz words when we fail to intentionally make them an important part of our every day life. So maybe we can make these types of resolutions and lose weight by just skipping the doughnut at the coffee shop while having that conversation.