My Cautious Gratitude

By Lauren McGrath

Clockwise from left: Heather, her daughter, her husband, and son.

Heather Mills never imagined her early adulthood would be interrupted by Ménière's disease, a chronic hearing and balance disorder without a cure. She was diagnosed at 21—just within the typical 20-to-50-year-old range of onset—after a slew of tests and follow-up visits with a specialist at the University of Minnesota.

Heather’s symptoms initially included a unilateral (in one ear) mild low-frequency hearing loss, tinnitus, and some ear pressure and pain. Within a few years, her hearing loss became bilateral and worsened from moderate to severe. She was regularly distressed by intense ear pressure, struggled with her balance, and experienced occasional bouts of vertigo. As Heather learned, Ménière's affects each patient differently. She considered herself fortunate not to face drop attacks (instances of falling to the ground without losing consciousness), one of the most terrifying symptoms associated with Ménière's disease.

Despite its prevalence Heather family, hearing loss—once her most debilitating Ménière's symptom—came as a surprise. Her father has lived with a unilateral hearing loss since childhood, while her mother and maternal grandmother both developed high-frequency sensorineural hearing loss in their late 40s. “It never occurred to me that it may one day affect me, too,” reflects Heather, who can recall her ability to hear whispers across her high school classrooms.

Though she followed her doctor’s directions to take diuretics and maintain a low-salt diet for her vestibular symptoms, Heather chose not to purchase hearing aids. Lacking amplification, Heather faced difficulty in her job as a legal project specialist, which required frequent verbal interaction with clients, lawyers, and vendors both on the phone and in person. She found herself increasingly dependent on a close friend and colleague who truly served as her ears by repeating information for her during and after meetings.

Heather’s untreated hearing loss, combined with her constant fear of a sudden vertigo attack, fueled feelings of isolation. Unable to participate in conversations with friends, Heather stopped receiving invites to social outings. Challenges with work and friends began to affect Heather’s mental health. “I became depressed, lonely, and developed anxiety because of two unknowns: not knowing when my vertigo would strike again, and wondering how I’d continue to work to support my family.”

Heather noticed a sharp decline in her job performance when her helpful coworker—her ears—left the law firm. Part of Heather’s role required instructing staff on new software, and she was humiliated to find out that her trainees’ questions went unanswered because they’d not been heard. “This is when I began to lose confidence in myself,” Heather remembers.

Heather realized she had to address her hearing loss. In line with Hearing Health Foundation (HHF)’s findings in a 2017 survey of more than 2300 participants, cost is by far the largest barrier to a hearing aid purchase. Heather delayed taking action for so many years—11 to be exact—because her insurance provided no hearing healthcare coverage.

“All I can say now is I wish I had gotten hearing aids sooner!” exclaims Heather, who, with newfound confidence, no longer struggles in her daily professional communications and social life. Prior to pursuing treatment, her conversations had soured quickly when she constantly had to ask other parties to speak up, repeat themselves, or remind them of her hearing loss. Most painfully, communication without hearing aids often left Heather dismissed by a “nevermind” when she requested repetition. With her new devices, Heather felt her confidence restored.

Now in remission, Heather considers her life happy and her health stable. Hearing aids have somewhat alleviated her tinnitus, her ear pressure has subsided, and the vertigo spells are very rare. She’s sought treatment for her anxiety and depression. Heather credits her husband, Billy, with whom she has two young children, for his support during her more difficult years. Engaging in online Ménière's support groups has been a beneficial coping tool.

Heather is cautiously grateful for her current health, knowing the unpredictability of Ménière's could alter her circumstances at any time. She hopes for scientific advancements in Ménière's research that will one day uncover the causes, more reliable diagnostic procedures, and a cure.

Heather lives in Minnesota with her husband and children. She is a participant in HHF’s Faces of Hearing Loss campaign.

Untreated Hearing Loss Puts Overall Health at Risk

Hearing Health Foundation (HHF) CEO Nadine Dehgan’s “Treating Hearing Health for Better Overall Health” was published online to My Prime Time News following its original print appearance in The American Legion’s December 2017 issue.

The article details how the state of the inner ear impacts other critical functions, like the heart and the brain. Cited are the various conditions that can arise as a result of untreated hearing loss, including cardiovascular disease, dementia, diabetes,  depression, and falls. When the auditory system is functioning well, however, the risk for these ailments declines.

Additionally, hearing loss is also linked to other medical conditions and drugs. People with anemia are twice as likely to have hearing loss. According to Peter Steyger, Ph.D., a scientific adviser to HHF. Further, certain cancer-fighting chemotherapy drugs, such as cisplatin, may permanently harm hearing.

While the relationship between hearing health and overall health is always significant, the publicity of “Treating Hearing Health for Better Overall Health” is an especially timely and helpful follow-up to ERG recipient Harrison Lin, M.D.’s new findings concerning the gaps between self-reported hearing loss and patients evaluation and treatments for hearing loss, which appeared in this month’s issue of JAMA Otolaryngology—Head & Neck Surgery.

Individuals who believe they may have a hearing loss are encouraged to consult an audiologist or ENT, and can learn more about the relationship between hearing health and overall health in the full article on My Prime Time News.

Protecting Your Hearing Means Protecting Your Mental Health

By Carol Stoll and Lauren McGrath

October is Protect Your Hearing Month—and, today, October 10, is World Mental Health Day, a time for mental health education, awareness, and advocacy. Hearing loss and tinnitus (ringing in the ears) can increase one’s risk of developing mental illnesses including depression, anxiety, schizophrenia, and dementia, and can trigger episodes of extreme anger and suicidal ideation. Protecting one’s hearing not only prevents or delays hearing loss, but also benefits mental wellness. Understanding the signs of mental illness and having access to mental health resources is critical—and can even be life-saving—to all individuals with hearing loss or tinnitus.

According to an April 2014 study published in JAMA Otolaryngology Head & Neck Surgery, 11.4% of adults with self-reported hearing impairment have moderate to severe depression, significantly higher than the 5.9% prevalence for those with typical hearing. Individuals with hearing loss have reported feeling socially inept in group settings, entering conversations at inappropriate times, talking off-topic, or dominating conversations and coming across as rude simply because talking is easier than listening. When a person cannot hear properly, engaging in conversations is a daily struggle, and can lead to social isolation and depression. Other factors that increase the risk of depression include being female, low-income, a current smoker, binge drinking, having fair or poor health status, trouble seeing, and sleep disorder. However, even controlling for these factors, those with hearing impairment still had significantly higher rates of depression than those without hearing impairment. In people 65 and older, hearing impairment is among the most common chronic conditions associated with depression.

In addition to depression, hearing loss has been linked to schizophrenia. Several studies support the social defeat hypothesis, which proposes that social exclusion and loneliness can predispose people to schizophrenia by increasing sensitization of the dopamine system. In a December 2014 study published in JAMA Psychology, participants with hearing loss reported significantly more feelings of social defeat than healthy controls. Though their psychotic symptoms were similar to the control group, exposing them to a stimulant drug showed that those with hearing loss had significantly higher than normal dopamine sensitivity. Further studies are needed to draw definite conclusions of the causation, but this research is a first step in understanding the relationship between hearing impairment, social defeat, and psychosis.

In older adults, hearing loss is associated with cognitive decline and dementia, according to a February 2013 study published in JAMA Internal Medicine and several other studies conducted at Johns Hopkins University. The scientists concluded that reduced social engagement and a cognitive load focused on coping with hearing loss rather than higher level thinking can lead to poorer cognitive functioning and faster mental decline. Hearing aids could possibly be a simple fix to increase healthy brain function in the older adult population and reduce the risk of dementia.

Exposure to noise often results in tinnitus instead of or in addition to hearing loss, which can also contribute to a range of psychological disorders. Tinnitus affects about 1 in 5 people in the U.S., and causes permanent ringing in the ears. Though research for therapies is ongoing, there is currently no cure. Without therapy, constant ringing in the ears can be debilitating; it can affect job performance, cause insomnia, and provoke fear, anxiety, and anger. This can lead to depression, anxiety, suicidal ideation, and can exasperate post-traumatic stress disorder (PTSD).

Compromised hearing is an invisible disability, often unnoticed or ignored even by those affected. However, hearing loss and tinnitus are widespread and can have serious psychological repercussions. Hearing loss caused by noise exposure is completely preventable by taking simple measures like turning down the volume on your earbuds and using hearing protective devices in loud situations. Regular hearing screenings can also help detect hearing issues early on. Talk to your audiologist about best ways to treat or manage your hearing impairment. Find help for mental illnesses here.

Per the National Institute of Mental Health: "If you are in crisis, and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (Voice: 1-800-273-8255 or TTY: 1-800-799-4889). Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals. If the situation is potentially life-threatening, call 911 or go to a hospital emergency room.”

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