Audiologist Natalie Stephenson shares how addressing hearing loss can support brain health — and overall health.
Hearing loss, especially if you do not address it with hearing aids or other hearing care, can increase your likelihood of cognitive decline. Because communicating with people and staying engaged in social interaction is vital for supporting brain health, not addressing hearing loss can accelerate cognitive decline. In fact, some of the symptoms associated with hearing loss can signal cognitive decline. That’s also why recent research suggests that care homes should provide hearing loss help for residents.
To provide more context on the importance of hearing care for supporting brain health, audiologist Natalie Stephenson joins Being Patient EIC, Deborah Kan, in a discussion on addressing hearing loss. Working as an audiologist for almost a decade, Stephenson provides specialist, person-centered, evidence-based hearing diagnostics and rehabilitation to children and adults. Within the holistic paradigm approach, her approach to hearing care counseling and rehabilitation is to meet a person where they are at and build trust. She was drawn to audiology because of its potential to empower and support people with hearing needs to have the life they seek.
Read or watch the conversation below.
Being Patient: This is an important topic because it’s not only older adults who begin to have hearing loss. With all of the music and AirPods that we constantly have in our ears, people’s hearing probably isn’t getting better. So, tell us a little about what you see regarding early-stage hearing loss. Who’s it impacting?
Natalie Stephenson: I think you’ve hit the nail on the head with regard to [hearing loss.] Traditionally, you would have seen people sort of realizing that their hearing is going [at] say 50 plus, maybe in the 45 to 50 plus age range. There has been a definite shift, where that’s moved away to a slightly younger demographic, because of the use of [headphones], and it’s not to put down iPods, and any other hearing, headphone device that’s on the market, but it is to say that it’s the volume of sound and the constancy of it.
[When] you go to concerts, for example, and many people don’t realize that their artist of choice is probably wearing an ear plug that’s a noise reduction plug, and the audience members aren’t necessarily doing the same. So, there’s that onslaught of sound at too loud a level, which then can cause [hearing loss.]
Initially, people present with tinnitus because they’ve been listening to sounds, music, [that’s] too loud. Initially, it might just be temporary, but then the more you do it, because of the degradation that occurs within the pathway, you accumulate and so you’re seeing an earlier onset [of] hearing loss as a result.
Being Patient: Do we know why tinnitus starts? Is that a sign you could be losing your hearing? I do know a lot of people who say they have tinnitus. So, is that an early sign?
Stephenson: Tinnitus could be attributed to a number of things. If it’s not to do with a heart condition or particular medications, but it is to do with sound, [it can be a sign of hearing loss.] What can happen is that when you’re bombarding your ears, the hair cells in the innermost part of your ear, so the cochlear— it looks like a snail. Basically, if you’ve unraveled it, it’s waiting to hear different sounds of different pitch, crudely speaking. When you’re bombarding the hair cells, they do degrade; they kind of stop dancing.
If I’m talking to patients about what’s happening with your hearing and why you’re losing it, from a sensory point of view, I would say that the hair cells have stopped dancing; they’re not as active. What can happen is the mechanism; when that happens, the hearing pathway itself can create an internal noise that could be attributed to the fact that there’s degradation in the hair cell level.
You’re hearing a noise, and then that’s like when you’ve got a piece of electrical equipment that’s going a bit wrong. It starts to make a noise that doesn’t sound like the system is working as it should. It can be very subtle, but it can present itself, say, in the evening when you’re trying to go to sleep. You’re trying to get off to sleep, and all the background noises are a lot more subdued, so of course, the auditory exercise you’re getting from hearing throughout the day because there are different things of sound going on when you’re going to bed because hopefully you’re in a quiet space, so it starts to kick in then.
“When you’re bombarding the hair cells,
they do degrade; they kind of stop dancing.”
Being Patient: How do we tell, though not only the difference between normal aging associated with hearing loss and hearing loss we should be concerned about? Do we all lose a little of our hearing as we age? Is that normal?
Stephenson: That can be a normal aspect over time, although I do see many anomalies with patients who have got really good hearing, but maybe their eyes aren’t so good. It’s like conversations, for example. You might be having a conversation, you might be in a busy place, and there might be background noise. You might notice that actually, you’ll miss hearing or you thought you’ve heard something. And they say, “No, no, no, I didn’t say that. I said this.”
It’s that smearing; it’s that subtle smearing of particular consonants in the words where you’ll catch the beginning, or you’ll catch the end. So you’ll get the gist. Especially if there’s context, it helps. You might start noticing that in background noise, the humdrum of the day, you’re not always picking up sharply what’s being said.
Being Patient: Regarding hearing loss, is the individual the best person to assess whether there’s something wrong? A lot of times, you probably don’t notice you’re not hearing well.
Stephenson: As human beings, we don’t just practice hearing; we cultivate listening. There’s a very fundamental difference between listening and hearing. Listening is about processing and attention and [about] you wanting to be present and engaged in what you’re hearing. Whereas hearing is [when] you go and have your hearing test, “Can you hear the sounds?” That’s a hearing test.
The other fundamental aspect is the listening aspect. That brings in processing, tuning, and readiness, and your emotional state as well can impact what you’re listening to. You can tune things out. So, your partner or your family member isn’t always the best person because there are many reasons why you might not be attentive.
“As human beings, we don’t just practice
hearing; we cultivate listening.”
Being Patient: How do people know when they should be concerned about hearing loss? Is it when, as you were saying, when you’re at a restaurant, the background gets really noisy, and words start to blend together— is that a sign to see an audiologist?
Stephenson: I think it’s much better for people to start really tuning in and being a lot more self aware. If they are starting to notice those things, there is absolutely no reason that you shouldn’t seek a proper formal, objective assessment and subjective assessment of your hearing.
Being Patient: As with cognition, do you need a baseline?
Stephenson: So, no. There’s a general understanding that within a certain range, you’ve got satisfactory access to sounds. We say satisfactory access to sounds, in layman’s terms, for satisfactory hearing. Again, hearing doesn’t mean that you’re listening well, so they are two separate things, but there’s a ballpark.
If you’re having those subtle differences or very nuanced changes, you may still go and get your hearing tested, and you’re still in the ballpark for satisfactory, but you might be at the top end. Or, it might be that you’re creeping past that ballpark, and you’re coming into that mild loss range. So, it’s really important to get a handle on that. You mentioned baseline, and that’s hugely important around people who are starting to experience cognitive issues as well, capturing a baseline.
Being Patient: How does hearing loss impact cognition?
Stephenson: Fundamentally, the idea of hearing is that it’s auditory exercises for your brain, it keeps things ticking over. There are parts of our brain that [are] waiting to hear sound. We have the auditory nerve that’s waiting to hear sound so it can be triggered to send that sound and the signals to the brain so that we can hear. It’s that constant stream of activity that the brain loves to have to keep it ticking over, if you like.
When you’re not hearing so well, it’s like you’re under-exercising that pathway. You’re not giving it the full breadth of what it should be receiving for it to be at optimum. It’s a huge component; it’s not the be-all and end-all, but it’s a massive component to supporting brain health because of the impact.
If you think about the social impact of not hearing well, it impacts emotions. Because when you don’t hear well, you become more isolated, you become less engaged. So, all of those emotional responses that the body goes through when we’re not hearing well then feed into our thoughts and our feelings, our concentration levels.
Our brain doesn’t like to be weighed down with stress, with cortisol, with all these things that stress does—it has the opposite effect to supporting brain health. It makes it harder. Supporting cognition with hearing support is fundamental, because it feeds into one’s ability to be in their life, to have a quality of life that then supports everything else— their emotions and all of that stuff.
“Supporting cognition with hearing
support … feeds into one’s
ability to be in their life.”
Being Patient: Does hearing loss trigger or accelerate dementia? Where’s the relationship there?
Stephenson: What I’ve come to understand from the research and the research is it’s coming thick and fast, [is] the idea that if you have gone for a long time, without hearing support, you’re more likely to have cognitive decline at a more rapid rate, because you’ve been under-stimulated. If you take people that are in sort of a setting where care hasn’t been provided to the level that they’ve been, maybe sitting there in a care home for 20 years, and they’ve not really had hearing support, then you would expect that would feed into dementia or that journey.
Being Patient: It is interesting to think about because social isolation is one of the worst things for our brains. If you’re losing hearing, it makes social engagement a lot harder.
Stephenson: 100 percent. A baby in utero can hear from 21 weeks gestation, so we’re primed from the very start to want to communicate. Notwithstanding, there are different modes of communication for people that you know will utilize [sign language] as their main language, but from a speaking, communication, or spoken word communication point of view, babies need love to connect. They look at you, they look at your face, and it makes them grow, like when you’re with that nurture, with that communication being bound.
Now, the flip side to that is when you become older, and you don’t have those connections as strongly as needed. Then, when you can’t actively participate, you can’t actively engage because you’re not hearing well, because you’ve got another sort of cognitive decline stepping in.
Being Patient: What should people do if they are experiencing hearing loss? I know many people may be hesitant to wear hearing aids, as it’s a sign that, “Oh, I’m getting older.” What are the options out there?
Stephenson: I tackle hearing loss in a holistic way with people because I completely get that people’s first reaction, especially when they’re of a younger age, is, “I don’t want to wear those. They’re gonna make me look a certain way.” The first thing I always say is, “What’s your view on self-care?” Because fundamentally, if we are about understanding that something’s not quite right with us, and we’re keen to make something better— to me, receiving hearing care is an act of self-care because it means that you are doing what you need to do to be able to live your life at its fullest.
It means that you can engage, it means you don’t have to avoid, it means that you can be productive and participate, and all of that stuff, which is fundamentally important to the human experience. So, I see it as an act of self-care. I teach self-care, even in pediatrics, to little children. We discuss “What does it mean? What do those words mean?” We break it down, “Do you do that self-care in the morning, brushing your teeth?”
For me, it’s just if it can be formed part of somebody’s identity in a positive way, so that they can actually get through that roadblock and just have the life that they were born to have, without barriers to communication, which are hugely detrimental.
“To me, receiving hearing care is an
act of self-care, because it means that you
are doing what you need to do to be
able to live your life at its fullest.”
Being Patient: Even linking it to cognition is incentive enough, right? What different things are available to people to address hearing loss? We all know that hearing aids are getting a lot better.
Stephenson: There’s some super technology, depending on how far you’re gonna go. There are some slightly smaller models. Even now, there are different colors. It’s like the resurgence of glasses. We see them. They’re on us. So, do we want them to blend in, or do we make a statement with them?
There are all these kinds of color options, and also the tech inside them can do some extraordinary things. If you’re outside and you’re busy, then it can adapt automatically. You don’t have to do anything; you just put it on, and you go. You can have additional programs for more kinds of situations, which perhaps might be more challenging.
We’ve come so far in the digitization of hearing aids that there are all manner of options, and there should be something for everybody, regardless of price point. I know price point can be a huge issue. There’s something for everybody because they’re all digital. And they’re all you know, so there’s Yeah, it’s exploring.
“We’ve come so far in the digitization of
hearing aids that there are all manner of
options, and there should be something
for everybody, regardless of price point.”
Being Patient: I’ve been impressed— I took my dad to the audiologist not too long ago, and they put something in his ears where the computer actually picks up on his deficits. They can adjust the aid to his deficits because everybody has hearing loss. Let’s talk a little about nerve damage because I’ve heard that if you have nerve damage in your ear, it’s not repairable. Can you speak to me a little bit about that?
Stephenson: With a damaged nerve, that is the tendency. That’s the mechanism by which the sound actually gets to the brain, and you then can hear it. So, if that is damaged, the result isn’t great for hearing.
Being Patient: What about implants? Is that a solution for hearing loss?
Stephenson: For a cochlear implant, you need a viable nerve. So, a cochlear implant is a device that [attempts] to replicate the hair cells that I spoke about earlier, those hair cells that degrade. So, if a child is born with permanent hearing loss to the level that is cut for cochlear implantation, then the nerve would need to be viable because otherwise, the sound doesn’t travel up.
What you’re replacing within the cochlear implant is you’re trying to replicate how those hair cells respond to sound. So, that is an option for somebody with a significant hearing loss where the cochlea and where the auditory nerve are intact.