While hearing loss was associated with a higher risk of hospitalization, use of hearing aids was not linked to a reduction in this risk for these patients, according to a cross-sectional study.
Among over 2,000 respondents to the National Health and Nutrition Examination Survey (NHANES) ages 65 and older, multivariable analysis showed that associations with hospitalization were seen for both moderate (OR 1.50, 95% CI 1.01-2.24) and severe hearing loss (OR 1.71, 95% CI 1.03-2.84), reported Uchechukwu C. Megwalu, MD, MPH, of Stanford University School of Medicine in California.
In a propensity score-matched analysis, hearing aid use was not linked to hospitalization (OR 1.17, 95% CI 0.74-1.84), including among those with moderate or severe hearing loss (OR 1.17, 95% CI 0.71-1.92), they noted in JAMA Otolaryngology–Head & Neck Surgery.
It’s not clear why hearing loss is linked to hospitalization even after adjustment for comorbidities and other factors, though it may reduce communication with healthcare providers, said co-author Anthony Thai, a resident in otolaryngology-head & neck surgery at Stanford, in an interview.
In a 2021 study, Thai and Megwalu linked high levels of hearing loss to more emergency department visits (OR 1.44, 95% CI 1.10-1.89, P=0.01) and avoidance of doctor visits (OR 1.63, 95% CI 1.21-2.21, P=0.002) compared with no hearing loss, while a 2019 study linked untreated hearing loss to a higher risk of inpatient hospitalization (incidence rate ratio 1.47, 95% CI 1.29-1.68) versus no hearing loss.
Charlotte S. Yeh, MD, chief medical officer for AARP Services, told MedPage Today that hearing loss may also cause people to withdraw from society and not bother to fill prescriptions. One theory, she said, suggests that the brain needs to work harder to communicate in people with untreated hearing loss, an overloading process that leads to inflammation, stress, and dementia.
The findings may be surprising to some, since it could be expected that use of hearing aids would help seniors stay out of the hospital by improving their ability to communicate, Thai noted.
He said there are several reasons why the study may not be detecting a benefit from hearing aids. “Most importantly, respondents may not be using hearing aids enough to have an impact. Another possibility is that regular hearing aid users lack access to services to optimize their hearing aid settings, reducing their efficacy. Lastly, hearing loss may increase risk of hospitalization through mechanisms that are not ameliorated by hearing aid use — e.g., cognitive decline, decreased social engagement, or poor mental health.”
Nicholas S. Reed, AuD, of Johns Hopkins University Bloomberg School of Public Health in Baltimore, who worked with Yeh on the 2019 study, said the current study’s approach “may not be valid.” He told MedPage Today that wealthier people in the U.S. are more likely to use hearing aids, “so it’s difficult to trust data regardless of statistical technique.”
Plus, he said, the data in the study don’t specify if people actually used hearing aids during communications with medical professionals. “We do know most adults leave their hearing aids at home during acute healthcare interactions for fear of losing them in the hospital.”
Randomized controlled trials may be helpful in offering more insight into the health-related benefits of hearing aids, he noted, and they can be designed ethically, even though some participants with hearing loss would go without hearing aids.
For this population-based study, Megwalu and team used audiometric and healthcare utilization data for respondents ages 65 years and older from four cycles of the NHANES from 2005 to 2016.
They included 2,060 respondents (mean age 73.9, 50.7% men, 61.3% white), of whom 42.5% had normal hearing, 31.7% had mild hearing loss, 21.1% had moderate hearing loss, and 4.7% had severe hearing loss.
Of 1,185 respondents with at least mild hearing loss, about 17% reported using a hearing aid.
The authors acknowledged that NHANES lacks data on cause for hospitalization, and their study could not assess whether the association of hearing loss and hearing aid use with hospitalization differed by type or cause of hospitalization.
The study authors reported no disclosures.
Yeh reported that AARP Services offers a branded hearing aid program.
Reed disclosed advisory board service to Neosensory.