Hearing loss associated with greater fatigue in middle-, older-aged adults

Key takeaways:

• People with hearing loss reported having fatigue nearly every day and half the days in a 2-week period.
• The association was independent of potential risk factors such as overall health, age and depression.

Hearing loss was associated with higher levels of fatigue in middle- and older-aged adults, according to study findings published in JAMA Otolaryngology-Head & Neck Surgery.

“Our piece suggests that hearing is associated with fatigue independent of other potential risk factors like overall health, depression, age, sex, smoking, drinking, occupation, and noise exposure,” Nicholas S. Reed, AuD, PhD, an assistant professor in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, told Healio. “There have been some previous studies on this topic, but the findings are varied and they've been very small and mostly in clinical samples. Our work broadens this to a population-level that is nationally representative.”

For the study, Reed and colleagues analyzed audiometry subsamples of data from 2015 to 2018 National Health and Nutrition Examination Survey (NHANES).

To measure fatigue, NHANES participants were asked how often they have been bothered by being tired or having little energy over the last 2 weeks. Response choices included “not at all,” “several days,” “more than half the days” and “nearly every day.”

Of the 3,031 participants included in the final cohort, the mean age was 58 years and 52.3% were women. Overall, 713 participants experienced hearing loss.

The researchers found that participants with hearing loss were more likely to report fatigue for more than half the days in a 2-week period (relative risk ratio [RRR] = 2.16, 95% CI, 1.27-3.67) and nearly every day (RRR = 2.05; 95% CI, 1.16-3.65) compared with not having fatigue.

Meanwhile, every 10-decibel hearing level worse of audiometric hearing was associated with greater likelihood of fatigue for nearly every day (RRR = 1.24; 95% CI, 1.04-1.47), although not for more than half the days.

Although associations tended to be stronger in younger, non-Hispanic white and female participants, Reed and colleagues noted that statistical testing did not support differences by race, age and ethnicity.

Reed explained something often misunderstood is that hearing loss “is a clarity issue more than a volume issue.”

“A really simplified example for people might be comparing hearing loss to listening on a bad cellphone signal rather than all sound being dampened — bits and pieces of information come through, but it is difficult to follow and takes a lot of concentration and energy to put it all together,” he said. “As such, it might not be surprising that hearing loss could cause fatigue.”

Additionally, “this might help explain how hearing is also associated with other health outcomes among older adults such as decreased physical activity, poorer mental health, and cognitive function,” Reed said.

He added that although the study does not prove hearing aids can address fatigue, “we believe that best-practice hearing care may be one solution to reduce fatigue.”

“We think primary care physicians could play a vital role in sharing this information and recommending hearing care in adults with hearing loss,” he said. “But an important caveat here is that using hearing aids themselves can be fatiguing — it takes a lot of learning and energy to get used to using hearing aids as they are not corrective like glasses.”

Reed concluded that future research “really needs to separate the concepts of mental and physical fatigue and look at treatment effects of hearing care.”