Measuring the Impact of Hearing Loss on Quality of Life

Hearing loss is common in the United States. More people have hearing loss than diabetes, cancer or vision trouble. Occupational hearing loss, which is caused by exposure at work to loud noise or chemicals that damage hearing, is the most common work-related illness. It is also permanent.

Hearing loss can have a profound impact on quality of life. The effects begin small and progress as hearing loss worsens. For most individuals, it starts with others sounding like they are mumbling because some sounds cannot be heard well. The individual often has to ask others to repeat themselves, and this becomes frustrating for both parties. Both begin limiting the length and depth of conversations. As hearing loss progresses, it becomes increasingly difficult to hear others in the presence of background noise. Social gatherings and even dinner at a restaurant become isolating activities because of the inability to understand what people are saying and individuals can’t contribute to the conversation. Over time, these barriers to communication can lead to strained marriages, diminished or lost friendships and limited interactions with coworkers and supervisors.

There are other effects, such as loss of enjoyment. Music…forest sounds…a grandchild’s voice…all of the sounds we want to hear become muted and lack quality. Even a person with mild hearing loss has trouble hearing softer sounds, has difficulty differentiating between the softest sounds and the loudest sounds, and has more listening fatigue. To compensate for this loss of hearing sensitivity, people with hearing loss will need to ”turn it up” whenever possible. Having the TV and radio at high volume can be annoying to others and a spouse or roommate may choose to watch TV in another room, again turning a group activity into a solo activity.

Safety can also be compromised. The sounds of a tea kettle, the warning beep as a fork lift backs up, and the engine of an oncoming car may be missed. There can be a general loss of situational awareness. It is also well known that workers with hearing loss are more likely to get injured on the job.

Not surprisingly, all of these challenges can affect a person’s mental health. Hearing loss is strongly associated with depression. Depressed people are also less likely to participate in activities with others, so the effects of hearing loss and depression compound and intensify isolation. Hearing loss is also associated with cognitive decline, which includes loss of memory and thinking skills. As people lose their ability to hear, they don’t use the hearing-related parts of their brains as much and these parts start to break down. It is a case of “use it or lose it”.

Often those with hearing loss also have ‘ringing in the ears’ (tinnitus). It can be an annoying buzzing, rushing or ringing noise in the ears or in the head. For some people, tinnitus is more than annoying and can disrupt sleep and concentration, increasing fatigue and affecting alertness. The symptoms can be intermittent or continuous. Like hearing loss, tinnitus can also impact mental health and is associated with depression and anxiety.

How does one assign a number to, or quantify the impact of hearing loss on these critical intangibles, such as communication and mental health?

One way to measure this impact is to calculate disability-adjusted life years (DALYs). These are the number of healthy years lost due to a disease or other health condition. For a condition like hearing loss, it doesn’t mean that a person dies younger, but rather that a person has fewer years of good health. The DALYs calculation takes into account life limitations caused by hearing loss as a lost portion of a healthy year of life, and we end up with the number of healthy years lost by a group of people over a specific time period.

NIOSH recently used DALYs to estimate the impact of hearing loss on quality of life in a CDC Morbidity and Mortality Weekly Report article titled “Hearing Impairment Among Noise-Exposed Workers in the United States, 2003-2012.” We examined noise-exposed workers because they have a higher risk of hearing loss. In our paper, we estimated the number of healthy years lost for every 1,000 workers each year. We also looked at each industry sector separately.

We found that 2.5 healthy years were lost each year for every 1,000 noise-exposed U.S. workers because of hearing impairment (hearing loss that impacts day-to-day activities). These lost years were shared among the 13% of workers with hearing impairment (about 130 workers out of each 1,000 workers). Mining, Construction and Manufacturing workers lost more healthy years than workers in other industry sectors; specifically and respectively in those sectors, 3.5, 3.1 and 2.7 healthy years were lost each year for every 1,000 workers.

Fortunately, no worker needs to lose years of good health because his or her hearing was damaged on the job. Occupational hearing loss can be entirely prevented with today’s hearing loss prevention strategies and technology. Visit our web site for more information on occupational hearing loss surveillance and links to resources to protect worker hearing.

Elizabeth Masterson, PhD, CPH, COHC

Dr. Masterson is an epidemiologist in the NIOSH Division of Surveillance, Hazard Evaluations and Field Studies