Fatigue and Hearing Loss

What is fatigue?

Fatigue is a term used to describe tiredness, typically over a long period of time. It can be used to refer to physical or mental fatigue, a combination of both, or a symptom. Broadly, it can be used to refer to feelings, or behaviorally, as various measures of physical or mental performance [1].

How is hearing loss related to fatigue?

There is evidence to suggest that people with hearing loss are at a higher risk of experiencing fatigue than those who have normal hearing, due to increased listening effort [1, 2, 3]. A recent cross-sectional study examining the association between hearing loss and self-reported fatigue in 3,031 participants in the US (as part of the National Health and Nutrition Examination Survey) showed that those with hearing loss were more likely to report fatigue for more than half the days and nearly every day than not having fatigue even when other factors such as age, sex, race, ethnicity, education, smoking, drinking, noise exposure, and body mass index was accounted for [4]. The study reports the relative risk ratio (RRR), which is the probability of the event occurring in the group with exposure (in this case hearing loss) versus those without. A relative risk ratio of greater than 1 means that the event is more likely to occur if there was exposure. Every 10-dB HL–worse of audiometric hearing was associated with a higher likelihood of reporting fatigue for nearly every day (RRR = 1.24; 95% CI, 1.04-1.47) but not for more than half the days [4].

What implications does fatigue have for those with hearing loss?

Fatigue, particularly chronic fatigue can result in:

1. reduced quality of life
2. deficits in cognitive processing (maintaining attention, thinking quickly, clearly, or efficiently)
3. reduced workplace productivity and safety [1]

Do hearing aids help?

There is not definitive evidence yet. The quality of evidence available from a systematic review to answer the questions of whether hearing loss has an effect on fatigue and whether hearing device fitting has an effect on fatigue is “very low” [5]. Having said that the review did highlight support for these questions.

There is some support that hearing loss increases fatigue; the “very low” risk categorization is due to lack of homogeneity among studies, and that there haven’t been any randomized clinical trials conducted thus far. Evidence from self-report measures did not support the hypothesis that hearing aids reduced fatigue in full, although the evidence was more promising for cochlear implants than hearing aids. There was a positive result from one study that used behavioral measures, suggesting that more studies with validated and consistent fatigue measures are needed to examine this hypothesis cogently.

A longitudinal study by the same group looked at the effect of hearing aids before fitting, at 2 weeks, 3 months, and 6 months post-fitting and found that hearing aid fitting significantly reduced listening (-related) fatigue but not general fatigue. Social activity and participation levels also were shown to be increased in the hearing aid group relative to the control group [6].

Given the role of motivation in the framework of listening effort, it is possible that motivation may directly or indirectly contribute to listening fatigue [3]. The interplay between fatigue and motivation to wear hearing aids has yet to be examined.

What to do about fatigue?

The following practices help with general fatigue, and likely listening fatigue:

• healthy diet and exercise
• good and consistent sleep schedule
• lower stress
• socializing that gives enjoyment

If you have hearing loss and own hearing aids, wear that hearing aid you purchased…and do things you love.

References

1. Hornsby, Benjamin W. Y., Graham Naylor, and Fred H. Bess. “A Taxonomy of Fatigue Concepts and Their Relation to Hearing Loss.” Ear & Hearing 37, no. 1 (July 2016): 136S-144S. https://doi.org/10.1097/AUD.0000000000000289.
2. Hornsby, B. W. (2013). The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands. Ear Hear, 34, 523–534.
3. Pichora-Fuller, Kathleen, M., Sophia E. Kramer, Mark A. Eckert, Brent Edwards, Benjamin W. Y. Hornsby, Larry E. Humes, and et al. (2016). “Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL).” Ear and Hearing 37, no. 1: 5S-27S.
4. Jiang, K., Spira, A.P., Lin, F.R., Deal, J. and Reed, N. S. (2023). Hearing Loss and Fatigue in Middle-Aged and Older Adults. JAMA, 149, 8, 758-760
5. Holman, J.A., Drummond, A., and Naylor, G. (2021). The Effect of Hearing Loss and Hearing Device Fitting on Fatigue in Adults: A Systematic Review. Ear andHearing, 42 (1), 1-11.
6. Holman, J. A., Drummond, A., and Naylor, G. (2021). Hearing aids reduce daily-life fatigue and increase social activity: a longitudinal study. Trends in Hearing, 25, 23312165211052786.

Copyright © 2023 Vidya Krull. All Rights Reserved.

How will we be when we are old?

Hiking in the Smokies, I was on the Chimney Tops Trail a few years ago. This is one of the more rugged trails that the majestic mountains have to offer, and if you make it to the top, you are rewarded with a panoramic view. It was a hot day, the rocky ledge at the end of the trail (picture attached) was pretty hot to grip, and there was no way I was getting to the top without gripping it. Long story short, I stopped just a few yards before I got to the top, where the view was brilliant as well. On the way back, I saw an old couple, likely in their 80’s, heading towards the top. I don’t know if they made it, but they sure looked determined. When I am that age, I would like to be like them – enjoying life and in good health.

What will we be like when we grow old? Will we have experienced all that life has to offer and look back upon it with satisfaction? Now I am beginning to get philosophical. In any case, researchers at the Center for Universal Design (CUD) at the North Carolina State University have come up with an ‘aging suit‘ that lets the wearer experience at least the physical challenges that are commonly associated with aging. The idea is to let users experience the difficulties older adults may have in performing a physical task, perhaps a task as simple as filling a jug of water. The ultimate goal is for the suit to aid in the design of products and workplaces that are more friendly to older adults. What a fantastic idea! Of course, the suit will not model the metabolic changes within the body itself, but even so, it offers a chance for young adults, or even caregivers, to experience the physical limitations faced by older adults: parents, relatives, or people living in assisted communities. That, in itself, is a valuable experience.

Several projects underway at the CUD are aimed at fulfilling their mission: improving environments and products through design innovation, research, education and design assistance. All projects seem to use the principles of Universal Design, which are listed on their website as:

1. Equitable Use: The design is useful and marketable to people with diverse abilities.
2. Flexibility in Use: The design accommodates a wide range of individual preferences and abilities.
3. Simple and Intuitive Use: Use of the design is easy to understand, regardless of the user’s experience, knowledge, language skills, or current concentration level.
4. Perceptible Information: The design communicates necessary information effectively to the user, regardless of ambient conditions or the user’s sensory abilities.
5. Tolerance for Error: The design minimizes hazards and the adverse consequences of accidental or unintended actions.
6. Low Physical Effort: The design can be used efficiently and comfortably and with a minimum of fatigue.
7. Size and Space for Approach and Use: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user’s body size, posture, or mobility.

Innovators, companies, and for that matter, any institution that sells a product or provides a service to the public would do well to follow these principles. Take a minute to look at your surroundings and think about whether the products you see are, indeed, compatible with universal design principles. I end this post with two questions for you:

What products or services can you think of that can be enhanced by universal design? And how would you like to be when you are old?

Copyright © 2023 Vidya Krull. All Rights Reserved.