January 31, 2018
By Scott Baltic
NEW YORK (Reuters Health) - Older patients with heart failure (HF) have high rates of hearing loss, and the vast majority do not wear hearing aids, according to a cross-sectional analysis of data from the 2005-2006 and 2009-2010 waves of the National Health and Nutrition Examination Survey (NHANES).
Data were analyzed from 1,658 NHANES participants age 70 or older, 147 of whom (about 9%) had HF. The prevalence of hearing loss, assessed using World Health Organization criteria, was 74.4% among those with HF and 63.3% among those without HF.
Although hearing loss was more common in the HF subgroup, HF was not independently associated with hearing loss after accounting for demographic and clinical characteristics. Participants with HF were older and had more cardiovascular comorbidities than their non-HF counterparts.
Overall, participants with HF had 1.67 higher odds of mild or greater hearing loss, compared to those without HF (95% confidence interval, 1.02-2.72), according to the research letter in JAMA Otolaryngology-Head & Neck Surgery, online January 25.
Only 16.3% of the participants with HF and hearing loss wore hearing aids, and most of those individuals had moderate or greater hearing loss.
“Since patients with HF are frequently in noisy hospitals and clinics where they receive myriad instructions about disease management, it seems likely that untreated hearing loss could impair patient-physician communication and ultimately HF self-care,” the authors write.
“The main finding of our study suggests that most older people with heart failure have significant hearing loss and only one in six use hearing aids,” corresponding author Dr. Madeline Sterling of Weill Cornell Medical College and New York Presbyterian Hospital told Reuters Health by email. “Doctors, including general internists and cardiologists, should be aware of this issue and make sure they ask their patients about hearing loss.”
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“A lot of people are embarrassed by their hearing loss and won’t bring it up to physicians,” she added. “Doctors can also speak more slowly, discuss care plans in quiet places, and use amplification devices, to accommodate heart failure patients’ hearing loss.”
Dr. Sterling further explained, “Many cardiovascular diseases, including heart failure, damage blood vessels, and this results in damage to organs, including the ear. In addition to microvascular insufficiency, heart failure patients also experience decreased cerebral blood flow and take medications (like furosemide) that are known to cause hearing loss.”
Dr. Heather E. Whitson, of Duke University School of Medicine, Durham, North Carolina, told Reuters Health by email that because HF patients receive many instructions about food, weighing themselves, follow-up appointments, and medications, “the key to good heart failure management is good communication between patient and provider. Yet we know that older adults with even mild hearing loss are more likely to miss the meaning of spoken instructions.”
That connects with the study’s other main finding, the low rate of hearing aid use by these patients, said Dr. Whitson, who was not involved with the current investigation. “Hearing aid technology has come a long way even in the past decade. However, problems with stigma and poor reimbursement models remain obstacles for hearing aid use.”
Two of the six study authors have ties to makers of cochlear implants and/or hearing aids.
JAMA Otolaryngol Head Neck Surg 2018.
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