Increased Fatigue Could be Linked to Hearing Loss in Older Adults

People with hearing loss may be more likely to experience fatigue, according to a new analysis that highlights the importance of interventions like hearing aids.

The research letter, published earlier this month in JAMA Otolaryngology—Head & Neck Surgery, has broad implications for physicians who treat people with hearing loss, Kening Jiang, MHS, a PhD student at Johns Hopkins Bloomberg School of Public Health and the first author of the paper, told Health.

“By addressing hearing loss, audiologists and [other] healthcare professionals might help manage fatigue,” she said.

The paper did not prove that one condition causes the other, only that the two are related, Sarah Sydlowski, AuD, PhD, MBA, an audiologist at Cleveland Clinic, told Health.

“At this stage, there are some associations, which is different from a causative effect,” she said. “We need more research about the causation.”

But the new findings do emphasize the need to seek help if you think you’re suffering from hearing loss, as the condition can affect multiple aspects of your life, Sydlowski said.

“If you find it’s more difficult to communicate,  if it just feels exhausting because it’s too much to try to overcome, you should have a hearing test,” she said.

Below, experts explain why patients with hearing loss may be more susceptible to fatigue, what kinds of treatments may help, and where future research efforts should be directed.

For the new paper, researchers used data from one question on the National Health and Nutrition Examination Survey (NHANES), a program run by the Centers for Disease Control and Prevention (CDC) that’s been collecting information since the 1960s. The team analyzed responses from 3,031 people 40 or older, collected from 2015 to 2018.

The question participants were asked was: “Over the last two weeks, how often have you been bothered by feeling tired or having little energy?”

Participants choose answers from one of the following options:

What they found was 10.7% of people with hearing loss reported “feeling tired or having little energy” more than half the days, compared to just 7% of people without hearing loss. Another 12.7% of people with hearing loss said they experienced this nearly every day, compared to just 7.3% of people without.

Higher rates of fatigue were reported among younger, non-Hispanic white, and female participants, according to the research letter. However, according to Sydlowski, these differences weren’t great enough to be statistically significant.

While the study helped understand the correlation between hearing loss and fatigue, Jiang noted two limitations: the results were based solely on responses to one question, and the responses were self-reported.

Data collected via participants’ observations are thought to be less accurate than data collected through non-objective measurements taken by researchers.

Still, the association between hearing loss and fatigue is one that experts in the field often warn patients about, Sydlowski said.

“The way I usually explain it to my patients is that you can think of yourself as having a bucket, and it’s full to the top with your cognitive energy,” she explained. “Patients with hearing loss are dumping a lot of that cognitive energy out right from the get-go because you have to use it to hear and understand. So you have less available to you.”

Some highly stimulating situations can cause hearing loss patients to be even more tired than usual, like conversations where multiple people are speaking at the same time, settings with a lot of background noise, or conversations with people with accents.

Sydlowski added that the stress of hearing loss may also be related to increased fatigue.

“I work frequently with people who have a hearing loss in one ear, and they worry about what they might be missing on the side where they don’t hear well,” she said.

People with hearing loss in one ear often get concerned about threats they may miss—such as oncoming cars—if they turn their head at an inopportune time. These accumulated stressors, Sydlowski explained, can be exhausting.

According to the research letter, the study didn’t include enough people with hearing aids to determine whether that intervention could have an impact on fatigue associated with hearing loss.

However, it is feasible that getting the proper treatment for hearing loss may help patients eventually experience less fatigue, Sydlowski said. “We’re continuing to gather more evidence of the benefits of appropriately-fitted devices.”

She noted that experiencing hearing loss can often feel like participating in a spotty Zoom call. “When it cuts out every few seconds and you’re only hearing every third or fourth word—so, when you use a hearing device that’s well-fit, rather than having to make guesses, you should have access to those sounds you were missing.”

For this reason, it’s crucial to get a hearing test if you think you’re not hearing as well as you should be. Older adults, like some of those evaluated for the new paper, often think age-related hearing loss is untreatable, though that’s not the case.

According to Sydlowski, the following warning signs should prompt you to inquire about a hearing test:

Though hearing loss and fatigue are related, fatigue is also linked to a myriad of other conditions.

“I would not say I’ve seen evidence that if someone has fatigue, it’s likely caused by hearing loss, necessarily,” Sydlowski said.

To determine whether hearing loss actually causes fatigue, researchers would need to conduct a longitudinal study, Jiang said. These kinds of studies, unlike the new study, follow participants over a longer period of time.

Additionally, it would be helpful if future studies employed more than one question to determine how fatigued participants are, she said. “Everything’s not conclusive, and we do need…to really test that.”

Lastly, Jiang noted that future research should distinguish between mental and physical fatigue related to hearing loss.

In the meantime, Sydlowski recommended that patients communicate openly with their doctors about all symptoms they’re having, regardless of how old they are.

“Hearing loss can affect anyone at any age,” she said. “It is more common with each increasing decade of life; however, with how noisy our world is, there have been reports that younger and younger individuals” are experiencing the condition.

If you notice any potential warning signs of hearing loss, Sydlowski emphasized that it’s worth bringing them up with your provider. “Anytime you have concerns—even if you just wish you were hearing better—get your hearing checked.”