Author: Sataloff, Robert T
Date published: January 1, 2012
Journal code: ENTJ
More and more of us are living long enough to experience hearing loss. According to the National Institute on Deafness and Other Communication Disorders (NEDCD)1 as of June 16, 2010, approximately 36 million American adults (about 17%) report having some degree of hearing loss.1 There is a strong correlation between hearing loss and age. Eighteen percent of Americans between 45 and 64 years of age, 30% between 65 and 74, and 40% 75 years or older have impaired hearing.1
The NIDCD estimates also that only 20% of people who could benefit from a hearing aid currently use one. As an added annoyance, 12.3% of men and almost 14% of women (ages 65 and older) have tinnitus.1 Interestingly, tinnitus is reported more frequently in white individuals than in other races» and the prevalence is almost twice as great in the South as in the Northeast.1
Most otolaryngologists are familiar with the inconveniences associated with hearing impairment. Its adverse effect on quality of life has been recognized for decades. However, somewhat less attention has been paid to the effects of hearing impairment on earning power. While additional evidence-based studies would be helpful, interesting data are reported through www. betterhearing.org. An article on that site revealed that untreated hearing loss can decrease an individual's income by as much as $30,000 per year.2 Despite the need for confirmation of this claim, a relationship between hearing loss and income seems credible.
Employees who have difficulty hearing supervisors, instructions, and customers are unlikely to perform as well as their coworkers with normal hearing. Mistakes made because of misunderstanding verbal instruction not only impair employment, but they are likely associated with increased job stress as the impaired individual struggles to compensate for hearing loss and avoid making mistakes. As more baby boomers remain in the workforce longer, this problem is likely to increase, and it is important for us to be cognizant of the problem and help prevent losses of jobs and decreases in income associated with remediable hearing loss.
When the problem is considered throughout society rather than individually, the impact becomes more apparent. In calculating their data, the Better Hearing Institute researchers assumed that there are 34 million Americans with hearing loss (rather than the 36 million estimated by the NIDCD), and estimated a loss in income of approximately $176 billion for people with hearing impairment who are unemployed or underemployed; that corresponds with a loss of $26 billion in potential federal taxes.2
The article also suggested that the problem can be ameliorated by amplification. It indicated a reduction in the risk of income loss of 90 to 100% for patients with mild hearing loss, and 65 to 77% for those with moderate to severe hearing loss, if hearing aids are worn.2 NIDCD noted that only 20% of patients who will benefit from hearing aids wear them.1 Betterhearing.org estimated that only 40% of Americans with moderate to severe hearing loss wear hearing aids, and only 9% of those with mild hearing loss wear hearing aids.2 They also estimated that only half of all people with untreated hearing loss have undergone a professional hearing test.
While acknowledging the need to add to the body of literature studying the association between hearing impairment and income loss, and while recognizing that the statistics reported above and in other literature require confirmation to determine the prevalence and magnitude of the problem, it appears as if we as otolaryngologists should at least recognize that there is probably an association between hearing impairment and job performance/income. Consequently, we should be doing everything possible to help lessen the burden of hearing impairment on our patients and society.
Most of us probably think we are already doing everything possible, but it may be worth reassessing that assumption. One of the striking (if unverified) statistics above is the suggestion that half of the people with hearing impairment have never had an audiogram. This seems believable, and possibly even an underestimate. It is common for us to see even elderly adults who have not had hearing tests since they were school children. Undoubtedly, some otolaryngologists are contributing to that problem. How often have we seen patients for a specific, nonotoíogic problem (nasal congestion, chronic cough, etc.) and focused on that problem only, neglecting to inquire about and screen hearing even in high-risk patients such as the elderly?
Admittedly, third-party carriers make this situation worse. If patients do not complain of hearing loss (as is the case with many elderly, hearing- unpaired patients) and we obtain an audiograra to screen for hearing loss, it is sometimes difficult to get reimbursed, especially if the audiogram is normal. However, this should not discourage us from looking actively and aggressively for unrecognized hearing impairment. Rather, the magnitude of societal costs of the problem should inspire us to develop, promulgate, and follow clinical guidelines for hearing screening in all age groups.
We should consider combining this effort with increased research iato the prevalence and societal impact of hearing impairment, as well as with educational programs for the general public and legislators to help increase awareness of the effects of untreated hearing impairment, the importance of comprehensive otologie assessment to identify potentially treatable causes of hearing loss, and the cosmetic and technologic advances in hearing amplification. Such awareness should lead to improvements in quality of life and workplace productivity that will be of great help to the hearing-impaired population, while we are working on the more challenging problems of hair cell regrowth and hearing restoration.
1. National Institute on Deafness and Other Communication Disorders. Statistics about hearing, balance, ear infections, and deafness: Quick statistics. www.nidcd.nih.gov/health/statistics/Pages/ quick.asps. Accessed December 9, 2011.
2. Better Hearing institute, Hearing better may mean earning more. www.betterhearing.org/press/articles/hearing_aids_and_income. cfm. Accessed December 9, 2011.
Robert T. Sataloff, MD, DMA, FACS
EAR, NOSE & THROAT JOURNAL