Includes the following article: Cognitive Manifestations
in Unmitigated Hearing Loss Questions may be submitted
online through the "contact us" section of this website
or sent directly to: DigiCare Hearing Research &
Rehabilitation, P.O. Box 706, Rye, CO 81069, or faxed to
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a reply from the Digicare team.
COGNITIVE MANIFESTATIONS IN UNMITIGATED HEARING LOSS
By Max Stanley Chartrand, M.A.
DigiCare Hearing Research & Rehabilitation
We know today that the very essence of cognition---or
one's awareness and connection to life around them---is
fed more through the auditory sense, than through all of
the other senses combined. Certainly an understanding of
auditory-cognitive relationships would shed more light
on how human beings depend upon "normal" hearing for
their health, safety, social relationships, mental
development, aesthetic skills, and over-all life
function. The loss of these attributes of humanity can
then be appropriately correlated to the real
cost-effectiveness of hearing instrumentation and
rehabilitation for the hearing instrument consumer (Ratcliffe,
1992).
If we were to survey professionals in all sectors of the
hearing health care field on the common effects of
hearing loss we undoubtedly would compile quite an
extensive listing of psychological manifestations
reportedly stemming from hearing loss. But would we find
the same agreement in classifying those effects by
degree and type of impairment, overlay factors, gender,
age, specified ear, and varied listening environments?
These variables tend to add complexity, which make easy
categorization virtually impossible. There could be
potentially as many "categories" as there are people
suffering from hearing impairment. So, simple
categorization is not a feasible goal when attempting to
understand the psychology of hearing impairment
(Sandlin, 1988).
On the other hand, a lack of understanding of this
subject---or worse, to ignore its very existence---can
unwittingly lead to a misconstrual of the true role and
value of the hearing instrument specialist. It
presupposes that the only true services provided through
the dispensing practice are merely business and
technical in nature.
But the fact remains, and will always be so, that this
is a people-oriented field with real people problems,
which need addressed alongside the more straightforward
physical challenges (Alpiner and Garstecki, 1996). No
amount of technology or abstract "service" can
effectively supplant the need for the human touch in
aural rehabilitation, or the mastery of its inherent
psychology. As we unfold the concepts of the psychology
of the hearing impaired, it will become more evident how
complex these effects can be and the potential negative
impact upon the lives of those who suffer under its
sensory filter (Chartrand, 1999).
Yet out of this complexity can be found a number of
simple concepts, and tools through which we may more
effectively guide the hearing impaired patient through
their rehabilitative journey.
"The greatest effect is psychological"
The consensus among many of today's audiological
researchers is that "the greatest single handicap in
hearing loss is psychological" (Moore, 1982). This fact
is echoed in myriad papers and texts by Ramsdell (1968),
Myklebust (1964), Newby (1985), Reiter (1985), Sandlin
(1988), to name but a few.
In fact, the author has spent most of his life
experiencing firsthand this very subject with a
progressive severe-to-profound sensorineural hearing
loss, and the greater part of those years researching
and teaching about discoveries from both the laboratory
and real life experiences in the psychological and
psychosocial domains of hearing health. The indisputable
evidence is there.
Following is an incomplete list of potential
psychological problems that have been reported as
arising, directly or indirectly, from hearing loss of
all types and degrees:
• Stress, anxiety
• Distrust, paranoia
• Insecurity
• Superior/inferior complex
• Lowered self-esteem
• Denial and disbelief
• Defensiveness
• Anger, frustration
• Social withdrawal, isolation
• Social inappropriate behavior or responses
• Bitterness, resentment
• Overly aggressiveness
• Lethargy, resignation, passivity
• Depression, cognitive dysfunction
• Emotionally driven hypertension
• Substance and familial abuse
The reader will notice that these conditions can be and
are manifested in normal hearing individuals, as well.
What sets apart the hearing impaired individual from the
normal hearing in the above manifestations are the
unavoidable and near inescapable debilitative factors
found in unmitigated hearing impairment. Prevalent
factors may be:
1. Without intervention, the effects of hearing
impairment can be virtually pervasive in all aspects of
life.
2. Progressive hearing impairment is insidious, and can
stifle personal progress in the various stages of life,
from educational and social achievements during
childhood to familial, career and retirement
expectations in adults.
3. Interpersonal relationship bonding can be
significantly hampered or severed without appropriate
auditory and communicative function.
It is the pervasive and insidious nature of hearing loss
that often creates the exaggerated manifestations in
those with acquired hearing loss---it’s invisibility to
all, including the sufferer. Presumably, rehabilitation
would minimize those same manifestations, and allow a
resumption of a more normal lifestyle and cognitive
connection (Van Hecke, 1994). Whether rehabilitation is
made complete through appropriate amplification, or
accommodated through a mosaic of cochlear implantation,
assistive devices, coping strategies, and acceptance of
limitations seems to matter little.
In other words, once outcomes are weighed against
available solutions, realistic expectations can allow a
sense of “normality”, and therefore, minimal
psychological effects. In this way, even those with
severe losses may enjoy an appreciable degree of
normality in their lives. But only after all viable
options of medical, technological and rehabilitative
resources have been utilized.
Denial & Defensiveness
Denial is one of the first responses of the hearing
impaired upon learning of their impairment (Tye-Murray,
1998). It matters little if the initial “assessment”
came from a spouse, a close friend, or even a trained
professional. Most individuals, upon first hearing the
unwanted news, feel as if they are being accused of
something over which they have some control. Does it
mean that I am inadequate, do I appear to be mentally
slow, am I somehow different from everyone else, less of
a person? What brings the impaired person to this point
is the near Pavlovian (social) reflexes developed from
repeatedly being accused of “not paying attention”,
“hearing when you want to”, “you never listen to me
anymore” (Chartrand, 1997).
Those harsh accusations are the natural outcroppings of
innumerable experiences during critical moments in one’s
life: during a noisy social function; dining in a
restaurant with friends; on the job with machinery
whirring in the background; or frantically following
directions while driving to a function for which one is
late. In these and countless other situationally
challenging listening situations, even a
mild---otherwise undetected---loss becomes exposed, but
only in psychosocial disguise. Emotions flare, patience
tried, and rationale searched for. So, at the very
beginning of, say a loss of merely 20-25dB PTA,
emotional walls are already being carefully put into
place.
Over time, accusations get returned “in kind”: you
mumble, there’s too much noise in the background, I was
busy doing something else when you…, this time you can
go alone. These are but a few responses typical of the
unintentional revenge of one who has suffered through
recurrent episodes of humiliation as a result of their
undiscovered/unmitigated hearing loss (Danhauer, et al,
1985).
Only the most patient, compassionate of
people---standing on either side of the
impairment---will not take offense during such stifled
communicative exchanges. So it goes without saying that
as the loss progresses, denial deepens and defenses
build. Hence, one with a moderate loss will be less
inclined to take that first step toward remediation on
their own, than even one with a mild loss. And---it may
come as a surprise to any rational, normal hearing
observer---those with uncorrected severe hearing
impairments are even less inclined to move forward on
their own than their less-handicapped counterparts!
Depression & Uncorrected Hearing Loss
Depression is generally classified as a cognitive
disorder in the sense that it colors one’s perception of
reality and the larger world around them. Indeed, many
recent studies examining hearing impairment and
Alzheimer’s Disease (AD) in the elderly consistently
show a positive correlation between the two afflictions
(Palmer et al, 1998). Conversely, most of these studies
note a remarkable reduction, even absence, of the
symptoms of dementia when the hearing impaired/demented
subjects are given an effective aural rehabilitation
program. This is no minor coincidence. We now know that
uncorrected hearing impairment causes depression and
cognitive dysfunction (Herbst and Humphrey, 1980)(Jones
et al, 1984)(Eastwood et al, 1985)(Mulrow et al, 1990).
While the above cited studies deal primarily with the
elderly, similar findings may be projected into younger
hearing/cognitively impaired populations, albeit to a
lesser or different degree. The general question today
is not whether hearing loss causes depression, but how
it causes it. Through the prism of a depressed mental
state, many deleterious changes can occur in attitudes,
relationships, and future outlook.
How does one get to this state of affairs? What manner
of forces work on one’s life that personalities and
relationships begin to change, life views diminish, and
opportunities wither away into the noisy void of
auditory lesions?
A Challenge for Hearing Health Professionals
Certainly, the normal hearing professional enters this
scenario at a disadvantage, for they lack a true point
of reference in their own experience with which to
relate to those they serve. Relying upon purely
intellectual understanding it is difficult to truly come
to grips with the forces spoken of above.
Many times over the years, this author has stated in
lectures that, whether one is a normal-hearing hearing
aid engineer, manufacturing marketing director, or an
audiologist or hearing instrument specialist, you are
the one who is handicapped.
For only an intimate and exceptional knowledge of the
forces that shape hearing impaired individuals will
provide the necessary foundation to succeed in truly
helping them. In doing so, hearing health professionals
may gain a better understanding of the possible forces
that rule the lives of the hearing impaired population.
That knowledge can go far in helping them accept both
the reality of a long-denied hearing impairment and the
solutions available to lift them back into better
hearing and communication, and greater cognitive
connection to life around them.
Dr. Chartrand serves as vice-president of marketing and
professional education at AmericanEar Laboratories, Inc.
He is also profoundly deaf and utilizes a cochlear
implant and a hearing aid. Correspondence: 6080 Burnham
Ave., Suite #1, Las Vegas, NV 89119, or 800-313-2744.
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