This document discusses the impact of hearing loss on quality of life and health. It notes that hearing loss is associated with poorer quality of life, increased fatigue, social isolation, cognitive decline, and other health issues. Hearing instruments are shown to improve quality of life by reducing listening effort and fatigue. However, more evidence is still needed on their impact on emotional perception, social integration, and third-party disabilities. The document also discusses the relationship between hearing loss and increased risk of cognitive decline, falls, and other health problems, suggesting hearing instruments could help address these issues.

1. Hearing loss and the
associated comorbidities
A conversation with Sonova
SVP Stefan Launer
© 2019 Valencell Inc.

2. Healthy Hearing in the Context of Healthy Aging
Stefan Launer
Senior VP Science & Technology, Sonova AG, Switzerland
Adjunct Professor University of Queensland, Brisbane, Australia
Adjunct Professor University of Manchester, Manchester, UK
Ulrike Lemke, Jana Besser, Gurjit Singh, Maren Stropahl, Emily Urry, Charlotte Vercammen, Mathias Latzel, Barbra Timmer,

3. Content
1. Hearing loss – impact on quality of life beyond speech intelligibility
2. Do hearing instruments improve quality of life?
3. Hearing loss and multi-morbidities
1. Cognitive decline
2. Systemic and physical comorbidities
4. Summary
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4. Role of hearing in daily life
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5. Hearing, communication – the social sense
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6. Hearing – the un-conscious sense, well-being …
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7. Hearing – the emotional sense
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8. Hearing the under-valued sense?!
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9. Hearing loss – impact on quality
of life beyond speech
intelligibility
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10. Ecologic Momentary Assessment
• EMA – needs Assessment (PhD thesis B Timmer)
 Asses personal listening needs
 Create awareness about hearing loss in the
person
and the significant others
 Speech understanding is not the problem but
increased listening effort
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11. Impact of hearing loss on non-speech sound perception
• Music perception
• Perception of affective sounds, speech and non-speech,
Singh et al 2017, Picou et al 2017
• Identification of environmental sounds
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• Hearing impaired subjects have difficulties identifying affective speech
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12. • Emotional vitality
 High personal mastery, happiness, low depressive symptoms, low
annxiety
 Subjective questionnaires to assess «emotional vitatliy»
• 3’000+ subjects from Health ABC study 70-79 years of age
• Audiometric assessment in year 5, emotional vitality year 6
• Hearing loss increases the odds of low emotional vitality
• Hearing instruments did not improve scores on emotional vitality
 Study may have been underpowered, few HI users
Hearing loss & emotional vitality
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13. Impact of hearing loss on quality of life
• Impact on ability to communicate easily
confusion, difficulty, focusing, distracting thoughts,
• Effort, fatigue, …
• Emotional perception
• Emotional vitality
• Emotional functioning
anger, frustration, depression, anxiety, anger, guilt, embaressment
• Social isolation, lonliness, self-esteem, distress
• Depression? Mixed results, control of confounding factors
• Impact on activities of daily living, particularly “social”
 Incl eg grocery shopping…
• Impact on ability to work  educational level, salary
• Third party disability (spouses - yes, children - yes, all SOs?)
 Activity limitations and participation restrictions reported by significant others
 Impaired relationships
• Third party disability – patient-physician communication
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14. Hearing loss, depression, lonliness
• Correlation between hearing loss, lonliness, depression?
•  confounding factors, multi-factorial
• LASA study in Netherlands
 Longitudinal study: various health conditions incl hearing loss over several years
 Considering confounding factors
• No correlation found between hearing loss and depression
• Hearing loss and lonliness  yes, for specific subgroups
• Hearing loss and lonliness
 depends on rate of decline of HL
 Not for mild HL
 Yes for decline beyond moderate HL
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Pronk, PhD thesis 2013
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15. From «not hearing and poor speech intelligibility» to a more holistic perspective
Hearing loss – impact on quality of life
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Impact on overall quality of life
Emotional functioning
Distress, fatigue
Social isolation, lonliness
Activities of daily living
Third-party disability
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16. Do hearing instruments improve
quality of life beyond speech
intelligibility?
3
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17. Behavioral observation
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ISAAR 2016, Palluch, Latzel, Meis
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18. Mental Fatigue
Goal
• Develop a method that measures fatigue
 Fatigue: reduction of function after excessive exertion
• Does hearing aid technology reduce fatigue?
Method
• Testing in a reverberation chamber (RT60 ~450 ms)
 Noise: 5 speaker cafeteria babble fixed @ 55 dBA
• Listen to and repeat NU6 words in noise
(individualized SNR ~70% correct)
 Present strings of 8-12 words (random length)
• Store last 5 words in memory for recall
• While doing this remain vigilant for a visual signal
Speech
108°
180°
252°
324°
36°
Hornsby, 2013
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19. Trial Block
0 1 2 3 4 5 6
ReactionTime(inms)
250
300
350
400
450
500
Unaided
Aided Basic
Aided Advanced
Mental Fatigue:
• Unaided multi-task Reaction time (RT)s increased over
time
 Onset of fatigue
• No change in aided RTs over time
 No fatigue
• Conclusion:
Hearing aids can reduce mental fatigue from extended
listening to speech in noise
 Patients less exhausted after an hour of socializing
 Patients can engage more with family and friends
Hornsby, 2013
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20. Working Memory Task:
 After every two sentences recall name,
number or object
 Parallel: Recording of EEG signal
 After complete run (2*8 sentences)
 Objective Measure:
 Correct Answer
Subjective Measures:
 Listening Effort (LE)
 Memory Effort (ME)
 Noise Annoyance (NA)
Working Memory paradigm
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OLSA Sentences
(1)Wolfgang kauft fünf weiße Autos
(2)Nina hat zwölf nasse Sessel
INSTRUCTION
„Please repeat the numbers of the two
sentences you just have heard!“

21. Less alpha band activity
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SZ (SNRHIGH) RES (SNRHIGH) SZ (SNRLOW) RES (SNRLOW)
AlphaBand

22. • Hearing instrument users report…
 Understand speech in quiet and challenging
listening conditions far better
 Better perceive environmental sounds
 Participate more in social life
 Feel less exhausted
 Feel less depressed
 Feel less forgetfull
 Sleep better
• Hearing instruments significantly improve
quality of life
Hearing instruments improve quality of life
Hearing Health Care - Sound foundation for well-being
EuroTrak, EHIMA 2016, 2019
In the evenings I often feel physically exhausted
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23. Wearing time of the HI per day over various Generations
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The distribution is skewed to the right. HIs mostly used somewhere between 9 to 20 hours.
650’000+ users
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Devices in a drawer Average usage time
per day + 1.5 h

24. Impact of hearing instruments on quality of life
• Sound evidence supporting the notion that hearing instruments
improve quality of life
• Different methods
 Lab studies (subjective and objective (EEG, pupillometry,
RTS) measures…)
 Subjective questionnaires in daily life
• Benefit dimensions
 Effort
 Fatigue
 Cognition
 General aspects of quality of life
• Open:
 Perception of emotional content?
 Impact on third-party disabilities?
 Social integration
 ….
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Trial Block
0 1 2 3 4 5 6
ReactionTime(inms)
250
300
350
400
450
500
Unaided
Aided Basic
Aided Advanced
Hornsby, 2013
In the evenings I often feel physically exhausted

25. Hearing loss and multi-
morbidities
4
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26. • Hearing-well  being-well
Hearing loss Ability to
communicate
Emotional
functioning &
vitality
Social
withdrawl &
lonliness
Cognitive
function &
decline
Depression?
Ability to
learn, work,
Impact on
familiy
Perception of
environmental
sounds
Emotion
perception
Increased
effort &
fatigue
Impact on
quality of life

27. Hearing loss strongly correlated with multiple health issues
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28. Hearing loss and cognitive
decline
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30. Hearing Loss precursor & potential risk factor for cognitive decline
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• Weak but significant correlation
• Causal relation?
• Modifiable?
• Hearing loss most likely is a pre-cursor

31. Correlation between hearing loss & various cognitive functions
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32. Correlates of hearing loss and specific aspects of cognition
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33. Do hearing instruments slow
down cognitive decline?
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34. Hearing instruments might contribute to slowing down cognitive decline
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35. Limitations of previous studies – no controlled trials
• Accurate data on hearing loss not obtained in many cases; self-report is unreliable.
• Change in hearing loss not followed over time.
• Information about treatment, ie. frequency of device use or benefit from device not collected.
• A limited number of other factors likely to influence cognitive outcomes not considered, eg. loneliness, social
isolation, cardiovascular health, exercise & diet.
• Many cohort studies not longitudinal.
• Limited tools have been used to assess cognitive function. This has been conducted in most studies using
screening tools - insensitive and verbal instructions not appropriate for people with hearing loss (eg. MMSE).
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36. Hearing loss and systemic &
physical health issues
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38. Hearing loss – difficult patient – physician communication
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Consultation content – misunderstanding 35 %
Communication breakdown – 16 %

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40. Can hearing devices help with preventing falls?
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41. Summary
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42. Summary I
• Hearing is a very important sense for our social wellbeing
 Social sense, sub-concious/monitoring sense, emotional sense
• Hearing loss has a very strong impact on quality of life extending
beyond speech intelligibility
 Often hearing problems can be compensated by investing more
cognitive effort
• Hearing instruments improve quality of life: Reduce listening effort
avoid fatigue, improve quality of life
 More evidence from daily life situations!
 eAudiology – EMA – learn more about hearing instrument benefit in
daily life from users and significant others
• Hearing instruments turn into vital sign and health monitoring devices?
 Implications for health care model in general?!
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Systemic
&
physical
health
Cognitive
health
Social-
emotional
health

43. Summary II: Translational aspects for hearing health care & audiology(sts)
• Psycho-social health considerations: hearing loss contributes to psycho-social
functioning, e.g. causes depression, loneliness, …
 hearing instruments contribute to improved quality of life and well-being beyond
speech intelligibility
 revisit some old but still open problems, eg Tinnitus …
• Cognitive decline - dementia: strong correlation, hearing loss supposedly
accelerates cognitive decline
 new indication for hearing instruments????
• Increased risk of falls in hearing impaired subjects: hearing loss is
a pre-cursor to problems with balance and posture
 new service and product: screen hearing impaired for
postural stability and offer training incl. a device
• Diabetes, cardio-vascular issues: co-occur with hearing loss,
the diagnosis of one is an indicator for the other
 counselling, collaborate with other HCP, help improve
communication
• Autism and speech communication problems (pediatric
and adults)
 new indication for assistive listening devices (e.g. Roger)
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Systemic
&
physical
health
Cognitive
health
Social-
emotional
health
Put hearing & audiological rehabilitation in a
different context:
sound foundation for well being!

44. Thanks You
THANK You for your attention!
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