Hearing loss and anxiety: What's the connection?
If you’ve just been diagnosed with hearing loss—or your hearing has gotten worse—you may be feeling anxious.
Anxiety is a persistent heightened state of alert. It's a normal reaction to stressful situations, but for some people it spirals out of control and becomes a disorder in and of itself. Often, that means they can't stop thinking "what if?"
Hearing loss can trigger or feed into anxious thinking or other symptoms, though the links haven’t been thoroughly studied. Sometimes the anxiety and rumination isn’t strictly focused on hearing, but seeps out like a stain on a dress.
When you have hearing loss, you may worry about a lot of things: What if I don't hear something important? What if I misunderstand someone and embarrass myself? What if my hearing aid batteries run out? What if I get passed up for a promotion because of my hearing loss? What if my tinnitus gets worse? And so on.
Physical signs of anxiety
Anxiety can trigger physical symptoms: nausea, dizziness, muscle aches, insomnia and trouble concentrating, among others. You may feel a sense of dread or doom, as if you're standing on the edge of windy cliff.
If these thoughts and physical sensations are becoming persistent, intrusive and affecting your quality of life, it may be time to seek professional help. This may require treating both your hearing loss and your anxiety. How this plays out day-to-day varies by your unique circumstances, however.
Why are you anxious?
Mental health professionals generally categorize anxiety into five buckets: obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, panic disorder and generalized anxiety disorder. If you have a car accident and banged your head, you might experience rapid hearing loss and possibly other symptoms of post-traumatic stress disorder. Your symptoms and treatment plan might look very different from someone who has slowly been losing her hearing and is constantly looking for signs that she's developing dementia (when it's really just hearing loss).
Complicating the picture is that people with hearing loss may have a related condition that causes tinnitus and dizziness, which can be unsettling and anxiety inducing, as well.
What the research shows
Struggling in everyday situations that aren’t difficult for other people is stressful. Anxiety is one response to chronic stress. In a 12-year study of nearly 4,000 French people age 65 and up, participants diagnosed with hearing loss at the beginning had a greater chance of developing anxiety symptoms over time.
Interestingly, people with vision loss weren’t more likely to become anxious. It’s often observed that people accept wearing glasses more easily than hearing aids—possibly because of the anxiety associated with hearing loss.
In general, evidence of a tie is stronger when it corresponds with severity. In a study of more than 1,700 adults aged 76 to 85 who were not living in an institution, those with mild hearing loss had a 32 percent higher risk of reporting anxiety. If you had a moderate or higher loss, your chance of anxiety rose by 59 percent.
Hearing loss severity and tinnitus increase risk
The tie to severity also showed up in research among adults of all ages. In an overview of 25 studies that evaluated more than 17,000 adults in all, the team found a higher risk of anxiety if your hearing loss was more severe or if you had tinnitus.
None of this means that you’re doomed to be anxious because of your hearing loss. Within the overview, in five studies that looked at symptoms among the hearing impaired at one point in time, between 15 percent and 31 percent of the participants had clinically significant anxiety symptoms. In other words, most didn’t.
Those numbers are higher than we’d like—but anxiety is common. About 18 percent of American adults qualify as having an anxiety disorder in any year, the Anxiety and Depression Association of America (ADAA) reports.
Do I have social anxiety or am I just frustrated by not hearing?
Age-related hearing loss, called presbycusis, typically sneaks up on you over time. You may not even notice that you’re giving up on noisy social occasions because of your hearing loss. Instead, you accept that you “just don’t like parties.”
People with social anxiety are afraid of any situation in which they might be negatively judged, from conversations with superiors on the job to dates, small-talk and parties.
Hearing loss does create situations that can irritate other people. When you can’t hear well, you may miss clues that let you know when someone is about to talk or hasn’t yet finished, and end up interrupting. You might pretend to hear, or guess, or think you heard someone—and reply inappropriately. You didn’t hear the joke—and you’re the only one who didn’t laugh. So hearing loss can make you feel left out or socially unskilled.
If you enjoy being around people, your social anxiety is mild. For example, Dr. Blazer notes that some people go to religious services, but come in late and leave early so they don’t have to chit-chat. Their problems might be solved by hearing aids. If you have extreme social anxiety, simply sitting with people would make you anxious.
People diagnosed with generalized anxiety disorder (GAD) may be flooded with worry and struggle with a gamut of physical symptoms for days before a date or job interview.
Communication tools can help
If your problem is primarily the struggles of socializing with hearing loss, you can learn to love social gatherings again. You can take someone to a quieter room and have a great conversation—once you’ve got your hearing aids. Also, learn the key communication tools for people with hearing impairments.
Even with hearing aids, living with hearing loss requires an attitude adjustment. For example, you may need to accept that you can’t hear the people at the other end of a long table. (As a person with hearing loss, I’ve learned not to be embarrassed when other people are laughing at a joke I didn’t catch. I just say, “I didn’t hear that.”)
Could anxiety disorders hurt your hearing?
Possibly. In a study of more than 10,500 adults in Taiwan, researchers found a greater risk of sudden hearing loss among those with an anxiety disorder. In the 12-year French study mentioned above, volunteers diagnosed with GAD but not hearing loss at the beginning of the research were more likely to develop hearing loss than those without GAD. Interestingly, those with GAD were not more likely to experience a decline in their vision.
More study would explain why hearing in particular might be affected by anxiety.
Anxiety is 'highly treatable'
What can you do? Most people with anxiety problems are never treated, the ADAA points out, although these disorders are “highly treatable.”
“Anxiety is very common but the healthcare profession doesn’t pay attention to it,” psychiatrist Dan Blazer told Healthy Hearing. Dr. Blazer, professor emeritus of psychiatry and behavioral sciences at Duke University Medical Center, chaired the National Academies Committee on Accessible and Affordable Hearing Health Care for Adults. “We just throw up our hands.”
So don’t wait for an annual checkup—you’ll need to reach out to your doctor or seek a psychiatrist or psychologist. Treatment for anxiety may include medication—Lexapro and Paxil are first-line choices—and talk-therapy such as cognitive behavioral therapy (CBT), in which you learn how to tame repetitive and negative thoughts. For the physical symptoms, tools like exercise and meditation can help. Be sure to wear your hearing aids when you exercise. If you have tinnitus, you also may be grappling with anticipatory anxiety.
Hearing aids and other devices
And of course, if hearing loss is triggering anxiety, hearing aids could dramatically improve your life. While they will not restore your hearing to normal, they can help you deal with some of the worrying aspects of hearing loss, such as communication snafus. There are also phone apps and other devices you can use to manage specific fears. For example, if you need to set an alarm very loud but wake up panicked by the shriek in the dark, consider a clock that produces a light like the sunrise, or a bed shaker alarm. There are many other assistive listening devices that can make hearing loss less anxiety-inducing.
But just the thought of hearing aids makes me anxious
When you’re anxious in general or about hearing, you may be anxious about your hearing aids as well.
Although it’s common to stall and be anxious when you first face your hearing problem, people tend to adjust to hearing aids over weeks or months, retired audiologist Richard Carmen and psychiatrist Dr. Shelley Uram write. Men are especially likely to take pride in being healthy, so they resist admitting what seems like a weakness.
Some patients seem to adjust, largely to please other people, but months later, simply stop wearing their aids. “Because their anxiety was never confronted or because their anxiety is too overwhelming, their coping mechanisms are unable to rise to the occasion of dealing with the hearing loss or hearing aids,” Carmen and Uram note. When these people give up on their hearing aids, they end up feeling isolated. Too many dig in their heels and get angry at family and friends who complain that they can’t hear.
Dr. Blazer describes a patient, a prominent man who felt uncomfortable attending his Lion’s Club because he couldn’t keep up with the conversation. “When he came to see me, five minutes in, he’d say, ‘I probably should put on my hearing aid,’” Dr. Blazer told Healthy Hearing.
Don’t be that person. Instead, be open with your hearing healthcare team so together you can make sure your hearing aids are rewarding enough to wear through the day. Don’t let anxiety get in the way.