Are hearing aids a good idea? (Better Brain Fitness podcast)


Josh: Welcome to Better Brain Fitness, hosted by doctors Josh Turknett and Tommy Wood. In this podcast, we will explore the frontiers of how to keep our brain fit and healthy so that we can perform at our best and do the things we love for as long as possible. Let’s go.

Okay. Welcome to another episode of the Better Brain Fitness podcast. I’m joined here today by my co-host, Dr. Tommy Wood. How are you? I’m very good. Thank you. How are you? I’m, I’m great, thanks. So, we have an excellent question on the docket for today. Again, that’s the format here. You ask us questions and we do our best to give an answer.

So if you have anything you’d like us to try to tackle on the podcast, you can submit a question by going to, or there’s also a link in the podcast description. So today’s question comes from Rick and he left it by audio.

Rick: Thank you . Gentlemen for your podcast. It was excellent.

My name is Rick Benson. I’m a retired director of spiritual care at a hospital dealing primarily with seniors and patients, primarily with Alzheimer’s and other forms of dementia. I’m also Josh, a banjo player. I’m actually restring my banjo as I was listening to this podcast. And I certainly have found this information to be very helpful.

And, and, you know, I’ve actually signed on to your Brainjo Academy, Better Brain Fitness, but I haven’t gotten around to actually looking at it yet, and I think that’s one of the issues. I think sometimes for a lot of us, we get too busy and we maybe avoid. One of the things I didn’t avoid is I got my hearing tested as well before Christmas, and wouldn’t you know it that I’m below average in, in a number of areas and that the hospital recommends [00:02:00] hearing aids.

My question for you is you how soon, and, and I’m, I’m not against, I don’t feel any stigma of wearing a hearing aid, but one of the things that the hearing specialist said, well, is your brain’s already shutting down some of those things that you can’t hear? And so you probably should do it sooner than later.

Again I’m hesitant to get going at it right away, but probably sooner than later. And that’s one of my questions. And again, thank you so much for your work.

Josh: Okay. So this is an excellent question. Partly because I think that you could see how you might make a case for getting hearing aids and you could also maybe make a case for waiting.

So with regard to the latter, you could maybe see it like you would a crutch or like getting a walker or a wheelchair. You know, you’re outsourcing one of your capabilities to something else. Which, you know, typically leads to under stimulation [00:03:00] and further decline in our own capabilities. So the more dependent you become on something other than yourself, the more likely your own capabilities are to decline.

So if I were to move around by wheelchair for the next four weeks exclusively, I’d lose a whole lot of muscle mass in my legs and I’d have to work to be able to walk again. So you might be inclined to think of a hearing aid in this kind of way, and that you’re relying on something else to do something that you used to do for yourself.

And in that way it’d be kind of less stimulating. On the other hand, if we look at it from the point of cognitive stimulation, any loss of function in a sensory system is actually going to lead to a reduction in cognitive stimulation, so including hearing loss, and that has to do with the resolution of the information coming into the brain.

So the higher the resolution of the incoming information that the brain has to work with, the more regularities that it can identify in that information or in that data. So if [00:04:00] you look at a picture on a computer screen, and it only has 16 pixels, there’s not a lot you can make out there, right? You can’t see much detail.

On the other hand, if it’s 4,000 pixels, then there’s a lot that you can see, right? So the higher the resolution of the incoming information, the more work there is, right for the brain to do. And in that sense, the more stimulating it will be. And in fact, we use this kind of argument as one of the pieces of evidence in support of the demand coupling model of cognitive decline and age-related dementia.

So, If a drop in cognitive stimulation is the driving force in these conditions, then you would predict a heightened risk of dementia in people with conditions that degrade sensory information or reduce the resolution of that information. And in fact, that’s what you do see across the senses.

So loss of hearing, vision, touch, smell, all are associated with a heightened risk of cognitive decline and a [00:05:00] heightened risk of dementia, even though the specific reasons for these declines in each of these cases may be very different. And so a reduction in cognitive stimulation is kind of a single unifying explanation that would tie them all together as to why that’s leading to an increased risk in cognitive decline and dementia.

And then you would also expect that correcting that problem could help to mitigate that risk. And that’s also what’s been found. So correcting a sensory impairment reverses that increase and risk that’s associated with it. So I think that we have, you know, pretty good theoretical and empirical evidence to say that you should intervene in these situations early.

And I think in this instance, we shouldn’t view things like a hearing aid as a crutch, which again, you could think of as being less stimulating. But actually something that’s leading to more stimulation because it’s increasing the amount of incoming information that’s able to get to the brain.

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Related to this particular topic, one area of cognition I think that we tend to overlook, which I wrote about in the last Brainjo Connection article is our perceptual abilities. So much of the first two decades of brain development are devoted to the creation of these complex perceptual networks in our various sensory [00:07:00] domains, and those ultimately allow us to extract all these high level details or high level patterns and regularities in our sensory data.

So, for example, the ability to parse and identify words in spoken language is a high level perceptual ability, and it takes years to construct the machinery that you need to be able to do that. Same is true of being able to visually identify all of the objects in the world around you. You must first, you know, have to figure out how to identify all the constituent elements like edges and lines and so forth.

So building out these perceptual systems is a big undertaking, and that alone provides a lot of ongoing stimulation throughout the cortex throughout early life. And then once those systems reach maturity that project is mostly done. And so I think that replicating that kind of stimulation in our perceptual system is one of the central challenges when it comes to creating a program that kind of rivals the cognitive challenge of childhood. [00:08:00]

And there are multiple factors that cause that kind of stimulation to kind of naturally drop over the course of our lives. And one of those factors being sensory impairments that can occur with age. And so I think we want to, you know, try to ensure we’re doing whatever we can to provide that kind of perceptual stimulation wherever possible.

In addition to looking for opportunities to acquire new perceptual abilities which is what I talked about in the Brainjo Connection post. And I’ll put a link to that one in the show notes. So that’s my thoughts on Rick’s question. Tommy you got anything else to add?

Tommy: Yeah, absolutely.

And I think that’s, you know, you sort of give a, a very strong case for why we both think that maintaining or restoring senses if they’ve become impaired is critically important. And, you know, I have some very specific evidence for this specific question. And actually some personal experience.

My mom just got hearing [00:09:00] aids for the first time and she came to visit and she was talking about getting them and the first thing that I said was that, that’s great. Like it’s great that you got them because I know that for a long period of time, she’d struggled with hearing in, in one ear and then it was the other ear was becoming affected.

And for the very reasons that we’re talking about, I said that this was an important thing that she could do. And I sent her a copy of our paper to support my thoughts. But two very recent papers of actually a large body of evidence that supports the idea of, of restoring hearing have come out.

So one just came out in JAMA a couple of months ago, the Journal of the American Medical Association, which is a very sort of prestigious high impact journal, and they looked at a nationally representative sample and found that those with either moderate or severe hearing impairment were at an increased risk of dementia.

And similarly, those who used hearing aids were at a decreased risk of dementia. And then actually towards the end of last year in JAMA Neurology, there was a [00:10:00] meta-analysis again, looking at this question, which showed individuals who use some kind of hearing augmentation if they needed it, were at a reduced risk of dementia.

The risk was reduced by about 20%. And similarly, there was also a prepost part of this metaanalysis, which showed that those who improved their hearing or restored their hearing with some kind of device, so either hearing aids or cochlear implants, for those who needed a cochlear implant they saw an improvement in cognitive function associated with that.

So not only can you prevent the onset of dementia by making sure that your hearing is restored, we think any loss of cognitive function may be reversible by restoring hearing. So, lots of good reasons, I think, to get a hearing aid.

And of course, supported by the demand model that you were talking about.

Josh: That’s great. So was your mom resistant at all to the idea?

Tommy: She sort of went through this whole process without me knowing and then just showed up [00:11:00] with hearing aids. So I, I don’t think so other than it was recommended to her and then, it was just a battle with technology, you know, finding ones where you didn’t, didn’t have to like, change the batteries all the time and were comfortable and that kind of stuff.

So obviously there’s some tinkering to be done to find something that sort of fits with, with your lifestyle still. And so now they have hearing aids that like, recharge in cases just like your AirPods do. And so she has something like that. Again, depending on healthcare and other stuff, like they can be expensive, I appreciate that too. But, you know, in terms of the long term costs, particularly if there is a reduction in the risk of dementia, I think almost certainly worth it. .

Josh: Yeah. And I do think the costs have recently gone down significantly for even the higher end ones, or you can get much better ones now for lower price.

But yeah, I think it’s one of these issues that I do know that over the years, just with patients, many were resistant to the idea of getting hearing aids as they got older. Some was [00:12:00] because they didn’t perceive there was a problem. But I think part of it too is like just our mindsets around aging.

And you might, you know, view it as a sign of a loss or whatever, so I think it’s one of those things where if we reframe it as sort of a cognitive augmentation tool you know, rather than a compensation for getting older or whatever, I think it may change our relationship to it. Like we said, it’s an important thing.

I know that I probably would have a natural inclination to be a little bit resistant to it myself. So I’m giving myself the argument as well in advance.

Tommy: You and I are well known Luddites. So, if we think that hearing aids are good, then obviously there really must be.


Josh: Exactly. Okay. Well thanks again Rick for this question. It’s a good one. It’s an important one, and I’m glad we had a chance to talk about it. And again, if you have a question for us, we would love to hear from you. Just go to, or you can also click the link to it in the podcast description.[00:13:00]

All right, we will see you next time. Thanks everybody.

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