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Copyright (c) 2024 Saeed Mubarak, Hani Mohammed M. Alharbi, Hassan Ahmed Mosa Swed, Boshra Obaid Rhil Alanazi, Muntaha Alasmar Dabis Albalawi, Waeel Ali I Derbeshi, Abdulelah M. Alqahtani, Saoud Nasser Al Dosari, Abdullah Ahmad Koriri, Hamad Mobarak H Alsharari, Bashayer Ayesh Hamad Albanaqi, Ahmed Abdu Hussain Mobarki
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Social Otology Model: A Narrative Review of Hearing Loss as a Multidisciplinary Determinant of Health Equity
Corresponding Author(s) : Saeed Mubarak
Saudi Journal of Medicine and Public Health,
Vol. 1 No. 2 (2024)
Abstract
Background: Adult-onset hearing loss (AHL) is a pervasive chronic condition, traditionally siloed within audiology and otolaryngology. This narrow biomedical focus fails to address its profound role as a social determinant of health, driving cognitive decline, depression, social isolation, and inequitable access to care. A purely device-centric model neglects the complex biopsychosocial ecosystem in which hearing loss exists and for which a coordinated, cross-sectoral response is required.
Aim: This narrative review aims to synthesize evidence to propose and define the "Social Otology Model," an integrated, patient-centered framework for AHL management.
Methods: A systematic search was conducted across PubMed, Scopus, PsycINFO, and CINAHL for literature published between 2010 and 2024.
Results: The review identifies critical gaps addressed by the Social Otology Model: 1) Screening & Medical Integration, linking AHL to dementia and cardiovascular risk in primary care; 2) Pharmaceutical Surveillance of ototoxicity; 3) Audiological Care transcending device fitting to include communication therapy; 4) Social Work Intervention to combat isolation and financial hardship; and 5) Practical Support from health aides for device literacy and home adaptation.
Conclusion: Hearing loss must be reframed from a sensory deficit to a whole-person, social-health condition. The Social Otology Model provides a roadmap for this paradigm shift, advocating for coordinated, team-based care that addresses medical, rehabilitative, social, and environmental dimensions to mitigate isolation, promote brain health, and achieve true health equity for individuals with hearing loss.
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- Arnold, M. L., Hyer, K., & Chisolm, T. (2017). Medicaid hearing aid coverage for older adult beneficiaries: a state-by-state comparison. Health Affairs, 36(8), 1476-1484. https://doi.org/10.1377/hlthaff.2016.1610
- Barker, A. B., Leighton, P., & Ferguson, M. A. (2017). Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners. International Journal of Audiology, 56(5), 297-305. https://doi.org/10.1080/14992027.2017.1286695
- Bennett, R. J., Conway, N., Fletcher, S., & Barr, C. (2020). The role of the general practitioner in managing age-related hearing loss: A scoping review. American Journal of Audiology, 29(2), 265-289. https://doi.org/10.1044/2020_AJA-19-00090
- Blazer, D. G., Domnitz, S., Liverman, C. T., for Adults, A. H. H. C., & National Academies of Sciences, Engineering, and Medicine. (2016). Hearing health care services: Improving access and quality. Hearing Health Care for Adults: Priorities for Improving Access and Affordability.
- Campos, J. L., & Launer, S. (2020). From healthy hearing to healthy living: A holistic approach. Ear and hearing, 41, 99S-106S. DOI: 10.1097/AUD.0000000000000931
- Castro, C. B., Costa, L. M., Dias, C. B., Chen, J., Hillebrandt, H., Gardener, S. L., ... & Sohrabi, H. R. (2023). Multi-domain interventions for dementia prevention–a systematic review. The Journal of nutrition, health and aging, 27(12), 1271-1280. https://doi.org/10.1007/s12603-023-2046-2
- Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., ... & Monjur, T. M. (2019). Clinical practice guideline: sudden hearing loss (update) executive summary. Otolaryngology–Head and Neck Surgery, 161(2), 195-210. https://doi.org/10.1177/0194599819859883
- Deal, J. A., & Lin, F. R. (2021). USPSTF recommendations for hearing loss screening in asymptomatic older adults—A case of missing evidence and missing treatment options. JAMA Network Open, 4(3), e210274-e210274. doi:10.1001/jamanetworkopen.2021.0274
- Dupuis, K., Reed, M., Bachmann, F., Lemke, U., & Pichora-Fuller, M. K. (2019). The circle of care for older adults with hearing loss and comorbidities: A case study of a geriatric audiology clinic. Journal of Speech, Language, and Hearing Research, 62(4S), 1203-1220. https://doi.org/10.1044/2018_JSLHR-H-ASCC7-18-0140
- Ekberg, K., Schuetz, S., Timmer, B., & Hickson, L. (2020). Identifying barriers and facilitators to implementing family-centred care in adult audiology practices: a COM-B interview study exploring staff perspectives. International Journal of Audiology, 59(6), 464-474. https://doi.org/10.1080/14992027.2020.1745305
- Feltner, C., Wallace, I. F., Kistler, C. E., Coker-Schwimmer, M., & Jonas, D. E. (2021). Screening for hearing loss in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 325(12), 1202-1215. doi:10.1001/jama.2020.24855
- Ganesan, P., Schmiedge, J., Manchaiah, V., Swapna, S., Dhandayutham, S., & Kothandaraman, P. P. (2018). Ototoxicity: a challenge in diagnosis and treatment. Journal of audiology & otology, 22(2), 59. https://doi.org/10.7874/jao.2017.00360
- Heffernan, E., Withanachchi, C. M., & Ferguson, M. A. (2022). ‘The worse my hearing got, the less sociable I got’: a qualitative study of patient and professional views of the management of social isolation and hearing loss. Age and Ageing, 51(2), afac019. https://doi.org/10.1093/ageing/afac019
- Hoffman, M. F., Landsman, R. A., Fasano-McCarron, M. E., Schoffstall, S. J., Witkin, G. A., & Parkes, W. J. (2023). Integrating psychology into pediatric audiology/otolaryngology clinics: Gaps and a model of care. Clinical Practice in Pediatric Psychology, 11(3), 338-349. https://doi.org/10.1037/cpp0000484
- Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2), 227-237. https://doi.org/10.1177/1745691614568352
- Hsu, A. K., Bassett, S. M., O’Dwyer, L. C., McHugh, M., Heinemann, A. W., Jordan, N., & Dhar, S. (2022). Cost-effectiveness of hearing screening in older adults: a scoping review. Research on Aging, 44(2), 186-204. https://doi.org/10.1177/01640275211008583
- Jiam, N. T. L., Li, C., & Agrawal, Y. (2016). Hearing loss and falls: a systematic review and meta‐analysis. The Laryngoscope, 126(11), 2587-2596. https://doi.org/10.1002/lary.25927
- Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The lancet, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6
- Manchaiah, V. K., Stephens, D., Zhao, F., & Kramer, S. E. (2012). The role of communication partners in the audiological enablement/rehabilitation of a person with hearing impairment: an overview. Hearing Balance and Communication, 10(1), 21-30. DOI: 10.3109/1651386X.2012.655914
- McKee, M., James, T. G., Helm, K. V., Marzolf, B., Chung, D. H., Williams, J., & Zazove, P. (2022). Reframing our health care system for patients with hearing loss. Journal of Speech, Language, and Hearing Research, 65(10), 3633-3645. https://doi.org/10.1044/2022_JSLHR-22-00052
- Meyer, C., Waite, M., Atkins, J., Ekberg, K., Scarinci, N., Barr, C., ... & Hickson, L. (2022). How can ehealth meet the hearing and communication needs of adults with hearing impairment and their significant others? A group concept mapping study. Ear and Hearing, 43(2), 335-346. DOI: 10.1097/AUD.0000000000001097
- Myers, C., Reed, N. S., Lin, F. R., & Willink, A. (2022, February). A broad examination of health policy barriers to access and affordability of hearing treatment for Medicare beneficiaries. In Seminars in Hearing (Vol. 43, No. 01, pp. 013-019). Thieme Medical Publishers, Inc.. DOI: 10.1055/s-0042-1743122
- Naito, R., McKee, M., Leong, D., Bangdiwala, S., Rangarajan, S., Islam, S., & Yusuf, S. (2023). Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies. PloS one, 18(1), e0280308. https://doi.org/10.1371/journal.pone.0280308
- Nicks, S., Johnson, A. L., Traxler, B., Bush, M. L., Brame, L., Hamilton, T., & Hartwell, M. (2022). The use of person-centered language in medical research articles focusing on hearing loss or deafness. Ear and Hearing, 43(3), 703-711. DOI: 10.1097/AUD.0000000000001168
- Rizk, H. G., Lee, J. A., Liu, Y. F., Endriukaitis, L., Isaac, J. L., & Bullington, W. M. (2020). Drug‐induced ototoxicity: a comprehensive review and reference guide. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 40(12), 1265-1275. https://doi.org/10.1002/phar.2478
- Shrubsole, K., Power, E., & Hallé, M. C. (2023). Communication partner training with familiar partners of people with aphasia: A systematic review and synthesis of barriers and facilitators to implementation. International Journal of Language & Communication Disorders, 58(2), 601-628. https://doi.org/10.1111/1460-6984.12805
- Shukla, A., Harper, M., Pedersen, E., Goman, A., Suen, J. J., Price, C., ... & Reed, N. S. (2020). Hearing loss, loneliness, and social isolation: a systematic review. Otolaryngology–Head and Neck Surgery, 162(5), 622-633. https://doi.org/10.1177/0194599820910377
- Tai, S., Barr, C., & Woodward-Kron, R. (2018). Competing agendas and other tensions in developing patient-centred communication in audiology education: A qualitative study of educator perspectives. International Journal of Audiology, 57(4), 274-282. https://doi.org/10.1080/14992027.2017.1385863
- Tolouian, R., Tolouian, A., Dastan, F., Farhangi, V., Peymani, P., Saeifar, S., ... & Sadighpour, T. (2022). Antioxidants and cisplatin nephrotoxicity; an updated review on current knowledge. Journal of Nephropharmacology, 12(1), e10556-e10556. https://doi.org/10.34172/npj.2022.10556
- Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline—The potential mechanisms linking the two. Auris Nasus Larynx, 46(1), 1-9. https://doi.org/10.1016/j.anl.2018.08.010
- Vas, V., Akeroyd, M. A., & Hall, D. A. (2017). A data-driven synthesis of research evidence for domains of hearing loss, as reported by adults with hearing loss and their communication partners. Trends in hearing, 21, 2331216517734088. https://doi.org/10.1177/2331216517734088
- World Health Organization. (2021). World report on hearing. World Health Organization.
- Yassine, H. N., Samieri, C., Livingston, G., Glass, K., Wagner, M., Tangney, C., ... & Schneider, L. S. (2022). Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group. The Lancet Healthy Longevity, 3(7), e501-e512. https://doi.org/10.1016/S2666-7568(22)00120-9
References
Arnold, M. L., Hyer, K., & Chisolm, T. (2017). Medicaid hearing aid coverage for older adult beneficiaries: a state-by-state comparison. Health Affairs, 36(8), 1476-1484. https://doi.org/10.1377/hlthaff.2016.1610
Barker, A. B., Leighton, P., & Ferguson, M. A. (2017). Coping together with hearing loss: a qualitative meta-synthesis of the psychosocial experiences of people with hearing loss and their communication partners. International Journal of Audiology, 56(5), 297-305. https://doi.org/10.1080/14992027.2017.1286695
Bennett, R. J., Conway, N., Fletcher, S., & Barr, C. (2020). The role of the general practitioner in managing age-related hearing loss: A scoping review. American Journal of Audiology, 29(2), 265-289. https://doi.org/10.1044/2020_AJA-19-00090
Blazer, D. G., Domnitz, S., Liverman, C. T., for Adults, A. H. H. C., & National Academies of Sciences, Engineering, and Medicine. (2016). Hearing health care services: Improving access and quality. Hearing Health Care for Adults: Priorities for Improving Access and Affordability.
Campos, J. L., & Launer, S. (2020). From healthy hearing to healthy living: A holistic approach. Ear and hearing, 41, 99S-106S. DOI: 10.1097/AUD.0000000000000931
Castro, C. B., Costa, L. M., Dias, C. B., Chen, J., Hillebrandt, H., Gardener, S. L., ... & Sohrabi, H. R. (2023). Multi-domain interventions for dementia prevention–a systematic review. The Journal of nutrition, health and aging, 27(12), 1271-1280. https://doi.org/10.1007/s12603-023-2046-2
Chandrasekhar, S. S., Tsai Do, B. S., Schwartz, S. R., Bontempo, L. J., Faucett, E. A., Finestone, S. A., ... & Monjur, T. M. (2019). Clinical practice guideline: sudden hearing loss (update) executive summary. Otolaryngology–Head and Neck Surgery, 161(2), 195-210. https://doi.org/10.1177/0194599819859883
Deal, J. A., & Lin, F. R. (2021). USPSTF recommendations for hearing loss screening in asymptomatic older adults—A case of missing evidence and missing treatment options. JAMA Network Open, 4(3), e210274-e210274. doi:10.1001/jamanetworkopen.2021.0274
Dupuis, K., Reed, M., Bachmann, F., Lemke, U., & Pichora-Fuller, M. K. (2019). The circle of care for older adults with hearing loss and comorbidities: A case study of a geriatric audiology clinic. Journal of Speech, Language, and Hearing Research, 62(4S), 1203-1220. https://doi.org/10.1044/2018_JSLHR-H-ASCC7-18-0140
Ekberg, K., Schuetz, S., Timmer, B., & Hickson, L. (2020). Identifying barriers and facilitators to implementing family-centred care in adult audiology practices: a COM-B interview study exploring staff perspectives. International Journal of Audiology, 59(6), 464-474. https://doi.org/10.1080/14992027.2020.1745305
Feltner, C., Wallace, I. F., Kistler, C. E., Coker-Schwimmer, M., & Jonas, D. E. (2021). Screening for hearing loss in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. Jama, 325(12), 1202-1215. doi:10.1001/jama.2020.24855
Ganesan, P., Schmiedge, J., Manchaiah, V., Swapna, S., Dhandayutham, S., & Kothandaraman, P. P. (2018). Ototoxicity: a challenge in diagnosis and treatment. Journal of audiology & otology, 22(2), 59. https://doi.org/10.7874/jao.2017.00360
Heffernan, E., Withanachchi, C. M., & Ferguson, M. A. (2022). ‘The worse my hearing got, the less sociable I got’: a qualitative study of patient and professional views of the management of social isolation and hearing loss. Age and Ageing, 51(2), afac019. https://doi.org/10.1093/ageing/afac019
Hoffman, M. F., Landsman, R. A., Fasano-McCarron, M. E., Schoffstall, S. J., Witkin, G. A., & Parkes, W. J. (2023). Integrating psychology into pediatric audiology/otolaryngology clinics: Gaps and a model of care. Clinical Practice in Pediatric Psychology, 11(3), 338-349. https://doi.org/10.1037/cpp0000484
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science, 10(2), 227-237. https://doi.org/10.1177/1745691614568352
Hsu, A. K., Bassett, S. M., O’Dwyer, L. C., McHugh, M., Heinemann, A. W., Jordan, N., & Dhar, S. (2022). Cost-effectiveness of hearing screening in older adults: a scoping review. Research on Aging, 44(2), 186-204. https://doi.org/10.1177/01640275211008583
Jiam, N. T. L., Li, C., & Agrawal, Y. (2016). Hearing loss and falls: a systematic review and meta‐analysis. The Laryngoscope, 126(11), 2587-2596. https://doi.org/10.1002/lary.25927
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., ... & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The lancet, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6
Manchaiah, V. K., Stephens, D., Zhao, F., & Kramer, S. E. (2012). The role of communication partners in the audiological enablement/rehabilitation of a person with hearing impairment: an overview. Hearing Balance and Communication, 10(1), 21-30. DOI: 10.3109/1651386X.2012.655914
McKee, M., James, T. G., Helm, K. V., Marzolf, B., Chung, D. H., Williams, J., & Zazove, P. (2022). Reframing our health care system for patients with hearing loss. Journal of Speech, Language, and Hearing Research, 65(10), 3633-3645. https://doi.org/10.1044/2022_JSLHR-22-00052
Meyer, C., Waite, M., Atkins, J., Ekberg, K., Scarinci, N., Barr, C., ... & Hickson, L. (2022). How can ehealth meet the hearing and communication needs of adults with hearing impairment and their significant others? A group concept mapping study. Ear and Hearing, 43(2), 335-346. DOI: 10.1097/AUD.0000000000001097
Myers, C., Reed, N. S., Lin, F. R., & Willink, A. (2022, February). A broad examination of health policy barriers to access and affordability of hearing treatment for Medicare beneficiaries. In Seminars in Hearing (Vol. 43, No. 01, pp. 013-019). Thieme Medical Publishers, Inc.. DOI: 10.1055/s-0042-1743122
Naito, R., McKee, M., Leong, D., Bangdiwala, S., Rangarajan, S., Islam, S., & Yusuf, S. (2023). Social isolation as a risk factor for all-cause mortality: Systematic review and meta-analysis of cohort studies. PloS one, 18(1), e0280308. https://doi.org/10.1371/journal.pone.0280308
Nicks, S., Johnson, A. L., Traxler, B., Bush, M. L., Brame, L., Hamilton, T., & Hartwell, M. (2022). The use of person-centered language in medical research articles focusing on hearing loss or deafness. Ear and Hearing, 43(3), 703-711. DOI: 10.1097/AUD.0000000000001168
Rizk, H. G., Lee, J. A., Liu, Y. F., Endriukaitis, L., Isaac, J. L., & Bullington, W. M. (2020). Drug‐induced ototoxicity: a comprehensive review and reference guide. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 40(12), 1265-1275. https://doi.org/10.1002/phar.2478
Shrubsole, K., Power, E., & Hallé, M. C. (2023). Communication partner training with familiar partners of people with aphasia: A systematic review and synthesis of barriers and facilitators to implementation. International Journal of Language & Communication Disorders, 58(2), 601-628. https://doi.org/10.1111/1460-6984.12805
Shukla, A., Harper, M., Pedersen, E., Goman, A., Suen, J. J., Price, C., ... & Reed, N. S. (2020). Hearing loss, loneliness, and social isolation: a systematic review. Otolaryngology–Head and Neck Surgery, 162(5), 622-633. https://doi.org/10.1177/0194599820910377
Tai, S., Barr, C., & Woodward-Kron, R. (2018). Competing agendas and other tensions in developing patient-centred communication in audiology education: A qualitative study of educator perspectives. International Journal of Audiology, 57(4), 274-282. https://doi.org/10.1080/14992027.2017.1385863
Tolouian, R., Tolouian, A., Dastan, F., Farhangi, V., Peymani, P., Saeifar, S., ... & Sadighpour, T. (2022). Antioxidants and cisplatin nephrotoxicity; an updated review on current knowledge. Journal of Nephropharmacology, 12(1), e10556-e10556. https://doi.org/10.34172/npj.2022.10556
Uchida, Y., Sugiura, S., Nishita, Y., Saji, N., Sone, M., & Ueda, H. (2019). Age-related hearing loss and cognitive decline—The potential mechanisms linking the two. Auris Nasus Larynx, 46(1), 1-9. https://doi.org/10.1016/j.anl.2018.08.010
Vas, V., Akeroyd, M. A., & Hall, D. A. (2017). A data-driven synthesis of research evidence for domains of hearing loss, as reported by adults with hearing loss and their communication partners. Trends in hearing, 21, 2331216517734088. https://doi.org/10.1177/2331216517734088
World Health Organization. (2021). World report on hearing. World Health Organization.
Yassine, H. N., Samieri, C., Livingston, G., Glass, K., Wagner, M., Tangney, C., ... & Schneider, L. S. (2022). Nutrition state of science and dementia prevention: recommendations of the Nutrition for Dementia Prevention Working Group. The Lancet Healthy Longevity, 3(7), e501-e512. https://doi.org/10.1016/S2666-7568(22)00120-9