It’s Not Just About Hearing

Why getting help for hearing loss is also a psychological journey. By Bill Hodgetts, Au.D., Ph.D.

When people think about hearing loss, they picture someone turning up the TV too loud or saying “what?” a lot. But what I’ve learned in more than 20 years as an audiologist is that hearing loss is rarely just about the ears.

It’s also about identity, emotion, and effort. And for many people, that’s the harder part. As a clinician and university professor, I’ve worked with hundreds of people who hesitated to seek help—not because they couldn’t afford it, or didn’t have access to care, but because doing so meant admitting something they weren’t ready to accept: that something fundamental had changed.

They were afraid of what that change said about them. About aging. About control. About being “that person” with hearing aids.

I’ve come to believe that hearing loss is as much a psychological journey as a medical one. And maybe if more people understood that, they’d feel less alone and more willing to take the first step.

The Brain Works Harder

Hearing loss doesn’t usually flip a switch from “typical hearing” to “not hearing.” It’s typically slow, creeping. You start asking people to repeat themselves. You feel exhausted after social events. You laugh along with jokes you didn’t quite catch. You start withdrawing from the edges of conversations, and eventually from the conversations themselves.

What most people don’t realize is that hearing loss taxes your brain. Imagine trying to read a book in a dim room. You can do it, but it takes more concentration. That’s what listening is like for people with hearing loss, especially in noisy environments. The brain works overtime to fill in the blanks.

Over time, this constant strain leads to mental fatigue and reduced cognitive capacity for other things, like memory and decision-making. It’s not just a guess—neuroimaging and longitudinal studies show it. In fact, large-scale research like the ACHIEVE study, a randomized controlled trial led by Johns Hopkins researchers, found that treating hearing loss in older adults at risk for cognitive decline reduced global cognitive deterioration by nearly 50 percent over three years. The effect was strongest among participants with increased risk due to lower cognitive reserve and higher social vulnerability.

This isn’t because hearing loss causes dementia directly. Rather, the constant cognitive strain, combined with the social withdrawal that often accompanies hearing loss, creates conditions where the brain is less stimulated, less resilient, and more vulnerable over time.

The Role of Psychology

So if hearing loss affects the brain and well-being, why don’t more people get help? This is where psychology enters the room.

Humans are emotional decision-makers. We think we’re rational, but in reality, we rely heavily on feelings, assumptions, and mental shortcuts. In fact, behavioral research has shown that even trained clinicians can make inconsistent choices when emotions or personal beliefs come into play.

One of the strongest forces I see in the clinic is cognitive dissonance. That’s the uncomfortable feeling when our beliefs don’t match our actions. For example, someone might believe they’re independent and capable, but needing hearing aids makes them feel dependent or “old.” That internal conflict can lead to denial, resistance, and even anger.

Another common obstacle is self-efficacy—our belief in our ability to do something. I’ve met people who are successful in business or leadership but feel completely overwhelmed by the idea of managing hearing technology. Their fear isn’t the device—it’s failing at something unfamiliar.

Even the way people think about memory and aging can be distorted. If you forget a word in your 40s, you joke about being busy. If it happens in your 60s or 70s, you fear it’s a sign of decline. Add hearing loss to the mix, and that fear amplifies. That’s why the stories we tell ourselves—and the ones society tells us—matter.

Being Truly Heard

The first audiology appointment isn’t just about a hearing test. It’s a conversation. We talk about how hearing loss is affecting your life: your relationships, your work, your confidence. We explore goals, concerns, and what matters most to you.

Sometimes, people expect to leave with a hearing aid and a fix. But managing hearing loss is a process, not a transaction. It takes time to adjust. Your brain has to relearn sounds it hasn’t heard clearly in a long time. That can be jarring, but also profoundly empowering.

This is why the relationship between clinician and client matters so much. Research consistently shows the most important factor in successful counseling—whether it’s for hearing or anything else—is trust. When people feel safe, valued, and understood, they’re more open to trying, adapting, and growing.

Not Weakness, But Wisdom

I often say that hearing aids are like umbrellas: They don’t stop the rain, but they help you stay dry. Similarly, hearing aids won’t reverse hearing loss or prevent aging. But they can reduce the strain of listening. They can help you stay socially connected. They can improve quality of life.

And as the ACHIEVE study reinforces, the cognitive benefits of intervention, especially those that are at a greater risk for cognitive decline, are not hypothetical. They’re real. When we help people hear better, we’re not just improving their social lives. We’re reducing their risk of accelerated brain decline.

Even if hearing aids didn’t offer cognitive protection, they’d still be worth it: for the joy of conversation, the ability to be present, and the chance to fully participate in life.

I know it can be hard to ask for help. But getting help doesn’t mean you’re broken. It means you value connection. It means you want to stay involved. It means you’re taking control.

So here’s what I hope people take away:

• If you’re struggling to hear, get your hearing checked— even if it’s just to get a baseline.
• If you’re offered treatment, give yourself time to adjust. It’s not about perfection; it’s about progress.
• If you know someone who’s pulling away socially, talk to them. Hearing loss is invisible, but its effects are not.
• And if you’re wearing hearing aids already, congratulations—you’re doing something incredibly proactive for your brain, your relationships, and your future.

As audiologists, we don’t just fix ears. We help people reconnect with their world. And that’s something worth hearing.

^{This article is republished from The Conversation under a Creative Commons license. Bill Hodgetts, Au.D., Ph.D., is a professor in the department of communication sciences and disorders at the University of Alberta, Canada. He holds a joint appointment at the Institute for Reconstructive Sciences in Medicine where he is program director for audiology and bone conduction amplification. For references, see hhf.org/references. https://hearinghealthfoundation.org/hearing-health-magazine}