Editorial: Say Again? Why Hearing Loss Should Matter to Orthopaedic Surgeons and Their Patients

The concept of “healthspan,” or spending more of our years living free from serious disease [12], seems new, because it has a new name. It’s not. Some 2400 years ago, Herodotus wrote about a spring whose waters promised those who partook of them a long life and an eternally youthful appearance, and Alexander the Great went looking for it. Countless others throughout the millennia have, as well, including innumerable healthy-living “influencers” today, who seek to convince the unsuspecting that they can sell us those waters. And sell 'em, they do: The “wellness industry” accounted for some USD 6 trillion in 2023—just over 6% of global GDP—a number that is expected to increase by 50% over the next 3 years [1].

I say, skip the waters. Here’s my best medical advice: Love the people around you, find a job that you care about, eat right, exercise, and read good books. You’re welcome. You can send me your USD 9.99 some other time.

But every once in awhile, something really healthy comes along that also is really easy to do, both for our patients and for ourselves. Over the last couple of years, a pile of high-quality research has made it clear that one of those things is attending to hearing loss.

Don’t worry; your vision isn’t going, too. And yes, you are reading about ears in a bone journal. Two reasons for this: (1) Many of our patients are older, and hearing loss is present in almost two-thirds of patients over the age of 65 [2] (and especially in older men [3]), and (2) some of us are older, but more importantly, many of us work in noisy operating rooms, and noisy workplaces can cause hearing loss [9].

This matters, because among patients with risk factors for dementia, a recent, high-impact randomized trial [6] found that simply receiving audiological counseling and hearing aids reduced the risk of dementia by 48% over the next 3 years. Those authors defined patients to be at “increased risk of dementia” if they had risk factors for atherosclerosis (you know what those are); most patients over the age of 70 fall into this group, as do many who are younger. This isn’t half of some small number—another study in Lancet [7] attributed some 8% of all dementia diagnoses to hearing loss, and a recent study in JAMA supports those main findings [4]. That’s an enormous healthcare burden, with each instance being a local family tragedy.

The ability to reduce the number of patients with dementia so substantially—as seems possible simply by referring a patient to audiology [6]—is a boon, and we should take advantage of it. We all have (or have had) family members with dementia, and we know how devastating this is. We all also have relatives who are hard of hearing, and they generally don’t like to be nagged about it. Your patients with hearing loss have heard complaints from their families on this already (you can count on it), and perhaps also from their family doctors.

But they won’t expect to hear it from you. You’re a trusted source, and you’d be stepping out of your lane a bit if you say something. But doing so conveys care, and because of this, your recommendation is likely to carry weight. I know because I’ve done this, and it works. If you have to shout for your patient to hear you, offer to refer him or her to audiology. Your recommendation will make a difference.

While you’re at it, take care of yourself, too. The best recent systematic review I found on this topic [8] concluded that dangerous noise levels in orthopaedic operating rooms is pervasive—regardless of whether it was assessed as peak noise levels or as a function of noise levels over time, such as those that might occur in a full day of using power tools—and that there is evidence of orthopaedic surgeons developing noise-related hearing loss as a result of this exposure. This is no outlier finding; a similar review in ENT (mainly mastoid surgery) found similarly excessive and damaging noise levels in their operating rooms [10]. This isn't some kind of come-lately, faddish research, either; that systematic review I mentioned earlier [8] shared studies of audiograms showing noise-related hearing loss in orthopaedic surgeons going back three and even four decades [5, 11].

It's a mystery to me not just that this problem persists, but that it’s so rarely mitigated or even discussed among surgeons or the entities that employ us. Heavy industry, agriculture, and the military all take this threat seriously, and they all manage to protect folks' hearing while still facilitating the safe performance of complex, important tasks. We can, too.

Given that persistent exposure to loud noises results in hearing loss, and that hearing loss is the most important modifiable cause of dementia (accounting for 8% of patients who develop that diagnosis [4, 7]), and that hearing aids can reduce the risk of developing dementia by nearly half in most older people [6], it seems to me we should do three things to better take care of ourselves:

1. Use suitable ear protection when working in noisy operating rooms,

2. Share these findings with our hospital administrators so they can make changes (some newer power tools are much quieter than older ones), and

3. See an audiologist for a hearing test if there’s any doubt, as treatment of noise-related hearing loss can, and will, prevent dementia in many of us as we age.