The Social Otology Model: A Narrative Review of Hearing Loss as a Multidisciplinary Determinant of Health Equity
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.
Full text article
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
Authors
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.