Dr. David Hill: This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today we're talking with audiologist, Dr. Jennifer Black at Carle Health Audiology about hearing loss awareness. Jennifer, welcome.

Dr. Jennifer Black, Au.D: Thank you. Nice to be here.

Dr. David Hill: It is lovely to have you here, and I have to get personal here for a minute. I'm really interested in what you're going to say today, because many years ago I was diagnosed with some mild high frequency hearing loss, and I'm kind of keeping an ear on it, if you will, and I'm a little concerned about when I'm gonna need to do a little more.

So, let's find out what me and people like me need to know. Can you tell us some of the early warning signs of hearing loss?

Dr. Jennifer Black, Au.D: Yes. Some of the early warning signs, would be, for example, if you have to turn the TV up louder than you know, other folks in your household might like, or you find that you have to use the captions in order to catch the dialogue on the tv. Of course, if you have to ask people to repeat themselves, or if you can't understand people when they're wearing masks, that's an indication. And of course, if you maybe decide not to attend a social event because you're afraid you're not going to be able to follow the conversation. Those are some pretty good warning signs.

Dr. David Hill: What about tinnitus? I think in my case, that's something that brought me to attention.

Dr. Jennifer Black, Au.D: So tinnitus is very often a symptom or a side effect of hearing loss. So the same mechanism that causes hearing loss often causes tinnitus, especially if there is any noise exposure, historically, that can typically cause hearing loss and tinnitus. Another good reason to get the hearing evaluated.

Dr. David Hill: Excellent. So let's talk now about evaluation and treatment. People have a lot of myths about hearing aids. They just kind of went over the counter and, what do people believe and what do they need to know about the whole process of getting an evaluation and getting treated?

Dr. Jennifer Black, Au.D: Sure. Well, if we start with over-the-counter hearing aids, the FDA just cleared the sale of over-the-counter hearing aids in October of 2022. So, I guess maybe some of the myths about over-the-counter hearing aids, is that they are equivalent to prescription hearing aids.

Over-the-counter hearing aids are for people with perceived mild to moderate hearing loss. And the tricky part about that is most people underestimate their degree of hearing loss. But the over-the-counter hearing aids, are available at Walgreens, CVS, and, those are intended, as I said, for people with mild hearing loss.

There are a lot of barriers, that people see in terms of getting hearing help. And so, that may be just having to make an appointment to get a hearing test and those types of things, but we recommend an evaluation, by an audiologist. and they'll be able to tell you not only if you have hearing loss, but if that hearing loss is treatable, by other means.

You may have a medically treatable hearing loss. You may have wax blockage, you may have an ear infection. You may have, any number of things that would require medical follow up. So we don't want to miss those things. And if with over the counter, you're not seeing a professional to know if there are other treatment options, for your hearing loss.

Dr. David Hill: And what happens? Somebody walks into your office for the first time, what sort of evaluation do they get?

Dr. Jennifer Black, Au.D: So the first thing we do is, of course, we take a complete history, find out if patient has family history of hearing loss, other medical concerns related to ears and hearing, noise exposure, tinnitus, those types of things. We do an ear exam to check for wax or other blockages or drainage or any other problems that would indicate a medical referral.

And then we evaluate the different parts of the ear. We evaluate the middle ear, the eardrum, to determine if there is anything going on, behind the eardrum that we can't see when we look in the ear. That test is called a tympanogram. And then we do an evaluation not only of an individual's hearing for soft sounds, but also their ability to understand speech, because that, of course is the key. That's what people want to hear. They want to hear conversation. We evaluate how well someone is able to understand speech, and then, based on those tests, we also measure hearing, what we call bone conduction or nerve hearing to make sure where the hearing loss is coming from, because then that directs the treatment for the hearing loss, and if it is nerve damage, then hearing aids are the best route of treatment, for that.

Dr. David Hill: All right. Well, let's go a little bit beyond hearing aids. I think one of the most exciting developments of the last several decades are these cochlear implants. Now I think of them for perhaps children who are born without hearing, or people with incredibly severe hearing loss. Who can benefit from these cochlear implants?

Dr. Jennifer Black, Au.D: Great question. Actually, medicare just expanded the criteria for cochlear implants. It used to be for people with severe to profound hearing loss, and that has just been broadened to include people with moderate to severe profound hearing loss. And so as cochlear implant technology improves, so do the outcomes.

And so we're able to provide cochlear implants to people with more hearing than used to be the case. And then what we're seeing is better benefits from cochlear implants. So the combination of fitting people with less hearing loss, not waiting until people are completely deaf. And then, I don't work with children, but typically with cochlear implants in children, as soon as hearing loss is identified in a child and hearing aids have been tested and shown not to provide enough benefit, than cochlear implants are absolutely, recommended.

We have kids that have been implanted at age nine months. The sooner the hearing loss is identified with children, the better the outcome. So we, we want to treat, as soon as we identify hearing loss, whether it's treating with hearing aids, treating with cochlear implants, the sooner the better.

Dr. David Hill: So speaking of catching things in time, for those of us who may be middle-aged, can we talk about the link between untreated hearing loss and cognitive decline in even dementia.

Dr. Jennifer Black, Au.D: Yes. So in 2020, the Medical Journal Lancet, published research confirming that hearing loss is one of the modifiable risks to cognitive decline or dementia. So, if a hearing loss is treated, the likelihood of developing cognitive decline as a result of hearing loss, is much less. And so, again, as soon as someone feels like they have a hearing problem, they should have it evaluated and have it treated because the sooner the hearing loss is treated, the less likely cognitive decline, will follow.

Dr. David Hill: So this is a really serious thing to jump on. Should not just leave it alone.

Dr. Jennifer Black, Au.D: Correct. And there's no reason to ignore a hearing problem. People don't ignore vision problems. When they can't see to read, they get glasses. With hearing loss there is still somewhat of a, I think, a stigma with regard to hearing aids. But so many people now have bluetooth receivers in their ears and it's less of an issue to see somebody wearing something in their ear. And certainly being able to improve the quality of one's life and being able to participate again in social activities and church and hearing your grandkids and those types of things, there's not really any good reason to wait to get hearing aids or at least to get your hearing evaluated.

Dr. David Hill: Well, that makes a lot of sense. Do you have any final thoughts for our listeners about listening?

Dr. Jennifer Black, Au.D: Yeah, I would say that if somebody is noticing that they have a hearing problem, the first thing to do is get evaluated, by an audiologist. The audiologist will be able to tell you if you have a treatable hearing loss, and if so, what are the treatment options? And the other thing is that many health insurance policies now have a hearing aid benefit that will help offset the cost of the hearing aids sometimes substantially.

I know cost is certainly something that would prevent somebody maybe from taking that next step. But check with your health insurance because a lot of policies these days have a benefit that helps to pay for the hearing aids.

Dr. David Hill: Well, Dr. Jennifer Black, we hear you loud and clear and thank you for speaking with us today.

Dr. Jennifer Black, Au.D: My pleasure. Thank you.

Dr. David Hill: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.