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Scott Webb: Hearing loss as we age begins to affect our quality of life, and my guest today wants us to know that there's a lot that she and her colleagues can do to help us. I'm joined today by Christine Maddox. She's a family nurse practitioner specializing in otolaryngology and ENT with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Christine, thanks so much for your time today. We're going to talk about hearing loss. And me at 54, I do believe that I've lost little bit of my hearing along the way. It seems like it's fairly natural for a lot of folks to sort of have that age-related hearing loss. So on that topic, let's talk about that. What are the most common causes of age-related hearing loss?

Christine Maddox: When we look at hearing loss, especially what they call age-related hearing loss, the primary reason for that is the degeneration of little hair cells inside the cochlea. But the degeneration of these little hair cells that are responsible for detecting the sound and being able to transmit that information to the brain, with age, unfortunately, we see these hair cells tend to degenerate and that leads to hearing loss. And then, the other thing, unfortunately, related to age is that the ear canal can become more narrow and that affects the ability of the sound waves to travel, you know, through to the eardrum to vibrate it.

Unfortunately, for myself, I know the exposure to loud noise, you know, listening to AC/DC and all those fantastic '80s hairbands, prolonged exposure leads to loud noise, you know, damaging those hair cells. And, you know, unfortunately, we might really not know it at that time, but I can tell you from personal experience that more than once I'd come back from a concert and, you know, I couldn't hear for about three days and, you know, my ears would be ringing. And of course, you know, as a 16, 17, 18-year-old, oh, you know, I was cool, but I'm paying for it now. And then, the other thing is genetics. If your mom, dad, grandma, grandpa, had lost hearing kind of at an early age, we look for that to travel along in families as well.

Scott Webb: Yeah, for sure. Behavior, lifestyle, family history, genetics, you know, all the sort of greatest hits if you will. There's no doubt, we do a lot of this to ourselves. And again, some could be family history, genetics. And I know for me the impact of all this has just been that I end up turning my headphones up now, like right now, that I'm wearing a little bit louder than I used to or I turn the TV up a little bit louder. But generally speaking, what's the impact of, you know, the aging on hearing and how does that sort of affect our daily lives?

Christine Maddox: Just as you had mentioned, you know, having to turn up the volume on the TV or the radio. One of the biggest complaints that a lot of my patients say is struggling to hear those higher pitched or softer noises. So, you know, "Hey, Christine, I can't hear my grandkids. I know what they're saying. There's words coming out of their mouth. But that ability to distinguish exactly what they're saying." Hearing conversation in noisy environments. So, have you ever been sitting down at a restaurant, right, and you've got the tables in front of you, behind you, next to you, and everything's going on, and you're sitting right across from somebody and going, "What? What? I know you're saying something. Your lips are moving, but I can't figure out what you're saying." And unfortunately, the elderly, they start to avoid social situations like, "I really want to go to this, but I'm not going to go because I'm not going to be able to make out anything."

A lot of it has to do with quality of life. And in the elderly, it'll lead to social isolation, depression, anxiety. And it's hard to participate in conversations, that's one of the biggest things. You know, "Hey, the ladies aren't going out for a drink or we're going to play some cards," and it's a mess because nobody can hear each other.

Scott Webb: Maybe you have some words of encouragement. How can we encourage folks like, "It's okay. We don't mind repeating ourselves at least, you know, a little bit."

Christine Maddox: I think sometimes, unfortunately, as a healthcare provider, there's a lot of things that I can sort of say and repeat and tell people, but until they really experience it. One of the little things I always tell my patients, they're like, "Well, do you think that I need hearing aids?" And I said, "Look, there's no way for you to really know at what level you are going to need hearing aids." As an example, I take off my glasses and I say if I were to walk out of my house and leave my glasses on the countertop, I wouldn't get very far. I'd get halfway down the driveway and say, "Uh-oh, I can't see. I can't function." So, what I tell my patients is, you're going to have to use hearing aids for anywhere from a month or two. And then, the question is, "If you were to walk out of your house and forget, would you turn around to go get them?" If the answer is yes, then, hey, you're getting good benefit out of those hearing aids and you probably knew you need them to function. So, that's kind of what I would say a litmus test for that.

Scott Webb: Sure. Yeah. And I know that sometimes it's real subtle as our hearing starts to go, so maybe you can talk about that. Like what are some of the signs, those subtle, gradual signs that, "Uh-oh, dad might need some hearing aids"?

Christine Maddox: You know, difficulty hearing conversation in noisy environments. So, same sort of thing, when you're at a restaurant, or let's say you're in church and you've got this expansiveness and you're like, "I know something's being talked about, but I'm, you know, not picking up on it." One of the things that you'll notice that people miss are the softer sounds, so like the ends of, you know, like "S" or something where it's a "pff," those very, very light sounds, people aren't picking up on that. And you know, that's one of those things to kind of look for as well.

Scott Webb: So Christine, you know, we talked about AC/DC, so besides maybe turning down the AC/DC when we're younger, what can we do? Are there any things that we can do? Let's assume that, you know, maybe some family history and genetics, but that behavior and lifestyle stuff, what else can we do to sort of slow the progression or however you want to put it, but slow things down a little bit, keep our hearing as long as we can?

Christine Maddox: You know, protection from loud noise, that's the biggest thing. There are 40 million adults in the United States have a noise-induced hearing loss. So, you know, you can't change your genetics and if, you know, there's really nothing that you're going to be able to do to stop that genetic thing from occurring to you. So, the best thing we always advise is hearing professionals in the hearing industry, is if you know that you're going to be exposed to loud noise is to protect yourself with ear plugs, over the ear. If the noise that you are experiencing is causing pain, damaging is occurring at that time. If you have ringing in your ears, again, after, like I said, going to a concert, after something, you know that damage is being done. If you're hearing is attenuated or decreased again, after exposure, that damage is being done.

So to sort of reduce those things to protect your hearing, there are medications. Unfortunately, some of which can cause temporary and some of which can cause permanent hearing loss. And one of those big things that I see are the ingestion of aspirin and something called an NSAID, which is a non-steroidal anti-inflammatory. So, I have a lot of patients that, many, many years like, "Oh, I've got this knee pain or this back pain, and I've just taken some over-the-counter naproxen sodium," and they've taken it on a regular basis or they've taken too much of it and now they've got ringing in their ears and they've got hearing loss. And it's always hard to make that connection about those things that have occurred in someone's life related to their hearing loss. Because it could not just be one single thing, it could be multifactorial, age, noise exposure, one of those things that has been in the news are the chloroquine and the hydroxychloroquine, that we had kind of during that COVID events over the last couple years. And temporarily, you can experience some hearing loss secondary to that. Certain loop diuretics medications to help with high blood pressure and cardiac issues, they can cause, you know, tinnitus and hearing loss and some individuals, they need to be on a loop diuretic.

So, it's always this trade off when you're on certain medication and there's about 200 different known medications that can contribute and cause hearing loss and ringing in the ears and tinnitus. I've had a few patients in the past. One was a truck driver and a tire exploded right next to him within a few feet. He lost his hearing on the side that that tire exploded. And I mean, that was just such a damaging event to those little hair cells inside his cochlea. And there was nothing that was going to be able to do to prevent him from having that hearing loss. I mean, you know, you could say, " Go live in a bubble. Go live in a bubble."

Scott Webb: Yeah. And most of us can't do that. We just can't avoid life. We can't avoid living and being around loud things, whatever it might be. Maybe with our work, we can. And we certainly know more now about hearing loss and preventing that and wearing ear protection, both for ourselves, for our kids, right? But at some level, like it's just sort of living life. So wondering, how do you determine hearing loss and the level of hearing loss, and then usually what are the next steps?

Christine Maddox: One of the first steps is you should either go to your primary care, you know, provider or an ear, nose and throat provider. For somebody to be able to take a look inside the ear and to look at that anatomical structure and say, "Hey. Maybe you have a big old blob of wax hanging out in there. Maybe you have fluid in the middle ear space." So, just an examination, you know, first initially by a healthcare provider.

The next step would be to do some hearing testing. And there's all sorts of different kinds of hearing testing that can be done, but not all of them are equal. We say in a full spectrum audiogram, meaning we test how sound waves travel through the ear canal, they vibrate the eardrum, which in turn vibrates the three little bones in the middle of ear space, and then how that sound is transmitted to the cochleas. And so, that's what we call air conduction. And then, bone conduction is how the cochlea picks up on the vibrations without the existence of the assistance of the air or the eardrum. You don't need an actual outside of your ear to hear. You don't need an ear canal. You don't need an eardrum. You don't need the three little bones in there. You just need a functioning cochlea to be able to hear, which kind of sounds weird. Like why do we even need these structures, you know, to be able to hear? Those structures help to provide amplification, but the true organ of hearing, your cochlea, that's where those little hair cells reside. So, we look then at, you know, your air conduction versus your bone conduction, okay? And we want those two to be equal. We want those to look the same.

And then, the other test we do is tympanometry. And that measures the flexibility of your eardrum. We know if your eardrums aren't working correctly, that could sort of be an indicator like, "Hey, this is why, you know, the air conduction is lower than the bone conduction." And then, we do something called speech audiometry. And the audiologist will put you in a booth and they'll, at a certain decibel level, speak to you, and they'll say different words and then they measure like a percentage of words that you get correct or incorrect.

Testing is done by either an audiologist who either has a master's or a doctorate, or you have licensed hearing aid professionals that necessarily maybe don't have a degree, but they know what they're doing in terms of testing. Not all hearing testing companies or not all these places are equal when it comes to testing for the appropriate test that that your provider needs to be able to make a diagnosis.

Scott Webb: As we wrap up here, Christine, when we think about the hearing aids and, you know, things that people can do. So, we know, as we've established here today, some of it is genetics and family history. Some of it is what we do to ourselves. So if we're having issues, right, obviously reach out to our provider, get some testing, and let's say that hearing aids are recommended or prescribed, just kind of take folks through that experience. I know it's been a long journey with my dad of getting hearing aids and the right hearing aids and the ones that are, you know, loud but not too loud. And now, he has a little remote control that he can turn them up and turn them down. So, I'll see him turn them down before he goes into a really loud environment, because it's just going to be overkill for him. So, maybe you can just talk to folks a little bit about that experience of hearing aids and why you recommend them and how best to use them.

Christine Maddox: Initially, we think, "Well, hey, I'm going to be able to take this little device, put it into my ear and I'm going to be able to hear just as well I was, you know, when I was five or 10 or 20," and that's not necessarily the case. The sound that's being transmitted through the device into your ear canal, the brain sort of interprets that a little bit differently. So, we almost have to give our brains an opportunity to readjust to the way that we hear. So when you visit the audiologist and they go through the hearing testing, depending upon the level of hearing loss that you have, will be the recommendation of the type of hearing aid that will work well for you.

I always tell my patients as well, "You got to give it anywhere from two to three months for you to wear are these hearing aids on a regular basis to know are they going to work for you." And to kind of get used to that and that's a very normal thing. And all of them now are typically digital. I don't think I've seen an analog hearing aid in quite some time. You have the ability to connect up with your cell phone and there's different settings that your audiologist can help set up for you.

I always tell my patients, when you're looking for a hearing aid as well, it's not a matter if they break, right? It's a matter of when. And regular maintenance is a necessary thing for these instruments because, again, they're so delicate and you need to always constantly have, you know, the little tubing changed, the little domes that go in the ear, those have to be changed out.

The biggest thing that I tell my patients is you're going to be spending anywhere from, you know, $1,500 all the way up to $5,000 for a set of hearing aids. I mean, I've even seen hearing aids for $10,000. If you're going to buy these things, you need to at least say, "Hey, I'm going to commit to wearing them and commit to using them," because that's a lot of money to be just stuffed in your sock drawer and not using. So, you know, your audiologist will get you fit for the type of hearing aid that he or she thinks will work for you.

And then, typically over the course of the first three to six months, they're going to have you coming back a couple of different times and saying, "Hey, how do you feel? You know, how are things going? Do you feel like, you know, you're picking up those sounds that you're missing? Do you feel like you can adjust them appropriately? Have you been having any ear pain?" One of the things that I see with my patients who have more solid hearing aids that are more hard plastic is they are quicker to develop an ear infection because that airflow into the ear, you know, isn't there. So, things tend to get sort of like wet and moist and, you know, we end up with a fungal ear infection. So, regular visits with your healthcare provider or an ear, nose and throat professional to just check the condition of the ears, especially those who are wearing hearing aids, is one of those things that's a good thing to do as well. And most of the people, after usually about three to four months, they're like, either you are really going to love them and you're going to wear them or, nope, I'm just not feeling it.

Scott Webb: For sure. Well, this has been educational and fun. Always great to talk about AC/DC. I don't get a chance to do that very much on these things. And Christine, thank you so much for your time today. You stay well.

Christine Maddox: Thank you. You too. Take care.

Scott Webb: For more information, visit franciscanhealth.org. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.