Joey Wahler (Host): May is National Speech Language Hearing Month, so we're discussing the speech and hearing connection for the hearing impaired. Our guests from Guthrie are Dawn Sharpe, she's a Speech Language Pathologist, and Dr. Kyle Conrad, an Audiologist. This is Medical Minds, Conversations with Guthrie Experts. Thanks for joining us. I'm Joey Wahler.

 Hi there, Dawn and Kyle. Thanks for being with us.

Dawn Sharpe, SLP, MS, CCC: Thank you.

Kyle Conrad, AuD: Thanks for having me.

Host: Great to have you both aboard. So first, I'd like you each to share the importance of National Speech Language Hearing Month from your standpoint and its significance in raising awareness about communication disorders. First you, Dawn.

Dawn Sharpe, SLP, MS, CCC: Well, you know, each May, ASHA does this celebration, to celebrate and give us an opportunity to raise awareness about the spectrum of communication disorders as well as hearing disorders. But, you know, most importantly, I think it highlights, what Kyle and I do as ASHA members, our roles in providing care, collaborative care, support for the members that experience communication and hearing disorders, both in schools, hospitals, community wide. A great opportunity for individuals to remember hearing value and communication value.

Joey Wahler (Host): And you, Dr. Conrad.

Kyle Conrad, AuD: Yeah, I mean, Dawn put it really well there. So, it's just an opportunity to get out there, maybe reach some of the public that may not be as linked or connected with their primaries or any of the specialties, specialty units of care here, and to just make sure that they're cognizant of some of the things that they can do to maybe prevent some of the conditions that plague an individual, with a communication disorder or get some treatment, for them if they already have them.

Host: And speaking of which, Dr. Conrad, what would you say are some common misconceptions people have about hearing loss and how audiologists can help address those misconceptions?

Kyle Conrad, AuD: Sure. So unfortunately, there's a lot of misperceptions and stigmatizing mindsets that are ingrained within our society and amongst some ancillary healthcare providers. Some of these misperceptions can include something like hearing loss only impacts the elderly when, in fact, we know an estimated 48 million Americans live with hearing loss and about two thirds of those are under the age of 65.

And in addition to that, The World Health Organization has warned us that there's an additional 1.1 billion children and young adults that are at risk for hearing loss due to unsafe use of personal audio devices and exposure to unsafe levels of recreational noise. Another myth that is pretty common is that hearing loss is inevitable and it can't be prevented when, in fact, hearing loss is not just age related. Hearing loss can be due to a number of different factors, including genetics, ototoxic medications, noise exposure, chronic diseases, and it's the cumulative effect of these conditions, which determine the severity of one's loss. So if we can minimize those effects by monitoring use of ototoxic medications, by limiting our exposure to noise, incorporating use of personal hearing protection and managing any sort of chronic diseases or illnesses under the supervision of our medical providers; we can be better equipped at preventing any further damage.

Another pretty common, misperception is that I may have a hearing loss and sure it may be a nuisance, but it's not impacting my overall health and my overall wellbeing. Well there's a lot of research out there that would argue against that. In fact, we know untreated hearing loss an individual is at an increased risk for depression, anxiety, social isolation, cognitive fatigue, cognitive decline, and even a mild hearing loss puts an individual at risk for falls. And they're three times more likely to fall with just a mild loss.

And I would say probably the last one is, obtaining treatment for a hearing loss can be expensive. And I would say that's probably the most common one that we run into is that, yes, I know I have a loss, but I can't afford it. It's financially, it's outside of my realm when there's a lot of techniques through oral rehabilitation, through audiologic rehabilitation that we can use, to try to manage one's loss, to help overcome some of those deficits that an individual may have, before jumping into hearing aids and trying to get something that meets the needs of one's lifestyle.

Host: So Dawn, how does speech therapy play a role in helping individuals with speech and language disorders?

Dawn Sharpe, SLP, MS, CCC: You know, I have to say, I'm probably one of the most excited speech pathologists you've ever met, and after 40 years, I still walk in the door every day, and there's something different, but there's one thing that is very clear, and that is our role as a speech pathologist spans over a lifetime.

We start with infancy. And we extend all the way through the geriatric years of a patient. So when you think about, what we might do with a little person, you know, maybe under the age of two, you know, we work with parents. That's where we teach parents language development, sound development, nurturing techniques to assist their child in facilitating language and development and socialization.

If there are diagnoses that are also identified early on that we try to educate and support pediatricians as well as families at that point. Moving on into the school aged, you know, that's where we get a lot of the kids who have sound challenges. Very often related to recurrent ear infections, which I'm sure Kyle would support. We work with teachers, we work with school psychologists, all with the intent of improving, facilitating age appropriate language and sound development, which influences reading, academics, not to mention social. We have some kids as we move into the adolescent years. This is one of the more challenging things that we work with that experienced disfluencies or stuttering as most people know that.

 You know, unless you have a child or know someone that has a significant disfluency or stuttering, the impact socially, emotionally, academically is enormous. And I don't think that, well sadly schools don't service that as readily as we wish they would just by virtue of there isn't enough speech pathologists in the school district.

So we here at the hospitals get a lot of the kids that need that very well rounded support for the communication impairment as a result of stuttering. Then you move on to, you know, the later years where you have neurological deficits, from strokes, from head and neck cancers, from progressive disorders, cognition as a result of traumatic brain injuries.

The things we do, I could turn a page every day and have a new diagnosis, a new condition and a new scenario, all that is related to how a person would interact with another, communicate with another. We also, you know, let's not forget voice. Voice is very representative of who we are. Men want to sound like men. Women want to sound like women. Horse vocal quality, high pitch. People are recreational singers. Teachers need their voice. Preachers need their voice. So we're not just disorders. We try to support employment through what we do in our work. I'm telling you, we're awesome.

Host: I'm sure you are, and the passion certainly comes through for both of you. How do audiology and speech therapy, as we touched on at the top, complement each other in treating patients with communication difficulties? Let's start with you, Dr. Conrad.

Kyle Conrad, AuD: So our two professions are inextricably linked. This connection is formed early on in our undergraduate studies and speech and hearing science. And as we move into our graduate courses and oral and audiologic rehab, our focus is pretty much on prevention, assessment, and intervention over the course of a lifespan kind of as Dawn has previously mentioned there.

And we continue with that clinical focus, in a manner to support the needs of our patients while ensuring their communication is being enhanced. So, there are many scenarios where an audiologist and speech language pathologist would be sharing similar patients, and Dawn had touched on this previously with a child who may be identified with reoccurring otitis media; in which case they're going to present with a hearing loss in grade school. The speech language pathologist is typically going to be the one that, is going to identify that as they're working through the school system, and then they would make the referral to the audiologist and we could work along with the family and the school.

And if they have an IEP, we can work along with that as well to make sure that they're meeting the needs. And one that maybe, later into one's life would be, an individual who ends up with a severe to profound hearing loss and needs a cochlear implant, in which case the audiologist would be the one that would be determining the candidacy and, the programming of the speech processor, while we heavily rely on the speech pathologist, to provide the rehab services through oral rehab and speech training to ensure that they're getting the maximum benefit of that sort of aided device there for them.

Host: How about you, Dawn?

Dawn Sharpe, SLP, MS, CCC: I don't think I could add much more to what Dr. Conrad said. When you're a speech pathologist, you need people to hear, to follow directions. You need folks to be able to hear sounds to effectively produce speech. So without that expertise, as a speech pathologist, I need to rely on the audiologist to give me direction as to will this person need to develop a sign language communication. Would this person need something supportive in regards to AAC communication, which might be a device? So depending on the expertise of the audiologist and what they recommend for us, that directs our level of care, for a patient. So we are linked early on.

Host: Absolutely. Dr. Conrad, how about the latest advancements in hearing aid technology and how they've improved the quality of life for those with hearing loss?

Kyle Conrad, AuD: Sure. So off the top of my head, I have three different ones, those being, artificial intelligence, Bluetooth connectivity, and rechargeable batteries. Touching on each one of those, AI is having a transformative impact on today's society and is being incorporated into all industries from social media, monitoring to self-driving cars. And then, with this increased sophistication, it's also being applied in hearing aids and has been for some time.

So how are we using AI in a hearing aid? And the two most commonly applied technologies, which we employ are called machine learning and deep neural networks. And machine learning is a form which uses algorithms or a rule based system to sort through data to make decisions and predictions.

 When we apply this to hearing aids, it helps capture information and learn from the hearing aid user's interactions with the device. So, manual adjustments to recognize and prioritize the sounds which are being identified by the user as important. In contrast, deep neural networks use a database learning to provide an accurate signal and improved signal to noise ratio.

And the deep neural networks are kind of similar to a human brain and learn through repetitive exposure to sound samples. And so this is kind of like when a child is learning language early on, we're typically not sat down and taught in a directive manner in the rather we go through experiences in life and we learn those over time and the deep neural networks do the same thing.

So as it continues to obtain more sound samples through the exposure that the manufacturer provides to them and does a better and more accurate job and becomes more efficient and effective at handling those sounds which are being captured in the user's environment. The second one that I mentioned was Bluetooth connectivity.

Someone's unfamiliar with what Bluetooth is, it's a wireless technology, which allows two different devices to communicate with each other. In the case of hearing aids, it allows an end user to stream media, such as telephone calls, audio books, podcasts, or music directly from an accessory, which could be their smartphone, tablet, or computer, directly to the hearing aids.

 So, not only do we have the benefit of direct streaming, but the connectivity also can be used in conjunction with an associated smartphone app which allows the user to have greater control of their hearing aids on a situational basis. Some of this control could be alterations to the device's frequency bands, the microphones, the noise reduction strategies, and activating certain different machine learning technologies.

In conjunction, these apps can also be used to help activate and deactivate additional accessories like remote microphones or, TV streamers. Another more recent advancement through the Bluetooth technology is having the connection, and the ability to use remote programming sessions.

And this is, something that's certainly utilized in more rural clinics or for patients with mobility issues because it allows an individual to meet with their provider from their home, allow the provider access to the devices and try to make some fine tuning adjustments for them, without having to leave the comfort of their home.

And then the last one I would say in the last few years is the rechargeable batteries. These are just becoming more common, they've worked through different types, and the most utilized one at this point is going to be a lithium ion rechargeable battery opposed to a traditional zinc air disposable. And the lithium ions are offering a more convenient for the end user, which minimizes their responsibilities, it provides a consistent power supply throughout the day.

It reduces the amount of waste in our landfills, and they're typically a little bit more economical than the traditional zinc air devices because we're not purchasing the disposable batteries on a reoccurring basis. So I would say those three, AI, Bluetooth, and rechargeable batteries are probably the advancements that stick out to me over the last few years.

Host: Great. And Dawn, how about advancements in speech therapy, the biggest ones you've seen of late?

Dawn Sharpe, SLP, MS, CCC: Well, there's two things that I want to mention. One of them is just forever evolving. But I'm going to start with something called a TEP and this is directly related to voice. So when we have a head and neck cancer patient who sadly loses their larynx or has a laryngectomy, of course they lose their ability to talk.

And in the last many years there's been the development of something called a tracheoesophageal puncture or tracheoesophageal voice prosthetic. And what that does or what it is, it's a tiny little prosthetic, or prosthesis, I should say, that is placed surgically in the esophagus, by the ENT or by the surgeon at the time or thereafter the surgery.

And what it does, it allows patients to vibrate air, if you will, and create voice. So despite no longer having a laryngectomy, voice can still be produced through this teeny tiny little plastic prosthetic by covering their stoma, which is the hole that remains, and communication is restored. To me, that is absolutely fascinating.

And that too is ever changing and evolving into, you know, producing a more natural like voice with more clarity. It's tremendous. The other thing I want to mention too, and this is something that changes every time I open up a magazine, there's something developed that is just more mind blowing, and that is called a speech generating device.

 So you know, we very often have individuals who are sadly paralyzed by accidents, or we have patients with ALS, for instance, who ultimately lose limb function, lose the ability to communicate verbally. So thank God for technology that can support a person's communication through what we call a speech generating device, which is a communication aid, and I'm going to give you like the highest tech one, which can produce voice sentences, novel messages, turn on lights, turn off lights, communicate through email, all by virtue of establishing eye contact with a photograph for three seconds or longer.

And that will generate the speech from the machine. I've never expected this to happen in my lifetime, but I had a conversation with my patient probably a month ago who does have ALS. We received this device for him from a company and there he is sitting in his wheelchair with the only movement he has is his ocular ability, which sadly is the one thing that is left with ALS.

As they are nearing the end of their existence on this planet. And he was able to tell me how he helped his daughter with her homework all by virtue of being able to gaze at a photograph, chain photographs text to her and his voice is created. Now how cool is that? That's why I'm a speech pathologist.

Host: Very cool indeed. And in fact, you answered another question I was going to ask you, which is about sharing a success story you've had, and you certainly did just that.

A couple other things, how about key ways that individuals can protect their hearing and vocal health to prevent communication disorders later in life, Dr. Conrad?

Kyle Conrad, AuD: Sure, so noise induced hearing loss is very prevalent and impacts about a billion people worldwide, 40 million of which are in the United States. And it's a byproduct of excessive occupational and recreational noise exposure in our ears natural resonance, the frequencies between 3,000 and 6,000 hertz.

So what would be the easiest way to protect one's ears? Well, that would be the avoiding all noisy situations or protecting their ears on a consistent basis. However, both of these are really unrealistic recommendations, and so what we need to do is try to determine what environments are they in that could potentially be harmful and try to obtain, the highest noise reduction rating for that particular environment, which allows them to continue to function and meet those needs.

So, for example, an individual who is an avid concert attendee, we wouldn't want to consider giving them a traditional ear plug or ear muff, which has a noise reduction, on average of somewhere between 27 and 32 decibels. Instead, we'd want to consider something with a noise reduction rating of around 10, which provides more of a flat attenuation across all frequencies so that the music can retain its natural quality to it.

Conversely, if you were an individual who's working in an occupation that has excessive noise, so maybe a miner or someone working in a factory, we also want to make sure that they're protecting their ears, but in that listening scenario, we typically run into complaints that the protection that we're receiving impacts our ability to communicate with our colleagues.

And again, it's because they're just giving them max noise reduction and that's going to impact the communication. And so what we need to consider is something that maybe has a noise reduction rating of somewhere around 17 - 20 decibels, which allows them to reduce the noise exposure to something that's safe, while also allowing them to continue to have access to speech so that they can communicate effectively. A pretty common one would be the use of firearms. And it's the same scenario. However, the interesting thing is when you look at noise reduction ratings for firearms, they're very similar to occupational. And what we're considered, or what we're more, concerned with is the peak noise reduction, which can occur.

And so when we're trying to fit an individual who's, you know, consistently exposing themselves to firearms. We need to, to look at the, peak sound exposure and what their choice of protection will offer them in the reduction of that.

Host: Dawn, back to you. And as a speech language pathologist, what advice would you give to caregivers or family members supporting a loved one going through speech therapy to ensure effective progress and support?

Dawn Sharpe, SLP, MS, CCC: Well, you know, I gave thought to that one. What came to my mind was my CVA or my stroke patients and if there's one thing I will never not remember in those scenarios is that when a stroke occurs, TBI occurs or something catastrophic occurs; it isn't just the patient, you know those insults and those, those changes occur to the spouse or the partner as well. And often those relationships and those dynamics and those relationships become flip flopped.

And so providing support to both the patient and the spouse, I think is critical for the positive atmosphere that is necessary to maintain support for each other, to maintain peace and harmony in the home. And there are some folks that don't like to do homework together, for instance.

 You know, they come here for therapy and home is home. You know, so you have to get a real sense of who you're working with right from the beginning and get a pulse on what kind of team members do you have with you. And you know, and based on that, you know what kind of support each one of them will need to bring out the best in the patient, but also to bring out the best in the care provider, because let's face it, those events happen to both people.

Host: Dr. Conrad, how can individuals differentiate between age related hearing loss and other potential hearing issues that may require professional evaluation?

Kyle Conrad, AuD: Hearing loss is generally broken down into three separate categories. There's sensorineural, conductive, and mixed hearing loss. So sensorineural hearing loss impacts the inner ear and the auditory nerve. Age related hearing loss, otherwise known as presbycusis, would be classified as that. So age related hearing loss is a sensorineural loss, and it's due to gradual decline and damage to the inner ear over time, and it impacts about one in three adults over the age of 65.

And it's the most common configuration is a high frequency loss, which consequently, can impact access to the consonants in the English language, which thus would make it difficult for them, to have, have appropriate speech understanding in complex listening environments. So that's the Restaurant, family gatherings, at a distance. And so if one suspects that they're experiencing an age related decline, they should certainly contact their local audiologist to obtain a evaluation and then discuss possible management strategies. You can differentiate between that age related sensorineural hearing loss and something like a conductive loss, which is due to a complication within the outer or the middle ear space, because the signs and symptoms are slightly different, they're typically a little bit more aggressive.

 They may include some ear pain, some ear drainage, some tenderness, fullness, plugged feeling. And if an individual feels as though they're experiencing any of those, they should certainly contact their local ear, nose and throat physician or their primary care for further medical oversight.

And the final form there would be a mixed loss. And this is due to complications with the inner ear, the auditory nerve and the outer or the middle ear. And this would be, age related sensory neural loss with a wax impaction. So ENTs are generally going to be the ones that take care of that.

They'll do your cerumen management and then the audiologist would be the one that would correct the loss from that point. Other otologic conditions that an individual may run into and would provide or would require more professional oversight would be, tinnitus or tinnitus, which is ear ringing, dizziness or disequilibrium, or a sudden change in hearing, which would be indicative of something like a viral infection.

Host: Well, folks, we trust you're now more familiar with the speech and hearing connection. Dawn and Dr. Conrad, thanks so much again.

Dawn Sharpe, SLP, MS, CCC: Pleasure!

Kyle Conrad, AuD: Thank you.

Host: Yeah, pleasure is mine as well. And for more information, we remind you to visit guthrie.org. Again, that's guthrie.org. If you found this podcast helpful, please share it on your social media. I'm Joey Waller, and thanks again for listening to Medical Minds, Conversations With Guthrie Experts.