Scott Webb (Host): Some form of hearing loss affects roughly 30 million Americans, and the loss of hearing can affect our jobs, families, and more. The good news is, there are experts who can help. And I'm joined by two of them today. Amy Welman and Gabrielle King are here. They're both Audiologists with Summa Health, and they're here today to explain the causes and types of hearing loss, and most importantly, tell us how they can help.

 This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

It's really nice to have you both on today. I was just relating to you some personal experiences with my dad and his hearing loss. And, you know, I know hearing loss has touched a lot of people, a lot of families. So I'm glad we're doing this one today. And Gabby, before we talk specifically about the loss of hearing, maybe you could just remind us all if we already know, or tell us for the first time, how do people hear?

Gabrielle King Au.D., CCC-A: Sound waves come in from someone talking or noise or any sound and it's funneled into your ear from your pinna, so the big thing on the side of your head. And it goes into the ear canal to the eardrum, which is a little wall of skin. And when it hits the eardrum, it causes it to vibrate like a drum, and then it moves these three tiny bones in your ear, causing fluid to move in your cochlea. And then that causes thousands of small hair cells to respond, which sets off a nerve impulse, and then it's read by the brain. In steps, that's how you hear.

Host: Yeah, and it's good to just have a little bit of a foundation there just as we get rolling here. And Amy, how common is hearing loss? I feel like it's more common than maybe it's talked about and it's certainly very common in my family, but how about for others? How common is it?

Amy Welman, Au.D.: Yes, it is very common. There's statistics out there, men are twice as likely to have hearing loss as women, over the age of 20, usually just due to noise exposure or occupational noise hazards or hobbies. But, also in America, one in eight Americans have hearing loss over the age of 12.

So it's about 30 million people in the United States. That's a pretty good statistic. Most people don't talk about hearing loss. It is kind of an invisible disability.

Host: Gabby, I'm wondering just to come back to you, what is it like? Maybe you can take us through that. You know, I think for those of us who don't have permanent loss, we've suffered at least temporarily. So for those who do have that permanent hearing loss, what, what do they experience? What's that like?

Gabrielle King Au.D., CCC-A: Most of the time we hear that people say, I can hear you, but I can't quite understand what you're saying. So a lot of the times with nerve damage type of hearing losses, you lose the higher pitches first. And so that's a lot of your consonant sounds, like S's, F's, T's, P's. So it's almost like you're reading a newspaper with the consonants erased. So you get a lot of the vowel sounds, the volume of the word, but you get some words confused and then it doesn't make sense in a conversation. So you're only getting half of what's being said.

Host: Amy, back to you. Are there different types of hearing loss?

Amy Welman, Au.D.: Yes, there are three main types of hearing loss. The most common is sensory neural hearing loss, or that's the type that we're talking about where you start to lose the higher frequencies or natural aging process usually, where the inner ear, cochlea, hair cells start to weaken. Also can incorporate the hearing nerve when we say sensory neural.

There's also conductive hearing loss, and that is anything that would be blocking the ear canal or the middle ear space, such as wax or fluid. Sometimes the bones of the middle ear don't function normally. So that also is a conductive hearing loss. And then if you have a conductive hearing loss and a sensory neural hearing loss, then we call it mixed; where both parts are not functioning properly.

Host: So there's different types, right, Gabby? And then also, I'm sure there are different causes. Like for my dad, he worked for the power company and he stood next to trucks, really loud trucks for 35 years and either he didn't wear them or they didn't provide ear protection; and that's definitely what was the cause for his hearing loss. But how about for folks in general? Are there different ways that we lose our hearing?

Gabrielle King Au.D., CCC-A: Yeah. A lot of it can be from noise exposure, like you're saying, power tools, gun shooting, farming equipment. People can have hearing loss from birth, so genetics, some syndromes can cause hearing losses from childhood age. There's just naturally aging, so just as our body changes, some of those hair cells kind of decrease and we can't hear as well, as well as like physical trauma to the ear. So if you get your eardrum broken or the bones in your ears start to erode, damage to the cochlea, that can all cause hearing loss as well.

Host: Yeah, so a variety of ways. Amy, let's talk about some of the signs and symptoms that we should look out for either in ourselves or loved ones. Like, how do we know? Is it that they don't hear the microwave ding or the turn signals. Is it a bunch of other stuff too?

Amy Welman, Au.D.: Yes, most commonly, I think people start to just ask people to repeat themselves over and over and they start saying what and huh a lot. Often they'll sit quietly during a conversation and not join in the conversation. Almost just the smile and nod and not really jump in as frequently because they're not catching the conversation, not able to pick up on what people are saying. A big one is the TV gets turned up too loud because there's always background noise, scenery, and TV and along with speech.

So everybody tries to turn up the TV to hear that speech, but they're also turning up the background noise too, and that makes it too loud for other listeners in the room. And then also visually, if someone is leaning one ear towards somebody, that would be a sign that they may not be hearing as well. It's kind of a natural gesture that people use, where they turn one ear or the other, whichever may be their better ear. So, those are just some things that are most commonly seen.

Host: Yeah, I definitely have what I refer to as my good ear. So I was like, could you speak into my good ear, please? So Gabby, how do you diagnose hearing loss?

Gabrielle King Au.D., CCC-A: Yeah, so people come to see an Audiologist like me or Amy, we do an assessment of your entire auditory system, from looking in the ear canal to doing a battery of testing to determine what type of hearing loss it is, whether it is the conductive, the mixed, or the sensory neural. And then we go over the results with you and do our recommendations on you know, what can be done about the hearing loss.

Host: Yeah. Amy, I want to talk about sort of the deeper impact of hearing loss that it can have on a person, on their relationships and so on.

Amy Welman, Au.D.: People with hearing loss, they can start to kind of feel tired throughout the day, because their brain's working extra hard to listen. They avoid social situations, so they don't want to go where there's people talking and a lot of background noise, so they avoid that. That can lead to loneliness. In general, reduced brain function or impaired memory. Also just, in general, reduced job performance if someone's working too, if they're not hearing as well. So it really can impact people a lot.

Host: Yeah, so Gabby, how does it affect relationships? If you can't hear someone, you can't like do things with them, go places with them and all of that, things that many of us may take for granted. What's the effect on relationships when one of the two people has hearing loss?

Gabrielle King Au.D., CCC-A: Yeah. Others can become like really frustrated with having to repeat themselves to someone, thinking that they're not being listened to, that they're just not paying attention. They can also misunderstand when the one with hearing loss begins to withdraw that they're not interested in what's going on or they're being rude.

Okay. They can also become concerned or worried for their safety and that their loved ones won't be able to hear alerting sounds like smoke detectors, doorbells, sirens, those types of things where it can put them into danger.

Host: Yeah, so there definitely can be some effect. And I think I've heard this as well, Amy, that there's really a connection between hearing and our brains, right? Maybe you could talk about that a little bit, the connection between hearing and our brain health, if you will.

Amy Welman, Au.D.: Yeah, it kind of expands on what I was saying earlier with people starting to feel fatigue and reduced memory. So if our brains are not receiving enough information or sound in our environment, or if people are not able to understand conversation and then they don't socialize as much; then that increases their isolation. So the less brain function that they're having from less socialization, can cause less brain activity, also can impair, you know, memory and other things just because there's less activity in general.

 Also if someone can't hear what someone says or is too busy trying to figure out what they're hearing in that moment, they're not going to have the ability to really remember what is said. So then it causes memory loss to seem worse than it really is. So somebody who may already have some memory loss or some dementia or something, then hearing loss just causes those symptoms to be much worse because their brain is not able to remember what's been said.

Host: Yeah, I feel like we could have a much longer conversation about this, especially about the brain health. And I'm wondering, Gabby, about other health conditions. Can hearing loss increase the risk for other health conditions in addition to sort of not stimulating our brains?

Gabrielle King Au.D., CCC-A: Yeah, so those people with hearing loss, they can be more susceptible to falls. There can be concerns for your heart health like hypertension, not great blood flow, cardiovascular events. Also people with diabetes are twice as common to have hearing loss. So there's other factors that can go into it that can affect people with hearing loss.

Host: Amy, are there some coping mechanisms? And we're going to talk soon here about how you help folks and hearing aids and things like that, but are there some other ways that folks cope with hearing loss?

Amy Welman, Au.D.: I mean, people can ask other people to speak clearly, repeat themselves, rephrase. Most of the time it's also asking people to slow down their speed of speaking if they're not understanding. There's technology, closed captioning on the TV and also talk to text, other things that can help them to communicate.

Also just people can advocate for themselves, asking to speak face to face or move to a quieter room, always use eye contact, things like that. There's also devices like vibrating alarm clocks that will wake them up, that shakes their bed if they need something like that.

Host: Sure. Yeah, there definitely technology, a lot of things. And let's talk about that, Gabby. Let's talk about technology, but specifically, what are some of the treatment options, hearing aids? Those types of things.

Gabrielle King Au.D., CCC-A: Yeah, so some hearing losses like we talked about that are due to like wax and the bones in your ears, some can be medically treated. So that would be by an ear, nose, and throat physician, with you know, medicine or surgery. But the ones that are the nerve damage, the sensory neural kind, that is when we look at options such as hearing aids. Or there are other surgical options like bone anchored hearing aids or cochlear implants.

Host: Yeah. And Amy, let's go into some more detail here about hearing aids specifically. Maybe you can take us through this in general about hearing aids. Do they work, which ones work, that kind of thing.

Amy Welman, Au.D.: Hearing aids are pretty sophisticated little devices. They could be basic, like basic amplifiers, but generally most name brand or digital hearing aids, I guess, the newer ones, pretty much how it works, there's a microphone picks up the sound, converts it into electrical signal. Then the amplifier amplifies the sound, increases the speech and filters out some other background noise and then the speaker converts it back into acoustic sound and sends it into the ear canal. So it's a lot that's happening in milliseconds. Like hundreds of milliseconds, things are changing and analyzing the background sound. So, they're pretty smart. Now they have AI, artificial intelligence in them and Bluetooth connectivity. And so they're pretty good pieces of technology that people are liking a lot.

Host: Yeah. So generally they work. I know that my dad, Gabby, has one, he's got a little like remote thing that he keeps in his pocket and he can switch things and turn things up and I don't know what he's doing, but he seems to know what he's doing. Maybe you can talk about that, just kind of the range of features and, you know, within reason anyway, if you spend more, do you get more features and are those features an advantage for people with hearing loss?

Gabrielle King Au.D., CCC-A: Yeah, and it just depends on who the patient is too. So some people don't need all the bells and whistles of a hearing aid. They can get away with having more of a basic hearing aid that just helps to amplify the sound and the range that they need based on their hearing test. Because that's a big difference with a lot of the products that are over the counter. Some of those you can't program specifically to their hearing loss, but the ones that we do as audiologists, they are programmed to a prescription based on where your hearing is. So, whether you're right and your left ear are different or the same, it's programmed specifically to you. There's different ranges of hearing aids.

It's from, yep, the basic all the way up to the most advanced. Just like Amy said, there's artificial intelligence, there's noise reduction, so that when you get into like a restaurant, it's trying to pick up the voices through that background noise so that you can hear a little bit more of that clarity of words.

Host: Yeah, so Amy, as we get close to finishing up here today, I just want to, I think we've covered this a little bit, but what can friends, family, colleagues do to better communicate with people who have hearing loss?

Amy Welman, Au.D.: One of the most important things that they can do is just to be face to face with the person. Be able to have the person with hearing loss be able to see your face, see your mouth. Everybody uses visual cues, but it's most important for people with hearing loss to be able to see the lips moving.

So don't put your hands in front of your mouth and, you know, also try to move away from loud sounds. Go to a quieter area in a public place and try to get away from a lot of that noise. Getting people's attention first with just a simple, Hey, I have a question. And then ask the question helps people's brains to prepare to listen easier instead of just blurting out a random statement. It is sometimes difficult for a person with hearing loss to just catch the first couple words and then they miss the next sentence. So those are some common things they can do.

Host: Yeah, I think most of us, I try not to when I'm hosting podcasts, of course, but I think most of us just talk too fast and we get so far ahead of ourselves and maybe that's fine for people who don't suffer any hearing loss. But for those who do, they're probably always like, could you just slow it down? Just hold on a minute. I'm preparing my brain to listen to you. Now, just a little bit slower. Yeah, I love it. Well, I want to give you both a chance. Start with you, Gabby. Just final thoughts today when we think about folks with hearing loss, what you can do to help, technologies that are available, and so on.

Gabrielle King Au.D., CCC-A: Get your hearing tested. Even if you're just getting a baseline test so that if there's any change in the future, we have something to compare it to. Try not to do the self test at home. Cause you never know if you have any earwax or an ear infection that we could treat first before doing a hearing test. You don't want to scare yourself at home and say, oh, I have this significant loss when maybe it's just something that's treatable.

Host: Yeah, maybe you just need to clean your ears, or Amy, maybe it's just with a kid, maybe it's that they shove something in their ear, some sort of toy or something that doesn't belong there, right?

Amy Welman, Au.D.: Right. No, don't put anything smaller than your elbow in your ear. what we always say.

Host: Smaler than your elbow. I love it. All right. Final thoughts, you know, last word to you here, Amy, especially, you know, just encouraging folks, they don't have to suffer. They don't have to isolate like that. There is help available and you're there waiting for them.

Amy Welman, Au.D.: Yes, and just reach out to a family member or a friend, to go with you on your appointments. It's always nice. I always say four ears are better than two. Have somebody be a support for you. It's not easy to do something new, especially wearing hearing aids can be a new thing and make a new habit of that. So, always have a support system if you can or even just ask people who already wear hearing aids about their experiences to see how they are successfully wearing their hearing aids.

Host: Yeah. They've just come so far. I can remember hearing aids that folks wore when I was a kid, you know, like in the seventies versus like with my dad, the ones he has, you can't even tell that they're in there.

Amy Welman, Au.D.: Right. they're pretty inconspicuous now.

Host: Yeah, that's a great word. Inconspicuous for sure.

Gabrielle King Au.D., CCC-A: Yeah, and I always tell people too, the stigma of hearing aids, wearing them, there's not as much anymore. And if you think wearing hearing aids makes you look older, not hearing in a conversation can also make you look older. So wear the hearing aids and be part of the conversation.

Host: Always asking people to repeat themselves and leaning in and asking them to speak into your good ear. Those are signs too. So, yeah, I think we're all on the same page. This is really great today. Just want to thank you both. You both stay well.

Gabrielle King Au.D., CCC-A: Thank you.

Amy Welman, Au.D.: Thank you. You too.

Host: And for more information, go to sumahealth.org/ent.

And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.