Scott Webb (Host): Hearing loss, especially age related hearing loss, is very common, and for most folks, hearing aids are still the gold standard in terms of treatment. Joining me today to discuss hearing loss and the various causes is Dr. Robert Block. He's an Otolaryngologist at Central Coast Head and Neck Surgeons and Salinas Valley Health Medical Center.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb.

Dr. Block, so nice to have you here today. We're going to talk about hearing loss, which I know affects a lot of folks. I have a little bit of hearing loss in one of my ears and sort of dealing with that in my mid fifties. So what are the most common causes of hearing loss?

Robert Block, MD: Thank you very much. The most common cause of hearing loss probably is age related changes of the auditory system. Aging of the ear itself and the neuro epithelium and the nerves going to the brain. We call this presbycusis, very common in the elderly. There's other common causes. Very common is noise exposure, probably the second most common cause.

Then there's hereditary or congenital hearing loss. There's certain medicines that can cause hearing loss, notably the aminoglycoside antibiotics, very strong antibiotics. Chemotherapeutics can cause hearing loss. Less common causes are trauma where the temporal bone, which houses the otic capsule, which is the inner ear, fractures.

But chronic disease, and this is very important, can also lead to hearing loss in the aged. Chronic disease, including diabetes, hypertension is actually an association of smoking with hearing loss. And there's other less common causes as well.

Host: Sure. So could be genetics, family history, behavior, lifestyle, illnesses, treatments. So running the gamut there, wondering, I mentioned there, as we got rolling here, that it is common. Can you give us a sense of how common is hearing loss?

Robert Block, MD: Well, It's extremely common. Probably 20 percent of the entire world's population suffers from some sort of hearing loss. Here in the United States, approximately 15 percent of all adults, greater than 20 years old have some degree of hearing loss. You can think of it this way; 30 million Americans may benefit from hearing aids.

Many of those don't have hearing aids. And there's approximately one in three adults, ages 65 to 75 that have hearing loss. And just about half of all adults older than 75 have hearing loss.

Host: Yeah, so as you say, it's obviously very common, very pervasive, and makes me wonder then if someone is experiencing hearing loss, which medical provider or providers should we talk to first about this, and when, like when do we know it's time to reach out to someone and whom should we reach out to?

Robert Block, MD: The first sign for age related hearing loss is having trouble hearing for men what your wife is saying. This is very serious. Also when you're in a environment of poor acoustics and lots of ambient noise and you're starting not to hear people in those environments. These are the first signs. The best person or professional to start with is, in a perfect world, a otolaryngologist, head and neck surgeon, an ENT practitioner who can do a full exam. However, we're not in a perfect world, and it's very reasonable to start with your primary care doctor or an audiologist who specializes in testing hearing and can identify subtle and less subtle types of hearing loss.

Host: Yeah, you mentioned ENT, audiologist let's talk about the treatments that are available for hearing loss.

We are going to talk about hearing aids and how many folks don't have hearing aids or don't use them, or don't use them properly, but for now what are some of the treatments available for hearing loss?

Robert Block, MD: It really depends on the cause of hearing loss. If we're talking about age related hearing loss, or what we call presbycusis there's no cure for that. There are treatments, and the best treatment is a hearing aid. There's also other types of treatment with assisted listening devices and if it's severe cochlear implants, but hearing aids are really the primary treatment for hearing loss. There are several instances when a patient gets hearing loss and it's imperative to see an ENT or an otolaryngologist and I think it's important to point out those types of hearing loss and that's number one; if the hearing loss is sudden and complete. That's a medical emergency, where the patient should go to their primary care and get an immediate referral to an ENT because in most types of sudden hearing loss, it's imperative to treat it quickly terms of getting the best result.

If the hearing loss is asymmetric, they should see an ENT, one ear much worse than the other. Certainly, if there's pain or discharge coming out of the ear canal. That should be a referral to an ear, nose, and throat. And if the hearing loss fluctuates over time, one day you can hear perfectly, the next day the hearing is out and it comes back, that represents a different type of hearing loss that an ENT needs to evaluate and also if you have ringing in the ear, especially in one ear you should go see your ear, nose and throat physician.

As far as the treatment available, not all hearing loss is age related and there's many different causes of hearing loss. And the treatment is dependent on exactly what is causing that type of hearing loss.

Host: I know there's some over the counter hearing aid options now that are less expensive, of course. What do you think about those options, those over the counter hearing aids, where we can just walk into the pharmacy and grab a set. What do you think about them?

And are there maybe some other strategies for folks who are thinking about hearing aids that might make them more accessible to them?

Robert Block, MD: I think that we're in a great age for hearing aids. The over the counter options are an excellent choice for certain patients and certain types of hearing loss. I recently was discussing this topic with one of my audiologists in our office, Dr. Griffin, and I asked him what he thought about the over the counter hearing aids because, of course we give prescription hearing aids.

 He made an interesting analogy that I thought is worth talking about. The analogy that he made was the same as over the counter magnifying reader glasses compared to prescription glasses. The over the counter glasses are excellent for a certain type of hearing loss. The over the counter hearing aids are new and are basically amplification.

They're not customized. They're only meant for people with hearing loss that are adults with moderate hearing loss. Severe hearing loss, the over the counter is not a good choice. If there's an elderly that is having trouble hearing in noisy environments, or environments with poor acoustics, or having problems with the TV; they may be an excellent choice, and they're significantly less money. There are differences between over the counter and prescription hearing aids as I alluded to earlier. And the main differences are the low cost for over the counter hearing aids, the fact that they're for only moderate hearing loss.

The benefits from getting a prescription hearing loss is any severity of hearing loss can be tailored to that patient to help with their hearing. They're good for all ages, including kids. Also, you need to remember that the hearing loss is comprised of multiple components. One of the hearing aid mold, the part that goes into the ear canal is customized due to the particular anatomy of their ear canal where the audiologist makes molds of their ear canal so that it is an exact fit. The other important aspect is that the hearing aid can be adjusted over time to the type of hearing loss because it can change over time. And of course, something that I feel very strongly about is when you go in for an over the counter hearing aid, you don't have the benefit of getting a specialized medical exam, which can be extremely important to determine exactly what type of hearing loss it is.

Host: Let's talk a little bit about loud noise exposure. I know that's how my dad lost his hearing. He worked next to loud trucks. He worked for the power company and I'm sure those guys did not protect their hearing in the sixties and seventies. And I'm sure that's true of a lot of folks, just maybe not wearing the right ear protection or any, or not understanding the consequences. In general, though, doctor, when it comes to loud noise, how much does it take to put someone at risk for hearing loss?

Robert Block, MD: There's two factors. Number one, it's the loudness or the decibel level of the noise. And the louder, the noise the more likely it is going to produce damage to what we call the hair cells of the inner ear, causing hearing loss. The damage is done by the time of exposure as well. So the factors are loudness and time of exposure.

And you mentioned the 60s, this is analogous to smoking. We didn't realize quite how bad smoking was and the risks of smoking. We didn't realize that early on of the risk factors of loud noise and the time exposed to produce hearing loss. And extremely loud noise at a very high decibel level like a jet engine for a very short period of time can produce significant hearing loss in the future, years in the future. When the patient is exposed to an extremely loud blast as a jet engine or a gunshot, a big military armament, then immediately afterwards, or even if you're in a concert, immediately afterwards, you walk out and you have what's called a phase shift.

So you have temporary loss of hearing and maybe some ringing in your ear. Then it comes back after a minute or two minutes, 5, 10 minutes, and you feel like you're normal, and you are normal in terms of your hearing loss for decades. That immediate exposure of a loud blast noise can, decades later, cause significant hearing loss.

 The most common noise related hearing loss is those that work in factories.

Host: Sure.

Robert Block, MD: And the time exposed can contribute to the risk of long term hearing loss.

Host: So, Doctor, we've talked about hearing aids and the range of folks who may suffer from hearing loss and why they're suffering from hearing loss. What are some of the other treatment options for hearing loss besides hearing aid devices?

Robert Block, MD: Well, like we said before, hearing aids are the most important. Aside from hearing aids, there's assisted listening devices, which can bring the sounds directly to the ears without ambient sound, no background sound. And there's these listening devices called TV ears, which you can hook up to the TV and go through earbuds or even in the remote control of the TV with a microphone jack, you can put earbuds in and the sounds are directly delivered to your ears.

The last treatment aside from hearing aids and listening devices are cochlear implants and those are very complex electronic devices that are surgically implanted in the skull and directly into the hearing mechanism of the ear and the technology of cochlear implants has advanced remarkably, and they're used in increased frequency with children and adults alike.

Host: Yeah, I've seen numerous videos on social media of small children who had been unable to hear and then they get either the cochlear implants or hearing aid devices, and they're just such heartwarming videos, because hearing is just such an important part of life.

And so these little children, hearing their mom's voices or dad's voices for the first time just always really heartwarming and such important work that you and others are doing. And along those lines, let's talk about the consequences of hearing loss. How does it affect a person's quality of life on a day to day basis that hearing loss?

Robert Block, MD: Well, it can be significant. The consequences goes well beyond the ability to communicate. There are vast numbers of people also who could benefit from hearing amplification and do not use hearing aids and it's been estimated that there are upwards towards 30 million Americans that are not using hearing aids that could benefit.

There are many long term effects of age related hearing loss. It's thought and incompletely understood, but agreed upon that in some ways it can contribute to dementia. Uh, it can lead to depression through isolation. People with hearing loss, especially the elderly can have emotional isolation, decreased self esteem.

The elderly with hearing loss tend to have lack of physical activity and lead more sedentary lifestyle, which can produce medical problems. They're less likely to participate in activities, which, among other things, can lead to cognitive decline, including dementia. People with hearing loss have lower household incomes. They're less employed or unemployed.

There's decreased productivity and elderly, have risk of falls. Now, this might not be intuitive, but the risk of falls in the elderly is known to occur at increased frequency if there is hearing loss. The thought is that there's cognitive depletion which means that they have a decreased ability to interpret different stimuli so that they're concentrating on their hearing and they may not be concentrating on their walking and they lose balance.

 It does increase the risk of falls. It can also lead to depression. There was a study I read recently that seniors in community dwellings with age related hearing loss are upwards towards 70 percent more likely to be depressed than those without hearing loss where they found depression affects approximately 30%.

So there are significant consequences in hearing loss.

Host: Yeah, significant for sure. And you touched on that. It was going to be my final question. Just how hearing loss can negatively impact cognition and how people think, basically. So just maybe we can drill down a little bit more into that and really address, the need to treat hearing loss early and aggressively to help preserve cognition, right?

Robert Block, MD: Right, absolutely. The mechanism is not fully understood, as I said, but may be related to social isolation uh, or decreased activity. However, there are studies that show correlation between hearing loss and actual structural changes in the brain, most likely due to similar neural pathways, the depletion of cognitive reserve, meaning that seniors with hearing loss have a decreased ability to process information.

They're capable of processing as much. So there is a huge benefit towards treating age related hearing loss early which sometimes is hard. Many patients come into my office especially men who don't want to use the hearing aids. They say it's a hassle. My hearing is not so bad and right behind them their wife is sitting nodding their head in a manner, so as to tell me to try to discuss the benefits of hearing aids with them. Patients with hearing loss, factors that increase cognitive decline are impaired mechanisms to cope. They have limited brain stimulation and there's actually a correlation between brain atrophy or shrinkage of the brain, and hearing loss.

Host: It's very interesting. You know, it seems so simple, right? You can either hear something or you can't hear something, but really speaking with you, having an expert on, that's why we ask the experts, of course, having an expert on to really understand this better, the connections between hearing and the brain and cognition and all of this.

I feel like we could go on and on today, but I think we've at least scratched the surface today for listeners and given them a sense you know, that early and aggressive treatment they may benefit from that, speaking with their primary or an ENT or audiologist. There's lots of options, lots of treatment options. The gold standard, of course, will remain hearing aids for most but good stuff today. Thank you so much.

Robert Block, MD: You're very welcome. I really appreciate having the opportunity to talk to you about this.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.