Transcription:
Hearing Aids

Amanda Wilde (Host): Hearing loss is common, especially as we age. Fortunately, there is technology that can help. Hearing aids have changed a lot. So today, we'll get an expert perspective on the what, when, how, and why of hearing loss and hearing aids with Valerie Moore, clinical audiologist, WakeMed ENT Head and Neck Surgery

This is WakeMed Voices, a podcast brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. I'm Amanda Wild. Thanks for being here, Valerie.

Dr Valerie Moore: Great. Thank you for having me.

Amanda Wilde (Host): Hearing loss is fairly typical these days. Is there a main cause of it, like noise or age or genetics?

Dr Valerie Moore: It's really a mixed bag of causes. Fifty percent of hearing loss can be genetic. So, we see a little bit of everything actually. So, as patients age or as we age, of course, hearing loss is common, just due to aging. Just like our eyes, as we get older, our eyes get a little bit worse. So, the same with the ears. And again, there are cases where there is family history of hearing loss, so some genetic component tied in with that as well. So, multiple reasons for hearing loss.

Amanda Wilde (Host): And what about headphones? We all have headphones in our ears all the time. Have you seen that affect hearing?

Dr Valerie Moore: Well, that's somewhat of a hard question to answer simply because there are different decibel levels with headphones. And the big piece of that is really considering the volume, how loud those headphones are set, and how long you're wearing them. So, there's something called a 60/60 rule where you want to keep in mind not to have the volume above 60% of maximum and no longer than 60 minutes. So again, a lot of variables can kind of come into play with that as well.

Amanda Wilde (Host): So, we have all these factors affecting our hearing. What sort of test do you do to determine if a patient has significant hearing loss?

Dr Valerie Moore: Well, what we do is really a comprehensive audiological examination, which is going to include a battery of tests. You've got otoscopy, where we're going to take a peak in those ears and see if maybe there's redness or swelling or bulging of the eardrums, something that could be medically causing that hearing loss or physically causing the hearing loss. And then, tympanometry is another test that we do to see how well the eardrums are moving, the mobility of those eardrums and whether or not maybe there's a hole in the eardrum or fluid sitting behind the eardrum. And then next, we would do pure-tone testing, which is really finding the threshold to how soft you can hear sounds. And lastly, speech testing would involve figuring out or knowing what your ability to hear speech and understand speeches. So again, along with all of that put together, we can determine, okay, is there some hearing loss here, what type of hearing loss, what degree of hearing loss, and kind of move forward from there.

Amanda Wilde (Host): When do you determine that a hearing aid would be helpful?

Dr Valerie Moore: So based on the hearing test or the audiological examination, we will determine if there is some hearing loss, what degree of loss there is, and what type of hearing loss. So after medical clearance from an ENT physician who's ruled out any medical reason for the patient to not have hearing aids, we would move forward with hearing aids and recommending hearing aids. So depending on what we find, again, any loss above normal hearing, we would typically recommend hearing aids.

Amanda Wilde (Host): So, are you able to help guide the patient through selecting the hearing aid that is right for them?

Dr Valerie Moore: Yes. So typically, we will have an in-depth consultation and asking questions of the patient about their lifestyle, their expectations, their personal preferences, and kind of walking them through those steps and really trying to figure out what issues they are having. And based on that and their degree of loss, what hearing aids would be recommended for them.

Amanda Wilde (Host): So, one thing that strikes me about hearing aids is how many kinds there are out there. But you're able to ask specific questions to help you identify what the right product is for each patient.

Dr Valerie Moore: Exactly. And we're looking at different considerations, the degree of hearing loss, even the medical considerations, is their ear drainage? If there's a patient who is consistently having draining ears, we may not want to go with a device that actually sits in the ear canal. There are different types of devices, bone-anchored hearing aids, where it actually sits outside of the ear. So even the aesthetics, what the patient's preferences is, manual dexterity, are they able to handle and manage putting a small device in the ear? Also looking at their lifestyle, if they have a pretty simple lifestyle where maybe they go out a couple of times a week and they're really not very active or going into meetings during the day, or restaurants or dinners and luncheons, things like that, then that's going to direct us to go in with something that's not as sophisticated, simply because they may not need all those bells and whistles that are available. And then, budget is going to be another big piece of it. I often tell patients don't break the bank trying to get these things. Because with the advances in technology, even basic level hearing devices are really going to do a lot for the patient.

Amanda Wilde (Host): But it sounds like you should get a prescription from an audiologist like yourself rather than try the over-the-counter types.

Dr Valerie Moore: Exactly. That would be preferred. And the ideal way of getting hearing aids is to really get a full comprehensive evaluation done, seeing an ENT physician for medical clearance, because it's hard to gauge what exactly and how those thresholds are going to be measured with those over-the-counter devices. If it's something through your phone, how accurate is that going to be versus sitting in a sound-treated booth, listening for tones in a quiet space and getting true threshold.

Amanda Wilde (Host): Yeah, it's tempting because it's much cheaper to buy over-the-counter, but the experience I know of those who've done that is that they end up not using them and they end up having to get a comprehensive exam anyway. It sounds like there's so many different factors to consider. Can you explain how a hearing aid works, whether it's in the ear or over the ear, how it helps us hear better?

Dr Valerie Moore: Sure. So, the major parts to a hearing aid are going to be the microphone, the amplifier, and the speaker. So basically on the outside of the device, you have your microphones that are to collect the sound. And then, there's a computer chip inside the device that converts that sound into a digital signal and that sends the sound to the amplifier, which increases the level of that digital sound. And then, that amplified sound is delivered into the ears through a speaker.

Amanda Wilde (Host): So, it is really amplifying sound, that's what hearing aids really do for us.

Dr Valerie Moore: Yes.

Amanda Wilde (Host): Are hearing aids compatible with other technology? You mentioned that some of those cheap ones they come through your phone. I'm wondering if hearing aids that are more sophisticated, are they also compatible with your iPad or your iPhone?

Dr Valerie Moore: Absolutely. So, that's one of the big things. Now, most of the hearing aids that we are fitting are Bluetooth compatible, for direct streaming, for phone calls. And then, you can also connect with remote controls or your TV or personal audio system, where it can directly stream the signal from that TV or that accessory directly to your hearing aids. And in addition to that, now you can download apps on your phone and application where the patient is able to control some of the settings and personalize those settings to how they want to hear in specific listening environments. So, they're pretty sophisticated. Again, even with the basic level set, you're going to get pretty much all of those features available with them.

Amanda Wilde (Host): Well, that's one of the big developments, isn't it, with the hearing aids. Are there any other big changes in how hearing aids are developed over the last decade or so?

Dr Valerie Moore: Absolutely. So now, also hearing aids are rechargeable, which has been a big convenience for a lot of patients because now you don't have to worry about finding a battery if your hearing aid goes dead on you. And these rechargeable devices, the batteries will last anywhere from 16 to about 20 hours on a daily basis, and it may take three to four hours to fully charge. In addition to that, just improvement in sound quality, water resistance, sweat resistant. So, you're getting a lot of cool features now with hearing aids, even just the automatic processing of sound for different listening environments. The hearing aids have definitely become smarter. There's data logging features and learning features available in them where, say, if you're in a particular setting, it may record what type of environment you're in. And if you're making adjustments in that particular situation, the hearing aid kind of remembers that and the next time you go into that same situation, it will set itself to your preferred settings. So again, they've really come out with a lot of cool features with them now, and definitely upgraded a lot of things.

Amanda Wilde (Host): Plus they're smaller, so they're not as obvious to others, and I know that's helpful.

Dr Valerie Moore: Exactly. Having things on our ears is so status quo now. People are wearing their Bluetooth ear sets or their earbuds. So, it's not as big of a deal, I think, today as it would've been 20, 30 years ago, to have something over your ears. But the design of the aids now, the ones that go behind the ear, I feel are pretty discreet just because there's a slim wire that slides down the front of your ear and the device itself sits behind your ear. And again, now hearing aids can kind of dub as a Bluetooth ear set as well, so it's not as noticeable, I feel, as it used to be.

Amanda Wilde (Host): Now as to the hearing part, how do you make sure patients are adjusting appropriately to their hearing aids? Is there some followup?

Dr Valerie Moore: Exactly. So definitely, followup appointments are needed just to really validate and verify that the patient is getting true real world benefit with the aids. So, we have tools that we can use. There are assessment questionnaires available to kind of note the differences and comparing how the patient performed without hearing aids versus how they performed with them. Even testing in the booth can be done, functional gain testing to see and compare their thresholds without hearing aids versus how they hear with the hearing aids in their ears. So, we definitely do follow up even for fine tuning, even with some of the ideal fittings where everything is pretty optimal. Patients may come back and have certain complaints where certain sounds may be a little bit too loud or they're still hearing their own voice a little bit too much, then we can fine tune some of those things and normalize those sounds to a point to where it's comfortable for them. But the main goal is to have sounds more audible than they were before.

Amanda Wilde (Host): So, that's when you're adjusting them. Is there other long-term care involved?

Dr Valerie Moore: Definitely. And these are things we would go over with the patients as far as care and maintenance, keeping them clean, changing the tips. There are little wax guards that need to be replaced periodically. And we also recommend coming in for routine maintenance visits, just to make sure the hearing aids are still doing what they're supposed to be doing, amplifying as loud as they should be. Because with any electronics, there's going to be some normal wear and tear. So, they may dampen the sound a little bit more than they initially were. And it may be something where, "Okay, we need to replace this speaker unit and put a new speaker on the device to amplify sounds better." So, just having that routine maintenance is good because you want to make sure the patient continues to hear better than they did before.

Amanda Wilde (Host): So, this is a medical device you're wearing. Do patients who wear hearing aids have any sorts of restrictions on what they can do?

Dr Valerie Moore: Not necessarily. A few years ago, I would say, "Oh, you can't go swimming with them." But again, with today's advances in technology, now there are devices available where the patient can swim in them. The only thing I would say is for those patients who do recreational hunting or any noise exposure, you have to realize that the hearing aids are not designed to protect your ears or be a form of hearing protection. So, we still recommend taking those aids out, wearing hearing protection to guard against the loud sound so you are not getting exposure to the noise.

Amanda Wilde (Host): Well, you kind of touched on my last question, which is will hearing aids prevent further hearing loss?

Dr Valerie Moore: Not necessarily simply because, in most cases, the hearing loss is more of a nerve loss, so there's always that chance that your hearing will progress and get a little bit worse over time. If anything, hearing aids have been found to preserve the usable hearing that you have, where there's something called sensory deprivation, more like a use it or lose it principle. So, hearing aids have a way of stimulating those little hairs in the organ of hearing, and sending that sound to the brain and your brain processes the speech. So if that ear is not being stimulated and you're not using any device, those little hairs kind of forget what they're supposed to do. And those skills of word understanding will tend to decline. It may be a slow progression. There's no way to really predict how soon your hearing may change. But we also recommend annual hearing tests for that purpose because we're going to do a full assessment. Again, getting those thresholds and also speech testing to see where your word understanding is and how those skills are maintained. So, if anything, I think hearing aids do help with the stimulation and reducing that sensory deprivation.

Amanda Wilde (Host): Dr. Moore, thank you very much for this important conversation as most of us will confront hearing loss, either personally or with someone we know.

That was Valerie Moore, clinical audiologist, WakeMed ENT Head and Neck Surgery. Visit wakemed.org to learn more about the services offered by WakeMed ENT Head and Neck Surgery. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

I'm Amanda Wilde with WakeMed Voices brought to you by WakeMed Health and Hospitals in Raleigh, North Carolina. Stay well.