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Emeritus College: Alexandra Tarvin is an audiologist committed to creating an environment inviting practice for her patients and a great place to work for her team. She founded elevate audiology in 2018, a private audiology practice in easily dedicated to evidence based practice exceptionally personalized patient care and supportive company culture. She specializes in evaluating and treating, hearing disorders.

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Emeritus College: fitting, hearing Aids and Titus, and sound sensitive counseling and management, and has recently added audiology processing disorder services. And she can tell you about what all that is later, because some of those I'm not really sure exactly what you do with them. But her Doctorate of Audiology is from the University of South Florida, and she's American Board Audiology certified.

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Emeritus College: She has won several awards throughout her career, and is a strong advocate for the profession she served on the South Carolina Academy of Audiology for the past 11 years, including a role as President, and serves on the National Board as director at large for the Academy of Doctors of Audiology. She actively champions the modernization of Audiology and the State licensure in South Carolina. She resides in Greenwood with her family, and enjoys

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Emeritus College: organizing and crafting in her free time. I can attest to her crafting because I've gone in her office, and I've looked at this little thing that hold her office supplies and her tools of her tray. And I'm like, where'd you buy that whole thing?

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Emeritus College: Cecil understands this because he looks at large computer screens. And he says, I want one of those. So all of those little things are really fascinating to me. So if you and you made all of those.

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Emeritus College: Hi, everybody and Hi, everybody online as well. Thank you for joining and attending. I am happy to be interrupted. I know that, Victoria said that this is informal, and people have questions. I'm happy to answer everything. I titled the presentation many things audiology. I like the alliteration of all things audiology, and then figured out that this is

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Emeritus College: not everything, and obviously by any stretch, as you all know, in your own expertise and professions, everything is pretty convoluted. So we're not going to be getting into everything we could possibly talk about in an hour. But I'm trying to touch some key things that Debbie shared with me that people had interest in. So if it feels a little random or scattered at times, it's because I was trying to highlight things that wouldn't have been in a typical presentation on the topic.

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Emeritus College: And so bear with me. Let me know if there are questions, Victoria, and we're happy to to go

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Emeritus College: right.

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Emeritus College: Okay.

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Emeritus College: alrighty, go back to me. And then we're back.

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Emeritus College: Okay? So one thing that did we share that somebody was interested in is cleaning our ears. And so in theory, our ears are supposed to be self cleaning. We are supposed to have ear wax. Earwax is a good thing. It helps lubricate the ear in times where even present times, where people live in non climate, controlled spaces, or might be more exposed to creatures and animals and bugs. Earwax is really good for helping things stay out of our ear canal.

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Emeritus College: However, some people do overproduce. We also a lot of people, whether you should or you shouldn't. People use Q-tips and depending on your anatomy. Q-tips can be fine for some people and for other people. They can push wax in deeper. Which then would impact it because the way that our ear is formed, the inner 2 thirds, the the inner, 1 3rd closest to the eardrum.

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Emeritus College: It's essentially skin on bone. You do not have sebaceous glands there, so earwax is not produced right in front of the eardrum, and so, if you

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Emeritus College: skin is though, and skin will sloth off like a little snake in our ears. But if there's wax back there, that means it was pushed back there, and it's not likely to come out on its own anymore. And so that's when people can have build up or they overproduce like anything else. People overproduce skin cells, you know. And so you might need it to be professionally taken care of. But if somebody is going to do self management, you don't want to overdo it. And so some at home

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Emeritus College: recommendations would be hydrogen peroxide in the year. You can even cut it with water. You can use over the counter products that would soften wax. But the reality is you have to remove it right? So

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Emeritus College: you have to flush it out. It's not just gonna any of those drops that would soften wax, the whole point of softening it is making it easier to remove. It's not going to go out on its own. Yes, mineral oil is fine. Mineral oil, though, is a non natural, like bioproduct. And so I do like the idea of something a little bit more homeopathic or a little bit more

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Emeritus College: natural that you're putting in the ear. But many people do use mineral oil, and then to flush it out. You would only do that manually. If you know you do not have a history of pathology in the ear holes in the eardrum. Anything like that, and you could do that with

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Emeritus College: a bulb syringe. You know what we like a little blue bulb syringe. The problem is, you can't clean those. So you're gonna get bacteria in them because you can't properly clean a bulb syringe. And so I prefer. And you can buy these online, you can buy them at Cvs. Sometimes it's a tri-tip syringe.

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Emeritus College: and so the little blue tip on the end you can screw off. You can clean the syringe portion, but the tip on the top water or liquid would disperse at 3 different points, which would allow it to disperse the pressure. So you're not getting one pressure point going into ear, which, if you did too much pressure. You could hurt your eardrum, you could cause a hematoma. And so it's kind of nice, because it will disperse the liquid and help hopefully get around the wax and remove it. If you don't want to do that.

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Emeritus College: seek a professional

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Emeritus College: a lot of primary care offices, do it. The nursing staff will do it, but they usually, only they usually only have like one system. Right? They have, like an elephant ear. Bottle that they pump water into your ear. Emts obviously will do it as well. You might wait a really long time. If you don't have an established relationship, and then, depending on your insurance. You're gonna pay a lot. Audiologists. We do it from back and sideways. And we, those of us

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Emeritus College: like doing it, have a wide variety of tools, because different earwax consistencies, different nationalities have different consistencies of earwax colors, skin. And so we use our when we're doing an examination, we would look and see what's appropriate for removal.

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Emeritus College: Okay, that's your wax hearing loss.

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Emeritus College: So before we go to hearing loss, let's just talk about hearing the fact that any people. Anybody is born with normal, healthy hearing to me is baffling because of how much has to go right in utero to have healthy hearing. It's such a

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Emeritus College: complicated organ

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Emeritus College: and so systematized. It's it's actually quite beautiful. And so those of us that are born with a hearing loss. Those of us that acquire a hearing loss, whether it be genetic, whether it be congenital, whether it be trauma based medicine life. There's a wide spectrum. And so, hearing loss has a wide spectrum as well.

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Emeritus College: There are a lot of people that have some degree of hearing loss. There are degrees where you could have a more mild loss all the way to a profound loss. In one given year you can have normal hearing and profound loss depending on the pitch.

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Emeritus College: Over a billion young adults are at risk of permanent, avoidable hearing loss because of. Well, it started with the walkman.

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Emeritus College: And now we've progressed right? And so the amount of people under 40 under age 40 that have hearing loss is rising pretty exponentially. Now, some consumer electronic devices like

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Emeritus College: your cell phones right? They'll sometimes give you a warning if you turn the volume up they'll give you a little warning like, hey, be careful! Don't get too loud. My son, he's 5. We, the headphones that he wears are kids, headphones that have output limiters, and so, no matter what he does, he can only get the volume to a certain level which I advocate for for younger kids as well.

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Emeritus College: Hearing loss is the 3rd most common, most prevalent chronic health condition facing older adults, and as we get older, the likelihood of us having hearing loss continues to go up each like 10 years. So 50% of people by age 75, 75% of people by age 85

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Emeritus College: have a question about hearing protection. Yeah, no, I don't think any of those are dangerous. As long as you're being mindful of how loud they are! The other thing, is

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Emeritus College: it it? They don't fit some people very well, the ones that go in our ear. So everybody's shape ear shapes are different, and a lot of those come with like different tips. So you can kind of change the size

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Emeritus College: there. We can also make custom ones. So we can also make like custom tips that can fit on air pods or can fit on different types of just consumer electronics. Why does that matter? If you have a poor fit, you have to turn the volume up to hear it right, or if you're on a bus, or if you're in a coffee shop, and it's loud you have to turn the volume up to overcome the environmental noise, because it doesn't have a good fit. So the better fit that you have, or just going over the ear.

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Emeritus College: the the lower the volume has to be for you to hear it comfortably.

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Emeritus College: The average amount of time that it takes for somebody to be aware that there has been a change

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Emeritus College: to doing something about. It is 7 to 10 years.

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Emeritus College: which is like way too long

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Emeritus College: in supposedly research, is saying that this is getting lower because of the introduction of over the counter hearing aids which we'll talk about later and stuff like that. But

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Emeritus College: it's still, even when somebody knows they have a problem, there still might be a reason or something, hesitate like causing reluctance to do a treatment, or just to start some type of path forward.

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Emeritus College: And why is this the case? There's a lot of reasons. I'll highlight a couple of them. This is a text between me and my friend Amanda, who is a primary care physician, and travel address.

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Emeritus College: I was getting her opinion on something, and she said. Oh, I get it anytime, lady, we truly don't get a lot of training on hearing at school, so any info is truly appreciated truthfully, especially when a referral source is included.

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Emeritus College: So she's a primary care physician, and she's admitting right that they they don't spend a lot of time on the auditory System Medical School. One of my best friends is cardiologist. We lived together when he was in his master's of anatomy, and then he went on to get his do, and then Residency, and he spent 3 h learning about the auditory system in all of his anatomy masters, and then Geo. Medical School.

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Emeritus College: an entire body part. We only have 5 senses. They spent 3 or 4 h learning about one of our senses.

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Emeritus College: and then they're trusted as a medical professional to be kind of the 1st line of guidance.

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Emeritus College: And so I love our medical community. But do I think there's significant room for reform and modification on referring to specialists when it's not your specialty. Yes.

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Emeritus College: definitely. And we, I think we could say that about a lot of things right? That's not unique to audiology. But it is a medical profession that is under referred to.

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Emeritus College: because hearing care is healthcare audiology. As audiologists, we are the doctors of hearing and balance. I'm not highlighting balance today in this presentation.

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Emeritus College: but

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Emeritus College: we literally spent 4 years learning our doctorate learning about the auditory and the balance system from a diagnostic and a rehabilitative and a preventative standpoint. And so we need to be as a community at large and healthcare at large. We need to be looking at these things because they're huge aspects of quality of life and healthy, aging and healthy living.

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Emeritus College: We get our eyes checked, we know, to get our eyes checked. We know to get our teeth checked. Nobody gets their hearing checked unless they think they have a problem

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Emeritus College: right? Whereas if we get earlier baselines now, we have something to compare against

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Emeritus College: because of our 5 senses. If there is a pathology, we can only do something about 2 of them

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Emeritus College: right? You can only do something about vision. If you lose your taste of smell, if you or if you lose your taste of smell, if you lose your sense of smell, taste, or perception. That's it.

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Emeritus College: There's nothing you could do about that. And so we need to make sure that the 2 things that we do have some control over. We're maximizing.

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Emeritus College: because that's how we get all of our information from the outside world.

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Emeritus College: So of course, there are consequences to hearing loss.

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Emeritus College: especially when left untreated, even treated. Hearing loss is not perfect. Hearing. Right communication isn't perfect, but when we have unaddressed hearing problems, there are factors associated with that you have personal interpersonal communication. You have familial challenges and difficulties, you have job factors. This was a patient of mine. When I 1st met her she was, I think, 31,

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Emeritus College: and she had come to me with hearing aids already, and

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Emeritus College: they were, I believe, appropriate for her when she got them. But she had a sudden change in her hearing, and now her hearing aids were essentially not useful to her, and so we were able to reprogram her hearing aids for her get her some different powers that she needed, and get her hearing a lot better. And she said, I'm not hiding in a room anymore and avoiding my boss, I'm confident, because her boss had basically said, the only thing

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Emeritus College: thing you can do is go stock in the back because you can't communicate with anybody in the front of the store.

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Emeritus College: and that did not make her feel great. And so there are employment factors associated with hearing loss. Right? We obviously understand it affects your mental, social, emotional health.

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Emeritus College: What are some causes of sensory neural hearing, loss, sensory neural hearing loss is the majority of hearing losses. It means that there is damage in the inner ear, the cochlea, or up the neural pathway to the brain. A lot of people will be

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Emeritus College: told that you have a nerve off.

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Emeritus College: You probably don't have a nerve loss. You might have nerve atrophy over time. If you've not done anything about it right? You might have different changes to neural pathways and neural connections. But your nerve is not severed. Your nerve is usually pretty intact. It's the sensory cells that fire to the nerve that are damaged. And so it's usually sensory loss. Those cells, sensory cells are damaged or gone, and so they can no longer fire robustly and provide the tonotopic information to the nerve.

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Emeritus College: It can happen from the natural aging process. Excessive noise, exposure, chronic infections, variety of diseases like meningitis.

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Emeritus College: birth defects, genetics, injuries, trauma, physical trauma, car accidents.

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Emeritus College: and then medications. There are medications that are known to be toxic to the ear from a hearing perspective which would be ototoxic, and then there are medications known to be toxic to the bowel system, vestibulotoxic, and these would be listed as side effects. Sometimes, it might say, a consequence of this medication is that you might feel dizzy.

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Emeritus College: That would be maybe vestibular toxic, or that you might have ongoing balance issues

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Emeritus College: as an example, a lot of the medications that are ototoxic are going to be your heavy dosages of antibiotics. These are going to be usually more on the thing, something that would be prescribed to you intravenously, like in a hospital stay or a cancer medication like a chemotherapy drug.

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Emeritus College: I think even advil in high quantities is ototoxic, but it's not a quantity that you should be taking over the counter

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Emeritus College: the natural aging process. So, hearing loss, there's certain configurations of hearing loss that we say is due to Presbycusis, which would be like the natural aging process of the year.

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Emeritus College: It's widely accepted. It's widely mentioned, somebody was saying, you know you, this person has Presby uses. This is the type of hearing loss.

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Emeritus College: What I what I what I think I don't like about it is that it almost acts like, it's okay, because it's part of the natural aging process.

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Emeritus College: It's really just because you've lived long enough to been exposed to more things

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Emeritus College: right? And so it's not okay, because you're older, that you have a hearing loss. It's just that it's more common. As you age. You've been exposed to more things that you develop this change to the health of the cells in your ear. But it

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Emeritus College: it's almost like saying like, Hey, when you turn 40, 45, your eyes are going to start to go, but, like that's normal, don't do anything about it gives that air. And so I'm not a fan of being like, Oh, it's the natural aging process, or patients will come in and say, Oh, I went to the ent or Oh, I did this, and they said, it's normal for my age. It's normal or it's not normal. It's not normal for your age. It's healthy or it's unhealthy. It doesn't matter how old you are, you're you still need input. You still need to engage with people doesn't matter how old you are.

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Emeritus College: That's my soapbox. So the hearing. But I like this graphic because it's talking about that changes to the health of the auditory system are connected to other health conditions. Please understand that this is not a causal relationship, just because it's saying that chronic kidney disease is related to hearing loss doesn't mean that one is causing the other. But they are associated with each other. There's

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Emeritus College: comorbidities. We know that in utero the inner ear the cells of the inner ear are forming at the same time as some of the cells in the kidney, so things that could affect the health of the kidney cells can also affect the health of the cells in the inner ear and falls is because your balance organ and your hearing organ literally are right next to each other and share the same fluids in the same bone structures of your head in your head. And so.

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Emeritus College: if you have a metabolic issue, if you have a little mini stroke in the ear, if you have a virus that hits those that fluid.

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Emeritus College: You're gonna have a hearing loss and a balance issue at the same time

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Emeritus College: depression because of the consequences. Social isolation. You go and hang out with your friends yesterday a patient and patient. She says. I might as well not even go to Christmas.

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Emeritus College: I don't hear anything that anybody any of my family saying so? Why should I even go to the gathering? Oh, I don't go to church anymore. Oh, one patient! I go to church. But I sit in the nursing room

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Emeritus College: because I can hear the TV better the service over the TV than I can sitting in the sanctuary

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Emeritus College: type. 2 diabetes, especially if not properly treated, which is about 53% of people with type, 2 diabetes are non compliant with their medications or their diet. So type 2 diabetes increases your likelihood of hearing loss 2 or 3 times.

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Emeritus College: comments, symptoms of hearing, loss, frustration, repetition, disengagement, difficulty with certain people's environments, inputs

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Emeritus College: following television movies. Please understand, though, with TV and movies, everybody has trouble to some degree with certain programs, I use captions a hundred percent of the time as it's a non American dialect.

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Emeritus College: any British programming anything on BBC captions are on. I'm 37. So yeah, I just turned 37. Yeah, okay,

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Emeritus College: So you know, and and young people like under 30 are using captions in high high numbers. And so it's not abandoned anymore. For a long time it used to be like, oh, if I have to turn the captions on, I'm like, kind of leaning into the fact that there's a problem. It's actually something that a lot of younger people are using pretty regularly, and I think part of that, too, is because of phones and social media. You're scrolling at night to 9. You might have somebody in the room with you, a roommate, a significant

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Emeritus College: and other. And you just read things. You're not listening to anything. And so we've gotten really used to captions.

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Emeritus College: So anatomy and physiology so briefly, you have 3 parts to your ear. You have your outer ear, which is your

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Emeritus College: what you see what a kid points to when you say point to your ear that's called your pinna or your oracle, and there's all different aspects to it. All of these different parts of your ear have names, so we can kind of point out what we're talking about. If there is a pathology or something. Then you have your ear canal. That's where the wax is. That's where a lot of kids ear happens in the outer ear.

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Emeritus College: Then you have the eardrum, and it ends at the eardrum, and that's what a doctor is looking at when they look in your ear is. They're trying to see, you know. Can we see the eardrum? Is it red? Is it protruded? etc?

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Emeritus College: Then you have your middle ear, which is the eardrums back, and you have the 3 smallest bones or 6. You have 6 small bones in your body, and then you have your inner ear, which houses the hearing organ, the cochlea, and the balance organs which are the semicircular canals, the saccul and the utricle.

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Emeritus College: And that's how our brain knows where we are in space.

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Emeritus College: And so

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Emeritus College: one of my one of the most common fun facts in the summers is, do you remember when you go take your kids to pediatrician? Maybe, like they have an inner ear. Infection?

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Emeritus College: No, they don't. They have a middle ear infection. But we would we say with, Yeah, there's sort of an inner outer ear they mean behind the eardrum or in front of the eardrum. It's actually middle ear infection.

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Emeritus College: You could have an inner ear infection, but it's usually viral and usually really dizzy, and have hearing loss associated with that.

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Emeritus College: And then you have your Eustachian tube, which is the tube that connects your middle ear to your throat, and that's what is the popping when you go up an airplane or up a mountain? Normally, your Eustachian tube is closed, but then, when you have a change in pressure air pressure. It opens to equalize the pressure between the middle ear and your and the outmospheric pressure. And if it doesn't, that's why you might feel stopped up. Foggy, you know one ear feels popped

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Emeritus College: are not popped because it hasn't open. You have a dysfunction

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Emeritus College: question. Yes, you still recommend where you like. Hold your nose and blow if you're stopped up you can. I get a little wary because I don't wanna

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Emeritus College: rupture anything right? I think sometimes you can, but it's still a pretty common recommendation from medical community if somebody stopped up. But it's usually a temporary thing, it'll drain the fluid. Yeah, I can. But if if the tissue is stolen, you're just getting a little air pocket, you're not really solving anything.

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Emeritus College: Have read in terms of another chronic condition that people have chronic reflux may have.

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Emeritus College: that those acids come up station to them, and how to precipitate like allergy like it's like there's the drainage and the body kind of responded to that. And I've never thought about that potentially impacting. Yeah. So you would want to get the reflex under control or right modify the sleeping setup like, if you can prop yourself, or even elevate a little bit where it's not able to go back up into the ear.

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Emeritus College: And when we're born babies, gestation tubes are a little bit more flat, and that's why we have issues with

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Emeritus College: reflux or or ear infections. A lot of babies, because if they're if they're not being held as much, they're being laid down like like they're laying down most of the time. Or it can impact that

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Emeritus College: fun.

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Emeritus College: So in the inner ear, we're gonna blow that up

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Emeritus College: and look at actual radiographic imaging. And so in your inner ears, it's it's coiled like a snail shell, right? The the area that's closest to the outside is the highest frequencies. And then, as we go into more of the base of that spiral. You get more towards the lower frequencies. Okay, and all over along, and you kind of fold it. Open the snail shell. It would be organized like a backwards piano.

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Emeritus College: Inside of that there's a whole bunch of different cellular structures, and you have what's called hair cells. A lot of people like the hairs in your ear. If they're broken, you have a hearing loss, that's true, but they're not hair. They're cells, and we do also have hairs in our ear canal. That's healthy. That's good. That's not we're talking about. These are microscopic. You have different 2 different types of hair cells. You have outer hair cells and inner hair cells, and they serve different purposes. Outer hair cells preserve a lot of the volume.

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Emeritus College: and inner hair cells really are the clarity.

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Emeritus College: And so if you have damage like these are

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Emeritus College: the top picture this happy face. You have a whole bunch of cells. Now, these are the tops of cells. These are stereocilia, the U, that stereocilia sitting on the top of the body of the cell, and then you have the body of the cell. Then you have the neurons that go to the nerve, and they make up the bundle of nerve or intracranial nerve.

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Emeritus College: Those are healthy cells, and the inner ulcers are healthy, and then you can see all of the dendrites, axons, and all the nerve stuff. Then you can see damaged cells. So these various lia are missing or significantly damaged, or you have clusters of unhealthy cells, and then you can see the significant difference into the neural information

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Emeritus College: you cannot accept.

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Emeritus College: Hearing aids do not fix this end of sentence.

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Emeritus College: If this damage is there, the damage is there. And that's why really good testing which we'll talk about later is so critical because we have to know what's the best case. Scenario. What is your natural limitation with what your body is able to do at this point? If you've had 4 knee replacements and 2 hip replacements. I don't think your orthopedist is gonna be like you're gonna be able to score 1st a marathon.

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Emeritus College: And so why people think that hearing aids should make them never misunderstand, never miss here. They should do amazing in background noise, if that's what their inner ear looks like you've been sold a story. You have to know what's possible with what your body is able to do.

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Emeritus College: I might do your best to work around it right?

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Emeritus College: Okay, I'll just say what she said.

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Emeritus College: And you know, so basically, after you leave the inner ear.

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Emeritus College: the sound, the the nerve sends information through your brain stem and it crosses the brain stem multiple times in multiple pathways. Ear, one sounds going into one ear, crosses the other direction up and up, and then eventually, the information ends in your temporal lobe for processing.

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Emeritus College: lexical processing, etc. And so

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Emeritus College: if we look at a brain that's obviously highlighting specific information. We know that if you're putting auditory information in and you have a healthy auditory system, you're gonna have more response. If you have an impaired auditory system, you're gonna have less response.

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Emeritus College: So our brain is responsible for orienting us to where sound is coming from

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Emeritus College: focusing on certain sounds, separating sounds and recognizing sounds and information right? And then mapping that to what we've learned this is our language. This is not our language right? That word is a cognit. That word is German, right? And you're like, Oh, that sounds the same right that makes sense to me. I recognize that.

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Emeritus College: So the information has to get out there, and then your brain has to do the rest of the work. But you might be able to hear something if somebody has a hearing loss and you have well fit hearing aids. And you go into a group. You're like, I hear everything, and I understand nothing right? You hear it.

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Emeritus College: But is your brain able to focus Orient, pay attention to one thing.

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Emeritus College: 12 other things right? This is a very complicated process, and it's all happening at the level of the brain hearing aids or amplification or treatments. Job is to give you access to the information and do your best. Do their it's best to clean it up right? So it's giving you a better chance. But your brain has to take it from there.

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Emeritus College: and that's we have bottom up processing the 8 parent nervous system. So sounds are initially coded. If you heard it signals the neural signals pass up to the system, and additional processing or find signal extracts. Information ignores other. You could be in a lab room, and somebody says Debbie, and all of a sudden, 2 seconds later, like, Does somebody say my name right. That was like background work happening right? You weren't consciously waiting for Debbie. You were, you know. But boom! Your brain processed it and said that maps my name.

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Emeritus College: Boom, attention! Right?

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Emeritus College: You then have top down processing. So this is the brain emphasizing certain aspects of the signal cognitive factors like attention listening effort, memory, multi sensory integration, executive function.

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Emeritus College: such as my kid has called my name 3 times. But I'm carrying on this conversation. I know that he needs me, so I put my hand on his shoulder, and I choose to do that instead of engage with him. So I teach him something right. This is all happening up here, and you have no behavioral action on that right. But your brain is processing that input and then responding.

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Emeritus College: and then use use to compensate for poorly resolved bottom up sensory cues

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Emeritus College: as an example. You hear your sister's voice on a recording, but it was over. Bluetooth, while she was driving in the car, and you're listening to the voicemail, and it sounds awful. But you know your sister's voice. You know the context of what she was going to be calling you about, and you can make it make sense.

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Emeritus College: even though the input was poor.

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Emeritus College: That's all processing.

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Emeritus College: But then you need all of these other aspects over time to make sense of it. So if you have a poor working memory or short term memory, you have changes to your cognitive health. It makes your brain's ability to do any number of these processing abilities lower and poorer. So somebody waits until they're 83 the first, st and they had hearing loss to some degree for 25 years, and now their family is kind of like enough.

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Emeritus College: like, we can't repeat ourselves anymore. You have to go to the audiologist and they finally come in.

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Emeritus College: They've had 25 years of deprivation. They've likely had changes to their cognitive health. And now we're asking them right? Here's more information. Do amazing

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Emeritus College: right? The likelihood of them, doing as well as they did would have in the early sixties is significantly lower, because there's likely other changes to executive function that would allow them to be successful.

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Emeritus College: and then long term memory.

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Emeritus College: I'm not necessarily talking about dementia or Alzheimer's when I'm talking about this. I'm talking about our brains, ability to map what we know with what we experience.

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Emeritus College: And so if there are mismatches, do it due to hearing loss, redirecting, episodic memory, coding, declining memory systems. It can really affect our brain's ability to do well when we're given more information. And so

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Emeritus College: if you give somebody a phone number, and maybe when you were a certain age or super with it, you would have been able to store that memory. So that store that phone number and working memory long enough to grab a piece of paper and write it down, or a zip code. Let's go shorter zip code right? If there are changes to that, then likely when you're presented with that information auditorily, if that system has not been exercised as much, it's going to be a lot harder for you to retain and use that working memory and then be able to do something with it.

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Emeritus College: And this is why we see a correlation. Maybe that's the wrong

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Emeritus College: statistical term, a relationship between untreated hearing, loss and cognitive changes.

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Emeritus College: You're tasking the system. You are. If you have an untreated hearing loss, and the information coming in is distorted. It makes it hard to decode it. If you're taking up that that brain load and energy to decode it, make sense of it. You're delayed. You're taking up the resources in the frontal load for reasoning, decision making and storage.

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Emeritus College: And then, if you didn't hear something. How can you remember it like if you truly didn't hear something? How could you remember? Right? So there's a lot of information out there about hearing loss and cognitive decline. It's been a pretty heavy topic in the media, because it's interesting. And it's concerning. And so it's easier for the media to highlight it.

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Emeritus College: I wanna highlight the

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Emeritus College: okay. We're gonna actually before we highlight it. We're gonna do an exercise. Okay. So you're just gonna read the words and say them out loud. Okay.

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Emeritus College: who knows?

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Emeritus College: That's it.

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Emeritus College: Table lines.

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Emeritus College: But

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Emeritus College: okay. So when the words no longer what we're what you expected, there was a delay.

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Emeritus College: Right. You guys had to reorient yourself and make sense of it because it wasn't right or it wasn't left to right. It wasn't in order right? It started getting funky. The fonts were different, and so it took more effort to sort through the information that wasn't in the form that your brain expected. The words to be in

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Emeritus College: it did not align with your map

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Emeritus College: of how lexicon is right. Your mental lexicon, or your semantic memory of how English written word is an example of brain effort and trying to sort out information that isn't easy. This would also be like listening effort.

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Emeritus College: So you have the occipital lobe which is responsible for visual input. You have the temporal lobe which is responsible for auditory input

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Emeritus College: and then you have the frontal lobe. You have other lobes, too. But we're highlighting these, the frontal lobe which is responsible for reasoning executive function. Decision making. This is what is not fully formed until you're 25 like teenagers are moron.

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Emeritus College: And so the reason why this is interesting is because these are 3 key role or key areas of the brain that we use for processing auditory information. And why, when somebody has hearing loss, they start, rely more on visual input. And here we're going to explain why this is research from Dr. New Sharma's lab.

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Emeritus College: cross modal compensation. So

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Emeritus College: cross mode, reorganization alters the auditory cortex. If listening becomes more effortful, due to a hearing loss requiring efferent nervous systems to compensate. So you have on the left side. You have the normal hearing group. They were played auditory information. They're listening to something. Their eyes are closed, or there's nothing to look at. Right? You see that their temporal lobe is responding.

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Emeritus College: If you look at the hearing loss group, the frontal lobe is responding to auditory input.

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Emeritus College: Those people with hearing loss are using their frontal of decision, making reasoning and problem solving to process auditory information.

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Emeritus College: If it becomes more effortful. Then you add visual information.

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Emeritus College: Okay, if you have visual information, people with normal hearing have the occipital load highlighting because it's visual information.

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Emeritus College: But in people with even a mild to moderate hearing loss, which is the kicker for over the counter, hearing Aids that we talk about

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Emeritus College: what area of the brain is being highlighted. Their temporal lobe.

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Emeritus College: You're showing them visual information. But their auditory areas we're supposed to be responsible for the auditory system is responding.

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Emeritus College: The visual system is literally encroaching on the auditory system to use it. Because it's saying, Hey, brain, you're not using this for hearing, we're gonna use it for vision. And this is why we have people with hearing loss. Leaning forward. Wait, wait! I can't see right now. Look at you. Wait. You need to turn the radio down in the car because I can't see what I'm looking at. Right. I can't. I want to find where I'm driving from the radio. It's because your brain literally reallocated resources

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Emeritus College: from the visual system into the auditory system.

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Emeritus College: Now, what happens if we pre did?

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Emeritus College: Can you reallocate back?

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Emeritus College: And that's what research is looking at now.

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Emeritus College: how early over the intervention does it take? We know early intervention with, everything is important.

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Emeritus College: You let something go. It's gonna be easier. It's gonna be a lot harder to rectify the situation.

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Emeritus College: I, Dr. Sharma, had an interesting. I've heard her talk many times.

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Emeritus College: So while they were doing this research in the early 20 tens.

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Emeritus College: One of the Lab assistants, I think came to work and had a sudden

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Emeritus College: hearing loss, and it was a more mild, sudden hearing loss. And so they did all this testing on him, and they saw that within 3 months of a mild hearing loss, that reallocation was already taking place

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Emeritus College: within 3 months of a mild hearing loss. Most people hear the word mild, and be like no big deal, you know, but the brain was already reallocating resources because it wasn't working the way it was developed to work.

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Emeritus College: So as the amount of hearing loss increases, the likelihood of

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Emeritus College: changes to the cognitive system increases.

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Emeritus College: We have to be really careful to not say that hearing loss causes dementia. We just know it increases a risk factor. And there are other risk factors associated with that. If somebody has a hearing loss that's untreated. But they're super social. They attend things and they engage and they compensate for it. They're not going to be as likely if they don't have other genetic markers right. But if they follow a typical trajectory.

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Emeritus College: then they might be more likely to to have some risks.

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Emeritus College: That chart this one, yes, illustrates that of all the factors associated with dementia.

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Emeritus College: hearing loss is the most modifiable, and this came out by the Lancet Commission, which, if you guys know, the Lancet Commission is like one of the highest well respected peer reviewed journals.

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Emeritus College: Now this is powerful information

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Emeritus College: and right, it's not the end. All be all right. There's a lot of factors associated here, but it was showing that. And and here, hearing loss and middle age.

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Emeritus College: non-hearing loss in advance age.

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Emeritus College: So if this is not making a case for screenings, baseline exams, you know more annual or biannual evaluations. I don't know what it is.

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Emeritus College: so what happens when you go to get your hearing checked. And this happened, my- my college roommate? And he said, well, hearing Aids might help you a little bit, but probably won't always the money.

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Emeritus College: Yeah, I think that's malpractice. So Debbie said. Like it's, you know. Somebody said, oh, they got a hearing test, and they were told, oh, it's not. It's not that big of a deal like if you do something about it. It probably won't help you, so just don't worry about it a couple of weeks and see how you think you're doing. And of course you know a couple of weeks you'll be. They're sort of irritating. So you know, you've been 2 weeks where you're like, well.

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Emeritus College: Heck, if they don't really do anything. Yeah. And so if somebody's given like an At home trial without any proper fitting, or follow over care, and then, like a black white, did it help or did it not help? And then it didn't help. That was the only experience you have to make it a very significant decision off of. And then they're like it wasn't worth the money. Yeah, I think that's malpractive.

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Emeritus College: It's it's okay to give an opinion. It's okay to guide somebody.

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Emeritus College: But don't say things that aren't true, and do it in a halfway, and then expect like amazing outputs. I'm not. I'm I'm guilty of it. I've never said to somebody like. It's not going to help you unless I truly know that because I've tested it, or I've measured it right. Or I'll say I understand. If you're as a person not ready, or you know there's other aspects to it. But to simply make a decision for somebody else's medical experience.

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Emeritus College: And you just unilaterally make a choice for another human being without any evidence, I think, is not appropriate.

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Emeritus College: Another soapbox.

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Emeritus College: There's a lot of tension between the

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Emeritus College: medical between medicine and patient because they're wanting to hear good news.

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Emeritus College: Yeah, agreed. But I I will say the the counter. So the counter argument to the idea that like the patient wants good news. Can can people hear people online here when others.

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Emeritus College: so that you do want the news or told that you're fine or you don't have to do anything. I agree. The flip is

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Emeritus College: in my experience, a lot of people actually come in wanting to feel validated, and if they're if they're at a point where they've made an appointment and they're in front of me. They know something is going on, or their family member knows something's going on. Maybe that person doesn't see it, or it's been so gradual that they can't see it, or or they're denial

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Emeritus College: right? Or they have some other ailment or pathology that prevents them from being in reality.

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Emeritus College: But the amount of people that come in, especially younger people, people in their thirties and forties or fifties, and they come in. And they're like, you say, Yeah, I get it like, this makes sense.

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Emeritus College: The amount of relief that comes from people is also really high. So there are 2 sides of that same coin.

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Emeritus College: because the amount of people that go to

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Emeritus College: maybe a more typical experience might say, oh, yeah, it's only my boss, you know. It's not that bad. See you? In a few years that person was like, Know something's going on. I came in here. I was asking for help, and you just said like, there's something wrong with you, or there is something wrong with you. But oh, well.

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Emeritus College: right! And and if if I don't remember, if I kept it active, if we get into the auditor process and stuff, I'll tell you about that, too. There's so much I could talk about here for hours. Okay. So in general, if we have a flow, you have hearing loss which can, which will lead to lower signal quality leads to higher cognitive load. You have to make work harder to be performed. The same way

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Emeritus College: changes in the brain, restructuring compensations that can lead to changes in behavior, social disengagement. And then health problems, depression, dementia and cognitive decline like worst case scenario. Right?

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Emeritus College: Okay, that's hearing loss. That's how it affects people, that's what it can look like. Another thing that was asked to be brought up is kind of the difference in professionals with hearing. Did you have a question. Yes.

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Emeritus College: depending on my hearing aids.

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Emeritus College: And I realized when we- we were all wearing masks that I couldn't understand

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Emeritus College: with masks. Yeah, the amount of people that worked in the schools, principals, vice principals, teachers, administration that came into our office. That 2020, 21

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Emeritus College: 37 year Olds 45 year olds that were like, I can't hear anything at school anymore, because everybody was wearing masks

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Emeritus College: very significant because they were like they were young. They didn't think about it. They were like so much on visual input to get through. And you took that away from them. And then they were like lost

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Emeritus College: huge and the amount of hearing aids that were lost because of masks. The parking lot of Ingles ate a lot of hearing aids. Okay? So you have

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Emeritus College: license providers in the hearing healthcare space you have. If somebody's not licensed they shouldn't be doing anything as of now.

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Emeritus College: That's where the regulation stands. So you have audiologists, and then you have hearing instrument specialists. Sometimes they're called dispensers or hearing aid specialists.

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Emeritus College: So audiologists

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Emeritus College: have their doctorate. That is the terminal degree. Some have their Phd. Maybe they got a dual degree

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Emeritus College: audiologist of a clinical doctorate. Phd. Research Doctorate. If you are a Phd. In most States, you can also practice clinically as long as you have clinical hours underneath you.

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Emeritus College: There are some audiologists that were master are still master's level, and they were grandfathered in into the licensure. It became a doctoral degree in 2,001, and it became required in 2,007. So if you had your master's before that you were grandfathered in.

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Emeritus College: and we are not physicians, but we are doctors, we are medical providers. We're licensed. We have continuing education credits that we have to abide by. We a lot of us get hearing. It's not all of us. We are trained hearing science. We can treat from cradle to grave. Right?

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Emeritus College: we can do balance disorders, auditory processing, evaluation diagnoses.

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Emeritus College: We're trained to clinically evaluate research, etc, right? We are a profession

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Emeritus College: hearing instrument. Specialists, are also a profession, and

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Emeritus College: there's differences in States on what their educational requirement is like in Illinois. They have to have at least an associate degree in hearing science in order to go down the trajectory of hearing specialist, which

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Emeritus College: I would strongly advocate, for in our State

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Emeritus College: they have to have a high school diploma or a Ged.

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Emeritus College: and then some type of training.

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Emeritus College: They just basically have to pass an open book test

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Emeritus College: and then a and then a practical exam in South Carolina.

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Emeritus College: And so I think there's some major discrepancy between, like what the requirements are. State by State. So that's a little bit of a challenge

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Emeritus College: no degrees. But like they're basically they're meant to. They're they're taught to test for the purposes of hearing aids.

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Emeritus College: So they are not allowed to diagnose.

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Emeritus College: They are not allowed to use the term diagnosis, because that's not what they're doing. But some of the testing they do look very similar to what an audiologist is doing.

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Emeritus College: I am not knocking this. What I'm saying is, there is a movement. The train is off the station, so we're working really hard. There is a movement that it wouldn't it be really, really cool if hearing management specialists were under audiology.

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Emeritus College: that the audio is like the overseeing professional, the higher degree right? And then we oversaw your instrument specialists. But in South Carolina, in theory and audiologist is not even allowed to train specialists, you have to be trained by by.

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Emeritus College: So there are some amazing Hi S's, and there are some awful ones. There are some amazing audiologists, and there are some awful ones.

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Emeritus College: So it's about integrity, right? But it does get in the boat when

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Emeritus College: we have people that are like, well, we're the specialists of hearing Aids where the, you know, and it's like we're the ones we all we do is hearing Aids. So we kind of do better than audiologists like, what? Okay? We'll count down so like

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Emeritus College: I have an amazing employee she has moved up from. I promoted her from front office to now assistant, and I'm likely gonna put her through his training so she could work under me. And so she do small things under a license that would help us in the in the office right? But I did not have. I do not plan on having her to be a provider like a full provider, but if a patient comes in, and they're hearing aid

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Emeritus College: that from here, and all we have to do real quick is do a feedback test. She can't do that as an assistant. She could do that as a dispenser which would make it much easier for patients. Right? You don't have to wait for the doctor. You just need a quick measurement that somebody else can do. So.

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Emeritus College: There's different degrees of training, and some people don't care

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Emeritus College: as a consumer, as a patient. Some people don't care about what their providers credentials are, and that's their choice. But I think there there is room for improvement on clear differentiation and understanding of what the 2 different types of providers are. And there's even a lot of movement. And you guys would appreciate this. Not everybody would in the academic situation. And I am heavily involved in this as a board member,

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Emeritus College: and as an opinionated person, that

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Emeritus College: there's significant room for reform on our audiology. Educational system. There's only like 70 plus doctoral programs for audiology, and some of them are dwindling. There needs to be reform. It moved into a doctorate because we there was an assumption that the more education you have, the higher reimbursement could be, the more that you could do in your scope

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Emeritus College: that did not come to fruition. So now we have all these people graduating with very high cost of education, and their compensation does not follow suit in the real world. And so we put a huge educational burden on people that want to serve in this role as an audiologist.

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Emeritus College: And so there needs to be change. We either need to have more training, more education, that allows us to expand our scope into things that are appropriate for the profession, and then the reimbursement would be commensurate to that.

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Emeritus College: or we need to change our expectations. Because if you're graduating with a hundred $50,000 doctorate and you're making $72,000 a year.

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Emeritus College: You're never gonna catch up

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Emeritus College: right? So. And Medicare reimbursement is a joke. You get like $30, $38 for hearing test diagnostic hearing test.

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Emeritus College: So when you see, like free hearing pass.

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Emeritus College: please understand that is a marketing tool to get you in the door, to hopefully sell you a hearing, because that's where the money is coming from. If you go somewhere. That says

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Emeritus College: we could bill your insurance for X. But there might be additional out of pocket. And this is what that is, and this is what that means, or we do these services. But they're not covered by insurance that should actually raise a positive flag of their going above and beyond, because what is covered by insurance is the bare minimum.

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Emeritus College: and depending on how much you care and value certain things you might want. You might. You may want those bare minimum

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Emeritus College: any questions about that great and ugly on both sides, but there is a difference.

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Emeritus College: It's interesting how health treatments fall into covered, uncovered, like

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Emeritus College: dental care is not covered very well. Eyes, ears, and teeth. Yeah, those aren't necessary. You don't need those. Yeah, I mean, you can get a you know, a useful out of testing. If your heart, if you have a heartburn or they're going to. You know

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Emeritus College: you do need a heart. Yeah, you do need a heart, but you don't need to see or hear anything. Well, and it's kind of it's interesting. I I guess I didn't, because the optometrist and the ophthalmologist and the clinicians that are involved with with the optical science.

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Emeritus College: You know, there's so many different levels of all of those things. Yeah. And so you have, like ophthalmologist, which would be the medical doctor. You have the optometrist, which is the clinical doctor.

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Emeritus College: and then you have the optician who is doing the glasses right.

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Emeritus College: Audiology took a different track, and it was born out of World War. 2 and audiologists started as the diagnosticians, because all these veterans are coming back from World War 2 and saying, you know, there's problems I'm not hearing, etc. And that audiology was born from that. And then you had audiologists as the diagnosticians with with therapy

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Emeritus College: We didn't have hearing aids yet right when hearing aids came on the market. Then the the profession of hearing instrument specialist came on. It was like the audiologists were the doctors and the therapists.

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Emeritus College: and then you would go down the street to get a hearing, aid, a 1 channel analog, hearing aid with a little screwdriver to train trim pot, and

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Emeritus College: and that's how it was.

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Emeritus College: and then in the eighties is when the audio just started being like, Wait a minute. Why am I only diagnosing? And I can't also help. I can't also treat. And so, hearing instrument specialists were around with hearing Aids first.st That's why the train has left the station. The train comes started in a different planet. And so in the eighties. And then audiologists had a bite, and they were able to prescribe and then treat.

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Emeritus College: And then there's been this interesting like little battle, whereas vision did it, they thought they did it right where they had more of this tier approach. And now Audiology is trying to now flip it to where, like audiologists don't need to be under Ents. Right? We refer to Ents when there's something medically necessary. But to wait 6 months to get an appointment at the Ent to get a hearing test. That's just like a waste. Right? We're not. We know if you need something medical right? We never refer.

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Emeritus College: But we it would be nice if the dispensers were more under audiologists. So we can have a more like systematized plan, and some places we'll get there. But

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Emeritus College: it's gonna be probably specific to

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Emeritus College: states and culture. Okay? So an evaluation

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Emeritus College: you have different types of hearing evaluations. You have a screening pass fail. It's like we play the beep at the left, at the top level of normal, at different frequencies. You hear it, or you don't. If you don't hear any of them, or hear this one of them, you fail.

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Emeritus College: You then have, like the free hearing tests, Costco, Sam's club miracle ear, belto and some dispensing practices, some even audio practices do free hearing tests. That means that they're not credentialed with medicare audio just doing that. And it's for the purposes of selling hearings. If an audiologist is doing it, they can still be doing a great job. They can still be doing diagnostics. They can give it away free and still the diagnostic test. But there's usually a different motive behind that.

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Emeritus College: And so free tests can be performed by a license dispenser and audiologist, or sometimes a tech at an ent ents are not giving them away for free. They're not but there are something called Oto techs, and they're neither a dispenser or an audiologist. They're certified to do testing at an ent office.

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Emeritus College: You then have a diagnostic exam which a diagnostic exam means it's medically necessary. So if if it was being built to insurance insurance would consider it medically necessary, there's a reason behind it. You have a change in hearing. You have huge tinnitus perception. You've developed dizziness, something along those lines. And so you have a medically necessary reason to have this evaluation.

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Emeritus College: These are performed by audiologists, and they may be covered by insurance depending on your insurance. And they are the standard basic level of care. Here the beeps, air conduction, bone conduction. 2 specific word tests monitorly presented, and that's it.

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Emeritus College: And then some other testing to look at the health of the ear, if medically necessary.

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Emeritus College: And then you have a new, not not new, but it's become more popular in the upper echelon of best practice providers, which is functional hearing assessments, or sometimes they're called like communication needs assessments, and this is, each office will have their own battery of what they

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Emeritus College: include in this. But this is going beyond. So this is where we would put other health screenings. Some offices do cognitive screening, some do blood pressure screenings, speech and noise, testing, tolerance, testing sentence evaluations versus just words. This is where they spend more time counseling and educating and go ahead. Tolerance testing.

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Emeritus College: We do a lot of how- How? When can you hear it? But when does it bother you? When is it too loud? Tolerance, testing? And that's what we would use to help set the hearing aids. Make sure the hearing aids do not go above your tolerance.

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Emeritus College: These are things that are done by providers that read the research

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Emeritus College: have a more patient centered approach to their care and often have higher outcomes.

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Emeritus College: You say it's not covered by insurance.

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Emeritus College: Functional assessments are never covered by insurance. Can you? Can you say.

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Emeritus College: ballpark, how much it costs? Oh, sure, yeah. Ballpark, I mean, some offices are doing a functional assessment. It's an additional 50 bucks, 100 bucks. Some might be 200 bucks for a functional assessment. But it's not like

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Emeritus College: thousands of dollars, my backgrounds in health promotion. And this sounds so familiar where prevention early detection is not

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Emeritus College: really appreciated for the value and

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Emeritus College: So we wait till it's a big problem, and then we throw money or don't throw money at and just resign to.

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Emeritus College: What's that? All these parallel things that are coming, whether that's caused by hearing exacerbated or

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Emeritus College: just concurrent. Those things maybe could have been here, just like all.

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Emeritus College: and latency not supported. Physical activity means. Well, then, there's

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Emeritus College: heart disease and diabetes and common function. Yeah, but you don't want to go. Do that because you can't hear them when they're talking to you. Right? So I don't want to go into that event right? Or or it's like the amount of people over the years that have come in, and they came in with an adult child or a partner, and their partner spoke for them

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Emeritus College: right. They were just kind of like a bump on a walk, or we're like, yes, no answers. And after their treatment, and they're doing well, they're they're driving themselves the appointments we're catching up in the room having fun, like I've learned their personality. They they weren't comfortable or confident before, right? But it's just like it's again like we've been down this road where you don't appreciate prevention, you know. Right? Yeah.

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Emeritus College: just kind of the parallel. There's a certain resistance I know, for my parents generation like. And now, hearing Aids implies, I'm wondering with like young people, they like it. Yeah, no. The people that. So if I'm going to be like general on generations. Yeah.

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Emeritus College: So the silent generation just says, Tell me what to do.

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Emeritus College: but we're having fewer and fewer right from the silent generation.

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Emeritus College: Then you have the 70 ish, you know your old side. And this is generalized. Obviously, people are different.

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Emeritus College: the sixties and the 70 year olds are much more concerned about cosmetics.

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Emeritus College: the and then I would even say, the 50 year olds but like the 30 and the 40 year olds are like, I want pink like, yeah, or like, I don't, or I don't care what it looks like, or they're just so much more unless they're like, you know, like, you know, but most of the time it's like

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Emeritus College: like they're way they're way more into it. Yeah, they're way more into it. They're like, I don't tell. I don't just tell, like you know. And they're super excited by things. And it could be an easier population to yeah. And they're much more comfortable with technology, so it's not looked upon. But I will say historically, part of the stigma to hearing loss. Is it used to be quoted as deaf and dumb. So if you look back.

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Emeritus College: it was you were deaf and dumb. And so there was this innate cultural stigma that got brought up through the hearing loss, and eventually that was taken out. And it was, you know, in the medical literature. It was not that anymore. But I think I think we're still dealing with that, that it's emasculating. It's showing that there's something wrong with you. There's a deficit. It means you're stupid, right? Because you cannot

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Emeritus College: age in the same way. So there's a lot of societal and cultural aspects to hearing loss that I believe are still ingrained. And I bring this up because in America, where our healthcare is very privatized in capital, a capitalist society.

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Emeritus College: There's this idea because hearing aids can be costly, they can be a financial investment. There is this idea that the reason why people, the reason why the market penetration of hearing aids usage is only sitting at

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Emeritus College: 27 to 39% of the people that need hearing aids. Getting them is only 25 to 39%. And it has been that way for decades. As technology has gotten better. There has not been a higher market penetration. Okay? And we assume what? What's the reason why

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Emeritus College: cost cost?

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Emeritus College: Maybe some vanity. Cosmetics is in there, maybe some. I just don't care enough, right? But most people say it's cost. You go over to the Uk. Where they have Nhs. And anybody who needs a hearing aid can get one guess what their market penetration.

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Emeritus College: Con. 35% of so

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Emeritus College: in America, yes, cost is a factor because of our healthcare system.

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Emeritus College: But it isn't. There's something else. There's other aspects to this. And so

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Emeritus College: you know, yeah, we can improve. And the prices are only going up. Yeah, I was just gonna say, I talked to somebody the other day that had just gotten hearings, and she said she was really upset because she said they told her it was a 50% hearing loss before getting it. And I'm thinking, how many years were you dealing with that hearing loss before you know before doing something. But I think you know, she's in that sixties.

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Emeritus College: Yeah. And and when people are told, like, you have an X percent carrying loss,

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Emeritus College: that drives me nuts, too, because they have a lot of opinions.

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Emeritus College: so you guys are smart when you have I'll when you have multiple data points on a graph

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Emeritus College: on a logarithmic scale graph, how do you have one single percentage like that? Doesn't math? And so basically, that means that where they went, said, Here's the chart. If most of your plots are halfway down that chart, I'm gonna say, 50% loss. It's just like totally random, and means nothing to me like when somebody comes to me. And they say, Oh, I went here, and they said, I have 40% off. It means

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Emeritus College: nothing to me. I have no idea what you're talking about, right? Right?

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Emeritus College: But it means nothing to me. 40% of what and what frequency was it? 40% speech understanding. Because that's atrocious. That's really bad. And like, you might have needed a vocal implant referral? Right? So it's like, anyway, yeah, I'm probably gonna go for an hour.

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Emeritus College: treatment. So do okay. Treatment in general, hearing aids. So to hearing aids prevent dementia. That's a good question, right? And so the jury is still out. But I have some recent information. So

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Emeritus College: this is a lancet article from 2023. I'm gonna highlight. The

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Emeritus College: folded average age of study participants at recruitment was 56 years old. People with hearing loss, not using hearing aids, had a 40%, 2% higher risk of all cause dementia, while no increased risk was found in people with hearing loss who used hearing aids.

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Emeritus College: The evidence is building that hearing loss may be the most impactful, modifiable risk factor for dementia in midlife, hearing loss may begin early in one's forties, and there is evidence that gradual cognitive decline before a dementia diagnosis can last 20 to 25 years.

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Emeritus College: Our findings highlight, the urgent need for that early introduction of hearing Aids when someone starts to experience a hearing impairment. So when somebody is told you've got a little bit, it's normal for your age. I don't know if your needs will help you see you in a few years

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Emeritus College: now inactive.

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Emeritus College: Now you could say something different, and the person can choose to not take that recommendation. They may not be ready, but that should not be coming out of your mouth if they read the literature

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Emeritus College: right?

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Emeritus College: So it's not black and white, but it is.

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Emeritus College: you know. You can say to somebody like, I'll say to people after doing a functional assessment, I'll say

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Emeritus College: there is a diagnosis.

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Emeritus College: You have a deficit.

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Emeritus College: I'm not sure at this time if technology is going to help you because I've measured it

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Emeritus College: right? I don't know if the cost, the benefit that you're gonna get is maybe worth the cost. What do you think?

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Emeritus College: Do you want to try what's important to you? If we wait 6 months or a year from now, we can reassess if you leave this office, and you feel regretful, and you say I feel better doing something than doing nothing. I'm here to support you. That's very, very different than just like blanketly telling people like, Here's my criteria. You don't meet it. You're done right.

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Emeritus College: So the achieve study came out in 2024. The achieve study was a very long study. I did research. When I was in grad school. I worked in a research lab on the human side, and some of the people that I worked with were associated with data input for the achieve study and it was achieve stands for agent and cognitive health evaluation in elders. The purpose was to look at, treated, hearing loss can slow, cognitive decline.

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Emeritus College: There were participants in the over 70, mild to moderate, untreated hearing loss, no major cognitive impairment. At the start. The design was had a hearing group. Best practice, audiologic care and hearing Aids best practice. We'll talk about it, but that means they were properly fit, evaluated, adjusted, etc. And then you have the control group control group that was just getting like General info.

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Emeritus College: It was a 3 year study funded by Nih

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Emeritus College: alrighty. Largest and most rare studying of its kind.

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Emeritus College: Okay, I'm sorry. Key results.

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Emeritus College: High risk participants

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Emeritus College: hearing treatment reduced cognitive decline by 50%. If you were at a high risk of developing cognitive decline, it reduced your risk.

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Emeritus College: modest, cognitive benefit across everybody with use of hearing aids and with general education. Biggest impact in those already at risk

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Emeritus College: hearing loss is a modifiable risk factor treating hearing loss, early potential brain health, protection, treating, hearing loss is not just about hearing. It's an investment in your long term, cognitive wellness, I will say. When they were finally presenting this at one of the conferences I was at. There was a lot of information like, Okay, give us some information. But it's really just talking about, for people that are already like at a higher risk. My question is like, How do you know if you're at a higher risk?

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Emeritus College: Like, yeah, you might have some markers that you know. But like, do you really know? Right? So it's kind of like, it's basically saying, like, Do your best right like, do your best. Do it early, if you need to at least know your status like at a minimum, know your status.

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Emeritus College: So what can you do? You can take hearing loss seriously. It's not a normal part of aging. It is more common as we age, but it's not normal. Right? Talk to an audiologist about hearing, testing, and treatment. Protect your hearing

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Emeritus College: like you try not to get very close. To begin with. Stay, start sharp, social, and informed.

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Emeritus College: properly selected and programmed hearing aids, so we know that they can improve independence, social engagement, safety, awareness at home. If we have patients that have a very significant hearing loss, we're going to talk to them about alerting devices for safety in their home. We ask them, Do you live alone? Do you live with other people? If you live with another person? Does your spouse travel like? Are there times when you are home alone? Could you hear the

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Emeritus College: fire alarm if you were sleeping in bed? And then there are assisted devices for safety to help people, and we'll point people in that direction.

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Emeritus College: For a long time there was a state program in South Carolina called fire safe.

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Emeritus College: and we would certify people to where the fire department would come out free and install a bed Shaker, and so they would put a smoke alarm at the front of the bedroom, and then it would.

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Emeritus College: There would be a bed Shaker under the mattress, and if that went off it would vibrate your bed and wake you up. That has lost.

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Emeritus College: I don't know if it's lost funding, or they can't acquire the tools, but that's put on pause.

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Emeritus College: what are best practices. I've highlighted 2 things for people who are really interested in this stuff. Dr. Cliff Olson is an audiologist. He graduated 2 years after me, and he has done an immaculate job at

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Emeritus College: creating an online

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Emeritus College: platform for educating the consumer, for people that are interested in audiology. On hearing Aids on tech.

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Emeritus College: He has videos on why Costco is great for hearing. He has videos on why Costco is bad for hearing Aids. I mean, he has covered so many things, and it's really expanded. So a lot of people follow him and read reviews when new products come out talking about different things. You know, you still have to take everything with your own lens, but he's done a pretty good job of staying fairly unbiased

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Emeritus College: barely in a month, and then hearing tracker is a website that's been around for I think it came out like we're like, we're the same Audiology age, I think, came out like shortly after I graduated. And Adam,

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Emeritus College: has done a really good job. So they have basically created an online system and helping the hearing aid role makes sense. So they say like, who owns what company? What company makes these products like? Beltone is owned by resound resound, is owned by gn resound like. And then what are the what are the sister brands of this company or that company? And where are they sold? And

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Emeritus College: there's even like each make and model has a review platform, and people can go on there and share, like what they think of these hearing aids. Again, you have to use some of this information with a grain of salt, because people going up and giving their opinions. You have no idea what their abilities are. You have no idea if they were fit appropriately right. You have no idea their story. So you you have to be mindful of that, too. But it is a cool way of seeing like what's out there. What are the names of things that are out there

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Emeritus College: when it comes to fitting, of hearing aids? What are best practices? Best practices are not fully formed yet. We actually have an organization practice standards organization.

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Emeritus College: One of my really good friend colleagues is on the board of that. And it's a group of audiologists that are trying to get together to actually create standards for the profession from Tinus care which I specialize in to audiology testing, to curating, fitting. They're basically trying to define what the minimum standard of care should be across the board. And then best practice would be like the gold standard above that right?

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Emeritus College: So best practices. I just kind of created a list. So custom, ear bolds are appropriate. The amount of people walking around with over the like over the ear, care gates with like a little bud on the end, where they need a custom. Fit ear mold is ridiculous. People are losing so much power because they're not coupled appropriately. It's just physics and acoustics which needs to be measured and validated.

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Emeritus College: Real ear measurements are critical. Nobody should be fit with your Indians without real ear measurements. If you are somewhere that is fitting and they are not doing real ear measurements, please. And I mean that real ear measurements are

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Emeritus College: taking your real ear, the physical resonance and shape of your ear canals into your fitting of your hearing aids. And so it involves equipment that the practice has purchased. We have 3 of them, one in each room.

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Emeritus College: and you sit in front of a speaker, and microphones get put into the ears, and we measure at the level of your eardrum what that hearing is doing in your ear, and then in real time modify the prescription. So it's taking into account your hearing, test your anatomy and the hearing aids output to make your prescription in real time. Otherwise the best bit of a hearing aid. What a manufacturer puts their algorithm. It's based in science. It is based in

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Emeritus College: research, but it's fit to a mannequin. It's fit to Kimar. He's the name of our mannequin and Audiology, and he is like a man

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Emeritus College: kind of shape. And as 2 CC. Ear Canal residents. And so it's like you're being fit to a mannequin. If you're not getting regular acoustic analysis, it's estimated like 1% of of practices. Use this equipment. We have 2 of them. Electro acoustic analysis is actually testing the hearing aid that it's meeting manufacturer specs.

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Emeritus College: So if we get a hearing aid in the office, we measure, we unbox it charge it because most of rechargeable. Now charge it, and we test each of those hearing aids. Make sure, before we put that on a patient's ear, that it's actually a functional working, hearing aid that we're not fitting a distorted or broken hearing aid fresh out of the box on a patient.

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Emeritus College: We then repeat that testing about once a year, or if the patient says something's wrong, we don't just say No, it's not. We listen to it. It's fine. They actually test it and know if it's healthy or not. We also do this like before they go out of warranty, or we send them in for repair. We test them when they come back from repair a lot of the time to make sure that they were. Actually, we do like our quality control, essentially

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Emeritus College: ongoing care and maintenance. Hearing aids are piece of technology that you have on a body part for 12 to 14 HA day, exposed to humidity.

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Emeritus College: exposed to oils, skin, wax, debris, the environment they need to be maintained. They need to be clean, they need to be taken care of. We remove moisture from them. We have like these humidifiers, we replace parts and pieces. There's now with technology and phone connectivity, they have firmware updates. They need updates and software updates. So they work with a new iphone. And they work with the new software like, it's all that kind of stuff

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Emeritus College: you need to be retested. Your hearing may change right? So you need some type of follow up plan. If your prescriptive needs have changed and your hearing aids. Don't know that until your provider tells your hearing aids that your prescriptive needs have changed, and they have to be reprogrammed

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Emeritus College: monitoring warranties, manufacturers, hearing aids come with by the way, I am talking about prescriptive hearing aids right now, which I will, I will highlight the difference. Prescriptive hearing aids meaning you're getting them from a licensed professional

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Emeritus College: monitoring warranties, measured improvements objectively, we do pre and post assessments for patients, for more updates, reprogramming

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Emeritus College: variables that can affect somebody's benefit with hearing aids how much hearing loss they have.

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Emeritus College: How long has have they had hearing loss? How long has it been untreated? What is their cognitive health? What is their attitude and their motivation. Are they wearing them consistently, or they cherry picking, and they're only wearing them when they leave the house, or they're only wearing them at church on Sundays.

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Emeritus College: the features in that hearing aid technology and the quality of the hearing aids how they're fit, the physical prescript, prescriptive aspects, the behaviors of the patient and their family.

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Emeritus College: You are not gonna hear like the bionic man. You're not gonna hear from 3 rooms away, either with hearing aids. And if somebody's loved. One refuses to look at them or get their attention before the talking and the faucets running and the TV still going.

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Emeritus College: Hearing is, don't fix that

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Emeritus College: some people really do need oral rehabilitation, and they need to do listening and auditory training exercises in order to get more benefit. A lot of people are not willing to do that. We're humans. Half of these resistance.

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Emeritus College: Using use of helpful accessories like Debbie has an accessory. She can show you attitude to monitor your processing.

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Emeritus College: Okay? Cool, auditory pro auditory processing is what the brain does with what ears here. So it's kind of alluding to this earlier. But we?

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Emeritus College: Well, I'll I'll talk about it so we can also measure through different tests and not not. This is not a common service that's offered. We just started offering it. It's basically you can measure how somebody's brain processes auditory information and actually see if there are deficits and then create their view specific to the deficits. We do this a lot with children.

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Emeritus College: But adults can do it as well.

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Emeritus College: Okay, hearing aids or hearing technology. So you have a spectrum of hearing technology you have

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Emeritus College: before you even have over the counter devices. You have peace apps, personal sound amplification systems. This is like you go to a Cabela's and get like a game ear right where it's just like an amplifier that you put on for hunting, or, you know, like spy thing like the kids would have like old spy amplifier. That's not meant for rehabilitation. That's not meant for treating a hearing loss that's just meant to amplify something else.

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Emeritus College: You now have over the counter, hearing aids which were signed into law in 2017, not implemented until 2020

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Emeritus College: 3,

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Emeritus College: yes, end of October 2023 over the counter. Hearing aids are hearing aids. They are not prescriptive hearing aids, so they are meant to be purchased at best. Buy or online. They're meant for people with mild hearing losses. They don't require any type of medical diagnostic evaluation, so it says, mild hearing loss. But like, if you don't get an evaluation. How do you know if you have that

392
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Emeritus College: you could go and find out, and then choose to get it over the counter device. It's a Diy, you have to look at what's out there. You have to fit it. A lot of them have apps. Some of the apps will test you in the app, some of them. It's more of like a do you like the way that sounds like A and B thing?

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Emeritus College: The idea behind this was to increase accessibility and awareness.

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Emeritus College: The real fundamental goal was to get something cheaper on the market if we're gonna be honest like for accessibility. But a lot of them are not. A lot of them are still $2,000 for a pair. And some of them are $800 per pair. The battery. Life in them might be 6 h on a rechargeable

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Emeritus College: it. Some of them, I think, are better than others, and some of them are coming and going.

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Emeritus College: you know, like a consumer comes in and putting out there, they realize how hard it is to treat people with hearing loss, and that how much wax gets in these devices, and they stop working, and then they get returned. Because they don't want anybody to help them. And so they're gonna come and go. But do they serve a role? I yes, I think they serve a role, and if nothing else, I think it does increase the conversation and awareness, and if it's an entry point for somebody to get a little bit of help or to use it situationally, it's worth it.

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Emeritus College: You then have prescriptive hearing aids which these are the main players. These are the ones that need to be licensed provider, and they have more features. They're more prescriptive. They have more settings, more just ability. They have different rules under the FDA. What they have to have in them. You then have hearing systems which are accessories that work with hearing aids or without hearing aids which are going to be more. For, like

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Emeritus College: noisy environments, group listening, school environments, etc. One thing that Debbie- Debbie passed around is what's called a table bike.

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Emeritus College: So that's an accessory specific to a manufacturer that is, that works with hearing Aids. So they're wirelessly paired to the hearing aid. And then, if that's turned on and put on a table.

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Emeritus College: it has 8 microphones, and so it can pick up sounds and process them bigger because it's bigger. It's big so it can hold 8 microphones. Hearing aids can only hold 2 each so that can get more information and process it and then present it to the hearing. Aids make a group environment easier like that one. For example, you can even pick one person like. I only want to hear that person better, or I only want to hear those 2 people better.

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Emeritus College: They can also be used, for like somebody could wear it so like. If Debbie and I were out for lunch together, and it was really hard for her. I could wear it, and it would pick my voice up and send it directly into Debbie's ears. So she hears me better than anybody else in the room. So accessories like that. That's more of a Mac Daddy one. There are similar ones. There's also ones that just

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Emeritus College: connect to the TV that can also be connected to the TV to make the TV audio directly interiors, and it's prescribed to the hearing loss. Right? So it sounds better than just a TV amplifier headset, because it's not just

403
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Emeritus College: making everything louder. It's making it louder by what you need.

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Emeritus College: and then you have cochlear implants. Cochlear implants are the the FDA requirements have gotten a little bit easier to get a cochlear implant, and more and more people can benefit from them. Cochlear implants are meant for people where hearing is no longer the best option for them to hear better, and a cochlear plan might be able to help them even further. I refer a lot of my patients for cochlear implant evaluations. I think knowledge is power.

405
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Emeritus College: and even if somebody is not quite a candidate, it's good to know where you're at from a different candidacy, evaluation requirement. So you know, maybe, how far off you are from meeting that coclear plants are outpatient procedures these days. They are. You do need to auditory training. They are have an external component. They're not just internal. A lot of people think like, I just don't wear anything out here. So I'm gonna go

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Emeritus College: hearing aid, but they can really help people. And a lot of my patients that finally took the plunge and got evaluated and got implanted are like, why didn't I do this. 5 years ago they waited too long because they were concerned that they're hearing aid like they want to lose what they had.

407
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Emeritus College: But it's definitely an option for some people.

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Emeritus College: So how do you know if you should consider an over the counter device versus the prescriptive? And I I think yes, degree of hearing loss is kind of what's put out there, but I think it really boils down to like, what's your intention? What are you comfortable with? I have a patient who has prescriptive hearing aids. She does very, very well with them. She's had the same pair for like 6 years now, and she's happy, but

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Emeritus College: she has to put them on the charger at nighttime, and her hearing has gotten worse, and she is the caretaker for her 8 year old granddaughter, and she can't hear at night time, and that makes her nervous. And so I'm helping her find an appropriate over the counter device that she can use

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Emeritus College: or sleeping right for at a different price point

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Emeritus College: because we need it for different purpose. My problem is, I don't know if we're gonna be able to find one powerful enough for what she needs, because they're not meant for that. But we'll see

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Emeritus College: also care and use the amount of people that we teach them how to take care of their hearing aids. We show them we give them cleaning supplies, and 5 days later they're like my hearing. Aids aren't working, and they come in and we're like you said, brush it off. It was called to wax, and it's like

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Emeritus College: over and over again, and we're happy to do it. And then we're happy to take the wax out. But

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Emeritus College: this is something people start to really rely on, and if they don't have somebody helping them, even when they do. It could be hard. If you don't have somebody helping you. It could be really frustrating. And the concern that a lot of audiologists had with the over the counter stuff a lot of people, I think, thought that it was like we felt like it was a monetary threat.

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Emeritus College: Most of us had a lot of concerns that people are. Gonna try this. It's not gonna work for them. And then they're never gonna get the actual care that they need. That was the biggest concern that we had internally.

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Emeritus College: And so this is describing that differently, more like over the counter hearing aids Diy lower battery life typically the form factors that fit nothing's like customized in that regard versus prescriptive. So they just really do serve 2 different purposes.

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Emeritus College: I wanna just highlight.

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Emeritus College: There's new. There's different paths to auditory help these days. When you enter insurance into the conversation. Medicare traditional Red light blue. Medicare has no coverage for hearing aids.

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Emeritus College: neither do supplements, because they're taking the other 20% if they follow Medicare guidelines. But a current advantage is a different monkey. Medicare. Advantage has a whole other group of benefits during benefits are usually included with a lot of miscommunication and misunderstanding and confusion, and there's a movement to make them be clear with what they're

420
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Emeritus College: What are the benefits that they put out there, and how they discuss them? And so.

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Emeritus College: Medicare. Advantage is what enters these 3rd party

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Emeritus College: hearing aid programs where you would like call your insurance. They would tell you if there's micro advantage, they would tell you who.

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Emeritus College: or even some commercial like State health like Blue Cross Shield State health plan has a managed care program with true hearing. So that means in order for you to access whatever benefit or discount is in that insurance policy, you would have to go to a provider that is great to be in the network of that plan. They've agreed to do the bare minimum, and they're paid horribly to do the bare minimum.

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Emeritus College: so a lot of practices that are doing best practices are not taking these plans because you simply can't take the plans, and be able to offer the level of care and keep your doors open. But for people that value or price is their ultimate goal, there may be more likely to take advantage of the Medicare advantage plan.

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Emeritus College: and that doesn't mean that places don't take it. Don't have different price points, financing other ways of helping people financially right. It just means that if you were only looking at what might be under your insurance plan, you probably would not be finding those practices.

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Emeritus College: So these I'm gonna go through all the major hearing aid manufacturers. Oticon's current flagship line is the intent.

427
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Emeritus College: Onx is illuminity resound. Is that Vivia?

428
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Emeritus College: Why, next is the alert?

429
01:32:18.336 --> 01:32:21.720
Emeritus College: Is their Ix line.

430
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Emeritus College: Starkey has the edge. AI, Peter, John has an avante.

431
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Emeritus College: and then you have accessories like those just happened to be, because they had a good picture. But the all of the manufacturers had accessory, some more elaborate than others.

432
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Emeritus College: and then they all have apps.

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Emeritus College: Some of our apps are more elaborate than others. Some of the apps give you a lot more control. Some of the manufacturers have less control in their apps, but they all have apps to access different features of the hearing aids, buying controls, adjustments depending on the phone. Most most people's phones now have streaming abilities.

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Emeritus College: There's also apps out there that are free that, like audiologists can certify a patient, for I know caption is one of them where you can actually download the app and set this like transfer thing forwarding. And then all of your phone calls can be transcribed, voicemail can be transcribed. So if somebody has a really hard time on the phone, they have ways, have texting features talk, top and text features.

435
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Emeritus College: There's also Telecoil Telecoil has been around a very, very long time. It's a magnet. It is something that would be installed like the Peace Center, the Brook Center.

436
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Emeritus College: Greenville Theater, Doug Mcdonald's drafters, some churches. If you go to Europe.

437
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Emeritus College: Telecoil has been installed a lot more places. Train stations will have. Telecoil banks will have telecoil, and it's essentially an electromagnetic field. So it's a copper wire that's put in some type of loop. We call it a hearing loop. It's put some type of thing usually under the floor or in the ceiling. And if somebody has hearing aids that are telecoil compatible when like, if you go to the

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Emeritus College: pizza, for example.

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Emeritus College: once you're in your seat and the show starts, you would put yourself in the telecoil program and the audio from the sound system would wirelessly go right into your ears. The piece or the Brooke center, I've been told, has it? As well. At the piece that right now you do have to wear a neck loop. I don't know why something happened with their system. So Telecoil has been around a really really long time. Not every hearing aid has

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Emeritus College: telecoil in it. It doesn't have a magnet in it. It's a We- we know as a provider if it does or doesn't. So we ask in our functional assessment, do you frequent the Peace Center, the Brook Center? Do you travel internationally a lot? You know we ask those questions to see if we need that feature.

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Emeritus College: The new thing that's coming out is forecast

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Emeritus College: or has to change the game when it comes to Bluetooth. The new version of Bluetooth that's out is low energy audio. It is not yet available in the new and the iphone. It is in some android phones think it's only one gap like Samsung Galaxy. It's only one TV right now.

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Emeritus College: This is where Bluetooth is going, and all the hearing companies are getting ready for it. Some of the ones out now are already ready to go, even though there's nowhere to use it. And then some are, gonna be they're calling it, or has ready where once it becomes available, there'll be a firmware update allowing the hearing aid to talk to the system

444
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Emeritus College: or cast is going to be. Think of it more like a radio where this room you can get an oraccast transitor.

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Emeritus College: It would be put somewhere. There would be like a code. You would download the oraccast app, and then you would type that code in, and the audio would go right into your ears. You could do this with hearing aids that are Orac has compatible. You can do this with headphones that are cast compatible. It's gonna be like the new Bluetooth, and so you don't have to have hearing Aids to use it. You can have. You'll be able to ipods bluetooth headphones, etc. And so people that just want to sync into a sound system can. It's also going to be a lot more affordable

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Emeritus College: to install. And it's not gonna require construction like the telecoil would where you have to like, basically do it when you're renovating and just put in the budget. What's also really cool about this is, it's not gonna bleed over. And so you could literally have forecast in this room, forecast in there, and if you think into either of them you would not hear from the other room.

447
01:36:27.760 --> 01:36:29.849
Emeritus College: and it will be unlimited.

448
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Emeritus College: So you could have a million people in a room all connected to it, and it will not affect the fidelity of the signal. And

449
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Emeritus College: so we're really excited because it'll it'll help a lot of people

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Emeritus College: like even think like see? It says, advertisements even think like you could literally go to a storefront in Manhattan, and they could have the word cast thing, and you could tune into it, and you'd be able to like, hear what it was talking about. Like you could. You know, it's gonna be really fun

451
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Emeritus College: convention centers, etc.

452
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Emeritus College: Oh, we're back. Oh, we're going back there. Okay?

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Emeritus College: Any burning questions? Yeah. You quickly went through all those brands. Yeah. And I think you mentioned you were showing pictures of the top line model for each

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Emeritus College: their current flagship model. So each of those has multiple tiers of technology inside of it. Yeah, so like the intent intent is our flagship line, but they have intent one which is their premium level, the 2 and the 3.

455
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Emeritus College: How do they decide amongst all those brands, do they? It's a good question. It's a really good question.

456
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Emeritus College: so the question is like, how does the provider aside amongst the brands?

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Emeritus College: You're gonna have variability on how a practitioner chooses to do it. There are some offices that only work with one brand.

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Emeritus College: And so if you go to that office, you're getting that brand, even if you're a square and it's a circle you're getting that brand. There's others that work with all of it. And there's others that work with many of them.

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Emeritus College: And so over the years when you're a practitioner, you kind of learn how they sound, what technology works for different people, different mindsets, how people score on different things, what companies work better with this type of hearing loss or that type of hearing loss. Or you ask questions in a functional assessment like, what matters to you? What are your goals? Do you want to have an app that you can change things? Or do you want to keep things simple? Right? And so a lot

460
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Emeritus College: that stuff will kind of be stuff out. Do we need accessories for that person? Yes or no. Does this brand have really good accessories, reliability, battery, life.

461
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Emeritus College: connectivity, all these factors are what's going through? I guess I can really speak to myself. My head

462
01:39:05.300 --> 01:39:07.290
Emeritus College: right when I'm thinking about this.

463
01:39:08.110 --> 01:39:18.753
Emeritus College: But as in any profession, you're gonna have preferences, you're gonna have things that you've seen be more successful or less successful. And that's gonna guide right? The conversation.

464
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Emeritus College: we know that if the patient comes to us and they they're very well informed. They've watched Dr. Clint videos. They read reviews.

465
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Emeritus College: We are so happy to sit there and spend so much time talking about channels and bands and wide dynamic range processing our engineers. The engineers are the longest appointments, and they are. They want to talk about everything that nobody cares about. But and

466
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Emeritus College: yes, and it's it's fun because it's they're interested, right? So it's fun. But

467
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Emeritus College: it's not black and white, and there are absolutely times where we fit somebody with something. And as we're doing our follow up. We're like this is not going the way we wanted it to. We learn new information and we exchange them and go with a different product.

468
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Emeritus College: In theory, somebody should be able to be successful if they're properly fit with all of them. But there are differences, and some people jive with one and don't drive with another. So it's it's it's a complicated answer, to be honest. But yeah, I would strongly recommend that anywhere. Somebody goes that that place works with more than one brand, consistently.

469
01:40:33.380 --> 01:40:48.831
Emeritus College: because if you go somewhere where they only really work with one product, and it's not right for you. There's not going to be another avenue to go down. One is

470
01:40:49.430 --> 01:40:55.519
Emeritus College: is there research that shows that we can rehabilitate the the brain. If it's had some of these

471
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Emeritus College: changes because of lack of hearing. And the second question is, if you're wearing hearing aid.

472
01:41:02.720 --> 01:41:16.780
Emeritus College: can you concurrently use hearing protection like I know there's some place. I just wondered, would I be able to do that if I'm wearing here? Yeah, no, hearing aid

473
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Emeritus College: are not hearing protection, and they should not be used. The only the only caveat to that can you do both is if you have hearing aids on. These are my tractor drivers.

474
01:41:30.480 --> 01:41:43.010
Emeritus College: Okay, they'll we'll put. We'll say you could put your hearing aids on if you want to stream music from your phone or something while you're driving the tractor and lawn mower. But you're gonna turn your amplification off, and then you're gonna wear your protection on top of it.

475
01:41:44.000 --> 01:41:49.149
Emeritus College: It sounds like you go to some of these shows they're so loud.

476
01:41:49.370 --> 01:42:14.339
Emeritus College: And I thought, I don't want to wear hearing. No, you wouldn't. No, or or you yeah like, or you would use your app to turn it down significantly. But if it's like a true, not just discomfort, but like they have, like, harmful yeah, hearing protection and hearing protection. A lot of us think like either over the ear mops or like foam inserts. So most people that use the phone inserts do not insert them properly. They're supposed to be so deep in your ear that you do not see them exactly

477
01:42:14.340 --> 01:42:38.489
Emeritus College: if you're looking at somebody straight on. And so we make custom, hearing protection, like audio protection from audiologists, and you can get ones for sleeping like if your partner stores, you can get ones for sleeping, you can get ones for concerts that have filters in them. So the fidelity of the audio is still preserved. But the overall volume is just down. I've made them for people that work in factories where.

478
01:42:38.900 --> 01:43:05.619
Emeritus College: if their boss comes up to them and says something, they need to be able to hear their boss. But the overall environment is too loud. Those have their special pressure based filters where they won't activate unless the sound pressure level increases a certain limit and then they compress. So it's like, if they get too close to the machine it compresses, but otherwise it's open. So there's some really cool hearing protection out there. So that would be where you were wearing a hearing. And you make a decision not to wear.

479
01:43:05.620 --> 01:43:17.429
Emeritus College: Oh, yeah, we have patients that are, they work and not jobs, and they just simply cannot wear their hearing aids at work, and that impacts their communication. But it's what you have to do. And then, with the recapping the brain.

480
01:43:17.520 --> 01:43:25.889
Emeritus College: It's I know it's a very classic thing. So again, bring the hearing back, does it read? And so

481
01:43:26.170 --> 01:43:39.529
Emeritus College: Dr. Lab wants to look more at that. But it's it's long term. Yeah, it's really long term. We know that the research is showing that there are some cognitive benefits.

482
01:43:39.530 --> 01:44:04.509
Emeritus College: But skill based benefits. We don't know. We know that the auditory processing therapies could be very effective at improving skills and processing abilities. And so if there was a deficit there, and you directly improved upon that, we would see a change, and we would then know that there was neuroplasticity involved in that. So there's cross. Oh, very much so we know it is. We know it is. But can the

483
01:44:04.510 --> 01:44:10.200
Emeritus College: research definitively say no, because it's just such a long term research study that would be needed. And

484
01:44:10.754 --> 01:44:30.325
Emeritus College: so what about options like lyric? I know they're still analog, but they are so convenient they're disposable. Mine last about 2 months. Do you see something like this becoming more advanced with bluetooth option? No, I don't. Not with lyric. So lyric are.

485
01:44:31.343 --> 01:44:42.006
Emeritus College: is under phone app makes lyric, and only certain providers can do it. Basically, you have to be like a pretty big phone app provider to be able to dissent lyric. But and I used to dispense lyric lyric.

486
01:44:42.590 --> 01:45:04.349
Emeritus College: it's an analog device, and it's place. It's not appropriate for everybody. It's placed in the ear, and it stays in there. It has a battery that works up to like 6 to 8 weeks. You shower with it, you sleep with it. You're not allowed to like submerge underwater swimming, but you could go in the pool if you don't submerge. A lot of people love them absolutely. Love them because they're very convenient. But

487
01:45:04.350 --> 01:45:27.040
Emeritus College: lyric has been what lyric has been for many years. And so I don't work phone. I don't work in the R. And D, it's definitely possible. But just by the nature of how small it is at the battery life. I imagine that if you added any additional power consumption to it, it would start to not be worth it. You were having to do public or any other type of transmission.

488
01:45:27.320 --> 01:45:29.200
Emeritus College: it wouldn't be what it is.

489
01:45:30.200 --> 01:45:31.090
Emeritus College: Yeah.

490
01:45:34.551 --> 01:45:59.859
Emeritus College: Have to say that I did the got me a program. That was a training program. It looked like it was designed originally for children basic words. But it was the sounds that I was missing, that I just hadn't heard for so long, and you fill in the words. In other words, you're having a conversation with someone, and even though you don't really hear what they're saying.

491
01:45:59.860 --> 01:46:11.539
Emeritus College: you would for the word that they're saying, so it could be which you don't hear like the or whatever. But there were. There was that

492
01:46:12.140 --> 01:46:34.869
Emeritus College: every day I did so many minutes training. Yeah. Yeah. And there's like a variety of options out there, the one that you did kind of got integrated into a different, more robust platform. And then, if if we do like auditory processing, testing, and actually like, figure out. If there's a deficit, then you can get targeted

493
01:46:35.120 --> 01:46:43.659
Emeritus College: therapy for that. But most people with hearing loss don't do those, because the normative data for auditory processing testing is with normal hearing.

494
01:46:44.170 --> 01:46:51.020
Emeritus College: And so because hearing loss is so varied, it's impossible to get normative data

495
01:46:51.320 --> 01:47:04.360
Emeritus College: from an age, sex and degree of hearing, loss configuration. So you have to make a lot of inferences when it comes to those therapies with hearing loss, not to say that it can't be therapeutic.

496
01:47:04.770 --> 01:47:08.359
Emeritus College: But you just go into it saying like, let's get what we could get out of it.

497
01:47:08.720 --> 01:47:12.260
Emeritus College: you know, versus saying like, this is the expectation

498
01:47:12.850 --> 01:47:29.459
Emeritus College: that little microphone. I sit around. I turn on and off the phone. I turn it on. There's a button to turn it on, and then I turn up with my my cell phone. But I use it. It's real interesting, because it connected to the TV at home.

499
01:47:29.660 --> 01:47:57.329
Emeritus College: But the other. And this is the problem with hearing loss. That we don't really talk about is how it affects relationships. So when you have hearing loss, you're always asking people repeat themselves. Victoria speaks very rapidly. If I'm not in the room with her, I miss a 3rd of what she will say to me, and so I've got to go. Have her repeated, and that is like, No, and and I think that's 1, you know. So

500
01:47:57.790 --> 01:48:21.060
Emeritus College: I got, I use that with the television. But the other night I had it because I could hear the television. But when Vince would talk to me I could no longer hear him, because all the sounds coming from the television. And I realized that he's watching TV with me. I can't use it. You can. You just have to mix it.

501
01:48:21.310 --> 01:48:44.980
Emeritus College: I'll mix it. But I obviously mixed him off spoilers. But I do think it's an interesting. It's an interesting process when you're

502
01:48:48.660 --> 01:49:02.890
Emeritus College: don't get well, but know it will

503
01:49:03.020 --> 01:49:14.010
Emeritus College: hearing loss. What's the percentage of the have this one year and not the other.

504
01:49:15.320 --> 01:49:23.691
Emeritus College: but like only a moderate hearing loss. That's pretty low. Yeah, moderate hearing losses are

505
01:49:25.100 --> 01:49:38.109
Emeritus College: typically sudden, sudden onset losses where you have a virus or like a mini stroke in the year, and you would like to wake up one day with that. That's probably the most common type of

506
01:49:38.290 --> 01:49:58.089
Emeritus College: hearing loss only on one side, because if you think, like most things that would be systemic, a medication, noise, exposure. Those are usually bilateral. Now, asymmetric hearing losses can be more common. We see that with our truck drivers, with our firearm users, with our hunters where one ear is worse than the other, so a truck driver, the left ear is always worse.

507
01:49:58.470 --> 01:50:13.919
Emeritus College: and then with our firearm users most people are right handed. So we see the left ear worse if they're know immediately if they're left handed trigger finger. Because, see the deficit, are you left handed? And they go. Yeah, like, yeah.

508
01:50:15.065 --> 01:50:23.265
Emeritus College: But it's bilateral is the most common, unless there was some environmental aspect, or like

509
01:50:23.860 --> 01:50:29.459
Emeritus College: pathology, but kind of more of the less common pathology that would affect one, not the other.

510
01:50:29.890 --> 01:50:32.059
Emeritus College: So most people should have 2 hearing aids

511
01:50:32.310 --> 01:50:36.900
Emeritus College: and a lot of people. Not a lot of people. But some people said, Can I just get one? I'm like.

512
01:50:37.500 --> 01:50:51.979
Emeritus College: would you row down the river with one oar, like, you know, you're only here to go in circles. Our brain. We have 2 ears because our brain uses information from both sides to understand where sound is coming from, to be able to process and noise.

513
01:50:52.560 --> 01:50:54.600
Emeritus College: space, orientation. So

514
01:50:55.120 --> 01:51:05.516
Emeritus College: the answer would be, no to that, but would rather you get 2 low, level, prescriptive hearing aids than one really good one.

515
01:51:06.430 --> 01:51:08.054
Emeritus College: if it's a budget choice.

516
01:51:09.950 --> 01:51:12.239
Emeritus College: Did that answer your question?

517
01:51:13.060 --> 01:51:18.780
Emeritus College: I have one ear that I can listen to the other

518
01:51:24.367 --> 01:51:32.682
Emeritus College: don't know.

519
01:51:37.740 --> 01:51:40.329
Emeritus College: Been on hearing Aids for several years.

520
01:51:40.620 --> 01:51:45.500
Emeritus College: and then I went to bed one night, and I woke up, and I couldn't hear out of my right ear.

521
01:51:46.110 --> 01:51:48.349
Emeritus College: And I turned up the volume

522
01:51:49.090 --> 01:51:57.169
Emeritus College: and basically make a long story short, I had total asymmetric sudden hearing loss. So this year.

523
01:51:58.100 --> 01:52:01.815
Emeritus College: in the span of 6 h just died.

524
01:52:02.360 --> 01:52:29.270
Emeritus College: Yeah. So yours was sudden, so yours was either the virus or the stroke in the ear. You had, like a metabolic disruption that killed the cells. His was gradual or or sudden, but from environmental exposure. So his was external. Yours was internal.

525
01:52:29.410 --> 01:52:40.000
Emeritus College: Yeah, I had a quick one, external, you know. Whoa! But it was very quick it was about. Oh, nanoseconds! We made water in a laboratory.

526
01:52:40.180 --> 01:52:41.500
Emeritus College: a lot of it.

527
01:52:41.680 --> 01:52:54.720
Emeritus College: It was like hydrogen explosion, and I lost hearing in this year at around 5,000 cycles and no other problem. Yeah, like, what frequency?

528
01:52:55.170 --> 01:53:11.659
Emeritus College: Yeah. So back to the black acoustic trauma that came in was more total. So there was like a 5,000 hertz more total sound versus like a noise sound that it blasted the the sound sound wave entered and went right to their blasted those out.

529
01:53:12.410 --> 01:53:22.009
Emeritus College: Yeah, yeah, I would say. So. I know we're running out of time. So are there any more questions online?

530
01:53:24.380 --> 01:53:49.069
Emeritus College: Just so you know at least 2 of the individuals with us are out of town. Lee is in Florida, and Forrest is in Columbia, and I'm not sure we've had 18 or 19 people. So we had 18 or 19 people online. So

531
01:53:49.120 --> 01:54:00.769
Emeritus College: thank you all for joining. Well, thank you for coming.