How is hearing loss treated? 

Transcript

Cheryl Martin (Host): As we grow older, it’s not uncommon to gradually have some hearing loss. Here in the United States, nearly 50% of those over the age of 65 experience this. Coming up next, the steps you can take to improve what you hear.

This is Flourish, the podcast brought to you by Prisma Health. I’m Cheryl Martin. Joining me this episode is Dr. Brent Wilkerson, an ENT physician and neurotologist, that’s a specialist training the whole ear; and Dr. Heather Strader, a cochlear implant audiologist, both with Prisma Health. Welcome to the podcast.

Dr. Heather Strader: Thanks for having us.

Dr. Brent Wilkerson: Thank you for having us.

Cheryl Martin (Host): Let me begin with you, Dr. Wilkerson. What are the different kinds of hearing loss?

Dr. Brent Wilkerson: There are three main categories of hearing loss that can occur. The largest category and the most common one is sensorineural hearing loss. So that’s nerve damage that occurs for various reasons. The second category is mechanical or conductive hearing loss, and that may be a result of a problem with the mechanics of the middle ear space. This may be a result of ear wax or eardrum perforation, or fluid in the middle ear or the ear bones not working correctly. And the final category is a mixture of both sensorineural or nerve hearing loss and mechanical or conductive hearing loss where the two come together.

Cheryl Martin (Host): So how do you know if you are experiencing hearing loss?

Dr. Heather Strader: So often, the patient themselves will come in presenting with some comments like, “I don’t hear very well in background noise” or perhaps “I hear, but I don’t always understand.” But I would say most often it’s actually their family or loved ones that will come in and report some changes in functioning for their loved one that is having trouble hearing.

They might report that they disconnect in noisy environments. They say, “What?” a lot. And then, sometimes even they’ll report some changes in memory or cognitive functioning that they’re concerned about. Current research shows that long-term untreated hearing loss does often coincide with cognitive decline, so there is a lot of concern that to keep the brain nice and healthy, we need good access to good hearing. So as people have long-term untreated hearing loss, when they don’t get hearing aids, when they don’t get any treatment for hearing loss, we see some cognitive decline, some memory loss, some early-onset dementia even, associated with that.

Cheryl Martin (Host): What do you believe are the common causes of hearing loss?

Dr. Brent Wilkerson: It depends upon the type of hearing loss that we’re talking about. However, sensorineural hearing loss, which is nerve damage that may occur, most commonly occurs from noise exposure or aging, and can also be contributed by genetics or family history.

When discussing conductive or mechanical hearing loss, this can occur because of ear infections; something called otosclerosis, where the third hearing bone, the stirrup bone, is fixed and not working correctly. It can occur because of trauma or hole in the eardrum or wax.

Cheryl Martin (Host): Is all hearing loss permanent?

Dr. Heather Strader: So it really depends on the kind of hearing loss it is, whether it’s conductive in nature or sensorineural. So, sensorineural hearing losses are often permanent and progressive in nature. These are most frequently associated with noise-induced hearing losses as well as age-related hearing losses. I’ll say when sensorineural hearing losses or when hearing loss is sudden in nature, it should be considered as a medical emergency and should be treated immediately to get the best possible chances of recovery for that hearing loss. As far as conductive hearing loss goes, often these are treatable with medical management and time for healing.

Cheryl Martin (Host): So let’s talk about treatment. How is hearing loss treated?

Dr. Brent Wilkerson: So hearing loss is treated depending upon the cause of hearing loss in different ways. And sensorineural hearing loss, most of the times, can be treated or is treated with hearing aids. However, if it progresses to the point where hearing aids are not helpful anymore, then a cochlear implant may be an option.

In conductive hearing loss, because of mechanical problems, there may be a surgery that can be performed that may improve or restore hearing in those cases. And so depending upon the hearing loss itself, whether sensorineural or conductive, the treatments may be slightly different.

Dr. Heather Strader: I just wanted to add to that, that hearing aids and cochlear implants should not be considered the last option or a scary option, but really a very positive option. Today, hearing aids and cochlear implants are small, they’re lightweight, they’re rechargeable. They have great Bluetooth compatibility to pair to phones and other devices. And so they’re really a great device in order to help patients perform better in a variety of listening experiences.

Cheryl Martin (Host): Is there a time when you would recommend an implant as the first choice above a hearing aid?

Dr. Heather Strader: So yes, we do recommend a cochlear implant often for people with more significant kinds of hearing loss. So once a patient’s hearing gets more into the moderate to profound range, there’s often some deterioration of the signal itself. So, if a signal is distorted and we amplify a distorted signal with a hearing aid, then it often is very hard or impossible for a patient to understand that signal.

So once a patient’s hearing loss progresses to that point, we would recommend they consider a cochlear implant, which would give them better access to a more robust signal or, of course, speech, which is what they’re trying to hear or listen to.

Cheryl Martin (Host): Will you go into more detail about how the implant works and how long does it take someone to adjust to it?

Dr. Brent Wilkerson: So a cochlear implant is a small electronic device, and it has an electrode that’s inserted surgically into the cochlea, which is the inner ear organ. And that electrode electrically stimulates the nerve of hearing. And that nerve of hearing then sends the signal to the brain, which is then perceived by the brain as hearing and understanding.

And the implant has external and internal parts. The external part sits behind the ear. It picks up sounds from the microphone, and then process the sound and transmits it to the internal part of the implant. And the internal part of the implant is the part that is placed by a surgeon like myself. And that implant is placed under the skin behind the ear during an outpatient surgery. And then, that thin wire and electrode is inserted to the cochlea. And then that wire sends signals to the cochlear nerve onto the brain. And Heather would be good to discuss about how long it might take to process and recover.

Dr. Heather Strader: So often patients when their cochlear implant is first turned on, they’ll report that it sounds maybe staticy or robotic in nature. Some even say it sounds like Mickey Mouse. But over time, the brain really starts to normalize that sound and naturalize it, and the person will get better at decoding the message and understanding speech more efficiently.

I’ll say that oral rehab is important in this process. So oral rehabilitation is a process of a patient learning brain exercises to help them learn to listen better. So if you think about somebody who has maybe a knee replacement getting physical therapy, somebody with a cochlear implant would get oral rehabilitation following in order to help the brain better learn to interpret that signal. Usually, it takes between six months and a year to really get the full benefit of a cochlear implant. And over that six months or year period a time, their brain is constantly kind of getting better at understanding and decoding those messages so that they can understand speech more clearly.

Cheryl Martin (Host): Now, can a person with a cochlear implant hear sounds like they would if they didn’t have hearing loss?

Dr. Brent Wilkerson: The sound perceived through a cochlear implant is not the same as the sound heard with normal hearing, especially at first. And cochlear implant wearers, who have previously heard naturally, often described the sound at first, like Dr. Strader was saying, as being robotic or tinny or cartoonish. However, with time, the brain adjusts to the new signals and what is heard becomes much more natural for that patient.

Cheryl Martin (Host): So are there any disadvantages to cochlear implants or reasons they may not be the right treatment option for some people?

Dr. Heather Strader: Yes. I would say cochlear implant is not the right option for everyone. There is a whole medical and audiologic workup involved to make a recommendation for a patient for a cochlear implant. And really, often the success of the cochlear implant often relies strongly on a person’s motivation and expectations for progress. So those patients who work really hard at rehabilitation post-cochlear implant tend to do better than those who are really resistant and hesitant to get a cochlear implant.

But all things considered, there’s a wide range of outcomes. I will say most everyone notes improvement in some situations. Some people note a lot of improvement. And some people’s improvement is much more limited, and some of those things can be based upon maybe their cognitive status. So patients who already have some amounts of dementia or cognitive decline might not have quite as much improvement. There’s also some medical indicators where a patient might not do quite as well with a cochlear implant due to maybe absence of their cochlear nerve or the shape of their cochlea itself. And so, like I said, there’s a lot involved in making a recommendation for a cochlear implant.

Cheryl Martin (Host): What steps do you recommend for people to protect their hearing, especially if they’re not experiencing a significant hearing loss now or no hearing loss? If both of you can answer that.

Dr. Brent Wilkerson: From my perspective, the first step is getting a baseline hearing exam. Most adults haven’t had one. They may not even realize that they have some baseline hearing loss. The second thing is wearing hearing protection. So of course, rock concerts or noisy environments, if you’re around machinery, construction sites, even things like airports and train stations can be loud enough to cause damage. So wearing hearing protection when you’re in those scenarios can be important. Taking break from noisy environments as well if you’re in those scenarios, even with hearing protection, can be advantageous to protecting your hearing.

And then, finally, monitor the volume on your device. We all have devices with us always now, and most of these devices have a monitoring app on them that will give us warnings if we’re listening too long or too loudly. But the loudness of the device, you should be able to hear it without straining, but not loud enough where if you leave the room, you can still hear it.

Dr. Heather Strader: And I’d just add to that, it’s always a wise idea to consult a hearing healthcare professional to figure out what kind of protection might be best for you. There’s a wide range of options. Ear plugs, ear muffs, there’s even some custom fit products and some with high frequency filters. So I have a friend who works in the race industry and he tunes race car engines as part of his job and came to me asking about the best kinds of hearing protection because he’s sitting next to an engine for hours at a time trying to discuss with other engineers the best tuning. And so, we fit him with a nice pair of custom hearing protection with high frequency filters so that he can still hear the speech and the people around him while he’s safely doing his job. So I think there’s a lot of benefit in talking to a hearing healthcare professional to make sure that you have the best possible option that is safe within the constraints of the situations you’re in.

Cheryl Martin (Host): Dr. Wilkerson, you mentioned us listening to all these devices now. Are you finding more people having problems even as a result of wearing the headphones or the earbuds all the time as they listen to devices? Has this brought a significant problem with hearing?

Dr. Brent Wilkerson: Well, I don’t know if it’s particularly the device themselves or listening to the headphones. Certainly, hearing loss in general is increasing. And it affects millions of people and some of those people may not even know that they have it. Having devices with earbuds in their ears all the time can be a risk. And so it’s important to monitor that and make sure that it’s not too loud in order to protect your hearing.

Cheryl Martin (Host): Any closing comments from both of you on hearing loss and how it’s treated?

Dr. Heather Strader: if you feel like you or a loved one have some hearing loss or, concerns with communication, get a baseline hearing test, be treated, and worked up by a medical professional in order to see what your hearing loss looks like. Because we know that the sooner patients adopt both hearing aids or cochlear implants once they need them, the better they do, because their brain has less cognitive decline. Their brain is healthier. Those who live with long term untreated hearing loss before getting hearing aids or cochlear implants have much more difficulty in adopting to them and getting the necessary benefit from them. So I think that it’s important to have your hearing evaluated and to consider the options.

Dr. Brent Wilkerson: And I would just like to second exactly what Dr. Strader said. it’s important to get your hearing tested, by a hearing professional and then, might be referred to a medical professional if a cochlear implant or hearing aids or potential surgery may benefit or help restore your hearing. So the first step is seeking out a hearing professional, talking to your primary care doctor for a referral, and getting evaluated.

Cheryl Martin (Host): What age do you recommend that? And you’re saying get one, whether you sense there’s a hearing loss or not, correct?

Dr. Brent Wilkerson: Not everybody that’s an adult necessarily needs a hearing test. However, the data suggests that the greatest hearing loss occurs in ages 60 and older. However, hearing loss also persists in all ages. And so if you are noticing that you’re asking people to repeat themselves or if your family is picking up on it, then that’s definitely a clue. If you’re over 60, you probably should have a hearing test. But age itself is kind of the greatest factor, but all ages can have hearing loss.

Cheryl Martin (Host): Some great information. Thanks to both of you for educating us on hearing loss and the best treatment, Dr. Brent Wilkerson and Dr. Heather Strader. To learn more, please visit PrismaHealth.org/Flourish. That’s PrismaHealth.org/Flourish. And thanks for listening to this episode of Flourish, the podcast brought to you by Prisma Health.