Tuesday, October 8, 2019

Hearing Loss and Quality of Life: A Visit with Karl Strom, Editor-in-Chief of The Hearing Review

Karl Strom is editor-in-chief of The Hearing Review, a leading trade journal and web resource (hearingreview.com) in the hearing industry. He's been reporting on hearing healthcare issues for over 25 years.

Prior to his involvement in publishing, Karl worked in Superior, Wis, as a technical writer at the specialty lubricants and aftermarket industry supplier, AMSOIL INC. thru which our own paths crossed, and later as marketing manager for Spectus Systems where he also worked in Rockford, Ill, and in Macclesfield, England. He now makes his home in Duluth, Minn, with his wife, who is involved with our local arts scene, and their two boys.

This summer, when we met again at Fitgers, he shared some fascinating facts about hearing loss. I intended to interview him about what it's like to be editor of a publication for a quarter century, but instead we went into the specifics of this niche he serves.

EN: Why is hearing loss something we don’t hear more about?

Karl Strom: I think it’s because hearing loss has been perceived as simply a part of aging. But that’s only partially true. We have about 12,000 outer hair cells in our cochlea—which is the pencil-eraser-sized organ responsible for hearing—and that’s all we get for the natural amplification of sound. They don’t grow back. Some of these hair cells die off gradually from overuse and abuse. And of course the more you age, the more you tend to lose them. Most hair cells die due to injury after loud sounds or exposure to chemicals (ototoxins can include anything from aspirin to cancer drugs), but they also die due to things like restricted blood flow (eg, heart disease, diabetes), physical trauma, etc.

Maybe the biggest reason you don’t hear much about hearing loss is it’s very common, and it generally occurs gradually. Everyone knows someone with a hearing loss, and usually they’re older and not in imminent pain or distress about it. In fact, about 10-15% of the US population (about 38 million people) has a “self identified” hearing loss which includes mild losses, and the National Institutes of Health (NIH) estimate that close to 25% of everyone over age 65 and half of everyone over age 75 has a disabling hearing loss—or a real hearing problem for which you should seek help.

Because hearing loss usually occurs so gradually, most people find ways to cope with it. Some are exceptionally good at bluffing or “filling in the blanks” of conversations—until they just can’t cover it up anymore. Most people who have a hearing problem don’t realize what a drag it can be for your spouse and friends. Continually asking them to “hear for you” or “be your ears,” and at the same time making mistakes during basic communication, just isn’t fun. If you had a friend with bad eyesight who kept bumping into furniture or falling down or misreading important labels, you’d make them visit an eye doctor. For some reason, this kind of cause-and-effect social pressure doesn’t always apply when it comes to hearing loss.

But I guarantee you that our attitudes about hearing loss will change—and soon.

EN: I imagine you’re talking about the research which shows how hearing loss impacts so many other aspects of our lives. Can you elaborate on this?

KS: Well, one thing is for certain: humans are social animals, and we use our hearing for many important things. In particular, when you start to remove a person’s ability to communicate well—and create strain, anxiety, and problems for them in communicating with their spouse, friends, relatives, or co-workers—it shouldn’t be a shock that bad things happen. Untreated hearing loss robs us of our self-confidence, spontaneity, independence and, frankly ,many of the things that make life joyful. It can also hinder your academic performance, career, and earnings. So, it shouldn’t be surprising that all kinds of studies—research going back more than three decades now—show that better hearing leads to a better quality of life.

Similarly, in the past decade, numerous scientific studies have linked hearing health to physical and mental health and wellness. Untreated hearing loss is associated with all kinds of chronic diseases, including falls, cardiovascular diseases, diabetes, cognitive problems and dementia, and even a shorter lifespan. Now, that doesn’t necessarily mean hearing loss causes these things, it just means it’s linked to them: something makes these chronic conditions connected or appear together (called “comorbidity”) with greater frequency outside of factors like age, economic status, etc.

Some of these connections are alarming. For example, earlier this year, one of the best-regarded medical journals, JAMA, published a study by Drs. Nick Reed and Frank Lin and their colleagues at Johns Hopkins who found that significant hearing loss results in a:

• 52% greater risk of dementia
• 41% higher risk of depression
• 30% greater risk for falls
• 50% more hospital stays
• 44% higher risk of being readmitted to the hospital within 30 days.

A lot of people are concerned about dementia and hearing loss—and there’s good reason for this. Studies continue to find that the brain actually changes in response to even a mild hearing loss, recruiting those areas once used for hearing and using them instead for other tasks like vision. A recent Lancet study showed that, if you’re concerned about your cognitive/brain health, the #1 modifiable factor you can do to prevent dementia is to make sure you’re hearing well. Other studies by Dr Lin have shown that mild hearing loss doubles your risk for dementia, moderate hearing loss triples your risk, and severe hearing loss makes it 5 times more likely that you’ll develop dementia. I find these data pretty persuasive: If you think you have a hearing loss, you should get your hearing checked!

And, even if dementia isn’t something you worry about, the bottom line is this: Healthy aging, higher income, better quality of life, and “aging in place” (ie, independent living) are almost certainly aided by hearing well. Good communicative participation and an active social life keeps your brain healthy—and you and the people around you sane and happy (or at least more-so).

EN: It’s easy to see how hearing loss diminishes our enthusiasm for social engagement. Is this part of the reason hearing loss is related to depression?

KS: In many cases, the answer is almost certainly “yes,” and in other cases it’s a “maybe.” Earlier this year, I helped produce a webinar and a special white paper by Victor Bray, PhD, who is an audiologist and the former dean of the George Osborne College of Audiology at Salus University near Philadelphia. (Fun fact: the late Dr. Osborne had an audiology practice in Cotton, Minn, and built and flew kit seaplanes around Duluth here.)

Dr Bray basically agrees with the traditional view about how hearing loss can cause depression: namely, changes in the ear and/or the brain can cause a cascade of negative feelings from having to concentrate really hard when listening, embarrassing moments or faux pas during conversations, a loss of self-esteem, anxiety and withdrawal, resulting in social isolation and loneliness—all of which can lead to clinical depression. So, in that way, the refusal to address a serious hearing loss is kind of the primrose path to depression.

But Dr. Bray also makes it clear that there could be other factors, including neurological or biomedical conditions, that link hearing loss to depression. So, as with the other chronic illnesses discussed earlier, we still need more scientific studies on this issue. But my opinion is that the link between hearing loss and loneliness and depression is pretty logical and persuasive, and it often boils down to how hearing loss influences your social engagement.

And, at any rate, in myriad studies, better hearing has been found to improve quality of life across the board, as we’ve discussed. That’s a pretty big deal when we’re talking about 25-38 million people in the US alone.


EN: I was unaware how extensive the problem is. What are some of the new technologies that have been developed to address this problem?

KS: I could talk about this all day, but I’ll try to stick to the “highlights.” The hardest problem to solve is speech understanding in noise. That’s the “gold ring” that every hearing aid company is pursuing—and has been pursuing for decades—but no one has really solved it yet, even though a lot of online products claim they have! But speech-in-noise technology is getting a lot better. Directional microphone technology, advanced processing algorithms, “self-learning” hearing aids, and hearing aids that can use remote microphone technology (ie, where you clip a tiny mic to someone) offer great benefits.

Connectivity has changed everything, and hearing aids now connect hands-free to almost any smartphone, computer, personal music device, etc. Motion-sensors are now being employed in hearing aids that can add fitness tracking capabilities like a FitBit, detect a fall or tumble and automatically alert caregivers, or even help the hearing aid figure out if you’re in a car or walking on a street, then adjust the hearing aid programming accordingly. Minneapolis-based Starkey now has a language translation function in its latest hearing aid, and Siri and Alexa artificial intelligence are increasingly being employed. Hearing aid wearers can say, “Siri, what’s the weather report?” and you’ll get the answer through your hearing aid. All this stuff exists today, and as a general rule, I think anything a computer or smartphone can do today will eventually be integrated into hearing aids, if they can be conveyed by sound.

We’re also seeing a lot more affordable hearing aid options. I’ll emphasize that I think the best place to get a hearing aid is from a licensed audiologist or hearing aid specialist—the professional makes all the difference in a hearing aid fitting. Most professionally fit hearing aids that cater to your unique hearing needs are going to cost between $1500-6000 per pair. The cheapest professional options are the Costco, SAMs Club, and other mass retailers. I think these can be good places to get a hearing aid, but you may not get the same level of attention/expertise from these offices.

Next year, there will be a new classification of hearing devices once the FDA establishes and regulates over-the-counter (OTC) hearing aids. In my view, these will probably look a lot like the personal sound assistive products (PSAPs) we have today. While some PSAPs are quite good, I’ll warn you that many (if not most) you find online are garbage. Some PSAPs you might check into are Lucid, Alango, SoundWorld Solutions, Bose, Eargo, and iHear, to name a few. There are also some interesting apps, like the Jacobi ListenApp, that may prove helpful, but you’ll need quality earbuds for them to work well. With some exceptions, these generally don’t come with professional assistance, they vary in quality (eg, I was wowed by a great PSAP, but it lasted only 3 months!), and they’re not really designed for more serious degrees of hearing losses. But my main point is that this “newer part” of amplification—along with teleaudiology where someone can assist you on your computer or phone—will continue to evolve quickly.

Speaking of telehealth, I think teleaudiology (or eAudiology) is one of the biggest current revolutions in hearing healthcare. It is allowing professionals to adjust your hearing aid anywhere in real-time through an app on your phone or via computer. Hearing aids can also tell where you are via geolocation and geocaching, and apply the best listening program for that location. Another important technology improvement is rechargeability, which is relatively new in our field because of the very small battery size and relatively tiny energy capacity.

Moving away from hearing aid technology, I’d be remiss if I didn’t mention that cochlear implants have also made near-miraculous leaps in progress during the last two decades. Many babies born with profound hearing loss and fitted with these devices by 2 years of age can perform on-par with normal-hearing kids. Although advocates for Deaf culture would disagree, I think this is one of the most remarkable success stories in our field. These devices are also being used increasingly for adults with severe and profound hearing losses—even for 90+ year olds—although the success rate isn’t quite as impressive as with children whose brains are much more plastic and adaptable.

So, here’s the good news: There is no longer a hearing loss that exists today that cannot be helped by some form of technology. I couldn’t say that a decade ago. Today, we have PSAP and assistive (and soon OTC) hearing devices for milder losses; we have hearing aids for the vast majority of people with mild-to-severe hearing losses; we have an array of bone-conduction and bone-anchored solutions for problems with the middle ear; and we have cochlear implants that bypass the cochlea and send signals directly to the auditory nerve if you’ve lost all or most of your cochlear function. We even have auditory brainstem implants for people with rare birth defects who lack a cochlea. There is also an important and diverse group of technologies like remote microphones and loop (telecoil) systems for listening in noise and in large groups (churches, auditoriums, etc), as well as for people with auditory processing disorders. There are streaming TV listening and (free!) captioned telephone systems that come with or without a hearing aid. I could go on and on. But the point is: if you have a hearing problem, there’s a solution for you. Depending on the complexity of your problem and your needs, you might need to find a really good audiologist or hearing aid specialist, but there is a solution.

Photo by Gary Bendig on Unsplash
EN: What is the future of hearing health?

KS: As I said, I think the future of hearing healthcare is one in which physicians and consumers are much more aware of the detrimental effects and the societal costs of hearing loss. I’m not sure where all the studies about brain health, cognitive decline, depression, or the association of hearing loss with falls, diabetes, heart disease, etc, will take us. However, it seems pretty logical that if you’re not hearing well, not communicating well, not understanding or easily conversing in a spontaneous manner with your friends and family, then you’re missing out on some of the best parts of life.

So, THE biggest changes in hearing healthcare relate to the connection between better hearing and better physical and mental health. In large part, it’s about healthy aging and living independently. And, to be totally honest, much of this change will boil down to money. Just as one example, the global cost of dementia in 2015 was estimated at more than $800 billion, and the number of dementia patients is expected to triple by 2050 due to increasing population and longevity. So…do the math.

When you also consider things like cloud-based AI, cyberbionics and nano-technology, neural networks, advances in pharma and genetic engineering, and quantum leaps in materials and power-source development, and the future becomes even more exciting, but less clear. Hearing aids have always been on the forefront of technological innovation because it deals with very low-power (1 V) microminiature circuitry. The first use of a transistor was in a hearing aid. You may not think about it, but parts of the hearing industry are literally involved in James Bond-type spy and listening gadgets.

One of the big questions we’re grappling with as an industry is this: Will hearing aids remain primarily a device for people with hearing loss or will they evolve into multifunctional electronic consumer products that just happen to have an “app” or feature for people with hearing loss?

Also, I think diagnostics in hearing care will also experience quantum leaps. The cochlea is an extremely difficult anatomical structure to study because of its size and proximity to the brain and key nerve pathways. So, we have some broad categories like “central auditory processing disorders,” “tinnitus,” and “Meniere’s disease” that I think will become much better understood and easier to treat in the future once we develop more sophisticated “differential diagnosis” technology—or more specific explanations and effective treatments for all the various types of hearing-related problems.

Another exciting area is pharmaceuticals or injections into the cochlea for the regeneration and restoration of hair cells, along with protecting your hearing after exposure to loud noises. Some of these pharma treatments, along with those to treat tinnitus (or ringing in the ears) and other hearing problems, may start to emerge in the next 10 years or so.

Finally, the consumer’s perception of hearing protection is evolving similar to how seatbelts in cars evolved. When I was young, nobody wore seatbelts and you had to literally dig them out of a seat cushion to use them. Today, kids squeal if you start moving and they’re not strapped into a double-decker protective seatbelt. That was a long process of education. People are now realizing they need to protect their hearing around loud music, vehicles, lawnmowers and snowblowers, power tools, hunting and recreational shooting, etc. Hearing conservation has also become a more important part of military training. And that’s why I’ll bring your readers back to where I started: you only have about 12,000 hair cells in your inner ear for hearing. When those cells die, you don’t get them back. So don’t burn them foolishly. And be sure to get your hearing tested, and seek help if you think you might have a hearing loss.

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Related Link
https://www.hearwellstayvital.org/support-materials/

Rabbit Photo by Gary Bendig on Unsplash

1 comment:

Shadow said...

Ennyman,

Another excellent article ... timely for me. Losing the hair on my head AND in my ears.