Hearing Loss and Treatment with Brian Taylor

Announcer (00:06):

You are connected and you are listening to specifically for seniors, the podcast for those in the Remember When Generation. Today's podcast is available everywhere you listen to podcasts and with video at specifically for seniors YouTube channel. Now, here's your host, Dr. Larry Barsch.

Larry (00:37):

One of the most common problems that older adults have is hearing loss and the inability to hear conversations clearly in a group setting, even when they are wearing their hearing aids, especially when there's a lot of background noise. So, we asked Dr. Brian Taylor, the senior director of Audiology for Signia to come on specifically for seniors to talk about the problem and the solution. Brian is the editor of Audiology Practices, a quarterly publication of the Academy of Doctors of Audiology, and an adjunct instructor at the University of Wisconsin. Dr. Taylor has been a member of the American Academy of Audiology since 1991. Welcome to specifically for seniors, Brian.

Brian Taylor (01:31):

Thanks, Larry. It's great to be with you.

Larry (01:34):

Let's start with a simple question. How common is hearing loss in older adults?

Brian Taylor (01:41):

Well, it's probably more common than people think. If you look at the entire adult population, we have data suggesting that about 15% of adults from 18 to over a hundred have some degree of hearing loss. Now, of course, the prevalence goes up pretty significantly as people age. Something like 80% of adults over the age of 80 have some degree of hearing loss. So we can see there's definitely an age component to the prevalence numbers.

Larry (02:15):

What are the main causes of hearing loss, especially in older adults?

Brian Taylor (02:20):

Yeah. Well, I think the main cause is just wear and tear and genetics, that combination. We know from genetics that some people are more prone to hearing loss than others, just like some people are more prone to get gray at a younger age than others. But it's also wear and tear of people that are in noisy professions or have hobbies that expose them to a lot of background noise or high levels of noise tend to get hearing loss sooner and also tend to get greater degrees of hearing loss. So that's really the biggest cause, just age related genetic wear and tear. Other causes are related to well noise exposure. That's another leading cause. Other medical conditions can cause sudden types of hearing loss or temporary types of hearing loss.

Larry (03:17):

And I know there are medical implications of hearing loss, but what about the social factor?

Brian Taylor (03:26):

Well, I think that, again, that can, that kind of flies under the radar. People that have a gradual hearing loss. Usually hearing loss starts when you're younger than you might think. You might not, may not notice it, other people may notice it. When you're in your forties and fifties, you have a small or a mild hearing loss. And over time it gets worse. And what usually happens is, as your hearing loss gradually declines, you develop coping strategies and what I would call maladaptive behaviors that help you understand, like cupping your hand behind your ear asking people to repeat, turning up the volume on the TV or the radio or whatever you might be listening to. And it's easy to kind of get by. And eventually what happens socially is you may get extremely tired at the end of a, an event that you're trying to listen really hard for a few hours, so you get more tired at the end of the day. And that's sort of a cascading or a snowball effect where you go into these situations and you're tired and then pretty soon you're feeling like it's not worth my time and my energy to go there. So you start avoiding those kinds of situations and then avoiding those situations kinda leads to frustration sometimes even isolation and loneliness. So there's this snowball effect associated with the social dynamics of hearing loss.

Larry (04:54):

And I've heard or read that there are some comorbidities with dementia and hearing loss.

Brian Taylor (05:03):

Yes. there's quite a lot of data now that suggests that there's a linkage between untreated hearing loss and cognitive decline, and dementia, meaning as your hearing loss worsens. And as, and the longer you delay treatment the more it's likely to impact cognitive decline. Now, it's important that I say that hearing loss does not cause dementia, but we know there's a linkage, meaning the greater the hearing loss, the more likely you are to have dementia. And that's one of many comorbidities associated with, with dementia. Hearing loss is just one of many.

Larry (05:44):

And there are different types of hearing loss,

Brian Taylor (05:49):

Loss. Yes, there's different types. It kind of depends on what site in the auditory system is the where the site of the damage. So remember from your high school biology that there is an outer ear, a middle ear, and an inner ear, and each one of those locations could be the site of some damage that causes a specific type of hearing loss. For example, if you have fluid behind your eardrum in the middle ear space, that's called the conductive hearing loss, it's blocking the transmission of sound into the inner ear. That's more common in children, but it can affect adults. The most common type, the most common site of damage in an adult with gradual hearing loss is the inner ear, what we call le cochlea. Le cochlea is lined with thousands of tiny hair cells. And those hair cells are susceptible to damage. We call that a sensory neural hearing loss. And it's typically irreversible. You can't once the damage starts, you can't stop it. You can only prevent it from getting worse. So those are the main nets, sensory, neural conductive. Those are the main types of hearing loss.

Larry (07:02):

And do hearing aids work to improve hearing loss on all three types of hearing loss?

Brian Taylor (07:09):

Yes. They work with all typically with a conductive hearing loss, that would be, there would be some sort of a medical intervention, medication surgery that might correct that. Sensory neural hearing loss is usually whe where hearing aids come into play. Now I think it's important to note that hearing aids don't restore normal hearing. They don't bring back those damaged hair cells. But I think they do a really, a remarkable job of of supplementing them of taking their place in the way that they work.

Larry (07:46):

And how, how do you diagnose the type and severity of hearing loss?

Brian Taylor (07:54):

Well, there's two professions that do that. One are o otolaryngologists e n t physicians with their examination sco, they look in the ear with an otoscope. They might do a tuning fork test, and they could identify what type of hearing loss. The other profession that does it is audiologists with a series of tests called audiometry and speech recognition. And that combination of tests will tell you not only the extent of the damage or the degree of the hearing loss, but also the, the sight of the damage in the in the ear

Larry (08:36):

When a patient has hearing loss. What, what concerns and complaints do they usually present to an Ali audiologist with?

Brian Taylor (08:51):

Yeah, that's a really good question, Larry. I think one common complaint or symptom would be ringing in the ears, which we call tinnitus or tinnitus, that in many cases of hearing loss, you have ringing in your ears that goes along with it. That's, and there's many different types of ringing. Sometimes it's constant, sometimes it's intermittent, one ear, both ears but ringing in the ears or tinnitus is very common with hearing loss. The other is difficulty hearing in background noise difficulty hearing weaker sounding voices, higher pitched voices like children and women hearing people from far away having other people complaining that the TV or the radio or whatever you're listening to has to be turned up louder. So those are the most common complaints that, that I've heard over the years.

Larry (09:47):

It's interesting you mentioned that tinnitus is associated with hearing loss. Does that mean that hearing aids can improve the problem?

Brian Taylor (09:58):

Sometimes hearing aids can help tinnitus. If a person has hearing loss and tinnitus when they're wearing their hearing aids, not only do they hear better, but they also then get relief from the tinnitus while they're wearing the hearing aids. And there's different theories about why that is, but essentially it's keeping the ear busy listening to other sounds, less likely to pay attention to the annoying internal ringing in their own ears. So usually hearing aids can help, but there's other treatments too, like masking different types of what we call cognitive behavioral therapy for someone that has debilitating tinnitus, and we know that only about 15% of people fall into that category of having 15% of people that have tinnitus fall into the category of having debilitating tinnitus. These different types of treatments can be quite effective.

Larry (10:50):

As a dentist, I know that there are some temporomandibular joint problems as well

Brian Taylor (10:55):

Sure.

Larry (10:56):

That are related to tinnitus.

Brian Taylor (10:57):

Mm-Hmm. <affirmative>

Larry (10:59):

The main problem, and, and the main reason I asked you to be on specifically for seniors is when I talk with friends of mine about problems they're having with their current hearing aids, the number one problem I constantly hear about is the inability to pick out voices in a crowd, in group conversations, especially with background noise.

Brian Taylor (11:25):

Mm-Hmm. <affirmative>,

Larry (11:27):

Is that consistent with your findings?

Brian Taylor (11:30):

Yes, it is. And it's consistent with about 50 years of data. In our profession, that's the toughest place for everyone to hear, regardless of hearing loss, regardless of age is hearing in a, we call it an acoustically complex situation, where there's background noise, reverberation, and multiple people talking.

Larry (11:54):

So, Signia recently released the press release mm-hmm. <Affirmative> that stated quote, Signia integrated experience, the world's first hearing aid platform capable of pinpointing multiple speakers in real times, enabling unprecedented sound clarity, and even the most immersive group conversations. Tell us about that.

Brian Taylor (12:22):

Well, I think like like all hearing aid manufacturers we're always on a quest to improve signal processing in these acoustically challenging situations. And I think at Signia over the last couple of decades, we've pioneered this approach that uses what I'll call spatially spatial noise reduction. So we're able to take several, what I call acoustic snapshots of the listening situation. And in each side of those, in each one of those acoustic snapshots, three from the front and one from the back, we can process voices in individually in each one of those snapshots. And that kind of technology and that kind of approach is highly effective when you get into a situation where there's multiple people conversing with you. Because not only does the hearing aid recognize the talker in each one of those snapshots, but once it recognizes or identifies the talker, then it can shape or amplify their voice so that you're more able to hear it.

Larry (13:36):

Does it reduce background noise as well?

Brian Taylor (13:39):

Well, it does, but I think it's important to realize that in those kinds of situations where there's noise and there's reverberation, which is sound kind of reflecting off the walls, that no system is going to get rid of that completely. If you did that, and, and we could, if we wanted to greatly diminish the background noise and the reverberation, the, the problem would be that it would also reduce much of the speech. Because in these kinds of situations where there's multiple people talking, oftentimes the noise you don't want to hear are other voices in the room. That's where the spatial component of this really comes in, because it'll lock onto voices that are to the front and to the side that you probably want to hear and amplify them.

Larry (14:28):

H how do you even do a research study on, on this type of process?

Brian Taylor (14:34):

Well, the, we do it in a lab environment where we can set up speakers all around the listener. You put the listener or the, the, the, the research participant in the center of the room. And then around the room you have multiple, sometimes 12, 15 speakers from different directions. And then you can divide, you can put noise from different angles, talkers from different angles. And that helps us actually tune the system so that we can kind of maximize performance from different locations. But anyway, we do it in a lab with multiple speakers.

Larry (15:10):

Is there a, a, a system that the individual works with in a crowded restaurant, for example?

Brian Taylor (15:21):

Well, I think that that's where the challenge comes in, because in the lab it's easy to design something. You know, you can carefully calibrate things and you can set things up the way that you want in the, in the, in the real world, of course a person can't always control the direction of the, of the talkers they wanna listen to, and the noise that they wanna try to ignore or suppress. I'll just say that when a person wa in the real world, when a person with a hearing aid walks, when they walk into a situation they need to know enough to try to control where the talkers of interest are coming from. And that usually requires, you know a little bit of knowledge about where to sit. A little bit of knowledge about maybe where to relocate themselves if they have to, to be assertive and say, Hey, I think it'd be better if we sat over there. 'cause It's gonna be a little bit quieter. I can control the, the noise better over in this situation. So it's a combination of the technology working well, and also the person knowing and being savvy enough to kind of situate themselves in a situation where they're gonna have better performance.

Larry (16:30):

Signia uses the term conversation enhancement. How does that work?

Brian Taylor (16:36):

Well, I mentioned those acoustic snapshots that you, we, we've developed in our IX technology, three from the front and the sides, basically, and one from behind. Within each one of those acoustic snapshots, the hearing aid can recognize speech and lock onto it and amplify it or shape it appropriately to match the, the what the person needs to hear it now. So that's, that's kind of what it is. And if the talker or the wear of the hearing aids moves, the hearing aid is smart enough to know that they're moving and continue to amplify their voice.

Larry (17:24):

So it almost tracks the speaker or the main speaker?

Brian Taylor (17:28):

It does, but the hearing aids, and this is not new we've had this for about five years. The hearing aids have a motion sensor in them, an accelerometer, so they know when the person moves that they need to, the processing needs to kind of move with it with them.

Larry (17:47):

Now, I, I, this is gonna be a little bit of a tough question, and I don't mean to have a gotcha in here. No,

Brian Taylor (17:53):

It's okay. Go ahead.

Larry (17:54):

Fire away. When we all reach a certain age, we become inundated with ads and promises for various types of hearing aids. This one's better, this one's cheaper. This one's, mm-hmm. <Affirmative> everything right. How do we know that Signia does what it says it claims?

Brian Taylor (18:14):

Well that's where regulation comes into play, and every time we launch a new device, a new product and we develop advertising or marketing for it, when we make a claim in that ad, we have to have data to support it that we're required by the F D A to do that. So for example, if we say that 95% of people that wear this device judge the clarity to be better, we have to have data from a study that supports that claim. So we're not making that up the f d a required hearing aid companies to start doing that about 30 years ago. And I think it's a good thing for consumers, and it's also good for manufacturers because it, it really sort of it forces us to make sure that we have our ducks in a row before we launch a product, because the last thing we wanna do is create a lot of uncertainty around a product that doesn't work very well. So we have data to support it. It takes years. People may not realize this three to five years from the time a new feature is thought up in the lab until it's put out into the market. And during that three to five year period, a lot of it is just making sure that it works, right. And it does what the claim says that it, that it does.

Larry (19:39):

But how does the individual person shopping or, or looking for a hearing aid get to test it on themselves?

Brian Taylor (19:51):

Yeah. Well, I, that's where the professional comes in. I think it's one thing to build a great hearing aid like we do at Signia. It's another thing to be in, to be professionally fitted by it. That's where licensed audiologists, licensed hearing aid dispensers come into play because only they know after an assessment and a needs assessment. And testing, hearing test from you, how to individualize the devices, what the limitations to you might be. You know, a big part of the assessment process should be to kind of figure out how well a person hears and background noise. Without that information, you really don't know how well the hearing aids are gonna perform on the individual. So I mean, over the counter hearing aids are, are around now. They've been around now for about a year. But I would say almost everybody benefits from sitting down with a, with a licensed professional gathering information about their, their situation, their hearing loss, where they're having difficulty hearing where they want improvements, and finding out what their options are. You can't go wrong when you have a trusted advisor or trusted professional to kind of help you navigate the process.

Larry (21:11):

Does the audiologist work through a trial period with your clients?

Brian Taylor (21:18):

Yeah. Most, I think every state that I know of hearing care professionals are licensed in each state, and each state requires that a person has at least a 30 day trial period. Some states it's actually longer than that, and that's, again, protects the consumer. It should give you confidence that you have enough time to kind of evaluate the situation, the product, to see if it's working for you.

Larry (21:44):

Where can listeners get more information about Signia products?

Brian Taylor (21:50):

You can go to Google or your favorite search engine and just enter Signia, S i g n I a Signia hearing aids. And you will go to our, our website, I think it's signia.net, but Google signia hearing aids, and you'll find our website.

Larry (22:11):

What, what type do you make? I know there's some in inner or ear, totally inner ear hearing aids and some external

Brian Taylor (22:23):

Well, we make all types. Yeah. So I

Larry (22:25):

Think, is there a reason why someone would select one over the other?

Brian Taylor (22:29):

I mean, there's different style preferences. Typically if you have a more significant hearing loss, you probably need something that goes behind your ear. But there are what are called receiver in the canal behind the ear products. They're very, very slim. We have one called stiletto that looks, it's very long, it's thin, fits behind the ear nicely connects to the ear with a wire where there's a receiver at the end. We also have what's called a, a completely in the canal, instant fit goes fairly deep into the canal of the, the ear canal called the silk silk ix. It's rechargeable, which I think is the first rechargeable instant fit c i c on the market. Again, that's where the expertise of the professional comes in to tell you what the pros and the cons are of the different styles. But there's a range of styles that are available to anybody.

Larry (23:27):

So the audiologist can also suggest what type of style of hearing aid is best for the individual.

Brian Taylor (23:35):

Exactly. They can kind of go through the pros and cons of each style for that individual and let you know, this is what I think would work best for you. Here's the upside, here's a potential downside. And you should always be able to have at least a couple of different choices to make.

Larry (23:50):

And are, are these covered by insurance or Medicare?

Brian Taylor (23:56):

Medicare does not cover hearing aids. They cover hearing tests, but not hearing aids. Various Medicare advantage programs and other private insurance policies do in part cover hearing aids. But of course, you always have to check the details with any insurance. But I do know that Medicare does not pay for hearing aids.

Larry (24:21):

Okay. Is there anything we you'd like to add that we missed?

Brian Taylor (24:27):

No, I think that just know that it's always good to work with a licensed professional to help you navigate the process. And that Signia has, you know, decades of expertise around trying to improve speech in background noise. And I think we have optimized the ability to hear conversations with our latest IX technology.

Larry (24:56):

Brian, thank you so much for coming on specifically for seniors. It was an interesting, informative discussion.

Brian Taylor (25:04):

Yeah, my pleasure, Larry. Thanks for having me on. I appreciate it.

Larry (25:07):

Thanks, Brian.

Brian Taylor (25:10):

Sure. That was good. Thank you.

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