The sense of hearing is essential to human connection. In this episode of the South Florida ENT audio blog, we spoke to Dr. Ariel Grobman, MD and Dr. Carmen Orta, AuD, and they discuss what causes hearing loss, how to prevent it, and some remarkable advancements in hearing aid devices. If you or a loved one suffer from hearing loss, this one is for you.
Shelby Stockton (00:00):
Welcome to the South Florida ENT Audio Blog. My name is Shelby Stockton, and today I had the opportunity to speak with ENT Dr. Ariel Grobman and audiologist Dr. Carmen Orta about hearing loss. We discussed what causes hearing loss, common disorders and how you can protect your hearing. Most importantly, both doctors emphasize why better hearing improves our quality of life. Take a listen.
Shelby Stockton (00:25):
Dr. Grobman, thanks for spending some time with me together.
Dr. Ariel Grobman (00:26):
So happy to be here. Thanks for having me.
Shelby Stockton (00:30):
And Dr. Orta, I appreciate you being here as well.
Dr. Carmen Orta (00:34):
Thank you for the invitation.
Shelby Stockton (00:36):
So we're going to talk about hearing loss. And my first question is for you, Dr. Grobman. What causes hearing loss?
Dr. Ariel Grobman (00:44):
There are many causes of hearing loss. There are genetic causes, which are causes that we're born with, and those are also called congenital types of hearing loss. There are also many causes that are acquired, or something that we develop, and those can be very varied. They can be from infection, they can be from trauma to the ear, from accidents. We can get hearing loss from various strong medications, such as chemotherapy and radiation, and other illnesses, and also acquire hearing loss over time as we age.
Shelby Stockton (01:28):
So what can people do to protect their hearing and help prevent hearing loss?
Dr. Ariel Grobman (01:35):
People can obviously, if there are medical problems causing the hearing loss, get them treated as soon as possible by seeing a qualified physician, such as a regular doctor or an ENT to take a look in their ears. There are a lot of occupations where noise exposure is a big problem, and helping avoid and limit time around very damaging loud noises can be very, very important. Then also avoiding things like sticking Q-tips in your ears and harming your ears by physically messing with them too much. Anything you'd like to add, Dr. Orta?
Dr. Carmen Orta (02:17):
Yes, well, to protect the hearing for noise exposure, there's ear plugs that we can use, and actually there is musician ear plugs, there's occupational ear plugs that are designed and customized for the patients. So a qualified audiologist can do perfectly fine that. We take an impression of the ears and we customize the ear plug for that particular ear. So we can use actually a different filter to do like 30 decibels reduction, 20, 15, 9, depending on the occupation, or if we do a musician plug, so that way the sound of the music stays perfectly fine, but the noise that can damage the ear is prevented.
Shelby Stockton (03:10):
So if someone suffers from hearing loss, how would they even know?
Dr. Carmen Orta (03:15):
Well, this is a very good question, because it is important the same way we monitor our eyes, that you go to the ophthalmologist and you do an annual eye exam. We encourage people to do a hearing test every year to see how your hearing is and you have a baseline. And especially now kids that they are exposed to loud music all the time, video games. We're seeing many, many kids, teenagers already with acoustic traumas. So it's very important to test our hearing and have a baseline so that we know how our hearing is progressing.
Dr. Ariel Grobman (04:03):
It's very important that early on in life, we make sure that people are hearing properly. Proper detection of hearing loss is something that we've developed pretty well as a healthcare system over time. But I really encourage parents to have their kids hearing tested. If they're concerned that they're not doing as well in school or not developing verbally as quickly as they would like to, because there are so many resources available to people.
Dr. Ariel Grobman (04:36):
We see a lot of pediatric patients in our office with even mild to moderate hearing losses that can really affect their development as they age and early intervention is key. So once detection happens, intervention needs to happen. And that's where a qualified team comes into play. On the adult side, there are a million tools now available for testing your hearing, given the fact that we all use smartphones and have access to the internet. So people can just go ahead and test their own hearing via a lot of apps on the app store on their smartphones or on the internet. And if they think that there's any kind of distortion or disruption of their hearing, come in and get a more formal exam with a qualified audiologist.
Dr. Carmen Orta (05:20):
Yeah, something that is important to note is that there's patients that they deny the hearing loss, that the family members are the ones detecting the problem. So that's very, very common. So we encourage also the family members when they see their parents or grandparents isolating themselves or not communicating in a fluent conversation to bring the patient for a hearing test and see if we can help them.
Shelby Stockton (05:55):
What are the most common hearing disorders?
Dr. Ariel Grobman (05:55):
The most common hearing disorder is age-related hearing loss, also called presbycusis. And this happens over time. Unfortunately, human beings are born with an amount of cells in the inner ear that we have throughout our entire life. They don't regenerate like starfish regenerates their legs. So some people have more hearing loss than others because those cells are not functioning as well and over time, some people have that loss that happens a little bit sooner.
Dr. Ariel Grobman (06:37):
So that would be the most common type of hearing loss. We also see, very commonly, ear wax impactions that can block people's ears. And that's obviously a very reversible type of hearing loss. Those would be probably the most common. And would you like to say something about that?
Dr. Carmen Orta (06:55):
Yes. I think that there are medical conditions that are not that common, but we see it very commonly here in the office, like Meniere's disease, otosclerosis also, as a disease or a condition that can cause hearing loss. So yeah, it is important to say that in the US, there's approximately 48 million Americans suffering from some degree of hearing loss. That's a huge number. And so we have a problem that is there and that we don't talk much about it.
Dr. Ariel Grobman (07:38):
Yeah. Hearing loss is considered the silent disability. It's so prevalent, up to 7 to 10% of all Americans will have some form of hearing loss, which you don't see because it's not an external disability, but it creates isolation. And it's more common than most people think. So we want to bring awareness to that and encourage people to get themselves tested, but also their family members, because people at every stage of life present differently with hearing loss. Children in early stage of life present with difficulty following instruction, verbal development, problems in school that may go unnoticed. Teenagers and adults have problems in the workplace.
Dr. Ariel Grobman (08:34):
People think that they're stupid because they're not responding as quickly as others do to their hearing loss. And then you get to the more elderly population, where patients become isolated. They really become withdrawn. There's a lot of studies showing that patients in the geriatric population with significant hearing loss can have an early onset and more severe type of dementia. So it's really important to look out for each other and encourage people to get their hearing tested.
Dr. Carmen Orta (09:03):
Yes. And another fact that is important to mention is that adults or the elderly population, they wait even seven years before seeking help and looking to fit hearing aids. That's a very long time, seven years without hearing properly and then finally getting the help that they need.
Shelby Stockton (09:30):
Well, that brings me to my next question. What are some available treatment options?
Dr. Carmen Orta (09:37):
The treatment options, well, there's medical treatment options that Dr. Grobman can talk about.
Dr. Ariel Grobman (09:43):
Sure. So on the medical side, a proper exam and history of the patient is absolutely key. The history may clue you into the type of hearing loss which exists, and a physical exam and testing, obtaining a proper diagnosis is probably the most important thing because there's not a one size fits all treatment for all patients. Once you've identified the type of hearing loss that patient has, there are some that are more easily treatable.
Dr. Ariel Grobman (10:19):
For example, if someone has an ear wax blockage that needs to be removed, they may hear almost instantly better. If a patient has an illness causing ear infection, that's causing muffling hearing. If we treat the infection with antibiotics or a procedure, we can sometimes improve the hearing very quickly as well. Certain patients are surgical candidates, meaning that they may have the little bones of the middle ear that need to be repaired for the patient to hear better. Others are candidates for a more advanced surgery called a cochlear implant that can treat very, very advanced types of deafness in ways that were not possible before. But the doctor is very reliant on a really good audiologist. So I'm going to pass this to Dr. Orta, where she can talk about some of the audiological tools that we use to help patients with hearing loss.
Dr. Carmen Orta (11:16):
Yeah. So we have hearing aids, conventional hearing aids that can treat sensory and oral needs or conductive hearing loss. So what we do with the hearing aids is basically what we do with eyeglasses and the vision we do with hearing aids. We're basically compensating or correcting the hearing loss the patient has. Right now the technology of hearing aids is amazing. We have the digital hearing aids with noise reduction filters for the patient, automatic filters for the patient to feel good and comfortable in any environment. We have hearing aids that connect to different accessories to watch TV, to talk on the phone, they connect directly to the phone, smartphone or conversation via Bluetooth. The hearing aids today are very, very, very advanced.
Dr. Carmen Orta (12:23):
So we have different styles. We have hearing aids that can go out of the ear, also in the ear canal. We have actually a hearing aid that can stay in the canal for even three to four months without removing the hearing aid. And the patient comes to the office every three to four months to remove the hearing aid and put a new one, so patient doesn't have to deal with cleaning, and they're completely invisible. They're going completely in their canal, very close to the eardrum.
Dr. Carmen Orta (12:59):
We also have bone conduction hearing aids that can be fit with a surgery or non-surgical as well. For example, of the Baha or osteo or Bonebridge are those type of hearing aids. The cochlear implant, the doctor, the surgeon is going to do the surgery to implant the internal device in the cochlea, the electrodes. And then the audiologist is going to activate those electrodes with a sound processor that is an external sound processor.
Dr. Carmen Orta (13:38):
So the variety of treatments with hearing devices is amazing right now. There's actually a new device that we're working with, we're starting to work. It's called Earlens, that instead of amplifying the sound, the ENT places like a contact lens over the eardrum and the device that goes in the ear canal vibrate that contact lens and makes the eardrum to vibrate. It's amazing what you have, all the options that we have for each patient.
Dr. Ariel Grobman (14:20):
The previous world of hearing rehabilitation has changed. We're in a brave new world in terms of options for patients suffering with hearing loss. All of the stigmas previously about gigantic hearing aids, about so much feedback, feeling taboo to have something in your ear, behind your ear. We don't have a one size fits all treatment. Our job is to customize a plan for auditory rehabilitation to our patients in a way that fits their lifestyle and makes their life easier.
Dr. Ariel Grobman (15:01):
It's just amazing what we can do with profound deafness now, and bring hearing back to that early population of kids who wouldn't have been able to hear, or to adults who have been robbed, unfortunately, of their ability to hear, to now restore their self-confidence, self-esteem, ability to interact with others, get back to work. I've got some patients who fell out of the workplace due to their severe hearing loss. We get the cochlear implant in, we rehabilitate their hearing as a team, and we get them back into their workplace. And I can't even begin to describe to you the joy of empowering somebody like that and making them feel like a complete whole human being again.
Shelby Stockton (15:50):
That's amazing. It's no longer your parents' hearing aid. It's completely different.
Dr. Carmen Orta (15:56):
Not at all.
Dr. Ariel Grobman (15:57):
The game has changed.
Dr. Carmen Orta (15:59):
It sure has, yes.
Dr. Ariel Grobman (16:01):
Can y'all explain to me how better hearing improves your quality of life?
Dr. Carmen Orta (16:07):
Yes, communication is the tool to socialize. That's something that is when you are socializing, you need to communicate and you need to interact. When we hear, and when we understand what other people are saying, we can have a conversation that is fluent, that it doesn't have any interruptions, and that makes that communication easy. So when there's a hearing loss, we interrupt that communication. So patients, they isolate completely. They isolate, they get depressed, they get emotionally affected by the hearing loss.
Dr. Carmen Orta (17:03):
So definitely what Dr. Grobman was saying, putting back the patient to where they should be in terms of work, family, gatherings with their friends, and interacting with people, definitely is an improvement in quality of life that it's going to be the only way to do it is fitting them with proper hearing aids or doing a cochlear implant or treating their hearing loss properly.
Dr. Ariel Grobman (17:38):
If you think about it, hearing is actually the first sense as an organism, as a human being that we feel. There are a multitude of studies that show that babies in the womb respond to the sound of their mother's voices and vibrations. So you can imagine coming into this world without a sense of hearing disrupts that connection between the child and the mother from early on.
Dr. Ariel Grobman (18:12):
That's not to say that you can't live a extremely fulfilling, wonderful life as someone without hearing. However, there's no denying that hearing is essential to human beings, connecting with each other. And from an early age, from a middle age with hearing loss, or from an elderly age, hearing properly is essential to that human connection. Society is built on human connections. Work, friendship, social interaction, things that make us human, hearing is essential in that human component.
Dr. Ariel Grobman (18:52):
In every phase, there are different challenges with hearing, be it a child's behavior, a lawyer's ability to function in the courtroom, an athlete's ability to perform at the highest level in front of spectators, or an elderly patient's ability to be happy and interact and live a fulfilling daily life. So there are challenges at every step when there's hearing loss and we find so much pride in being able to help patients at all those various steps of life, get to their full potential.
Dr. Carmen Orta (19:31):
Like Helen Keller said, she was blind and deaf, and she used to say that the hearing loss kept her away from people, but her blindness kept her away from objects. That's the difference when you see, you see objects. But when you are hearing, you are communicating and you're getting that interaction with others, with society and other people. So that's very, very important.
Shelby Stockton (20:12):
Yeah. That's great advice. Doctors, thank you so much for taking time out of your day. I know you're very busy and I appreciate it.
Dr. Ariel Grobman (20:22):
Thank you for having us. We love talking about the ear and hearing and hearing rehabilitation, so anytime.
Dr. Carmen Orta (20:30):
Anytime. Thank you so much.
