A personal story from Dr. Roa, while she also discusses different treatment options and the pros and cons of over-the-counter hearing aids versus prescription hearing aids.
Shelby Stockton (00:00):
Welcome back to our two-part series on hearing loss with Dr. Maria Roa. In episode two, Dr. Roa shares a personal story about how treating hearing loss has a positive effect on the patient and their loved ones. She also discusses different treatment options and the pros and cons of over-the-counter hearing aids versus prescription hearing aids.
Can you share an audiology story that has impacted you?
Dr. Maria Roa (00:26):
Yes. So I have to think back very early on into my training as a doctoral student, I had to see an elderly woman for a hearing aid evaluation. She came in with her two adult children, and for an hour we discussed everything about her, her needs, her lifestyle, her day-to-day routine, so that I could select a pair of hearing aids that would be best suited for her. But I remember that she was extremely disengaged throughout that entire appointment. She was basically mute, she didn't say anything, and really her children were the ones that had to answer every question for her. Ultimately, I ended up ordering a pair of hearing aids for her, and I will never forget the day of her fitting, because the moment that I put those hearing aids in her ears and turned them on, it was like an entirely different person came out of her.
She went from being completely mute to talking nonstop, literally for the rest of the appointment, and we were all absolutely shocked. And it was actually a really, really good learning lesson, not just for me, but also for her children. They had mentioned that her hearing had been going for some years, and they'd essentially already mourned the loss of their mother, even though she was still physically with them and physically healthy, her personality had just changed immensely over the years that they felt like she wasn't the same person that they used to know, but they attributed these changes to aging. Turns out all this time, the same person was still in there. Full of input, full of opinions, with stories to share, so many things to say. So it was a shocking moment for everyone in the room.
And statistically, we know that this is true. The majority of people wait an average of seven years before they do anything about their hearing loss. And in her case, this was true. For years, she was stuck inside her head without a means to communicate. And when communicating is so hard with a hearing loss, why even try? So she'd just given up. And as a society, we really tend to normalize this. We expect hearing loss as we age, but we don't do anything about it. And it's totally normal for us, which is so astounding to me, that grandma or grandpa just sits quietly at dinner. They don't participate in the conversation, and we just write that off and say, "Oh, well, they're just getting old," but this is actually so wrong because for all we know, grandma or grandpa is still in there. They just can't hear the conversation.
So it was a beautiful moment for everyone because her kids got their mother back, she was able to get some of that independence back, some of her opinions. She was able to verbalize things. And since that, I think that was the day where I became such a huge advocate for earlier intervention when we're talking about our seniors and not playing into this, "Oh, they're just getting old. That's just what happens." Because since then, I've honestly had so many cases like this, and every time I turn those hearing aids on, it never gets old. There's honestly no better feeling than reintroducing communication to a family that's gone without it for so long. That definitely had to have been the most impactful experience.
Shelby Stockton (03:57):
That's really inspiring, and it's a good story for all of us to remember. Sometimes something just as simple as going to visit your audiologist can completely change your life.
Dr. Maria Roa (04:06):
Literally.
Shelby Stockton (04:07):
Besides asking people to repeat themselves, what are some other effects of hearing loss?
Dr. Maria Roa (04:12):
Yeah, that's an excellent question. And we know that hearing loss is a big deal. That's no secret. There's lots of data out there that shows that untreated hearing loss is associated with all sorts of negative health and social outcomes. And I have to give a big shout-out to Dr. Rao because she did an excellent job at covering these effects. So if you haven't checked out her audio blog yet, please definitely do so. But to summarize a few of her points, we know that people with hearing loss start to socially retract, and that increases our risk for depression and anxiety. We also use a lot more brain power when we have hearing loss, and this increase in cognitive load is exhausting for people. Patients often say that they don't feel as sharp mentally, and they experience a lot of listening fatigue after they interact with people.
When we go without hearing for a long period of time, we also worry about something called auditory deprivation, which is a fancy way of saying that when we don't stimulate the auditory nerve, and consequently the parts of our brain that help us interpret sound, they actually shrink at a more rapid rate. Those three factors contribute to a decline in cognition, which is a very hot topic at the moment. But there are actually other overarching effects that we don't talk about nearly as much as we should, so I want to get into that. We know that when people don't hear well, they also aren't able to follow doctors' orders. They misunderstand treatment recommendations, and this results in increased hospitalizations. They also experience more adverse medical events that are actually preventable. So things like accidental injuries, we see that a lot. And we also see an increase in readmission to the hospital. So this, if you can believe it, totals 3.3 billion in excess medical expenditures per year for older adults in the United States, so it's a financial burden on the healthcare system.
Now, in another sense, we also have to consider how this affects the people around us, because while we're living longer nowadays, that doesn't necessarily mean that we're living more healthy. So for people with untreated hearing loss that end up falling in this category, a large burden is placed on the family or caregivers. We see loss of independence way sooner into the lifespan. Patients have to continue going back to the hospital when they're not able to absorb all that information, and so the visits almost seem useless. And for the person that's taking care of them, this turns into a full-time job that consumes their time for a very long time. So in terms of negative consequences of untreated hearing loss, we know there are consequences for the patient, there are consequences for the caregivers, and for the health system as a whole. But the nice thing is that when hearing loss is treated, every single one of these things improve. So it's super important to realize that and attack it as soon as we identify it.
Shelby Stockton (07:30):
Okay, so let's say you get a hearing loss diagnosis. How do you figure out what treatment to use?
Dr. Maria Roa (07:37):
So once hearing loss is diagnosed, lots of things have to happen. First, we have to determine the type of hearing loss, and that can fall into three general categories. If there's a mechanical blockage in the outer or middle ear that's not allowing the sound to enter and get processed in the inner ear, that's what we would consider a conductive hearing loss. This could be things like wax impaction, a middle ear infection or an outer ear infection, an eardrum perforation, issues with our middle ear bones, things like that. Now, a lot of these types of things can be treated medically or surgically. So for example, if you have an ear infection, that might clear up once you receive some antibiotics, or you might get tubes put into your eardrum, and that helps clear out the liquid in your inner ear. And as a result, sound is able to get through the way that it should.
Now, if that's able to be taken care of, that's usually done by the otolaryngologist or the ENT, but there is another type of hearing loss that means there's been damage inside of the inner ear. And again, we're going back to those itty bitty, very delicate sensory hair cells, which once they're damaged, that's just done. We have not found a way to bring them back to life, so that is a permanent hearing loss. And generally, when we're talking about a permanent hearing loss, that should be treated by a hearing aid or a cochlear implant because there is no medical or surgical way that we can improve this. So that's typically when an audiologist comes in and they evaluate you a little bit further. It's the hearing aid that's that's best for your lifestyle, for your needs. And a cochlear implant comes in when the hearing loss gets so bad to a point where we feel like, even with the most robust hearing aid, powerful hearing aid, it's just not going to help. It's not going to help you understand better and noise. That's typically where when people end up falling into that cochlear implant category.
But there is a last category, which is a mixed hearing loss, and that's exactly what it sounds like. It's a mix of both conductive and permanent hearing loss or sensory neural hearing loss, and that can warrant help from both the otolaryngologist and the audiologist. The nice thing about South Florida ENT Associates is that we are able to collaborate with our ENT doctors so that patients feel like it's a one-stop shop. They're able to get whatever they need medically taken care of, surgically taken care of, and then if they also need that intervention with technology like hearing aids, we can really do that all in one place. So really, to answer your question, it's all about the type of hearing loss, the severity, and the needs that a person has, and that's how we figure out what is the best way of treating it.
Shelby Stockton (10:59):
Great. Okay. So what's the difference between an over-the-counter hearing aid and a prescription hearing aid?
Dr. Maria Roa (11:07):
That is also a very hot topic question nowadays. So legislation for over-the-counter hearing aids actually first passed in 2017. It was supposed to go into effect in 2021, but then COVID happened, and that delayed things. So we finally were able to see it come into effect in October of 2022. And basically all it is, it's FDA-regulated simple amplifiers that oftentimes look like hearing aids, but they're intended for people that have a mild to moderate hearing loss. The reason that the government did this is because we recognize that hearing aids historically have been very expensive, so we need to increase accessibility, and that was their first step in doing so. But this only has so much amplification in it, so it's not intended for everyone. If you can think of it any way, think of it like the first set of non-prescription glasses that you're able to buy in the store.
So when you're not ready for your prescription readers, you can go to a CVS or Walgreens and buy just a non-prescription pair of glasses, so that's exactly what this is. It's a simple amplifier. It's not customized to you, but it's a good starter pack. And what we hope for is that it gets people into the door, because custom hearing aids or prescription hearing aids are entirely different. Their technology is much more sophisticated. They can fit a variety of losses, going from mild all the way down to a profound hearing loss. They're fine-tuned to your hearing needs specifically, and typically the audiologist will measure with a microphone in your ear what's coming out of the hearing aid, and that's how we fine-tune it. So it's a very customized experience, and that's why the price is a little bit different, because there's a lot of care that goes into it compared to an OTC where there's no provider at all.
So probably one thing that I'll say is that the one concern out there for the OTC products are that research shows us that people absolutely underplay their hearing loss all the time, and I can tell you this from personal experience. Patients come in all the time thinking that they don't have a problem at all. It's actually usually their spouse that's the one raising havoc, if you will. They're the ones that are like, "They're not hearing me at all whatsoever," et cetera. But the actual patient themselves, a lot of the times they don't even feel that. So we worry sometimes that those are the kind of people that are like, "Eh, I don't really need anything yet. I'm just going to appease my spouse. I'm going to go buy something at CVS." But if we were to test them in the booth, their hearing loss is probably way more than a moderate level.
So I think that OTC is a great option for people that are starting out, but I definitely am an advocate that you should absolutely go see an audiologist to get your hearing tested beforehand, because we will tell you honestly, if you're not there yet, if you can buy this in the store, we'll tell you that. If you don't need to spend your money on a hearing aid just yet, that's okay. But what we don't want is a ton of people walking around with severe hearing loss and a little itty bitty amplifier that's not going to do a whole lot for them.
Shelby Stockton (14:54):
Dr. Roa, thank you so much for your time.
Dr. Maria Roa (14:57):
Oh my gosh. Thank you so much for having me. It was a pleasure.
