A specialist in otology, neurotology, and skull-based surgery, Dr. Villasuso shares his expert insights on the early signs of hearing loss and its impacts on cognitive function and dementia. Discover how early intervention can make a significant difference and why staying connected through improved hearing is more crucial than ever.
Shelby Stockton:
Welcome to the South Florida ENT Audio Blog. I'm Shelby Stockton, and today I spoke with the newest addition to the South Florida ENT team, ear specialist Dr. Eloy Villasuso.
Dr. Villasuso graduated with honors in electrical engineering from the University of Florida before transitioning to medicine at the University of Miami. There he achieved leadership honors Alpha Omega Alpha induction and research distinction. He then completed an otolaryngology residency at the University of Miami and a fellowship at the Michigan Ear Institute specializing in ontology, neurotology and skull-based surgery. We're excited to have him with us.
In this audio blog, Dr. Villasuso explains the early signs of hearing loss and how they can affect cognitive function and dementia. If you or someone you love suffers from any stage of hearing loss, this is an episode you don't want to miss.
Dr. Villasuso I want to welcome you to the podcast.
Dr. Eloy Villasuso:
Thank you. Great to be here.
Shelby Stockton:
Thank you very much. I know you're a busy guy. So let's get into it. Today we're going to talk about hearing loss and how it relates to dementia. So my first question for you is, what are the early signs of hearing loss?
Dr. Eloy Villasuso:
Well, oftentimes people start noticing the television volume is getting a little louder. They're asking “what” a little bit more often, co-workers, or spouses, or children are letting them know, "hey, I'm trying to get your attention. You didn't hear what I said." There are a lot of little subtle signs, some of the more glaring signs are when your co-workers or your boss call your attention to it. That's when a lot of people really go, “oh, I better do something about this.” But there's a lot of those little things, volume of the radio going up in the car, difficulty in restaurants. Those are the common scenarios; people want to hear better in those situations.
Shelby Stockton:
Okay, so what is cognitive function in dementia then?
Dr. Eloy Villasuso:
So cognitive function is the smart part of our brain. It's kind of divided into two parts, the smart part, and then the part that runs all the systems like your blood pressure, and your breathing, and your heart rate. And that smart part is the cognitive part, which is thought, and it has to do a lot of work. The brain is amazing. If we think about it, as we're walking around every day, everything you see out of the corner of your eye, every little sound that goes bump in the night, your brain is constantly processing signals, 24 hours a day, 7 days a week. It is an amazing amount of information, but very little of it actually reaches the smart part of the brain where we need to take actions. For example, there may be a million things bumping in the night, but you don't wake up for every single one.
But if the fire alarm goes off in the middle of the night, not because it's loud or an unusual sound (not the cat meowing), all the sudden you wake up to investigate even if it's not all that loud. So, the brain is amazing, and it deals with a ton of sensory input, but as we get older, like the rest of us, it doesn't work as well as it used to. And that's age-related cognitive decline where things just start slowing down. Dementia is maybe something a little bit different where there may actually be structural changes, or tau proteins, or other physical things going on that lead to dementia, which is a little bit different than cognitive decline. We all undergo some kind of cognitive decline, but cognitive decline doesn't equate to dementia.
Shelby Stockton:
Interesting. Okay, so then how does hearing loss play a role in cognitive function and dementia?
Dr. Eloy Villasuso:
Well, so hearing is one of our major senses. If we think about it, our two main senses are vision and hearing. We're predominantly visual beings, but after vision our hearing is probably the next most important sense. So, poor hearing or poor vision increase cognitive load and the amount of work to complete daily activities.
As you get older, the other part of your ears is your balance function. As your knees get bad and your back gets bad, and you're a little overweight, and you're a little hunched, it gets harder to walk and maintain your balance. And all these things are part of the cognitive load of the brain. When we're young, we don't think of any of these things. It just happens automatically. We hear everything we're told, we run, we jump, we hop, we skip, we run up and down the stairs.
As we get older, we must start paying more attention to all these things, and that increases our cognitive load, which is our smart part, and it must work harder to make it. When you're at a restaurant and it's noisy, you're leaning in and you're really paying attention to listen. That's harder than if you're just sitting back relaxed and hearing everything that's going on. After a half hour of leaning forward, you find a lot of people give up and get tired and they withdraw, and that leads to social isolation. So that cognitive load is increased. And as we get older, that cognitive load is spread across hearing and vision. If you have cataracts and you're struggling with vision or wear bifocals and struggle with vision, and your balance, the cognitive demands of the brain increase and put a strain on the brain, which in turn, it's not as young as it used to be, and has those challenges. That’s how it leads to cognitive decline and its relation to cognitive decline.
Social isolation - once you start withdrawing and you're not going out and you're not interacting with family, that decreases all that stimulation that I told you the brain is used to. The brain loves as much stimulation as possible, and like the old adage says, "use it or lose it." The more you use it, the more you stimulate it, the happier the brain is going to be and the less age-related cognitive decline there'll be.
And then lastly, as these things persist for years, the brain adapts and not necessarily in the best ways. If it's deprived of stimulation, we know that the brain starts undergoing structural changes to compensate. But if there's no stimulation coming in, those changes may not be beneficial. And then how that plays in with dementia and the structural changes of dementia is still a mystery. We don't know exactly the relationship, but we do know that all these things impact it. So the more we can stimulate our brain, the more we can try to slow the decline. Hence, they say hearing aids are a way to mitigate, which is a little bit of a stretch, but it increases the stimulation.
Shelby Stockton:
Okay. So does the degree of hearing loss pose a higher risk for dementia?
Dr. Eloy Villasuso:
So some of the studies show that the more severe the hearing loss, the higher the risk for dementia. And we must remember that it's a risk. It doesn't mean you're going to get dementia, I have a lot of patients with really bad hearing loss that don't have dementia. So it's not a foregone conclusion or far from it. But there are overlarge population studies that have seen an association. It’s always better to start treating it when it's early so that you don't have to suffer the effects of long-term structural changes that may occur with sensory deprivation.
Shelby Stockton:
What type of cognitive intervention or rehabilitation programs help alleviate the impact of hearing loss on brain health?
Dr. Eloy Villasuso:
I think the best thing to do is see a neurologist so that they can help you manage the cognitive decline and then exercise your brain doing crosswords, doing Sudoku, hearing everything that's going on around you. Even if you don't want to hear your wife anymore, it's important to listen to her and see things and do the things that you can. Stay fit, stay active. That trains the balance system. And the balance system is very important as well. As we decrease our mobility, we're less likely to go out, we're less likely to interact socially. And it just becomes way too easy for people to say, I'd rather not. Rather than look forward to going out, interacting, taking that walk. Staying physically fit and mentally fit are both key to helping reduce cognitive decline and maintain performance.
Shelby Stockton:
Why do you think people don't want to get hearing aids?
Dr. Eloy Villasuso:
Oh, still, unfortunately, all the usual causes. It makes me look old. It makes me feel old. They don't look attractive. Everybody will know that I'm having trouble. A lot of things like that. And finances are sometimes challenging as well. Hearing aids are becoming more affordable and there's better insurance coverage, so that addresses the financial issues. And the social stigma issues really are from a day's gone by. I mean, that's from when our parents and grandparents had hearing aids. Today's hearing aids, you can't even barely see them. They're super comfortable to wear. After wearing them for 20 minutes, they're more comfortable than the AirPods and headphones that you're wearing. They're going to connect you to life. They have Bluetooth, so they're going to connect you to your phone, to your TV, to your computer, to your tablet. What's younger than being hip and being connected to everything? So there are a lot of advantages and they don't really look bad and nobody can really see them anymore. So you get all the benefits and really none of the negative impacts. And once you feel younger, you'll be younger and you'll act younger.
Shelby Stockton:
Definitely. Do you have maybe a positive story you could tell us about one of your patients who got an hearing or a spouse of somebody who had an hearing aid?
Dr. Eloy Villasuso:
Absolutely. So, we had a patient, it's been several years now. She came in a little reluctant to get hearing aids, but we talked to her and discussed her hearing loss. We explained all the different ranges and that she was in the range where hearing aids would help. So, she got her hearing aids and then she came back two weeks later for her adjustment, and she ran up and down the hallways saying, "wow, they need a new ad campaign. Hearing aids make you feel young!" And everybody was like, all right, that's great, but what do you mean? And she said, "Well, nothing makes you feel older than when people look at you with that, ‘what's wrong with you lady’ stare. Now that I got my hearing aids, I'm answering all the questions right, I'm hearing everything everybody is saying, I'm going out more, I'm interacting more. Nothing makes me feel younger than participating and being alive and not getting that look, ‘lady, what are you talking about?’ That was what made me feel the oldest. People used to ask, ‘why is she going, huh? Why can't she hear?’ Now I hear everything, and I feel young. It's great. I am re-engaged."
That’s my favorite story, and that's what I think hearing aids really offer people, the opportunity to re-engage with other people and technology. There are a lot of techies out there. When the guys find out that they can listen to their phone through their hearing aids and listen to the TV through their hearing aids, their eyes light up, “wow, that's really cool.” So they're cool devices. They're not your grandparents' hearing aids. I'd say it makes you feel young again, gets you back into the conversation.
Shelby Stockton:
Yeah. Hearing aids just need to be rebranded. There was a time when online dating was thought to be gauche and now everybody's doing it.
Dr. Eloy Villasuso:
Yep. Everybody should be doing hearing aids.
Shelby Stockton:
Definitely. Well, thank you so much for your time, doctor. We really appreciate and this information is very helpful.
Dr. Eloy Villasuso:
Oh, it's been my pleasure. Thank you.
Learn More About Dr. Eloy Villasuso
