Audiology: all about ears & hearing loss


[announcer] Welcome to glass half-full with Leslie
Krongold she shares her stories, experiences, and
knowledge of living and coping with a chronic health condition. learn about
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are you ready? [Leslie] Today’s episode is all about hearing. I’ve wanted to address hearing loss for a while and hoped to interview a woman in the local disability community. She has a condition which has caused her
progressive hearing loss I can’t progressive hearing loss; I can’t remember the name of the condition but
she reads lips and she also has this device that can be worn around the neck
of someone she’s speaking with which enables her to hear better. I have
worn it when I talked her a couple of times.
anyhow we’ve been conversation for over three years about doing an episode on
hearing loss together but she’s been hesitant and non-committal so I finally
discovered someone to address these issues – an audiologist who is even a
fellow podcaster. the other hearing related issue I’m thrilled to finally
address is that beginning with this episode I will have a captioned version
on YouTube. People with hearing issues don’t listen to podcasts. I’ve had a few
requests for episode transcripts and I’ve been investigating free automated
services because you know transcribing an audio interview is time-consuming and onerous. anyhow there is something called
an audiogram which is the easiest way to go you
using an online application that transcribes the audio track. the main
drawback for me is that it allows only one visual it seems like a video with a
transcription of the dialogue running along the bottom of the screen but
there’s no change in visuals and I would have all the glass half from pi episodes
caption so I’ll now commit to this though the majority of them will be
audiograms. I love to have visuals for all of them after all I did go to film
school but it’s so time-consuming so I’ll do a selection of them you know in
a real video style when I have some extra time but most of them will be
audiograms. back to my guest the audiologist. Dr. Lilach Saperstein. we met
in a Facebook group for podcasters or rather I saw her post about her podcast
and I realized she’d be the perfect guest and she is. You’re going to learn a
lot now about the ear which I suspect you have two of; I do anyhow she covers
everything from good ear health hygiene to some of the more common hearing loss
conditions. Dr. Saperstein is originally from New York but now lives in Haifa
Israel. She is currently working at the Rambam Medical Center on the cochlear
implant team and she is very passionate about all things related to the ear. By
the way one acronym mentioned frequently in this conversation is ENT that’s an
ear nose and throat doctor; they’re specialists and I actually saw one this
last year. [Dr. Lilach Saperstein] Audiology is an incredible field a field
of healthcare of medicine that deals with any disorders of the ear including
hearing and balance so what a lot of people don’t know about audiologists is
that audiologists do lots of different things not just hearing tests and maybe
giving out hearing aids which is something that many audiologists do do
but audiologists work with children and adults
so people have throughout the lifespan from babies all the way through
geriatrics and they can work in hospitals and ENT practices and private
practices in schools and also part of industry with some of the companies
that make the devices that people are using lots of different things that
audiologists can do. you have audiologists in private practice and you
have plenty of audiologists employed by hospitals and I think the different
route how you would get to one or the other would be based on what what are
the symptoms what are the presenting issues so if someone is having kind of a
typical issue with their hearing as they age then they’ll probably find
themselves at a private practice looking to get solutions for that maybe a
hearing aid or some other communication device or they just want to get their
hearing tested so they’ll find someone in the community whereas if someone else
is experiencing the more medical issue they’re having otosclerosis or any kind
of middle ear disorder or they have balance issues so those things that are
more heavily medical then they’ll probably go through the ENT which may or
may not be affiliated with a hospital and then they’ll see audiologists there. [Leslie] I asked Dr. Saperstein how common are hearing problems. [Dr. Lilach Saperstein] When we talk about
babies is about two to three out of a thousand babies will be born with some
level of hearing loss. about one one in a thousand will be deaf so that’s when
we’re talking about newborn babies but when you talk about the population
overall one-third of people over age 65 will have hearing loss.
and when you get to age 75 you’re up to half so it’s really one of the
most common conditions across you know across the lifespan and there are so
many different causes so you know someone who is born with a hearing loss
has something very different and a very different experience than someone
who develops it later in life and this is something I talk a lot about on my
podcast, that you need to be able to know what kind of hearing loss you have and
what was the source of the hearing loss what age the hearing loss began to
really know how to deal with it and so like sometimes you hear people say
hearing aids don’t work because you know a man who is 85 and
and he doesn’t hear anything even with his hearing aids so children
shouldn’t use hearing aids. it’s like two totally different cases, different kinds
of hearing loss, different devices you know when people try to extrapolate from
one anecdotal issue to everybody… that drives me crazy, but to answer your
question, there are a lot of things that can lead to hearing loss and one of the easy ways to understand this is about how ENTs are ear nose and
throat doctors and our ear nose and throat are all connected, they’re all
like one big system with our sinuses and with our throat so sometimes when
there’s a general sinus issue that can lead to back up in the ears and cause
like middle ear issues or there’s a lot of fluid or ear infections or things
like that and if that’s if that goes untreated or if that becomes a chronic
issue then that can cause permanent hearing loss in the middle ear and then
there’s just other issues that happen to the permanent hearing loss in the
cochlea in the inner ear and that can be from a head trauma like a car accident
or any kind of thing like that it can also be from acoustic trauma which is
like really loud noises, gunshots blasts… we see that a lot with veterans or
people who work in the music industry or people in factories so
there’s that cause of hearing loss and there’s also medications. unfortunately a
lot of medications especially medications given for cancer and things
that are life-threatening, they have a side effect of causing hearing loss so
you have that in the population of people who survive a major health situation and then they survive that which is wonderful and amazing but
then many times they have this side effect of the medication. [Leslie] it’s
fascinating I never heard that before. [Dr. Lilach Saperstein] those drugs that are for cancer are
really destructive in many ways to the body. so one of the things they are as
oto toxic toxic to the ear or they can also be vestibulo-ocular toxic to the
vestibular system our sense of balance yeah and you wanna of course you want to
save the person’s life you want to help them you know get over this
life-threatening illness and so hearing is not one the priorities but there is a
lot of monitoring that goes on with people who are going through those kind
of treatments where you can try and get the dose where it’s effective but not
harmful you know. [Leslie] so there were a few terms that I probably gleaned from
listening to a couple of your podcast episodes and looking at your website;
can you describe conductive hearing loss, sensory neural hearing loss, and mixed
hearing loss? [Dr. Lilach Saperstein] so to understand these terms just a tiny brief overview of how
the ear works which is my favorite thing to talk about. so so we have three parts
of our ear: the outer ear, the middle ear, and the inner ear. the outer ear is the
part you can see, it’s the part we call our ear where you might have earrings or
you could put your finger in your ear canal and that’s funneling the sounds in.
it’s bringing sounds in from your environment and sending them in to the
eardrum and then the eardrum is where the middle ear starts. the middle the
eardrum vibrates to the sounds that are coming in and behind the eardrum there’s
three little bones, the smallest bones in the body ossicles
and those little this chain of bones vibrates and then moves the sound
conduct brings it moves it forward into the cochlea
and then the cochlea is where inside of there there’s fluid that’s supposed to
be there. fluid that’s kind of going through this
snail and all along that spiral there are these hair cells. those hair cells
are nerve endings that are then sending those signals up to the brain so when
you have the outer ear, the middle ear, and the inner ear all working and all
functioning properly and everything’s in place then you have good hearing and
also the nerve needs to be working as well to send the messages from the ear
up to the brain and then the brain needs to process it so really if the process
is bigger than just the ear it includes the ear and then all the different parts
of the brain that are processing the sounds so if there’s a problem with the
outer ear or the middle ear that would lead to a conductive hearing loss
because sounds are not being conducted properly. they’re getting stuck so there
could be a hole in the eardrum. there could be tons and tons of wax so sounds
can’t get in past the wax. there could be an ear infection or fluid in the middle
ear space where those little bones are because if you have those little bones
they need to move and they’re supposed to have an air around them they need to
be in a cavity space but if that space fills up with gunk like fluid you know
that’s a technical term right yeah like back up from the nose or ear infections
or any of this like glue ear very very very common in childhood,
that’s like 75% of children will have an ear infection before age 2 so that’s one
of those things that like is very very common in early childhood but adults get
it too and it’s very painful and uncomfortable so anything that’s
obstructing sound from getting into the middle ear or the outer ear would be
considered a conductive hearing loss.. there could also actually be problems
with the little bones themselves; they can break or they can become stiffened
and hard so they’re not moving correctly. all different things like that whereas
the other kind of hearing loss which is sensory neural hearing loss is where
there’s a problem with the cochlea with those sensory cells that are inside and they float in the fluid so they need to be able to be mobile if
they become immobile or if they die off then that will lead to a sensory neural
hearing loss or if there’s an issue with the nerve so it’s like a delineation
between which part of the ear it has the problem – is it the conductive part or the
sensory neural part? and if somebody has elements of both of those issues then
they would have a mixed hearing loss so [Leslie] Is it part of your role to sort of
tease out what’s going on, where you know the origin of the loss is? [Dr. Lilach Saperstein] precisely
that’s a major part of the diagnostic process. when you do the hearing test in
the booth in this little tiny room you’re raising your hand every time you
hear the beep but actually more things are going on there then just getting
how loud you can hear the sounds because we can test just the cochlea by itself
and then test everything from the whole pathway from outside the ear and then if
those things are different then we can know that the where the problem is. it’s
the problem in the cochlea or is the problem on the way to the cochlea or in
both? [Leslie] so these diagnostic tests do you need to do them in person or is it like
telemedicine? has that impacted the field of Audiology? [Dr. Lilach Saperstein] that’s definitely
on the horizon and it’s coming, some of it has started but really to get a full
diagnostic picture you need the equipment. you need the sound treated
room but most importantly you need the expertise of the person who’s who’s
doing the testing because even if you had all the equipment and didn’t you know what you were looking for, like we just mentioned, there’s some apps that
you can kind of do a hearing test with and they they can be pretty accurate but
they’re not gonna give you all that information and also know what to do
with the information, who to refer you to, or what the treatment options are.
and there’s a reason that you know audiology is a doctorate degree.
it’s a four-year degree not a medical degree but it is you know a clinical
doctorate that requires all this background history. you know you have to
know how to ask the question so you get the information you need and how it fits
in with all other diagnoses and things like that.
[Leslie] what could you recommend as preventive behaviors for your health
auditory health? [Dr. Lilach Saperstein] yes okay so one of the major things that we can do is to
protect our hearing from very loud noises and very loud environments that
will go on for a long time so what that means is if someone goes to concerts or
very loud events and that’s one time they’re doing that, you know once a
year, okay so they should go enjoy the concert but if they’re the kind of
person who’s going you know every weekend or you know, the whole
summer, every weekend in the summer they have something going on or that they
themselves are in an industry where they’re exposed to this. we see a lot of
music engineers and DJs and people who work in catering or things like that
where they’re at events at weddings all the time and things like that and that’s
one of the the preventable kind of hearing loss is a noise-induced hearing
loss because someone was exposed to loud levels of noise for a long amount of
time .we can definitely use ear protection, earplugs, and earmuffs.
you know people also people who are using really extensive machinery even
for a hobby like jet skiing or mowing the lawn and you know gardeners and
things like that so people should be using those earmuffs and ear plugs
because they really do bring the noise down. [Leslie] those those leaf blowers oh maybe
yes they’re horrible. [Dr. Lilach Saperstein] yeah they’re annoying you when you’re in your house
and they’re doing the neighbor’s yard so can you imagine if you’re the one
holding that leaf blower how loud it is to you, how proximity yeah sure it’s
quite damaging. yeah I always pass by the gardeners and
make sure they’re wearing ear plugs. I keep an eye on them in my neighborhood.
that was the first thing of protecting the hearing but the second thing is that
getting a hearing test I would say pretty much when you turn around 50 years old, is a good time to go and get a hearing test just to have one on file even if
you don’t think that you’re having any problems with your hearing.
it’s a good idea because if there’s a little bit and if you could monitor it
and then you go five years later and you see was there a change you know so if
you’re getting that if you have the data and you just have a hearing test on file
for you that’s very good preventative kind of medicine, just like you go to the
dentist every year. I’d say around middle age is a good time to start getting
annuals and for sure if you’re having any issues with your hearing or you feel
like you’re saying WHAT? all the time, you’re having trouble on the phone, it’s
a great idea to do the hearing test as soon as you feel like there’s anything
going on and especially if someone else tells you that you’re having the problem
because that’s usually what happens right, the spouse or children or
co-workers will say why are you not hearing me
and you don’t know what you’re missing. if you’re missing it so if someone
notices some hearing loss whether it’s someone you know telling you or you just
are able to be aware and mindful that yes you do have some hearing loss what
should they do should they just talk to their doctor first you can you can talk
to your doctor but you can also make a appointment with an audiologist right
away and just go in for the the hearing test because sometimes doctors actually
are not as proactive as we would like them to be physicians sometimes look at
things like quality of life kind of things if you’re not suffering you’re
communicating fine with me, everything’s fine right .so I think this comes into
also a personality, what kind of person you are in general with with your health
but if there’s if you’re noticing a change and you’re asking the question
that’s enough, that’s enough to get a hearing test because our testing
doesn’t just say you know look at how the hearing is it’s also looking at the
health of the ear, if there’s a difference between ears, that’s a red
flag. why are your ears different? they’re the same age, and you eat the same thing
with you know your whole system, there’s no reason why your ears should be
different. or if someone has a chronic issue with with fluid they don’t get
that looked at that can turn into something permanent
whereas if they would have gotten help and treated it then it would have
resolved with medication. there’s just so many things that it’s not like
well this is what it is and nothing can be done sometimes things can be done so
go and find out what it is. something that’s incredibly dramatic that many
people don’t know about is that there are some viruses that people can just
have a cold upper respiratory infection and that can have an effect on
someone’s hearing. this is it’s pretty rare it’s called sudden sensorineural
hearing loss and it’s exactly that. it’s just sudden, usually after a viral
infection, and if it’s caught within the first 48 hours and someone is getting
steroid treatment to counteract what the virus is doing then they can save some
of the hearing but if they miss that window, then that’s pretty much the end
of the of that ear. very very unfortunate. we see that a lot, that people come in
with that issue and then they went to the doctor, maybe they did, maybe they
didn’t, and no major drama was made about it. like oh you’re hearing
went down dramatically over one day, let’s just wait till tomorrow and see
how it goes you know instead of going to an ENT, instead of going immediately to
get your hearing tested like that’s an emergency. there’s not a lot of
emergencies in audiology but that’s one of them. so I will put that
out there, just in case anyone needs to know that and tinnitus is extremely
common, especially with people who have hearing
loss. sometimes it’s one of the common reasons that people come
in is because they have tinnitus and then they discover that they have
hearing loss and when people have ringing in the ears it could be their
brain producing the sounds that are not coming in. like how come I’m not getting
new sounds, I’m gonna produce them myself. then they drive people crazy, they could
be very very difficult, hard to sleep, hard to focus. those are the you know
extreme cases. everyone gets a little tinnitus once in a while. if you
haven’t slept well, if you’re very tired or if you’ve you were in a loud
environment and then you came out of that environment, sometimes have
all sorts of thoughts like am i hearing things that I hear? if someone has a chronic loud obnoxious tinnitus, it could really interfere with
their life so then again we have different things to do,
different maskers where you can like put in a sound into, like the easy version is
having a fan on or something like that in the background but we can have these
little devices that kind of look like hearing aids that aren’t hearing aids
but are just producing a constant stream of white noise or sounds of a river
or something like that to to help cover up the tinnitus sound. and there’s also a
lot of CBT cognitive behavioral therapy that goes into that that’s outside my
scope but a lot of referrals with that [Leslie] so there’s cognitive based see what did
you say? cognitive behavioral therapy okay; did it make the
distinction that you didn’t say CBD? [Dr. Lilach Saperstein] oh no yeah. I worked for a few months in
the Veterans Administration Hospital in Brooklyn. the VA and we had a support
group for veterans with tinnitus that was a weekly support group. it’s a very
common issue especially if people had acoustic trauma
it was IED blasts and all those things. it was a group run by the audiologist and a
psychologist. there’s a whole curriculum of making peace with your tinnitus
because part of the problem is that if you’re hearing the sounds all the time
then you get angry and upset and anxious that you’re hearing them and that’s
that’s been the problematic cycle but maybe making peace with your tinnitus
and then it’s the new background you know you have your own music. yeah yeah it’s just kind of a hard hard
pill to swallow for some people but there are lots of different approaches
and techniques for dealing with tinnitus [Leslie] so what led you to launch a podcast? [Dr. Lilach Saperstein]
I launched my podcast the “all about audiology podcast because I think I was
getting that itch where I just always” wanted to be talking about audiology and
having this great interest and enthusiasm and passion for what I what I do and I
needed to do that without driving my husband crazy and I felt like there were some things that I wanted to say that were a little
bit maybe. not controversial. maybe not harsh. but you know. taking a
stance on certain issues that I felt were important to be broadcast and
I said no one is gonna give me a platform if I don’t take it for myself.
so I had the the motivation to to get some of my message out there a lot
of the things that I do are with children. and with the education of
children. who are deaf and hard of hearing. and how the conversation around
cochlear implants and sign language and language deprivation was happening. I
felt like there’s a bit of miss not misinformation but maybe incomplete
information so that’s kind of my soapbox but I really do love talking
about how the ears work and how our brains process sound because it fits in
with our emotional experience of the world and it fits in with how we create
relationships so it’s like a much bigger topic and I have an interesting, a sneaky
way to get into. [Leslie] do you have anything to say about those candles that people use
for you know? [Dr. Lilach Saperstein] I’m rolling my eyes is my answer.
okay so there’s actually an amazing YouTube video from an audiologist Dr.
Cliff, he did a test side by side where he burnt one down just in a cup and
burnt one down in someone’s ear and the result was identical. so basically if
they show you what comes out of your ear quote-unquote it’s actually just the
candle itself burning into a nasty gook that you can think looks like your wax
but is just the candle itself. not to mention how dangerous it is to have a
fire right next to your hair, not a good idea. so no this is not a real thing and
my professional opinion, and if you have earwax then you
should see a professional ENT or audiologist that does room and management
which is fancy words for they take the earwax out in a safe way. [Leslie] is it common to
develop more ear wax as you age? [Dr. Lilach Saperstein] it’s a lot of factors. it has to do with your
sebaceous glands which are with the parts of your skin that make oil though
the oily glands and then it mixes in with dead skin cells though the skin
cells of your ear canal with the oily substances with hair with dust and that
all mixes up into making earwax. and our ears actually flush that out in their
own natural system which is amazing. the way the skin grows, it grows in this
rotating outward way and you really should never ever ever use q-tips
because they will just push it in deeper and cause more harm than good.
plus they can cause scratches oh my gosh the people who use pins don’t get me
started. do not use anything sharp and your ears whatsoever. [Leslie] so how should we
okay so no q-tips so tell me what we should do? [Dr. Lilach Saperstein] you should, after you
take a shower, you should just use a little washcloth or a towel or a napkin
and wipe the outside of your ear and that’s it. now if there’s someone who’s
using q-tips all this time then it’s gonna take like a week or so to
recalibrate because the ear is going to make as much wax as it needs
and if you keep flushing it out it’s gonna keep making it so someone who’s
always using q-tips might have a couple days where it’s uncomfortable let’s say
but it will all even out and if you if some people who do get a great
accumulation of wax should have that removed by an ENT who has all this
special tiny equipment and lights and cameras to
get it all out and an irrigation like a water sprinkler and drainage system. it’s
like it’s complicated. you don’t just want to go in there with a pen or a
bobby pin. it’s based on like your hormones
in your skin level and and that but I don’t think it’s more common as
you age necessarily. I think it’s just an individual thing. what’s interesting is
people who use hearing aids, they do develop more more wax because the
hearing aids are blocking that natural mechanism of clearing out the
wax so people who have hearing aids do need to have their wax cleared out
more often. I would like to talk a little bit about communication
strategies which I think are overlooked. An amazing thing that
audiologists teach their patients and really can teach everyone are communication
strategies that help you communicate better when there’s misunderstandings
from the level of MIS-hearing like I didn’t hear you well, or I thought you
said this but you really said something else. and that happens to everybody even
people with normal hearing. in a quiet environment it happens you know we all
experience that but people with hearing loss experience that much more often and
it really can begin to interfere with your relationships, with your
productivity at work, you know it’s all the things that matter talking on the
phone and the more that hearing loss there is, the more isolated
someone can become and avoidant of those situations which are just more and more
frustrating so one of the things that we teach is using communication strategies
like asking someone to rephrase what they said if they didn’t hear properly
because if they just repeat it it might be difficult to hear those same sounds
again. so instead of saying what or say that again, asking someone to say I heard
this part of your sentence but what was the second part or can you say that in a
different way right? so learning how to ask the question that’s helping you to
hear better in a conversation and educating for yourself, for what your
needs are like where you’re going to sit in a restaurant like not near the
kitchen you know like get a quiet spot or or even what time you go to a
restaurant. if you’re having trouble and then
and you want to have a conversation with your people that you’re going out
to eat with, then maybe recommend a quieter place or a different time of day.
things like that, learning to work around the things I think that applies to any
kind of limitation you might say instead of having it as a limitation being
working with it you know and knowing what are the things that you can change
that will make it easier to communicate and overcome those barriers. [Leslie] I did
two things soon after interviewing Dr. Saperstein. I made an appointment with my
HMO for a baseline hearing test because I don’t think I’ve had my hearing tested
since I left seeing a pediatrician and the second thing, I stopped using q-tips.
I hope these podcast episodes reach a larger audience now that they’ll be
available on our YouTube channel with captions. I will no no longer say thanks
for listening but my announcer may continue saying it. I’ll speak with them
about thanks for continuing to tune into GLASS HALF FULL podcasts whether
it be online, on your phone, on youtube or any other place you follow us. thank you! [Announcer] thank you for listening to glass
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this helps spread the word to others dealing with chronic health issues. for
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