Audiology: all about ears & hearing loss

August 23, 2019

Approximately 20% of Americans have hearing loss. This can be a result of any multitude of situations — a symptom of a health condition, tinnitus, viral infection, acoustic trauma, or side effect from a medication.

Dr. Lilach Saperstein, an audiologist with her own podcast, discusses issues related to the outer, middle, and inner ear. Learn how to best protect your hearing as well as communication strategies to use when there is hearing loss.

This podcast episode — as well as future and all previous episodes — will be available with captions at the Glass Half Full YouTube channel.


welcome to glass half-full with Leslie cron goal she shares her stories experiences and knowledge of living and coping with a chronic health condition learn about tools and resources and hear inspirational interviews that help you to live a life filled with quality and dignity with two decades of support group leadership Leslie is ready to help you make lemonade out of life’s lemons are you ready

she’s a condition which has caused her 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 impact 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 was 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’m 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 the anthem and journey and 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 you know had some extra time but most of them will be audiograms back to my guest the audiologist dr. Lila 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 to of I knew 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 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 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 I asked dr. Saperstein how common are hearing problems 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 seven 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 then 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 I know you know I’m a man who is 85 and and he doesn’t hear anything even with his hearing aids so 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 one of the easy ways to understand this is about how ents are ear nose and throat doctors and our eat 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 and are always or 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 you know situation and then they survive that which is wonderful and amazing but then many times they have this side effect of the medication it’s fascinating I never heard that before those drugs that are for cancer are really destructive in many ways to the body so one of the things they are as odo 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 on 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 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 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 ear infections 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 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 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 it’s not part of your role is to sort of tease out what’s going on where you know the origin of the losses 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 and 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 so these diagnostic tests do you need to do them in person or is it like telemedicine does that has had impacted the field of Audiology 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 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 who to refer you to or what the treatment options are and there’s 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 what could you recommend as preventive behaviors for your health auditory health 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 that 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 every 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 those those leaf blowers oh maybe yes they’re horrible 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 your how proximity yeah sure it’s quite damaging yeah I always pass by the gardener’s and make sure they’re working they’re here 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 fifty 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 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 , can turn into something permanent whereas if they would have gotten help and treated it then it would have resolved with medication there’s 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 in 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 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 no major drama was made about it was like oh you’re hearing when 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 and hearing 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 the 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 close 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 when 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 this figure that but if someone has a chronic loud obnoxious tinnitus it could really interfere with their life so then again we have different 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 or sounds of a river or something like that to to help cover up the tinted 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 so there’s cognitive based see what did you see me T yeah cognitive behavioral therapy okay what did it make the distinction that you didn’t say CBD 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 had acoustic trauma it was ID 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 your own toys 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 so what led you didn’t launch a podcast 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 in 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 there was some there were some things that I wanted to say that we’re a little bit maybe not controversial maybe not harsh but you know taking a stance on certain issues that 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 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 was happening I felt like there’s a bit of miss not misinformation but maybe incomplete information so that’s kind of my 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 do you have anything to say about those candles that people use for you know I’m rolling my eyes is my answer I’m kind of weird no 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 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 [ __ ] 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 piñon and if you have earwax then you should see a professional ENT or audiologist that does cerumen management which is fancy words for they take the earwax out in a safe way is it common to develop more ear wax as you age 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 so how should we okay so no q-tips so tell me what dangerous no which 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 equipment the ante has all this tiny equipment and lights and cameras to get it all out and a 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 base it’s based on like your home moans 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 that natural mechanism of clearing out the wax so people who have hearing aids do you need to have their wax cleared out more often good common I would like to talk a little bit about communication strategies which I think are the over looks and amazing thing that that audiologists teach their patients and really can teach everyone 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 and the more that the more hearing loss there is the more isolated someone can become an 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 fir 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 it 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 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 those barriers 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 am 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 it thanks for continuing to tune into glass-half-full pine casts whether it be online on your phone on youtube or any other place you follow us thank you thank you for listening to glass half-full Leslie invites you to leave a rating and review on iTunes this helps spread the word to others dealing with chronic health issues for show notes updates and more visit the website glass-half-full dot online


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