The Surprising Truth About Hearing Loss Nobody Tells You

Foreign like to welcome everybody. Today's presentation on modifications to improve mental health for people with hearing loss. I'm your host, Dr. Donnelly Snipes. Now, I know this doesn't sound like a super exciting concept or topic, but it really is. Hearing loss is One of the 20 factors that they found is modifiable and in order to reduce the risk of dementia and cognitive decline in older adults. And so I want people to be aware of the impact that that might have. But there's a lot of things that you're going to see as we always talk about how something like hearing impairment, which doesn't seem to be related to mental health, can be intricate, intricately involved in all pieces of their life and really have some significant impacts. We're going to begin by developing an understanding of the causes and consequences of acquired hearing loss and each piece of life. And when I say acquired hearing loss, I am talking about someone who develops it over time or in result of, in. As a result of a trauma. I am not talking about people who are deaf. People who are deaf have different issues and have often learned to deal with those issues in a different way. So what we're talking about is people with acquired hearing loss. And then we'll identify interventions in each piece of life to reduce the negative impact of acquired hearing loss. And remember, PEACE stands for physical, interpersonal, emotional, cognitive and environmental. Hearing loss can be temporary or permanent. You can have temporary hearing loss after an accident or, or as a result of a gunshot or because you've got a really bad sinus infection and you can't hear to save your life. It sounds like you're underwater. There are a lot of reasons why somebody might have temporary hearing loss. That doesn't mean it doesn't impact the rest of their life. We need to recognize that temporary hearing loss, for example, a sinus infection, is going to affect people's balance and it's going to make them more likely to fall. It's going to make them less aware of their situation, of their surroundings, which could be more dangerous. And it can be really frustrating when you can't hear. So we don't want to ignore temporary hearing loss. Obviously, temporary hearing loss can be permanent. It can also be genetic. And some of the genetic disorders, the person is not born deaf, but because of issues in their ears, they develop deafness over time. And it can be acquired from exposure to a variety of ototoxins and exposure to loud noises, etc. We're going to talk about each of those and I'll explain why as we go through it. The prevalence of acquired hearing loss is between 5 and 12%, or 1 out of every 12 adolescents. Just let that sink in for a minute. If you're sitting in a classroom of 30 students, three of them, well, two and a half of them may have hearing loss. That is a lot, and we need to pay attention to that. For younger people, adolescents in particular, a lot of it has to do with listening to loud music and having headphones on while they're playing really loud video games and causing disruption to their ears. There are other things that, that we'll talk about, but they highlight that as one major preventable factor of hearing loss in adolescence. In adults over 50, it is, or under 50, I'm sorry, it is 15 to 20%. So people under 50 years of age, one in five has hearing loss. That's a lot. Think about when you go to church. Think about if you have people over for the holidays, for Thanksgiving. If you've got 15 people in the room, it's likely that at least three of them have hearing loss. And then in adults over 50, one in three, or about 35%, experience some level of hearing loss. Now, the levels vary widely, but what they're talking about is hearing loss that causes impairments in functioning hearing loss that may require assistive devices. What causes hearing loss? Well, you've got noise induced hearing loss. And that's what a lot of us think about when we think about acquired hearing loss. Prolonged exposure to loud noises. If you work in a factory or if you're work on a train or on an airplane, or you do lawn maintenance, you know you can. The list goes on. There are a lot of loud occupations or sudden extreme exposure to a loud noise, such as a gunshot or a car accident or, or something that goes really loud. All of these can damage the delicate hair cells in the cochlea, leading to permanent hearing loss. Sometimes it's temporary. Like if you go to a concert that's really loud and your ears are kind of ringing the next day, that tells you that those hairs got irritated, those cells got irritated. But generally that goes away over time. However, there is a significant portion of people when they are regularly exposed to these sounds that the hearing loss is permanent. We have age related hearing loss just getting older. Oh my gosh. This is another one of those things that as we get older we start to see this problem. The age related hearing loss can be due to the degeneration of those hair cells in their, in their cochlea and which is not something that we can do any Anything about really, but we'll talk about some preventative measures in a minute. There's changes in the auditory nerve that lead to reduced nerve signal transmission. And just like our arteries start to stiffen, our middle ear starts to stiffen, and that leads to less efficient sound trans. Therefore, hearing loss in aging, just like vision loss as we age, partly happens because of stiffening of the. The tissues and things. Okay, we need to help people acknowledge it and accommodate it. Otherwise they're going to struggle. When we can't hear. And think about when you have been sick and your ears have been all stopped up and it's been hard to hear, how did that impact you interpersonally? Did you really want to hang out with a bunch of people? If you're going, huh, what, what are you saying? Or if you had to use a lot of attention to focus, to try to hear, did the. Some of the things that you do for recreation, like watching TV or going to the movies, maybe you didn't want to do because it took so much mental energy to focus emotionally. It's frustrating. It's exhausting. Cognitively, it can make it harder to really solve problems and things. If you're stressed out because you can't hear, if you can't get the information that you need. So there are a lot of impacts. We also see hearing changes as a result of hormones, hormone changes. We know that testosterone and estrogen, among others, decline with age. Declines in these hormones are associated with increased risk of hearing loss. Estrogen provides neuroprotective and vascular benefits. So when estrogen goes down, we lose those benefits. We lose the hormone that was sort of trying to protect those hair cells in the cochlea. And then testosterone influences auditory processing and vascular health. We need to make sure that we're getting blood flow to all parts of our body, including our ears. Declines of these hormones leads to oxidative stress, inflammation, reduced cochlear blood flow, and compromised neuronal integrity, all of which contribute to hearing impairment. When your ears are not getting the oxygenated blood, when they are, then they're struggling because not only are they not getting the nutrients they need, if you will, the resources they need, but they're also not experience getting the helpers, if you will, that come in and reduce, take away some of the garbage. So they've got that oxidative stress that builds up. Now let's talk about ototoxic medications. This is another thing that can cause temporary or permanent hearing loss for a lot of people. Ototoxic medications may be temporary and when you stop the medication gradually, the hearing comes, comes back. That's not always true, but obviously if you notice a significant change in hearing when you start a medication, then it's important to discuss it with your doctor because the earlier you intervene, the better your chances of regaining your hearing. Certain antibiotics, including gentamicin and streptomycin and these ototoxic medications, even if you're taking them orally, they're going to potentially impact your hearing. Chemotherapy or radiation? Oh, chemotherapy and radiation are just buggers. They negatively impact everything. Loop diuretics. Diuretics such as those used for management of fluid retention due to congestive heart failure, liver cirrhosis or renal disease. Now why am I telling you all this? You're not a prescriber. The same reason I've told you about other medications and other disorders. If you're working with someone who has congestive heart failure and you notice that their hearing is starting to decline, you may explore whether they have recently had an increase in their diuretic medication. This is something that can be modified. This is something that can be addressed to reduce, reduce the progression of hearing loss in somebody with congestive heart failure or cirrhosis. High dose of non steroidal anti inflammatory drugs. This includes your ibuprofen and your naproxen and your aspirin. Those things for some reason do have an impact on people's hearing. And we're, when we're talking about high doses, we're talking about again, low, long term, high doses of the medication. Most people's stomach can't take long term, long term exposure to high doses of ibuprofen or, or etc. So we don't see this a lot, but some people may, some people may experience it even if they have just recently started taking higher doses than maybe they're used to. Antivirals and antimalarials such as hydroxychloroquine used to treat rheumatoid arthritis, systemic lupus, malaria and other things that YouTube will flag me if I say. But what's interesting about this is people who took hydroxychloroquine for any of these disorders may be at higher risk for hearing loss if they are currently taking this medication. And there are a lot of people who take it continuously because of their lupus or their rheumatoid arthritis. And if they are starting to experience hearing decline, we need to be aware of that. Infections, viral infections such as mumps, measles and cytomegalovirus, bacterial infections including Meningitis and syphilis and chronic ear infections can all cause hearing loss. Now, obviously, the ear infections are obvious if you've got a lot of pressure in the ears. If you've got an infection in the ears, that's going to affect the cells and the hair cells in the. In the ear, in addition to lots of other places. We also want to recognize that when we have these infections and when we're exposed to toxic medications, when we're exposed to toxic anything, it increases our stress. Whether you realize it or not, it. Your body physiologically recognizes, oh, that's not supposed to be there. So it increases your stress level, increases your HPA axis, and increases that oxidative stress, which develops as a byproduct of stress, if you will. And we know that oxidative stress is related to the development of hearing problems as well as cognitive decline. Trauma, head injuries damaging the auditory pathways in the brain or the structures of the inner ear can obviously cause hearing loss. If you get your bell rung, you may hear ringing in your ears for a couple of days afterwards, or hopefully not any longer than that. So head injuries, it can be, again, temporary or permanent, depending on the severity of the head injury and barotrauma, which are sudden changes in air or water pressure affecting the ear. Common, common in scuba diving or flying. Now, most patients you're working with are not going to be experiencing significant changes in barometric pressure. They're not going to be in a plane that is rapidly descending or scuba diving at such a depth and coming back up so quickly that their ears can't adjust. But if you've flown, you know how, or you may know how, it feels like pressure is building up in your ears, and then it equalizes. That's what your ears are supposed to do. But when it happens too quickly, the pressure can't equalize, and people may experience ear trauma as a result. Now, again, most people are not going to experience barotrauma, but I thought it was interesting to just kind of put it in there. Vascular issues that impair blood flow to the auditory system, such as stroke, um, and blockages in blood vessels supplying the cochlea, or auditory nerves. If we start having blood vessel blockages, which a lot of people start as we age, start having arteries that are more narrow and start having more blockages, unfortunately. And these things can contribute to hearing loss, basically, you're starving the ear, if you want to think of it that way. Autoimmune diseases, including autoimmune inner ear disease. Who knew it existed? It does and systemic lupus can both contribute to hearing loss. Now, we know that autoimmune diseases are triggered or exacerbated by stress. And so stress can activate these autoimmune conditions, which can ultimately end up causing hearing loss in people. Which is why when we're working with people who have lupus, who have autoimmune diseases, who have other issues going on, we need to make sure that they understand or they recognize how toxic stress really is. We can't avoid all stress. I wish we could, but we can't. However, minimizing unnecessary stress is huge. If we can find the. If we have the ability to minimize unnecessary stress, we're going to reduce a lot of biopsychosocial issues. Metabolic and endocrine disorders. Diabetes causes microvascular damage that affects the earth. And so people with diabetes, in addition to peripheral neuropathy in their fingers and their hands, they also may likely experience hearing loss as a result of the damage of uncontrolled blood sugar. Additionally, and. And my husband's grandfather has this problem with his hearing aid. Peripheral neuropathy in the fingers makes it difficult even for somebody with a hearing aid to push the little buttons to adjust the volume and adjust it as needed. They can't feel the stinking buttons, and that is frustrating. It's exasperating. If you know that you have the ability to change it and you can't, we need to figure out a way to address that one. Some hearing aids, you don't have to use the little button. So people with peripheral neuropathy can download an app, and they can adjust the different settings on their hearing aid using an app, which is much less fine motor, if you will, and that can go a long way to helping people feel more independent. Thyroid disorders, particularly hypothyroid. Remember, hypothyroid reduces your base metabolism, reduces blood flow. You start feeling kind of sluggish. So we're going to have reduced blood flow to the ears. We're going to have increased oxidative stress because the body's not able to effectively and efficiently clear out stress byproducts. And we know that a lot of people experience hypothyroid as they get older, as their gonadal hormones go down. It also, we know this, it impacts their thyroid hormones. People who are exposed to chronic stress, whether it's, you know, lifestyle stress or traumatic stress, chronic traumatic stress are much more likely to develop hypothyroid because remember the HPA axis, your hypothalamic pituitary, adrenal axis, HPG gonadal axis and HPT thyroid axis, they all work together. So when you're stressed, when the adrenal axis kicks off, it recruits its buddies, the gonads and the the thyroid to provide energy and neuroprotection and what's needed. Therefore, when our go nadal hormones start to go down naturally, then the levels of all of our other hormones tend to go down in concert because it's trying to maintain that balance, that proportion. And which is one of the reasons why we see a lot of people who are over 50 beginning to take thyroid medication. Lifestyle factors. Smoking is linked to hearing loss, possibly due to reduced blood flow to the cochlea. Deficiencies in essential nutrients like A C E and magnesium can also contribute to hearing loss. What's important to recognize here is a healthy diet is going to provide most of this. Some people may need a multivitamin, okay, and I will go on a soapbox about magnesium in the future. But a lot of these nutrients are essential for neurotransmitter production for healthy nervous system, etc, but if you mega dose on something, for example magnesium, it actually inhibits other necessary things like iron. So megadoses generally, unless your doctor tells you to, generally megadoses are not ideal because they throw everything out of balance and may cause other problems. You may solve one problem and cause another. Try to eat a healthy diet, try to eat a colorful diet and if your doctor thinks it's advisable, take a multivitamin. But that should be ample to get the nutrients you need. Excessive alcohol consumption may also contribute to nerve damage because one of the reasons is when people start sobering up, their blood pressure goes way up. Even if you're not like a chronic drinker and you're in detox, okay, if you're a chronic drinker and you're detoxing, you're at risk of a hypertensive crisis during that early detox phase. And you need to be under medical care for certain. But for people who go out and they have a lot to drink on Friday night, it's still not good for the body. And when as the alcohol leaves the body, there's that compensatory rebound where blood pressure goes way up, up. And those blood pressure fluctuations, especially the high blood pressure, can contribute to hearing loss. Eustacea tube dysfunction can cause fluid accumulation in the middle ear, chronic inflammation and structural damages from recurrent infections. I have eustachian tube dysfunction and it sucks, I can tell you that. But when those eustachian tubes, when your ears get plugged up if you've had that experience. At best, it's uncomfortable. At worst, it's painful. And we know that when, when we're in pain, we're going to be more stressed out. We're going to have more difficulty concentrating, focusing when we're in pain. When we've got that pressure in our ear, we're not going to sleep as well, which is also going to negatively impact cognition. And if you notice that the person that you're working with is experiencing clogged ears, make sure that they go see the doctor. It may be wax buildup, it may be eustachian tube dysfunction. Whatever the case, if there's something going on that's causing pressure or discomfort, it's likely negatively impacting their sleep and causing additional unnecessary stress that can cause a whole suite of other problems. Chemical exposure. And a lot of us are exposed to a lot of chemicals. Industrial solvents like styrene and toluene, which can be found in house paint, nail polish, construction sites, machinery maintenance and factories, and trains, recycling and waste management plants, to name a few. There are a lot of places where you may encounter these, these chemicals, and being cognizant of it. Wearing respirators when you need to is important. Heavy metals such as lead and mercury, depending on where you are living, where you're working with your clients, there may still be lead in those pipes. There may be lead paint in their walls. If it's an older house and if they have a lot of imported goods, they may have lead paint on those as well, because that's not as regulated. We need to be conscious of this. Obviously, an older adult's probably not going to be chewing on something that's painted and exposing themselves to lead, but they may be drinking water that's coming from lead pipes. If you notice hearing issues, even if they've been ongoing for a while, might be worth testing the water for the lead as well as getting a, a hearing evaluation. You can also, if you are in law enforcement or the military, if you're handling ammunition a lot, it has lead, it's made of lead, part of it. And so handling it with bare hands, you can expose yourself to, to higher levels of lead than the average person. Air pollution, especially from industrial admissions, especially from smelting and coal combustion. Now, coal itself is not ototoxic, but when you combust the coal, it produces a chemical that is ototoxic. Therefore, people who are working in coal power plants need to be aware of their exposure. People who work in, I don't even know if trains still are operated by coal or not. But back in the day they used to be and those people were exposed to those chemicals. So there are a lot of incidental exposures people may be exposed to. Additionally, psychological factors because I know I've already mentioned this, but I'm going to mention it again. Psychological factors causing stress can indirectly affect hearing. Chronic stress triggers the release of stress hormones such as cortisol and adrenaline, causing stress induced increases in your blood pressure, which can reduce blood flow to the cochlea and oxidative stress. Remember, that's the stress byproduct, damaging the cochlear hair cells responsible for sound transmission. We want to help people reduce psychological stress, cognitive, emotional stress, as much as possible. Whether it's causing the hearing loss or whether the psychological stress is caused by the hearing loss and worsening the hearing loss, we can address it. That's what we do, is address psychological stress. Sympathetic dominance. In last week or the week before, we talked about how as we age, unfortunately, our autonomic nervous system tends to default to sympathetic dominance, which means you tend to trigger that stress response a lot stronger than the relaxation response. And one of the things we can do with that is help people use techniques to strengthen their vagal tone, strengthen that relaxation response, so when they get stressed out, they can downregulate more easily and they can buffer against that high stress, staying up in that high stress level for too long. But that sympathetic dominance, when your HPA axis kicks off and you have that adrenaline dump, it potentially disrupts normal auditory processing, which increases stress for a lot of people. Think of a time when you've been, you know, had that stress response really triggered and you kind of felt like you were in a tunnel and you weren't really hearing much. It was all kind of daisy, if you will. And that's an indication that your auditory processing is disrupted. Your brain's trying to figure out what the heck to pay attention to and cognitive load. High stress due to hearing difficulties or life can impair cognitive functions affecting how auditory information is processed and interpreted. They found that people with hearing loss tend to have a much higher cognitive load. They're using their brain a lot more to try to take in those sounds that they're not hearing clearly and decipher and interpret. And they're straining to, to hear and understand. And that excess cognitive load causes additional stress and actually worsens hearing stress. Related behavioral changes that indirectly affect hearing health include substance use, because increased alcohol consumption, consumption, or smoking. Both are related to hearing loss. Being around cigarette smoke and tobacco smoke has been associated with increased ear infections in children. Therefore we know that that smoke is doing something to affect the respiratory system and indirectly affect hearing. And neglect of health also can impact your hearing. If you're not paying attention to your personal health, if you are going into noisy environments without hearing protection, and I know my husband's going, yeah, that's you. I'm bad about hearing protection, I'll admit it. But those things are preventable factors that can negatively impact hearing. Now why do we care? You know, we talked about how it happens. Now we know how it happens. Why do we care? People with hearing loss, whether it is due to an ear infection or age related hearing loss, when the hair cells in the cochlea and when the auditory nerves, when those things start becoming impaired, it impacts balance, it impacts proprioception. Proprioception is when you're walking and you know where your foot is. You don't have to look down at the stairs to know where your foot is and step on the stairs. If you've got poor proprioception, you're going to trip a lot more frequently. You may not lift your foot up high enough or you may lift it up too high. When people's are having hearing loss or having hearing problems, it affects their balance and their proprioception. Dizziness and vertigo increase the risk of falls and disorientation, which can make it more difficult especially for older people to live independently. If they are risking falling, breaking their hip, having some sort of consequence, we need to be aware of that difficulty maintaining balance while walking or standing, which affects mobility and independence. Poor proprioception increases risk for trips and falls and may lead to shuffling. So this is a solution that ends up causing a problem. If they can't tell where their feet are, they're going to shuffle more. And people who have diabetes and peripheral neuropathy tend to shuffle more as well. And when they start shuffling more, then they're not picking their feet up. So little things like the, the lip of a carpet can actually be a trip and fall hazard, even if it's tacked down really well. Being aware of this is important in some households if and long term care facilities, et cetera. If people are having hearing loss issues, especially to the extent that it's affecting their proprioception, their balance, they're doing more shuffling or at risk of falls then taking out the throw rugs. Taking out anything that could be a trip and fall hazard as they shuffle is really important and, and recognizing also that changes in textures. If you Go from a tile floor to a carpeted floor. That can also be problematic and increase the risk of trips and falls. Nystigmus is not something that I've seen a lot, but apparently with hearing loss, it's not uncommon to have these involuntary rapid eye movements or which can be disorienting and contribute to the sensation of vertigo. Tinnitus, this is a persistent ringing or buzzing or hissing in one or both ears when there's no external sound that's causing it. It's just. It's in your head and it's so exasperating. Tinnitus can actually be caused by hearing loss and it causes additional stress that can worsen hearing loss. Tinnitus doesn't just happen during the day either. So tinnitus impairs sleep, which can be aggravating. And we know that impaired sleep is going to lead to emotional distress, cognitive difficulties, etc. We also know, and I haven't mentioned it enough, I don't think that lack of sleep and any of these things that add stress are going to increase people's blood sugar. Stress triggers the stress response, which triggers the release of blood sugar into the bloodstream. If somebody with diabetes is experiencing tinnitus, they're probably going to have more difficulty regulating their blood sugar than someone who doesn't have this stressor. If someone with diabetes is experiencing vertigo and dizziness, they're pro. They're going to have that stress response because the body doesn't want to fall and it's going to impact their blood sugar, which is going to. If they can't get it under control, it's going to worsen their symptoms of diabetes, including peripheral neuropathy and hearing loss. Earfulness and pressure can cause discomfort and affect hearing clarity, balance, and sleep. And I mentioned the other class, in the other class that, you know, I have a little bit of hearing loss because I'm not good about paying attention to it. I'll be better now. So watching television now, especially in the. In our living room, can be really hard for me because they have the background noise, the sounds and the music and everything so loud compared to the voices. It's hard for me to hear what they're saying. I use a lot of cognitive load to try to hear and understand what's being said. I turn on the closed captioning so I can read it instead of having to struggle to hear. A lot of times. There are other modifications we'll talk about that you can use that are short are different than turning on the closed captioning. But that's one thing that can help. Hyperacusis. This is something that, again, a new thing that I learned. Normal sounds may feel uncomfortably loud or even painful when you're having hearing loss. Interestingly, some parts of your ear may actually become more sensitive. You may be more sensitive to treble or bass sounds than you are to other types of sounds. And being cognizant of this, if the person is living in long term care, for example, being in the dining room maybe, and hearing the clanking of the glasses may be painful for them. And identifying ways to reduce the sound or having a particular dining room for that's quieter. I don't know what you would call it, but one that's quieter. Hyperacussus limits the ability to tolerate everyday noises, leading to anxiety and avoidance and reduction of social activities. We have dogs. I've told you all before, we have dogs and they're loud. That can be. For somebody with hyperacusis, it can be excruciatingly painful when the dog barks. It's not just that it's annoying, it's not just that it's startling. It hurts. And that can cause them to not want to be around dogs. For example, if somebody's experiencing hyperacusis and it seems counterintuitive, I've got hearing loss, but noise hurts. We need to educate them that, yeah, it's a thing that happens. You've got dysfunction in your auditory system. So some parts have become more sensitive and some parts have become less sensitive than they're supposed to be. That's not weird. And let's look at things that we can do to help you navigate this situation. Let's talk to an audiologist, of course, but also look at environmental modifications that can be conducted in order to reduce problems. My husband, for example, has become exceedingly sensitive to the sound of the vacuum cleaner. It's just too loud. And if he vacuums, or if I vacuum when he's in the room, or if he vacuums without earplugs in, his ears will ring for like two or three days afterwards. And I didn't really understand why that was happening, but that's hyperacussus. And he doesn't have. I mean, he has pretty good hearing, but I'm seeing some changes in his ears and in his hearing. As, as we both age, people with hearing loss can have headaches and migraines mainly. It's not because of the loud noise. It's because of persistent muscle tension in the neck and shoulders from straining to try to hear Better. You're like, huh? What? What's going on? If you do that, you can feel those muscles tensing up and your spines getting all out of alignment. Other stress related impacts of hearing loss Increased blood pressure when you get frustrated, blood pressure goes up. Difficulty managing blood sugar because stress response is increasing blood sugar Fatigue if your blood pressure's up, your blood sugar's all over the place, you're straining, you've got muscle tension. I'm exhausted just thinking about it. A reduced pain threshold Chronic stress and I've mapped this out in other in other classes, but suffice it to say that chronic stress alters the body's pain threshold because of changes in hormones and neurotransmitters. Interpersonal Impacts of hearing loss Misunderstandings and miscommunications can cause frustration for both the person with hearing loss and their communication partners, which can lead to conflicts or reduced contact. When you're talking, you may misunderstand what they say, or they may say something to you and you don't hear it at all. Or we had this right before class. My husband's downstairs and he said something to me and I've got the door pushed up and I'm in the room, I've got the air purifier going. I didn't hear it. So I was like, huh? What? What did you say? And he repeated himself and I still didn't hear it. And that can cause frustration and agitation. Figuring out what you need to do, being in the same room, making eye contact, reduced participation and struggling to keep up with conversations, especially in noisy environments, can cause withdrawal and make people feel excluded or overlooked. Whether it's a family gathering like Thanksgiving and they can't hear and it's just exasperating. They can't understand what's going on. There's so much noise and cacophony that they, they may just sit there and fall asleep. They may sort of check out, they may go to another room and it's not because they don't like you or want to be a part of the conversation, but they're not part of the conversation because they can't hear and they can't understand what's being said and it caus causes them distress. Reliance on alternative communication methods, such as written communication, require effort and adaptation from both parties, which may not always be feasible or comfortable. Obviously, this is in the later stages of hearing loss where something may need to be written down because you can't hear. Or if somebody has an acute hearing loss for some reason, maybe they were exposed to some sort of blast and they temporarily lost their hearing. So they're writing things down. Their hearing may come back and, you know, great, they can go back to living like they were living. But in the short term, community, in order to communicate, they may have to write things down, which isn't always practical. Thankfully, we have, most of us have these wonderful little things called mobile devices that have a microphone on them. And you can talk into the mobile device and it will type it out for you. You can dictate and it will type out what you want to say. So that does prevent a lot of the slowness of having to write things out. There can be decreased social support as social networks shrink due to avoidance behaviors. Whether it's because it's too noisy or because they don't understand, they can't understand what's being said and it's just too frustrating. Whatever. The availability of emotional and practical support diminishes, which worsens feelings of isolation and negatively impacts mental health. We want to increase social activity and social support. Let's figure out why they're avoiding social activity. And if it has to do with hypercussis, what can we do to make it less painful for you? What can we do to make this comfortable? So you're not worried that you're going to be having this sharp pain in your ears or if it's due to not being able to interpret and understand. There are a ton of apps and a ton of devices that are available to make communication and socialization possible. Even in group settings, there can be increased stress, anxiety, and depression because the person is constantly struggling to hear and, and it's just mentally exhausting. Your brain is one of the biggest users of blood sugar. And when your brain is doing double duty trying to interpret this sort of garbled message that's coming in, it's. It's exhausting. It's tiring and persistent. Communication barriers and social isolation can lead people to feeling hopeless and depressed. They may feel like too much of a bother. They don't want to ask you to repeat yourself. So they just, it's like, okay, fine, y' all are talking, whatever. If something's important, you'll let me know. And I've seen this with my husband's grandparents. And it can be kind of heartbreaking to recognize that his grandfather's really not participating. He wants to, he's staying there, he's trying, but he's only probably getting about 10% of what's being said. Hearing loss can alter the dynamics within a family. If misfortune understandings and frustration lead to tension and conflict. If it feels like the person with the hearing impairment is not paying attention or not wanting to be engaged, or if it feels like to the person with the hearing loss that people are being insensitive, it causes frustration. Partners may experience reduced intimacy or decreased relationship satisfaction because they're not communicating as much. When you stop communicating, intimacy goes down. Friends and younger family members may feel frustrated or unsure how to communicate effectively with the person with hearing loss, which can lead to reduced social interactions and weakened friendships. They may not know how to communicate, they may not know how to help you hear what needs to be heard. And that's what we're getting ready to talk about cognitively. Well, if you're stressed out, if you're struggling to hear, if you don't feel acknowledged, if you feel overlooked, if you can't participate in conversations, if you're dizzy and have difficulty, you're with your balance and maybe you can't drive anymore because of it, you know, all of those things can be really stressful and increase negativity and hopelessness. We want to help people focus on what they can do, what's what skills and strengths they do have. And then look at how can we modify the environment to give you back some of those things that you feel like you've lost? What can we do? Cognitive distortions may include things like I can't go anywhere and hear or participate, so why should I even leave the house? If I go to church, I'm not going to be able to understand what the pastor is saying, so why am I going? If I go to Thanksgiving dinner at the, at the grandparents house, I'm not going to understand what everybody's talking about because of all the cacophony. I can't hear, I can't filter out the voices from the rest of the stuff. Everybody's always mad at me. They're. They get frustrated because they've got to repeat themselves or I don't understand or I don't hear them at all. So everybody's always mad. I as well just stick to myself. People don't want to spend time with me because I'm too much of a bother. We need to identify in the person with hearing impairment, what thoughts are you having that are contributing to your distress? What thoughts are you having about your ability to hear and participate in conversations that are contributing to you feeling isolated that are contributing to you wanting to withdraw or not wanting to exert the effort to go out and engage with others physically? Hearing aids and Apt to hearing aid communications are available now. And one of my best best friends has a hearing aid now. And when he got it, he was so thrilled because it pipes in Bluetooth. He just types whatever he wants to on his phone, pulls up a playlist, and he's got music right in his ears. And he just thinks it's the greatest thing in the world. Podcasts, whatever. And as I mentioned earlier, a lot of people can control their hearing aids with an app if they don't have the manual dexterity because of arthritis or peripheral neuropathy. To adjust the hearing aid using the little buttons, they can use the apps. Surgery is possible. For some things, we can address the underlying health conditions, allergies and ototoxic medications. A lot of times, if you remove the allergens, the congestion will release and the person will be able to hear better. Imagine that. But you've got to recognize the allergy first. For me, I know I'm really sensitive to mold and mildew. And we lived in a rental house at one point where the basement, it looked fine, you know, there was no obvious signs of mold or mildew. But every time I went went down there, within 15 minutes, my ears would start popping like crazy. And that's a sign that my allergies were acting up. So sometimes there are things that we can do. We can manage diabetes as best as possible to prevent worsening peripheral neuropathy. We can address those allergies in order to, you know, reduce that inflammation and reduce that pressure in the ears. And again, examine medications people are taking to see if they are ototoxic. And if they are, have them talk with their doctor about if there are alternatives available. Maintain a healthy diet rich in antioxidants. Antioxidants, get rid of, if you will, the oxidative stress. They go in there and clean all that stuff out. Antioxidants are in colorful fruits and vegetables. So just kind of simplifying it. If you have three colors on your plate at every meal, that doesn't include condiments or skittles, three colors on your plate at every meal, you're probably getting a good array of different antioxidants and effectively manage your blood sugar, your blood pressure. And I didn't add it, but I'll add it now. Your thyroid. All three of those things have significant impacts on your auditory health. Make people aware, interpersonally. Let them know, hey, I've got hearing loss or it's difficult for me to hear when there's a lot of background noise. If they're Aware that there's a problem and they know what they can do to help, then it's going to make everybody feel a lot more empowered. Educate people about the impacts of straining to hear. So if you go to Thanksgiving dinner and you're sitting there and you're just straining to hear and you really want to participate, after Thanksgiving dinner, you may be tuckered out and need to go lay down for a nap or fall asleep in the easy chair. I usually do and that's okay. But they if they understand why, then they can under understand your behaviors better. If you want to motivate people to accommodate your hearing loss, then it's important to communicate with them. Hey, I can't hear so well. When I can't hear, I get confused and exhausted and frustrated and I kind of check out. And this is what you can do. Educate people about your needs to hear clearly and avoid pain. If loud noises or like doors slamming or dogs barking bother you, let them know. Kids shrieking, cockatiel shrieking, whatever. Let people know so they can try to avoid doing that. They can put the dogs up while you're there. They can be sensitive to not slamming the door when you're there. Let them know that it helps a lot if they make eye contact with you. You're not lip reading, but at least the sound. If I'm making eye contact with you, the sound coming out of my mouth is going directly to you. And it's not like it's going over here. And your ears have got to reach out and grab those sound waves to figure out what's going on. Enunciation is important. Don't mumble. For people who have hearing loss, then it's hard for them to understand what you're saying if they're mumbling. So enunciate, say what you mean and speak clearly. No background chatter or ambient noise. Turn off the television. And if somebody's in your household that has hearing loss and they're trying to participate in a discussion one person at a time, no side chatting because that will impair their ability to hear and interpret what's being said. And if the environment is really noisy and you need to communicate something to somebody, you can write it down. Obviously that would be just some little note or something that's not practical for long term communication. Couples therapy can address the loss of intimacy and relationship satisfaction. Some of the issues that come up are they don't listen to me and both people may end up saying that. The person with the hearing loss may say, well, she doesn't even listen to me anymore anyway. And the person with good hearing may say, he quit listening to me 20 years ago. Well, he quit being able to hear you 20 years ago. The person with hearing loss may think I'm not important. They don't even ask me to help anymore. Instead of repeating yourself instead of, you know, trying to work through that communication barrier. Sometimes people who are in relationships with others who have hearing loss may just do it because it's faster. But the person with hearing loss may start to feel less needed and increasingly dependent. It's too hard to share how I feel and my thoughts again, setting aside quiet time where you can look at each other and communicate, writing things down, writing cards, drawing, whatever. I'm too depressed, stressed, angry about my hearing loss, about my health conditions, whatever, to be intimate. Okay, well that's a whole other issue that you can address in therapy. But recognizing it's not that I don't want to be intimate with you, I don't want to be intimate with anybody because I'm stressed out and they talk to me like a child. Sometimes people trying to accommodate someone with hearing loss may speak really slowly and really loudly and even use very small words. But we all found that annoying. I found it annoying just saying it that way. So understanding the person can't hear. They're not dumb, they're not ignoring you and not not to over enunciate what you're saying to speak to them like normal. Just make sure there's not that background noise that's going to impact them. And look at them. Support groups can be really helpful for both the hearing impaired as well as the hearing partner to understand what's what you're going through. So the person that still has good hearing can start to really recognize, oh, that's why I'm feeling so frustrated, or that's why they're acting this way. And meaningful activities that are conducive to hearing loss you can do together include painting, fishing, cooking, puzzles, board games. There's a whole list of things that you can do at so you're spending quality time together, but maybe you're not having to communicate in an auditory fashion. Emotionally. Help people develop distress tolerance skills and strengthen that vagus nerve so they can down regulate and avoid excessive stress on on their system. Avoid excessive amounts of blood sugar and blood pressure increases. Help the person develop an empowerment plan. What is it about your hearing loss that makes you feel powerless? And what can we do to help you feel more empowered and process fears and grief related to hearing loss? For some people, they may Know they've got diabetes. Their hearing loss is going to be progressive and it may eventually be total. Not everybody has that issue, but if they have fears about it, then we need to start addressing it environmentally. Improve the acoustics in rooms, but don't add trip and fall hazards. Arrange soft furniture to prevent and prevent large sound blocking obstacles. So soft furniture is anything that's stuffed. You don't want to have hard furniture that's going to bounce sound around. I put tapestries in this room for the acoustics in order to record. I have tapestries on the wall that help absorb some of the sound so my voice doesn't bounce off all of the walls. Add curtains and pull the curtains closed if you need to when people are around, because that will again absorb some of the sound so it's not ricocheting around the room. Optimize lighting. This helps not only avoid trip and fall hazards, but if the person can see you and they can see your lips moving. Even if you don't know how to read lips, you get an idea. I mean, you can turn off the volume on the TV and you can kind of guess what people are saying. So believe it or not, we actually do use our eyes some when we're listening. Reduce dog barking. Add lights in place of auditory alarms. If the alarm on the kitchen stove or the dryer or something is auditory and the person can't hear it or it's painful to them, add a flashing light. You can find things that you can add to those devices and create hand signals the person can use to indicate they're not hearing. Well, maybe they can tap their ear or something to let other people know without having to interrupt in a conversation. Hey, y' all are making too much noise. I can't hear what's going on. Tapping their ear and apps. I know we're down to the last minute. Ava facilitates real time communication for multiple users by providing everyone in a conversation live captions, enhancing inclusivity in group settings. So it's an app you can download on your phone and everybody in the conversation can download it and then everybody can hear. I mean, you're just like reading the conversation on your phone. Roger Voice is tailored for phone communication, providing real time transcription of the phones of phone conversations. This app is particularly beneficial for individuals who find it challenging to understand people over the phone. I know I do. Especially on these mobile phones. I wish we could go back to the ones that hung on the wall. Super here enhances environmental sound awareness by selectively amplifying important sounds and providing visual alerts. So if you can't hear as well and you've got this dog that you truly love, super hear, you can actually amplify the sound of the dog whining if you really want to. And get a visual indication on your mobile device that Fido's there and wants to be picked up. You can see that Fido's there and whining Web captioner can be accessed on mobile devices, making it a flexible tool for individuals with hearing impairments. There are a lot of other apps, TV listening systems that the person with hearing loss, instead of cranking the volume up on the tv, they can actually wear headphones that will provide the hearing in in a way that they can hear it. Certain hearing aids can actually be tuned to communicate via Bluetooth with the tv. There are things called tinnitus maskers that provide a variety of different sounds that you can play around with to figure out what works for you to mask the sound of the ringing in your ears. If you've got tinnitus doesn't make it go away, but it can help people get better. Sleep and loop systems directly link the audio source to the user's hearing device and ensure clear and direct sound transmission. This is really helpful in churches and movie theaters and places where there may be a lot of people who need to hear a variety of physical and emotional issues by way of stress. Autonomic nervous system dysregulation may either cause or worsen hearing loss. As clinicians, we address emotional issues. I mean, I gave you a lot of tips for environmental issues that can make it easier for the person to hear. But to prevent the progression of the hearing loss, we need to address those emotional issues and that stress dysfunction. We need to eliminate known causes of hearing loss and empower the individual and their significant others with the knowledge and tools to live a rich and meaningful life and have hearing loss. It's important to do this to reduce further deterioration in their hearing and health and relationships and improve their quality of life. Alrighty, I know I went through a ton of stuff about hearing, but ultimately it's all connected. If, as our health goes down, it can impact our hearing, as our hearing becomes impaired, it can impact our mood and our health. You can't extract one from the other. People with hypertension and diabetes are at even more risk for hearing loss and at even more risk of worsening of hearing loss as a result of stress. So we do want to pay extra attention to those issues. And Chuck points out that my clone, my AI is now available for text questions as well as verbal conversations. You can pull pull up the clone on your mobile device and you can click the little microphone and you can talk to it so you don't have to type. I know, I hate typing. If you want to type or you don't want to use the little microphone, you also can dictate through your phone's own microphone and communicate with the clone. I have two clones that are available. One's the expert clone that gives you the long winded responses y' all are so used to from me. And then the other one is a lot more conversational and that's my coach clone and I've told it to really shorten its responses so it can be more interactive and less word dump if you will. I encourage you. You can go to docsnipes.com clones and C, L, O, N, E s gotta have the S on the end and you can try out both of them to see which one you might like and you can communicate. You can ask 10 questions every month for free or you can sign up and ask unlimited questions 24 hours a day, seven days a week. Speaking of asking questions, we actually have a live that is starting. It was supposed to start five minutes ago. So I am going to sign off and go over to that. I really enjoyed seeing Roller Care back and or Roller Girl back and. Hello daycare. Glad to see you back. Hello, Sammy. I know I didn't see some of you check in. I am glad all of you came. I hope you have a wonderful holiday and I will see y' all next week unless you're over in the Q A that I'm going to right now. Bye everybody.