Hearing Loss and The Latest in Hearing Aids with an Audiologist, Brian Taylor

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani.

Greetings to everyone joining us today on our podcast. You're listening to one of our Successful Aging episodes this month on the Living to 100 Club program, and I'm your host, Joe Casciani. Each week, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. In today's podcast, we explore the latest technology in hearing aids. We talk about the risks of not addressing hearing loss and the options that are available to those looking to improve their hearing. This includes over-the-counter hearing aids. Our guest is Dr. Brian Taylor, audiologist and senior director of audiology at Signia. We explore the latest research on social isolation when accompanied by hearing loss and how it can contribute to cognitive decline. Also discussed are the most frequent problems of those who start using hearing aids and how they can be prevented. Our guest also shares the latest technologically advanced hearing aid from Signia with better and more accurate signal processing. Our conversation offers information and insights that will benefit most seniors. Before we start, a little background. Brian Taylor, Doctor of Audiology, is the Senior Director of Audiology for Signia. He's also the editor of Audiology Practices, a quarterly public publication of the Academy of Doctors of Audiology, and an adjunct professor at the University of Wisconsin. Dr. Taylor has been an American Academy of Audiology member since 1991. Brian, welcome to our program today.

Thanks, Joe. Happy to be here.

Great. Yeah. Glad to have you with us. I'm looking forward to our conversation. I always like to open by asking our guests to share maybe the highlights that brought you to where you are today. You've had a long distinguished career as a professional. Tell us maybe the highlights or the touchpoints that brought you to where you are today.

Well, I'm a very lucky individual in the sense that I've got to work with some tremendous mentors over the years, and I've got— in the field of audiology, which is a relatively small profession, I've had the privilege of doing many different things. I've been able to be— work in a medical practice, practice at a high level in a multi-specialty clinic, operate private practices, work in industry. With a hearing aid manufacturer and teach classes at a university. So I feel, and also edit one journal and publish in a few others. So I've had a chance to do many things and, you know, it's a privilege that I've been able to do all that.

Sure. Yeah. You come at this from many different perspectives. I think that's valuable. You've been in a lot of different roles and I think you, You can see the perspective of many individuals from the areas you've worked in. Yeah. So let's start with— let's talk about the consequences of hearing loss. Not an unusual, you know, situation as we age. What are the greatest problems faced by those with hearing loss?

Well, I think there's a— it's multifaceted. I think that Primarily, it affects day-to-day communication. When a person doesn't hear well, they have a tendency to avoid situations, to withdraw, to become frustrated. And that often cascades into other quality of life issues where a person may be socially isolated. They might be more likely to experience loneliness as a result of the hearing loss. They also— and there's quite a bit of data that's been collected over the last decade or so that that tells us that untreated hearing loss plays a pretty significant role in cognitive decline and dementia.

Yeah, I've seen some of that literature. When you and I talked, we cited the article from the Lancet Commission on preventable dementias, and that is one of the 12 conditions that, if left untreated, can lead to dementia. And again, it's a modifiable risk of dementia. So like other conditions, head trauma and diabetes and obesity and a lot of these conditions can, again, lead to cognitive decline if they're not addressed. So that's, that's pretty significant for people who are facing this hearing loss condition that it can contribute to probably some disorientation and A little bit of confusion and, of course, disconnection from those around them. Yeah, sure.

I mean, I don't want to overstate it, but it is a leading modifiable risk factor, which means you should certainly have your hearing checked maybe earlier than you might think. And also, if you need help with your hearing, the earlier the better.

Sure. Sure. So how do hearing aids work? What are there— Are there major differences among the different manufacturers out there, or is it the same kind of process that they all follow?

Well, I would say that all of them— and a big reason for this is because they're FDA-regulated medical devices— they have similar components, and they all work in a similar way. They use a microphone to pick up sounds in the environment. They have sophisticated chips that turn up certain sounds more than others, suppress certain noises more than speech, and turn that electronic signal back into an acoustic signal with a receiver. So all hearing aids have that same basic function. But as far as how they implement the different technologies under the hood, so to speak, can be quite different.

So I've known people, and I'm sure you've come across a number of people who really have difficulty when they're fitted with hearing aids. And there are a lot of different reasons for this, of course. So poor fitting, for example. And as you said, you can never— we can never return to a healthy cochlea. But even mental decline or cognitive, you know, maybe even some psychomotor difficulties. What are the leading barriers to having a, you know, a good fit? With hearing aids so they really work for you?

Yeah, that's a, that's a, that's a much studied area of audiology. And you're probably not surprised to hear that there's many contributing factors. You can start with the, the psychology of hearing loss and the fact that most people go many years, sometimes more than a decade before they get help, where their hearing gradually declines. And over that Over that gradual decline, they develop some compensatory strategies that help them get by. So that's one area that you have to sort of overcome. You know, you can go a long time asking people to repeat, cupping your hand behind your ear, turning up the volume, avoiding noisy situations before it kind of comes to a head and you really start to have difficulty. So there's this whole psychological aspect. That's one area. That causes hearing aids to be underutilized. Other areas have to do with just the aging process per se. Your finger dexterity, your hand-eye coordination as you get older sometimes starts to wane, and that can get in the way of using a very small device that has to go in and out of your ear and requires you to manipulate a volume either on the hearing aid or on a phone, a smartphone. There's another set of reasons. There's also some data that would suggest that cost is a factor and access. The average price of a pair of hearing aids is north of $3,000. And it's a fairly, you know, I acknowledge that's a large expense for most people. And then I think a final issue I would say has to do with, I'll just call it convenience factors. Typically when you get hearing aids, you have to come in for handful of in-person visits. And more and more people find that to be an inconvenience. They might be working, they can't get in, takes time, those kinds of things. So those are some of the leading factors that kind of hearing aid use on the low side.

Yeah. So let me stay with the last one there, the convenience and the frequent visits. Is that where the fitting comes into play, where people are not properly fitted?

Yes. I think that in order to be It varies a little bit from person to person, but usually you want to, to experience the best benefits from hearing aids. You have to work closely with the provider that you trust to kind of guide you through the process of learning to hear again. Not only do you have to make sure the hearing aids are tuned properly, but you also have to kind of learn or relearn how to listen and to sort of unwind some of these maladaptive behaviors that you may have acquired over the last decade. You don't have to maybe ask people to repeat as much, or you don't have to avoid noisy situations. So it really helps to have a professional guide you through that process. And that usually takes a handful of visits over the course of the year, 3 or 4. The good thing these days is some of those visits can be done in the virtual world, which is a time saver.

Online. Yeah. So if someone is— maybe has not had severe hearing loss, and they just want to correct some, let's say, a mild hearing loss, and it's not working for them, that— is that still part of the fitting, that if they're not accurately suited or not fitted for the individual?

I think that the challenge is for an individual out there is you don't know if you have a mild hearing loss or something maybe more severe. In my clinical experience, you run into a fair number of people that come in and say, I think I have a minor or a mild problem. And it turns out their hearing loss is fairly significant. So it's always good to get a baseline check to see where you are, because your own perception may not match what's actually happening inside your ear. That's one consideration.

I see. Sure, sure. And then, as you said also, that the types of problems that people have with the aid, they tend to be consistent, and it's It's not so much the problem of eliminating distracting sounds and the, you know, ambient sounds. It's really more of kind of being able to distinguish different voices. Can you explain that? Help us understand that?

I can try. I think the biggest challenge— well, first of all, think about somebody who has completely normal hearing. Take a 25-year-old healthy adult, when they walk into a crowded restaurant or café or even a crowded meeting at work where there are a lot of people talking and maybe the room has got a lot of reverberation in it, sounds bouncing off the hardwood floors, off the concrete ceiling and walls, all that reflected sound makes it very difficult for everybody to hear, even people that are healthy, young, and have completely normal hearing. Now, you take somebody who's older that has some hearing loss and put them in that same situation, they're going to struggle even more because, again, in many challenging situations, the background noise that you don't want to hear is other people talking. Luckily, the human auditory system has the remarkable ability to kind of pay attention to the talkers of interest and automatically suppress the talkers that you are not interested in. And the ability to do that also starts to decline slowly as you age. So that's a real challenge, is trying to mimic what the normal auditory system does, pay attention automatically to talkers of interest and ignore the talkers that you don't want to listen to at that moment. And that's the challenge of hearing aids. Hearing aids today, I think, do a really good job of suppressing noise that you might find in your kitchen, the hum of a refrigerator, a fan, something like that. Other noises that are similar to speech, other people talking, that is, those are much more challenging to try to suppress. But luckily, hearing aids over the last decade or so have really, I think, innovated around what we call directional microphones or what we call beamformers, spatially-based noise suppression. So it can— the hearing aids can lock into a certain area in the listening space and amplify the speech in that area, or what we might call that acoustic snapshot. So hearing aids with directional microphones give listeners a much greater chance of being successful in some of these really challenging listening situations like a restaurant.

So the microphone picks up the speech of the person in front of you and can suppress speech from others behind or on the side? Is that—

that's true. That's kind of the early beamformer that was around 20 or 30 years ago. But what's advanced over the last decade, or maybe the last 5 years, is that sensitive sweet spot of the microphone can actually automatically detect and shift. So if there's talkers on the side, or in the case of the Signia device, if there are multiple talkers, it will recognize that that's speech and it will kind of hone in on it and amplify it automatically.

I see. And still filtering out the unwanted sounds somehow?

As much as possible, yes.

Well, yeah. Okay. All right. So And again, the improvements in the past few years have these faster processors and better noise suppression technologies. So what about, you know, we see a lot of the new approvals for over-the-counter products, and this was probably this year or early this year, I think, when FTC said, okay, you can buy these products now without without the prescription of an audiologist. What do you think?

Yeah, I think it's a great— I think it's great for consumers. It's also great for the profession. Now let me explain why. First of all, I think it was October of last year, 2022, when the FDA approved over-the-counter hearing aids. Considering that 75-80% of people that need hearing aids don't wear them, having another option that might be easier to buy at a lower price point is a positive for them. So I think it's great that there's another option over the counter. I think that over-the-counter hearing aids, you have to be a little bit cautious. First of all, they've been around now for more than 6 months. And the last I checked about a month ago, they only comprised about 1% of total hearing aid sales in the US. So they haven't exactly changed the marketplace yet, but I think that could happen over time. The prices are still in alignment, in my opinion, pretty close to what a lower-tiered product, lower-tiered hearing aid, pair of hearing aids might cost, you know, upwards of $1,000, maybe a little bit more for a pair of over-the-counter hearing aids. But for the right person who is very skilled at using their smartphone, somebody who maybe is sort of likes to do things themselves, doesn't mind stumbling through the process at home, I think OTC is a great option, but it's great.

It's not, yeah, that's, that's good. I'm glad to hear you say that because it does really give people more options, as you said, and we have to be more informed when we're making these decisions, but it does allow us to make an entry into this. Although 1% is pretty small. I mean, even after 6 or 8 months, 1% is still pretty small in terms of, well, it's early.

It's still early, but yeah, it's, yeah, sure.

So what are the, what are the risks? What are the downsides to doing this yourself?

Well, I think the risks are pretty minimal, at least to your ear. You know, the good thing about FDA regulations is they kind of, they can design the point of the regulations, of course, is to kind of greatly lower the risks associated with harming yourself. So it's be really difficult with an OTC hearing aid to have too much output from the hearing aid. Too much output can be a problem. It can actually cause hearing loss. That's extremely rare. It's been rare for a long, long time. But it could happen if the output of the hearing aid was set too high. And a person may not even know that. But that's like I said, the output has been regulated by the FDA. So you really can't harm, physically harm your ears. I think the harm is more that it's more likely that you could underfit yourself. You're not getting the gain or the amplification that you need. That could be a— I see that as a bit of a problem, underfitting. And also, if you're spending upwards of $1,000 or more for a pair of devices and you're not getting optimum benefit from them, you're kind of hurting your pocketbook or harming your pocketbook as well. So those are some of the downsides with OTC.

So should a person get a consult, like an audiology consult after?

Yeah, I mean, there's nothing wrong with that. In fact, you know, I tell my colleagues that make your counter the over-the-counter counter for people that buy those kind of devices. Why not let it be your counter where they come and see you if they get a problem, have a problem? Offer services to help somebody get better use out of what they may have bought elsewhere.

So these over-the-counter models are less expensive than the higher-priced ones that are prescribed, but similar technology, or is it just like an inferior, not inferior, but lower-grade quality?

I wouldn't say it's lower-grade quality. I would say that some of the electronics are maybe not as sophisticated. I think it's hard to find a poor quality device today. They, you know, I say that with maybe a 30-year frame of reference when back in the '90s there were some devices out there that just didn't sound very good. But today I think the microphone technology has improved. The algorithms we put inside the hearing aids have improved. It's hard to get a device that just sounds bad, but some devices sound better than others and Most importantly, the devices really need to be fine-tuned to your hearing loss. And it's hard to do that by yourself. It's possible. It's much more likely to happen with some guidance from a professional.

Sure. Well, that's good. That's really good to hear, Brian, that they're safe. There's not a lot of risk based on, you know, of course, what the FDA has approved. All the studies and compliance factors that they ensured with these products. So that's encouraging. Then the, the option is to, you know, avail yourself of something that's less expensive, but to be followed up with some, some professional advice or, you know, consultation so you, you're using them properly. That's good to know. Good to know. Yeah. What are the options someone is faced with when he or she goes shopping? What are they looking at? What are they— what should they be looking for?

Well, a couple different things. I think you want to look at what we call the style or the form factor. That's the way the hearing aid looks. Some go over your ear, and there's different styles of devices that go over your ear. Some are thinner, some are a little bit thicker. You want to look at, The power supply, is it battery operated or rechargeable? Almost all hearing aids sold today are rechargeable, which is— there's a lot of advantages to rechargeability. So that's something you want to consider. Do you want the hearing aid to interface or connect to your smartphone? Not only can you stream music from your smartphone and talk on the phone with your smartphone and with Bluetooth, but you can also use your smartphone to control the hearing aid, kind of turn your smartphone into a remote control that operates the hearing aid. But you don't have to have that. If you're somebody that doesn't like cell phones, doesn't like smartphones, you don't carry one routinely, there's no reason you have to buy one just to have hearing aids. But that's a consideration. And then beyond that, I think it's more around just— there's 6 different major hearing aid manufacturers, and each of them brings a little something different to the table. Some, I think, are probably better at amplifying music or voices in quiet. Others are maybe better at suppressing background noise in everyday noisy settings. And, you know, all hearing aids need to be tuned to your loss. There's different ways that the professional does that. So they're all good, but there's just different variations or different flavors kind of depending on what you and the audiologist might think is best for you.

Well, yeah, so that sounds complicated, of course. I mean, if we have different types of hearing loss and some of these aids are better for us than others, that would be hard to, I guess, hard to ferret out when you're doing, when you're searching. How do you—

Well, I think that's the value of the professional. They need to help you with that process. And it's in, and again, the, I think the positive is, is that all the devices are these days are high quality.

Mm-hmm. So what you really want is an evaluation before you go shopping.

I think that's probably, if it was me, yes.

Yeah.

That's what I would advise someone is to get the evaluation first, do some homework first, talk to a licensed professional, find somebody that you can trust. And, uh, take it from there.

Yeah. All right, that, that makes good sense. And then, um, ideally you make the purchase with this information in hand, and then you can follow up with the professional afterwards for fine-tuning, so to speak, right? Yeah, makes good sense. So all of these options, I mean, I, I can see the value of connecting it to your smartphone because it gives you more controllability. That adds probably some, some level of cost to it, these extra options, right?

Usually it does. Not only does it cost more for the hardware or the technology that drives the hardware, but also I think if you're committed to using your hearing aids with a phone, you probably need a little bit more coaching and counseling from the professional. And that might drive up the cost a little bit too. You might need a couple extra visits either in person or online with the, with the professional to make sure that you're using things right. 'Cause there's a lot to learn.

Yeah.

You're not gonna learn it all overnight.

Yeah. All right. Well, that's some good advice. And how much is covered by insurance, if any? The health insurance, Medicare, Medicaid, any benefits there?

Well, Medicaid is driven by each state, so that really depends on the state that you're in. And some Medicaid programs do pay for hearing aids. Medicare does not pay or reimburse for hearing aids. They do often pay for the test, but they don't pay for the devices. But a lot of Medicare Advantage plans, which is a really— start sort of becoming— becoming— has become a popular program for a lot of folks out there. Many Medicare Advantage programs do offer a hearing aid benefit, which can keep the out-of-pocket cost down for you.

Yeah, yeah, you see that with the advertisements that they do cover the hearing aids and the valves. Yeah, that's good. That's good. And Medicare may cover the evaluation, but certainly not the product itself, not the hardware. Yeah, correct, correct. Okay, well, tell us about the new technology from Signia, the You're the director of audiology there at the company. And what is the new IX technology? How's it different? And when's it going to be available?

Well, it'll be available in the United States in October.

October. Okay.

Yep. So coming up soon. And I have to say that Signia is a real pioneer in the area of bilateral beamforming. We talked about these different types of microphone configurations. And we're on about our 5th or 6th generation of bilateral beamforming. And we're able to identify and speech in 3 different areas around the person, 4 different areas if you count what's going on behind them, and amplify the speech in those 4 different areas independent of each other. We call that split processing. And we think that doing that really allows a person to hear well in these situations where there's multiple talkers and where there's probably background noise and reverberation. Now, I have to preface, when you go into a highly reverberant situation, even the best technology might fall a little bit short of your expectations. But with this split processing, happening in 4 different streams, we think that gives you a much better chance of identifying and then hearing and understanding multiple talkers in a conversation.

So it differentiates these 3 positions, or even behind you, it can differentiate where the sound is, speech is coming from.

Well, not yet differentiated, and also then identify and then understand those different talkers that might be around you.

Mm-hmm. Mm-hmm. So this is the newest technology being released in October. I take it that's not going to be over the counter.

It's not over the counter. I think it requires the expertise of a professional to kind of make sure that it's tuned properly and that you know how to use it properly. For sure. We call it, the name of the platform or the technology is called IX. And like I said, it's our 5th or 6th generation of this type of, this evolution of wireless beamforming technology that has automatic speech identification in each of the streams or the beams.

Wow. Okay. And you would need the professional to prescribe this particular make. Would all audiologists have access to this, or it's going to depend on What they're familiar with, which products they're familiar with, I guess.

Well, it depends on which— they all have access to it. Any licensed professional would have access to it. Some are more well-versed than others, but they all have access to it.

Okay. So any, any listener, for example, that wanted to visit their audiologist, they might ask about the Signia product, the iX product, and look at the pros and cons of that. Yeah. Cool.

Exactly. Yeah. Yep, they can do that.

Well, we're just about running out of time. Let me ask you, what's the main takeaway for our audience, Brian? What do you hope our listeners take away from this conversation?

Well, I hope they take away that when it comes to treatment for, we'll call it, age-related hearing loss of gradual onset, which is the vast majority of hearing losses out there, that you have many options. Including over-the-counter, that it's always beneficial to get a baseline test. The earlier the better. If you're in doubt, go get it checked out. And if you're looking for the best technology to hear in situations where there's multiple conversations, multiple talkers, I don't think you can beat the latest generation that's from Signia, which we call IX.

Okay. Well, that's great. Thanks. Thanks very much. Uh, we are out of time, but, uh, before we wrap up, I just wanna remind my listeners to visit my website, livingto100.club, sign up for my email list and download a free copy of my 9 Tips to Make Living Longer Enjoyable. You'll also see an option to contact me with your questions and comments. So Brian, thanks very much for being a guest on our program. For those who might wanna contact you, or how would they access the, the website?

Well, they can find me on email, brian.taylor@wsa.com. That's the best way to reach me. Or you can just go to the Signia website if you want to check out the technology. Just do a quick— go to your favorite search engine and enter Signia, S-I-G-N-I-A, and that will take you to our website.

Okay, your email address, brian.taylor@wsa.com.

Correct.

.com. Okay. And Signia, is it signia.com or Signia US? I forget.

I think, well, I only, I use Signia, S-I-G-N-I-A.

In the search.

In the search. And that'll take you to the US website.

Great. Okay. Well, thanks so much for being a guest on our program today. I found it very useful and I'm sure our listeners did too. And thanks to all of our listeners for tuning in. Hope to see you next time.

Thanks, Joe.

You're welcome.