Interview with Pat Biondi on Hearing Health

What important health screening is almost always omitted as part of yearly checkups?

Hearing tests are not usually a part of annual physicals for seniors.  Annual health exams often include screenings and tests for cholesterol, blood sugar, colon health, urinary tract health, heart, lungs, head and neck, abdominal health, and muscle strength including reflexes and balance. 

Hearing health does not make this list even though the co-morbidities of hearing loss is abundant with cognitive decline and falling, among others, these being two of the most alarming.

When hearing diminishes, it is almost always a very gradual process.  So much so that the individual will generally not notice anything is changing.  Over time, significant hearing loss can develop.  The individual will often think that they are still hearing everything.  They are in fact hearing everything they hear, without knowing what they are missing. 

When a doctor inquires “How are you hearing?” Patients will often say they hear everything, and they honestly believe that to be true.  If they don’t hear correctly, they will often blame the person speaking to be mumbling or there was too much noise in the room.  It is never their fault, because they simply do not know or are in denial that they may have a hearing loss.

People with hearing loss are extremely good at masking the problem.  All it takes is a smile, a nod of the head, a repeat of one or two of the words that were said and actually heard correctly, or simply saying yes or Uh-huh.

The other issue is a hearing loss has no discomfort or pain associated with it.  Without something hurting us, we are often not aware there is anything going on that needs medical attention.

The World Health Organization (WHO) defines health as complete physical, mental, and social well-being.  Good health is not merely an absence of disease or infirmity.  The WHO states “there is no health without mental health”.  There is a very real connection between mind and body. 

Mental health along with social well-being are strongly connected to the function of our senses.  Smell and taste have received a lot more attention lately by Doctors because of COVID.  Touch is a concern as it is sometimes a symptom of Diabetes.  Vision concerns are often self-reported and actively cared for. Hearing, however, is rarely stated as a concern and is often actively dismissed by doctors and patients alike as not being an important element of overall health or a detriment to the quality of life.

Why is it necessary to make sure seniors know how important it is to get a hearing test as part of their annual health physical?

Hearing is one of only five inputs our brain gets to experience.  When analyzed, hearing is by far the most complex, and certainly the most important to our human relationships.  Our relationships are developed, nurtured, and embraced by communication.  Spoken words that are correctly processed with good hearing is the glue that bonds our relationships.  Hearing accomplishes this much more successfully than touching, seeing, smelling, and tasting. 

A person with significant hearing loss will continue to hear the approximate 500,000 sounds that humans can identify in our environment.  Dogs barking, babies crying, and hands clapping can be identified easily and with confidence.  A person can have an 80% hearing loss and still be able to identify the sound of a dog barking, a baby crying, and hands clapping.

These half a million sounds are simple, and accuracy of hearing them is not necessary to know what they are.  In contrast, the 44 different sounds we use in English are complex, quick, often not very loud, and sound very similar to each other.  Hearing the difference between the words Church or Search requires the ability to acoustically sense the tiny nuances between the S and the CH.  Even a 25% loss of hearing will make that a difficult task.

The average speaker of English knows 42,000 words and actively uses 20,000 of them.  When hearing correctly, the brain must first have audibility for each phoneme in the word.   Our memory must then be able to correctly identify each of them in the sequence that they are presented. 

The word Hip po pot a mus has five syllables.  Each syllable has a sequence of phonemes.  The word hippopotamus uses twelve phonemes that must be heard in sequence with the brain using its memory to identify each one correctly. This is no easy task, especially for a hearing-impaired individual experiencing sound voids. Even if the phonemic sounds of the word are identified, memory must then be available to define the word for things to make sense and have meaning.

The longer the brain has sound voids and is deprived of the subtle differences between the 44 speech sounds of the English language, the more phonemic regression occurs.  Phonemic regression is the process of not hearing along with forgetting what the exact speech sound or phoneme is and how it sounds differently from other phonemes.  The brain needs constant reminders as to the differences between the speech sounds or phonemes.

As a hearing loss occurs, the brain is deprived of hearing, and gradually forgets what the sound is. This might not be a problem for the sounds of doors closing and toilets flushing.  It is however a huge problem for the phonemes of a language.  Getting hearing help with good hearing devices will bring the sounds back in most cases, but the brain still might not know what it is hearing or have the ability to separate sounds and focus in noisy places if too much time has passed.  Correctly identifying phonemes can be relearned but that will take time and patience.  Understanding speech in noise is a more difficult task but time helps as well, and the best technology goes a long way in helping achieve some success.

How can Doctors be assured that their patients get their hearing tested?

A Doctor asking their patients to please get their hearing tested will simply not result in acceptable levels of compliance.  The patient is experiencing no pain and is hearing everything they are hearing.  They do not perceive a problem and certainly do not want to.  Compound this with the fact that it is the rare person who is willing to accept a hearing loss, let alone prepared to address the problem with the utilization of hearing devices.

The proven way to achieve patient compliance in getting their hearing tested is for the Doctor to first tell the patient that a hearing test is needed.  The patient then needs to be told that their name and phone number needs to be provided during that visit so that the hearing professional can call them to arrange an appointment.  Their information is then supplied to the Audiologist so they can call them.  If it is not done this way, a hearing test will rarely happen.

What advice should Doctors dispense to their patient should they learn that a hearing loss is present?

There are many co-morbidities associated with hearing loss.  The most alarming is the cognitive decline linked with Dementia. The Baby Boomers are a massive amount of people that need to take care of themselves so not to overwhelm the medical community and their loved ones.  Good hearing gives a person the chance to maintain a rewarding, socially relevant, confident place in life while enjoying a safe and meaningful existence in their later years without being a burden on their families and medical community.

Doctors should make sure their patients know that an untreated hearing loss is a tremendous burden and frustration on their family members and friends.  A burden and frustration that most people with hearing loss have no idea exists.  The following true story exemplifies this.

A few years ago, a daughter brought her mom into our clinic for a hearing test.  The mom was in a wheelchair and was very weak and looked as if her time was near.  The daughter told me that her mom has been hearing impaired for more than a decade but has refused to address it.  She says her mom no longer has the energy to push back and asks me to do anything I can to help her mom hear better. 

Her evaluation revealed that her hearing was very poor.  We ordered her the best hearing devices per her daughter’s wishes.  The devices cost $5,700.  The plan was to come back in a week to be fitted and return a week after that for follow up.  As always, a 30-day return period was in place with 100% of the money refunded if the patient was not satisfied.

The following week the daughter returned with her mom.  Her sister came with them as well.  The hearing devices were fitted.  They were turned on while the sisters were chatting about a family function.  The mom heard them, was able to understand what was being said, and interjected a comment.  The sisters were stunned that the mom actively participated in the conversation.  They were elated beyond belief that their mom was able to join them in their discussion. 

One week later the follow up appointment was missed.  I called, and the daughter sadly informed me that her mom had passed away three days earlier.  The mom got to use the devices for only four days.  I reminded the daughter that we had 30 days to get a full refund and to please bring the device back to me so the $5,700 could be refunded back to the family.

As the 30 days were closing in, I called the daughter to remind her to bring the devices back. She thanked me for the call and for providing her mom and their family with four wonderful days of reconnecting and togetherness.  She shared that she knew her mom was close to her end and that she invited family and friends to come and visit with her during her last days. 

With her hearing devices, her mom was able to participate and enjoy the conversations and togetherness of her loved ones. Many stories were shared resulting in wonderful moments of laughter and crying with grandchildren, sons, daughters, family members, and friends.  These were moments that never could have happened without the benefits of her hearing devices. 

The daughter was very grateful and thanked me multiple times for helping her mom.  She then shared with me that her family was very happy and grateful that their mom had become their mom again for those four days. They were so appreciative to have had those four days, that the family made the decision to have those $5,700 hearing devices join their mom in her forever resting place.   This clearly reminds us that the value of better hearing cannot be measured enough as it pertains to family and friends.

Keeping hearing at a reasonable level of function goes a long way toward reducing social isolation, depression, confusion, falling and the cognitive decline research is finding to be associated with untreated hearing loss.  Patients need to be encouraged by their Doctors to embrace the benefits of wearing hearing devices and incorporating the ongoing Audiological care and treatment that is necessary for their continued success and enjoyment of their best hearing.

How do hearing devices differ from each other in terms of cost and function?

Hearing devices are a tool used to manage hearing loss. A licensed Audiologist or Hearing Aid Dispenser is needed on a regular basis to assure that the devices achieve and maintain their purpose over the lifespan of the products.

There is a lot of confusion regarding hearing devices and the multitude of random products found on the internet that profess to be FDA-approved including the new category called OTC or Over-the-Counter. Confusion also surrounds their function, cost, and care.  In general, the better technology uses better computer speeds, better algorithms, better microphones, better speaker systems, and better software.  It handles the processing of speech with more effectiveness, comfort, clarity, and ease of listening.  It also costs more. 

The more socially active a person is or wants to be, the more advanced the devices should be.  A trial attorney needs to give his or her hearing a better level of success than a person in a retirement home with little daily social encounters. 

Managed care insurance companies have recently entered the dispensing process.  Most are making money by selling hearing devices and attempting to control the delivery process.  They do save the patient money up front, in most instances, which is done by purchasing the device directly from the manufacturer at a significant discount but then eliminating the Audiological follow up care.  This is detrimental to the patient as hearing devices are capable of functioning well for five years if the patient and the devices are cared for properly.  Studies show patients wear their devices more and are much happier with them when care and treatment follow them throughout the ownership of their devices. 

A hearing device is a tool which is used to help manage hearing loss. Hearing is very complicated, with many layered elements experienced by the individual.  There are many adjustments and a lot of follow up care that play into successfully wearing hearing devices.  A hearing device by itself is not a solution nor a cure for the hearing loss. 

Follow up care is essential for successful utilization of hearing devices.  Listening to augmented sounds with hearing devices can be experienced as being too loud, too harsh, too soft, too tinny, too boomy, too raspy.  Other issues can include physical comfort, feedback, not staying securely in the ear, confusion with its Bluetooth capabilities, confusion with its App, problems with understanding conversations in noise, difficulty inserting it into the ear correctly, keeping it clean of wax and other debris, changing batteries and more.

Hearing is a unique experience to the listener.  A chef can have a great recipe, great ingredients, cook the food precisely perfect, and the meal still might not taste acceptable to the person eating it.  This is the case with hearing.  Everything can be clinically perfect but there is no guarantee it will sound as the person wants or is willing to accept. This is where follow up care is so important.  The Audiologist or Hearing Aid Dispenser must bridge the gap between what is needed and what is liked.  This process is not an easy one and it continues for as long as hearing aids are used. 

Since managed care insurance companies deny the inclusion of proper care in their plans, our practice includes this care at a discounted rate.  This will allow the patient to have the intended success with their hearing aids for at least its 5 years of expected life. 

Doctors need to mandate good hearing health which starts with a hearing test, then encourage treatment with good technology and uninterrupted ongoing care and treatment.