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The Dose Transcript for December 7, 2023

Host: Brian Goldman

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BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. A surprising number of Canadians have significant hearing loss. Not just older people, but a surprising number of young people as well. More than one billion young people worldwide may be at risk of hearing loss, according to the World Health Organization. Some Canadians aren't fully aware that they have significant hearing loss. We're doing this topic now because decreased hearing affects quality of life in several pernicious ways for older people and younger people. And for a lot of us, it's largely preventable. So this week, we're asking, how can I prevent and treat hearing loss? Hi, Emma. Welcome to The Dose.

EMMA LEBLANC: Hi, Brian. Thanks so much for having me.

BRIAN GOLDMAN: Hearing loss can be gradual. You know, what do you hear from your patients about what made them seek medical help?

EMMA LEBLANC: Most of the time, it's family members who are pressuring them to come in and see us. Because it is such a slow decline, people don't notice it from day to day. But if you think of your hearing five years ago to today, it has significantly decreased. So your family members are pressuring you to come in and see me because the TV is having to be turned up or they're having to have louder conversations with their loved ones.

BRIAN GOLDMAN: And I think sometimes, there's an ego thing. I think with my late father, he, you know, he didn't like the idea of requiring some kind of assistance and appearing to require assistance. And I suspect that for some people, that that's true for you for your clients as well.

EMMA LEBLANC: Absolutely. Stigma is definitely part of it. People don't want to wear big hearing aids and that are visible. But the good thing is with technology, things are getting smaller and smaller and more discreet. So we can help everyone now.

BRIAN GOLDMAN: Well, can't wait to hear what you have to say about this. But before we begin, can you give us a hi, my name is? Tell us what you do and where you do it. Just adlib.

EMMA LEBLANC: Yeah, sure. So my name is Emma LeBlanc. I'm an audiologist and a manager of the hearing and balance Centre at Toronto General Hospital, and I'm a co-owner of the Munk Hearing Centre Clinics.

BRIAN GOLDMAN: Okay, let's begin. How many people, roughly speaking, in Canada, have hearing loss?

EMMA LEBLANC: We know that there's about 23% of Canadians who have hearing loss in Canada. It is broken down a little bit more by age. It's around 9% of individuals 20 to 39 years old have hearing loss. It jumps up to about 27% among those who are 40 to 49. And then over the age of 50, it's as much as 51%. And it actually gets up to 94% of individuals 70 to 79.

BRIAN GOLDMAN: And, you know, one of the things we did want to talk about is the fact that younger people are getting or experiencing hearing loss. And that's not exactly new because, you know, there have been ultra-loud concerts for decades now. But what do you know about the trends of younger people getting hearing loss?

EMMA LEBLANC: Yeah. As you mentioned in the beginning, there's one billion people worldwide who are estimated to be at risk of hearing loss between the ages of 12 to 34 years old. And the primary reason for that is unsafe listening practices related to personal listening devices. So things like headphones, earbuds with your cell phones. And then the other thing is, as you just mentioned, high volume in loud music venues.

BRIAN GOLDMAN: So I think it's fair to say that, you know, concerts have been around for decades. But is there something newish about the personal listening devices that people are using that are making them more at risk of hearing loss?

EMMA LEBLANC: Yeah. So I think just the accessibility of having your phone as your main source of music, your main source of listening enjoyment and having that on you at all times means that we can be dialed in to whatever it is that we're wanting to listen to 24 hours a day. And so that coupled with the fact that we have Bluetooth that makes things wireless and easy to just pop those earbuds in and go about our day means that we're exposed to noise much more than what we were even 10, 15 years ago.

BRIAN GOLDMAN: Now, thinking about primarily seniors, you know, at what age do we typically start to experience significant hearing loss?

EMMA LEBLANC: It really depends on quite a few factors related to hearing loss. So one is genetics. The other is age and the other is environment. So whether or not you have hearing loss in your family, you're going to be more likely to have hearing loss. Same thing with your environment. So if you're somebody who's been around loud noises, whether it's through recreational things like shooting or through your job, then you're going to notice hearing loss much, much sooner than somebody who's, let's say, 70 years old. So we tend to… it's really dependent on a multitude of factors of when we would expect to see somebody in our clinic. But generally speaking, I would say 60 and over is when we certainly start having the conversation of all right, you have some hearing loss, now we should think about hearing aids.

BRIAN GOLDMAN: What are the most common causes of hearing loss?

EMMA LEBLANC: Age related. So just purely as we get older, our system just doesn't work as well. And that really… that causes hearing loss. And if we're looking at a hearing test, we test frequencies or pitches from low pitch to high pitch just like a piano. So those base notes to those treble notes. And as we age, we lose those high pitch or those treble notes more and more. So it's high frequency, high pitch hearing loss. And what that translates to everyday world is that we feel like people are mumbling. We're not hearing them clearly. We're not hearing those consonants, those f, s, t, h sounds which help us to hear the clarity of speech.

BRIAN GOLDMAN: People listening to this may think that hearing loss is hearing loss, but there's conductive hearing loss and there is nerve damage hearing loss. Can you give us a little précis on the difference?

EMMA LEBLANC: Yeah, absolutely. So as I mentioned earlier, there are three parts of our ear. There's the outer ear, the middle ear and the inner ear. So the inner ear is where we have all the nerves, and that's what conducts the sound to our brain. We have the middle ear space, which just sends the sound to that nerve. So if we have a blockage that's preventing the sound from getting to that nerve, that's what we call a conductive loss. The sound is not able to be conducted from the outer ear all the way into that hearing nerve. People may have heard of the term cochlea. So that cochlea is our hearing organ, and which is the inner ear. If we have no problems with that middle ear space, the sound just gets right on and goes through all those little tiny bones and then gets to the cochlea. And if the cochlea is damaged, then we have a nerve damage or what we call sensorineural hearing loss.

BRIAN GOLDMAN: Some people who are listening to this podcast have experienced tinnitus, ringing in the ears. What's the relationship between tinnitus and hearing loss?

EMMA LEBLANC: We know that tinnitus affects about 17% of the population, and the cause is unknown in about 40%. So of that 60% of the known cause, it's often hearing loss. So we know that if somebody has hearing loss, they're more likely to have tinnitus.

BRIAN GOLDMAN: So is it an incidental finding in that case, it's just something that they're noticing and that if their hearing is improved with, say, a hearing aid, that the tinnitus will be less? Because I know for some people, they're really bothered by ringing in the ears, by tinnitus.

EMMA LEBLANC: Yeah. So tinnitus is definitely something that we see a lot of in our clinic, and it is extremely… it can be extremely bothersome. And so one of the first things that we do if somebody is complaining of tinnitus, or I guess I should take a step back and say that tinnitus is any type of noise that you hear in your ear, whether it's ringing, buzzing, hissing, sounds like that that are not in the external environment, but they are heard inside your head. And so if somebody complains of tinnitus, the first thing we do is a hearing test. And that's the first step in identifying truly the cause of the hearing loss, of the tinnitus, excuse me. The way that we counsel patients is that, I like to think of it almost as phantom limb pain. So when we've lost a limb, oftentimes, our brain is giving us an input that we can still feel it. Our arm is still itchy or it's still hurting, something like that, but it's not there. The same idea as with tinnitus is that there is a sound that's missing. We're not hearing as well as we used to. And so our brain is almost giving us that signal. It’s telling us something is different. Something has changed. And so we know that if we put sound back into people's ears through the use of hearing aids, we can actually benefit people and help them with their tinnitus and their tinnitus management.

BRIAN GOLDMAN: So restoring their hearing can actually cause the tinnitus to be reduced.

EMMA LEBLANC: Exactly.

BRIAN GOLDMAN: Got it. I think we're mainly talking about persistent hearing loss, but there are some very specific conditions. And in fact, I see some of them in the emergency department in which the hearing loss is sudden and temporary. Can you talk about that?

EMMA LEBLANC: Yeah. So sudden hearing loss is absolutely an emergency. And we know that if a patient can get into the emergency room within 24 hours and get that sudden hearing loss identified, that we have a better chance of improving their outcomes and recovering that hearing. But essentially, what it is is whether you wake up in the morning or just in a split second, you lose complete hearing on one side, often, it's just single sided or one side. And that is something that's, as I mentioned, an emergency, and we need to get people into the emergency room as soon as possible.

BRIAN GOLDMAN: And that's because there are treatments that can reverse it. And sometimes, that involves the use of high doses of what we call corticosteroids, drugs like, medications like prednisone. And I've actually prescribed it for that very purpose. And I know that it has restored hearing almost as quickly as it had disappeared. But there is another cause of acute hearing loss that I think is also worth talking about, and that is a build-up of cerumen or wax inside the ears.

EMMA LEBLANC: You got it. And that's actually a conductive hearing loss. So that's when the sound is just not able to get to that hearing nerve because there is a block of wax. The good thing is that with either drops in the ears or through under section or under microscope like we can do here, at the hospital, we can remove that wax and the hearing is completely restored.

BRIAN GOLDMAN: Okay, let's get back to people who have more persistent impairment in their hearing. One of the things you said off the top is that people often have to be kind of dragged or persuaded heavily to speak to an audiologist to go to a hearing clinic. When should they? When should they be seeking medical help for hearing loss above and beyond that sudden catastrophic loss of hearing that we were just talking about?

EMMA LEBLANC: So we recommend that anybody, anybody really over, I would say over the age of 30, over the age of 40, should do routine hearing checks. Just like we go to the dentist routinely, just like we go to the eye doctor routinely, we really should be checking our hearing every one to two years, depending on your age. So we can go maybe every two to five years over the age of 30. But then at the age of 50, then maybe we should be doing it more frequently.

BRIAN GOLDMAN: And I'm going to ask now a little bit personally, what are you checking for? And I say that because, you know, I had a sense that I was losing my hearing and that I thought I might need a hearing aid. And I got tested and I was told, no, you know, you can wait. So what's that all about?

EMMA LEBLANC: Yeah. So what happens is we can lose some of our extra high or ultra-high pitched sounds that can cause us to have more difficulty hearing in background noise, which would bring people into our office sooner. And it's something that we can't aid. So we can't put a hearing aid on. Hearing aids have a very specific range of pitches that they can help. And so if you have hearing loss that's beyond those that the hearing aid can help, then we just say, let's monitor the hearing and we'll check it every couple of years. And we do know that eventually you'll probably need hearing aids, because if we have some hearing loss, often it just kind of gets progressively a little bit worse over time.

BRIAN GOLDMAN: So then let's talk about hearing aids one on one, as it were. What are they good for? And you've already told me what they're not good for. But can you be more specific about what they help restore?

EMMA LEBLANC: So hearing can help… Sorry, hearing aids can help restore hearing. But unfortunately, hearing aids are not like glasses. So you don't just put them on and go about your business and you have perfect hearing or perfect eyesight. So hearing aids are excellent to bring back your hearing to a louder level. But what they can't do is pick out what you want to hear when you're in a party, let's say. So if you're in a group setting, the hearing aids are going to increase the volume of everything. And so we're really working with your brain with hearing aids. The more people wear their hearing aid, the more they get used to their hearing aid, the more successful they are going to be long term in these more complex environments. So we know that they can help you. They can make sounds louder and help you in these louder environments as well as in quiet environments. But we really need to work together, practice wearing those hearing aids and wear them as much as possible to be the most successful. If somebody has a problem with speech, what we call word recognition thresholds, so just word recognition, just it's like a lack of clarity of speech. Once that clarity of speech has declined, it's not something that we can fix. So if we test your hearing, so we test hearing through thresholds, so you hear a beep and you press the button, but we also test speech. And so people repeat words after me. If their words are, let's say at a 65%, if I get a 65% word recognition threshold, I put hearing aids on them, I still expect them to only get 65% of the words correct.

BRIAN GOLDMAN: Hmm.

EMMA LEBLANC: So even though the hearing aids make it louder, it cannot correct for that distortion.

BRIAN GOLDMAN: So we've been talking about hearing aids that you place in the ear and they emit sounds that pass through your, you know, into your inner ear. What about bone conduction hearing aids? How are they different?

EMMA LEBLANC: So bone conduction hearing aids are little implantable devices. This is actually just a little post that gets implanted behind the ear, and then the hearing aid processor gets snapped onto the back. And so what it does is it bypasses all that outer external ear as well as the middle ear, and it goes directly to the cochlea , directly to that hearing organ to stimulate it there. So we would use a BAHA or a bone anchored hearing system for somebody who has something wrong with getting the sound, conducting the sound to that cochlea.

BRIAN GOLDMAN: And is that the same as a cochlea implant?

EMMA LEBLANC: No. So a bone anchored hearing aid is just a little abutment that goes into the bone behind the ear. A cochlea implant is a device that actually gets implanted through the ear and into the cochlea. It's actually got an electrode array that goes into the cochlea. And the sound is actually an electronic sound that goes into the cochlea and then sends a signal through the hearing nerve.

BRIAN GOLDMAN: You know, I think we're talking mostly to the population that's older and is experiencing age related hearing loss. What about younger people who have either lost hearing because of their occupation? Maybe they didn't wear protective earplugs to decrease the sound input, or perhaps they went to a lot of concerts, so they're using personal listening devices at too high a volume. What sort of damage do they have? How do hearing aids help them?

EMMA LEBLANC: So over repeated exposure to loud noises, the hearing doesn't recover. So we do know that there's what we call a temporary threshold shift. So if somebody has exposure to a loud… say if they're standing beside a loud speaker at a concert, they could experience a sudden or a temporary threshold shift the next day that recovers. The more we do that, the more temporary threshold shifts we have, the more likelihood that that doesn't… that the shift never actually goes back to normal. So that would just be a purely sensorineural nerve damaged hearing loss. So the best thing for those individuals in terms of helping them with their hearing would just be a traditional hearing aid.

BRIAN GOLDMAN: And clearly, since it's self-induced, that's something that should be preventable. We'll get to that. I think we'll close off by talking about that in a few minutes. But, you know, you were talking about hearing aids. You know, the message I got from you was that, you know, you want people once they start using hearing aids to use them all the time so that they get used to them. Is there an ideal age before which it's more optimal to get used to hearing aids as opposed to waiting later? Because, you know, my sense is that once you become very old, once you're 85 or 90 or 95, I don't think it's impossible, but it becomes more challenging for people to adapt to hearing aids.

EMMA LEBLANC: You're absolutely right. I don't have a specific age, but I do know that the sooner we get hearing aids on somebody, the more likelihood they're going to be successful long term. We also know that the sooner we get hearing aids on, the less likelihood that the word recognition scores are going to decrease. So that distortion, if we can keep the ear from… it's almost like it's working. So we're continuing to put sound into the ear and continuing to make that brain work. As long as the brain doesn't forget how to work, then the hearing aids are going to be successful. So let's keep that sound going into the ear from as early as we can. So as soon as we identify hearing loss, as soon as we identify somebody is a hearing aid candidate, then that's as soon as we should get the hearing aids on them.

BRIAN GOLDMAN: Well, so there's a use it or lose it component to this, to hearing loss as well.

EMMA LEBLANC: Yeah, to some degree. Like I said, not the threshold. So we cannot prevent the hearing from decreasing, but we can prevent some of that distortion from happening. Not all the time, but it's something that we absolutely strive for.

BRIAN GOLDMAN: So I said we're going to talk about prevention because I think it's really, really important here. What can I do now to protect my hearing?

EMMA LEBLANC: So the best thing that you can do is to wear earplugs. So depending on what you're doing, depending on what you're exposing yourself to, you can go as simple as the over-the-counter at the drugstore little foam earplugs that you put in your ears any time that you are doing anything that's loud. So that's power tools, that's mowing your lawn, that's using a saw, anything like that, to custom made earplugs for somebody who's in construction maybe who wants to… who needs to wear earplugs all the time that needs to be comfortable. And then for somebody who's listening to music at a concert, we have what we call musician plugs that could be non-custom and custom. Non-custom obviously are cheaper. They're kind of a small, medium, large size fits all. And what they do is they filter out the noise properly so you get the fidelity or a better sound when you're listening to music. So you can do that. Or we have the same thing in a custom made product. So it's molded to your ear, and they have these special filters in them that again keeps the sound quality. So you can still hear your music, but it's not at a loud level, it's at a safer level. And then lastly, in terms of listening to music on a personal listening device, there are apps that you can download. I think most of the phones now actually have a limiter on them where they tell you when you're listening to music too loud. So absolutely download those apps if it's not already on your phone, pay attention to that. And then my last tip is to use noise cancelling headphones. So when you're listening to your phone and you're going in a subway or you're driving and there's traffic and the window is down, you're going to be inclined to turn up the volume so that you can overcome that external noise. By wearing… by wearing those noise cancelling headphones, you're going to be able to listen to it at a much quieter level and be safe.

BRIAN GOLDMAN: You work in a teaching hospital hearing clinic. Where should people go to get their hearing tested?

EMMA LEBLANC: They can go to any audiology clinic. You can really just Google audiology or hearing test near me and you'll find one. The most important thing is that if you get… if somebody recommends hearing aids, is that you make sure that you're comfortable with the people that you're talking to because it is a relationship that you're going to be developing for quite some time. And so you want to make sure that you're comfortable and that they have the clinic policies or something that you're, you know, you want to come back to and get your hearing checked regularly.

BRIAN GOLDMAN: Seek the advice of a trained audiologist because they're the ones who can best advise you. That is certainly, you know, one of the most important things I'm getting from you, Emma LeBlanc. But I want to thank you. You are a fountain of information, and you certainly told me a lot of things I didn't know before. So thank you very much for coming on to The Dose to talk about hearing loss and what to do about it.

EMMA LEBLANC: Thank you so much for having me. I really appreciate it.

BRIAN GOLDMAN: Emma LeBlanc is an audiologist and manager of the Hearing and Balance Centre and co-owner of the Munk Hearing Centre Clinics at the Toronto General Hospital. Here's your dose of smart advice. Hearing loss is very common, especially among older Canadians, but the incidence is also increasing among younger people. Some begin experiencing hearing loss in their 20s or 30s. Some of these cases may be caused by otosclerosis, a condition in which there is abnormal remodeling of the bones of the middle ear. Noise exposure is also a major factor in the rising prevalence of hearing loss in younger people. Sources of excess noise include frequent use of personal listening devices, attendance at loud concerts, bars and nightclubs, and occupational exposure. There are three types of hearing loss. Sensorineural results from damage to the inner ear nerves. Conductive is the result of blockages to the outer or middle ear. Mixed hearing loss is a combination of both. Factors in hearing loss among older people include age related nerve damage, the aforementioned otosclerosis, smoking and chronic diseases. A whole host of medications can cause or contribute to hearing loss. Earwax Build-up is a common cause of hearing loss that is completely reversible through safe removal of the wax or cerumen by a trained professional. Sudden sensorineural hearing loss is a condition that causes rapid hearing loss over hours to days and is considered an emergency because prompt medical treatment can reverse it in many instances. Hearing aids are effective for those who experience progressive hearing loss. The choice depends on the type and severity of hearing loss, the size and shape of your outer ears and inner ear canals, manual dexterity and lifestyle. An audiologist can help you find the right device. With age, it gets harder to adapt to hearing aids. So the sooner you start wearing them regularly, the better. Assistive listening devices use an external microphone to amplify speech and direct it to earphones or earbuds. These portable devices make it easier to follow conversations in certain noisy environments with poor acoustics. Cochlea implants are electronic devices that converts sound to digital signals that are sent to the brain, bypassing damaged nerve cells. They help patients with severe or profound hearing loss who can't benefit from hearing aids. There are several reasons why it's important to address hearing loss. Not being able to hear affects quality of life and causes social isolation. In older adults, it increases the likelihood and severity of dementia and can contribute to falls. Noise related hearing loss is preventable by wearing proper hearing protection on the job or at concerts and by turning down the volume on listening devices. Finally, it's important to get your hearing checked regularly to detect hearing loss while it's amenable to treatment. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you like this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Isabelle Gallant. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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How can I prevent and treat hearing loss? - Transcript

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