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“As an audiologist, treating hearing loss is a part of my everyday life. Even still, I’m sometimes amazed at the difference hearing aids can make in patients’ lives. For example, recently, when an older patient with longstanding hearing loss was fitted with a pair of hearing aids, he was suddenly able to participate in conversation with his son again. The smile across his face said everything.”
Amy Sarow is an audiologist.
She shares her story and discusses her KevinMD article, “How hearing is connected to well-being.”
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Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Amy Sarow. She’s an audiologist, and her KevinMD article is titled “How hearing is connected to well-being.” Amy, welcome to the show.
Amy Sarow: Thanks so much for having me on.
Kevin Pho: So we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.
Amy Sarow: Yeah, so I’m an audiologist. I got my doctorate in audiology from the University of Iowa, and I spent my fourth-year externship at the Mayo Clinic in Jacksonville, Florida. I really enjoy helping people with their quality of life and being able to connect with others and communicate. That’s something that I’m passionate about. I currently live in Michigan, where I work as a clinical audiologist, helping people with their hearing, as well as with hearing devices such as hearing aids and cochlear implants, in addition to dizziness or imbalance.
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Kevin Pho: So we don’t have very many audiologists on the show. So take me through a typical day and some typical cases and patients that you would see.
Amy Sarow: Sure, so it can vary day to day. Some days I’m in the clinic, where I’m working alongside a neurotologist, and I do hearing tests on those patients as needed. We’re a fairly busy clinic, and so we see quite a few patients. They may be coming to us because perhaps they’re already aware that they have some hearing difficulty, and they’re coming in to see how we’d be able to help or offer solutions for them.
Other times, I might be doing some vestibular testing or balance testing for patients who are having dizziness. Perhaps they have a tumor in the ear where they’re needing surgery, or other types of vestibular therapy in physical therapy. We work with a lot of other professionals there in that setting, and so it could be something like that.
Other days, I’m in the clinic working with patients to do some troubleshooting on their hearing aids, talking about what hearing devices might be appropriate for them, and evaluating them for cochlear implants or bone-anchored hearing aids. So we have a wide range of devices and solutions for people based on their hearing and their needs.
Kevin Pho: So you have a platform here primarily of clinicians, mostly physicians. What’s one thing that you want my audience to know about audiology?
Amy Sarow: Yeah, so I think that hearing is something that affects everyone’s quality of life. We don’t often notice it until hearing starts to deteriorate. And I think I would love it for people to just have more conversations with their patients about getting a hearing test, even if it’s just a baseline after age 50. Hearing loss can be gradual, and it can sneak up on you, and it can really interfere with your quality of life and how you connect with others, and some people are just feeling isolated.
Especially in the pandemic, we’ve seen a lot of people who may not have been fully aware of their hearing difficulty, and then once people started wearing masks, it became really challenging to communicate. And tinnitus as well, during the pandemic.
Kevin Pho: All right, let’s talk about your KevinMD article now. It’s titled “How hearing is connected to well-being.” Now, for those who didn’t get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.
Amy Sarow: Yeah, because your audience is quite a few physicians and other health care practitioners, I thought this would be a great audience to share this message with, that hearing is a part of your overall well-being. Sometimes I see this with older patients. They come into the clinic, and people assume that they have some cognitive decline or some dementia going on. And actually, when I’m talking to them on the audiometer, if I turn the volume up and they can hear me, you can just see the light in their eyes, and it’s, “Oh my gosh, I can hear.”
It’s hard to overcome that hearing difficulty sometimes, and it can be hard to tease out. Do they have some hearing loss? Do they have cognitive decline? Do they maybe have some of both? So that’s really important, and I would love for people to just have more of those conversations with their patients.
Kevin Pho: Tell me in more detail in terms of the impact hearing loss could have, especially on older patients. You mentioned things like health care costs and income. So there are some socioeconomic repercussions from hearing loss, right?
Amy Sarow: Oh, definitely. There’s some interesting research going on. So the NIH recently was looking at some things here, where untreated hearing loss can have an additional cost of, they estimate, roughly $22,000 in health care over a 10-year period, compared to someone with normal hearing. And so we know that can have an impact on it, and you might ask yourself, “How can it have that much of an impact?”
When you go into an appointment, usually people are able to take away a few pieces of information, maybe two or three takeaways from a medical appointment. Well, if you’re struggling to just hear the words, sometimes things don’t process, or you didn’t ask questions that you needed to at that moment. And so you can miss out on important things like “Should I take this medication once a day, or should I be taking it multiple times a day?” or just things like that. And so that’s an opportunity where things are missed out on, and it can be hard if you have hearing loss that’s untreated. Perhaps you’re not fully aware of the difficulty. If you don’t have someone else with you there in that appointment to get that information, it doesn’t always come through and get the message across.
Kevin Pho: And you also made a connection between cognition and hearing loss. So talk more about that.
Amy Sarow: Yeah. So we know also that there’s work being done in terms of listening effort and hearing. When you have hearing loss, it causes you to have to expend more cognitive resources just to pick up the words. So your brain is working a little bit harder to figure out, was that “rose,” or was that “road,” or “path,” or “past,” especially those consonant sounds. And so when you’re using more effort to get just the words, you’re not able to think about the meaning or to make really good memories of what was being said.
And research was starting to show that when we’re able to get some resolution with that, by amplifying or getting treatment for the hearing loss, we can actually have better memory of what was said, and that can help with cognition and make things easier, especially if you can get someone treatment before the cognitive decline sets in, if they’re at more risk, let’s say, and if they have family history or any kind of medical predisposition for that. It can just really help to prevent that from worsening and to keep that intact.
Kevin Pho: So I’m a primary care physician, and let’s say I’m in a room with a patient. When people have hearing loss, sometimes it could be obvious, but sometimes, of course, it may not be. What are some clues that I should be looking out for to send a particular patient for a hearing test where the hearing loss isn’t immediately apparent?
Amy Sarow: Yeah. So one thing that’s tricky: I know, especially with physicians, your time is valuable. You may have a lot of time to spend with them. One way that you can think about getting at it is if you can try to avoid asking yes-or-no questions, because sometimes people with hearing loss will just nod and say yes, but they didn’t actually get what was said, but they’re in that habit of doing that because they don’t want to admit that they have a problem or have difficulty. So if you could ask questions where you can just get a few more words from them, that helps you know if they actually understood your question. So that’s one way, one small thing that you could try.
But also, just having a conversation with them about how they’re doing, how they’re feeling. Sometimes it can look like they’re depressed or they’re just having a hard time, because all of that can pile on and they just feel disconnected. They feel isolated; they feel frustrated. So having that kind of a conversation with them too can be really helpful, just to talk to them about how they’re doing.
Kevin Pho: We’re talking to Amy Sarow. She’s an audiologist, and her KevinMD article is titled “How hearing is connected to well-being.” Amy, there’s been recent news about hearing aids becoming over the counter and more readily available, so give us your take on that.
Amy Sarow: Yeah, so I do think there’s a lot of different opinions about this, but I think overall it is a good thing, because it’s going to give a certain part of the population access to something that they may need. So this will work best for somebody who has mild-to-moderate hearing loss, or maybe the finances are constrained, and if they have some technical skills or if they have a family member who can help them, because a lot of these devices are going to be accessed with an app on their phone, where they’re able to adjust the loudness to what they feel is beneficial for them. So you need to be able to fit into those categories: the mild-to-moderate hearing loss, some tech skills or someone who can help assist with that, and then perhaps somebody who is looking to just get their feet wet and try something first.
It might not be best for somebody who has a difference in how they hear, where one ear is significantly better than the other. I would always recommend that they go see a professional about that. If they’ve had a sudden hearing loss, it’s going to be best to see a professional too, or if they have more than a moderate hearing loss. So someone who has severe hearing loss, or they have difficulty hearing normal conversation at all. Normal conversation is at about 65 decibels, so when someone’s speaking normally, if they can’t pick up any of that, and they need to have a really loud volume before they’re able to hear something, someone almost shouting at them, then they’re going to need something more than they can get over the counter.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Amy Sarow: I just want people to be aware that hearing is an important part of your overall health. Sometimes we don’t think about it because it’s invisible, right? We don’t see hearing loss. It’s not something on the outside, but it can have a big impact on how somebody feels, how they’re doing in their life, and how isolated they are, and it can also impact their overall health because of that.
Kevin Pho: Amy, thank you so much for sharing your time and insight, and thanks again for being on the show.
Amy Sarow: Thank you. It was a pleasure.
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