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Melanie Cole (Host): After a lifetime of listening, you might find that your hearing doesn’t seem as sharp as it used to be. Our hearing tends to change gradually over time; however, there are some steps you can take to protect your precious hearing. My guest today is Dr. Nicolle Yopa. She’s an audiologist in the Marietta, California area. Dr. Yopa what is the prevalence. Speak a little bit about hearing loss. Is it a natural progression? Does everybody lose their hearing as they get older?

Dr. Nicolle Yopa (Guest): That’s a great question. So there’s a not a written rule that at a certain age you should have a certain amount of hearing loss, but we are more likely to develop hearing loss with age simply due to the wear and tear of our hearing structures over time. There are other risk factors; however, if you have cardiovascular issues, diabetes, if there’s a family history of hearing loss, those could increase your risks for developing hearing loss at any point in life.

Melanie: So you mentioned diabetes and some other things, what else are some common conditions or things behavioral, lifestyle, things that we do that can contribute to hearing loss?

Dr. Yopa: So sometimes, patients are on certain medications that are known to be ototoxic. So if there’s a history of chemotherapy, for example, one of the side effects can be hearing loss. Noise exposure, so somebody who has a loud occupation or they just have loud hobbies such as recreational shooting, that certainly could increase your risk for a more permanent type of hearing loss and some folks just have recurrent ear infections. They have issues where they often get infections in the middle ear and that could certainly effect one’s hearing either temporarily or over time, it could become more permanent as well depending on the situation.

Melanie: So what are some signs of hearing loss and how do we know if that’s what’s going on or if there’s just wax in our ears?

Dr. Yopa: The only way to really find out whether the problem is from wax is getting a full evaluation. So you can come in, we can take a look, remove the wax and do some testing, but the common signs would be simply just feeling like your hearing is muffled or just reduced in general than it used to be, feeling like people are mumbling. You hear their voices but you’re having a hard time distinguishing exactly what they’re saying. Another common symptom of hearing loss is ringing in the ears. It’s actually called tinnitus or tinnitus, either way is fine to pronounce, but that just means any kind of phantom sounds in the ear, whether it’s ringing or buzzing or chirping sounds, those are common signs that something’s going on with your hearing.

Melanie: So tell us what the evaluation is like with an audiologist. What do you do to determine how severe the hearing loss is and what we might need as far as treatments.

Dr. Yopa: So when the patient comes in, of course I take a thorough case history related to risk factors, any prior noise exposure, are there any other underlying health issues, is there any family history of hearing loss, take a look in the ears to see if any wax needs to removed, and then we do objective testing to see how mobile the ear drums are. If they’re freely able to move then we know most likely that middle ear space is good that there’s no fluid or infection going on, and then we actually do a subjective hearing test where the patient listens to various tones across different pitches and we start to see how loud that pitch needs to be before they can barely hear it and that gives us an idea of how severe the hearing loss is, but there are additional measurements that we take to see whether the hearing loss is considered conductive, meaning it’s not really at the level of the nerve, it’s more mechanical or if it’s a permanent type of hearing loss at the level of the nerve. So we get all of that from that one visit through all of the audiologic testing.

Melanie: So then what? If you determine that someone has a significant enough amount of hearing loss that they need some sort of intervention. Let’s start with hearing aids since they’re the most common and people have you known really know about hearing aids, they’ve come a long way haven’t they Dr. Yopa? Tell us how much they’ve changed over the years.

Dr. Yopa: They’ve changed a lot. So one thing I think a lot of people notice is they’re not as large as they used to be. They’re much smaller, even the behind the ear style. Functionality is much different as well. It used to be years ago hearing aids were considered analog, which means whatever those microphones picked up was made louder, whether you wanted it to be louder or not. Now with today’s hearing aids, there are multiple microphones, so the hearing aids can pinpoint what is the main speech source versus what is extraneous background noise and it’s able to separate the two so that you can hear better over that noise and there’s noise reducing technology built in in addition to that. So there’s compression. We’re able to compress those unwanted sounds relative to the main speech sounds. So no longer are they analog. There’s a lot more that they can do across multiple environments and cosmetically they are just much smaller. We’re able to get a lot out of a computer chip in such a small size, so altogether all around is just so many advancements over the years.

Melanie: And as far as hearing aids, the batteries are tiny and so many people with hearing aids are older individuals. They have a little trouble with those batteries. I know because I’ve changed a few for people that I know, so do all of them have those little tiny batteries? Are there some different ones that now have a longer life? How does that work?

Dr. Yopa: That’s a great question. We are now entering this phase where a lot of the manufacturers are offering rechargeable options. So Phonak is one company where they now have a fully lithium ion hearing aid. So that means there’s no battery door at all. You just set the hearing aids in a dock and they charge while you sleep every night, and then you have a full charge for your whole daily use. There’s another option that other companies have where there is a battery door, but you can go back and forth between a rechargeable type of battery or disposable type of battery, which is attractive to folks who don’t want to rely on a power source, say if they want to travel and not take their charger with them. So there are options for rechargeability that will help with poor dexterity or poor vision so we’ve come a long way with that as well.

Melanie: Dr. Yopa do you think that there is a stigma as it were about hearing loss? Nobody would ever yell at a blind person for not seeing them, but people seem to be more frustrated, more easily frustrated, with someone who can’t hear and they get yelled at because people think you can’t hear me and then they yell at them or they speak slower and louder. Do you think there’s a stigma and if so, what do you want people to know about that?

Dr. Yopa: That’s a really good question. Yes, unfortunately I feel like it’s still there. It’s not like it used to be. I think as the public are becoming more and more educated on hearing loss and how it affects people across the whole age range, people are becoming more understanding of it. It really comes down to the patient advocating for themselves. I always tell folks that hearing loss is much more noticeable than hearing aids. So I feel like we take our hearing for granted, so the folks who are getting frustrated because they have to repeat themselves, they don’t see hearing aids, so they’re just assuming you’re not paying attention to me or there’s something else going on and they’re quick to assume, but if we’re treating the underlying hearing loss and improving our communication abilities but also informing the person with whom you’re talking that you have a hearing impairment and you need to look directly at me and keep your voice at a steady volume and also slowing down, I think that goes a long way, but it really comes down to self-advocating, letting people know your limitations and people are more understanding than we give them credit for. We just have to educate them.

Melanie: Good point. Now tell us about some of the other devices that might be available if hearing aids just are not working for somebody, what devices might available to help them? Tell us about some of the newer implantable hearing devices?

Dr. Yopa: So when it comes to implantable devices, and I mean surgically implantable devices, there are two main types. So earlier I mentioned a conductive hearing loss, and that’s when the nerve of hearing is intact and there’s a hearing loss due to a mechanical malfunction of the ear such as something’s wrong with the eardrum or there’s something wrong with the middle ear. If that problem cannot be medically addressed by the physician, there is an implantable device called a bone anchored hearing aid and it is implanted in the skull right behind the ear in the mastoid area. What that does is it picks up sound in your environment and it reroutes it. It takes the sound and sends it directly to the hearing nerve so that sound doesn’t have to be pushed through that area where there’s a mechanical issue. So I do have several patients in that type of hearing device. In some patients with a conductive loss, they can’t wear a traditional type of hearing aid because sometimes their issue is recurrent ear infections, and sometimes having something inside the ear will make that become more of an issue so we have to keep the ear free from anything. The other type of hearing implantable device is a cochlear implant and that is altogether a completely different animal. So a cochlear implant is reserved for folks who have a hearing loss so severe and a more permanent type of hearing loss that even the most powerful, traditional hearing aids available are providing little to no benefit. So that is an implant that actually electrically stimulates the nerve directly to bypass all the damaged parts earlier on in the nerve. So we also worked with a lot of these cochlear implant recipients at the clinic where I am now. A lot of success but it really is for a certain degree of hearing loss. It’s meant as a last resort means of treatment.

Melanie: Wrap it up for us, your best advice for hearing health and protecting our hearing in any way that we possibly can and what you want people to know about what you do for a living and really what they can do to protect their hearing.

Dr. Yopa: So the biggest take home message that I would love to get out there and I am trying to get our there is the cognitive effects of hearing loss. So when somebody has hearing loss, especially if it’s untreated, depending on where the person is in their life, what age they are, it does increase our risk of dementia later. So the more severe the hearing loss, the higher the likelihood. Now hearing loss is something that’s treatable. So while this is a risk factor, it is a risk factor that we can help to reduce by treating the hearing loss. So that’s why I tell patients everyday that if there’s a hearing loss, treating it sooner than later is better for so many reasons and this is one of them. The other thing that I really want to get out there that a lot of people don’t realize that you can suddenly develop hearing loss and when I say suddenly, I’m talking waking up one morning and having little or no hearing in one ear. A lot of these folks when this happens, they go to urgent care or the emergency room for treatment, which seems reasonable and they’re often given antibiotics, but the only surefire way to figure out whether something is bacterial in nature or if there’s something else going on is through full audiometric or audiologic testing and being examined by a physician, preferably an ear, nose, throat physician. So the problem is often see these patients months after the initial onset after going through multiple rounds of antibiotics. They come to see me and mechanically everything’s fine and I find a very severe sensorineural hearing loss, which is a more permanent type of hearing loss. Had they come in at the initial onset, they most likely would have been put on high dose steroids by our ENT physician and with that type of thing there’s a small window of time where that type of treatment is going to be most effective so time really is of the essence. If you ever experience an acute change in hearing like that, it’s imperative that you get into an ear, nose, throat clinic either that same day or ideally within the next 72 hours.

Melanie: Wow, that’s great advice and so important for people to understand. Thank you so much Dr. Yopa for clearing that up for us today and for sharing your expertise and explaining all about hearing loss and hearing health for us today. You’re listening to TVH Health Chat for Temecula Valley Hospital. For more information, please visit temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks so much for listening.