 Hello and welcome to this edition of quality of life. I'm your host Dave Augustine. Today we're going to talk about audiology and how basically the ear works. Today joining us is Tracy Okerman who's an audiologist from Prevea Health and Prevea Audiology obviously. Tracy, welcome to the show. Thank you. Just to start off with some of your background, how long have you been in the field of audiology? I've been practicing for over 20 years. Most of my career started in Ohio where I'm from and the last 10 years have been here in Sheboygan. Okay, what type of an educational background do you have to? Back when I was in school we had to get a four-year bachelor's degree and then we had to go on to get a two-year master's degree. So I have a master's of audiology. A few years ago they did change the requirements and they require you to have a doctorate of audiology now but that's just the last four years that have been requiring that. Okay, so do you yourself have a doctorate or is that something? I don't have a doctorate yet. I have a couple kids to put through school first. Maybe I'll consider it. Okay, I know I've always wanted to go back for my master's but it just hasn't happened yet. Someday maybe. How long have you been in the area? Just about 10 years. Oh, 10 years in the area here in Sheboygan. How long with Prevea? Well I worked for Dr. Campbell originally and then we merged with Prevea about four or five years ago. So I've been with Prevea about five years. We practice in Sheboygan on Taylor Drive at the Prevea-Sheboygan site and I also spent a few days in the Prevea Health Center in Plymouth. Okay, wonderful. The study of audiology. What is it? How does it work? How does the ear work? Can you give us for our viewers a little background? Sure. The study of audiology is basically the prevention, the identification, and the treatment of various types of hearing losses and I also work with some balance disorders. So if the balance problem is due to the vestibular system which is the balance organ itself then I would be the person you would call for that. Okay. Over the years how has the study of audiology changed? Well the biggest thing I think besides the degree change and requirements there would be a lot of the study of audiology has been integrating the study of hearing loss with other disorders in the body. So a lot of the study not only have we done a lot of changes in technology and hearing aids but also they've been doing tons of studies these days when they're linking dementia, fall rates to hearing loss, associating diabetes with hearing loss. So one of the biggest changes in audiology is really associating us with other disorders and other specialties. Okay. As far as audiology for hearing loss in today's population has the rate of hearing loss gone up or gone down and what's the age of people? It's absolutely gone up quite a bit. 31 million Americans have hearing loss and more than 60% of those patients that have hearing loss are under the age of 65. So majority of our patients are actually under retirement age, one in five teenagers have hearing loss. So we're seeing that's the greatest population that's changing is we're having more and more kids with hearing loss because they're wearing their iPads or their iPhones a little bit longer and a little bit louder and back in my day we had the big CD players and so those were kind of cumbersome to wear for very long periods of time but we're finding teenagers are wearing them much longer and also they're hunting at much earlier ages and exposing themselves to gunfire and so in rural areas we're seeing a lot younger kids with noise induced hearing loss and with more cancers coming out we're seeing more young adults with chemotherapy related hearing loss and so it's definitely gone up. Okay. How about disorders during birth? Has that stayed the same or has that gone up as well? Yeah that's actually gone up as well. The state of Wisconsin does mandate that all infants being born have to be tested for hearing so once they are tested at the hospital if they fail then I get those referrals for diagnostic testing and the state of Ohio or Wisconsin requires that we identify all babies that are born with hearing loss and fit them with hearing aids before the age of six months that way that there's no decline in hearing or their ability to develop speech and language so hearing loss is a significant birth defect is one of the highest one in a thousand babies are born with hearing loss. Okay for our viewers at home can you give us a general overview of how the ear works how do we detect sounds you know the different pitches of the sounds the noises? Sure we have three parts of the ear our outer ear which you can see right here. Okay. That's shaped the way it is to gather sound into the ear and you can have hearing loss in all the parts of the ear and one of the examples of hearing loss that you have in the outer ear would be like a swimmer's ear or a swelling of the external ear from swimming in cold water you can also have hearing loss in the middle ear section and the middle ear includes the tympanic membrane which is the eardrum and the three bones behind the eardrum so those are the three smallest bones in the body if people remember from eighth grade health class the malisthenicus and the stapes and you can have hearing loss in there as well you can have middle ear fluid that's usually treatable you can also have almost like an osteoporosis of the bones in the ear that fixate the bones and so they don't vibrate as well and they don't transmit sound and that usually is surgically corrected you can also have hearing loss in the third part of the ear and that's the inner ear which is the cochlea that's that snail shaped organ that all the fine hair cells are and that hearing loss is the most common kind of hearing loss and most of that type of hearing loss we do have to correct with hearing aids. Okay is there a proper method that one should use in caring for their ear to promote health like do you take the q-tip and dig it way in there to clean it out or I guess what is the preferred you know for to promote the proper. The preferred way is to not do anything, don't stick anything bigger than your elbow and your ear but your ear is actually a self-cleaning organ so the skin on the ear grows outward like a conveyor belt to bring out the wax and debris so that you can get it when it gets to the outside of the ear. Most normal healthy individuals do use q-tips and you just don't want to push those in very far. If you do have a lot of wax and sometimes our elderly population tend to have a higher wax production you could use over-the-counter ear wax softeners. Our doctor also recommends using just a sweet oil or olive oil at home a couple drops in your ear to soften the wax and then it'll come on its own. If you have an itching ear you can use like a hydrochlorazone over the counter cream on a q-tip just on the outside not on the inside of your ear. That can help with itching. Some people have a little bit more severe itching can use a combination of vinegar and water and you could put drops in your ear for that. Anything more significant than that if you have pain should probably see a doctor. Okay I know I while back I had a massive your I don't know if it was an infection or just a cyst or whatever but I couldn't hear and I couldn't do anything and actually I went to one of the physicians and they went in and tried to get some things and sucked it out you know like with suction and he gave me some drops with the flush with the you know the big round bulb in the bottom with the tube and he said put in your drops let that and then you flush it out with the flush as well. Yeah if you're if you're a healthy individual that's not a bad idea but if you're prone to ear infections or you have a hole in your eardrum then that's probably not something you should be doing but most healthy individuals can get by with doing that. Okay where does earwax come from? What is earwax? There are glands in your ear and they're in the just the first third of your ear so that's why when we see wax really far in the ear we know that wax isn't produced that far in so we know patients have been pushing it in so they just come from glands it's very natural and normal to have earwax it's actually a protective secretions in the ear it keeps the bugs out and other debris so you do want a little bit of wax in your ear people will over clean their ear end up getting very itchy ears and you can actually cause infections and abrasions in the ear canal so that's why we generally want you to leave the ear alone. Okay when you're on an airplane or once while riding high in the mountains or whatever your ears what they say is pop or you got to take your nose and then the kind of pop your ears what's causing that? That's your eustachian tube which is the tube that runs down the back of your throat to your middle ear space adults don't usually have too much trouble with that because it's more vertical and up and down the reason children have so much ear infections is their eustachian tube since they haven't grown it tends to sit a little bit more horizontal so it doesn't drain so you have a flap in your station tube that opens and closes and that's what you hear when you hear that popping so sometimes if you have too much mucus in your sinus or the back of your throat that flap you'll hear it popping and crackling as it's opening so we do recommend people popping their ears a lot to keep the airflow up there so that your ear doesn't get too much negative pressure build up. So there is a connection between your nose through the sinuses and to your ears yep it's all connected in the back of your throat wow I didn't know that other than I guess once wow and if you sneeze or whatever that so that makes sense do excuse me do children still have you know when they're in their teens or whatever when they're going through a huge um the acne stages or whatever is that still a big thing for in the ears as well I know when I was younger well I was always younger and I always got you know big cysts or whatever in my ears it seemed like when I was in my age when I had acne and everything yeah we don't see that very often I would say that maybe one of the biggest things is we see is eczema of the skin which you can get anywhere in your body and we have prescription drops that we treat with that okay what are some of the other disorders one can have with the ears I know I've had vertical and that is terrible you know could you tell us about that yeah we actually um they've been doing more studies and that they have found that people who have hearing loss are three times more likely to have a fall so we see a high association with people with hearing loss and falls we also see a huge association and this is new research where um diabetic population have 50% more likely um chance to have hearing loss and a lot of that has to do with that diabetic blood flow um and overall health you know you have very small capillaries that feed the inner ear and that supplies oxygen to the inner ear which keeps it healthy so a lot of diabetic patients that don't have very good oxygen flow into the inner ear get hearing loss we also find that in high levels with patients who have obesity they have much higher risk at hearing loss 70% higher risk for smokers to have hearing loss so anything you know even hypertension anything that affects your general health and circulation can affect your hearing okay how about the environments that we work in can that play a role in our hearing yes it can and the number one cause of hearing loss is noise induced hearing loss and it actually is the only kind of hearing loss that's 100% preventable so um you definitely want to protect your ears when you're around noise and a lot of people know to do that around factory noise but a lot of people don't know to do that when they're doing recreational exposure snowmobiles motorcycles we see a lot of Harley-Davidson riders with high incidence of noise because the wind across their ear can reach over 120 decibels if they don't wear a helmet um we also see um other environmental aspects that can cause hearing loss would be like jet engine fuels carbon monoxide certain paint solvents and heavy metals so but noise exposure is the number one environmental cause and it is 100% treatable I know you had mentioned earlier about hunting you know and things and I know years ago like you said you go shoot the shotgun or do whatever sighted and you just shoot or trap shooting in the way you go but like a lot of the guns they have nowadays in the pistols they're much more higher caliber yeah it really just takes one shot and yeah that I do a lot of occupational hearing tests for some companies around and a lot of them wonder how their hearing continues to decline even though they're wearing ear protection at work then I deal further into their history and I find out that they hunt and they're like oh I only shoot two or three times a year but we really want people to know that it just takes one shot and so you really shouldn't protect your ears I know that's 100% treatable preventable that's why I use the bow and arrow more it's quieter very safe so um along with you know the whole hearing is once in a while I'm in a crowded room and I find it harder too with everybody talking to understand like us having a conversation I can't understand you because everything is just buzzing could you go into that or what's happening with that with the ringing yeah yeah ringing is also it's actually a sign of hearing loss 90 of people who have ringing in their ears also tend to have some form of hearing loss so when we're talking about signs of hearing loss the number one sign would be ringing another sign of hearing loss would be people who feel like they can hear very well but don't hear very well at distances or when people have their backs turned or when there's background noise people also who have hearing loss tend to complain that people mumble and so we have a lot of people hearing loss usually happens so so gradually that it just most people don't notice it right away and just gradually they start noticing that they don't hear birds or whistles or high-pitched sounds maybe self-spoken people too but ringing usually is a sign of hearing loss and what usually we think is happening and there's still a lot of studies going and also a lot of studies that need to be done with ringing there is no cure for it but often hearing aids actually help because by amplifying the outside external sounds it kind of qualms out your internal sounds so we're kind of masking it over but what people think is happening is when you have hair cell damage which is your inner ear you're it's kind of like you're turning a radio station in you're trying to find a station and you're getting static where your ears are trying to receive signal across a damaged auditory pathway so your brain is getting mixed signals and sending out signals such as hissing ringing chirping humming it's different for everybody so it's not always high-pitched but but you should see a doctor if you have it okay the other thing that people go is you know I used to be able to hear this to higher pitches or the higher sounds or like even the woods you used to be able to hear you know leaves or something way off it's like the different pitches are the different decibel levels how does that work well most common type of hearing loss is in the higher frequency range so that would affect your ability to hear the rustling of leaves affecting your ability to hear water birds high-pitched women's voices I have a low pitch woman a voice for a woman so most people hear me really well but some elderly women have higher pitch voices and they have difficulty hearing and the sounds of the alphabet that are usually higher pitched are like the s is the f the th the ch the p and those tend to be endings of words so a lot of patients who have this high frequency loss can hear things but they don't understand because they're mixing the s with the f and sounds it sound alike so hearing aids can help with that too sure you had mentioned it but what other excuse me what are some of the other signs of hearing loss that one can you know if you detect yeah basically like the people who mumble people feel like they hear well but they don't understand speech another sign would be increased sensitivity to loud sounds so if a patient is bothered by dishes or the sound of something loud a lot of people think hearing loss just involves not hearing anything but it also involves increased sensitivity to loud sounds so that would be another sign is there anything you can do to filter out scratching on a blackboard or anything that was always one that really gets people that's right actually there's something in a hearing aid you can use for that really really that's interesting okay you have signs of the hearing as far as signs of the hearing loss what are we touched on it already but what are some of the other causes of hearing that we talked about well we did talk about noise exposure which again is the hundred percent preventable but the other types that are not preventable generally would be aging so as our body gets older everything goes the ears yeah including hearing genetics so some people have a hereditary component which I do have we also have I have that in my family so that's how I got interested in the field of audiology ototoxic medication which would be medication that is toxic to your ear and one of the biggest things is chemotherapy treatments so a lot of these things doctors have to use to save your life but we do ototoxic monitoring in our office so when you're on a ototoxic medication we can follow your hearing and see how significantly it's affected by certain chemotherapy agents another cause of hearing loss as we mentioned a little bit before you know you have a higher incidence with diabetic and smoking and obesity population too many aspirins or ibuprofen if you're taking six to eight or ten ibuprofen a day for a couple weeks on then that can definitely cost some hearing loss so certain medications as well as cancer treatments cancer treatments are there any other types of diseases you know like you have there's certain diseases that'll affect the muscles there's certain diseases that'll affect the eyes is there certain diseases that other you know you had mentioned diabetes and cancer but earlier there are other diseases that can yeah there actually go after specific ear diseases like maniae's disease we're touching on dizziness a little bit one of the hallmarks of maniae's disease is dizziness hearing loss that fluctuates and ringing in the ear so it's the big three hearing loss is fluctuating so some days are better than others people get a sensation of fullness in the ears and that is treatable through certain medications sometimes we do hearing aids on those patients as well some people can get just a viral infection of the inner ear which i've actually experienced myself which patients just randomly just like you would catch a cold you get a little viral infection on the inner ear sometimes it can cause sudden severe hearing loss and sometimes it also causes dizziness sometimes it just causes dizziness without hearing loss and sometimes it causes both so that's another something that we would treat in the office is that what they called years ago just a simple old earache yeah it depends or you know simply some someone says something i have vertigo a lot of times that's that there's also a positional vertigo that we see with patients that is dizziness but there's usually no hearing loss associated with that so when people call um or they call it top shelf vertigo so people would often get dizzy when they're just in certain head positions or they look up or they lay in bed in a certain direction can cause dizziness and that's something we also treat it's probably the number one dizziness that we see in the office i've had that the vertigo like you said and i couldn't believe it and they laid me on the table let's rotate your head so they started rotating my head and doing the exercise so almost i just about got nauseous i almost threw up and it felt like i was gonna fall off the table i couldn't believe it yeah it is it's really interesting treatment and people think it sounds like voodoo but it is it is 80 effective in one treatment and sometimes we have to do two treatments on someone but we do see that a lot in our office yeah i know i got my exercises you know then they do it home and lay on the bed on your back on your side and just slowly rotate your head and you could just almost feel it when you're working it of yeah i'm getting to the spot there yeah absolutely and i didn't have that type of dizziness i had actually a viral infection so there's nothing you could do for that is that weighted out yeah i know what was the bummer is when i had it i was down in Illinois on a hunting trip in the side jet so here i am and just like boy i woke up in the morning it's like i can hardly stand it's like there's no way i'm gonna crawl into a tree yeah and we see that as we get older over 40 it happens a little bit more often and once you have it you're actually at risk for it happening again great unfortunately thanks for sharing thanks for sharing so okay we talked about you know some of the things what are some of the treatments we can have like as you had mentioned hearing aids how far has the technology come from years ago to you know hearing aids you could see on people's ears versus now the little implants to we ever see a bionic ear like the you know bionic woman hearing aids have come a huge distance in the 20 some years that i've been practicing i remember in college adjusting hearing aids with a little screwdriver at the ear and now we completely wirelessly program them from our computer there's no cords we just send information from our computer it's sent to the hearing aid we can instantaneously make changes to address most patients issues so hearing aids are one of the things that we use to treat hearing loss but in our office depending on the cause of the hearing loss and if it's simply wax we'll remove it it's an ear infection we treat it with antibiotics or medication a tube in the ear maybe if it's sensory neuro which is that's when i come into play and i treat them usually with hearing loss so most patients will go through a trial with the hearing aid and we try it for 60 days see how they like it and most people do like it because hearing aids it's the only thing that will help nerve loss right doesn't give you back your normal hearing because the nerve is always damaged but hearing aids have really come a long way in their noise reduction ability to reduce background noise and while we're on the subject one of the biggest things is every hearing has a microphone just like you're wearing sure microphone picks up sound from all directions well now all hearing aids have two microphones if they're big enough and that microphone picks up sound all around you but then the second microphone will kick in to focus on sounds from the front so that's really how we can say that hearing aids help reduce background noise because wherever you turn your head is where the hearing aids going to pick up more sound and even last year there was a new technology that came out that picks up sounds from the side so when you're not able to look at a patient or someone to talk with like if you're in a car or you're walking all hearing aids are focusing on the front well now we have a hearing aid that once it senses speech from the side it'll actually go into a mode or it picks up more from the side and reduces all the stuff from behind so that's how we can help people hear better noise nice i know you coming back to the hunting thing is some of the ear protection they have nowadays i mean the pair i have i put them on and they have a little batteries triple-a batteries you can turn them on and you can't believe how it enhances your hearing just in the woods wearing them but then you know if you're shooting as soon as you shoot they automatically cut off to protect your ears so that's really neat technology that they've come over the last few years they do have that in different levels of pricing too so you know that you can get that for a thousand dollars or more and you can actually get a non-custom version for probably under a hundred even so there's a lot of nice ear protection out that helps hunters i know a lot of hunters don't want to wear ear protection because they want to hear the prey and they want to hear the rustling of the leaves and i do understand that but they they make ear protection that have filters that allow that stuff to come through the ones you're talking about will actually amplify it or enhance it so that's even better but that's a little bit more expensive but they even have less expensive filters that will allow that through but still protect your ears when the gunfire goes off and you know it comes down to years ago like i said it was the shotgun you went through or maybe a rifle you know like a 30 on six but now they have these high power pistols and these high power rifles that they cracked so loud that you know one i even shot a 44 pistol by accident and i did well it was by accident but i didn't my hear my hearing protection on when i pulled the trigger was like wow everything got quiet and i'm looking around and yeah i remember it all gee yeah and you can actually get temporary hearing loss from no noise and you can also get permanent instantaneous hearing loss so i always kind of think of it as grass and a truck running over grass like if a truck runs over grass the grass falls over and then it comes back so that's like one gunfire on your ear hair cells falls over you experience some fullness in your ears a little bit of ringing and maybe some temporary hearing loss a couple days later you're probably hearing better but the more and more you're exposed to noise the more the truck is running over that grass and the less that grass comes back up so that's how you end up with permanent hearing loss well what should i look for in a hearing aid you know is there certain functions features or you know that's just what i go with you know with you to look at or analyze well it's important to go to a provider who knows what they're doing and will give you lots of options because there are lots of options with hearing aids so as an audiologist again with all the college education we can describe the different types of hearing aids that you might need after you describe with us the types of problems that you're having how active your lifestyle is where you need to hear because every patient is different not only do they have a different budget but they also may have different hearing needs based on if they're retired or they're working or they travel so we talk a lot with the patients about what their activity levels are what types of environments they need to hear and then we talk about the features but i do like when a patient comes in and they're a little bit advert they you know they've gone online and they have some really great questions about hearing aids but we don't expect you to know everything when you come in we usually tell you what the features are and if they will work for you and then we can well that's why you're there yeah me exactly so what i'm having hearing loss or if i'm you know having an issue am i better to go to my regular physician first and get referred to you or would it be just you know pick up the phone and kind of depends a lot of insurances do require you have a referral from your family doctor before you see us so you'd have to check you with your insurance but the audiologist is the professional to see regarding your hearing so that's who you should be sent to but because your primary doctor is in charge of and kind of helps coordinate all your specialties it's probably a good idea to talk to your family doctor first and also they can check for wax because a lot of insurances won't cover me to remove the wax even though it's in my scope of practice but the doctor can make sure your ears are clear and then refer you to us and then we can do the hearing tests and the evaluation okay do most insurance plans cover audiology treatments most cover audiology diagnostic testing so any balance testing that i'm doing or hearing testing they're covering it but not as many insurances are covering hearing aids unfortunately although more and more every year or more plans are adding insurance policy on it so medicare is not which is again a primary population that we see but they specifically do not cover hearing aids but more and more insurances are okay how about i know we're getting kind of close to the end but surgical techniques or other techniques to help repair hearing well we are starting to do a new surgical hearing aid that is we're going to be the only ones offering the specific hearing aid in the county and actually within at least an hour it's called a bone anchored hearing aid and there are some facilities that do it but we're the first to do a magnetic version of it where the doctor would and i would start with the testing and then the doctor would do the procedure in the surgical center where he would lift up the flap of skin put a titanium implant on the bone we'd close it up and a magnetic hearing aid could go on top of it and amplify sound it's really nice because there's very very low surgical complications it is for a very specific type of hearing loss so it's not the majority of people who need that type of hearing aid but it is really nice to be able to offer a hearing aid like that that has very low surgical complications and has low infection rates okay how often should somebody have their hearing tested depending on your age of course at birth you start with a hearing test and then we we like to test your hearing at preschool and then probably every other year until they hit middle school and then as an adult you should have a hearing test probably by age 50 just to get a nice baseline the one of the things that frustrates us is we'll get somebody who is reported a decline in hearing either after chemotherapy or after an illness or meningitis and without having a baseline we just don't know how much hearing loss they've had so even if you're not having a trouble you should have a hearing aid baseline or hearing test baseline about age 50 and then every you know three to five years after that because again we could test you every year but we really shouldn't see much hearing change if you're pretty healthy okay i don't have a couple minutes left so do you have any final thoughts or advice or words of wisdom for our viewers sure you know what you know your show is called quality of life and they've done lots and lots of studies about the quality of life with hearing impaired patients and they really are finding that patients who do not treat their hearing loss loss have higher tension and stress higher fatigue more anger social withdrawal they tend to not be able to remember or learn new things they also tend to make less money on our working population so it is really important to treat your hearing loss when you're aware of it because we can reverse a lot of these effects a lot of people have social isolation irritability you know it's very tiring to not hear all day right so people tend to be more irritable at the end of the day okay well Tracy i'd like to thank you for coming on the show and sharing your wisdom of audiology with us thank you so it's been an honor um that's our show for quality of life audiology if you have any questions or have any ideas for further shows you can visit our website at www.wscsboygan.com and Tracy do you have a website we do and for more information www.prevea.com and if you go into search and search audiology we have a very great website that talks about all the diagnostic testing that we do and a lot of information about the different hearing aids and all the different audiology providers we have okay wonderful well on behalf of Tracy i'm Dave Augustine for quality of life and thank you for watching