 So we have a fantastic speaker today, extremely relevant, has to say. So we're happy to welcome Dr. John Roche. Roche? Roche. Roche! I practiced it too. Welcome. Good morning. Thank you for being here. Thank you. So you're here to talk to us today about hearing loss. Yes. And I know so many of our residents either are struggling with this or are hesitant to admit that they're struggling with it. So you just talk to us about why this is such a big issue amongst our senior population. So in the population over 65, one in three people have significant hearing loss. They have such hearing loss that they actually start to withdraw and maybe not participate in things that they're used to. And it also affects loved ones and friends and the community around them also. Right. And it really does. And you think, you know, you mentioned things that happen here lately just walking with friends. But our dining rooms as well, our big open spaces that we have. Yeah. The noise in the background, yeah. It really makes it tough. So why do we lose our hearing as we age? It's a normal process. We have special sensory cells within the inner ear. And age-related hearing loss is associated with those cells deteriorating, losing them over a course of our lifetime. We only have a set amount of them and over time we lose a portion of them. And once we get to a certain population that are gone, then we start to develop hearing loss. Some people lose it quicker than others. They have some hereditary predisposition to hearing loss. If you've had a lot of noise exposure through your life, hunting, music around engines, earphones, which is actually becoming much more of a problem with younger people, we're starting to see them losing their hearing even earlier because of the amount of noise exposure. And it's not just one moment of noise exposure. It's over your lifetime. It's additive. So it's not what did I do yesterday, but it's what I did 20 years ago, 15 years ago, 30 years ago, even that affects our hearing today. And it all has to do with these cells? So they're called hair cells. But they are not hair cells. They're just hair cells that have small... Exactly. They would have better hearing because they're developing more. No, but they're in the bone of our skull. We cannot see them except under micrographs when we have specimens. But you can't look through someone's ear and say, oh, you have a certain amount of hair cells. You look at their hearing on an audiogram and then we can determine, most likely, the population that's lost. The hair cells, again, we're only born with a certain amount of them. And once we lose them, we don't have the ability to regrow them at this point in time. They can be damaged and regrow themselves. But once they're lost, they're lost. We are starting to develop medications that we're infusing in the middle ear that will hopefully help to regrow them, but that's not FDA approved yet. It's still in very experimental trials at this point. And you can't do transplants like they do on people's heads. But we can do implants, not transplants, but implants where we can put in a cochlear implant. For instance, a cochlear implant is a device that directly stimulates the nerve. So it bypasses those hair cells. We use those in patients with severe hearing loss, not in patients who still get a benefit from their hearing aids. These are the cases that you hear about people who have heard very little or nothing for a long time and then have these implants and are able to hear? Well, even in patients who progressively lose their hearing over their lifetime, once they get to the point where their hearing is so bad that their hearing aid is not benefiting them, then we can consider putting hearing aid or an implant in it. I didn't know that. I haven't heard that around here. Absolutely. Yeah. And they do it. I mean, the health insurance will pay for it for an older person? Medicare pays for it and most health insurance covers it. We have certain testing that we have to have the patient go through, meaning audiologic testing, hearing testing that's specific for people who are considering an implant. And if they meet criteria based on those testing, then we do implant them. Also, they have to be healthy enough to undergo a surgery. It's about a two-and-a-half-hour, three-hour surgery at the most. But once they meet those criteria, most insurance carriers will pay for it. Now, is that part of your practice or is that a special? It is. It is. There's two of us at Coastal Lear, Knows and Throat who do cochlear implants myself and Dr. McAfee. And a lot of people here go to that office. It's nearby and it's got a lot of good people there. We have three offices now. We open an office also in Manna-Hawken and then in Homedale, we're actually opening an office today. Congratulations. It's the off to that. Open up today. So what advice then can our residents give maybe to their children and grandchildren about protecting their hearing? So the greatest thing is avoid too much noise exposure even when you're young. What I tell most of my young patients who are using headphones, I say you can go up halfway up to the five mark or halfway up the volume. Once you start to go beyond that, you're possibly going to develop hearing loss as you get older. We know from studies that over 80 decibel of sound levels, which 80, it's a random term, but right now my voice is at about 35, 40. Okay. It's a logarithmic scale, so it's a jet taking off is about 140. Gotcha. So somewhere between those two. Yeah. So running a lawnmower is in the 110, 105. An exposure with that over about two and a half hours, three hours, you can develop hearing loss. A leaf blower. A leaf blower. Right, absolutely. So when we see people out there cutting along without earphones, we should be worried about them. Exactly. I mean, my hearing's pretty good for my age. And I had two grandmothers who had lost their hearing. One was a lady and sat quietly, and the other was always saying, what, what, what? And I have real memories of them. And my sister and I are fine. How can that be? So I'm not sure what their noise exposure was when they were young. It seems to me it would be less than our noise exposure. Well, but if they were in, say they worked in the industry, say they worked in a factory, they did not have requirements. So it really is related to noise. Noise but also heredity. Okay. There are hereditary, you know, consideration. There are some people who will lose their hearing earlier and have had no noise exposure and they've been protective of their hearing. Other medical problems, diabetes and high blood pressure, if it's uncontrolled, can lead to worsening of your hearing also. So other than the obvious, not being able to hear people as well, how do people identify for themselves that it really is a hearing loss issue? I think if you find that you're asking, you know, what, excuse me, people are getting frustrated with you when you're having conversations. A lot of people come to me and said the TV used to be at 24, now it's at 46. You know, you know you're developing hearing loss. People are starting to rely on closed caption, which I heard you comment on when everything was in closed caption. A lot of closed captioning here, yeah. If you're relying on that, you have significant hearing loss. Well, not when you're watching PBS and those English accents. Not necessarily. So we do encounter that here where you find residents don't want to, not admit, but really just share or cope or get the appropriate care. Why do you find that it is, doctor, that people struggle with maybe getting care for that? There's a few things. One is they hear a lot of their friends say, I hate my hearing aid. And so they just assume that the hearing aid won't do, it's going to be the same for them as it was for their friend who they eat with. Another is if it's a sign of losing a special sense and a lot of people just don't, glasses have become somewhat of a fashion statement. Hearing aids aren't a fashion statement. I wish we could get to that point, but they're not. Like leopard print hearing aids, we'll see it right. They do have different colors. They do have different designs and such, but people still don't want to... It's a pitch for an influencer. Well, the implants, they're still an extra portion of it. But we can match it to the color of your hair and things like that. If you have some hair. It's really that change that it's a change. It seems to me there used to be a bigger denial problem than there is now because I see lots of people here using them comfortably. Isn't it partly the improvement in the technology? The technology has gotten much, much better. The aids have gotten smaller. Most of the behind-the-ear aids that fit behind you, it actually fits within the crease of your ear and does not even project out. I had an audiologist in our office who was new to the office. Six of my partners didn't even know that she had hearing aids and she wears bilateral hearing aids. The other benefit of being a woman is your hair's longer. Yeah, grow out of your hair. That's great. So what is it? I'm sorry, go ahead, Leah. What's the process? If somebody wants to go and have their hearing checked, what can they expect during that time? So, you know, make a call our office. We have audiologists within the office as well as the physicians. The first thing we do is typically do a good exam of their ears. Make sure there's not earwax. Make sure they don't have a narrow canal for one reason or another that it's just not allowing sound to get in. There is an interesting phenomenon called surfer's ear and it happens frequently in this area because of the colder water. If you've been in the cold water a lot, some people will develop these osteomas which are these benign bony growths in the ear canal and they actually narrow the ear canal to the point where wax gets stuck behind it and also they get frequent infections and hearing loss. That's not real common, but wax. Wax is a very simple thing. Sometimes we remove the wax and people say, oh, my gosh, I haven't heard like this in the last two years. Well, you could have had wax pushed down in there. Another tip is no Q-tips inside the ear canal. You can use them on the outside just to not go in the ear canal because they tend to make it worse. They push the wax in and impact it. How often should somebody go to get their ears checked? So, once you're identified as having a hearing loss, probably every year to every two years, have it rechecked and again an exam and then we have the audiologist do their exam. The audiologist's exam usually takes about a half an hour and they do pure tones but they also do speech testing to see at what point do you hear a speech and then we give sentences or sets of word lists and see how much you understand the speech. One practical limitation of hearing aids is if your understanding of speech drops to such a point, no matter what we do to amplify their hearing or increase the volume, they still don't understand what they're hearing. And that does happen over time. If you don't do anything about your hearing loss, over time you will start to lose your speech understanding. So, is that a selling point for doing it early? It is. It will preserve it. It prevents the, not prevent but prolongs the chance that you develop worsening of your speech understanding. Interesting. We do encourage when patients come and they're starting to get a drop in their speech understanding that hearing aids would be something to try to prevent that from progressing faster. And that is so frustrating for people. I've worked with residents who have had just the processing of it. They say, I can hear you fine. Exactly. You just can't process what you're telling me. I didn't know that was preventable. Very frustrating. A friend of mine's son in his late 40s got hearing aids and what he said, the relief of it afterwards, was that his brain power wasn't all going to try to, he just had all this energy he didn't have before that had been going into trying to figure out everything. We hear that all the time. We hear people saying I had to concentrate so hard on everything and now I don't have to concentrate so it just, I feel like I can think quicker. Is there a good reason to have a baseline test at some point in your life? So, if you've had noise exposure, it's probably a good idea. All of us typically now get baselines at least in about second or third, fourth grade. We're usually tested in school and also all newborns have to undergo a newborn hearing screening test before they leave the hospital. And if they fail that, they're referred to us to further work that out. The average adult, if they're not having any difficulty with communication and they don't feel that they have any other symptoms in their ears, do they require an appointment? Probably not. But once you start to find that something's changing, then it's better to have it evaluated. The one time that I would say that everyone needs to be checked is if you develop sudden hearing loss or hearing loss in one ear more than the other, you should get in to see us because there are occasionally other medical issues that we can... Well, there are sometimes tumors that occur on the hearing and balance nerve that can cause hearing loss on one side and not the other side. Occasionally masses within the ear. There are benign tumors that occur underneath the eardrum. There are cysts that occur on the eardrum that can cause hearing loss on one side and not the other. So single-sided hearing loss, we consider that you need to come in to be evaluated. You mentioned narrow ear canals. And if that's genetic, is that going to necessarily cause hearing loss? And is there anything that can be done about it? No, some people have narrow canals but they're not occluded, not stenosed. They do fine except that they sometimes get waxed a little bit more frequently. But it doesn't really impact their hearing as much. So is there anything we haven't asked you that we should know? The other thing that we come and hear as far as complaints associated with hearing loss is ringing or noise in the ears. We call that tinnitus. Tinnitus isn't exactly from hearing loss but it's often associated in combination with hearing loss. Tinnitus is a big problem, very common. There are a lot of associated possible causes of it but the most common is related to hearing loss. And as we lose some of those cells, those hair cells the nerve starts to just give a spontaneous impulse and once you get enough of those loss of hair cells that impulse gets loud enough that we start to hear the ringing or noise or buzzing in our ears. We don't have anything to absolutely cure it but there are some things that cause it that are easy to reverse meaning even wax in your ear canal and touching your eardrum can sometimes cause ringing. Fluid in your middle ear. Fluid or inflammation in our sinuses can sometimes cause ringing in the ear. So there are some reversible, preventable things that we can do to stop that but a lot of the time it's associated with hearing loss. But it does sometimes happen to people when they're younger and aren't having hearing loss. Is it ever medication related? It can be. So there are some antibiotics that cause it. Aspirin if you're taking too much aspirin a little higher dose aspirin that can cause it. Some of the non-steroidal anti-inflammatories can cause it. There's a list of probably 400 medications that potentially that's their side effects. So we always ask people bring in your medication list to make sure we know everything you're taking including supplements because taking too much vitamin K or A can sometimes cause it. So we need to look at everything medication-wise and all their other medical history. Just having diabetes predisposes people also to some ringing in their ears. That's why it's so important. Every physician you've ever spoken with if you're having an issue to talk with your doctor about it because there's so many ways and reasons it could be reversible. And I'm thinking how much rewarding it must be to be in your field and to be able to do so much for people. Absolutely it is. The hard time is when you can't do things for people and you feel yourself I've let this person down but at the same time you just have to know that some things we can't absolutely stop. It's part of the process of being human. But a lot of the things we can help and prevent and make a big difference. You mentioned earlier that you are part of a group that corrects cliff pallets. Could you tell us a little about that? So the group that I've been traveling with for the past nine to ten years is called Faces of Tomorrow. It originated in the West Coast. I trained at University of California, Davis and Sacramento, California. So I got involved with a group when I was in my residency and that group kind of morphed into this group. But for the past nine to ten years we've been going to the Philippines. We have a trip coming up to Ethiopia and another one to Ecuador. Ecuador is next October and I'll participate in that one. But that's a very fulfilling. I'm sure it is. Wonderful thing that we do. It is. The pictures are so painful to look at. You think about what it must be like to live in that face. And the patients who are born with cleft lip and pallets in developing countries, unfortunately they're not always allowed to do the things that other children are allowed to do and they're kept at home and to be able to get them back to go to school. And when they do go out they get bullied. So allowing them to go to school and participate in the normal things that the kids are doing, that's great. It's unbelievable you're sharing your gifts in that way. It's wonderful. So a Jersey boy went to California to school and came back to Jersey? I did. It happened. You're the one. I did it too. But you said you're only recently in this area. So I was in practice in Virginia Beach, Norfolk area for the last 17 years. Part of a private practice that we also trained residents through our practice. So I was part of the Eastern Virginia Medical School in Norfolk. But wanted to get back home. Home to Monmouth County? Well, no. So I spent all my summers in Long Beach Island in Harvey Seeders. We'll let you in. Are you living down there? No, I live in West Long Branch now. And what drew you to your specialty? I think it was all the toys. All the cool stuff. All the neat little instruments. But also I thought it was the most complicated anatomic part of our body. So that really interested me. And the other thing that's interesting about ENT is we take care of all the medical as well as surgical problems in our area where that's somewhat unique in medicine in that there's surgeons and there's medical people. And sometimes you don't do both. You really get to follow that patient all the way through. And I get to handle neonates up to elderly people. And it's just nice every day is different and different issues. That's great. So this is a very personal question. Did you come back to New Jersey because you had children that needed to be near their grandparents? No. No, okay. That's usually what happens, right? I do have children, but they are ones just starting in medical school and two are in college. Oh, my goodness. You got married when you were a baby. Thank you. But no. Well, that's wonderful. We really appreciate you being on. Thank you. Quite wonderful for us. I think I'm going to get a chest. It's worth it. You were talking about testing as babies. But I have little ones. Every year when they go for their annual checkup they check their hearing. Is that right? They've been doing that over here. Yep. It's interesting that they don't automatically do that for us. I know. I'm not sure that the closed captioning on PBS is only because they talk funny. I have to find out and make sure. Absolutely. Well, thank you so much. Thank you. Good luck with your opening today. Thank you. And I have to put a shout out for, you know, the headline is that with Bayshore and Coastal Lear Nose and Threat, we pretty much have everything covered in very basic otologic ear issues up to the very complicated problems. You have an office right down the road from us. So there's an office right down the road here on Route 33 in Neptune and then an office in Manahawk and then Homedale. And we utilize Bayshore Hospital and Jersey Shore University Medical Center as well as Southern Ocean Medical Center. Good. Many of our residents know you well. Wonderful. Thank you so much. So I had great intentions. I printed out today in history and all of today's holidays. Me too. But we don't need that. Yeah, no. And notice I don't have them with me. So I do know today this day in history was the day that... Oh, my goodness gracious. Moby Dick was published. Thank you. That's what I was going for. That's why Lee always saved me on the show. Today was the day Moby... And I learned and I didn't know this when it initially came out. It was a flop. Isn't that interesting? I didn't know. You read up. I only saw the day. Of course not. Of course not. Anyway, we've had a very full morning. Do you think we should do any more of these? Oh, you want a few more? Well, Apollo 12 launched. That was the second moon launch. Okay. And the Dow went above a thousand for the first time in 1972. 72? It's over 18,000 now. Isn't that amazing? And we're celebrating. I don't know what that means. Anyway, today's Claude Monet's birthday. Okay. It's Nero's birthday. Mamie Eisenhower was born on this day. And Veronica Lake. Look, you don't remember her. I know the name. I've seen the pictures. I have my Veronica Lake do this morning. My sister was a blonde who wore a Veronica Lake. She was blonde and she wore her hair. Is that very dramatic? Yes. I'm not a blonde. I don't pass. And my hair's too short. Anyway. Who needs Veronica Lake? We've got me, Jocelyn. Okay. Thank you so much for watching. Be sure to tune in. A special guest on Wednesday in anticipation of the turkey trot. I wonder who that could be. Well, it won't be the turkey. They hide their identity. I don't know. Are you telling us something? No, nothing. Nothing at all. You don't look like a turkey to me. No, I'm not the turkey. I almost was, but we found somebody to do it. Good. Thank you so much for watching. Have a great day.