Dale Johnson: Welcome to the conversation starts here on KFOR FM 103.3, 1240 AM, with Dr. Sandra Miller of Complete Hearing. Happy new year.
Dr. Miller: Happy new year. We’re going to say happy new year the whole month of January.
Dale Johnson: I pretty much cut it off after the end of January.
Dr. Miller: Do you? Oh, yeah. Have you taken your Christmas decorations down yet?
Dale Johnson: We didn’t have them up.
Dr. Miller: Oh.
Dale Johnson: No. Just too busy.
Dr. Miller: Too busy?
Dale Johnson: Too much going on in December to even have put them up.
Dr. Miller: I told my husband. I decorate for winter, therefore it’s not all Christmas-y, so I can leave it up for an extra month.
Dale Johnson: Nice style.
Dr. Miller: Right? There we go.
Dale Johnson: New year, new you. We’ll go down that road today with Dr. Miller because this is the time of year where people look for self-improvement.
Dr. Miller: Absolutely.
Dale Johnson: Sign up for the gym for a month and a half and then you get out of the mode of doing that. But we’re always looking at improving ourselves and in the conversation that we have with you today, it’s training your brain.
Dr. Miller: Training your brain.
Dale Johnson: Getting your brain into shape with aural rehabilitation. And we’ll talk about the tools.
Dr. Miller: Yeah. Well, I think when people hear the word aural, and I want to spell that aural, not oral, like mouth oral. Like your ear. Aural rehabilitation really does include the part that there’s, hearing aids is one of the parts, but that is the very beginning of that aural rehabilitation process.
Dr. Miller: Our job really, as audiologists, and at Complete Hearing, we want to do some sensory management. That means we want to find out do you have hearing loss? And then we want to give you some options and some tools to help you.
Dr. Miller: And so it goes very much beyond just putting a device on your ears. The goal of aural rehabilitation, honestly, is to help people communicate more effectively. And that can be through the use of a hearing aid. That can be through auditory training, speech training, speech reading.
Dr. Miller: We’ll talk about some programs today that we recommended and that we use, but I think it’s really important that your listeners understand that when we put a hearing device on, it’s simply the beginning. And the goal of that hearing device is simply to deliver sound to your brain.
Dr. Miller: Oh my goodness. Well, now what happens? Because if the brain hasn’t been hearing, the brain hasn’t been at the gym working out for sound and so we provide all this sound to the brain. The brain has to figure out what to do with it and how are we going to train the brain to know what to do with all that new information.
Dr. Miller: I thought today we could just talk about what happens with the brain when we hear sound and then what the struggles are when we throw some hearing loss on top of that.
Dale Johnson: It’s important to realize as a patient, when I walked through the doors to Complete Hearing, that the hearing device is the beginning.
Dr. Miller: The hearing devices is the beginning.
Dr. Miller: And so it’s not “put it on and see you later.” Again, its job is just to simply get it to the brain. And so when we get to the brain, we have to decide “what is the brain going to do with this information?”
Dr. Miller: And so I would say there’s three things that we usually talk about with our patients is consistent use. We need to get that sound to the brain consistently. Get the brain exposed to what that information is. If you’re only wearing your devices part time, that’s like going to the gym part time and you’re only going to get half of the benefit and you’re not going to get the maximum benefit.
Dr. Miller: The second thing is just knowing that there’s things that hamper us in terms of how we process information. As we age, and it starts early, doesn’t mean this is an old person problem. This just means that as we age distractions put a load on our brain, background noise.
Dr. Miller: Our brain doesn’t process sound as quickly, and then our working memory just doesn’t work as good. And so imagine now that we have these things going on with our brain and then we throw some hearing loss on top of that. And we think that just by putting a hearing device on the ear and giving the brain sound, it should fix everything and it doesn’t.
Dr. Miller: And so what we have to do is we have to retrain our brains how to focus, how to listen, how to sort, how to ignore. The biggest complaint that we have in our office is “I hear, but I don’t understand” or “I hear in quiet, these hearing aids work in quiet, but they don’t work in noise.”
Dr. Miller: And so we have to figure out a way to help our patients get over that. How can we train our patients to understand, “here’s a tool for you to use, to help you in that background noise environment.”
Dale Johnson: In some cases it isn’t the device that isn’t working, it’s the brain that’s not accepting what the hearing aid is sending it?
Dr. Miller: Exactly. And so I would, it’s a big encouragement for me to tell you, the longer you wait, the harder it is. Our brains become less malleable and less trainable as we age. Not that we say it can’t be done, but it is harder.
Dr. Miller: And so I think when you think about, if we can take into the point of let’s figure out how we can train our brain to do these things. One of the tools I thought we could talk about today is something called LACE. It’s listening and communication enhancement. And it’s honestly an interactive brain training.
Dr. Miller: And we tell our patients about it, “I can give you this device, I can program it, I can give your brain great information, but now we need to train your brain to know what should we do with all this information.” And this program is great. It teaches you how to be able to fill in the gaps more easily.
Dr. Miller: “How do I focus and background noise?” And it helps you go through training exercises to get your brain rewired for all this new sound that you’re hearing. Again, the hearing device is just the beginning, now let’s get you into a training mode to help you with it.
Dale Johnson: A point that really was beneficial for me is LACE doesn’t use the term hearing. It uses the term learning.
Dr. Miller: Yes.
Dale Johnson: And there’s a big difference.
Dr. Miller: Mm-hmm (affirmative). Exactly. And I think that it’s one of those things of taking the next step. I always say “I wish it was just easy like glasses where we put those on and there’s this instantaneous thing that happen.”
Dr. Miller: Hearing is so much more complicated than that. And as people have waited a longer period of time to do some correction or help for their hearing, we find that this training of the brain is vitally important.
Dr. Miller: And if you look up on, even if you just searched aural rehabilitation programs online or something like that online, you’ll find this LACE program and they will tell you that they can give you, what the potential of having a 30% improvement in your speech understanding and noise. That’s substantial.
Dr. Miller: If you think about going out to dinner with your family and it’s been the holiday season and you’re like, “Yeah, hey, we went to the restaurant or we’re with our friends or our family was over and I could maybe hear those two people beside me, but the rest of the table? Forget it.”
Dr. Miller: And so I think about, “yeah, that happens to me.” I have normal hearing and that happens to me. But if we can figure out how to help your brain engage and be focused and train you on how to sort through some of those things, when we give you the right amount of sound, your success should be so much higher.
Dale Johnson: Where do you start? Where does a person start with LACE?
Dr. Miller: Such a good question. When you come to our office and we do a fitting for you, we’ve found you have, and I think this is appropriate for anybody. It doesn’t necessarily have to be, I love what you said. This isn’t just about hearing, it’s about learning to focus and do well in this environment. I think I benefit from LACE just because of the fact of I’m older now and I just find that I don’t process sound as effectively.
Dr. Miller: And so background noise is challenging for me, but I have optimum hearing. And so for our patients, we tell them a good way to get started with LACE is just go online and look at it. We explain what it is and how it works, but it’s a training that you would do at home.
Dr. Miller: Some of our patients are more elderly. They may not have this capability to go online and do something like this. We do offer programs in our office as well. We have coffee and conversation the first Thursday of every month and we talk about not just LACE, but we talk about “what does it mean to have good communication, where should I sit, how do I get the best optimum ability here? What are some good communication strategies I should be using?”
Dr. Miller: It’s a whole nother program to talk about facilitating things that are going to optimize hearing for you.
Dale Johnson: I want to go back to something you said. Google LACE. Find a website that offers the online training sample.
Dr. Miller: Yeah. If you type in LACE, you’re going to get some weird stuff. Just type in, I would type in LACE or hearing rehabilitation, something like that. And you’ll find this program and I’ll post the link on our website as well.
Dr. Miller: If something is really interesting to you and we have a sheet in our office that lists some of the programs that you can do at home online. We would love to be able to spend all this time with you and go through this process with you, but we find it’s nice to do it at your own pace, in your own home, making sure that you can get on here.
Dr. Miller: And there’s ways you can subscribe to it. There’s different tasks and tests you can do. I know that you-
Dale Johnson: I took the test.
Dr. Miller: Yeah. You told me you did well.
Dale Johnson: I believe I did well. I don’t have issues with restaurant noise, background noise. Where I seem to have issues are competing voice sources or sound sources that are fairly even in volume.
Dr. Miller: Yep.
Dale Johnson: Someone’s not in the background. Someone’s not in the foreground. They seem to be side by side.
Dr. Miller: Yeah.
Dale Johnson: That’s probably my biggest challenge.
Dr. Miller: Yeah. We call that signal to noise ratio. That just means “how loud is the signal you’re trying to hear?” versus the noise that’s in the environment. And the challenge is definitely when you get into that environment, when it’s equal, “okay, how’s my brain even going to sort through what’s important here?” And that’s where LACE really comes into play is just to think of how is my brain now designed to focus?”
Dr. Miller: “I’ve gotten the information, now what do I do with it?” And so the training program does really help with that.
Dale Johnson: And rapid speech.
Dr. Miller: Oh my.
Dale Johnson: I hear, from politicians to doctors, people talk fast. And that’s a challenge to be able to hear what they’re saying as they’re saying it in that pace.
Dr. Miller: I started noticing that I couldn’t process rapid things anymore at about age 35 and I think to myself, “is that when that really started?” But it’s so interesting that our brain does not process sound as effectively I can’t go to a social event like I could when I was 21 and be able to be in that environment and socially engaged with everything that was going on around me. Now I have to really work at it and focus and you think about how our processing speed is slower and it’s harder.
Dale Johnson: Word memory. I didn’t see this coming in the training, but they quote a sentence to you.
Dr. Miller: Mm-hmm (affirmative).
Dale Johnson: And then the next step is to put it on the screen and show you the sentence with words that are emphasized and see if you were able to pick up the inflections within that sentence. So it’s hearing it, but it’s understanding what you’ve heard.
Dr. Miller: Exactly. I think a lot of things, too, is when you, whether you have hearing loss or not, there’s many times when we’re in those background noise environments that we’re trying to fill in the gaps, right? We’re filling in the gaps.
Dale Johnson: Right.
Dr. Miller: And so if we can get the focus and you’re getting the meaning of the message, LACE is teaching you to say, “okay, here’s the sentence and here’s the dynamic parts that matter.”
Dale Johnson: Mm-hmm (affirmative).
Dr. Miller: And a lot of times you just need more information. And if that program can teach you how to focus on what’s important, you can fill in the gaps more easily. And if we improve your processing speed through that ability to be “Hey, now I’m trained and my brain knows how to do this in a more complex environment,” you’re going to have less gaps to fill in.
Dale Johnson: And I missed one. It asked me what the emphasis points were in the sentence or the main one. And I pointed out the word clothing, for example.
Dr. Miller: Yeah.
Dale Johnson: And in this particular sentence clothing was not the point of emphasis. It was deeper into the sentence.
Dr. Miller: Yeah.
Dale Johnson: I’m going, “Oh wow, okay.”
Dr. Miller: I know.
Dale Johnson: Let’s go on to the next one.
Dr. Miller: I know.
Dale Johnson: It put me in a place to try to improve through this test.
Dr. Miller: I need to find a program that teaches me how to understand foreign accents because I watch shows now and I’m like, “I am not catching any of this.”
Dale Johnson: Subtitles.
Dr. Miller: Subtitles. Oh, they have a fix for that. Subtitles.
Dale Johnson: My wife, that’s her last resort.
Dr. Miller: Yeah.
Dale Johnson: She’s “Did you just hear what they said?” “Nope. I missed it too.”
Dr. Miller: Yeah, I know.
Dale Johnson: Then on comes the subtitles in the setting.
Dr. Miller: I know. I would tell you it very much makes me feel like I have hearing loss because I’m not getting all the information, so I feel like I’m trying to fill in the gaps. Well, there you go. There’s a whole nother nice fix for that and I encourage my patients to, even when you are home, if you have that ability to turn on closed captioning, it’s a wonderful thing. It really is because it gets you understanding better, not being frustrated by “I missed that. I had to rewind and I didn’t catch that.”
Dr. Miller: “I don’t know what the plot is.” I think it’s a great tool.
Dale Johnson: And by the way, when you’re on the website, you will see that among the local hearing professionals, Complete Hearing is on that limited list of businesses that are specifically trained and can talk to you in deeper detail about LACE.
Dr. Miller: Absolutely.
Dale Johnson: You’ll find that on the website, Complete-hearing.com.
Dale Johnson: You can always hear these conversations again at the Complete Hearing website. Of course, tune in every Saturday morning at this time for the conversation starts here.