Episode 4 It is all about the why

The Transcript

Dale Johnson: It’s all about the why every Saturday morning at this time. You are listening to The Conversation Starts Here. Dale Johnson on KFOR FM 103.3 1240 AM. Dr. Sandra Miller from complete hearing is by my side. Good to have you in again.

Dr. Miller: Good morning. Great to be here.

Dale Johnson: I said it’s all about the why.

Dr. Miller:
It’s all about the why.

Dale Johnson: And you explain that so well. You want to know why from your patients who come in; why they are experiencing what they are experiencing in their degree of hearing loss.

Dr. Miller: Exactly. I think one thing that I want the listeners to know is that when you have your hearing evaluated, it’s very much about not just what you can hear, but why are you having these symptoms? Where did this hearing difficulty come from? Where did this ringing come from? Why am I having balance issues? And I think when people go to their doctor, they want to know. We want to know what’s going on and then how do we best treat it.

Dr. Miller: So when we look at you, we’re looking at you as a whole entire person. We’re not just looking in your ear, testing your hearing and say, “This is what you need.” We look at every effect that may have affected your hearing and why it is that way. So you have an understanding of, “Oh, well hey that makes a lot of sense. What would I do differently? How can I live a healthier life and have that contribute to good hearing? What does that mean?” So we want to treat you as a whole person and not just talk about, “Yeah, you don’t hear a good, here’s a hearing aid.” We want to talk about, “Let’s talk about why you have this. And let’s figure out the best solution moving forward and really how to protect your hearing moving forward as well.”

Dale Johnson: And to answer the why question, you are a detective of sorts, so you look for causes.

Dr. Miller: We do look for causes. And I would tell you one of the major things we see is that, hearing loss tends to be very hereditary. So if you do have family members that have had hearing loss in the past does come through, in terms of whether it’s mom or dad. Sometimes you’ll see it run genetically in a family as well. So that’s important, especially when we start identifying children. You’ll see that if we find a child that has hearing loss, we’re definitely going to dig into the genetics and make sure we make an appropriate referral to find out where this hearing loss may be coming from. So hereditary is a very big one.

Dr. Miller: The other big one is going to be exposure to loud noise. And people think, “Oh well I’ve never been in the military, or I didn’t grow up on a farm.” Those are two major ones for sure, but this can be even an impact sound that happened with a 4th of July firecracker that went off by your ear. This can be mowing the lawn as an occupation and never wearing hearing protection.

Dr. Miller: So there’s noise levels that we even talked about last week where we live in such a noisy world. When you think about how much of this is doing damage to my hearing? And once levels get above 85 decibels, which is actually a lawnmower is louder than 85 decibels. We can talk all about those noise levels that are appropriate, but the damage that can be done to the hearing, it can actually happen pretty quickly depending on the level of the sound. And so we want to make sure we are talking about hearing health as well. So exposure to loud noise is a really big one.

Dr. Miller: And I think the other one that’s really pretty dominant that people have in their minds but may not be true is that, “I’m older and I have hearing loss.” It happens at every age. And I would tell you just because you’re over 65, do you have a more chance of having decreased hearing? Honestly, it depends a lot on your genetics and your environment and it’s not just due to the aging process. There is a role that that plays, but we find that hearing loss is more prevalent to actually people who are more in that 40 to 60 range.

Dr. Miller: And so it’s interesting. People have this conception of, “Well now I have hearing loss, I’m old.” That’s not true at all. And I would tell you with we talked about last week, sometimes we’re wearing earbuds and we’re damaging our hearing, is that we’re seeing hearing loss more prevalent in other age groups, than we even are of people who are over the age of 65. So aging, yes is a cause. But is it the dominant cause? I would say, in some areas, yes. But when you think about age related, you’d be surprised at the statistics that are actually showing it’s not at the age of over 65 that’s most dominant.

Dale Johnson: Let me ask a why. Why aging does a part just wear out?

Dr. Miller: Such a good question. So the reason the aging process has a lot to do with the process of, as our hearing gets less or diminishes, is because of course we’re not meant to live forever. And some of our parts wear out. And that equates to your hearing as well. And the cochlea is where all the organ of hearing is. And what happens is those little hair cells that are inside that inner ear space, they die off. And that can be due to so many different reasons in terms of it can be genetics, it can be blood flow to the ear, it can be noise exposure. And once those hair cells die, they don’t grow back. And so that’s where permanent hearing loss comes from.

Dr. Miller: So as our body, yes, starts to fail us, we find some times it can be so many different things and that’s one of the areas we definitely see it is that it could be blood flow, it can be just that aging process of the ear not working as effectively. And the aging process starting to affect those inner ear hair cells.

Dale Johnson: Medicine can cause hearing loss.

Dr. Miller: Medicine, oh my goodness. If you look on our website, we have a great little note that just says, “There are over 200 different kinds of medications that negatively can affect your hearing system, which I think is amazing. When we have patients come in and they’re taking more than four or five prescription medications, they interact with each other and then we’re always looking for the side effect to them. People don’t realize, and I know I’m not very good about reading the back of my prescription bottle or reading my side effects of what I might be taking, but you’d be surprised at how many medications people do take that it has an impact. And that’s because of blood flow to the ear, what it does to the cells in the body.

Dr. Miller: I often tell my patients, all your cells are tied together. Your ears isn’t just isolated by itself, sitting there on your head. It’s affected by everything else that happens in your body. So when we talk about patients who take medications for high blood pressure or diabetes, or they may have had cancer, they may have had radiation or they may have had chemotherapy. What does that do to your whole entire body? It’s not just affecting that one area. It affects everything.

Dr. Miller: And the inner ear is so dependent on good blood flow, and it’s very microvascular, just like your eyes are, meaning that that little vessel leading to the ear is very small. When that blood flow gets upset that ear doesn’t like that. And when it shut off for long enough or disrupted in any way for long enough, it has a longterm impact, in terms of permanent hearing loss.

Dale Johnson: And to complicate matters, they may be taking medicine because of a disease or an illness. So now, your detective skills come in [crosstalk 00:06:07] to go back to find the disease or illness.

Dr. Miller: Exactly. So a lot of times when we’re looking at a case history, when our patients do come in for an evaluation, we’re looking to see, what are they telling us in terms of their previous history and their current history. If they’ve had say a heart attack, they’re taking a blood thinner. “Yes, I have had cancer, I had radiation and chemotherapy.” When the treatment, it has that type of impact, we’re always looking for signs and symptoms that may come along with that. And yes, it’s tied to your ear. People are like, “Really? That’s connected to each other?” Absolutely. And so disease processes … And we know that as Americans we’re not as healthy as we should be.

Dr. Miller: And so I think a lot about that. We try to just provide the education not only to our patients but even to primary care physicians that they have such a very comprehensive job to do with their patient understanding how the disease processes are tied to the important sense of hearing because it’s vital. And understanding the connection between the two of them. Is there a cause effect? Sometimes there is. Sometimes it’s just they’re correlated to each other. “Oh really? That’s interesting.”

Dale Johnson: One of the most common parts that gets brought up in conversation is the ear drum. And someone said, “Well, I punctured my eardrum swimming.”

Dr. Miller: Ah!

Dale Johnson: Or, “I punctured my ear drum playing football, head injuries.” What is the eardrum? And talk about head drama.

Dr. Miller: Such a great question. I’m going to dial back and just tell you, when we look at the year, we look at three parts of the ear. And so we look at your ear canal. And a lot of people would just want to come in and say, “Please just tell me this is wax.” And we always go, “Let’s look.” A lot of times wax can be an issue. I always tell my patients, “Wax is a normal thing. It’s meant to protect your ear from bugs.” But when you have too much of, it’s not a good thing. So, that’s your outer ear.

Dr. Miller: When you get to the middle ear. Yes, we’ll talk about the eardrum in the middle ear bones. Puncturing the eardrum is painful. Number one, causes that hearing loss that we would call either conductive or mixed. And so trauma, a lot of times I’ve had people water skiing and they’ll land on the ear, and there’s so much pressure that happens, they puncture their eardrum. For all of you Q-tip users out there, please stop. I’ve had people cleaning out their ears with a Q-tip and they sneeze and they puncture their ear drum.

Dale Johnson: And it’s really a puncture.

Dr. Miller: It’s really a puncture. So your ear drum is like a thin piece of paper. Think about it that way. And what happens is when we puncture our ear drum, it creates a hole and it creates hearing loss. What’s nice about your ear drum is it’s super efficient. And if the hole is not too large it’ll honestly just grow back together, which is a wonderful thing.

Dale Johnson: Nice.

Dr. Miller: Nice. It is one of those hearing losses. That way if we see that you’re having something with the middle ear space, like a punctured ear drum or there is infection in the middle ear space, we’re definitely going to be referring you on back to your primary care physician or to an ENT physician. Because that’s something we need to medically manage. What’s nice about conductive hearing losses is they can be medically managed. And that just means we can do some type of either surgery or medications, pending what the cause is.

Dr. Miller: But yes, trauma to the ear is bad. Trauma to your head is bad. We can have transverse fractures of your temporal bone that cause … So if you’ve been in a car accident, if you’ve been hit really hard on the head, that can cause hearing loss. So there’s just other trauma incidences that are definitely very prevalent. Explosions that go off by your ear, I would call that trauma, tying it into noise exposure, but trauma as well.

Dr. Miller: So it’s one area I think that we hearing … I always think hearing often tends to get overlooked. When somebody is having head trauma or they’re having some type of disease process, hearing is one of the last things they think about. You want to deal with what’s at hand. But having an understanding of how that disease or those medications or what has happened has tied to your overall system.

Dr. Miller: And as you know, I’m so passionate about hearing because it’s what I do every day, but I just, I love people to know that it’s such a part of your daily life, because you communicate with people. And when you’re dealing with other things, the communication piece is one of the largest pieces when you’re having, even when you’re having a disease process. And you’re wanting to communicate with your doctors and communicate with your loved ones, it’s important that you hear well. So I would love hearing loss to be taken off the back burner, and put more toward the front to say, “I need to consider this as well as my overall health.”

Dale Johnson: Concussions constantly in the news. But rarely do I hear hearing loss tied into the concussion conversation.

Dr. Miller: And hearing loss more like you … Concussion wise, I would say concussion is honestly, we’d be more concerned about balance than anything else. I would tell you there’s a great program that’s been going on at the university for the past few years, in terms of making sure we assess our athletes to say what’s happening in terms of what they have a baseline done. And if they have a concussion, how is that affecting their balance? So that’s really tied to that as well.

Dr. Miller: When I think about trauma to the head, I definitely think about, you have to have some pretty big trauma to the head to in terms to impact that, but it’s overall something we should be evaluating for sure.

Dale Johnson:
More critical in children?

Dr. Miller: I think it’s critical for everyone.

Dale Johnson: Good point.

Dr. Miller: Yeah. I think it’s critical for everyone.

Dale Johnson: The reason I bring that up is I’m reading more about hearing loss in children.

Dr. Miller: Yes.

Dale Johnson: Which we don’t have enough time in this show-

Dr. Miller: We’ll have to have a whole show about it.

Dale Johnson: -to go to, but I’m reading a lot more about parents taking their children in earlier for tests and taking it seriously. “Oh, they’ll grow out of it.” Or, “I don’t want Susie to have hearing AIDS in kindergarten.”

Dr. Miller: Yeah.

Dale Johnson: Reading a lot more about that these days.

Dr. Miller: Yeah. And in the future what we will have, and keep tuning in on Saturday mornings, because we are going to have some great guests coming in. Just to have conversations about the things we’re talking about today, whether it’s children and hearing loss. How is brain trauma tied to hearing loss and balance? Let’s talk through those specifically, because they’re great topics where I think it’s, we need the education so we know what does that truly mean.

Dr. Miller: And I agree with you in regards to children and hearing loss. I think our public school system does a good job. Let’s make sure we’re evaluating these kids just like we do a screening. But what are the symptoms I should be looking for with my child? And how important is this that … And people think, “Well they passed their newborn screening, and their speech is developing pretty well. Okay, we should not look at this anymore.”

Dr. Miller: We would never do that with vision. I always think like usually with my kids it was “Hey I have a headache.” “Oh Hey we should take you to the eye doctor.” But I think that acuity of making sure these senses are definitely all at optimum, because that would facilitate obviously optimum learning.

Dale Johnson: Go to complete-hearing.com, you will hear this conversation again and previous conversations with Dr. Sandra Miller from Complete Hearing. And we’re here every Saturday morning. You’ll learn more by going to the website. You’ll learn even more by making an appointment. Complete Hearing at 4,200 Pioneer Woods Drive in Southeast Lincoln, near 70th and Pioneers. And we’ll talk next week.

Dr. Miller: See you next week. Thank you.