Hearing Aids for Mild Hearing Loss – Amyn Amlani, PhD – #07

Do you have mild hearing loss and have questions about hearing aids? Listen to hearing researcher Amyn Amlani, Ph.D. discuss his personal experience with his mild hearing loss and how he uses hearing aids

Amyn Amlani, PhD

I am actually wearing hearing aids now I have a mild hearing loss myself, a lot of this is due to overexposure as, as a young adult, with music, concerts, that kind of thing. I’m struggling, if you will, to hear on the computer, I struggle to hear with the TV, my wife complains, and my kids complain that it’s too loud. So somebody could have a mild hearing loss and not have the troubles that I’m having. And you don’t necessarily have to spend a ton of money on devices, find the device that works best for you through a professional that’s going to fit these things. And so we’re probably looking, at least from my estimation, that the over-the-counter availability or framework will be available. Probably the beginning of 2022 is my estimate.

Dr. Amyn Amlani is interviewed about hearing aids for mild hearing loss.

Ben Thompson, AuD

This is Amyn Amlani, the director of professional development and education at Audigy. What we’re here to talk about today are some important facts about hearing loss, research for hearing aids, and how that applies not only to someone with a bad hearing loss but someone who may even have a mild hearing loss. I found it fascinating. On your LinkedIn page, you had mentioned some of your research interests: the important journey of how someone decides to try hearing aids, and then different products that maximize their outcomes with speech understanding, or tinnitus, and also the influence of hearing aid technology on the perception of speech and music. So it’s a valuable place for us to be in because a lot of our audience has hearing loss or tinnitus. And there’s a lot of information online. There’s a lot of misinformation online. So what do you think are the important takeaways for someone to know who has a mild hearing loss about what they should do? Should they treat it? Should they look for help? Who should they go to? And when should they do it?

Amyn Amlani, PhD

That’s a great point. So I’ll share this with you, I am actually wearing hearing aids now. I’m trying out the new Resound devices. I have a mild hearing loss myself a lot of this is due to overexposure as a young adult, with music, concerts, that kind of thing. And so I’m struggling, if you will, to hear on the computer, I struggled to hear with the TV, my wife complains, and my kids complain that it’s too loud. And so you know, I’ll use my example to answer your question. To me, it was all about two things. Number one, it was my inability to hear what happens at the dinner table. What happens at a restaurant, my dad is in New York, 78 years old, I have a hard time hearing on the phone. And when the opportunity came about to demo, try these demo devices from the for the new resound product. I’ve had these things about now a month, and I’m starting to realize how much information I was missing. how tired I was at the end of the day because I was fatigued from trying to listen, and how many things I actually misunderstood, which actually made my job harder, put some strings if you will, on my marriage because I wasn’t getting the right things done around the house. And it’s allowed me to be a little more engaging. So if you have a mild hearing loss, it’s well worth it to try these devices. Get your hearing tested. You know there’s some cognitive benefits as well. We know from the Johns Hopkins research that mild hearing loss will eventually lead to some cognitive issues. And the quicker that we can get sound amplified to the brain. The more neurons get fired, the more likely we are to remain at a higher level, as opposed to having the auditory system kind of deteriorate, if you will.

Ben Thompson, AuD

And how would you recommend someone approach that decision of first of all being real with themselves admitting that they may need help and that hearing aids may be what can help them. that next step of researching what’s out there and then picking something to try. What do you recommend for them.

Amyn Amlani, PhD

Yeah, So the first step is you have to go get your hearing tested. So you have to know how much of a loss you have and where you have a loss. And, you know, I recommend going to see an audiologist having your hearing tested most, 90 to 95% of our individuals with hearing loss have a Cochlear hearing loss, meaning it’s not medically treatable, I can’t take a pill or have a surgery to correct the loss. And then from there, it’s not so much the technology. And what I mean by that is, is most technology that’s available on the market today is equal, where the difference comes in and who’s actually fitting the device and how the device is being fit. So you know, just as there are good apples in a profession are also bad apples in a profession. And, you know, going to a professional who uses best practices, looks at your communication needs, does an assessment of what it is that you’re looking for, does a speech and noise test to see where you’re having some issues, can then take those that information along with your audio metric, or your hearing test results, figure out what features you need because you don’t need all features, you just need the ones that have been a benefit to you. And then from there, you know, provide the level of service White Glove service, that then tailors the product to your needs, is the way to go. And I think as a consumer, you have to be very, very demanding of what it is that you’re going to get. And if you’re not getting the quality or the service that you need, go somewhere else, because you know, we have trial periods with these devices. And like I said, there’s good apples and bad apples.

Ben Thompson, AuD

So on that thought of even a mild hearing loss could benefit from hearing devices, hearing aids. Is that always the case? When is it not necessary? If you have a mild hearing loss, when would it not be the right time to try them?

Amyn Amlani, PhD

Yeah, so that’s a good question. So somebody could have a mild hearing loss and not have the troubles that I’m having. Right. So there’s an underlying neurological, neurological, a neurophysiological function of inside the hair cells where you know, you have a synapses that is starting to deteriorate. And that doesn’t happen for everybody. It happens for some folks, and it doesn’t happen for others. And this is the stuff that comes that’s coming out of Massachusetts. So for me, if I do a speech and noise test, my performance is going to be maybe a little more elevated than the average person. But somebody with a mild hearing loss who’s not having those issues might be able to cope. And in that situation, these devices may not be the right thing. Instead, it may be using something called a hirable, which is essentially taking your air pods or your earbuds, streaming them to your phone, and using those as an amplifier, as opposed to getting devices like the ones that I’m wearing now.

Ben Thompson, AuD

That’s a good point is that it’s not only the hearing test result but also the functional challenges the real-world challenges because my hearing test is the same as yours. But I’m just I’m having a fine time hearing my family, my work colleagues, my family, they tell me no, you seem to be hearing me just fine. And I’m not reporting difficulties. That’s not comparing apples to apples. But even if I wanted to try something, there is a stepping stone for everyone no matter how much difficulty they have. What have you seen in terms of the research that your colleagues, Ph.D. audiologists are working on providing data and research? How is that fueling the engineering of different devices and technology to meet the needs of the market?

Amyn Amlani, PhD

That’s a great question so that you can come at this from a lot of different angles. So I’ll try to I’ll try to be broad here in the sense that so they can capture all the pieces because this could be a session on its own. So there’s a couple of different schools of thought. One is is if you look for example, at some of the new technologies that are available in the market, it’s not looking at amplifying devices on the ear as simply hearing aids but as something called wearables. So Starkey has the Livio device the Livio devices and hearing aid but it also measures your fitness it measures your blood pressure, you know, those kinds of things. And that’s that’s where we get those other pieces. You also have devices, the Phonak devices, the paradise in the Marvel before that, which are excellent at streaming, people like to stream music or like to stream videos and So those technologies are now available. It’s not to say the Livio doesn’t have it. But there are some manufacturers that a little bit better at it than others. And so I think it’s just a matter of finding, again, your needs based on the functionality, the communication needs, that you have the things that make you happy, the things that make your life improve, by having these devices on, and finding a professional that can then guide you in getting that best technology. But from a research standpoint, you know, I think you’re gonna see hearing aids in the future that are cloud-based, you’re going to be able to be fit remotely. So I’m in Dallas, Texas, and you’re in California, if you were my audiologist and I was on a business trip, I could call you and say, Hey, Ben, I’ve got a real issue here, I can’t hear this meeting. Can you do some things to improve the high frequencies or whatever, and you’re going to be able to fit me without me struggling and all that, I think the other thing that you’re going to see in the future is a lot more artificial intelligence. So the hearing aid is going to become a lot smarter at the environments in which you go in the settings because on the devices, you’ve got the smartphone app. So you are, you can go in and manipulate if you will, the frequency response, it will then know that you like highs more than lows or you like this more than that. And as you walk into an environment, it will make that analysis for you. predictively, and then be able to give you the frequency response that you need, which our ears that are normal do on their own.

Ben Thompson, AuD

That’s definitely a hot topic, artificial intelligence, big data. For someone listening, they may just want the simplest effect of hearing. But what they don’t realize is that this artificial intelligence this behind the scenes calculation, this is what’s making hearing aids a much more enjoyable experience wearing them today than it was 20 years ago. Do we? Are we seeing exponential changes in the technology? Or is it more linear development over the last 10/20 years?

Amyn Amlani, PhD

Yeah, so that’s a really good question. So you know, I came out when analog hearing aids were converting to analog programmable, right. So that was an exponential jump. And then from there, we went into our first stage of digital devices in 96. And, you know, we’re probably on our 12th or 13th iteration of digital. And so you know, as the digital signal processing has improved over time, we’re seeing gains, but we’re not seeing the huge gains that we’ve seen before. And that’s not to say that the technology is not getting better, it’s being refined. Because we learn more about people’s abilities to perform in different environments, which we didn’t have five years ago. That’s all being uploaded to a cloud. And we can kind of get a sense of how people are performing and all that. But I would say that the smaller games are now just refining the device in order to make the device. It allows for not so much audibility, we’re now starting to get into a very, very, we’re starting to get into the area of sound quality, which is really, really hard to measure. And as you know, it being in the clinic, we don’t have any tests to measure. And there’s no real year measures, or there’s no test that we do clinically to measure sound quality. And I think that’s what these new technological advances are going to allow us to get a better sense of is, what is the sound quality that makes you happy? versus me and is there some sort of a bound that everybody kind of fits in so that the devices can be geared? And engineered to better accommodate that particular aspect of the psychology?

Ben Thompson, AuD

That’s interesting. It makes me think of music because there are there are resonant chords and then there are dissonant chords where you play a dissonant chord and you think, Oh, no, that’s just not a good sound. But objectively, they’re both just sounds. So for individual listening of speech in background noise, do you expect there to be some common preferences in terms of the quality of sound?

Amyn Amlani, PhD

That’s a really good question. And I think I would answer that as I think it’ll be variable depending on you as the individual, how well your brain because your abilities to, to deal with noise occur at the brain level as well as you know, the periphery. And so that I think, is going to be the invariable part, which is where the professional is going to come in. And that’s where the over-the-counter devices I think are going and want to use the word fail, but they won’t be as beneficial. They’ll still help but won’t be beneficial, and that’s where the traditional devices will become the Cadillacs. And the need for the professional will be much, much much needed.

Ben Thompson, AuD

Yeah, I can also see a smart device option. And I know some manufacturers I believe widex came out with this a few years ago where you can press A or B and you can go through these two forced choices. Okay, um, in this situation does a or b sound better? And then with the device, and the software, just giving you all these options for choosing what sounds best, over time that AI inside of the software can say, okay, Ameen. Dr. Imani. They prefer this kind of sound. But Ben, he prefers this kind of sound. So we’ll give them what they each want because they’re slightly different. I want to change the subject a little bit. What are the historical rates of adults who have a hearing loss trying hearing aids, because as doctors who go to conferences and read research, this is something for us that we read about a lot. But for someone who may have just found this podcast, by searching about tinnitus, or hearing loss, they may not understand these big trends in terms of how many people who may need help actually seek help, and then actually get treatment? What are your thoughts on that?

Amyn Amlani, PhD

It’s a good question. And this is measured a couple of different ways. So we’ll start large, overarching. So there’s something called the adoption rate. And essentially, what that is, is the number of hearing aid users divided by the number of individuals in the marketplace. And so if we look at the United States, we know roughly that there are about 12 million hearing aid users. And that there are roughly just to make the math easy, about 36 million people who could benefit from amplification of some sort, right? So we’ve got about a 30% adoption rate if you will. So that’s the overarching look, now that I want to while we’re talking about this, there’s also the clinical right, which is a little bit different, where you have a patient come in, and we know that they have a hearing loss, and then you convert them into wearing a hearing aid. And that’s what we call it an effectiveness rate. So they’re two different things. And so I want to make sure the public understands that, when we’re talking about an adoption rate, we’re talking about the number of individuals that are worrying devices versus the population, whereas in the clinic, these are the number of people that are willingly coming in. And these are the people that are getting fit, because the effectiveness rate is going to be somewhere around 5055 60% given that you have a captive audience, so to speak. So, knowing that what’s interesting is that this 30% rate has stayed essentially the same for about 30 years. And the question becomes, why is that this is something that’s kind of driven me for probably the last two decades or so. And it’s in when I was a, when I was a graduate student working on my doctorate, it was all about the technology, because we were moving from analog to digital, digital was going to allow us to do all these fancier things with noise reduction, and multiple mics and all that kind of stuff. And the thought was is better signal processing would yield better results, and it has it. And so that doesn’t mean that the technology’s gotten worse, it just means we need to do something more. That something more was we’re what we’re learning about has to do with the standard of care in which we see our patients or patient-centered care versus paternalistic care. And as we’re moving from paternalistic care where the patient is told what to do versus patient-centered care where it’s a shared decision-making option, we’re finding is that more people are willing to adopt amplification. And I think over the next five to seven years, as more and more people come into the marketplace, we’ll start to see those adoption numbers shift up a little bit. And the reason being is our customer service is just better.

Ben Thompson, AuD

I thought on that to build on that. About two years ago, the US lawmakers created the over-the-counter hearing aid Act, which I which I believe was supposed to be completed in 2020. But COVID slowed that down or delayed that. How do you what do you haven’t, first of all, give an update on that? And then how do you believe that will impact this whole idea about adopting hearing aids when we can start with them? Who can afford them and how we seek help for them?

Amyn Amlani, PhD

Yeah, so let me give you an update for us. So what we know, what we’ve been told is that COVID has put a damper on the FDA, his ability to review this document, the understanding is, is that they will get to it sometime in the first or second quarter of 2021. The framework will then be given to the public for their review and appraisal. And then there’s a six-month period for that the comments get kicked back, there’s a few months of where they make some changes. And so we’re probably looking, at least from my estimation, that the over-the-counter availability, your framework will be available. Probably the beginning of 2022 is my estimate. In terms of how this is going to help, the reason that this bill came about was two things, accessibility, and affordability. So if we look at it from an accessibility standpoint, there are some issues as it relates to getting a patient into a licensed practitioner’s office. There’s a bandwidth issue. And I’ll explain this, in 2000, there were 12,000 to 13,000 audiologists in the United States, in 2018, which is the last set of data that we have from the Department of Labor, there’s still only 13,000 audiologists, right, so the population is going three to 4% organically cheer, but our abilities to help these individuals, right number of professionals that we have has not grown in proportion with the individuals that are coming into the market. So there’s an accessibility issue there. The second piece is affordability for some individuals, not for everybody. But for some individuals, the cost of these devices is just exorbitant. The average cost of a device in the United States is about $2,000. Although we know that you can buy these things from about $500 apiece up to a lot more, right. And so what the government is doing is they’re allowing individuals to purchase these direct to consumers and try these devices out. Now, I see two things happening. Number one, folks that don’t benefit from these devices, will become increasingly stigmatized and are less likely to enter the market. Okay. But I think on the flip side of this, we’ll have a majority of individuals who try these devices realize that they’re missing things, they’ll see some benefit, it may not be a perfect benefit, because again, they’re fitting themselves. And that will then allow for a couple of different things, awareness of hearing loss, it will allow them to see the benefits of the device itself. And then they will know that they’re not able to do this on their own and that there’s a need for some professional guidance. And I think you’ll start to see some changes in the way that we offer service delivery, again, through cloud-based opportunities.

Ben Thompson, AuD

Thank you for that update. It’s important and the over-the-counter hearing aid act. I mean, they definitely chose a catchy name we can give them that everyone’s familiar with over-the-counter products. I’ll have one question here, which is a fun personal question. I’ll give you a moment to reflect on this. I like to ask every guest on the pure tinnitus and hearing podcast. What are their favorite sounds? And for me, personally, this would be someplace in nature. So for others, it’s the sound of voice or a distant memory or music. What are your favorite sounds? The sounds that really make you remember who you are?

Amyn Amlani, PhD

Oh, that’s a great question. So I’ll give you four. And I’ll give them to you in no particular order. I love music. So the ability to hear music is huge for me. I live in the great state of Texas. So we like to eat steak. And I like to grill so having a steak on the grill and listening to it. sizzle is another one of my favorite sounds. And then of course I have to say you know my family, I really enjoy the giggling and the laughter and all the stuff that goes on in the household. It just makes me feel like you know, my wife and I have done a really good job raising three kids. And then the last thing is, is I like to write so I like the popping of the keys on the keyboard here. It allows me to, to kind of remember that, you know, I need to write papers and do those kinds of things in order to have a sense of worth in this world and pay the bills of course.

Ben Thompson, AuD

I asked for one sound and he gave us four. That’s what we call overperforming Thank you. I want to open this up for you any last words of encouragement or wisdom for our listeners, most of whom have tinnitus, some of whom have hearing loss? What kind of words you want to give to our audience here before we wrap up?

Amyn Amlani, PhD

Yeah, that’s it, I appreciate this, you know, hearing loss and I attended us as well, you know, can be debilitating. And I’m starting to notice the tinnitus a lot more as I moving into my mid-50s. Now. So my advice to you is, go get your hearing checked. It’s, it’s no different than getting your eyes checked, it’s no different than going in and getting your blood pressure checked. Your ears will allow you to have a better quality of life. If you’re there, they’re fixed. There, you’re able to hear what’s going on in the world. And you don’t necessarily have to spend a ton of money on devices. Find the device that works best for you through a professional that’s going to fit these things to your functional needs and your communication needs.

Ben Thompson, AuD

Thank you so much. We’re so happy to have you as a guest on this podcast. For all the listeners out there. Let us know in the comments. Do you plan to get a hearing test? Have you already gotten a hearing test? Or are you considering trying hearing devices? If you ask any questions, I’ll do my best to reach out.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson, Au.D.

Dr. Ben Thompson is an audiologist in California and founder of Pure Tinnitus. Dr. Thompson has a comprehensive knowledge of tinnitus management. He completed his residency at University of California at San Francisco (UCSF) and is a past board member of the California Academy of Audiology. Via telehealth, Dr. Thompson provides services to patients with hearing loss and tinnitus.

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