Latest / Starkey Sound Bites: Hearing Aids, Tinnitus, and Hearing Healthcare / Dr. Jamie Hand on Tinnitus

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Dr. Jamie Hand on Tinnitus · Starkey Sound Bites: Hearing Aids, Tinnitus, and Hearing Healthcare

• 0:01
  SPEAKER_01: Welcome to Starkey Soundbites.
• 0:03
  SPEAKER_01: I'm your host, Dave Fabry, Starkey's Chief Innovation Officer.
• 0:07
  SPEAKER_01: This week is tinnitus awareness week.
• 0:10
  SPEAKER_01: Tinnitus is commonly described as ringing in one or both ears, and the great debate among many professionals is whether it's tinnitus or tinnitus.
• 0:19
  SPEAKER_01: But to that I say tomato, tomato, whatever you're most comfortable with.
• 0:23
  SPEAKER_01: It is nonetheless an enormous problem for many of the professionals working with patients who have hearing loss.
• 0:31
  SPEAKER_01: The Centers for Disease Control and Prevention estimate that upwards of 20 million people in America have chronic tinnitus.
• 0:40
  SPEAKER_01: And in fact, it's one of the, or it is, I believe, the number one or number two disability among our veterans.
• 0:46
  SPEAKER_01: And another group that may not quite be as obvious, that is at high risk of tinnitus, are dentists and dental office employees.
• 0:56
  SPEAKER_01: Joining me today to talk more about this is uh Starkey's very own Jamie Myers Hand, who conducted a study about the high rates of tinnitus in dental health professionals.
• 1:08
  SPEAKER_01: Dr.
• 1:08
  SPEAKER_01: Hand, thank you for being with us here today.
• 1:11
  SPEAKER_01: And I look forward to this discussion.
• 1:13
  SPEAKER_00: Yes, thanks for having me, Dave.
• 1:15
  SPEAKER_01: Yeah, it's great to have you.
• 1:16
  SPEAKER_01: And who's your friend on your lap?
• 1:18
  SPEAKER_00: Yes, this is Pippa, my cat.
• 1:21
  SPEAKER_01: This is I like it.
• 1:22
  SPEAKER_01: So she appears very comfortable and all nestled in your arms, ready for this discussion.
• 1:28
  SPEAKER_01: So so before we um uh talk a little bit about Dennis and the study that and the work that you did and the rationale for why it is that you explored this topic, let's talk about tinnitus in general.
• 1:41
  SPEAKER_01: So first of all, how how many people have it?
• 1:43
  SPEAKER_01: I we mentioned 20 million.
• 1:44
  SPEAKER_01: That may be a conservative estimate because I've seen numbers that are actually even almost double that, but CDC is using the number of 20 million.
• 1:54
  SPEAKER_01: But talk a little bit about how it is that uh people uh come to notice that they have tinnitus, who's at greatest risk, uh uh gender differences if you have that, age, et cetera.
• 2:06
  SPEAKER_01: What uh let's talk a little bit about the background.
• 2:08
  SPEAKER_00: Certainly.
• 2:09
  SPEAKER_00: I mean, I think you know, constant tinnitus is probably where we get to be have those conservative numbers.
• 2:15
  SPEAKER_00: I think we've all experienced what we call more transient ear noise, which is that comes and goes, or maybe you've experienced tinnitus just after a loud event, a sporting event, a concert, what have you, and then it goes away.
• 2:28
  SPEAKER_00: So I think we've all experienced tinnitus or ringing or a sound in your head that is not um what you're hearing from an external source.
• 2:37
  SPEAKER_00: So um, however, I think those statistics, it's you know, 14% of adults or 13% um have tinnitus, and that's constant.
• 2:47
  SPEAKER_00: I mean, and everyone experiences it a little differently.
• 2:50
  SPEAKER_00: We always think of just that high-pitched ringing, but there's certainly really a multitude of things that you can hear as you're tinnitus.
• 2:58
  SPEAKER_00: Um, you know, certainly living an active, noisy lifestyle certainly um makes you more at risk.
• 3:05
  SPEAKER_00: And I think, you know, as audiologists, we hear I have tinnitus.
• 3:09
  SPEAKER_00: And our second thought is well, you probably also have some hearing loss, if not now soon, that you're going to notice.
• 3:16
  SPEAKER_00: So I think that's something to note is it's usually just a symptom of an underlying hearing loss or just damage to your system.
• 3:25
  SPEAKER_01: Yeah.
• 3:25
  SPEAKER_01: And you mention and allude to the fact that many people with tinnitus also have at least some hearing loss.
• 3:32
  SPEAKER_01: Are there other concerns in terms of tinnitus and the nature of it that would suggest an individual should seek medical care, medical treatment to rule out any more serious issues other than peripheral hearing loss, which is in itself a serious concern that people should be concerned with.
• 3:54
  SPEAKER_01: But are there any other uh indications or contraindications that you can think of where an individual should seek the uh additional assistance of a physician, their primary care or an ear notes and throat physician?
• 4:08
  SPEAKER_00: Certainly.
• 4:08
  SPEAKER_00: I mean, if if the the kind of first red flag that we hear, if somebody says it's a whooshing or a tinnitus or a sound that kind of corresponds with your heartbeat, that is certainly a big red flag.
• 4:21
  SPEAKER_00: Go and see a medical professional.
• 4:23
  SPEAKER_00: Um, usually, like you said, an ENT will certainly be your best first stop to see what next steps you need to have.
• 4:30
  SPEAKER_00: Um, from more of the mental health side of things, that's also kind of the other avenue I think of.
• 4:36
  SPEAKER_00: You know, if your tinnitus is is driving you to be um more anxious, more depressed, more recluse, you know, that is certainly something that a hearing healthcare professional can help you tackle the tinnitus part of things, but really the partnership of that mental health care professional is certainly needed at for some patients, not all.
• 5:00
  SPEAKER_01: Yeah.
• 5:00
  SPEAKER_01: And and also what if someone has tinnitus only in one ear?
• 5:04
  SPEAKER_00: Yes, good point.
• 5:06
  SPEAKER_00: Yeah.
• 5:06
  SPEAKER_00: Unilateral tinnitus is always, you know, when we're talking to patients, we always say, you know, yes, it feels like it's in your ears, but it's really in your brain that this is happening.
• 5:18
  SPEAKER_00: So anything that is unilateral is certainly a red flag as well.
• 5:23
  SPEAKER_00: Well it's been your own.
• 5:25
  SPEAKER_01: Certainly in a worst case scenario, it can suggest an acoustic neuroma or something like that.
• 5:30
  SPEAKER_01: Very low likelihood, but it is, you know, it is worth mentioning that if someone has, you know, it's only in one ear or it's considerably worse in one ear than in the other, that is again one of those red flag symptoms.
• 5:45
  SPEAKER_01: Even if they're seeking uh over-the-counter hearing aids and they have ringing just in one ear, maybe that's a good idea, a good time to go and get a diagnostic evaluation from a hearing care professional or seek uh uh help with their primary care physician, or ideally do both.
• 6:02
  SPEAKER_00: Yes, of course.
• 6:03
  SPEAKER_01: Good point.
• 6:04
  SPEAKER_01: So then what as an audiologist, what's been your personal experience in working with patients who have tinnitus?
• 6:11
  SPEAKER_01: Um, can you talk a little bit about the spectrum?
• 6:13
  SPEAKER_01: I mean, we talk about this 20 million who have chronic tinnitus, certainly maybe double that number who have occasional uh uh tinnitus, uh, just like you said, situationally after a concert or engaging in loud activities.
• 6:27
  SPEAKER_01: Um talk a little bit about the spectrum of the impact of tinnitus on those 20 million people, uh, and maybe a little bit of reflection on your personal experience with tinnitus patients.
• 6:38
  SPEAKER_00: Yeah, absolutely.
• 6:39
  SPEAKER_00: Um I would say most patients that you see in the clinics, adults um more likely, um, say that they do experience tinnitus.
• 6:49
  SPEAKER_00: Now, when you dive into that, I think they estimate it's 2% that have the severe tinnitus, that are really truly bothered by it.
• 6:58
  SPEAKER_00: It keeps them up at night, makes them even when they're in a quiet place, you can't truly ever rest, which then, like I said, leads to more of those um mental health concerns.
• 7:08
  SPEAKER_00: However, the majority of patients I think we see in clinic, which I think I saw predominantly, you know, oh yeah, I have tinnitus.
• 7:17
  SPEAKER_00: And uh, sometimes it bothers me, sometimes it doesn't.
• 7:19
  SPEAKER_00: I'm able to kind of block it out.
• 7:22
  SPEAKER_00: Or there's the patients that come in and say, I have tinnitus, period.
• 7:26
  SPEAKER_00: That's what I have.
• 7:27
  SPEAKER_00: And so you kind of start to break them into these groups of what how you need to approach each patient, you know, is tinnitus their main concern, or is it more hearing loss is their main concern?
• 7:39
  SPEAKER_00: Oh yeah, and I also hear ringing all the time.
• 7:42
  SPEAKER_00: So um that's certainly been my experience.
• 7:45
  SPEAKER_00: I really, again, going into that 2% of severe tinnitus, I really only saw one patient that truly I was reaching out to mental health care professionals saying, I can address part of this, but this is really going to be a larger issue.
• 8:01
  SPEAKER_00: So, unless you're in a tinnitus specialty clinic, um you probably aren't going to see a ton of those patients, but you need to obviously have the resources to um know where to turn to.
• 8:14
  SPEAKER_00: Um, however, the treatment of tinnitus has certainly gotten much, much better with the help of hearing technology.
• 8:21
  SPEAKER_00: I mean, I would say, and I think the studies say too, you know, 75 plus percent of just these average tinnitus sufferers can be helped with just the use of hearing amplification.
• 8:32
  SPEAKER_01: Yeah, just the noise floor that is introduced by the use of amplification in quiet environments where their tinnitus is bothersome is often distracting enough from that internal noise that many people once once you've held rule out, if they need uh a physician to sort of do some testing to rule out any contraindications for proceeding with amplification as a solution, um, and patients know that the tinnitus isn't going to kill them, um, is often enough to lower that anxiety.
• 9:03
  SPEAKER_01: And then it's a matter of the masking impact of a hearing aid alone.
• 9:07
  SPEAKER_01: Have you worked with any other tinnitus masking solutions as well, inherent in some devices, like those, you know, we offer hearing aids that incorporate a tinnitus masking solution.
• 9:19
  SPEAKER_01: Can you talk a little bit?
• 9:20
  SPEAKER_01: I know that the vast majority of prof of people listening to this podcast are professionals, so they're familiar with tinnitus maskers, but maybe just a brief discussion for those uh who might be suffering from tinnitus, uh, a little bit about what a tinnitus masking device is.
• 9:37
  SPEAKER_01: Does it cure tinnitus?
• 9:39
  SPEAKER_01: Does it uh how does it manage it?
• 9:42
  SPEAKER_00: Right.
• 9:42
  SPEAKER_00: And that's certainly another ribs like you brought up is anything claiming to cure tinnitus is snake oil.
• 9:49
  SPEAKER_00: You know, we know there isn't a cure yet.
• 9:51
  SPEAKER_00: Maybe there will be in the future, but um, so this is all treatments.
• 9:55
  SPEAKER_00: And when we talk about maskers, it's that same idea of raising the noise floor.
• 10:00
  SPEAKER_00: I always call it a shiny object over here of trying to almost trick your brain to not perseverate, to not pay attention to that rain, buzzing, hissing, whatever your tinnitus may be.
• 10:12
  SPEAKER_00: Um and so hearing aids alone, you know, help reintroduce those soft environmental sounds like your air conditioner, your toes on the floor, your cat brewing on your lap, things like that, so that your brain will kind of notice those things.
• 10:26
  SPEAKER_00: Um, however, in conjunction with that, we can also use these maskers, which can be a variety of sounds, different frequencies, they can oscillate.
• 10:35
  SPEAKER_00: Um, we also have apps that do the same thing.
• 10:38
  SPEAKER_00: Um, so you can have rain, wind, fan, whatever is calming to you.
• 10:44
  SPEAKER_00: Um, and really the point of all of this, it's never to cover up the tinnitus entirely.
• 10:50
  SPEAKER_00: We actually know that'll make tinnitus worse over time.
• 10:53
  SPEAKER_00: You want to try to tow that line where if you really concentrate, you can still hear the tinnitus, but it's certainly in the background.
• 11:01
  SPEAKER_00: So maskers are certainly effective in that way.
• 11:04
  SPEAKER_00: And again, if if you're a tinnitus sufferer wanting more of that over-the-counter solution, there are all of these apps out there that you can simply stream through earbuds, through hearing devices, what have you, to help again calm that response.
• 11:19
  SPEAKER_01: Yeah, many, many people find that just um tuning a radio station slightly off-tune or or using uh YouTube videos now with streaming devices and bedside uh uh tables work for that solution.
• 11:34
  SPEAKER_01: The beauty of hearing aids is that they can stream directly to the devices discreetly, whenever and wherever they happen to be, uh, if they find either a uh a tinnitus stimulus that has been matched to their tinnitus, uh, the frequency or the frequency range, or just something that's more soothing that reduces the anxiety associated with tinnitus.
• 11:58
  SPEAKER_01: Have you worked with cognitive behavioral therapy in treating tinnitus patients at all?
• 12:04
  SPEAKER_00: Personally, I have not.
• 12:06
  SPEAKER_00: Um, not in the not in the formal sense of it.
• 12:08
  SPEAKER_00: I mean, I think in training to be an audiologist and um some hearing care professional trainings, you know, you are taught a lot of the um thought processes behind tinnitus to help talk patients through, just like you said, you know, you're not gonna die from this.
• 12:24
  SPEAKER_00: This is something that is happening within your head.
• 12:27
  SPEAKER_00: And if we can distract you from it, it will lessen.
• 12:29
  SPEAKER_00: You know, there are things like nicotine, like alcohol, like lack of sleep and all of these things that exacerbate it.
• 12:36
  SPEAKER_00: So you might notice a spike in your tinnitus after that, but just know that it's going to go down.
• 12:41
  SPEAKER_00: And, you know, just the knowledge of explaining tinnitus to patients oftentimes is that um calm a release.
• 12:50
  SPEAKER_00: But in the formal sense of cognitive behavioral therapy, I cannot claim to have that training.
• 12:57
  SPEAKER_01: Well, and it's just so often the case that even if they choose a device like a hearing aid or hearing aids that can work to mask the stimulus, it also helps to incorporate elements of cognitive behavioral therapy for that anxiety associated with this.
• 13:13
  SPEAKER_01: And I think um in in my experience over my career, one of the issues that we find is often the audiologists and the the the hearing care professional um is and can be and should be, in my opinion, serve as receptive, a receptive set of ears to the the problems associated with tenants.
• 13:33
  SPEAKER_01: It's not just for those uh the individuals who are disabled, as you mentioned, you know, the two to five percent who are whose lives are profoundly impacted by this.
• 13:42
  SPEAKER_01: But I think in many other cases, maybe the next 20th percentile, um, they've been troubled enough by this that they're seeking answers.
• 13:52
  SPEAKER_01: But it's often the case that people uh diminish their symptoms or say, ah, it's not gonna kill you, don't worry about it.
• 13:59
  SPEAKER_01: But they're more than casually bothered by it, and they just want somebody to listen to their their concerns, provide them with some solutions, and help uh really hear what they're what they're talking about, because so often they're just dismissed.
• 14:17
  SPEAKER_01: Their concerns are dismissed as unimportant.
• 14:20
  SPEAKER_01: And and there is a significant number of that 20 million people for whom it may not be disabling, but it's still disturbing, let's say.
• 14:29
  SPEAKER_00: Certainly.
• 14:30
  SPEAKER_00: I think having that empathic care model is you know great for tinnitus, certainly, because that typically does have that emotional response.
• 14:38
  SPEAKER_00: But really, any hearing loss that our patients are suffering from, I think you can get jaded just like any healthcare profession can, and just say, oh, yeah, yeah, that's just part of it.
• 14:48
  SPEAKER_00: You know, hearing in restaurants is hard, move on, you know, and just having that empathy to say, I know that is hard, isn't it?
• 14:56
  SPEAKER_00: Here are some tools and tips and tricks that we can implement to make it better, but it's still going to be difficult.
• 15:01
  SPEAKER_00: And it's it's the same with tinnitus treatment as well.
• 15:04
  SPEAKER_01: Yeah.
• 15:05
  SPEAKER_01: Well, so let's talk a little bit about occupational and non-occupational uh settings that place people at risk for tinnitus, and especially those individuals who might be at risk of tinnitus associated with acoustic trauma to their ears from being in loud environments.
• 15:26
  SPEAKER_01: We certainly know farmers, police officers, uh, military personnel uh uh are at high risk of tinnitus associated uh with uh the noise levels that they're exposed to.
• 15:41
  SPEAKER_01: Talk a little bit about some of the other um areas that maybe I missed the of of uh uh occupations that place people at high risks, and then maybe some that aren't so obvious.
• 15:54
  SPEAKER_00: Yeah, I mean, um I grew up and went to school in Oklahoma, so it's always certainly like you said, farmers, oil field workers, you know, you always think about these heavy machinery impact um jobs that, you know, anyone would go, ah, you know, that's so loud.
• 16:12
  SPEAKER_00: Very obvious that that's going to cause hearing loss.
• 16:14
  SPEAKER_00: Um, but we were going to discuss today.
• 16:17
  SPEAKER_00: I mean, one of them is is dental professionals, you know, around these um what we found again, not jumping ahead, but these these pieces that are just above that average that you you should start wearing hearing protection, that, you know, again, it doesn't make you go, ah, and grab your ears, but it is still unsafe.
• 16:39
  SPEAKER_01: Yeah.
• 16:40
  SPEAKER_01: And uh uh I actually um back in the 90s when I was at Mayo um started talking to dentists who at the time reported that they noticed after some of their older counterparts, colleagues, um, were suffering from hearing loss.
• 16:58
  SPEAKER_01: And that sort of blew a lot of people's mind because as you said, it was initially thought, oh, ah, factory workers, hunters, et cetera, were at risk, but dentists.
• 17:08
  SPEAKER_01: So how is it that you became interested in working with dentists to assess their risk?
• 17:16
  SPEAKER_01: And where do those risks come from in their work environment?
• 17:20
  SPEAKER_01: And um what did you do about it?
• 17:24
  SPEAKER_00: Yeah, I um this all stemmed from my graduate school studies.
• 17:30
  SPEAKER_00: Um, and at the time that I was needing to choose a research study, um, I was a graduate assistant in the dental hygiene department.
• 17:38
  SPEAKER_00: It was just an on-campus job, very, you know, easy for a grad student to do.
• 17:43
  SPEAKER_00: I would input dental hygiene students' clinic hours into a computer.
• 17:47
  SPEAKER_00: I would just, it was right across the street, super easy after class.
• 17:51
  SPEAKER_00: We'll just go and do that for a couple hours a week.
• 17:53
  SPEAKER_00: And in doing that, got to discuss with the dental hygiene professors, the dental professors, and they um, you know, knew I was an audiology student and said, Hey, have you heard our lab before?
• 18:04
  SPEAKER_00: And I was like, Oh, I'm I've been to dental clinics before, like, I'm sure.
• 18:08
  SPEAKER_00: And they're like, No, come down here.
• 18:10
  SPEAKER_00: So I would walk down to the to their office with them.
• 18:13
  SPEAKER_00: And I mean, it's set up like a typical dental office, but certainly a lot more hand pieces going at once.
• 18:21
  SPEAKER_00: Um, and I was like, hmm, wow, never heard it in this situation.
• 18:25
  SPEAKER_00: Like, let me do some research and get back to you.
• 18:28
  SPEAKER_00: So started looking into really the evidence behind it, and it is very hit or miss.
• 18:35
  SPEAKER_00: It's it's equivocal, I guess.
• 18:37
  SPEAKER_00: You know, you you look at one, it says, yes, it's too noisy.
• 18:40
  SPEAKER_00: You look at another, it says, eh, not really.
• 18:42
  SPEAKER_00: And like you said, again, with timing, you know, older equipment certainly would be noisier, newer equipment slower.
• 18:48
  SPEAKER_00: So um, I kind of went back to them and said, you know, yeah, I think this is something I want to look into.
• 18:54
  SPEAKER_00: And um, they connected me with the dental professor who um helped really unlock the doors to all of the sound level measurements I could possibly want.
• 19:03
  SPEAKER_00: Um, so in doing that, we did a few sound level measurements of, you know, just the professor on these really creepy dental dummies that they use.
• 19:14
  SPEAKER_00: That yeah, yeah, it's nightmares.
• 19:17
  SPEAKER_00: Um, so you can put all these different teeth in, which is really fun.
• 19:21
  SPEAKER_00: I got to go to a um dental student um test lab where there were, I forget, it's in the article, I think 30-something students.
• 19:29
  SPEAKER_00: Actually, I think it was 60 students, um, and they wheeled out this rolling cart of all of these mouths, and the students just chose a mouth and popped it in the creepy dummy and drilled away.
• 19:40
  SPEAKER_00: Um, so took a lot of different measurements, whether it was one-on-one and a room full of students doing all the high-speed hand pieces.
• 19:48
  SPEAKER_00: And that was kind of the red herring of this whole study was we said, oh, that really annoying high-pitch sound is going to be the thing that's causing this.
• 19:59
  SPEAKER_00: And yeah, like you said, you're shaking your head.
• 20:01
  SPEAKER_00: It's it wasn't.
• 20:02
  SPEAKER_00: And that's what a lot of the other studies said.
• 20:04
  SPEAKER_00: They're like, ah, kind of, it's really high pitched, not really.
• 20:08
  SPEAKER_00: Um, and it was really Dr.
• 20:10
  SPEAKER_00: Fruits, the dental professor.
• 20:12
  SPEAKER_00: He said, Yeah, you know, this thing's really annoying, but it's the suction that we're using in conjunction with it that's really noisy.
• 20:19
  SPEAKER_00: And we said, Well, what the heck?
• 20:20
  SPEAKER_00: Bring that thing out.
• 20:21
  SPEAKER_00: And so when he brought that out, that's when the sound level meter really skyrocketed.
• 20:27
  SPEAKER_00: So, and having that partnership with him, he said, you know, yes, when it's on full blast, it's high, but I rarely have it on, you know, unobstructed.
• 20:37
  SPEAKER_00: I usually have it about halfway.
• 20:39
  SPEAKER_00: And when he put it like that, man, it just got even noisier.
• 20:42
  SPEAKER_00: So that's when we really knew there's a noise source, there it is, and all of this.
• 20:48
  SPEAKER_00: So um did the um measurements in the lab with him, both drilling, not drilling, et cetera, all these different circumstances.
• 20:56
  SPEAKER_00: Um, and then also had his partnership in getting the database for the Oklahoma Dental Association, um, which was about 300 plus members, and sent them all a survey um and got excellent responses.
• 21:09
  SPEAKER_00: I mean, I think it was like a 36% response.
• 21:12
  SPEAKER_01: Yeah, that's remarkable.
• 21:13
  SPEAKER_00: Yeah, there, which I think speaks to how interested dentists are in this.
• 21:19
  SPEAKER_00: You know, they got it and went, oh yeah, I think this is a noisy environment.
• 21:24
  SPEAKER_01: So and so let's talk a little bit about the levels you were measuring from suction or from the high frequency drills, or perhaps even some of the lower frequency drills.
• 21:38
  SPEAKER_01: You talk about some of the drills that give some people nightmares about dentists, that low frequency grinding.
• 21:45
  SPEAKER_01: Um, but uh talk a little bit about the levels you observed and then what percentage of time dentists might be engaged in these activities that would place them at risk.
• 21:57
  SPEAKER_01: And then ultimately leading up to The conclusions from your study regarding the need for dentists.
• 22:05
  SPEAKER_01: Number one, I think awareness is crucial in this because so many would never have thought that they would be at risk until they got into one of those teaching labs or until they themselves noticed that after 30 years as a dentist, they were starting to have difficulty and the damage has already been done.
• 22:23
  SPEAKER_01: So let's talk about the levels and um and the levels from some of the different exposures that they're engaged in.
• 22:32
  SPEAKER_00: Yeah.
• 22:32
  SPEAKER_00: So the first um the measurements we did in conjunction with the high-speed handpiece or low speed handpiece, um, which I learned they like to call them hand pieces, not drills.
• 22:43
  SPEAKER_00: That's a scary word.
• 22:45
  SPEAKER_00: So um so with the subsection obstructed um and this suction and hand piece together, those both were 94 and 96 dba.
• 22:57
  SPEAKER_01: So above the level that is a concern.
• 23:00
  SPEAKER_00: Yes.
• 23:01
  SPEAKER_00: And I mean, using the NIOSH, you know, more conservative level of 85 for eight hours was the kind of um trade-off that they they propose.
• 23:12
  SPEAKER_00: Um, that is certainly at 94 to 96 dB.
• 23:16
  SPEAKER_00: We only want you around that for an hour, hopefully less a day before you need to start wearing hearing protection.
• 23:23
  SPEAKER_00: So that was certainly the red flag.
• 23:25
  SPEAKER_00: And in my mind, you know, I've always had kind of routine dental work.
• 23:30
  SPEAKER_00: I've never had to have a lot of um the hand piece work on me.
• 23:35
  SPEAKER_00: And so I'm thinking, like, I I bet maybe it is an hour a day, if not zero hours that dentists are really around this.
• 23:43
  SPEAKER_00: So that's really where the survey came in.
• 23:45
  SPEAKER_00: How long are you around this um suction is really what we asked.
• 23:50
  SPEAKER_00: Um and I'll have to look through it again to take cheat sheet on my notes, but it was 94, I believe, percent of the dentists that responded said, oh yeah, more than an hour a day.
• 24:03
  SPEAKER_00: I'm around that.
• 24:04
  SPEAKER_00: Then asking, okay, so do you wear hearing protection in your office?
• 24:08
  SPEAKER_00: One out of the, I think 144 respondents said that they did wear hearing protection.
• 24:15
  SPEAKER_00: So one.
• 24:16
  SPEAKER_00: Yeah.
• 24:17
  SPEAKER_00: So that's really where the concern is.
• 24:23
  SPEAKER_00: And I I get the the hassle of wearing hearing protection.
• 24:28
  SPEAKER_00: I mean, as an audiologist, I have musician earplugs, and one out of every five concerts, do I remember to take them and use them?
• 24:36
  SPEAKER_00: Um, but I think in this case, there are certainly better noise protection options that we have for dentists and their staff, really, you know, the dental hygienists, the assistants, the everyone that's sitting around the patient as well, helping with that procedure, um, certainly needs to be wearing them.
• 24:54
  SPEAKER_00: Um there's yeah.
• 24:57
  SPEAKER_01: Yeah, and one question, I apologize for interrupting.
• 24:59
  SPEAKER_01: Of the 94% who said they were an hour or more, were there any situations or any specific uh subgroups that you found in your analysis were especially vulnerable to um these high levels of exposure for more than an hour a day?
• 25:19
  SPEAKER_01: I've seen some literature suggesting that pediatric practices or pediatric focused practices may have, you know, several hours of exposure a day, placing them at elevated risk.
• 25:30
  SPEAKER_01: But I'm just wondering what your study might have shown.
• 25:33
  SPEAKER_01: Uh, is that in concert with that, or or did you see anything else?
• 25:37
  SPEAKER_00: We didn't um address subspecialties, which is a good question.
• 25:41
  SPEAKER_00: I mean, that would have been interesting to see, you know, and the periodontists and the ones that are really around um a lot of more of these procedures might be more at risk.
• 25:54
  SPEAKER_01: Yeah.
• 25:55
  SPEAKER_01: But I think, you know, for those hearing care professionals who are working with dentists and and uh building on this work that you've done to raise awareness for those practices where they may not even think about it.
• 26:09
  SPEAKER_01: You know, uh if this was a factory worker who was exposed to 94 dBA for um more than an hour a day, we would be indeed discussing hearing protection.
• 26:20
  SPEAKER_01: And yet one of the biggest challenges for dentists is they need to use these the hand pieces and suction intermittently and then engage with the patient to give them some instruction or to ask them some questions or engage with them in some way.
• 26:39
  SPEAKER_01: So that's why you said adoption of the use of traditional sort of foamy earplugs, which are an inexpensive solution.
• 26:46
  SPEAKER_01: But you know, the the best hearing protection is the protection that is used on a regular basis.
• 26:53
  SPEAKER_01: Like you said, even forgetting, you as an audiologist, forget to bring you musicians' plugs for you know some of the concerts you're going to in a dentist where every day, where the hygienists and the dentists are working uh a good portion of their day and still having to communicate with patients in between the need for protection.
• 27:12
  SPEAKER_01: You mentioned there are better solutions that might be out there.
• 27:16
  SPEAKER_01: Talk about what some of those solutions might be.
• 27:20
  SPEAKER_00: Yeah, I think um, you know, the easiest, cheapest solution are those um semi-insert earplugs that a lot of people have when they're mowing the lawn.
• 27:30
  SPEAKER_00: You know, that has the string, you hang it around your neck, they have a conical shape.
• 27:34
  SPEAKER_00: So you can just easily pop them in.
• 27:36
  SPEAKER_00: You don't really have to mess with the foam plugs.
• 27:39
  SPEAKER_00: Um, certainly those are easy to just simply insert in and out, in and out all day long.
• 27:44
  SPEAKER_00: Um, then you have the fun, more techie aspect of things like the sound gear phantom that we have.
• 27:51
  SPEAKER_00: So, I mean, it's a custom molded to your ear.
• 27:54
  SPEAKER_00: It can stream.
• 27:56
  SPEAKER_00: So for longer procedures, they could be streaming music.
• 27:59
  SPEAKER_00: Um, and then it has the active noise suppression.
• 28:02
  SPEAKER_00: So when something hits that unsafe level, they're going to kick in, act as earplugs.
• 28:06
  SPEAKER_00: When it's not, they have the active microphones to pick up those around them.
• 28:11
  SPEAKER_00: So we usually think about those poor hunters that need to talk with their hunting buddies or just listen to music or hear deer approaching, et cetera.
• 28:21
  SPEAKER_00: Um, however, I think there's a lot more use cases for those active noise suppression systems like those for workplaces like this.
• 28:29
  SPEAKER_00: You can wear them all day.
• 28:31
  SPEAKER_00: They're molded to your ears.
• 28:32
  SPEAKER_00: What's comfortable?
• 28:33
  SPEAKER_01: Yeah.
• 28:34
  SPEAKER_01: So and really it's an investment in your hearing.
• 28:37
  SPEAKER_01: Um, the other thing I think that deserves mention is many professionals like dentists, where they are engaged in noisy activities that maybe aren't obvious or that they don't think about, um, also have noisy hobbies.
• 28:51
  SPEAKER_01: A lot of dentists that I know like to work with their hands.
• 28:54
  SPEAKER_01: They may want to go home and do woodworking or lathe work or some other activity uh and hobby that they might have.
• 29:02
  SPEAKER_01: And talk a little bit about the fact that it's really the aggregate exposure throughout your work day plus your play day that uh elevates that risk.
• 29:11
  SPEAKER_01: So I I mean, I think your your your idea of sound gear really is something where is ideally suited to a dentist or another professional who may have intermittent loud sounds, but then still have the need to communicate and really improving that ease of use, that user interface to keep them in their ears and get the protection when they need it in the communication by having that acoustic transparency, if you will, when they're not engaged in that activity is a solution that is easy to use.
• 29:44
  SPEAKER_01: And I think that is really what has to occur for this, so that it doesn't interrupt or interfere with the patient provider relationship.
• 29:53
  SPEAKER_00: Oh, absolutely.
• 29:54
  SPEAKER_00: Yeah, I think that's the perfect um solution.
• 29:57
  SPEAKER_00: And then, like you said, any the best used hearing production is the used hearing production.
• 30:02
  SPEAKER_00: So um really anything that works, if the semi-inserts work for you, that's perfect as well.
• 30:08
  unknown: Yeah.
• 30:09
  SPEAKER_01: Yeah.
• 30:10
  SPEAKER_01: Well, it so in your study, then did you publish that?
• 30:13
  SPEAKER_01: And where did you publish it if you did?
• 30:15
  SPEAKER_01: So people could look for it.
• 30:17
  SPEAKER_00: Um, it is a noise and health journal.
• 30:19
  SPEAKER_00: And if you just look up really dentists and ten and tentus.
• 30:28
  SPEAKER_00: Tinnitus and dentists.
• 30:30
  SPEAKER_00: Um, it's usually one of the first things that pop up, but it is um the prevalence of tinnitus and noise-induced hearing loss and dentists.
• 30:40
  SPEAKER_00: And you might be thrown off.
• 30:41
  SPEAKER_00: I was Jamie Myers at the time of this, so that is the first author, is Myers.
• 30:46
  SPEAKER_01: Um for those who want to get that, then I encourage you to go and find that or contact Jamie as well.
• 30:53
  SPEAKER_01: Um, and I'm sure she can direct you to where the work was.
• 30:56
  SPEAKER_01: Was there any surprises that came out of it other than what you've talked about, that you wouldn't necessarily think of Dennis as being at high risk, but any other surprises in the study that you found?
• 31:08
  SPEAKER_00: I mean, really the um the response to the survey was a big surprise.
• 31:12
  SPEAKER_00: I was very pleased.
• 31:13
  SPEAKER_00: I mean, most surveys get like a 13% response rate.
• 31:17
  SPEAKER_00: Three times that.
• 31:18
  SPEAKER_00: Yeah.
• 31:18
  SPEAKER_00: Yes.
• 31:19
  SPEAKER_00: So that was nice.
• 31:20
  SPEAKER_00: Um, but really, I mean, we also compared um the self-report of tinnitus among dentists to those of their age range.
• 31:28
  SPEAKER_00: And dentists out outperformed, we don't want to say outperformed, out um outreported their colleagues um and their prevalence of tinnitus.
• 31:40
  SPEAKER_00: Um, not the same with hearing loss.
• 31:42
  SPEAKER_00: Um, however, we all know the the waiting period, unfortunately, between knowing, seeing signs that you have a hearing loss and actually getting tested.
• 31:52
  SPEAKER_00: So I think that has also reflected in this study.
• 31:55
  SPEAKER_00: But as we mentioned earlier, you know, the notice of tinnitus is usually the precursor to the notice of hearing loss.
• 32:02
  SPEAKER_00: Um, so I didn't draw that conclusion in the art in the study because it's it's a study.
• 32:09
  SPEAKER_00: But if I'm just speaking as an audiologist, I would venture to guess that that certainly hearing loss is a higher risk as well.
• 32:17
  SPEAKER_01: But it's certainly I bet you had a few nightmares about some of those hand pieces after doing this work uh in in the labs uh from your experience.
• 32:27
  SPEAKER_01: I did not know that you had had, and that was really interesting that you were doing this as an elective as part of your training and sort of brought you into that environment.
• 32:36
  SPEAKER_01: And I think we're all the better for it.
• 32:38
  SPEAKER_01: So uh I appreciate your taking the time to talk with us today a little bit about that during tinnitus awareness week.
• 32:46
  SPEAKER_01: Any final parting words for uh dental hygienists or dentists that they should um what they should do to protect their hearing, what sorts of things can they do if they think that they've uh got hearing loss or notice that they have tinnitus?
• 33:03
  SPEAKER_00: Yeah, I think you know, the first step is seeing your local hearing healthcare professional and getting that baseline hearing test, you know, and every other occupation that we know you're in that noisy environment.
• 33:15
  SPEAKER_00: We have the baseline, you might get measured every year, every three years as part of your company um need for your OSHA or NIOSH safety standards.
• 33:25
  SPEAKER_00: And I think dentists and dental hygienists, and like you said, any any office workers should take it upon themselves to do that as you start to notice a change in annual audiogram, but first getting that baseline so we know where you started from is would be a best practice and would be very helpful in the future treatment of your hearing loss.
• 33:49
  SPEAKER_00: Um and then thinking of the hearing health care professional side, you know, this is a great opportunity, especially during something like Tenetus Awareness Week, to go to your local dental offices and introduce yourself.
• 34:04
  SPEAKER_00: They maybe don't even know what a hearing health care professional is, that your services are there.
• 34:10
  SPEAKER_00: And um, you know, giving them this article, for example, um, giving them the research on hearing loss, hearing protection, and then offering your services, even a screening um, would be great.
• 34:24
  SPEAKER_00: So that would be my call to act call to action for both sides of the equation.
• 34:30
  SPEAKER_01: I love it.
• 34:31
  SPEAKER_01: I love it.
• 34:31
  SPEAKER_01: And thank you for uh sharing that on behalf of audiologists and dispensers who are working with patients to prevent raise awareness really and prevent uh hearing loss and treat and acknowledge tinnitus uh as a precursor to hearing loss for many individuals.
• 34:50
  SPEAKER_01: So during tinnitus awareness week, I think it is particularly important to sort of have that top of mind.
• 34:56
  SPEAKER_01: And uh thank you for all you've done in this area and continue to do uh in your role at Starkey now.
• 35:03
  SPEAKER_00: Yes, no problem.
• 35:04
  SPEAKER_00: Thanks for having me.
• 35:05
  SPEAKER_01: Oh of course.
• 35:06
  SPEAKER_01: The the last question I'll ask is it's become the tradition whenever we have time and we have just a minute.
• 35:11
  SPEAKER_01: But uh given you're somebody who's devoted your career to hearing, um what are some of your favorite sounds that you personally would miss if you had hearing loss that prevented you from hearing sounds?
• 35:27
  SPEAKER_01: We know that hearing is a uh you know an anatomical and physiological sense, but it's really the emotion that connects us to other people, other things, other sounds.
• 35:36
  SPEAKER_01: What are your favorite sounds that you would miss if hearing was suddenly taken away from you?
• 35:43
  SPEAKER_00: I think um bacon sizzling would probably be my That is like the last sound that I would have expected to hear from you, but I love it.
• 35:52
  SPEAKER_00: Oh man, I I am a bacon connoisseur.
• 35:55
  SPEAKER_00: My mom would have to hide the bacon from me growing up because I once I learned I could microwave it, I would just eat the whole pound of bacon.
• 36:02
  SPEAKER_00: I love it.
• 36:03
  SPEAKER_00: Um but that's how my family gets me out of bed if they want me to wake up is okay frying some bacon.
• 36:08
  SPEAKER_01: So excellent.
• 36:10
  SPEAKER_01: All right.
• 36:10
  SPEAKER_01: Well, I thank you for that candor and for this discussion today.
• 36:15
  SPEAKER_01: And uh for those of you who are listening, thanks for listening to this episode of Starkey Sound Bites.
• 36:21
  SPEAKER_01: We encourage you to listen to it on your play favorite platform, share it with your friends, like it, and subscribe so that you're sure not to miss a single episode.
• 36:31
  SPEAKER_01: We uh appreciate again your taking the time, Jamie, to be with us and uh look forward to seeing you again soon.
• 36:38
  SPEAKER_01: And uh, and for the listeners, uh thank you for listening and uh I hope to see you on the next episode.
• 36:44
  SPEAKER_00: All right, thanks for having me, Dave.