Audiology Updates: Featured Hearing Loss Research

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in Otolaryngology, Head and Neck Surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on Twitter @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology - Head and Neck Surgery by following @CleClinicHNI on Twitter, that's CleClinicHNI. And new this year, find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today, I'm excited to be joined by our first returning guest, Sarah Sydlowski. Dr. Sydlowski is the Associate Chief Improvement Officer at Cleveland Clinic and the Audiology Director of the Hearing Implant Program of our Head snd Neck Institute. You can follow her on your favorite social media channels, and we recommend going back and listening to our previous episode from August of 2022. Dr. Sydlowski, it's great to have you back on Head and Neck Innovations.

Sarah Sydlowski: Thanks so much for having me back again.

Paul Bryson: For our new listeners, let's start by having you share some of your background, where you're from, where you've trained, how you've come to Cleveland Clinic, and maybe an update on your current roles.

Sarah Sydlowski: Sure, happily. I originally grew up in Michigan. I decided to pursue my clinical doctorate in audiology. I originally was really excited about patient care and, of course, wanted to help as many people here better as I possibly could. I then realized that I wanted to do that, not just in direct patient care, but in administrating programs and also in teaching students. I went back to pursue my PhD, that brought me to the Cleveland Clinic, and eventually I became interested in the business side of healthcare as well, so I went back for my MBA.

Paul Bryson: Yeah. Well, it's great. You are a bit of a trailblazer for our group, and I tried to follow in your footsteps to get the same degree and the same program. I do always want to recognize and thank you for providing that spark and impetus to pursue that.

Sarah Sydlowski: It's my pleasure. I think it's so important that we recognize that healthcare has many dimensions, and I think it's really important that all of us who are clinical providers also understand the bigger picture, policies and regulations and how they impact the care that we're able to provide for our patients.

Paul Bryson: You want to try to have a systems mindset so you can maybe navigate a little bit better and try to enact the programs that you want to enact.

Sarah Sydlowski: Yes, absolutely.

Paul Bryson: Well, to kick off 2023, you've been busy. You've recently presented at several meetings, including the Ohio Academy of Audiology, the National Academies of Practice, and the American Academy of Audiology. Can you give our listeners an update on some of the research you and your group here at Cleveland Clinic have presented?

Sarah Sydlowski: Sure. There is a theme, I would say, across the research that we've presented, and that's really how do we connect more people to care? We know that many people who have hearing loss aren't receiving the care that they need. There's roughly 40 million Americans who have hearing loss. The number is even greater worldwide. I think it's around 500 million people who have hearing loss. We also know that only about 20 percent to 40 percent of people who need them are using hearing aids, and we know that among people who need cochlear implants, only 2 percent to 12 percent have them, which is really just so disappointing. Most of the work that I do is around, how do we remove barriers to care? How do we make sure that hearing health is important in people's minds? How do we make sure that people who need care are able to access it?

The first study that we presented was related to cochlear implants in single-sided deafness. This is a population that historically has not been candidates for cochlear implants. You used to have to have hearing loss, very significant hearing loss in both ears before this could be an option. Then, we started thinking, we have two ears for a reason, and one of them is not a backup, so why do we wait until both ears have hearing loss before we try to do something about it? Given that mindset, we started to look at each ear more individually in our clinical program, and we were finding that our single-sided candidates are actually some of our most successful recipients. I think it's in part because we are catching them early. We weren't waiting until the other ear progressed, and so we went back and looked at our outcomes for those patients. Particularly, we looked at those patients who wouldn't necessarily be your typical candidate, those who don't meet FDA criteria because they still have some pretty good hearing even in their poorer hearing ear.

What we found is that it doesn't matter how good your hearing is in the other ear, hearing loss is still really significant. It's really impactful objectively in terms of speech understanding and subjectively in terms of the handicap that people were feeling from their hearing loss. We found that offering a cochlear implant provided benefit across all our patients, whether they had an asymmetric hearing loss where they still had hearing loss in the better ear, or if that ear was totally normal. That was what we shared at the Ohio Academy and the audience there, of course, is many audiologists, and so the purpose was to make sure that our referring providers and our partners who see patients for diagnostics and hearing aids know that cochlear implants are a viable option, even in candidates they wouldn't historically have thought of. I was really proud of that work because I think it helps to push the envelope, move the needle, connect more people to the care that they need.

Paul Bryson: I was going to say, aside from spreading the word and working with your colleagues within audiology, I know you've undertaken pretty sustained efforts with primary care providers as well.

Sarah Sydlowski: Yes. Yes, exactly. That's the research that we're presenting at National Academies of Practice and that we're also presenting at the American Academy of Audiology. I'm really proud of that work, because I believe so strongly that we can't wait for people to make it into our audiology practices in order to help them with their hearing. We have the perfect partners and primary care providers who see these patients on a regular basis. They're probably the people who are going to have the first opportunity to ask about hearing, and there's a lot of research that shows that patients trust their primary care providers.

If their primary care provider tells them something is important, they're a lot more likely to take action than if they have to be self-motivated or if they have to wait for a specialist to tell them. Unfortunately, there was some research that came out that we were a part of in the last year or so that suggests that primary care providers also aren't aware of what hearing loss really is, they don't know what normal hearing should sound like, and there's a strong opinion among the primary care community that there's nothing that can be done to improve hearing, which of course is not the case, but they may not have had exposure to some of the research that would suggest people can do better.

The work that we're doing here was very much in partnership with physicians in geriatric medicine, as well as in primary care. What we did is we embedded hearing screening tablets in their practices, so that as a normal part of the rooming process, they could screen the hearing of all their patients who are 50 and up because they're more likely to start to have signs of hearing loss. We also had them ask a few key questions. For example, are you concerned about your hearing or is anybody else concerned about your hearing, your friends or family? Then, we also asked the question, how important is it to you to improve your hearing today? We're still working on our data analysis right now, but interestingly, some of what is emerging is that about two thirds of people tended to say, I'm not concerned about my hearing, and nobody's told me they're concerned about my hearing.

About two thirds of people failed the screening and about two thirds of people said, it is important to me or very important to me to improve my hearing today. We're taking away a few key messages there, I think. One is that more people have hearing loss than they realize. If you ask someone who has hearing loss, if they do, and they say, yes, they're right, and they're very reliable, and we know that we should move them forward for more comprehensive testing. But if you ask someone who has hearing loss, if they do and they say no, then obviously, they're very unreliable, and that's the majority of people. That's in line with a lot of the existing research that you can't tell what you're not hearing.

I also think an important message is we're probably asking the wrong question. We tend to ask, are you worried about your hearing? Do you think you have hearing loss? People might not want to either admit that or they might not realize it, but I think if we turn that question around and say, do you want to be hearing better? We might do a better job of grabbing people who would acknowledge, yes, there are situations where I'm not hearing as well as I want to be.

Paul Bryson: It's super important. How do you break down that barrier? How do you get that awareness? How do you get the patient to perhaps know that there's options and to maybe care more? There's also been some new findings that I'm sure you're aware of that were published at the end of last year around the connection between hearing loss interventions and cognitive decline. This seems like a big deal to a lay consumer of this information. Can you give us some background on this? How does this dovetail with what you just described?

Sarah Sydlowski: Sure. This is really exciting research, and it's not because it's anything that's surprising. If you asked any audiologist, we all would've told you for a long time that if you have hearing loss that you haven't managed, it's going to impact many aspects of your life. It could be cognitive decline, it could be how connected you are to friends and family, how vital you can stay in the workplace. It could be at higher risk for falls. We've even seen instances of greater mortality, so hearing is so essential. But there was never good evidence in the literature that really supported that. The impact of that has been that it's been really hard for our profession to be able to integrate screening for hearing loss coverage for hearing aids. A lot of the things that we know are important for the public, it's difficult to move forward without the evidence that it has this greater impact.

Much of the research that's coming out now, and this has really just become a hot topic, everybody's looking into it, of course, now, what is that impact? Number one, we have to quantify how much of an impact there is, and number two, if we do something about it, does it help? A lot of the early evidence is related to the first question. There's been a couple reports in the Lancet that suggested that hearing loss in middle age is the single most modifiable risk factor for Alzheimer's disease. That, of course, catches people's ears, because no one wants to have that cognitive decline. They might have thought, "Eh, hearing. Maybe it's important, maybe it's not," but everybody agrees cognition is important to health. Now, there has been additional evidence that suggests not only is untreated hearing loss related to that cognitive decline, but also we're starting to see emerging evidence that if you do something about it, it can help, which is really key because it's one thing to know that it's a problem, it's another thing to know that there's something you can do about it.

Paul Bryson: Yeah. Just in the neurocognitive space, modifiable risk factors are a big deal. It seems that once those diagnoses are rendered or the disease state is underway, it's really hard to go back.

Sarah Sydlowski: Yes. I think that's so important. Most people wait until they can't tolerate their hearing loss any longer, and that's one of the reasons that our study was so important, because it's really aimed on catching people earlier, getting them the information that they need to make informed decisions, creating a place to have a dialogue about what your options might be, and I think bringing it into the health space. Historically, I think we think about hearing loss, number one, as something that's just related to aging that we have to deal with, something we have to get used to. Then, there's also been a big push lately to think of it more related to a device and putting it into the consumer electronic space. Of course, hearing aids are now available over the counter, and I think this is an important advancement in terms of increasing access.

But I also think that people have to recognize that hearing is something you need to invest in, that it impacts every aspect of your life. The first step is always to get your hearing checked with an audiologist to find out, do I have hearing loss? How much hearing loss do I have? What kind of hearing loss do I have? Is over the counter an appropriate option for me? If not, then to talk about prescription hearing aids or cochlear implants. To have that first step of talking with your primary care provider about concerns you have or the results of a failed screening creates a space to know, where do I go next? That's something that I think we're missing right now.

Paul Bryson: Yeah. I congratulate you on all these contributions. It seems like a very active space and has lots of exciting cross-collaborative opportunities. As we wrap up, what's some final take home message or messages for our listeners?

Sarah Sydlowski: Sure. Well, I think that one of the most amazing things about the Cleveland Clinic is that we have such breadth and depth of experience. We have all of these wonderful colleagues in many different specialties. We probably don't take advantage of those connections and collaborations enough. I think that we are uniquely positioned to really lead a lot of these efforts, to connect with primary care, to make sure geriatric medicine knows how important hearing health is, and to worry less about who owns this specialty and focus more on how are we going to reach people and how are we going to move them to care?

I'm very excited to be a part of Cleveland Clinic and to be able to be a part of this research that's going to move the needle. In general, I would say, our work is going to continue to focus on making sure that we remove these barriers to access to make sure that more people can have this care, and really just to spread the message that our ears are vital and you have one set, and they are going to impact so many aspects of your life, and it's just so important to invest in them, to make them a priority, and to know that they're key to health.

Paul Bryson: There's no backup ear.

Sarah Sydlowski: There's no backup ear.

Paul Bryson: Yeah.

Sarah Sydlowski: But they're both important.

Paul Bryson: Well, Dr. Sydlowski, thank you for joining us again here on Head and Neck Innovations. I look forward to the next update from you.

Sarah Sydlowski: Thanks so much.

Paul Bryson: For more information on audiology services at Cleveland Clinic, please visit clevelandclinic.org/audiology. That's clevelandclinic.org/audiology. To speak with a specialist or submit a referral, please call 216.444.8500. That's 216.444.8500.

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