is now starting. All attendees are in listen-only mode. Welcome everyone to the webinar on Hearing Aids and the Brain. We are super glad you could be here today to learn more about the importance of getting sound to the brain and the science behind it. Your moderators for today are me, Fran Vincent, IHS Marketing and Membership Director, and Courtney Pitts, Marketing Specialist. Our expert presenter today is Kelly Tremblay, Ph.D., CCCA, FAAA, an audiologist and a professor of Speech and Hearing Sciences. She has a 30-plus year history of serving and advocating for people with hearing loss. As an audiologist and educator, she teaches hearing health care professionals how to prevent, assess, and manage hearing loss. As a neuroscientist, she studies the effects of hearing loss and hearing prosthesis on the brain, in addition to the public health benefits of intervention for our aging society. Her research is funded by the National Institutes of Health and is published in top-tier journals. We are very excited to have Kelly as our presenter today, but before we get started, just a few housekeeping items. Please note that we are recording today's presentation so that we may offer it on-demand through the IHS website in the future. This webinar is available for one continuing education credit through the International Hearing Society. You can find out more about receiving continuing education credit at our website at IHSinfo.org. Click on the webinar banner on the home page or choose webinars from the navigation menu. There you will find the CE quiz along with information on how to submit your quiz to IHS for credit. If you'd like to download a copy of the slideshow from today's presentation, you can access it from the webinar page on the IHS website. Feel free to download the slides now. Tomorrow you will receive an email with a link to a survey on this webinar. It is brief and your feedback will help us create valuable content for you moving forward. Real quickly, we have an obligatory slide from our legal department, which basically says the views presented in this webinar are that of the speaker and do not necessarily reflect IHS policy and viewpoints. Today we will be covering the following topics. The link between cognitive decline and hearing loss. The limitations of new wearables, hearables, and how they are not a threat to your business. Three ways that you can prepare your practice to meet future needs of consumers. At the end, we'll move on to a Q&A session. You can send us a question for Kelli at any time by entering your question in the question box on your webinar dashboard, usually located to the right or top of your webinar screen. And we will take as many questions as we can in the time we have available. Now I'm going to turn it over to Kelli, who will guide you through today's presentation. Kelli? Thank you, Courtney. Thank you, Friend, for having me today. And I see we've got a nice number of people registered and online today. So that's great. I'm happy to be here. So let's get started. Let's talk about this first agenda item. The link between cognitive decline and hearing loss. And this is becoming an increasingly relevant conversation that we'll see in the media a great deal. And it's becoming increasingly relevant to us as hearing health care providers. And it's going to increasingly be so, given that we know as we age, we lose our hearing. And so we've got audiologists and hearing professionals online here who know this as well as I do, that depending on the statistics, if we cut it off at 55 or 60 or 65, that maybe one in three or one in two adults over the age of 65 or 75 have significant hearing loss. And not only is this a sensory problem, but it contributes to overall health, hearing health. So it therefore becomes a public health problem. And because it's one of the top three chronic health conditions and its potential link to cognitive decline, it's become something that is of great interest, not only to us hearing professionals, but to allied professions as well, such as gerontologists and community care workers and families. So as I mentioned, this prevalence of hearing loss is not going away anytime soon. If anything, if we look at the data according to the U.S. Census, and if we look at, say, where we are now at 2018, we're right at that knee point where the portion of society that is on this planet or in this country, at least from these data, is about to increase rapidly. So not only people who are 65 and older, but people who are 85 and older. And as much as I'm showing these data from the U.S. Census data, for those international folks, we know this is not unique to the United States. This is something that's happening at a global level. So it does mean that we have a number of people, an increasing number of people, with some degree of hearing loss that need hearing help. And if left untreated, many of the people on this call already know the literature, that there's converging evidence to suggest that untreated hearing loss, not surprisingly, can result in social isolation or a loss of independence. So if it takes too much effort to enjoy an evening with friends or going out socially to a public place that is noisy, if it's too difficult, then people withdraw. And if they withdraw, then it's possible to feel isolated and depressed. If they can't function and work, then perhaps we're looking at early retirement and that may be related to financial decline. So we can see all the consequences and how this may be related to hearing loss and the social aspects of that. But the one point that I've highlighted at the bottom is the increased risk of cognitive decline and dementia. So how are these two things linked is often the first question we get. And so I want to present today's webinar with the perspective of how do we handle those and tackle those tough questions when people come in off the street with a newspaper headline in hand and saying, explain to me how hearing loss can affect my brain, how can it be tied to dementia, and I'm scared or I'm frustrated or I'm annoyed. How do we ask these tough questions and what is our role as a professional? So let's take a broader look first and let's recognize that hearing loss has been related to other health issues. So clearly, you know, we've already talked about the loneliness and the isolation potential, the depression and anxiety, but certainly we know through our training that being exposed to ototoxic medications can affect our kidneys, can affect our ringing in our ears. Certainly the relationship between hearing loss and diabetes has been established and increased risk of hospitalization. So it's this part, the link between dementia and Alzheimer's and the fact that dementia has been shown to have increased our risk up to perhaps five times higher risk when people have significant hearing loss. And because of this, we see headlines that appear in the popular press or in advertisements in people's mailboxes that look like this. And so these types of headlines have a number of different effects. On the one hand, they're good in the sense that it's not just us hearing professionals talking to ourselves that we value and recognize the unmet need and we need help to be able to get more people into our clinics and to our waiting rooms and engaged in their hearing health. So the fact that these headlines have gone beyond our professional societies and made the popular press, I think is good. It's raised awareness. However, getting the balance of information in the popular press is maybe not such a great thing. The potential downfall is that we have seniors who are feeling overwhelmed or fearful or just confused about, you know, how do I reconcile? How do I navigate all of this information in the popular press? So this is where I think we as hearing professionals have an obligation to try and present this association in a way that is fair and based on facts, that is informative, but also sets the tone in a way that is of good intentions to not necessarily contribute to the fear, but to set this person on a path so that they can make some informed decisions. So let's talk a little bit more of what that link between cognitive decline and hearing loss looks like. And from this, I pulled an infographic that I like to use from Hearing Health Matters. And I encourage you to go visit this website and read the story and even use this website or distribute this link to your clients, to your patients, if it helps them to break it down of what this relationship might be like. And there's multiple ways. This is not to say that this is the only way to present this relationship, but I think I personally like this infographic. And so let's put ourselves in this scenario on the left, where in our everyday world, we've got a lot of incoming information coming at us through our various senses. So we are listening, we are seeing, we are feeling our emotion, we've got a lot of sensory information coming in. So let's just take a hypothetical situation and say, I'm in a car driving, and I see the stop sign. Visually, that information then takes me over to the cognitive processing, where it gets my attention. It sets in motion my visual processing, and it gets processed very rapidly with the processing speed. It gets all of these wheels turning at the same time. I have to reason through, what does that stop sign mean? I have to compare it to my memory of what I learned a stop sign to mean. And with that information, very rapidly, it goes into the knowledge bank that connects the stop sign to an alert that says, I need to do something. And what that output behavior is, I need to put my foot on the brake and depress the brake and stop the car. So this connection of information, of input incoming information to outcome, output information, happens in real time and is very rapid. So what happens when we have auditory information coming in? Well, we'll have auditory information coming in. It gets our attention. We have to process what those acoustics mean to fit it according to a phonetic structure, to a word level, to a semantic level, to a syntax structure, to a language learned over time. And then it gives us the opportunity to put those things together from our knowledge bank, and then either act on what we hear or respond through a cogent reply that lines up with what we were being asked. So what happens when we lose some of this incoming information is the belief that if we lose visual processing, then certainly we're not using the components of the brain that are responsible for visual processing, for tying that information to memory and to exercising that knowledge bank. The same can be said with audition. When we have hearing loss and we lose some of that incoming information, then not only is that sensory input and the way it's encoded in the brain is not being stimulated, and I'll show you in a few slides, again, if you don't use it, you lose it. So if we're not only using those sensory centers of the brain, we're also not using the neural networks that are responsible for tying that sensory information for our attention and working memory. And so the neural networks that connect that to our knowledge bank and our behavior slowly, you know, become ineffective. And with that, we see changes in structure and function in the brain. So we can understand now that how the sensory input relates to cognitive function, and but we need to remember that changes in structure and function don't necessarily on their own equate to a decline in cognitive ability. So let me explain this. We all know people who may be deprived of incoming sound because they were deaf, they were born deaf, they're severely, moderate to severe deaf audiograms that would fit into the deaf category. But just because that auditory input is gone, doesn't mean that they can't use other sensory input, like visual input, to use signed language or other types of means to keep those wheels moving and to keep that means of communication open in a way that draws on a very rich knowledge bank so that they too can still remain active in their communities and in the workplace and have very, very rich and productive lives. So just thinking that a loss of sensory input means someone is going to definitely have dementia is, I think, mistaken. And we can look at many cultures in ways that sensory input is deprived, but clearly there is not a cognitive deficit, so to speak. But if we look a little closer, I think there is good reason to remind our clients, our patients, that hearing loss affects more than just the brain. So clearly all they see is the ear, and they assume that everything that they've learned in elementary school and high school about the cochlea is responsible for hearing and things stop there, when in fact we know that sound as it comes through the ear is not only going to stimulate the cochlea and the hair cells, but the place coding of high frequencies, middle frequencies, low frequencies is preserved all the way up through the pathways up to the cortex. And if we have some type of degree of hearing loss, so say just those high frequencies are lost at the level of the cochlea, then that's going to interfere with the signal relaying itself all the way up the auditory system. And if those hair cells are encoding higher frequencies and they are directly mapped to neurons that are responsible for relaying high frequencies in the brainstem or in the cortex, if that information is being stopped from being relayed up the system, then clearly those neurons aren't going to be working. And when we don't work those neurons, we're going to see changes in structure and function in a way that they're going to atrophy. So it's important that they understand that hearing loss at the periphery of the cochlea does impact systems further up. And what I'm going to try to help differentiate is that despite the fact that we see these changes in structural and function as a result of hearing loss, that doesn't necessarily mean that we see structural changes that automatically guarantee cognitive decline. In fact, it also means that if we put a hearing aid on, that it doesn't, it's not going to necessarily reverse or undo the damage or the atrophy that people have experienced perhaps for 20, 30 years in the case of presbycusis. What a hearing aid will do is it will increase the volume or increase the level of sound as you know, and by delivering that signal through the relay, initiating that communication starting from the cochlea all the way up, we're going to activate neural networks that haven't been activated for a long time. But it's still going to be subjective to or subjected to the years of deprivation that have impacted the way that the brain is encoding sound. And I think sometimes this evidence, which we won't dispute the fact that deprivation and stimulation affect the way that sound is encoded in the brain. But as soon as we use the word brain, I think that ends up getting confused with dementia. And does that mean that structural changes are equivalent to dementia? So let's try to set the record straight. And I think walking people through this design of, you know, whether it's just taking a pen and paper and drawing an ear and taking a brain and drawing somebody's head and a happy face for that matter, and just, you know, reminding them that sound involves more than the ears is important. And then orienting them to studies like this, where research has shown, we're not discounting the fact that there is peer-reviewed evidence to show that, you know, we are at a greater risk of cognitive decline in older adults with hearing loss. And to take a study from or a figure from one of these papers, we can help explain the relationship a little better. So just to orient you, this is figure two from one of those references. On the x-axis, we can look at hearing loss here. And as you can see, they've defined hearing loss according to 0 dB, 20 dB, according to a pure tone average of four frequencies in the better ear. And we can see that the hazard or the risk of all-caused dementia in relation to hearing loss is very little if we've got pure tone thresholds around 0 dB. And you can see the confidence interval, the range of susceptibility or risk is quite tight. It's narrow. There's not a lot of variability. But as our hearing loss severity increases, we can see this hazard or this risk of all-caused dementia increases significantly. And you can see the spread of variability and the 95% confidence interval also increases, suggesting that there's a range of risk that is very broad. And why might that be? So we described this in terms of a correlation. And I think it's another way to explain this, but keep it into perspective, is to use something that everyone can identify with. Something that doesn't necessarily hit too close to home in the hearing world and may be actually kind of silly, but I think it's a good teaching tool. If we look at the relationship between two items, we can find significant correlations, but this does not necessarily mean it's causation. So in this case, if we take the x-axis, instead of it being degree of hearing loss, if we look at the months of the year, we know that because the warmer months are in July, August and September, there's going to be an increase, because of the hot weather, in ice cream sales, for example, over these summer months. We also know that over these summer months, people are likely to go swimming at these same times, they coincide. So there's also a greater chance of shark attacks. So just because we're eating ice cream does not put us at risk of a shark attack. There's certainly not a causal relationship there. It's more that our behavior and our situations are being modulated by shared factors, in this case, the weather. So the idea that we would necessarily have degrees of hearing loss increase with age is not surprising. The relationship between cognitive decline and advancing age is not surprising. So they're going to correlate. But it's still too early to know if there is actually a causal relationship, because many things can relate to cognitive decline. And there are new research studies coming out all the time. However, this does not necessarily mean that this causal relationship should be used in a way that induces fear or provokes behavioral outputs that put people at risk. So using this to draw fear in a way that will have someone go out and buy a hearing aid that they cannot afford is not necessarily good practice. Also, it's hard to navigate the fact that a number of things are being published on a daily basis that are showing links to cognitive decline. So here's an example of a sarcastic title that I published that shows that hearing loss and diet soda cause, I emphasize the word cause because in this story, I try to explain why this is not the case, the causal matters aren't factual here. And that's because there are some suggestions that our diet can also contribute to cognitive decline. And so what does that mean that buying a hearing aid and drinking regular soda will eliminate our risks of acquiring dementia? And the answer to that is no, it's more complex than that. Also, new research is evolving to show that it's not just auditory, it's not just the hearing sense that may be contributing to a risk of cognitive impairment. Here's a study I encourage you to look at that looked at not only hearing input, but our senses of vision and olfactory. And all of them were found to be related to an increased risk of cognitive decline and cognitive impairment. So it's not just that hearing is one unique system, one sensory system, but that there may be multiple reasons or common causes that are insults to the brain that involve a sensory declines on many modes that are creating some chain of events that is contributing to cognitive decline. And that's not surprising when we look at aging. I love this slide from Cheryl Grady, if you're interested in looking at using this as a counseling tool to remind people to keep things in perspective that just with aging alone, we do see changes in white matter and gray matter. We do see changes in neurotransmitters that connect our neural networks together. And so no surprise if you go to the bottom of the aging pattern here, we see changes in brain function. So the functional connectivities of our brains change. And much of this can be influenced by other factors on the left, our education, our early life experiences, the quality of life that we're living now in relation to stress and a nutritious diet, our exercise, all of this affects brain health. And if we look at the genes that we were dealt are going to set us up or predispose us to certain age related disorders once and others. So where is aging fit on here? And where does hearing age related hearing loss fit on here? Well, if we go to the right under cognition, you can see perception. Well, perception is tied to not just audition, but vision, sense, smell, proprioceptive cues. And so you can see that hearing loss is one only one of the factors that contribute to all of these changes in the brain. So in some ways, it would make sense that hearing loss on its own cannot be solely responsible for acquiring dimension. And I think it's important to make that point clear to our to our clients. So I also want to turn to you turn with you to this Lancet infographic that you can download. And this comes from the Lancet Commission on modifiable risk factors for dementia. And so, you know, I just mentioned to you the genetic predispositions, the things that we are wired, that we come to this life with. And those we would consider non modifiable risk factors. And if we look at that, and when we think of that as being perhaps 65% of our risk factors, you can see that that's a significant portion. This is more genetic predisposition. This is a number of different things that we don't yet fully explain. But if we look at potentially modifiable risk factors, this is important. This is exciting, because this allows us an opportunity to intervene or change what we're doing at various stages of our lifespan. So for example, early in life, if we know the more education we have, the reduces the risk factor of acquiring dementia. In midlife, if we have untreated hearing loss, and hypertension and obesity, that is going to increase our risk of, it's believed according to the literature at this point, that to increase our risk of dementia. So if we can intervene at this point and reduce obesity or reduce our hypertension and provide some help and rehabilitation for hearing loss, then in theory, we would decrease our risk of acquiring dementia later in life. But you can see there are many other types of things that contribute to the risk of acquiring dementia, including smoking, depression, physical inactivity, social isolation, and diabetes. And this is based on the literature as we know it today. More and more literature is coming out to suggest that there's more evidence that there are multiple things and multiple complexities and interactions that may be contributing to dementia. So the idea that targeting just one system like hearing loss, when we put it in the big perspective, I think is important in the sense that it puts us on the radar. But to think that there's going to be one magic bullet, one silver bullet, that knocks out this hearing loss independently of everything else, I think we need to be cautious about. And I think we need to get that message clear to our people so that we can reduce their anxiety but work with them because the good news of it is that they're now curious or engaged in their own hearing health and coming to us with questions about getting hearing help. So how do we engage them but not necessarily use fear as a means of provoking them into linking hearing loss equals dementia? I'd also suggest that this is important to acknowledge to them that changes in the brain structure and function do change with hearing loss. So this is why it's important for them to become engaged in some form of intervention and work with us so that we can measure their hearing loss and make recommendations on whether it be with technology or listening strategies so they don't withdraw from their circle of friends and family and colleagues. And that's why introducing sound also changes the brain. We use it and there's physiological evidence for that. So regardless of whether it's a silver bullet for preventing dementia, I think it's a good education opportunity to let them know that at this point there's no proof that wearing hearing aids will prevent dementia, but there is proof that wearing hearing aids and stimulating the brain can improve someone's quality of life. So I'll turn to a systematic review that was done, a nice systematic review that surveys all the research that's been conducted to find some consistencies and converging evidence so that people are not confused with all kinds of different mixed messages and to see is there a common message that comes out of the literature. And in this case, it was the use of hearing aids for mild to moderate hearing loss. It was the idea is that does the use of hearing aids reduce the negative consequences of hearing loss and improve participation in everyday life? And the answer is yes. There is scientific evidence to support this. And for this reason alone, amongst others, I think it's good to be able to educate people about hearing loss and the brain in a way that helps promote healthy hearing and a healthy lifestyle so that they can become engaged, not by fear, but by curiosity and education out of purpose and an interest in improving their quality of life. I'd also say that there's a literature out there in the marketing world to question whether fear-based marketing actually works. For some people, it might just simply overwhelm them and say, you know, this is just too much. For other people, it might be sufficient to get them through the door, but it might set up unrealistic expectations of the dispenser to say, you know, a lot is at stake here and if you don't make my hearing perfect, then I'm going to get dementia. And that's certainly not what we want. So I'd be curious to hear from you at the end what you think. Does creating fear help sell hearing aids? What comments do you have on that? Because this is really relevant to the next topic that we're going to move through, and that is the new wearables and hearables. How do they relate to cognitive decline? And are they a friend or a foe? What does this new industry look like? Is this something that we should encourage to be part of our healthy hearing and healthy life platform? Is it a friend or is it a foe? Is it something that we're concerned about that may be bringing our consumers and our patients off track in ways that could be potentially damaging to them? And depending on your background, depending on what you've been exposed to, there are reasons to argue that it could be a foe or a friend. So I'm going to take the position and I'm going to tell you why I choose to see this new industry as a friend. I'm going to choose to see it from the public health perspective of the prevalence of hearing loss and the increasing proportion of society that we, as hearing health care professionals, are not prepared to deal with, not only in the U.S., but in countries around the world, that there isn't a service provider model that can handle the number of people who need help. We also are not necessarily doing a good job of getting the number of people that we have that need hearing help through the door, which means that we have a large portion of our people going with untreated hearing loss. And as a result, we've got these consequences. Depending on the statistics that you look, if we think of 50% of the people who need hearing help, if we're looking at these people 70-something and older, and if we look at the statistics that suggest that maybe half of these people who need help actually get hearing help, and of those people who get hearing help, 12% of them actually wear hearing aids, then our current systems are not meeting the needs of our consumers and our patients. So from a consumer standpoint, when I speak to them, they think, why is this a problem? Clearly their expectations are out of line with what we are currently providing. Why can't we just make sound louder? Why is it so difficult? Why isn't 100% of people making use of their hearing aids? Is it because the hearing aid isn't working well? Why is this case? Clearly this brand that I purchased is defective, or the service that you're providing me is not allowing me to increase my audibility and improve my hearing in real-world situations. Well, the statistic isn't necessarily new. If we look over the past decades, starting from 1983, there's been no significant changes in hearing aid use over time. The percentage of people with hearing loss who can benefit from hearing aids and who use hearing aids has not changed. This is a bit perplexing given we know that the hearing aid industry has put a lot of money and effort into their research to develop signal processing strategies that are much better than they were in 1983. If we look at a different metaphor, if we look at the cell phone industry, if we can look at what we've gone from in 1983, this block of cell phone compared to the computers that we have in our back pockets now, we know that our devices and our technology has improved greatly, not only in the cell phone industry, but in the hearing aid industry. Why hasn't there been a significant increase? I would argue that that's because much of the explanation and training that we get has focused on the device and providing a hi-fi signal to our patients. We got to remember that the clearest signal possible still has to go through an ear and a brain that belongs to a patient and that has changed over time. There are biological changes as a result of having high-frequency presbycusis hearing loss, for example, in a way that has deprived the neurons and the neural networks over years that have now atrophied or have now changed. When we put a hearing aid on and make sound louder, it's going to now ask those neurons to function in a way that they haven't functioned in a while. Why would we think that putting a hearing aid on is going to repair the damage that we've experienced over time as a result? This is a key important point here that I think at our early stages working with our patients, if we provided an infographic like this that shows that we are going to work with you in providing the best device we can and giving you the best fit, but we also are working with you as the patient and the individual wiring and the individual genetics and the individual factors, biological factors that are unique to you, that is going to be part of the equation and part of the success that you experience. Reminding them that hearing loss involves and affects more than just the ears is key here and engaging them in that at the early stages to set realistic expectations is important. Even showing them a slide like this that shows them and just knocking out the high frequencies and how the brain works and then showing them that going to simulations and things like this can show how making sound louder doesn't necessarily make it clearer and they're going to provide some links for you at the end of this webinar shortly that you can use in your practice. I'm also going to direct you to webinars that follow this that can go a little bit deeper and offer tools for you to take this into your practice by going to my website. So you can even provide them with some neuroscience to show them that if you use EEG and you deliver sound to the brain, we can track how quickly and how strong that sound gets to the brain. So if we look at a figure from one of the research studies that I published showing individuals who are 22 years old, 43 years old, 77 years old, you don't need to be a neuroscientist to show that when you deliver a thousand hertz signal to a young brain, the strength of that signal as recorded from the brainstem is much stronger than the 43 year old or the 77 year old. And you might think, well, maybe that's just because the 77 year old has abnormal audiometric thresholds. Well, these people all had normal audiograms and that point is really important. If their audibility and their thresholds were in normal limits for all of these people and still we see a decrease in neural conduction, then why would we think that increasing the level of sound and providing amplification to provide the best audibility would provide any better a scenario than this 77 year old has with thresholds within normal limits already. So it's important to remember that our listening experience depends not only on the device, but also the patient. So if we replace hearing aids with various over-the-counter devices or apps on our cell phones, this is great because it's offering various ways to provide an incoming signal, but it doesn't repair the biology. So we're in some ways we're no further ahead. And I think as hearing professionals, we are training and our future training should really work and emphasize working on with the patient aspects in addition to the device and the technology. So that's a key element is that there may be an opportunity here to remind people that as much as there may be encouraged to go out and find something that's more affordable at a different price range and something that's more accessible because it's within reach or online and are in a big box store. The percentage of people who make use of those devices and stick with those devices over time may not be any different than the gold standard that we try to provide our patients with every day. In which case, it could introduce people to the hearing health pathway and engage their curiosity in ways that says, you know, this is good, but could it be better? And so then they find themselves in an instrument specialist or audiologist's office. Or it may turn them off, but at least now it has got them curious about their hearing health and set them up, hopefully, on a pathway for advocating for themselves and fulfilling that curiosity. But I think the key point here is that there are age-related changes in the ear and the brain that the technology does not overcome. And the degree and the quality of various PSAPs we don't necessarily understand. I, you know, think over time we're going to see certain products evolve and certain products disappear. And so our job at this point, I think from a public health standpoint, to make things more accessible and affordable from a public health perspective and from a neuroscience perspective of the importance of getting sound to the brain, I encourage people to think differently about what our role is in the dispensing world. I think that maybe as things evolve in various delivery systems, that some may work and some may not. But I think the human aspect of aging and what we know from boomer marketing and things like that, is that people look for trustworthy relationships. People look for that human element in addition to technology and enjoy that hand-holding. And hearing loss is a health issue. So we don't know where people want to get to know, to get their devices or what devices they want. It's too soon to know. But it's not too soon for you to be able to set yourself up for the future so that you can prepare your practice by considering the future needs of your clients and your participants, your patients. And one way may be to provide a more affordable list of tools. So it may be that you start to embrace, based on the literature, certain PSAPs or certain tools that are low-cost and that are more appealing to our patients because they may be Bluetooth based or PSAP based that are alleviate some of the stigma that they would have would have prevented them from getting a traditional hearing aid. It may be that they are open, after learning about the range of products that you have, both low cost and higher cost and more low technology and high technology, to, after being educated, to recognize what certain devices have to offer. And at least they can make informed decisions that go beyond the gold standard of hearing aid fitting. Remember, hearing loss is progressive and if the OTCs are being designed with mild to moderate in mind, this is an opportunity for you to develop a relationship earlier in their lifespan and earlier in the degree of hearing loss so that you can work with them as hearing loss progresses and offer the appropriate tools that may not be OTCs and PSAPs as their hearing loss gets worse. So once it falls in the moderate range and severe range. So rather than fear and dismiss this new movement, we can't stick our head in the sand. We know that there are risks involved. We know there are disadvantages involved of this new market, but it's not going away. And so I'd rather choose to embrace it and incorporate it into my practice by offering diverse tools and really emphasize the human aspect, the counseling aspect, and maybe even build differently so that we can educate our patients to understand that your services aren't just about the device, it's about the patient as well. So some tips, three tips, as we wrap up. I would use that the expectations early. When they first come to you, draw the ear-brain connection so that they can understand that you're not a miracle worker and this device is not a miracle worker. That there are going to be changes in the brain that are not corrected by hearing aids and explain how these brain changes occur with age and hearing loss and how wearing hearing aids can help stimulate the brain and keep things going. But explain Sam versus George random people scenarios because we all know that people come into our clinics and say, you know, I'm not happy with the hearing aid you provided for me and clearly it's your fault because my friend, neighbor down the street, George, likes his hearing aid and he got it at this other place from another hearing professional and it's a different brand. So if he's happy with his hearing aid and I'm not and my name is Sam, well then clearly we've done something wrong. So I'm going to return my hearing aid and I'm going to go where George went because he's happy. Well I think we can prevent some of these scenarios from happening if they understand that Sam and George may have different biology. Sam and George may have different genetic predispositions, may have had different exposures to noise, to different diets and other systemic changes that are making one person's brain age differently than the other. And so to do this I think it requires establishing more of a therapeutic relationship with our clients and our patients. It's important to add something that the big-box stores cannot and that's listening and developing a trust and a loyalty that you're not just going to dispense the most expensive thing in your practice. You are going to offer a range of tools whether they go back to even pocket talkers or other types of low-cost low-tech options depending on what their personal needs are. And to do this you will prepare goals that are specific to their situations because sound is going to be imperfect no matter what device they're using whether it's a piece app or a an app on a phone. So the more that you can make this their experience personalized and develop that relationship with them and engage them in problem-solving and encourage them to find the right technology that maybe they only use in certain scenarios a couple of hours a day is likely to have more success than fitting them with something and sending them into environments where they're doomed to fail because it's just unrealistic to expect that they're going to be able to hear clearly in certain environments that are hostile with speech and noise. So on that note I'll just summarize that I hope us as professionals who can offer more than just a package on a shelf that our role as professionals is as an educator. It may mean changing our billing systems so that we can provide these services in a sustainable way but my experience is that what people are willing to pay for services that are not necessarily tied to a product and in doing so we can we can develop a relationship with our clients and our patients and we can develop their trust by educating them on the relationship between things like cognitive decline and hearing loss and we can use this as an opportunity to say it's important to get sound to the brain and whether that comes from the wearables, hearables or gold standard high-tech hearing aids is going to be something that you decide together because you offer a range of different services and in doing so you're going to prepare your practice to meet the future because it looks different than how we've been doing things over the last couple of years by making a decision. Am I going to embrace these changes or am I going to be a traditionalist and stick with what I've got and get that small portion of society who's going to come through my door who may be not happy with whatever they've tried but I can tell you that is that this is not going to be a sufficient model to meet the increasing demand over time. So I'm going to end there. I'm going to invite you to add some questions to your question box and I'll turn it over to Fran and Courtney. Hi, thanks Kelly. Well we are so excited everyone that more than 300 of your fellow colleagues have joined us today on this webinar and we have people calling in from as far away as Australia, Zimbabwe, South Africa, various countries in Europe and the Middle East and of course USA and Canada. So we do have some time for questions. If you have a question for Kelly please enter it in the question box on your webinar dashboard. Our first question is from Stephanie and she is asking Kelly if you could provide some additional tips for practice owners given the rapidly changing times. Sure, so I get in addition to what I was just mentioning I think using some of the materials that are already in existence through our professional societies and integrating them you don't necessarily have to invent your own images or invent your own infographics. If you go to websites like the CDC.gov or NIH.gov it's surprising how much information is available there for free and you know it's accurate information that can save you time and money in developing some of these learning tools and putting them in your waiting areas and integrating them into your advertising will I think you set you above and beyond what other practitioners provide and I think you know will be a hook that appeals to patients and clients that it makes you a trustworthy source of information. So I don't want people to feel overwhelmed that they need to invent all these informational and educational tools on their own. There are nice resources already for free on the web. Well thank you Kelly. Paul has asked do you agree that there is a solid association between hearing loss severity and degree of cognitive decline? That's his question. To some degree the association you know between severity and cognitive decline I think could be supported by the literature because one of the theories is the greater the hearing loss the more apt you are to socially withdraw and if you don't with if you're not using your brain it's not only the hearing loss but now you're not using necessarily your cognitive networks to be involved in an enriched environment and that is believed to contribute to cognitive decline. So loosely they're you know and as that figure would suggest that from the Lynn study that as the degree of hearing loss increases the all-cause dementia increase goes up but I don't think we know enough yet to understand even the degrees of cognitive decline and the link between the degree of hearing loss and all of the other aspects that are that contribute to dementia at this point. So how that interacts with our genetic predispositions and our the contribution of lifestyle factors and things like that. So you know I would say there there may be an association just like I mentioned to you there are associations between many things and cognitive declines but the fine-grained details and the minutiae we can't say at this point. Thank you Kelly. John is asking given the information that you shared that there are limitations to what the hearing aid can do due to the changes in processing etc. How do you deal with the question from patients of why should I spend this much? Why should I not go with an over-the-counter device? It's a great question that puts us in a dilemma every day. I think that's why it's important early in the process to set expectations so that they can make informed decisions. If a hearing aid is not going to provide perfect sound within setting that expectations that it's still going to take work on behalf of the person to modify their environment to set themselves up for success by turning you know background noise down to use our listening strategies to do all of this this extra work I think then makes it the pressure on this expensive hearing aid you know false falsely you know providing a cure will I think make people more tolerant to understand that it may not make things perfect but there are also more features and more signal processing options that you can on this expensive hearing aid but I think you know the lower cost option if you are willing to make informed decisions and what can determine what you carry it by giving them the choice of a lower cost option that may not have directional microphones may not have Bluetooth compatibility or or T coils it too will provide imperfect sound but depending on their lifestyle this might be a low cost option that is better than nothing than the high cost so there are pros and cons and price does not necessarily guarantee or dictate someone's listening success we know that from the research as well so this is where I think we need to work with the people and talk through trial and error find what works for them and I think a lot of what will contribute to their final decision are things that we can't necessarily quantify through speech and noise tests or aided aided thresholds it's going to be their subjective impression of this makes a difference in my life so I think by being transparent and open and honest about the pros and cons just like you know buying a low-end car for transportation purposes only versus a high-end car there's going to be consumers in different spaces and so if you can provide and diversify and make that known I think you're your chances of growing over the disruptions in the hearing industry are going to be more positive than trying to do things the same way we've done them for the last decade thank you Kelly we have a question from David David asks do you believe that new neural connections can be cultivated through hearing aid use good question that's something that we're looking at in our lab of course we you know we use human research and we use far-field recording so we'll never truly know if there are new neural connections I think what we can say is that there is increasing rest research to suggest that amplifying sound and exposing people to sound does change the way the brain fires and we can record that objectively and if you want to learn more about that that's I've got some slides in a follow-up webinar to this that you can access on our website that gives you some vision some images and some results from everything from auditory training and as a form of listening experience how we can alter the way that these networks work together and there's physiological evidence of that happening so this is why I'm also a supporter of getting sound to the brain however we can do it in a way so that we can encourage the brain to be active how that translates into someone's quality of life and listening experiences and speech and noise that's a little bit trickier and I invite you to join me on that webinar to learn more about that but what's happening at a cellular level we might never know because we can't go in in vivo and measure those things in while putting a hearing aid on on on a cell box so on a petri dish so we have to infer from the research that the brain is alive an organism and it's changing all the time and introducing sound and changing the sound input is part of what can stimulate the auditory system and keep it active thank you Kelly well everyone we have time for just one more question and then we'll wrap it up even though we have a number of outstanding questions out there Joanne asks do you think we need to be prepared to offer both a bundled and unbundled price structure for patients to help combat against PSAPs and OTC or mail-order instruments good good question I think you need to choose what works for you but from the consumer standpoint from my experiences with the consumers working in various non-profit boards and advisory boards I think the bundling is a system that we've created for ourselves with the hearing professionals because of the limitations and constraints we have to get reimbursed but it's it confuses the consumers and so unbundling has the advantage of making things clearer to the public about what they're paying for and I think in doing so that increases the trust and transparency with that said we all know that people don't like to pay for what they don't feel they need and they may not feel that they need the support and the components of the package that we would call AR that traditionally isn't built for so how you present it I think is important and I think this again this is why education educating the person that they're coming to see you not just for the device but we're going to we're going to work with you just think about Weight Watchers if weight loss was so easy that just reducing calorie intake would was solving the problem then none of us would have obesity problems clearly no it's not all about a calories but I'm just going to make it that simple for now but providing you know then the new service of hearing health in a way that Weight Watchers has had by providing support groups by providing a community and providing that extra edge I think people are willing to pay for that and so it depends on how you package your services and I think there's enough information out there in the literature as we intersect marketing and and health and and health services to help guide our industry in a way that you can make informed decisions about what your practice looks like over the next over the next decades and I encourage us to look at that different and we reconsider the billing structures because of that well thank you Kelly for an excellent presentation and thank you everyone for joining us today on the IHS webinar hearing aids and the brain if you'd like to get in contact with Kelly you may email her at kelly at lend and ear dot CEO and you'll see her information on the screen for more information about hearing aids in the brain you may like to also visit her website at lend and ear dot co and she has some CE webinars available if you'd like to take a deeper dive into the topic for additional information about receiving a continuing education credit for this webinar through IHS please visit the IHS website at IHSinfo.org click on the webinar banner find more information on the webinar tab on the navigation menu I just members receive a substantial discount on CE credits so if you're not already an IHS member you can find out more information about becoming a member at IHSinfo.org please keep an eye out for the feedback survey you have received tomorrow via email we ask that you take just a moment to answer a few brief questions about the quality of today's presentation I want to thank you again for being with us today and we will see you at the next IHS webinar

cognitive decline

hearing loss

wearable devices

hearables

educate patients

brain changes

hearing aids

personalized solutions

building trust

engaging patients