Audiology at Aldersgate with Dr. Tomas Cabrera

Audiology at Aldersgate with Dr. Tomas Cabrera

Tomas: This is Dr. Cabrera with the Hearing Imbalance Center and today you’re listening to Aldersgate OnAir.

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Mike: Welcome back, friends, to Aldersgate OnAir. According to the National Institute on Deafness and other communication disorders, approximately 15% of American adults ages 18 and over report some trouble hearing. That translates to roughly 37.5 million people across the country.

To take it one step further, the strongest predictor of hearing loss among adults ages 20 to 69 is age itself with the greatest amount of hearing loss attributed to those ages 60 to 69. Needless to say, if you’re affected by one of the many forms of hearing loss, you’re not alone.

It should come as no surprise then that Aldersgate is working diligently to help provide solutions to its residents and team members. As such, the organization has partnered with local audiologist Dr. Tomas Cabrera to begin the process of providing onsite resources for those with hearing loss.

We invited Dr. Cabrera to join us today for a candid conversation about options, resources, advances in technology, possible legislation, and his partnership with Aldersgate in their commitment to honor elders. Hi, Dr. Cabrera. Welcome to Aldersgate OnAir. Thank you so much for joining us today for this important and long-overdue conversation.

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Tomas: Yeah, Mike. Thank you very much for having me. I’m excited to be a part of this.

Mike: Yeah, absolutely. Well, before we dig into the meat and potatoes of kind of what we’re going to be talking about today, if you could, for the listeners, please tell us a little bit about yourself, about your background, kind of what you do, and how you came to be associated with Aldersgate.

Tomas: Yes, so I am an audiologist. My name is Dr. Cabrera. For those listeners, you can call me Tomas.

I have been in the field of audiology now for about two years. I received my doctorate degree from a school in Philadelphia called Salus University.

Upon graduating, my wife and I moved to Charlotte for some warmer weather. Unfortunately, today we’re at about 28 or 30 degrees, so I might have to go further south to Florida. We’ll see.

Mike: [Laughter]

Tomas: No, so we moved down to Charlotte. Love the area. I was working at a small clinic in downtown. Had a chance to meet a few of the patients there. Come to find out they are residents at Aldersgate.

After developing a rapport with them and kind of establishing some of their needs, they really expressed to me that they sometimes travel and transportation can be a little difficult. I said, “Well, you’re not too far from our office. Why don’t we come out and see you guys there?”

We kind of got the wheel rolling there, and here we are four, six months later. We are now visiting Aldersgate on a regular basis, providing service to those residents.

Mike: Oh, that’s outstanding. I love the idea of providing a centralized location, making it convenient for people because, as we know, sometimes not even just as we age, but just people in general. We have a hard time making those commitments to take care of ourselves in those fashions to get to places that we need to go. I think that this is a really cool idea.

Speaking of the aging population, obviously, as we get older, hearing loss does become more of a concern. I, myself, am a musician and have been for many years, and so it is a very big deal in the industry that I come from, so that’s really cool.

We are going to talk about a lot of cool stuff today. We’re going to talk about hearing loss. We’re going to talk about tinnitus. We’re going to talk about the things that patients and people in the world are telling you about, what they’re experiencing. We’re going to talk about the big, fancy word called comorbidities, what does that mean, and which ones are associated with hearing loss.

Tomas: Yeah.

Mike: We’ll talk about how to impact your quality of life, technology, quality of care, and current legislation. I know that’s a whole ton of stuff.

Tomas: Yes, it is.

Mike: But it’s all-important, and I think that (after just speaking with you for a few minutes) I can tell that you’ve really got your stuff dialed in, so I think that we’re going to make this an educational and informative conversation and also very approachable.

Let’s just dig in a little bit. We’ll start with hearing loss. Now there are tons of different kinds of hearing loss and different causes. If you would just kind of get the ball rolling for us, we’d appreciate that.

Tomas: Yeah, so when we look at hearing loss, we’ll focus on hearing loss that’s permanent in nature, one that affects the nerve. It’s very common among our patients and some of the older populations.

It’s essentially hearing loss that cannot be medically corrected. It’s called sensory neuro hearing loss.

Patients perceive it differently. A lot of patients (with this hearing loss), it’s not that they don’t hear sounds. It’s not that they don’t hear volume. It’s not that they don’t hear someone speaking to them. They have difficulty discerning the consonance or understanding what people are saying.

If someone around you says that they’re not hearing you well, please don’t yell into their ear like you have a megaphone.

Mike: [Laughter]

Tomas: When they say, “What?” or “Huh?” or “I didn’t hear you,” all they’re looking for you to do is slow down, face them, look at them, and say clearly what you wanted to say. That is hearing loss in a nutshell.

Mike: It’s not so much a matter of the hearing in and of itself as what’s being heard and how that signal is being transmitted to the brain.

Tomas: That’s exactly correct. As we age, our processing slows down a little bit, so some things, our senses just aren’t as in tune as they used to be. Sometimes our patients just need, hey, slow down. Speak clearly. Once they have the chance to hear it and understand it and process it, then they got it and they’re good to go.

Mike: Yeah, so what are some of the treatment options and how do you combat that if it’s kind of a permanent thing or getting to the stages of being a permanent thing? What can be done to make it easier to live with?

Tomas: Yeah, so when we think about how to compensate or cope with hearing loss, good, proper communication strategies are very important. That’s kind of what we just touched on. Speak a little slower. Speak clearly. Look at the person when you’re speaking to them.

We are (I’ve been told) marriage counselors (from our patients) in that—

Mike: [Laughter]

Tomas: We have our patients who want to try and talk to each other from different rooms. We say, “Hold on. Hold on. That’s not going to work. One of you has to come into the other room and get that person’s attention first before you start speaking to them.”

Communication strategies are very important. Then on top of that, if we have a significant hearing loss and we can’t function on a day-to-day basis, hearing aids may be an appropriate option. Hearing aids, in short, are working to increase or amplify the sounds that are deficient for us, you know, make them a little bit easier to understand.

Mike: Yeah, so we’re going to talk about hearing aids specifically more in-depth a little bit later on, but that’s great to let people know that technology is also there for you, and also to keep in mind that hearing aids of today are not like the hearing aids of back in the day, right? They’re quite a bit smaller, quite a bit more sensitive, very easy to use, and you can use apps and all kinds of crazy stuff with them.

Tomas: Yes.

Mike: The word hearing aid, anymore, it’s not even the same thing.

Tomas: No.

Mike: We’re talking about a huge boost in lifestyle improvement, so we’ll probably get into that stuff here again in a little bit.

But what are some of the symptoms of actual hearing loss? Obviously, we have our times where maybe somebody is just not speaking properly or we’re in a bad, boomy environment, something like that. But if you think there’s actually something wrong, what might be some of the telltale signs?

Tomas: Yeah, I think that takes us right into our next point. What are our patients telling us here in the office? That is that, as I said earlier, a patient will come in and say, “Hey, you know, I’m having trouble with difficulty understanding people when there’s a lot of background noise.” Having difficulty understanding the television.

What they’ll tell you is it’s not always about the volume. It’s the clarity. Sometimes, hearing loss is so progressive, we’re not really familiar. We’re not really aware of how fast it’s happening or how bad our hearing loss gets. It may be a family member who tells us, “Hey, you know, you’re not hearing too well. The TV is turned up a little loud.” Those are some difficulties, in general – communication situations.

Obviously, symptoms directly associated with hearing loss, one ear is significantly down from the other. We’re not hearing well out of it. It can be a sign of something more serious going on.

Then tinnitus is a very big one. Ninety percent of patients who have tinnitus have some form or some degree of hearing loss. Tinnitus is a direct correlation of resulting of hearing loss.

Mike: Number one, you said tinnitus, which tells me that I’ve been saying it improperly for 47 years, but you know. Now is that when you have the ringing in your ear, like the constant presence, or is that something else?

Tomas: Exactly. To that point, I believe it is correctly pronounced “TIN-ni-tus.” Although, due to different generations, we’ll accept “tin-NYE-tus” for today.

Mike: All right, so I pass today’s test.

Tomas: You pass today’s test. Yes.

Mike: [Laughter]

Tomas: Yes, so the tinnitus itself is only a sound that we perceive. It cannot be measured. Typically, if someone says, “I have a tinnitus and it’s at a level of one (or level of ten),” as far as intensity, we have to take our patient for their word and say, “That’s a subjective thing that only we can tell or we can understand.”

Yes, patients perceive it as a clicking, a ticking, a humming, a buzzing. They can perceive it very differently. Typically, it’s a result of damage to the ear.

Mike: What would cause that damage? Would that be long-term exposure to certain kinds of sounds or environments?

Tomas: Yeah, so in your case, you may have experienced it throughout your life as a musician being around loud noise. An isolated incident of noise exposure, or a long-term working in a factory, a warehouse for many hours a day, are the most contributing factors of tinnitus.

Other things that can cause it are trauma to the ear or the head. Maybe we fall and we hit our head. Tinnitus results from that. Then a change in medication, a change in blood pressure medication can also affect some tinnitus onset.

Mike: It sounds like it’s, unfortunately, a pretty common thing. It’s something a lot of people out there in the world have, so you see it quite a bit in your day-to-day operations, I’m sure.

Tomas: Yes. There are many, many patients who have tinnitus, and it’s not diagnosed because they never go in to see someone. They just think it’s normal, it’s supposed to be there. But then, typically, we get a phone call whenever it gets to a point that it’s affecting their everyday life.

Mike: At what point then do you have an evaluation done to determine if this is actually a problem or if this is just, say, in your head and something you’re going to have to just live with and it’s not that big of a deal?

Tomas: Yeah. I think any onset of tinnitus warrants an evaluation immediately. It’s always great to establish a baseline and say, “Okay, if this is tinnitus, what can be causing it? Is it hearing loss related?” If it’s not hearing loss related, then we have to refer that patient out to have a full evaluation done.

Mike: Is it progressive? Is it something that starts out small and gradually gets more predominant, or does it kind of just come in, boom, there you have it, and it’s just like that forever?

Tomas: Yeah, so it can change. Some patients who maybe, as we said earlier, it starts off a very low sound. They’re not really aware of it on an everyday basis. Then a few years later, they become more aware of it. Now it’s happening all day every day, which is why I think it’s a great idea to have an evaluation done immediately because now we can get more information, be educated on it, and find ways to cope with it or compensate with it whenever it does become bothersome.

Mike: Well then moving on to the next point we’re going to talk about, obviously hearing loss is more than just an inconvenience. It can actually lead to other things that can affect your life in other ways. We’re going to bring up that big fancy word we talked about a few minutes ago, the comorbidities. Tell us a little bit about that.

Tomas: Yeah, so I think – full disclaimer – I am not an MD. I have my clinical doctorate. Some of the things that we’re going to talk about are not things that we directly treat on a day-to-day basis. It’s more information, trying to educate our patients.

Mike: Sure.

Tomas: When we talk about the comorbidities associated with hearing loss, there are many different health conditions that can be linked or correlated with hearing loss, not necessarily saying hearing loss causes one of these conditions or the other. But a very big one is diabetes.

Actually, an audiologist here in North Carolina, Kathy Dowd, she started The Audiology Project. The Audiology Project is aiming to draw more awareness to the correlation between hearing loss and diabetes. I don’t have the exact percentage off the top of my head, but we’re talking possibly one in three patients with diabetes have some form or degree of hearing loss.

Mike: We’ll provide a link to that as well in the show notes.

Tomas: Yeah, so diabetes is a big one. But then what I think our patients see a lot of is the dementia, the Alzheimer’s, and that’s very important, right?

If we think about something like dementia or Alzheimer’s, and we look at the factors that contribute to those conditions, a lot of it has to do with isolation, a loss of stimulation, meaning that that person, their brain is not being stimulated adequately.

Well, then if we look at hearing loss, we think about hearing loss and we have normal hearing, we’re hearing all the sounds around us. When hearing drops to a significant or severe level, there are a lot of sounds around us that are not getting to the brain, and that is also a loss of stimulation.

We see a lot of correlation, a lot of links between the two. There’s a lot of research out there, especially out of John Hopkins, with new studies showing all these links and correlations.

Mike: Yeah, I think that whether or not one is directly tied to the other or one is causal, the fact that those correlations do exist is plenty enough reason to really kind of examine those different elements. I think that the depression and the isolation, not being able to communicate, feeling like you can’t express yourself, feeling like you can’t understand others is hugely isolating for people, especially for those that might already be susceptible to varying degrees of either dementia, memory loss, mental illness, or any number of things. I think that that’s definitely an important correlation for people to be able to make.

Tomas: Yeah. Yes, and we think about hearing loss. Our patients with hearing loss who, let’s say, they’re predisposed to dementia. If that hearing loss goes untreated, they will see an accelerated onset of that dementia, significantly faster than a patient who is treating that hearing loss because it’s about getting stimulation to the brain, keeping the brain sharp, keeping ourselves active.

Mike: That’s absolutely spot on. Besides those elements of it then, this can affect your overall quality of life, right? Not just assuming maybe that you’re having memory loss, dementia, or other things, but just your day-to-day, what you do can be affected by your hearing status.

Tomas: Yeah. Yeah, and I think when we speak about quality of life, one of the things that really sticks with me, being in the field now for a few years, I had a patient come in to see me who was actually a member of a local retirement facility. They told me, “When I moved into the facility,” we’ll say eight years ago, “the first three or four years, I loved going down to the dining room and interacting with my friends and having dinner.”

They told me that their hearing loss progressed so significantly that they actually stopped going down to the dining room. For about four years, they would eat by themselves in their room. That’s the last thing we want to hear, but I think it really goes to show of how much the hearing loss can affect our patient’s quality of life, which is something that we always aim to fix and get our patients back in those situations that they love and have them interact with their peers.

Mike: It’s funny you mention that because I come from a culinary background, and room design is a huge thing. Dining rooms, if you go out to a lot of the modern, big restaurants, super high ceilings, really big, open concepts, and what happens with that? Sound just bounces. It just goes everywhere. All of the different frequencies and all the different sounds put together – a clinking of plates and glasses and all that stuff – creates an environment that makes certain frequencies difficult to hear.

Tomas: Yes.

Mike: Things that you can do acoustically with rooms just make a huge difference. I’m glad you brought that up. I think that that’s kind of something people don’t always think about when they’re designing dining spaces.

Tomas: Yes.

Mike: At least commercial dining spaces. Every time I walk into a room, a restaurant for the first time, or a place for the first time, I go, “Wow, this is just one big, open high ceiling room. I know for a fact that I’m going to be struggling to have a conversation,” and I’m relatively unaffected by hearing loss. I can only imagine what it’s like for those who really have to struggle with those conversations.

Now, you mentioned that you had some thoughts on holistic approaches to improve the quality of life.

Tomas: Yes, so when we think about a holistic approach, we’re speaking to understanding our patients in every aspect of their life. When we see a patient in our office, it’s not just, “Okay, what’s the best hearing aid we could put you in?” It’s, “Okay, well, what are the situations that you’re struggling in the most, and let’s tailor those to your needs. Let’s find the best option for you based on the big picture,” you know, that patient’s needs.

Then also, holistically, what other comorbidities? Do you have diabetes? Are you prediabetic? Do you have hypertension, you know, cardiovascular disease? Do you have dementia, early-onset dementia, or Alzheimer’s? We really take everything into account to see how we can treat that patient best.

Mike: It’s not just a matter of jumping straight to the technology. It’s a matter of really treating all of the areas that could potentially affect each other and determining an individual path that’s right for a person and their lifestyle and where they’re at.

Tomas: Exactly right. I think everybody should be treated as an individual. We shouldn’t say, “Oh, well, for this person this worked, so let’s do this.” I think it needs to be that individual-specific, “Okay, let’s take everything into account, and let’s move forward with this option.”

Mike: Speaking of technology, because we kind of touched on that at the beginning, once we’ve established that holistic approach, obviously the number one thing that’s going to come to everybody’s mind is what device am I going to have to have in my head to get through the next stage of my life here? Let’s talk about that. Today’s hearing aids have come a very long way.

Tomas: Yeah. When we think about hearing aids, gone are the body-worn hearing aids, the big air horns that maybe we see in pictures.

Mike: [Laughter]

Tomas: Now if we think about a hearing aid, I mean it is a few millimeters or centimeters in length. It’s a very small, compact device that they’re kind of stuffing all this technology into. Now we see rechargeable hearing aids. We see blue-tooth connectivity hearing aids that can be connected to a television, a cell phone. They can be controlled directly from the app on the phone.

The hearing aids, when we think about the actual processor itself, it is scanning the environment, hundreds of milliseconds, and it’s looking for sound patterns and sound waves. Based on those sound waves, it’s saying, “Okay, this sound wave is speech. This sound wave is noise.” It’s processing all of this information, and it’s trying to elevate the speech to a level that is above or greater than the noise.

Even going back to the dining room, those noisy situations can be very difficult. The hearing aids are working to process all that sound, break it down, and it is doing this at every individual frequency. If we think about hearing loss, we don’t just have hearing loss. We have hearing loss affecting different frequencies to a greater extent. It could be a very mild hearing loss or a significant hearing loss. The hearing aid has to differentiate between all that.

Mike: Yeah, and as you kind of touched on, also the technology can interpret those signals in practically real-time and add elements of either frequency reduction, frequency boost, or overall environmental noise reduction, which is amazing – over the hearing aids of yesteryear.

Tomas: Yeah.

Mike: I had an old boss back in the day. We worked in a restaurant. Her hearing aids, they were like the big brown ones from back in the day.

Tomas: Okay.

Mike: Kind of like Band-aids.

Tomas: Oh, yeah.

Mike: She had a hard time with high frequency. For instance, she would say nobody is allowed to whistle around me. She couldn’t have any high frequencies because it would cause feedback. That’s just not so much a thing anymore, at least to the degree that it was.

Tomas: No, and you’re exactly right. Everything, as far as the hearing aids, has expanded. Every individual company has its new feedback suppression, so gone are the days where you’re sitting next to a family member and you hear their ear just kind of whistling.

I had some patients in the past that told me, “Oh, I got fit with hearing aids 5, 10, 15, 20 years ago.” They were holding their children or their grandchildren, and their hearing aid would be whistling. They would just have this scared and confused look coming from the children.

Mike: [Laughter]

Tomas: Gone are those days.

Mike: Yeah, I mean if your hearing aids are scaring the kids, it’s time to move on to something else.

Tomas: Yeah. Exactly.

Mike: You have choices. There are people that have problems with things being in their ears, so there are some really cool over-the-ear options that kind of tuck in behind that are very non-noticeable. I’ve seen quite a few of those popping up from time to time.

What’s your experience? Do you feel that people are preferring one over the other, or are there advantages to one over the other?

Tomas: Yeah, so I think, as you said, we have a hearing aid that will go over the back of the ear, a small wire that will come down in the ear, and then we have a small hearing aid that just goes in the ear. The pros and cons, the over-the-ear one definitely handles a broad range of hearing loss, whether it’s a mild hearing loss or a severe hearing loss. An over-the-ear hearing aid can take care of it.

The over the ear hearing aid gives you a lot of those bells and whistles with the blue-tooth, rechargeable, control the hearing aid from the app on your phone. I think, personally, the over-the-ear one is more beneficial for our patients.

Now, the in-the-ear one is a little more discrete (if we can make it small enough), but that also depends on the ear canal anatomy. If we have a very small ear canal, they may not be able to fit those components into the ear. The in the ear one is very beneficial for retention, keeping the hearing aid on, keeping it in place.

One thing our patients have had a very difficult time dealing with over the last two years during this pandemic is wearing masks. We’ve had quite a few patients who have lost their hearing aids by taking the mask off and pulling it from the back to the front.

Mike: Oh…

Tomas: It can catch the hearing aid and send it on its way.


Tomas: We tell our patients, “If you’re going anywhere, put the mask on in the car. Take the mask off when you get back in the car,” because the last thing we want you doing is leaving it in the parking lot, coming back to find it a few hours later, and it’s broken up into a thousand pieces.

Mike: Yeah, that’s a great call. I would have never considered the fact of how mask use can affect that. That requires a pretty high level of awareness, I think.

Tomas: It does. Yeah. We, unfortunately, had a patient lose their hearing aid this week. Thankfully, due to the advancement of technology, they were able to utilize a “find my hearing aid” tab on their phone. They ended up locating the hearing aid and saving themselves some money. That’s always a good thing.

Mike: Just like finding your lost phone, folks. “Find my hearing aid,” that’s pretty epic.

Tomas: Yeah.

Mike: Who should people see in regard to a hearing difficulty? Do you go straight to an audiologist? Do you talk with your primary care first? How does that work?

Tomas: Yeah, so I think that when we talk about quality of care, it’s very important who we’re going to for these decisions. There are a lot of great professions in the field, whether they’re considered an HIS (hearing instrument specialist), an audiologist, your general care family physician, or an ear, nose, and throat physician. But I think what’s most important is that we make sure that person is credentialed, that they’re certified, that it’s not just someone selling hearing aids out of the back of their truck on the street.

Mike: [Laughter] That does remind me, real quick, that I’ve seen those TV ads where it’s got the guy who’s sitting in the back of the room, and he can’t hear anything. His family is off in the corner doing something else. They’re like, “Buy this device off the TV and you’ll hear,” so you’re saying that’s bad news.

Tomas: Of course. Right. I think a lot of the stuff that we’re seeing on TV are considered amplifiers.

Mike: Right.

Tomas: Amplifiers are only going to treat a small – I shouldn’t even say treat. They may assist you for a small range of hearing loss. Some of them aren’t regulated. If they’re not regulated properly and we turn them up too loud, now they can damage the ear or damage our hearing. It’s definitely a great idea to speak to your family care doctor, call a local audiologist, and make sure that the person you’re seeing is accredited.

Mike: There was a topic that you’d brought up (I wanted to make sure that we touched on), which is, does the average provider have your best interest at heart, or do they have a separate agenda? Is there some kind of a corporate kickback these guys are getting for prescribing this or that? What’s going on there?

Tomas: Yeah. I appreciate you for bringing that up. There are clinics or offices who do have certain partnerships in place with the large manufacturers to fit or sell or dispense a certain percentage of those hearing aids. There may be some sort of financial benefit. Obviously, everyone is different.

I think that it’s also important, when we speak about who am I going to see, for that hearing care provider. Directly ask them, “What do you recommend for me?” If that provider cannot say, “Well, we have five to six different options. I like these two for you for this particular reason.” If they’re just saying, “Well, we have one for you. This is it. This will be great,” if they can’t tell you why or give you proof or information, then some red flags need to go up.

Mike: Yeah, if you’re only being provided one solution, that seems sketchy to me.

Tomas: Yeah. Yeah, and we actually have a resident there at Aldersgate who we recently just got a new pair of hearing aids. Long-time hearing aid user. Worn hearing aids and actually a musician. You musicians are a very special niche patient. Your ears are a little too dialed in sometimes.

Long-time hearing aid wearer came in, tried a particular hearing aid, didn’t love it, and we said, “Well, you know what? Let’s come back in, and let’s try a different manufacturer.” They ended up loving it. We said, “Great. Well, let’s go with that one.”

We have the flexibility to do that because we’re not tied to a single manufacturer, and we can do what’s best for our patients and give them what they want.

Mike: Bottom line is you should have options. Let’s just say somebody tries option A and it doesn’t work out. They should not feel like they’re stuck with that forever, right?

They should be able to go back to their audiologist or their doctor and say, “Listen. I’m having problems with this. Can we try something else?” There is absolutely nothing wrong with doing that. Correct?

Tomas: No. No. There should not be. Most clinics will give you a 30-, 60-, 90-day trial period. Typically, you would pay for the devices upfront, and you would pay for the provider’s time and services over that period. If the provider cannot get the hearing aids to your liking, then you should, by all means, be able to say, “Okay. This one isn’t great for me. It’s not really working out. What are my options to try something else?”

Mike: There are a lot of people that they just assume that they’ve got their solution. They went. They saw their person. They got their device. Boom. That’s it forever. That’s all I’ve got. That’s just simply not the case.

Now, in today’s world on – we’ll call it – the general radar, as you put it, where are we in terms of hearing loss awareness and just kind of what people think about that in the world? Where are we with that?

Tomas: Yeah. I would definitely say that we’re not where we want to be, but we are certainly headed in the right direction. Hearing loss itself, there are about 30 million to 40 million individuals in the U.S. currently who have a diagnosed hearing loss or maybe hearing loss that’s not diagnosed.

They are estimating that number is going to significantly increase by the year 2050. Obviously, with some younger generations coming up listening to loud music, headphones, iPods, AirPods all the time, working in loud noise, our military, our veterans, so we are seeing an uptick in the amount of people who have hearing loss.

Just real quick. May itself is also designated to the Better Speech and Hearing Month, so there’s a lot of awareness being pushed out at different times in the year. “Hey, come out and get a hearing baseline. If you have different things that are affecting you, come in and get it checked out.” So, we’re getting there.

Mike: Options for people, because obviously hearing aids, they’re not the cheapest things in the world, right? There are going to be a lot of people inquiring, “How does this work through my insurance? Is this out of pocket?” I hear Medicare could potentially be an option, maybe.

Tomas: Yeah. For a patient who has hearing loss, hearing aids could potentially be the third largest investment in their life.

Mike: Okay.

Tomas: When we think about a house, we think about a car, think about hearing aids. Hearing aids can range anywhere from – depending on the clinic – $2,000 to $6,000, typically. That puts you at a $4,000 to $5,000 average. The price can range.

When we think about options to acquire a pair of hearing aids, there are some insurance companies who do provide benefits, a private benefit. There are different third-party companies associated with the insurance company. So, the insurance company would partner with, we’ll say, company A over here.

The insurance company will say, “Hey, we have a million clients under our insurance policy. We want to offer them a specialized benefit utilizing your services.” This third-party company will call the hearing aid manufacturer and say, “We have a million patients. Can you give us a good deal?” They will. They could then lower that cost to the patients.

Those are two things.

Medicare itself, we hear a lot about the current presidential administration trying to pass the Build Back Better plan. Within the Build Back Better, there was originally hearing, vision, and dental services provided under that. They have since gotten rid of the vision and dental. Hearing is still in that.

Within that program, Medicare would provide some sort of benefit for our patients with hearing loss and hearing aids. Obviously, they haven’t gotten it passed. They are still working to do that. They haven’t given us any exact details as far as how much, what type of financial incentive is there. Hopefully – we’ve been saying this for a long time – in the next two, three, four years, there will be something put in place for our patients with Medicare.

Mike: But worth noting that at least it’s being discussed. It’s been put out there to the world. The possibility does exist, so we can just always hope for the best and want that stuff to move through.

Tomas: Yeah, I think that we’ve definitely seen progress. I think we’re definitely closer to having it happen than we were a few years ago.

To that point, another bill that was passed, actually in 2018, they’re still finalizing the regulations. It kind of shows you the time it takes. We’re four years now removed from the bill that Senator Warren passed. That bill allows companies like Sony, Bose, and different large tech manufacturers to produce hearing-like devices that can be sold directly to the consumer.

Mike: That’s an interesting angle, and I know Bose, for instance, is definitely a front-runner in consumer-grade audio technology.

Tomas: Mm-hmm.

Mike: You know speakers and amps and all kinds of good stuff like that. Potentially, under certain regulations, certain companies could be able to release devices that might, I guess, not replace a traditional hearing aid but maybe bridge the gap.

Tomas: Yeah, and that’s exactly right. I think that bridging the gap is a great point. Those devices being sold directly to the consumer are going to be stripped down, more sophisticated than an amplifier but not quite to the level of a current hearing aid today.

Mike: Maybe you notice something, you try out a device, that device maybe works for a bit of time, and then you say, “Clearly, there’s an issue. I need to take this to the next level.”

Tomas: Yeah, and I think, to that point, “I think there may be an issue,” I think it’s a great thing for our patients who are considering an over-the-counter option through, like, Best Buy or Walmart (once those devices are in place) to still receive a comprehensive evaluation from an audiologist or an ear, nose, and throat physician before you explore that route.

Mike: Sure.

Tomas: The last thing we want to see is someone thinking, “I woke up one day and my hearing is down a little bit.” Then they go to the store, they buy a device, and say, “Oh, my hearing came back up a little bit. That works.” Then they continue to use that for a few weeks, a few months, or a few years, but what happened was maybe they had a sudden decrease in hearing loss.

One treatment option maybe could have been to go to an ear, nose, and throat physician, get some sort of steroid injection that would have cured or brought the hearing back up. So, we definitely want our patients to still make sure they’re getting a full evaluation if they think there’s anything wrong.

Mike: Yeah, absolutely. Consumer-grade stuff might seem enticing, but you do want to be careful with it because hearing is clearly a very important part of life and it does affect you in many ways once that starts to deteriorate.

Now, if I am a friend or a family member or a close associate of somebody, what steps might I take if I see somebody might be having a decline in their hearing? How do I approach that in the proper fashion?

Tomas: Yeah, I think that hearing loss (for so long) has been the stigma we’ve kind of danced around. I think it’s appropriate to just be very upfront.

Let’s say we have a grandparent. “Hey, grandma. You know you’re just not hearing very well. A lot of us are straining to communicate with you. We’re finding you repeating yourself quite a bit. We think it’s a good idea for you to get your hearing checked out.”

I think when in doubt, just address it directly. Get that person in for a full evaluation to really give you more information on what’s going on and what could be the cause of it.

Mike: Get to the point, folks. Don’t beat around the bush.

Tomas: Yep, that’s it. That’s it.

Mike: [Laughter]

Tomas: The reason being is hearing loss affects so many of us, not just the person who has hearing loss.

Mike: Right.

Tomas: A lot of the time, we see our patient’s family members get them into the office and say, “Hey, listen. We’re going to kick this person out. I can’t do it anymore. We can’t communicate.” So, it’s important that people with hearing loss understand that it affects everybody. And those around that person with hearing loss, it’s important to address that concern with them.

Mike: Yeah, absolutely. If you’re a person with hearing loss, don’t worry. At this point, the stigma that was once surrounding it is just not really an issue anymore. There are so many things to help you improve your quality of life and so many people out there are in the same position.

Tomas: Yeah. You know it’s funny. Obviously, being an audiologist, I see many hearing aids out when I’m out throughout the course of my day. I don’t look for them, but obviously, I’m more aware to notice them.

Mike: Sure.

Tomas: I’m always tempted to ask, “Hey, what are those? What are you wearing? Do you like them? What features do you like?” I have to kind of tell myself to relax a little bit because—

Mike: [Laughter]

Tomas: I don’t know how they feel about the hearing loss.

Mike: Plus, some random dude coming up to them on the street and just like, “Hey! Why is this guy talking to me about my hearing aids?”

Tomas: Yeah. Yeah.

Mike: Now that you’ve established with us kind of all of the environmental and cultural things around hearing loss and things that might be associated with it, what final words of encouragement or advice would you like to leave with the Aldersgate OnAir listeners today?

Tomas: Yeah. I think it’s important for our patients (and anyone who thinks they have some hearing difficulty) to understand that you’re not alone. There are millions of Americans in the United States who deal with the same thing. But as we said earlier, there are many avenues to get your hearing checked out, to find a treatment option.

It is not normal for you to sit in a dining room and not be able to interact with the person you’re sitting across to. It’s not normal for you to not be able to interact with loved ones. It’s not normal for your television volume to be at 100 when it could be at 20 or 30. Right? I think that if we are changing our daily habits, we don’t want that.

Mike: Yeah.

Tomas: We need to get the hearing checked out. Get a hearing test and see what’s going on.

Mike: If you’re a senior living community or a restaurant or a dining establishment, a cafeteria, treat your room. Hang some curtains. Put up some acoustic tiles. Try to eliminate some of those reflective surfaces. You can do that in your own homes as well (relatively inexpensively).

Even a trick that we do in the recording studios is we hang rugs and carpets and things in the environment to help dampen sound. That’s definitely a really approachable way that businesses and communities can help with folks that are having some kind of hearing loss, especially in dining avenues.

Tomas: Yes.

Mike: It’s fantastic.

Tomas: Yep.

Mike: Now you’re doing some of this stuff on site with Aldersgate. Are we on a regular schedule yet? Is there something that somebody might be able to look forward to?

Tomas: Yes.

Mike: How do they go about taking part in that?

Tomas: Yes, so I think, for many of the residents at Aldersgate, we’ve had the chance to interact with some of them. Where we are at now is in the process of setting a schedule for those residents. But for our residents who are already patients, just know that we’ll be there soon. We’ll be there to see you.

For the residents who are inquiring about getting a hearing evaluation, that is in the works. We are hoping to be onsite at least two times a month to see those patients on a regular basis. Then those patients also know that if there’s a time we can’t get in to see them, they have the ability to come see us.

Mike: Well, Dr. Cabrera, this has been very enlightening, very eye-opening, very ear-opening, right?

Tomas: Yeah, exactly.

Mike: Thank you so much for joining us today. I think that this is going to be some amazingly helpful information for folks out there in the world to take that next step and to take care of themselves. It’s been an honor talking to you, my friend.

Tomas: Yeah. Well, thank you so much. I really appreciate it. I think that you guys are doing a great thing with Aldersgate OnAir. I’ve had the chance to listen to some of the podcasts you’ve done in the past, and I think if we can continue to educate our patients, the consumers, and the residents, it’s better for everyone.

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Mike: Thank you so much. I look forward to talking to you again in the future once everything is up and going.

Tomas: Yeah, of course. Thank you so much.

Mike: You bet. Another amazing conversation. I’m glad we had this opportunity. And thanks, as always, to all of you for listening. It really does mean the world to us.

Since we have dedicated this episode to those with hearing loss or to those who know someone who is living with hearing loss, I wanted to take a moment to mention that we also fully transcribe every episode of Aldersgate OnAir, so no one has to miss out on the important messages that we’re sharing with the world.

Simply visit the Aldersgate website at and click on the “What’s Happening” link at the top right of the home page. There you can go to the dedicated podcast section that has all of the episodes and transcriptions.

By popular request, we’re also working very hard behind the scenes to bring you more episodes this year. You asked. We’re answering.

We’ve got some really amazing things planned, rest assured, but we need your help getting the word out. In addition to subscribing to the show and liking all the pages on social media, please share the episodes with your friends, family, and colleagues.

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