Can You Hear Me Now? Examining the Relationship of Hearing Loss to Dementia

What is the relationship between hearing loss - the third leading cause of chronic disability in older adults - and risk of cognitive impairment and dementia? We dig into the research in this episode: https://bit.ly/4eUuQ7N

Age-related hearing loss – which is the third leading cause of chronic disability in older adults – has been shown to be associated with increased risk of cognitive impairment and dementia. Hearing loss also causes worse health care professional–patient communication, more frequent hospitalization, more social isolation, functional declines, and falls. Hearing loss can be well-managed with hearing aids, yet most people refuse to wear them.

In this Episode:

• 05:46 – Heart Healthy is also Brain Healthy
• 13:57 – Recipe of the Week: Classic Spinach Quiche
• 15:44 – What Does Research Say About Hearing Loss and Dementia, and Can Hearing Aids Slow it?
• 38:51 – Don’t Wear Your Hearing Aids? You’re Not Alone
• 48:59 – Outro

What are the parts of my auditory system?

• Your auditory system (hearing system) consists of many different parts, including your: Outer ear, Middle ear, inner ear, and auditory nervous system.  Successful hearing requires all these parts to function properly.

In this episode we talk about the importance of hearing and the relationship of hearing loss to dementia. Refer to the above image when Marianne describes the anatomy of the ear.

What Do I Need to Know About Hearing Loss?

• About 38 percent of adults between the ages of 65 and 75 have age-related hearing loss—and this climbs to 54 percent in the years after that. Don’t wait to see an audiologist for an exam and treatment.

Is Hearing Loss Permanent?

• The most common type of hearing loss is sensorineural (permanent), but there are a few causes of hearing loss that can be curor surgery. See an audiologist for a diagnosis and treatment plan.

What foods will help me keep my hearing?

• Fish, Citrus Fruits, Dark Green Veggies, Eggs, cantaloupes, bananas, dark chocolate, garlic, whole grains, milk

What Do I Need to Know About Hearing aids?

• Hearing aids are not covered by Medicare or Medicaid, so you will have to pay for them if those are your only insurance. Despite price, they all work in the same way. If you go through an audiologist, they will usually bundle their services for one price (cost of hearing aid, fitting appointments, training on how to use, follow-up visits and repair. Big-box stores also sell these devices, so it makes sense to shop around.

#hearingloss #hearingaids #dementia #cognitiveimpairment #socialisolation #audiology #canyouhearmenow #elders #aging

Transcript

Can-you-hear-me-now-examining-the-relationship-of-hearing-loss-to-dementia

This podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording. Hello and welcome to Everyone Dies, podcast where we talk about serious illness, dying, death, and bereavement.

I'm Marian Matzo, a nurse practitioner, and I use my experience from working as a nurse for 45 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every person viewpoint to our podcast. We are both here because we believe that the more you know, the better prepared you are to make difficult decisions.

So welcome to this week's show. Please relax, get yourself something comforting to drink and some pie, and thank you for spending the next hour with Charlie and me for our discussion about hearing loss and dementia. Like the BBC, we see our show as offering entertainment, enlightenment, education, and divide that into three halves.

I know there's not three halves, but it's what we do here to address each of these goals. Our main topic is in the second half, so feel free to fast forward to that no chitchat zone if you need to. Our topic this week looks at the intersection between hearing loss and dementia.

Now, you're probably thinking that hearing loss is not a terminal disease, and you're right, but hearing loss results in many quality of life issues and can also have an impact on the development of dementia. In the first half, Charlie talks about what foods you could eat to help prevent hearing loss and has our recipe of the week. The second half, I'm going to chat with you about the research that ties hearing loss to dementia.

And in our third half, we're going to talk about why people don't wear their hearing aids. So, Charlie, how are you? I'm sorry, what? Hang on, let me get my hearing aid. No, just kidding.

Like all audiologists don't hear that joke every day. Thank you. You're welcome, folks.

You know, people are dying. So, as of this recording, yesterday, the great performer and entertainer Chita Rivera died. No! Yeah, yeah, yeah.

I missed that. She was 91 years old. Holy smoly.

Yeah. She's a talented woman. Oh, absolutely.

The original Maria and... No, Anita. Sorry, sorry. No, Maria.

Anita. Yeah, I know theater well. The original Anita in West Side Story.

And then when they did the redo, they had her in it too. Yeah, I think it was almost the entire original cast. Yeah, almost the entire... Wait a minute.

No, years after West Side Story finished on Broadway, then it went on national tour, I don't know, for like two or three years. Then several years after that, they brought it back with just about the entire original cast. Only one or two people were not part of the original cast.

Wow, but that never happens. Yeah, I don't... That's incredible. No, yeah, it really, really is incredible.

But she's gone now. Yeah, there was... Well, rest in peace. Absolutely.

There were a couple other people also, and now I can't think of who the hell they are. Well, you know, I was reading in the Times... I know she was older, but yeah. I was reading in the Times this week that this porn star, and forgive me for not remembering her name.

Right, yes, I saw that. I didn't read it. I tried to find pictures, but nothing came up.

She was in her 40s, she was only like 49, but as I'm reading it, she lived in Moore, which is like the next city over from me. And I thought, how cool would that to be like bump into, no pun intended, a porn star like at the grocery store or something, you know? Yeah, yeah. But it sounded like it was a sad end, because it was both her and her boyfriend, but there weren't any other details, so it probably wasn't my natural causes.

Wasn't a pleasant way to go, yeah. Yeah. Who else was it? It was Tulsa? But I didn't know we had a porn star right here in town.

Well, there you are. Congratulations. Well, there goes my ambitions.

Oh, dear. I wanted to be the only porn star in town and, you know? I want to be the only porn star in town. Yes.

We could write a musical. Sure, we could. What would we call it? Oh, Dies the Musical.

There we are, Everyone Dies the Musical. And we already have the first song from Mike, from Mike Ward, who recorded, spoiler alert, Everyone Dies. Oh, right, right, right.

It's given to us. Yeah. Yeah.

We have the first song. Oh, good. So those of you who are listening, who write music, send us those songs, and Charlie's going to work on getting a backer and put it all together into a musical for us.

What you talking about, Willis? So, Charlie, if I want to be able to hear in my old age, what do I have to eat? Well. I'm not sure that came out right, but you get the point. Well, listen, eating a heart-healthy diet will help more than your heart.

Foods. Well, there we go. I'm done.

Yeah. As soon as I read that, it's like, oh, shit. I'm out of here, too.

Especially since I just found a new fried chicken place. So eating. Yeah.

Where was I? Oh, yeah. Eating healthily. Healthily.

Healthily? Healthy. Eating healthy. Oh, never mind.

Listen, eating a heart-healthy diet will help more than your heart. Foods that are good for your brain, heart, and lung, specifically a diet rich in fruits, veggies, lean protein, grains, and healthy fats helps maintain hearing. These foods are high in antioxidants and reduce inflammation in the body that can increase hearing problems.

Curran and colleagues published a study in 2018 of a longitudinal cohort study that took place between 1991 and 2013 of nearly 82,000 nurses. They assessed diet every four years and risk of self-reported moderate or worse hearing loss. These authors concluded that adherence to healthful dietary patterns is associated with lower risk of hearing loss in women.

Consuming a healthy diet may be helpful in reducing the risk of acquired hearing loss. There's no evidence that what you eat can reverse hearing loss, but a healthy diet may help delay or slow further progression of hearing decline. The connection between your heart and your hearing turns out to be a steady flow of oxygen-rich blood.

The sensitive hair cells in the inner ear convert sound waves into electrical impulses that the brain interprets as sound. Poor blood circulation or inadequate oxygen damages these sensitive cells. So, what do you need to eat to slow your hearing decline? A balanced diet rich in crucial nutrients can stave off further ear damage and promote hearing health.

Hearing depends on the flow of oxygen-rich blood to the inner ear's delicate cells. These cells translate sound waves into signals for the brain. Poor circulation harms these cells, like the harmful effects on your heart.

Here are some foods that are good for hearing health. Bell peppers. Rich in folate, which is vitamin B9, these crunchy beauties help make red blood cells that carry oxygen throughout the body.

Researchers link low levels to the risk of age-related hearing loss. Bananas. Potassium-rich bananas help regulate levels of body fluids.

Their magnesium improves blood circulation and oxygen supply in the inner ear. Bananas regulate levels of glutamate, a significant factor in hearing loss among older adults. Garlic has a dual role in lowering cholesterol and fighting inflammation in your ears.

Better circulation results, helping improved hearing functions. Whole grains are rich in magnesium, fortifying the nerve functions in your inner ear. Exposure to loud noises often damages the inner ear.

Whole grains can offer a layer of protection. Milk has vitamins like A, B, D, E, and K. These vitamins improve metabolism and act as antioxidants. Minerals like magnesium, potassium, selenium, and zinc regulate inner ear fluid, which is vital for hearing health.

Carrots. Not just for Bugs Bunny anymore. Beta carotene, the plant pigment that gives carrots their color, may help reduce the risk of hearing loss.

Dark chocolate. Dark chocolate. Now we're getting to something I can relate to.

Well, you see, and I prefer milk chocolate. So, uh, so, so with the limit, let me read this one. And then briefly, what's the difference? Dark chocolate.

Dark chocolate is high in zinc, boosting immunity and cell growth in the ears. However, consult a physician if you have health conditions that limit its consumption, like diabetes 1. I'm going to wait till I reach this whole thing, so nobody gets annoyed that I'm not finishing the list before I yammer on about milk chocolate. You're welcome, folks.

Cantaloupes. Melons. I like melons, Marianne.

Melons contain the mineral. I had no idea. Yeah.

Melons contain the mineral potassium, which helps regulate fluid beneficial to the cochlea, the main organ of hearing. Citrus fruits. Oranges, grapefruit, lemons, and other citrus fruits contain folate, aka vitamin B9 that helps make red blood cells.

Low folate levels have been linked to the risk of age-related hearing loss. Vitamins C and E act as antioxidants and cell protectors against hearing loss and ear infections. Dark green leafy vegetables.

Broccoli, kale, Swiss chard, and spinach contain folate, again, vitamin B9. Vitamins K and C, along with potassium and magnesium. These nutrients combat free radicals that could harm the sensitive inner ear tissues.

Eggs. Loaded with vitamin D. Eggs are associated with lower odds of hearing problems. Potatoes.

Sweet and white. Both are rich in zinc, which helps ward off infections that can affect the inner ear. Pumpkin has pigment beta carotene that can help reduce the risk of hearing loss.

Tomatoes. Tomatoes. Potassium-rich tomatoes or tomatoes, red, yellow, and even green, help regulate fluid in the inner ear.

Fish. Two or more weekly servings of fish, such as tuna, salmon, or herring, is rich omega-3 and vitamin D. These nutrients strengthen inner ear bones and improve brain-ear coordination, effectively preventing hearing loss and are linked to a lower risk of heart disease. And as a bonus, omega-3s from food may reduce your dementia risk.

Your mission. Should you choose to accept it, is to eat nutrient-dense food rich in vitamins and minerals, as well as fiber and omega-3 fatty acids, which help the cells in your body function as they should. And try to get these vitamins from foods rather than pills.

Be sure to check with your primary healthcare practitioner before starting any supplements because they may cause unwanted side effects. This tape will self-destruct in five seconds, which brings us to our... I can only hope. Which brings us to our recipe of the week.

Finally, a hearing-healthy dish to take to your next funeral repast. We have a wonderful recipe for classic spinach quiche. This classic spinach quiche has a buttery, flaky crust, a generous amount of spinach, onion, garlic, rich custard, egg filling, and lots of melty Gruyere cheese.

Bon appétit. Can you say the bon appétit like Julia Child would? Bon appétit. How does that sound? I'm trying to remember.

Bon appétit. Do it for me. I can't.

You're the actor. You know, this is my upper range. I can't do an upper, upper range anymore.

This is not. Bon appétit. Have you watched the show, Julia? I have not.

Oh my god. It's in the second season already. I'm... David Hype... David Hype Pierce.

Yeah, husband, yeah. Her husband. It is really good.

I'm telling you, it's really good. Please go to our webpage for this week's recipe for quiche and additional resources for this program. Your tax-deductible donations are always welcome so that we can continue to offer you quality programming.

Thank you in advance for making your donation at www.everyonedies.org. That's every, the number one, dies, dot org. Marianne. Thanks, Charlie.

Age-related hearing loss, or presbycusis, is the third leading cause of chronic disability in older adults and has been shown to be associated with increased risk of cognitive impairment and dementia and is associated with worse healthcare professional-patient communication, more frequent hospitalizations, more social isolation, functional declines, and falls. An estimated 48 million Americans, about one in five people, have some form of hearing loss according to a Johns Hopkins study. So, what is hearing? Hearing is the process of perceiving sound waves in the environment and translating them into electrical signals that the brain can interpret the sound.

The ear is responsible for this process and it's divided into three parts. There's the outer ear, the middle ear, and the inner ear. So, I'm going to give you sort of a step-by-step explanation of how hearing works.

And in our show notes, we have a really good, kind of clear picture of the structure of the ear. So, you can take a look at that and follow along. So, first, sound waves enter the ear through the outer ear, which includes the pinna and the ear canal.

The sound waves cause the eardrum to vibrate, which in turn causes the three bones in the middle ear to vibrate. The vibrations are transmitted to the inner ear, where they're transformed into electrical signals by hair cells in the cochlea. The electrical signals are sent to the brain via the auditory nerve, where they are interpreted as sound.

So, there are two primary types of hearing loss. One is called conductive and one is called sensorineural. Conductive hearing loss occurs in the outer ear and it's caused by either something blocking the ear canal, most commonly earwax, ear infection, benign growth of cells and keratin, traumas like bone fractures, or overgrowth of the bone near the stapes, also called otosclerosis.

The second type of hearing loss, which is our focus for today, is called sensorineural hearing loss. This occurs because the sound reaches the inner ear, but it doesn't get relayed to the brain or the brain can't interpret the information. It causes a loss of sound frequency and can profoundly affect hearing.

Most sensorineural hearing loss is permanent. Sensorineural loss is caused by damage to the sensory hair cells within the cochlea in the inner ear. As a result, sound is unable to be converted into electrical impulses for the auditory nerve to deliver to the brain.

Tinnitus, or ringing in the ears in the absence of an external source, is also a chronic auditory disorder that increases with age. Scientific evidence documents the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both age-related hearing loss and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression.

So hearing loss is a common and chronic diagnosis in older age that, if left untreated, can affect physical, mental, social, and financial health. Treatments include amplification through hearing aids or cochlear implants, but a permanent cure does not exist. While most hearing loss can be treated with hearing aids, less than 30% of people over the age of 70 use them.

The usage is even lower in the 20 to 69 age range, which drops to about 16%. Hearing aids are not covered by Medicare or Medicaid, and the mean cost for a pair of fitted hearing aids ranges between about $2,200 to $7,000. So as I talk to you about the scientific evidence, I want to also explain a few things to pay attention to when you see a study report.

I'm not going to do this every time we do a study report, but for this one, I just want to talk about that. Now, as I was looking for studies looking at the association between age-related hearing loss and cognitive decline, these studies go back to about 2006. One study of U.S. Medicare beneficiaries found a 61% higher dementia frequency in those with moderate to severe hearing loss compared to those with normal hearing.

In this study, even mild hearing loss was associated with increased dementia risk, although it was not statistically significant. And the use of hearing aids was tied to a 32% decrease in dementia prevalence. Another large study documented that hearing aids significantly reduced the risk of mental decline and dementia and even improved short-term cognitive function in individuals with hearing loss.

Another study by Amviva and colleagues conducted a longitudinal cohort study that ran from 1989 to 2014 with 3,670 people over the age of 65. So let me stop for a second and say longitudinal cohort study. That means it ran over a long period of time with the same people.

So let's say in 1989, they went to Charlie, they did whatever their study protocol was, and then they continued to follow him all the way up to 2014. And then they take that data and they look at it and say, well, so what happened with this person? Because different people are going to have different experiences, but that one person is going to have different experiences, but they're all theirs. So that's what a longitudinal cohort study is.

When we design a study, we can use subjective or objective data or a combination. Subjective data is what a person reports. They may say, I did not have sex with that woman, while objective data is something that can be measured through physical examination, observation, or diagnostic testing, like testing a stain on a dress and getting DNA to determine where that stain came from.

In this study, they used self-reported hearing loss. So they said, if we were talking about Charlie, hey, Charlie, how would you rank your hearing? And they also used objective data, which was the mini mental status exam, which is a well-known exam to measure cognitive design. Now, just if we were looking at this one study, a better design would have been to have an audiologist test Charlie's hearing at each one of those points and to do an objective test like the MMS, because people, you know, none of us are very good at, here's how I really am.

Sometimes we report how we think we are, but if you talk to other people, they'll say, no, he's deaf as a doornail. You know, he's not reporting that accurately. So if you want to get the most accurate kind of data, an objective test is the way to go.

So in this study, self-reported hearing loss was significantly. Now that's mathematically the most stringent test. And we look at a significance level of 0.001. So when somebody says it's significant at 0.05 or 0.001, the best level of significance you can have, or which is most commonly seen is 0.001. So they found that self-reported hearing loss was significantly associated with a lower baseline mental status score and a greater decline during the 25-year follow-up.

And that significance level was 0.01, which is still really good. And that this decline was independent of age, sex, or education, meaning that those three factors did not influence the finding. They ran the numbers with those in there as a variable, didn't change anything.

They also looked at the rate of change in the mental status exam score over the 25-year follow-up. And those participants with hearing loss not using hearing aids and those with hearing loss who used hearing aids, they looked at those numbers. Those not using the hearing aids had a significantly greater decline in their mental status score, 0.001, while those subjects who used hearing aids had no significant difference in cognitive decline, 0.08. The study authors concluded that self-reported hearing loss is associated with faster cognitive decline in older adults, and hearing aid use slows this decline.

A University of Utah longitudinal study by Gergel of more than 4,400 older adults, what they found was that subjects with hearing loss develop dementia at a higher rate than their normal hearing counterparts. People with hearing loss can experience earlier onset of cognitive decline, can experience greater severity in cognitive decline, and hearing loss may be an indicator to assess for cognitive decline among people 65 and older. So I've listed a few studies that utilize different methods and documented similar findings.

I think it's safe to say that wearing a hearing aid has multiple benefits that include the ability to socialize, prevent loneliness, and help decrease your risk of dementia. Now my mom was 89 when she died, but she was very hard of hearing, very hard of hearing. You had to talk really loud for her to hear, but she refused to get a hearing aid.

She never gave a reason, but she just said she wasn't getting it. So it was really hard to communicate with her, and especially if Wheel of Fortune was on because the TV blasted so she couldn't hear you, and no voice could compete with that. Well, I was visiting her one time with my kids, and she said to me, you know, nobody comes to visit me anymore.

And she seemed, you know, a little sad, and I said, well, why do you think that is? And she said, I don't know. And I'm thinking, it's kind of hard to scream for a whole half hour or an hour so I could see where people might not, you know, come. I didn't say that.

I just thought it. I used my inside voice. Well, after she had a major stroke, and she was on hospice care, and I was there taking care of her, people would come and visit her and talk with these nice, soft tones, and, oh, Catherine, blah, blah, blah.

And I'd look at them, and I'd say, you know, she was deaf before the stroke, and she's still deaf. So you've got to talk loud if you want her to hear. And it was really funny to me that people who'd been, you know, you know, grandchildren and my subs, you know, had been screaming at her for years in order for her to hear, and suddenly they thought that because she was on hospice that the nice, gentle voice was going to be heard.

So, you know, no matter what happens with the elders in your life, if they can't tell you that they can't hear, but they couldn't hear before whatever event occurred, they can't hear you now. So there is scientific evidence that points to a link between age-related hearing loss and cognitive decline. But, you know, the reason is not clear.

The amount of attention to age-related hearing loss has been growing not only from the perspective of being one of the most common health conditions affecting older adults, but also from the perspective of the relation to cognition. Results from population and laboratory studies have demonstrated a significant link between hearing loss and cognitive decline, which brings me to an issue that I've seen argued on the internet that I just feel like I need to comment on. There have been frequent news stories about academic research, plagiarism, and the question of trustworthiness of science and research scientists.

I earned my PhD back in 1996, and the research available to us as scientists were light years behind what's currently available. When I started my doctoral program at UMass, I didn't even have a computer, and the library was a place I had to physically go to and use the card catalog to find books. It was really the dark ages compared to now when you can stay at home and get full scientific articles through computer search.

There's plagiarism software to help ensure that your work can stand up to review. There's all of these additional kind of computer-generated help. And when you have something, let's say you something from 1996, and let's say you run it through these plagiarism software, yes, if you run something through that kind of stringent testing that we didn't have back in 1996, you're going to find things that maybe you could have referenced better, or oops, that's a little too close to the original way, I didn't rephrase it enough.

You're going to find that in every dissertation, and you can't blame the people who supervise the dissertation or even the person who wrote it, because in doing that and going through all of those studies, it's not very hard to have what appears to be plagiarism by what a computer is going to find compared to what you can find just reading it. So the academic views of late have left some people feeling like they can't trust the scientific finding, can't trust the scientific process nor the findings that are published. Specific to today's topic, there are three studies that were retracted from the Lancet last year about hearing loss and the link to dementia.

The Lancet is a British scientific publication health journal of excellent reputation. When the paper first appeared, it seemed to conform to the widely held belief that hearing loss is associated with developing dementia and using hearing aids can help to reduce risk. An outside researcher tried to replicate these findings, because if you're using a huge data bank like these scientists were, they were using the UK biobank data set.

That's, you know, you can get permission to use that. Everyone has the same numbers. So if I say, here's what I did, another person on the other side of the world can go into that data set, run it the same way and say, yep, I get the same thing too.

Well, this person did that, but they didn't get the same thing. And they tried it numerous times. Of course, you know, most authors are going to say, I must be doing this wrong.

When in fact, what they found was that the authors made an error. So after they communicated with all the scientists, it was realized that some of the data was miscoded. Meaning that, think of it as being labeled as a dog and not as the cat it was.

They put the wrong label on it. Is that acceptable at this level? No. Does it happen? Absolutely.

Especially, you know, in a research institution, you're expected to have students working with you and sometimes things can get moved and you don't realize it. So when they found out this is what happened, the research findings were backward and incorrect. So the journal, the Lancet, along with the authors had to retract those papers, which as an author, I can imagine would be horribly humiliating.

And I can't even imagine how bad those people felt and how embarrassed they felt. The scientific process by its nature requires ongoing exploration of the subject of interest and will change based on the studies that are conducted and scrutinized. My point here being, expect changes in what we know based on the science that's conducted.

You know, these people made a mistake. The data were retracted. I assume they'll rewrite the paper with the right headings on it and report it.

But what that says is that there are watchdogs within this scientific community so that if and when these things happen, they're found. So back to hearing loss and dementia. The reason why hearing loss may increase the risk of developing dementia is really not well understood, but there are some theories.

One theory is based on the impact of hearing loss on the cerebral cortex. Hearing loss increases the amount of mental effort and resources used by the working memory, and that diverts the brain's resources to processing sounds at the expense of other brain activities. So if you're hard of hearing, your brain has to use more of its energy in order to hear, which might be what causes the dementia.

Another hypothesis is that hearing loss leads to social isolation, which has been shown to contribute to dementia. A third prominent explanation is that a common cause of both diseases and that hearing loss is an early sign of the underlying pathology of dementia. It's also possible that these proposed processes are not mutually exclusive and a decline in one pathway automatically affects the other.

If the connection between hearing loss and dementia could be determined, hearing loss could potentially be a modifiable risk factor, meaning, you know, just like smoking is a modifiable risk factor for heart disease, it's something you could stop and keep your heart healthy. Just like if there's something that you're doing in terms of, you know, you don't eat enough fish, so you have hearing loss. I'm making that up.

That's not true as far as we know. So you could, you know, eat more fish, and maybe you would have better hearing and lower your risk of dementia. Interventions delaying the onset of dementia by even one year could potentially decrease the worldwide prevalence of dementia by 10%.

So we can take steps to protect the hearing that we do have and help younger generations protect theirs. So to protect your hearing, you should use ear protection like ear plugs or ear muffs during loud activities such as concert, riding motorcycles or snowmobiles, or working with loud machinery. When you're listening to music through headphones or earbuds, keep the volume level low enough that you can hear people speaking around you.

Another good rule is not to exceed 80% of volume for more than 90 minutes a day. My standard is, I shouldn't be able to hear your music through your earphones, but I'm old and cranky. Don't stick anything in your ear canal, including cotton swabs or hairpins.

These objects could become lodged in your ear canal or cause an eardrum to rupture. Avoid smoking, which can impair circulation and harm your hearing. Get regular exercise to help prevent health issues like diabetes or high blood pressure that can cause hearing problems.

Manage any chronic illness to prevent further damage, and eat a healthy diet like Charlie told you. Given the evidence that validates advantages of using hearing aids in the treatment of hearing loss, depression, and tinnitus, the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of hearing loss and tinnitus have been strongly recommended. And Charlie's going to talk with us about the reasons that people don't wear their hearing aids.

And I come from a family of hearing impaired people, and one of my favorite stories is when my children's grandfather, Pepe, had really bad hearing and finally he got hearing aids, and he would though take them out when he answered the phone. So one day he's eating some peanut brittle and the phone rings and he takes out his hearing aid, puts it down the table, talks on the phone, and of course whenever you called Pepe, Meme got on the phone, or if you called Meme, Pepe got on the phone. So it was always two people and you trying to have a conversation.

So they finish the call, he hangs up the phone, he takes a bite, a piece of peanut brittle, puts in the mouth, crunches down on it, and realizes it's not peanut brittle, it's his hearing aid, and he just destroyed his hearing aid. So pay attention to what you're eating, and let's hear what Charlie has to say about why people don't put the hearing aids that they've purchased for lots of money into their ears every day. And yeah, if you have hearing aids, and like Marianne says, you put off wearing them, you are not alone.

Nearly 80% of Americans who could benefit from using their hearing aids won't use them. Instead they gather dust in drawers and containers. So here are four reasons from Emeritus as to why people say they won't wear their hearing aids.

One, they are difficult to use. New hearing aid styles feature sleek, nearly invisible designs. Many can be easily adjusted using a smartphone app.

But users often complain that they can't figure out how to use the app or change the batteries. So they give up and put the hearing aids in a safe place out of sight. Most hearing aid companies can help customers resolve these problems with a phone call or online chat.

And if the devices are purchased at a local hearing center, associates are trained to help people get full use of their hearing aids. And let me, if I can comment on that. Yeah.

You know, it's, you put them in your ear. They have, you know, now like a little case, just like iPads, iPods that you can put them in to charge. You know, so you don't even have to have, you don't even have to change a battery.

And they're really small. Like I can remember when they were big and everybody could see them a mile away that you were wearing a hearing aid. But you know, nowadays with people having all kinds of different things in their ears, you know, like the ear pods and those kinds of things, they really, they have flush color.

They blend in. People are not going to know. So yes, I just want to comment as somebody who lives with a man with hearing aids, Dave was in the air force for nearly 40 years and planes and guns and all that kind of stuff.

His hearing is not ideal, but you know, like, like if you wear glasses, when you get up in the morning, put your glasses on and put your hearing aid in, you know, like one without the other. It's just think of, think of it as your glasses. It helps you do something that your eyes used to be able to do.

And now they can't, it's not a thing. Yep. Second on this list, too much bother for daily use.

Hearing is a brain activity that requires regular stimulation to interpret sounds correctly. Hearing aids are designed to help the brain recognize conversations and noises. Some people wear their hearing aids only for special events, but hearing experts say that if people won't wear their hearing aids every day, they may not get the full benefit of better hearing.

Third, uncomfortable design. Just like prescription eyeglasses, hearing aids need adjustments to fit correctly. Depending on the hearing aid design, at first wearing the devices may be uncomfortable or they may fall out.

But with a little patience and a visit to a hearing aid expert, hearing aids can fit properly and provide the full benefit of good hearing. And fourth, they don't work anymore. Over time, hearing aids can collect dirt and grime so that they won't work as well.

Some people may not realize that all they need is routine hearing aid maintenance. Also over time, people can experience age-related hearing loss. So consult a hearing professional for assistance to identify the source of the problem so hearing aids keep working properly.

And you know something else that new hearing aids do now, Charlie, is that they can connect directly to your phone. So they really are like, you know, the earpods in that the phone rings, you get a little tone in your hearing aid, and you can just hit a button on your hearing aid, and it'll answer the phone, and you can have a conversation with somebody. They can hear, you know, they can hear you, and you can hear them better because they're in the hearing aid.

And I was having, I've, I guess a soft voice, I don't know. But, Yeah. I was repeating myself a lot with David, and my daughter's an audiologist, and I said to her, is there something? And she said, well, there's this thing called a companion talker, and it's just a little square, and it connects into the hearing aid, so that it's like having a little microphone that goes directly into the hearing aid.

So I'll wear that, and I'll say to David, can you hear me? And he'll be like, yes, like, of course I can. But it's, I'm right there in the ear like a phone, or a bug, or whatever, and you can actually hear me. So that has been a major savings for my throat, because I've had some throat damage from being intubated, and I just functionally can't talk that loud all day.

And I have like really great comments, you know, like when I'm watching a movie. I'm very funny, Charlie. So he misses all my jokes.

It's just so sad. So there's lots of new technology, and I really encourage people to get hearing aids, because we want to talk to you, but we want you to be able to hear us. What? Unless you don't want to talk to us, then that's a whole other story, right? That is a different story, yeah.

You know, and one thing that you had mentioned about, you know, people sometimes are conscious of having them, what are other people going to say, what are they going to think? You know, screw that. You know, just take care of yourself. There's a whole big world out there.

Wear the damn hearing aid. But it's actually part of your socialization, because like if we go to a dinner at a restaurant with the kids, with all the ambient noise, you know, the noise of, you know, they've got the music on so loud and people are talking, even with a hearing aid, it's difficult to track a conversation because you've got all this stuff coming in. And so, you know, we'll go to dinner and David will like, maybe not respond to something and the kids have had to learn, he just didn't hear you, you know? So it's, it really could impact your relationships.

Oh, wow. I know, I was laughing because I suddenly remember with my dad, as he was getting older, oh, that's crazy. He would say that he looked forward to getting hearing aids because when, you know, my mother would then just start rambling on and on about something and getting annoyed at him.

Oh, I just remember that my dad said, I can just turn them off. Well, I'm sure that helped the relationship. Yeah, considerably.

No, but the thing about it, he did not wear hearing aids and we just could not understand why. We asked him, you know, and pretty much everything you covered in the second half. And then, you know, these four things, I mean, my siblings and I, it didn't matter.

He just did not want to wear a hearing aid. I said, listen, we can get you something state-of-the-art or if you want one of the traditional ones that, you know, everyone can see, no problem. You know, you're 90 something, nobody's going to care.

You're not a fashion maven anymore. He thought that was funny. He still didn't, he still didn't get them and we just never understood why.

Maybe he really didn't want to hear you, you know, like, and I don't say that meanly. I find that hard to hear. I don't say that meanly, you know, because David will, you know, he'll get up, he'll do things and I'll be talking to him and I'll say, is your hearing aid in? He says, oh no.

I said, well, I guess you don't want to talk to me then. And I'll just stop talking. And he's like, oh no, no, no, no, runs and he gets his hearing aid because he wants to talk.

But for whatever reason, putting it in is, he just forgets about it. And the thing is, he's had it for like five years. So it's not like, oh, it's a new thing.

He'll get used to it. Yeah. I don't know.

You know, the thought of that, and I'm sure at some point in my life, I will need hearing aids, I don't know, the thought of like taking them out and sitting and just reading, then reading and taking a little nappy. I don't know. It just sounds very, very nice.

But you live alone, Charlie, you can do that all the time. Yeah, that's true. Yeah, that is nice, actually.

Well, actually, but you know, sometimes there's noise outside construction and it's nuts. But yeah, it's not even about isolation. It's just a very nice solace, just that quietness.

But I would always, but I, no, I would definitely get hearing aids. I want to hear. Okay.

So with that thought in mind, please stay tuned for the continuing saga of Everyone Dies. And thank you for listening. This is Charlie Navarette and from Troubadour, Bob Dylan.

Man thinks because he rules the earth, he can do with it as he please. And if things don't change soon, he will. Man has invented his doom.

And I'm Marianne Matzo. And remember, there is a difference between peanut brittle and your hearing aid. Don't confuse the two.

And we'll see you next week. Remember, every day is a gift. This podcast does not provide medical advice.

All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment. Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast.

If you think you may have a medical emergency, call your doctor or 911 immediately. Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.