Ever wish there was a fast way to get up to speed on a complicated topic? Well, you’re in luck. This series might just be for you. As providers, it’s hard to stay on top of all the specialties in a multi-specialty world. So join us for the month of October and get back in the loop about everything that’s happening in cochlear implants from the fundamentals, candidacy, patient characteristics and the latest in tech – and you’re going to hear it from the best of the best.

This series drops in groups of episodes each week, served up in a sprint, through the month of October ending the week of November 7th. The goal is to help busy providers stay at the top of their game, by delivering the what’s happening, how we got here and where we’re going, in short episodes that are casual and easy to listen to. You can’t help but be just a little smarter by spending 20 minutes with one of these special guests. Who should be listening? Any provider who sits in front of a patient that may have hearing loss. Some episodes are narrow and detailed, focused on the otolaryngology & audiology of it all, but most are bigger picture and meant to bring in all the providers that are part of the patient’s journey to better hearing. If you practice along that continuum, than enjoy the catch-up by these impressive experts – if you know them, well, you know that you should listen up and if you don’t know these folks – then you’re in for real treat.

We open the series with the Fundamentals, basically a little overview and a little history; kicked off by Brent Lucas, CEO of Envoy Medical, followed up by my co-host, Camille Dunn, PhD. Then we meet Donna Sorkin, Jolie Fainberg, AuD, Aniket Saoji PhD and KK Gross. Next up, Candidacy with Terry Zwolan, PhD, Melissa Hall, AuD, Craig Buchman, MD, Ted McRackan, MD, Paul Shea, MD and Matt Bush, MD. Then we dive into Patient Characteristics with special guests Bruce Gantz, MD, William Shapiro, AuD, Jill Firzt, PhD, Rene Gifford, PhD, Sarah Sidlowski, AuD, PhD, and then rounding out the series with Tech and What’s Next featuring Lisa Aubert, MS, Ray Gamble, Victoria Carr-Brendel, PhD and Brent Lucas, JD. And keep your ears open for a few surprises along the way!

Check out today’s newest episodes below and be watching for the next group of episodes, dropping next week!

Episode 1: Cochlear Implants: Special Series | Introduction with Brent Lucas | Join us for the month of October for this special series on all the things that are happening in Cochlear Implants. Hear from the experts as they break down what is happening with CI in 2022. And if you’re wondering why the CEO of Envoy Medical is opening the series? Well, let’s find out!

Episode 2: Meet my Co-host, Camille Dunn, PhD | We wouldn’t be doing a CI podcast without her!  Meet Camille Dunn, PhD, CI expert audiologist, industry leader and genuinely kind and funny person that I’m lucky to call a friend.  I’m so glad she raised her hand and offered to co-host this much needed series on everything that is happening with Cochlear Implants.  I used to think that CI was for a small group of patients and that there was only a small group of providers that delivered the care – not any more.  CI in 2022 is breaking all the rules for the better of everyone – get in the loop quick with the short series podcast covering the fundamentals, candidacy, characteristics and tech – all with the best of the best.  

Episode 3: From patient to advocate, Donna Sorkin shares her extraordinary journey | Meet Donna Sorkin, the Executive Director of ACI Alliance.  She’s had quite a journey.  She gives credit to her audiologist that went above and beyond, in a time when recommending CI may not had been the norm.  That experience inspired her to become a champion of others and was the beginning of a new career of advocacy. Check out the ACI Alliance Provider Resources Here  

Episode 4: Walking the walk with Jolie Fainberg, AuD | Did you ever want to meet someone that has worked with all of the cochlear implant models that have ever been released in the US?  Well, now you have. Dr. Jolie Fainberg has quite the perspective on how the field has changed over the years.  Don’t miss out on the insight.

Episode 5: The Inventor Among Us, with Aniket Saoji, PhD | Do you remember what it felt like when you got the call that your patent was accepted?  me neither.  But this guy… he could tell a story.  Meet Dr. Aniket Saoji. He is an audiologist that understands the clinical and industry perspective, as he’s worked for the manufactures, he holds more patents than I can count on all my fingers and toes, and he sits at the helm of the audiology department at Mayo Clinic, Rochester MN.  

Episode 6: When Your Parent is the Patient. A Caregiver Perspective with KK Gross. In this episode, KK shares her experience with cochlear implants from the caregiver perspective.  Her mom, who had a sudden hearing loss in one ear over 30 years ago, decided she wanted a cochlear implant, at the young age of 90.  This short episode is an overview of that story.  

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This CI special series is sponsored by Envoy Medical.

If your patients have uttered these words recently, they are not alone.

The World Health Organization estimates that over 1 billion young adults are at risk for hearing loss[1] and there are an estimated 37.5 million adults in the USA who report some trouble hearing.[2] Additionally, with the majority of people in America wearing masks/face coverings due to COVID-19, it has created communications challenges even for those without hearing loss.

New hearing challenges in a pandemic

The face coverings worn throughout the pandemic, as well as plexiglass partitions and social distancing, have made it difficult to hear others. It is estimated that different types of facemasks attenuate everyday speech sounds by as much as 10-15 decibels.[3] This is like having a mild hearing loss, meaning people realized very quickly what it was like to suddenly have difficulty communicating each day.

Indeed, throughout the pandemic your patients likely noticed that listening was no longer easy.  Sorting out words and filling in the “missing” parts of a sentence from a loved one, colleague, or friend became difficult and tiring. Even those with otherwise normal hearing levels likely understood what it was like to have hearing loss, finding it more difficult to understand others than before. 

Discussing hearing loss

Given the widespread hearing challenges, now is the perfect time to have a conversation with your patients about their hearing. How can you begin? Try asking about their experiences during the pandemic, and if they can recognize instances before the pandemic when they had difficulty hearing or understanding conversations. And as face mask restrictions continue to ease up, you can ask them if they have any challenges when communicating even when speaking to people who aren’t wearing masks.

You can also bring up the following example, which illustrates how simple misunderstandings can be an early sign of hearing loss. For instance, your spouse or significant other may say “Please go and get my keys,” but you might hear “Please go and get some bees.” This demonstrates how quickly communications can break down by mis-hearing just one word. Given the many conversations that happen throughout the day – at home, in work meetings, at the grocery store, and even when watching TV – these simple misunderstandings can add up and cause a great deal of frustration. If left untreated, hearing loss can lead to more serious conditions, such as social isolation and even increase your risk for dementia. Unfortunately, many people with hearing loss

choose to avoid social situations out of fear of embarrassment or frustration by not being able to participate in a conversation. 

New technology delivers an enhanced hearing experience

What can patients do to address their hearing loss? The first step is to get their hearing baseline checked by an Audiologist. You’ll also want to let them know that hearing loss shouldn’t stop or limit them from going out and enjoying life again – especially as life gets back to normal! We were stuck inside for too long to miss out on any more fun, and with proper hearing treatment, they can hear all the sounds around them like never before.

Of course, some patients may be nervous about wearing hearing aids and even getting a hearing test. You can help calm their nerves by explaining the process and the wonders of today’s hearing technology.

Make sure to let them know that today’s audiology consultation involves a lot of cool tech and listening experiences that are NOT anything like the hearing aids of the past. Today’s technology like that from Widex, a 60+ year old Danish tech company, includes the WIDEX MOMENT, the smallest rechargeable receiver-in-the canal device with Artificial Intelligence and machine learning. The WIDEX MOMENT hearing device is fully automatic and can learn how wearers like to hear/listen and adapt to their unique preferences over time with My Sound. 

The sound quality from WIDEX MOMENT is one of the most coveted natural sound experiences, thanks to ZeroDelay technology that delivers the fastest processing time in the industry and eliminates the artificial sound experienced with other devices. No matter how they like to spend their time,  wearers can enjoy it with their individual listening preferences, from listening to their favorite music to enjoying social activities. 

If they still aren’t convinced about the benefits for checking and treating their hearing loss, you may want to mention how 91% of the adults who tried the new WIDEX MOMENT could now participate in life once again![4]  

The time to act is now

To help your patients hear like they used to and live life to the fullest, be sure to refer any patients with hearing loss to your practice’s Audiologists. To learn more about Widex, visit: https://www.widexpro.com/en-us/

[1] World Health Organization. (2021, April 1). Deafness and hearing loss. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

[2] National Institute on Deafness and Other Communication Disorders. (2021, March 25). Quick Statistics About Hearing. https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing

[3] Corey RM, Jones U, Singer AC. Acoustic effects of medical, cloth, and transparent face masks on speech signals. The Journal of the Acoustical Society of America 148, 2371 (2020).

[4]Balling LW, Townend O, Helmink D. Sound quality in real life–Not just for experts. Hearing Review. 2021;28(2):27-30.(2):27-30.

Diabetes and hearing loss are two of America’s most widespread chronic health concerns. More than 34 million people in the US have diabetes, and an estimated 34.5 million have some type of hearing loss. Those are large segments of patients, and it appears there is a lot of overlap between the two groups. 

Studies continue to reveal a correlation between diabetes and the increased risk for hearing and balance disorders. A recent study found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. What is even more alarming is what may be happening in the prediabetic segment. Of the 88 million adults in the U.S. who have prediabetes, the rate of hearing loss is 30 percent higher than in those with normal blood glucose. Often we ask patients about their history, and if they have diabetes may be in the list of questions we run through; however as providers evaluating a patient’s hearing and balance, it’s important to dig a little deeper. When is the last time we inquired about prediabetes? And on top of a more robust history, the more we understand about the basics of the disease, the better we will do as we manage their care over their lifetime. 

Blocking and tackling – understanding the basics of Type 1 & Type 2 diabetes.

Type 1 Diabetes

So, what is important to know out of the gate about Type 1 diabetes? Type 1 diabetes happens at every age and in individuals of every race, shape, and size. Basically, the key message is that in type 1 diabetes, the body does not produce insulin. The body breaks down the carbohydrates we eat into blood sugar, called blood glucose, and uses for it for energy.  Insulin is a hormone that the body needs to get glucose out of the bloodstream and into the cells of the body, where it can do its work. This condition can usually be managed with a lifestyle of proper diet and exercise. Insulin therapy and other lifestyle related treatments and long-term habits can lead to successful management of this condition.

Understanding Type 2

Type 2 diabetes is the most common and instead of not producing insulin, the body doesn’t use insulin properly. Type 2 diabetics can sometimes manage their disease with healthy eating and exercise, others more often, patients require medication or insulin to help manage it.

When managing a patient with diabetes, there are often a lot of players on the field.  The patient is the most important one on the team, as they are responsible for new habits and sometimes a new medication to successfully address the issues.   As a provider, getting to know the other players, communicating and collaborating on care is really important to the team’s star, as the more support a person has, be easier it is to stay on track.

Let’s get to know the different kinds of health care providers who can be part of the diabetes management team.

These can include the professionals listed below, but keep in mind, this team is broad. Talking with your patient to understand who is involved in their care is key to getting the entire picture of who is in the know, and helping with the overall management of your patient’s health.

• Primary Care Provider: the general practitioner physician or mid-level provider such as a nurse practitioner or physician assistant provides the routine medical care, including physical exams, lab tests and prescriptions for medication.
• Endocrinologist: this physician specializes in diabetes and other diseases of the endocrine system, when things get tough, they call in the big dawgs.  This team is the specialist.
• Ophthalmologist or Optometrist: Just as hearing is impacted by this disease, so are the eyes.  The medical physician or Doctor of Optometry both can play a part in the diagnosis and treatment of patients and any related eye diseases and disorders.
• Podiatrist: The foot doctor jumps in when circulation to the lower extremities is impaired.  The podiatrist is trained to treat feet and lower leg problems.
• Pharmacist: Everyone has a job here; the local pharmacist often is the one who sees the big picture when it comes to patients and their medications.  They keep an eye how they interact with each other.
• Dentist: Diabetes impacts our oral care too.  The patient’s dentist is an important player, keeping tabs on our patient’s teeth and gums.
• Registered Nurse: Often there is an RN that is overseeing chronic care management and coordinating the patient’s visits to multiple providers.  They can really make the difference for our patients and asking if there is someone in the primary care office that provides an extra hand is a good habit to get into when taking this patient’s history.
• Registered Dietitian: Being an expert in nutrition, the registered dietitian an important part of the team.  They are often advising our patients about the best foods that help manage blood sugar.
• Certified Diabetes Care and Education Specialist:  Certified Diabetes Educators have extensive training and experience working with people with diabetes.  They are coach our patients about from manage the things you need to do to take care of your diabetes, in a way that fits with your daily life, routines, environment and family dynamics. To work with an expert in a diabetes education program recognized by the American Diabetes Association, visit diabetes.org/findaprogram or call 1-800-DIABETES (800-342-2383) to find a program in your community.
• Mental Health Professional: This person may be a psychiatrist (MD or DO), psychologist (PhD) or clinical social worker (LCSW or LISW). These professionals can help you deal with the day-to-day challenges of living with diabetes as well as more serious emotional issues. Be sure to work with a mental health professional who understands diabetes and the medicine and insulin you are taking that may affect your blood sugar.
• Fitness Professional: A physical activity specialist may be an exercise physiologist, personal trainer or physical therapist. These professionals can help you find exercises that are safe for you, and ensure you get the most out of your exercise program. Be sure to work with a fitness professional who understands diabetes and the medicine and insulin you are taking that may affect your blood sugar.
• It is important to choose diabetes care team members who can provide the level of support you want and provide help when you need it. The more information you can give when you get help, the easier it is for someone to assist you. Be sure to write down questions and concerns to bring with you to your appointments.

Check out the CDC brochure that talks Ears and Diabetes – and suggests ways to prevent the negative outcomes of hearing and balance impairments. Download a quick reference here! https://www.cdc.gov/diabetes/pdfs/library/Diabetes-Ears-h.pdf

A Tale as Old as Time.

How many times have you seen a patient that told you they went to the ER because they lost their hearing?  Had a change in hearing? Or were dizzy?  When they finally arrive at your ENT practice, and you ask what was wrong, they report they had a middle ear infection.  However, after the round of antibiotics and decongestants, they still feel like their hearing isn’t any better, so they thought they would follow up with the ENT physician. The majority of time, the patient has already waited several weeks or months before they decided to come in for the appointment. When they arrive, the ENT completes a simple TFT and finds immediately that the loss is most likely not conductive in nature.

So, it makes you think, are there other medical providers that could provide better patient care if they knew how to perform a TFT? 

In talking with a number of our otologists and general ENT providers, it’s a common frustration.  Many voiced that if ER providers had performed a simple TFT, they would have made a different diagnosis! They could have treated the patient for sudden sensorineural hearing loss, referred them more urgently and the likelihood of the patient regaining some, if not all, of their hearing would had been a greater possibility. 

So, let’s think about it from inside our own house – within the ENT practice. What is the benefit of the ENT physician and other providers doing a TFT when they have audiology available to them and they indeed intend to order an audiological workup?

I recently sat down with our neuro-otologist, Mark Widick, MD, FACS and posed the question: 

“What are the benefits of performing a TFT when you have an audiogram in front of you?”

” When I was at Vanderbilt, all the audiologists did TFTs as part of their workup. The TFT would help them understand if they might have a conductive component prior to starting the testing. It helped them pick what ear to begin in, sometimes what test to start with and also sometimes they would ask different or more detailed questions. Would this not help you have more confidence in your results, especially when they are not necessarily following the pattern of hearing loss that you expected to see?

As a physician, it allows me to confirm that what I see on the audiogram is consistent with what I am hearing from the patient and finding during my TFT testing. I’m looking for consistency for diagnosis and treatment plan.

By using multiple placement sites for a Weber; forehead, mastoid, and front incisors, typically with a 512 Hz tuning fork, you can again see the consistency or inconsistencies between the placements, which when dealing with bilateral conductive hearing loss with possible masking dilemmas, gives you added confidence!

Many times, the TFT will be the final confirmation for which ear I consider performing surgery on first, in the case of bilateral involvement, i.e., typically selecting the ear with the best bone line that I see on the audiogram and again has been confirmed with the TFT. 

Sometimes the things we do are more for the patient than for us providers. Many times, the patient has an ah-ha moment when I put a tuning fork on the mastoid or teeth and an ear that the patient considered “dead” or “of no use” all of the sudden can “hear”. This helps open them up to different treatment options, where they may have not been in a place where they would had truly considered them without the experience.”

As we continued our conversation, Dr. Widick asked me to put myself in his shoes, the shoes of the surgeon, and it quickly gave me insight into why they SHOULD be validating the audiogram.  If I was the surgeon, and there was a simple way to back up the results of the audiometric battery, which can reveal conflicting results particularly when there is disease, I would feel it was my responsibility to do so.  Also, as providers, we want our patients to trust that we are aligned as a team and working toward the most positive outcome possible. 

Ultimately, the physician performing the TFT had nothing to do with his trust in my ability as an audiologist nor was it a dispute that the TFT was a more scientific approach to the assessment and diagnosis of hearing loss.  More holistically, as a physician that is getting ready to take a patient into surgery, it was about knowing that he did everything to confirm that the results were aligned, and the procedure was truly indicated. 

Not every patient will need a TFT; however, for many it may be the final piece of the puzzle that confirms results and assures the provider that their medical or surgical treatment plan is the best path for the patient.  

A big thank you to Dr. Mark Widick for his time and insight.  Check out the “Under the Microscope” presentation for great information and discussion of the TFT.

About Mark H. Widick, MD, FACS

Dr. Mark H. Widick graduated from the University of Florida School of Medicine in Gainesville, FL in 1987. He completed his general surgical residency and otolaryngology residency at Vanderbilt University and completed a fellowship in Otology and Neurotology under Dr. Michael Glasscock at The Otology Group. Dr. Widick is Board Certified by the American Board of Otolaryngology.

Dr. Widick has served as President of the EAR Foundation of Florida and Delegate to the Board of Governors at the American Academy of Otolaryngology – Head and Neck Surgery.

He is actively involved with the American Academy of Otolaryngology – Head and Neck Surgery, the Florida Medical Association and the Palm Beach County Medical Society. He is currently the President of the Florida Society of Otolaryngology – Head and Neck Surgery. Dr. Widick has lectured at numerous conferences and has published in several medical journals. He has also served on the faculty of Vanderbilt University as a Clinical Instructor in the Department of Otolaryngology.

Read Dr. Mark Widick’s Bio