As our global population ages and many older workers delay retirement, a company’s roster is more likely to include employees with significant hearing loss. According to the National Institutes on Deafness and Other Communication Disorders, 37.5 million American adults (15%) report some trouble hearing, with the greatest amount of hearing loss in the 60–69 age group.
Adults with hearing impairment suffer from adverse consequences in interpersonal communication and emotional well-being, often leading to depression, difficulties in relationships, occupational stress and reduced productivity. In fact, “those who lose their hearing later in life, and whose jobs depend on effective communication, run the risk of eventually losing their jobs if satisfactory accommodations … are not instituted,” write Robert A. Dobie and Susan B. Van Hemel in their research work, Hearing Loss.
Receiving a cochlear implant can be a life-changing experience for these individuals, says David Haynes, MD, professor of Otolaryngology, Neurosurgery, and Hearing and Speech Sciences at Vanderbilt University Medical Center. But overly complicated and time-consuming healthcare protocols have created barriers that prevent some hearing-impaired employees from getting the help they need.
Employer Insights spoke with Dr. Haynes about overcoming these barriers as well as his role in building MyHearingHealth, a new Vanderbilt Health bundles program that provides employees with simplified access to cochlear implant surgery. The offering—set for an October 2020 debut— eliminates unnecessary appointments and travel and is streamlined to a single-day experience in many cases. MyHearingHealth’s highly experienced clinical team will not only enable a fast and convenient care experience for employees with hearing impairment, but the optimized process will also deliver predictable and transparent costs for employers.
Dr. Haynes gave a sneak peek of the enhanced cochlear implant surgical experience in the following Q&A:
Can you describe the stigma around hearing loss? What can help overcome those misperceptions?
It's amazing how many people with hearing loss don’t want to wear a hearing aid, but I hope this is a stigma we can address within my lifetime. It’s a cultural issue: If you need glasses, you don’t walk around without them, even though they’re much more obvious than a hearing aid would be. Even though people might be ok with glasses that are more visible on their face, they don’t want to be seen with a hearing aid.
As we move toward restoration of hearing through other means, I think that perception will change. For example, a child may not be willing to wear a hearing aid but is more than willing to wear wireless headphones. The makers of iPods are already putting amplifiers into their devices to aid those with hearing loss. Perhaps this means the kids of tomorrow will wear iPods to classes for the purposes of hearing better and no one will think anything of it. These kinds of innovations are transformative. Technology that enhances connectivity through our ears is going to happen pretty quickly. And once it does, the concept of wearing hearing aids and implanting cochlear devices are going to become much more commonplace.
Is there a growing prevalence of hearing damage in younger people because of various environmental issues or because of the use of headphones?
Theoretically, a 40-year-old now has been exposed to more noise than a 40-year-old in the 1940s, but there’s also more knowledge today that noise can be harmful. Occupational health programs are checking sound levels and employees’ hearing more often and recommending appropriate hearing protection devices.
As for headphones, I think most people are smart enough not to blare them. I wear them, too. The type of headphone matters. You would assume the bigger ones that fit relatively tightly around your ear would be so much worse, but the reality is that the smaller ones that fit poorly are worse. They are actually designed to play a louder level of sound to overcome environmental noise. So, you're better off with the big ones that actually block out all environmental sound. Technologies are improving so you can set the maximum decibel level of a headphone to shut off if it exceeds that.
Hearing loss is extremely prevalent but only 15–18% of those who need a hearing aid have gotten them. Even worse, only 4% of those who need a cochlear implant have gotten this technology. There's room for improvement, and with awareness and screening campaigns, we’re trying to let people know that there’s treatment and it can be easier than they think.
How can you break down the barriers and convince people of the benefits of cochlear implants?
We’re studying the barriers, which include those cultural perceptions around hearing loss as we mentioned, as well as a lack of knowledge and awareness. The FDA first approved cochlear implants in the mid-1980s to treat hearing loss in adults. But 40 years after FDA approval, we’re only placing them in 4% of the people who could benefit from them. It’s hard to imagine saying, “We have a treatment that restores sight,” but only a small group of people who are blind take advantage of it.
The cochlear implant bundle is a way to break down some of the barriers that patients have described to us. For patients who have difficulty understanding conversations, an implant can provide a greater benefit than hearing aids that simply make sounds louder. As technology improves, we will be able to implant more and more people with differing levels of hearing loss.
How has the population of eligible candidates changed from when you first started implanting cochlear devices?
When I first started performing these surgeries, an implant candidate had to be completely deaf with no detectable hearing of any kind. That’s because the FDA feared that if you implanted a device in someone who has some hearing and it didn’t work, you would make their hearing worse.
Now, we're implanting patients who have what we call residual hearing, which means they have enough hearing to benefit from hearing aids, but they’re not getting enough benefit from them. The implant steps up those advantages. Today, highly performing processing devices are being placed in patients with differing levels of hearing impairment, and it’s launching success stories to the forefront.
Length of deafness may play a role in performance. When a person who has been deaf for 40 years gets a cochlear implant, he or she may not show as much benefit as one with shorter periods of impairment. Yet, this period is negated in some ways by people whose ears have been primed by wearing hearing aids and are now ready to receive enhanced sound.
Here’s a typical scenario: A group of guys regularly plays golf together. Fred has the worst hearing of the foursome. But then he gets a cochlear implant and now he has the best hearing. All of a sudden, his friends want to get a cochlear implant, too. More examples of this kind of enhanced hearing performance are starting to get out there. (Read about one patient’s successful experience here.)
What can a patient expect from the MyHearingHealth experience?
The cochlear implant surgery experience used to be a long process that involved multiple players and would take weeks and even months to be complete. Now we've optimized it to a same-day process. If you would have told me back in the early days of cochlear implants that we could get the process down to one-hour operation all done in a single day, I wouldn’t have believed it.
We have built in so many efficiencies and can coordinate everything patients need in a much shorter period of time. Patients don’t have to travel to us 10 times for a CT, an MRI, and to visit with a doctor and audiologists just for one surgery—it can happen all in one to three days. In some situations, all the necessary prep work can be done in the morning, and surgery can be in the afternoon. We’re actually able to do much of a patient’s prep by telehealth, which gives us the ability to have a much more relaxed experience the day of surgery. By beginning their care before they arrive, patients show up for surgery very informed. We’re communicating with them regularly and providing them with helpful educational videos. These videos aren’t substitutes for face-to-face discussions but rather they enhance our instruction. (Learn more about the process here.)
The cochlear implant bundles experience is life-changing. It makes these people better employees, better spouses, better fathers and mothers, and better friends. When you realize that these astounding stories are only told by 4% of those who could be getting the benefit, you want more people to know.
What do you see for the future of hearing devices?
I'm a big believer in technology, and you can think of so many situations where technology can outperform human performance. Night vision glasses enable the human eye to see at night, for example. A hearing aid can’t yet outperform a regular hearing ear, but that could change. With some of the research that's being done, it's not farfetched to think that sometime in the future an implant patient could hear even better than normal.
To learn more about the features of Vanderbilt Health’s innovative MyHearingHealth and how the experience can help your workforce, click here.
