Specialties: Otology & Neurotology, Skull Base Surgery, Otolaryngology, and Pediatric Otolaryngology CredentialsPositions
Board Certifications
Education and Training
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery at NYU Grossman School of Medicine
- Director, Resident Research, Department of Otolaryngology
Board Certifications
- American Board of Otolaryngology (Neurotology), 2018
- American Board of Otolaryngology - Otolaryngology, 2015
Education and Training
- Fellowship, NYU Langone Hospitals, Otology/Neurotology, 2016
- Residency, NYU Langone Medical Center, Otoloaryngology, 2014
- MD from New York University, 2009
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seventy ten WOOR It's the Chairmanof Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Good morning everyone, Welcome the
CATS's Corner here on wr iHeartRadio.So glad you could join me this morning.
(00:42):
We have a wonderful show for youtoday. I think that you all
enjoy it. It's a topic thatdoes come up quite frequently, and that
is hearing issues in age related hearingloss. I certainly deal with this a
lot in my practice as a urologist. We certainly see I particularly see older
men with this problem, but itcertainly affects both men and women as well
(01:06):
as younger people as well. Andto help us with the discussion, I've
asked doctor David Friedman, whose AssociateProfessor of odol Arongology had an next surgery
in the Division of Neurotology and Skullbase Surgery at the NYU Grossman School of
Medicine. Doctor Friedman does lots ofclinical and research in this area. His
(01:26):
clinical focus is related to medical andsurgical management of both adult and pediatric hearing
loss and your disorders. He hasextensively published his outcomes on cochlear implantation,
which we're going to discuss this morning, and does lots of research. His
research has been funded by the NIHand the VA Health systems, including an
(01:51):
ongoing clinical trial to establish hearing screeningand rehabilitation program in primary care for older
adults. And he is all alsoa principal investigator of a randomized clinical trial
to which looks at repairing eardrum perforationsin the office setting. So something else
that we're going to get into allof that. Thank you so much,
(02:13):
David for coming on the show thismorning. Really appreciate you coming on Katz's
Corner. Thank you, It's reallynice to be here. Thanks for having
me. Yeah, so maybe wecan start out with some basic questions about
hearing loss, And you know you'vebeen doing this for a while, and
I know that you're up on thelatest and greatest research here. What is
(02:34):
the prevalence and how common is thisage related hearing loss? You know,
we think about hearing loss, wethink about it from some different perspectives,
and that includes what we could measurewhen you do a hearing test, but
also just what patients perceive. AndI think that the reality is like many
other issues that we both deal with, you know, with age, there's
(02:54):
changes in our physiology and how oursystems work, and hearing is certainly one
of them. Really from the timewhere kids we're losing some degree of hearing
function over time, it's not necessarily, you know, enough to make much
of a difference into young adulthood,but certainly when we look at adults,
you know, sixty years and older, there's a measurable proportion of those that
(03:16):
have what we would consider significant hearingloss. It's not always the case that
they recognize it or notice it.Sometimes it's brought to attention by spouses or
friends. But as we get older, we lose hearing and in terms of
exact numbers, you know, there'sdifferent studies depending on if you talk about
(03:37):
a subjective report of somebody saying theyhave hearing issues or something that you measure,
but it's close to, you know, almost fifty percent when we get
into the late sixties early seventies interms of our age. Yeah, I
often wonder, I see and I'ma do this myself listening to music or
on the AirPods. You know,people are walking around all kinds of things
(04:00):
in their ears, headphones and soforth, listening to music. Do you
think that that's detrimental anyway? Doyou think that that could be harmful down
down the line? Yeah, No, I mean I think you know,
I've heard sometimes you go to academicmeetings with other ear surgeons and we think
of those as future patients really becauseunfortunately, there's quite a significant amount of
(04:23):
exposure that can come with you know, loud volumes, even from personal amplifiers
or you know, whether it's airpods or whatnot. And I think,
you know, really, uh,you know, the traditionally people think about
occupational exposures, working in factories,working in the military. The reality is
(04:43):
that if you're listening loud enough andlong enough, so it's both intensity of
sound but also the duration you knowwhether or not you're listening for a few
minutes versus hours, you can causean ifidiant damage. And and the companies,
you know, I'll say, domake that information avail in terms of
safe levels, especially for parents thathave children that they might be concerned about
this. But it's not, youknow, something that you sort of have
(05:08):
to put in place. There's nodefault protections generally with some of the more
widely used consumer products. And certainlyI think that we know that exposures that
those volumes can definitely cause long termdamage. Yeah, I wonder that myself
all the time. I mean,I've certainly, you know, we certainly
know about some things that clearly arerelated to hearing loss. I know that
(05:30):
there's certainly, you know, inthe area of oncology, we certainly see
patients that are receiving various forms ofchemotherapy that may be related to hearing loss,
any anything else, any other predisposingfactors that are that are common or
that you know, people can beconcerned about or aware of. You know,
well, I think the thing isthat these things do, these things
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do combine, so you know,there's simulative effects when you think about you
know, I think you're alluding tosome what we call outotoxic medications, and
there's an a lot of them,you know, some very commonly used and
some less commonly used, but youknow, a whole list of medications that
hopefully before especially if it's being prescribed, your provider might have gone over the
fact that, you know, there'sa relationship with hearing loss. Also in
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the in the urology space, andyou know, we we have patients coming
in often reading about, you know, medications used for rectiudysfunction that have been
linked to sudden hearing loss in somecases, so certainly they I think it
pervades all fields in terms of atleast some of these relationships with hearing loss.
And I think the thing to pointout is that we all get older,
hopefully, and so the age aspectsort of comes with you and what
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sort of exposures did you have whenyou were younger, whether medications, whether
it was going to a lot ofconcerts, listening to loud, occupational stuff.
These things sort of all add onto each other. And of course
a big aspect of this that wereally can't do all that much about at
this point as genetics, there arecertainly just predispositions, you know, aside
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from those of us born, youknow, those children born with hearing loss
or whatnot, to a great extent, there still can be a genetic predisposition
to developing what we call you know, from earlier onset age related hearing loss,
and so those things can come together. And so there's factors like you
know, environmental that you can control, maybe medications and noise exposure, and
then other things that are really notin our control. Certainly, it's very
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common medications that we use that youknow, we just prescribe, you know,
antibiotics, I'm sure well known,autotoxins, things like that, but
certainly even things that we're not evenaware of it. And I didn't you
know, I was doing some researchibuperfana. Is that is that not like
non steroidals? Is that related tohearing loss or not? Yeah? I
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would say more so what we seewith aspirin in particular is what we call
reversible tentatives or tenus or some peoplesay tondis. People will often come to
our attention sooner with that than withhearing loss per se. And for those
that don't know, you know,tenadus is essentially sort of a sound or
an auditory sensation that's not really presentin the environment, but that we perceive.
(08:03):
And so sometimes aspirin, as anexample, is cited as a medication
that can bring about in high doses, not you know, not sort of
conventional use, but sort of overdoseof aspirin. Patients will often describe having
tenetus or ear ringing. Interestingly aboutaspirin is that it's often reversible with decreasing
the dose. In general, auditorydamage or hearing damage is not necessarily reversible,
(08:30):
but that's an example of one thatactually is. What about the erectile
medications is that reversible? I'm surea lot of guys listening are wondering.
I mean, I hadn't really heardabout that, but have you seen that
in your practice, like viagracialis relatedto Yeah, as recently as in the
last week or so, I didhave a patient. We talked about it.
No, I think the difficult part, as you know, is sort
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of can we do we attribute thisto that medication? Unfortunately, that's a
common problem or how this function andpeople trying to use medications to treat it.
Hearing loss as we alluded to,is common, and so you know,
in these large studies. Are thesereally just sort of in essence coincidences
or correlations, or are they reallyis one causing the other? I have
(09:13):
dug into this data a bit justbecause of seeing patients with it, and
some of them, after suffering asudden hearing loss in one ear, were
really unsure what to do. Thiswas a medication that was important to their
quality of life. Was it safefor them to continue? Should they stop
because they didn't want to risk losingtheir hearing and their only hearing ear that
was remaining. I really did notsee any clear evidence of a causal relationship,
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but I think there are ideas aboutsort of from a mechanistic standpoint,
how one might lead to the other. I really think sort of the juries
still out and need some more definitivedata to answer that question. Sure,
I mean you mentioned genetics earlier,and I think that's certainly something that probably
needs work, further work or lookinginto. I mean, certainly if someone
is parent has had hearing loss ata younger age, that maybe they would
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be more aware of certain medications andtry to stay away from those that have
been associated with with hearing loss,just because you know, you can't run
from genetics right, so that maybethey are predisposed, and like you said,
it could be a cumulative effect oreven maybe a one time thing if
someone has some underlying genetic defect thatmay predispose them. Perhaps, you know,
(10:24):
it's a great point. And Ithink you know what's gotten a lot
of attention is and even you knowin the late press these days related to
the genetics the genetic causes of deafness. You know, what can we do
about a child is born without hearing? What has received less attention, but
I think still is important and stilldoes have a genetic basis is like you
alluded to, sort of earlier onsethearing loss, and whereas at the moment
(10:48):
we don't currently have treatments for that, there is a whole lot of work
going on related to essentially gene therapyto try to address specific issues genetically that
might be going on in some casesto actually cause these inner ear hair cells
sort of the sensory cells within thecochlea, to see if we can figure
out a way to regenerate those.Essentially, as it is now, we
(11:09):
are all born with a set numberof those and as they sort of die
off with time, whether it's fromnoise exposure, whether it's from just sort
of medications or age related effects.We don't get those back, and so
there is research going on in termsof seeing whether or not there's a way
to actually regenerate those But to yourpoint, you know, in terms of
(11:31):
what we can do now, whatI talk to patients about, whether they're
coming in with a genetic cause ora medication related cause, noise noise related
costs you related to sort of thisgoing on in the VA and military populations,
as I just focus on what wecan do moving forward, and because
this effects are cumulative, you know, sometimes getting a hearing test, which
(11:52):
which many patients never do get,is an important opportunity to sort of think
about, well, okay, where'smy hearing at now? What sort of
steps can I take in terms offuture exposures, whether it's you know,
bringing earplugs if I'm going to goto a loud event, or being a
little bit more mindful about how loudI listen to music on my personal system.
These are these are the kinds ofthings that we do have control over,
(12:15):
and sometimes it sort of takes whetherit's a hearing test or some sort
of event to make us realize thatwe're we're really exposing our ears to dangerous
levels of sound in a number ofdifferent environments. You know, there's a
lot of focus on this recently.There really is no time in life unless
you brought it to somebody's attention whereyou might might have gotten one otherwise.
(12:35):
As it relates to men's health issuesand women's health issues, you know that
there's a lot of work that goesinto the what we call the US Preventative
Task Force recommendations where they review thedata. And you know this has been
in the news a lot recently formomography and other things. Interestingly, when
that when that board, when thatgroup looked at hearing loss in terms of
whether or not screening should be consideredan adult. This is only in the
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last few years. They did notrecommend routine hearing screening for adults, and
you know, a lot of usin the field sort of scratched our heads,
well, why would that be.This is important, this is common.
This is affecting people's quality of lifeand communication. The reason was that
they cited was the lack of reallyevidence that getting a hearing test changes anything
in terms of what patients do.Do they go out and get some sort
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of treatment, does that treatment helpthem in some way? And so,
you know you alluded to earlier thisstudy that we're working on, and part
of what we're trying to do issort of develop that evidence space to support
those recommendations changing. So that's thatwe can expect that adults, especially at
a certain age, would be gettinghearing tests more commonly. In terms of
(13:39):
your question about what is what goeson during a test, you know,
hearing tests specifically are generally performed bylicensed audiologists, and in the traditional place,
they'll be performed in a some sortof sound treated or soundproof booth,
and like like you described, youknow, it hasn't changed all that much
in terms of what we typical audiometry. You might put on a pair of
(14:03):
headphones or ear insert plugs and theywould evaluate the two years individually. Usually
that's from a standpoint of both yourlevel of hearing sensitivity, but also importantly
what we call your speech recognition oryour ability to understand speech provided the sound
is loud enough. And that sortof gets at the issue for example that
okay, maybe if we boost thesound, if you use something like some
(14:26):
amplification, like some hearing aids wouldthat overcome some of the issues that you're
having with communication. And I'd sayfor most patients with age related hearing loss,
if you make the sound louder,their experience with communication is going to
be better. They're going to havean easier time understanding what other people are
saying. There are a subset ofpatients, especially with more severe hearing loss,
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that even when you make that soundlouder, they still will have difficulty
understanding the speech or having what wecall speech clarity. And you know,
those are patients that potentially other optionsare better choice treatment wise than cochlear implaps,
sorry, such as cochlear implaps,But you know, you really wouldn't
know that so much without some sortof evaluation. It is true that now
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there's more and more opportunities to dothis with your smartphone. So there are
a number of apps that you candownload to test your hearing, and certainly
from a sort of sophistication and calibrationstandpoint, you know, they may not
be as definitive, but I thinkfor a lot of patients, just to
get a sense of am I hearingsort of things at a level that that
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I should be or do I needto get this checked out. Potentially,
some of those things that you coulddo on your couch would be a good,
good, good start to help youin particular that you're that you're a
fan of or that you want toYou know, there's I mean, there's,
there's, you know, there therethere's more and more, honestly all
the time. I think if yourlisteners were to go on it and sort
(15:58):
of sort of google the topic,you'd see a number of them in different
ones, and you know, Ican't vouch brain them individually in terms of
their validation and whatnot, but it'sjust getting a sense of again, you
know, I think to a degreeof is this something that you know,
especially if you're having other people aroundyou sort of raise that concern I alluded
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to earlier. We often will hearyou know, or sometimes paste coming in,
will come in with their spouse andthey may sit there say, I
don't you know, I don't havea problem. I don't know why you
know. So and so thinks thatI do. But but sure enough,
when you do assess those stations interms of their hearing, they usually do
have fairly significant hearing loss, andso there is that sort of potential issue
(16:38):
of a of a connection between whatsomebody perceives they're missing out on or not.
You know, I use the exampleof glasses a lot where when we
you know, those of us thatwear glasses or have experience putting on glasses,
I mean, all of a sudden, you can really experience things in
a different way. And you'll hearthis from patients sometimes when they do seek
treatment, if they get a pairof hearing aids, if that's appropriate for
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them, they just didn't realize allthe sounds they weren't hearing. You know,
they didn't realize how many birds wereliving outside their apartment or their house.
You know that now all of asudden they're hearing in the morning that
they weren't hearing, or their spousewas yelling at them to clean up the
clean up the apartment of the house, and they I never hear you.
You know, that's selective hearing loss. I think if you're just waking up
in the morning. Here and Katzis corner, we're talking with doctor David
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Friedman, Associate Professor voter Alerngology,Head next Surgery in the Division of Neurotology
and Skull Based Surgery at NYU.Grossman School of Medicine. He's been kind
before the show to give me hisphone number, so if you are interested
in a consultation, please write thisnumber down. I'll give it one more
time at the end of the show. It's two one two two six three
fifty five sixty five two one twotwo sixty three five five sixty five.
(17:48):
And I you know, we havethese recommendations too by the United States Preventive
Task Force, and if you listento them, we wouldn't be doing PSA
testing and we wouldn't be able to, you know, screen for prostate cancer
appropriately and pick up all these disorders. And I think it's you know,
you're right. You know, weget our eyes checked, we get our
call and checked or prost checked orbreast checked, and you know, you
know, we should be testing ourhearing more often. And I hope your
(18:08):
research will bear bear that and showthat we do need to do more screening.
Let's get into the to the optionsthough, it's you know, what
are the options for people when theystart noticing the hearing loss. You've done
some hearing testing, and you knowthere's a there's certainly, you know,
an objective measurement that there's hearing loss, Where do what are the options for
(18:30):
for for folks out there? Yeah, so, I mean I think the
first is usually just what'll be calledjust an understanding of sort of what are
some basic strategies you could use andso you don't even need to have a
hearing test to sort of take advantageof some of these, and some of
them are are sort of common sense, but you know, making sure that
you can see the person who's whoyou're talking with, you know, see
their lips, and certainly mask maskingduring the last few years with COVID posed
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a big problem for a lot ofpeople with hearing loss, actually exposed some
people that didn't know they had hearingloss because you know, all of a
sudden they were really having trouble understanding. They didn't realize how much they were
relying on visual cues from seeing people'syou know, mouths move while they were
speaking. But you know, beingaware that that can help you, making
sure that you know your you're usingloud voice and and sort of the some
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of the basic things that that sortof enhance communication. Beyond that, you
know, these options have really expandedin the last years. More more traditionally
I alluded to earlier that a hearingaid, you know, something that amplifies
sound, and these comes in varietyof different sizes and shapes, would really
be the definitive way to treat youknow, age related hearing loss. These
would be usually fit and dispensed byan audiologist, a licensed audiologist. This
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is not a service unfortunately that CMSor Medicare has has included as part of
the care that's provided that way,and so a number of older adults would
have to go and you know,pay pretty significant fees out of pocket to
get hearing aids. And so what'schanged is you know, really going back
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now a couple of years, thegovernment, federal government has taken on the
challenge of making these devices, orat least some type of device, some
type of amplification device available direct toconsumer, at least for sort of what
we consider mild moderate levels of hearingloss. So some of the more common
issues that patients might experience, theynow can, at least if they're interested,
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explore this on their own. Theydon't need to see a position,
they don't need to have a formalevaluation with an ideologist. They can essentially,
you know, you can go ononline and buy something on Amazon or
through direct through these different companies andat least try what they have to offer
in terms of you know, mostcases they're just giving you a boost and
volume. What's different about these thanlet's say, turning up the TV or
(20:55):
turning up the volume on your phone, is that ideally your amplification devices giving
what we call frequency specific gain.When we lose hearing with age, we
don't just lose all hearing. Wetend to lose high frequency hearing. If
you think of a piano, highfrequencies are the sort of the keys on
the right side and with higher pitchedsounds that really affects the speech clarity issues
(21:18):
if you're not hearing those, andso turning up the volume specifically on the
high frequencies is what's needed. Sowhen you go to an audiologist, they
have the ability to sort of selectivelyamplify or increase the volume for the sounds
that you need to sort of configureyour particular pattern of hearing loss. And
so what some of these over thecounter devices do, at least the better
(21:41):
ones, is they will do you'lldo a hearing test on your own through
their own app, proprietary app,and it'll configure what your hearing pattern is
like, and you can then goin and it will automatically program your hearing
aid or you're over the counter deviceto give you the boost and volume where
you need it. And this issomething that is really the first line for
(22:08):
patients with hearing loss to try.Whether it's again whether you choose to go
through a licensed provider, a licenseideologist, or or you want to try
one of these newer technologies, butboosting the volume is going to be the
first thing that we think about whenwhen patients are having and besides the costs
(22:29):
and not working, are there anyother potential downsides of doing an over the
counter type of hearing aid? Youknow, there are there are particular sort
of what we call red flag typeissues, you know, if somebody has
something going on, and you know, some of those probably worth mentioning that
if somebody has one sided hearing loss, if they have ringing that's particularly more
significant than one side versus the other, those are definitely patients that should be
(22:52):
seeking medical attention first and sort ofgetting a clearance that okay, you know,
this is nothing else that needs tobe investigated. You can go ahead
and get you know, hearing aidsor over the counter if you choose to
go that way. But in general, it's a it's a it's a safe
initial approach. And if you know, I think the other things that come
(23:12):
up that you know, I thinkwe have a long ways to to to
try to address as a society,is really some of the issues related to
stigma and why is it that,For example, at least in my experience
talking to patients, you know,many patients with eyeglasses on will tell me
I'm you know, I'm too I'mtoo young to get a hearing aid and
why is it that, you know, sort of that sense is really viewed
(23:33):
differently in terms of what what theimpact of the stigma is associated with hearing
loss that's compared with something like,you know, decline and vision or other
things that you know, many ofus experience not even necessarily related to age.
I just want to ask you,because we just have a few minutes
left, about the you mentioned earlierabout a cochlear implant. Who would be
a candidate to that and what's involvedwith that if you could do that in
(23:57):
a minute and a half. Yeah, no, I mean it's really important.
I think, you know, unfortunatelywe know that many fewer patients who
would be appropriate forget for a cocreimplant do not get them. So I'm
a cochlear implant surgeon as part ofthe NYU team and one of the largest
and really longest running cocre mdplant programsin the country. So co core implants
(24:18):
when they first were developed, werereally for patients who couldn't hear anything.
If you could hear the difference betweena you know, a car horn and
somebody speaking, then you probably weren'tin a candidate at that time in the
nineteen eighties for a cokeler implant,And things have really progressed over the years
where you can you can have acertain level of hearing and even speech understanding.
But if it's not sufficient for you, whether that's something that you decide,
(24:41):
you know, in conversation with yourteam or based on sort of preset
standards that we have, then youmight be a candid for cochlear endplants.
So different different than amplification or likea hearing aid, a cocrand plant is
a surgically implanted device that requires aprocedure, and these devices actually restore hearing
by directly ste mulating the auditory orthe hearing nerve. So it's sort of
(25:03):
a totally different pathway and a slowlydifferent approach to hearing. But you can
actually restore hearing, and these arethings that are commonly done for children that
are born without hearing. And thenthe other largest growing portion of the population
that we serve are older adults,adults over eighty or even ninety years of
age, who you know, losetheir hearing over time and aren't getting benefit
(25:26):
from hearing age. So an indicationfor a patient would be if they're not
if they're not benefiting from a hearingaid the way they used to, they're
not having an issue. If they'recontinue to have issues with speech, understanding,
with having clarity, then certainly beingvalued for a cokeram plant is a
good idea, and it is thatcovered by Medicare and CMS the implant.
Yeah, it would be hard forme to explain to you why that is,
but yes it is. Ironically,so CMS does cover Cokera implants and
(25:49):
it's a safe you know, it'sa safe procedure that good you know.
I really encourage people to think aboutif they're having trouble with with the hearing,
even with hearing aids all right,and at least to fix problem,
the cochlear implan is doing that.You can get it through Medicare insurance and
certainly someone that has hearing loss shouldcall you. Doctor David Freedman. I
want to thank you so much forcoming on the show this morning. His
(26:11):
number again and his team at NYUis two one two two six three fifty
five sixty five. That's two onetwo two six three five five six y
five. If you are a loverand have any sort of hearing loss,
I would strongly encourage you to givehim and his team members a call.
Thank you so much, David.I really appreciate you coming on the show.
It was great you're you're a terrificperson and great wealth of information and
(26:34):
I can tell you're very passionate aboutthis field. So thank you very much
and we'll have you on again soon. Thanks so much. Well, that's
the end of the show everyone.I wish you are all happy Sunday.
Have a great day. Everyone tunein every Sunday here on Katsus Corner.
We'll be back next week with agreat show. This is doctor Aaron Kats.
You've been listening to Katzer's Corner comeback every week to hear more straight
(26:55):
talk on a wide range of men'shealth topics and advice son how to live
of your healthiest life. The proceedingwas a paid podcast. iHeartRadio's hosting of
this podcast constitutes neither an endorsement ofthe products offered or the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Katz's Corner with doctor Aaron Katz.
You're trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seventy ten WOOR It's the Chairmanof Urology at NYU Land Gone Hospital,
Long Island. Here is doctor AaronKatz. Good morning everyone, Welcome the
CATS's Corner here on wr iHeartRadio.So glad you could join me this morning.
(00:42):
We have a wonderful show for youtoday. I think that you all
enjoy it. It's a topic thatdoes come up quite frequently, and that
is hearing issues in age related hearingloss. I certainly deal with this a
lot in my practice as a urologist. We certainly see I particularly see older
men with this problem, but itcertainly affects both men and women as well
(01:06):
as younger people as well. Andto help us with the discussion, I've
asked doctor David Friedman, whose AssociateProfessor of odol Arongology had an next surgery
in the Division of Neurotology and Skullbase Surgery at the NYU Grossman School of
Medicine. Doctor Friedman does lots ofclinical and research in this area. His
(01:26):
clinical focus is related to medical andsurgical management of both adult and pediatric hearing
loss and your disorders. He hasextensively published his outcomes on cochlear implantation,
which we're going to discuss this morning, and does lots of research. His
research has been funded by the NIHand the VA Health systems, including an
(01:51):
ongoing clinical trial to establish hearing screeningand rehabilitation program in primary care for older
adults. And he is all alsoa principal investigator of a randomized clinical trial
to which looks at repairing eardrum perforationsin the office setting. So something else
that we're going to get into allof that. Thank you so much,
(02:13):
David for coming on the show thismorning. Really appreciate you coming on Katz's
Corner. Thank you, It's reallynice to be here. Thanks for having
me. Yeah, so maybe wecan start out with some basic questions about
hearing loss, And you know you'vebeen doing this for a while, and
I know that you're up on thelatest and greatest research here. What is
(02:34):
the prevalence and how common is thisage related hearing loss? You know,
we think about hearing loss, wethink about it from some different perspectives,
and that includes what we could measurewhen you do a hearing test, but
also just what patients perceive. AndI think that the reality is like many
other issues that we both deal with, you know, with age, there's
(02:54):
changes in our physiology and how oursystems work, and hearing is certainly one
of them. Really from the timewhere kids we're losing some degree of hearing
function over time, it's not necessarily, you know, enough to make much
of a difference into young adulthood,but certainly when we look at adults,
you know, sixty years and older, there's a measurable proportion of those that
(03:16):
have what we would consider significant hearingloss. It's not always the case that
they recognize it or notice it.Sometimes it's brought to attention by spouses or
friends. But as we get older, we lose hearing and in terms of
exact numbers, you know, there'sdifferent studies depending on if you talk about
(03:37):
a subjective report of somebody saying theyhave hearing issues or something that you measure,
but it's close to, you know, almost fifty percent when we get
into the late sixties early seventies interms of our age. Yeah, I
often wonder, I see and I'ma do this myself listening to music or
on the AirPods. You know,people are walking around all kinds of things
(04:00):
in their ears, headphones and soforth, listening to music. Do you
think that that's detrimental anyway? Doyou think that that could be harmful down
down the line? Yeah, No, I mean I think you know,
I've heard sometimes you go to academicmeetings with other ear surgeons and we think
of those as future patients really becauseunfortunately, there's quite a significant amount of
(04:23):
exposure that can come with you know, loud volumes, even from personal amplifiers
or you know, whether it's airpods or whatnot. And I think,
you know, really, uh,you know, the traditionally people think about
occupational exposures, working in factories,working in the military. The reality is
(04:43):
that if you're listening loud enough andlong enough, so it's both intensity of
sound but also the duration you knowwhether or not you're listening for a few
minutes versus hours, you can causean ifidiant damage. And and the companies,
you know, I'll say, domake that information avail in terms of
safe levels, especially for parents thathave children that they might be concerned about
this. But it's not, youknow, something that you sort of have
(05:08):
to put in place. There's nodefault protections generally with some of the more
widely used consumer products. And certainlyI think that we know that exposures that
those volumes can definitely cause long termdamage. Yeah, I wonder that myself
all the time. I mean,I've certainly, you know, we certainly
know about some things that clearly arerelated to hearing loss. I know that
(05:30):
there's certainly, you know, inthe area of oncology, we certainly see
patients that are receiving various forms ofchemotherapy that may be related to hearing loss,
any anything else, any other predisposingfactors that are that are common or
that you know, people can beconcerned about or aware of. You know,
well, I think the thing isthat these things do, these things
(05:51):
do combine, so you know,there's simulative effects when you think about you
know, I think you're alluding tosome what we call outotoxic medications, and
there's an a lot of them,you know, some very commonly used and
some less commonly used, but youknow, a whole list of medications that
hopefully before especially if it's being prescribed, your provider might have gone over the
fact that, you know, there'sa relationship with hearing loss. Also in
(06:14):
the in the urology space, andyou know, we we have patients coming
in often reading about, you know, medications used for rectiudysfunction that have been
linked to sudden hearing loss in somecases, so certainly they I think it
pervades all fields in terms of atleast some of these relationships with hearing loss.
And I think the thing to pointout is that we all get older,
hopefully, and so the age aspectsort of comes with you and what
(06:36):
sort of exposures did you have whenyou were younger, whether medications, whether
it was going to a lot ofconcerts, listening to loud, occupational stuff.
These things sort of all add onto each other. And of course
a big aspect of this that wereally can't do all that much about at
this point as genetics, there arecertainly just predispositions, you know, aside
(06:57):
from those of us born, youknow, those children born with hearing loss
or whatnot, to a great extent, there still can be a genetic predisposition
to developing what we call you know, from earlier onset age related hearing loss,
and so those things can come together. And so there's factors like you
know, environmental that you can control, maybe medications and noise exposure, and
then other things that are really notin our control. Certainly, it's very
(07:19):
common medications that we use that youknow, we just prescribe, you know,
antibiotics, I'm sure well known,autotoxins, things like that, but
certainly even things that we're not evenaware of it. And I didn't you
know, I was doing some researchibuperfana. Is that is that not like
non steroidals? Is that related tohearing loss or not? Yeah? I
(07:42):
would say more so what we seewith aspirin in particular is what we call
reversible tentatives or tenus or some peoplesay tondis. People will often come to
our attention sooner with that than withhearing loss per se. And for those
that don't know, you know,tenadus is essentially sort of a sound or
an auditory sensation that's not really presentin the environment, but that we perceive.
(08:03):
And so sometimes aspirin, as anexample, is cited as a medication
that can bring about in high doses, not you know, not sort of
conventional use, but sort of overdoseof aspirin. Patients will often describe having
tenetus or ear ringing. Interestingly aboutaspirin is that it's often reversible with decreasing
the dose. In general, auditorydamage or hearing damage is not necessarily reversible,
(08:30):
but that's an example of one thatactually is. What about the erectile
medications is that reversible? I'm surea lot of guys listening are wondering.
I mean, I hadn't really heardabout that, but have you seen that
in your practice, like viagracialis relatedto Yeah, as recently as in the
last week or so, I didhave a patient. We talked about it.
No, I think the difficult part, as you know, is sort
(08:52):
of can we do we attribute thisto that medication? Unfortunately, that's a
common problem or how this function andpeople trying to use medications to treat it.
Hearing loss as we alluded to,is common, and so you know,
in these large studies. Are thesereally just sort of in essence coincidences
or correlations, or are they reallyis one causing the other? I have
(09:13):
dug into this data a bit justbecause of seeing patients with it, and
some of them, after suffering asudden hearing loss in one ear, were
really unsure what to do. Thiswas a medication that was important to their
quality of life. Was it safefor them to continue? Should they stop
because they didn't want to risk losingtheir hearing and their only hearing ear that
was remaining. I really did notsee any clear evidence of a causal relationship,
(09:39):
but I think there are ideas aboutsort of from a mechanistic standpoint,
how one might lead to the other. I really think sort of the juries
still out and need some more definitivedata to answer that question. Sure,
I mean you mentioned genetics earlier,and I think that's certainly something that probably
needs work, further work or lookinginto. I mean, certainly if someone
is parent has had hearing loss ata younger age, that maybe they would
(10:01):
be more aware of certain medications andtry to stay away from those that have
been associated with with hearing loss,just because you know, you can't run
from genetics right, so that maybethey are predisposed, and like you said,
it could be a cumulative effect oreven maybe a one time thing if
someone has some underlying genetic defect thatmay predispose them. Perhaps, you know,
(10:24):
it's a great point. And Ithink you know what's gotten a lot
of attention is and even you knowin the late press these days related to
the genetics the genetic causes of deafness. You know, what can we do
about a child is born without hearing? What has received less attention, but
I think still is important and stilldoes have a genetic basis is like you
alluded to, sort of earlier onsethearing loss, and whereas at the moment
(10:48):
we don't currently have treatments for that, there is a whole lot of work
going on related to essentially gene therapyto try to address specific issues genetically that
might be going on in some casesto actually cause these inner ear hair cells
sort of the sensory cells within thecochlea, to see if we can figure
out a way to regenerate those.Essentially, as it is now, we
(11:09):
are all born with a set numberof those and as they sort of die
off with time, whether it's fromnoise exposure, whether it's from just sort
of medications or age related effects.We don't get those back, and so
there is research going on in termsof seeing whether or not there's a way
to actually regenerate those But to yourpoint, you know, in terms of
(11:31):
what we can do now, whatI talk to patients about, whether they're
coming in with a genetic cause ora medication related cause, noise noise related
costs you related to sort of thisgoing on in the VA and military populations,
as I just focus on what wecan do moving forward, and because
this effects are cumulative, you know, sometimes getting a hearing test, which
(11:52):
which many patients never do get,is an important opportunity to sort of think
about, well, okay, where'smy hearing at now? What sort of
steps can I take in terms offuture exposures, whether it's you know,
bringing earplugs if I'm going to goto a loud event, or being a
little bit more mindful about how loudI listen to music on my personal system.
These are these are the kinds ofthings that we do have control over,
(12:15):
and sometimes it sort of takes whetherit's a hearing test or some sort
of event to make us realize thatwe're we're really exposing our ears to dangerous
levels of sound in a number ofdifferent environments. You know, there's a
lot of focus on this recently.There really is no time in life unless
you brought it to somebody's attention whereyou might might have gotten one otherwise.
(12:35):
As it relates to men's health issuesand women's health issues, you know that
there's a lot of work that goesinto the what we call the US Preventative
Task Force recommendations where they review thedata. And you know this has been
in the news a lot recently formomography and other things. Interestingly, when
that when that board, when thatgroup looked at hearing loss in terms of
whether or not screening should be consideredan adult. This is only in the
(12:58):
last few years. They did notrecommend routine hearing screening for adults, and
you know, a lot of usin the field sort of scratched our heads,
well, why would that be.This is important, this is common.
This is affecting people's quality of lifeand communication. The reason was that
they cited was the lack of reallyevidence that getting a hearing test changes anything
in terms of what patients do.Do they go out and get some sort
(13:18):
of treatment, does that treatment helpthem in some way? And so,
you know you alluded to earlier thisstudy that we're working on, and part
of what we're trying to do issort of develop that evidence space to support
those recommendations changing. So that's thatwe can expect that adults, especially at
a certain age, would be gettinghearing tests more commonly. In terms of
(13:39):
your question about what is what goeson during a test, you know,
hearing tests specifically are generally performed bylicensed audiologists, and in the traditional place,
they'll be performed in a some sortof sound treated or soundproof booth,
and like like you described, youknow, it hasn't changed all that much
in terms of what we typical audiometry. You might put on a pair of
(14:03):
headphones or ear insert plugs and theywould evaluate the two years individually. Usually
that's from a standpoint of both yourlevel of hearing sensitivity, but also importantly
what we call your speech recognition oryour ability to understand speech provided the sound
is loud enough. And that sortof gets at the issue for example that
okay, maybe if we boost thesound, if you use something like some
(14:26):
amplification, like some hearing aids wouldthat overcome some of the issues that you're
having with communication. And I'd sayfor most patients with age related hearing loss,
if you make the sound louder,their experience with communication is going to
be better. They're going to havean easier time understanding what other people are
saying. There are a subset ofpatients, especially with more severe hearing loss,
(14:48):
that even when you make that soundlouder, they still will have difficulty
understanding the speech or having what wecall speech clarity. And you know,
those are patients that potentially other optionsare better choice treatment wise than cochlear implaps,
sorry, such as cochlear implaps,But you know, you really wouldn't
know that so much without some sortof evaluation. It is true that now
(15:13):
there's more and more opportunities to dothis with your smartphone. So there are
a number of apps that you candownload to test your hearing, and certainly
from a sort of sophistication and calibrationstandpoint, you know, they may not
be as definitive, but I thinkfor a lot of patients, just to
get a sense of am I hearingsort of things at a level that that
(15:35):
I should be or do I needto get this checked out. Potentially,
some of those things that you coulddo on your couch would be a good,
good, good start to help youin particular that you're that you're a
fan of or that you want toYou know, there's I mean, there's,
there's, you know, there therethere's more and more, honestly all
the time. I think if yourlisteners were to go on it and sort
(15:58):
of sort of google the topic,you'd see a number of them in different
ones, and you know, Ican't vouch brain them individually in terms of
their validation and whatnot, but it'sjust getting a sense of again, you
know, I think to a degreeof is this something that you know,
especially if you're having other people aroundyou sort of raise that concern I alluded
(16:18):
to earlier. We often will hearyou know, or sometimes paste coming in,
will come in with their spouse andthey may sit there say, I
don't you know, I don't havea problem. I don't know why you
know. So and so thinks thatI do. But but sure enough,
when you do assess those stations interms of their hearing, they usually do
have fairly significant hearing loss, andso there is that sort of potential issue
(16:38):
of a of a connection between whatsomebody perceives they're missing out on or not.
You know, I use the exampleof glasses a lot where when we
you know, those of us thatwear glasses or have experience putting on glasses,
I mean, all of a sudden, you can really experience things in
a different way. And you'll hearthis from patients sometimes when they do seek
treatment, if they get a pairof hearing aids, if that's appropriate for
(16:59):
them, they just didn't realize allthe sounds they weren't hearing. You know,
they didn't realize how many birds wereliving outside their apartment or their house.
You know that now all of asudden they're hearing in the morning that
they weren't hearing, or their spousewas yelling at them to clean up the
clean up the apartment of the house, and they I never hear you.
You know, that's selective hearing loss. I think if you're just waking up
in the morning. Here and Katzis corner, we're talking with doctor David
(17:22):
Friedman, Associate Professor voter Alerngology,Head next Surgery in the Division of Neurotology
and Skull Based Surgery at NYU.Grossman School of Medicine. He's been kind
before the show to give me hisphone number, so if you are interested
in a consultation, please write thisnumber down. I'll give it one more
time at the end of the show. It's two one two two six three
fifty five sixty five two one twotwo sixty three five five sixty five.
(17:48):
And I you know, we havethese recommendations too by the United States Preventive
Task Force, and if you listento them, we wouldn't be doing PSA
testing and we wouldn't be able to, you know, screen for prostate cancer
appropriately and pick up all these disorders. And I think it's you know,
you're right. You know, weget our eyes checked, we get our
call and checked or prost checked orbreast checked, and you know, you
know, we should be testing ourhearing more often. And I hope your
(18:08):
research will bear bear that and showthat we do need to do more screening.
Let's get into the to the optionsthough, it's you know, what
are the options for people when theystart noticing the hearing loss. You've done
some hearing testing, and you knowthere's a there's certainly, you know,
an objective measurement that there's hearing loss, Where do what are the options for
(18:30):
for for folks out there? Yeah, so, I mean I think the
first is usually just what'll be calledjust an understanding of sort of what are
some basic strategies you could use andso you don't even need to have a
hearing test to sort of take advantageof some of these, and some of
them are are sort of common sense, but you know, making sure that
you can see the person who's whoyou're talking with, you know, see
their lips, and certainly mask maskingduring the last few years with COVID posed
(18:53):
a big problem for a lot ofpeople with hearing loss, actually exposed some
people that didn't know they had hearingloss because you know, all of a
sudden they were really having trouble understanding. They didn't realize how much they were
relying on visual cues from seeing people'syou know, mouths move while they were
speaking. But you know, beingaware that that can help you, making
sure that you know your you're usingloud voice and and sort of the some
(19:18):
of the basic things that that sortof enhance communication. Beyond that, you
know, these options have really expandedin the last years. More more traditionally
I alluded to earlier that a hearingaid, you know, something that amplifies
sound, and these comes in varietyof different sizes and shapes, would really
be the definitive way to treat youknow, age related hearing loss. These
would be usually fit and dispensed byan audiologist, a licensed audiologist. This
(19:45):
is not a service unfortunately that CMSor Medicare has has included as part of
the care that's provided that way,and so a number of older adults would
have to go and you know,pay pretty significant fees out of pocket to
get hearing aids. And so what'schanged is you know, really going back
(20:06):
now a couple of years, thegovernment, federal government has taken on the
challenge of making these devices, orat least some type of device, some
type of amplification device available direct toconsumer, at least for sort of what
we consider mild moderate levels of hearingloss. So some of the more common
issues that patients might experience, theynow can, at least if they're interested,
(20:30):
explore this on their own. Theydon't need to see a position,
they don't need to have a formalevaluation with an ideologist. They can essentially,
you know, you can go ononline and buy something on Amazon or
through direct through these different companies andat least try what they have to offer
in terms of you know, mostcases they're just giving you a boost and
volume. What's different about these thanlet's say, turning up the TV or
(20:55):
turning up the volume on your phone, is that ideally your amplification devices giving
what we call frequency specific gain.When we lose hearing with age, we
don't just lose all hearing. Wetend to lose high frequency hearing. If
you think of a piano, highfrequencies are the sort of the keys on
the right side and with higher pitchedsounds that really affects the speech clarity issues
(21:18):
if you're not hearing those, andso turning up the volume specifically on the
high frequencies is what's needed. Sowhen you go to an audiologist, they
have the ability to sort of selectivelyamplify or increase the volume for the sounds
that you need to sort of configureyour particular pattern of hearing loss. And
so what some of these over thecounter devices do, at least the better
(21:41):
ones, is they will do you'lldo a hearing test on your own through
their own app, proprietary app,and it'll configure what your hearing pattern is
like, and you can then goin and it will automatically program your hearing
aid or you're over the counter deviceto give you the boost and volume where
you need it. And this issomething that is really the first line for
(22:08):
patients with hearing loss to try.Whether it's again whether you choose to go
through a licensed provider, a licenseideologist, or or you want to try
one of these newer technologies, butboosting the volume is going to be the
first thing that we think about whenwhen patients are having and besides the costs
(22:29):
and not working, are there anyother potential downsides of doing an over the
counter type of hearing aid? Youknow, there are there are particular sort
of what we call red flag typeissues, you know, if somebody has
something going on, and you know, some of those probably worth mentioning that
if somebody has one sided hearing loss, if they have ringing that's particularly more
significant than one side versus the other, those are definitely patients that should be
(22:52):
seeking medical attention first and sort ofgetting a clearance that okay, you know,
this is nothing else that needs tobe investigated. You can go ahead
and get you know, hearing aidsor over the counter if you choose to
go that way. But in general, it's a it's a it's a safe
initial approach. And if you know, I think the other things that come
(23:12):
up that you know, I thinkwe have a long ways to to to
try to address as a society,is really some of the issues related to
stigma and why is it that,For example, at least in my experience
talking to patients, you know,many patients with eyeglasses on will tell me
I'm you know, I'm too I'mtoo young to get a hearing aid and
why is it that, you know, sort of that sense is really viewed
(23:33):
differently in terms of what what theimpact of the stigma is associated with hearing
loss that's compared with something like,you know, decline and vision or other
things that you know, many ofus experience not even necessarily related to age.
I just want to ask you,because we just have a few minutes
left, about the you mentioned earlierabout a cochlear implant. Who would be
a candidate to that and what's involvedwith that if you could do that in
(23:57):
a minute and a half. Yeah, no, I mean it's really important.
I think, you know, unfortunatelywe know that many fewer patients who
would be appropriate forget for a cocreimplant do not get them. So I'm
a cochlear implant surgeon as part ofthe NYU team and one of the largest
and really longest running cocre mdplant programsin the country. So co core implants
(24:18):
when they first were developed, werereally for patients who couldn't hear anything.
If you could hear the difference betweena you know, a car horn and
somebody speaking, then you probably weren'tin a candidate at that time in the
nineteen eighties for a cokeler implant,And things have really progressed over the years
where you can you can have acertain level of hearing and even speech understanding.
But if it's not sufficient for you, whether that's something that you decide,
(24:41):
you know, in conversation with yourteam or based on sort of preset
standards that we have, then youmight be a candid for cochlear endplants.
So different different than amplification or likea hearing aid, a cocrand plant is
a surgically implanted device that requires aprocedure, and these devices actually restore hearing
by directly ste mulating the auditory orthe hearing nerve. So it's sort of
(25:03):
a totally different pathway and a slowlydifferent approach to hearing. But you can
actually restore hearing, and these arethings that are commonly done for children that
are born without hearing. And thenthe other largest growing portion of the population
that we serve are older adults,adults over eighty or even ninety years of
age, who you know, losetheir hearing over time and aren't getting benefit
(25:26):
from hearing age. So an indicationfor a patient would be if they're not
if they're not benefiting from a hearingaid the way they used to, they're
not having an issue. If they'recontinue to have issues with speech, understanding,
with having clarity, then certainly beingvalued for a cokeram plant is a
good idea, and it is thatcovered by Medicare and CMS the implant.
Yeah, it would be hard forme to explain to you why that is,
but yes it is. Ironically,so CMS does cover Cokera implants and
(25:49):
it's a safe you know, it'sa safe procedure that good you know.
I really encourage people to think aboutif they're having trouble with with the hearing,
even with hearing aids all right,and at least to fix problem,
the cochlear implan is doing that.You can get it through Medicare insurance and
certainly someone that has hearing loss shouldcall you. Doctor David Freedman. I
want to thank you so much forcoming on the show this morning. His
(26:11):
number again and his team at NYUis two one two two six three fifty
five sixty five. That's two onetwo two six three five five six y
five. If you are a loverand have any sort of hearing loss,
I would strongly encourage you to givehim and his team members a call.
Thank you so much, David.I really appreciate you coming on the show.
It was great you're you're a terrificperson and great wealth of information and
(26:34):
I can tell you're very passionate aboutthis field. So thank you very much
and we'll have you on again soon. Thanks so much. Well, that's
the end of the show everyone.I wish you are all happy Sunday.
Have a great day. Everyone tunein every Sunday here on Katsus Corner.
We'll be back next week with agreat show. This is doctor Aaron Kats.
You've been listening to Katzer's Corner comeback every week to hear more straight
(26:55):
talk on a wide range of men'shealth topics and advice son how to live
of your healthiest life. The proceedingwas a paid podcast. iHeartRadio's hosting of
this podcast constitutes neither an endorsement ofthe products offered or the ideas expressed.
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