Ben Thompson, AuD.
Hello, and welcome to episode 21 of the Pure Tinnitus & Hearing Podcast. This episode will focus on hearing. We are speaking with Dr. Jacob Iveland, audiologist in the Los Angeles area. And Dr. Iveland has hearing loss that runs in his family. He himself was diagnosed with a moderate to severe inner ear hearing loss at the age of three, which is when he received his first pair of hearing devices. I recently listened to Dr. Iveland counsel, counsel patients about the hearing technology available and the journey from mild hearing loss all the way to cochlear implants. Dr. Iveland, welcome. I’m going to pass it to you. How do you typically counsel a patient on the full range of hearing treatment available?
Jacob Iveland, AuD.
Yeah, so patients have, everyone’s on their own journey and sometimes patients come to me and I’m the first person you’ve ever talked. Sometimes patients come to me and I’m the 20th or the 30th person that they’ve talked to. And I have different people on different spectrum through their hearing journey. Hearing losses range to the wide variety of hearing losses, anywhere from normal hearing, so just having some difficulty in noisy areas, all the way to almost no hearing at all. And so when patients come in and they asked me what’s available, how can you help my hearing? I think a lot of professionals jump straight to the hearing aid, and that’s mostly what is done, but I like to explain kind of the whole spectrum of treatment so that they know where they’re at and where they could be if their hearing is worse, and give them a little encouragement to show that they’re not completely deaf. So what I do is I have a spectrum of communication and basically if you’re just having some mild issues, don’t really feel like you have a hearing loss, but you’re just kind of, you’re noticing that things are not as clear, I show them a picture of what an over-the-counter hearing aid or some sort of amplifier, something that’s simple, it’s cost-effective. To be a successful hearing aid patient you really have to be motivated to hear better, and you really have to be willing to invest a lot of time into hearing aid, where if you’re just trying to get a little help and see what things sound like, an amplifier or something that would help if you did have a mild loss. An example of that would be with Apple AirPods. Those can treat someone with mild to moderate hearing losses. I do that myself when I work out, I actually wear my AirPods to give me a little bit of gain when I’m working out. So it’s just, it’s a simple cost-effective option. Then I show them, when that is no longer effective, it’s no longer loud enough for you, no longer clear enough, that’s when you’re going to look at hearing aids. And there are a huge variety of hearing aids, some as low as a couple thousand, some as high as 10,000, there’s a lot of different technology levels and there’s a lot of stuff that goes on with hearing aids. And that where most patients fall into hearing loss, when they have hearing loss, that they just need a hearing aid. Eventually, with hearing aids, you may lose enough cells in your ear where the hearing aids are no longer going to benefit you on their own, so you need an additional device to help, such as an accessory, like a companion microphone, where you give it to your wife, or your spouse, or anyone you’re with, and they can, the microphone connects right to the hearing aid, it makes the thing a lot easier to hear.
Now, even though the patient may have aidable hearing, hearing that would be just perfect with the hearing aid, I still talk about the extreme ends, and the extreme end is complete deafness. I tell the patient, you may never lose all of your hearing, it’s not that common to lose all of your hearing, and to lose all of your cells, you’re likely going to be a great hearing aid candidate for the rest of your life. But if you do lose your hearing for whatever reason, if you have a loud explosion and you lose hearing, if you have a viral infection and you lose hearing, whatever reason it is, there is a cochlear implant that can help you regain access to the sound that you lost. So even though I’m talking to a patient and they’re not a candidate for a cochlear implant, I try to explain that a cochlear implant is an option. And I explain it to everyone so that they know that their hearing isn’t the worst, give them a little bit more motivation on using a hearing aid. But if they’re hearing were to decline, they’re not going to be left out in the dust, there’s going to be an option that we can pursue, and I’m just kind of educating them early, early on. Am I talking too much?
Ben Thompson, AuD.
Pretty great, you’re talking wonderful. So when you lay out all the options there, how do your patients respond to that of, “Okay, Dr. Iveland just laid out all of my potential options. How do you, the audiologist, the doctor help me find out where I should land on this?” What kind of tools or tests are helping you with this?
Jacob Iveland, AuD.
I might just straight up tell them where they’re at. I’m like, “You’re here, you’re where the hearing aid is, you don’t need accessories yet, you don’t need a cochlear implant.” I show them that just to know that there’s more that we can do, but you don’t need that yet. Some of the testing that I’ll do to help me with that is the sound booth testing to see where your hearing levels are. If you’re hearing level is within a range where I think we need a hearing aid, we’re going to talk about that. The one test that I do use to help me distinguish whether or not you can do a hearing aid by yourself, or if you need a hearing aid with a companion microphone, or a TV microphone is a test that looks at how well you can hear noise. This test tells me how much do I need to lower the volume of noise in order for you to hear the sentence perfectly. Most patients can do pretty well with just hearing aid, but sometimes I have to lower the volume significantly in order for you to hear, the volume of noise significantly in order for you to hear speech, and that’s when I’ll talk about the microphone. So that’s kind of what helps me decide if they need an accessory or not.
Ben Thompson, AuD.
I love how you lay out that full spectrum. And when I first heard you describe this to another patient, I thought I need to bring you on this podcast to share this because tinnitus is one of the first symptoms of hearing loss, right? Tinnitus, what we specialize in here, on this community, Pure Tinnitus Community, tinnitus often leads to some degree of hearing loss, some degree of hearing decline. And that brings up a lot of questions. Tinnitus already brings up a lot of questions, hearing technology, and treating hearing loss, and when should I start this, brings up a lot of questions. Let’s bring it back to your personal story, Dr. Iveland, tell us about what you’ve learned in the 20 plus years you’ve been living with hearing loss. What is it like? How do you advocate for yourself? Tell us about that.
Jacob Iveland, AuD.
Well, I’ve been wearing a hearing aid since I was three. I was a stubborn kid and so I put my hearing aids off a lot throughout my early ages. But when I was in fifth grade that’s when I started wearing hearing aids full time. And I went from being kind of a troublemaker kid to being a, I wouldn’t say perfect kid, but my grades were good from that point on. And so hearing aids have just really been all I’ve ever known. I don’t treat it as a disability, it’s not something that I hate, not something that I looked down on. I actually look at my hearing loss as something that has really changed my life for the better. I wouldn’t be a doctor of audiology if I didn’t have a hearing loss, I wouldn’t have decided to pursue a career in helping people hear if I didn’t have a hearing loss, I’d be doing something completely different. I self-advocate, whenever I’m with friends, even my own girlfriend and my own family when we’re out at restaurants forget that I have a hearing loss because I don’t make a big deal about it. And if I don’t understand them, I’m not afraid to ask them to repeat themselves, or to ask them to clarify what they said. I don’t think people get annoyed with me because I don’t get annoyed with them, I don’t get frustrated with the fact that I didn’t understand them or hear them. The way I talk to people in my environment is I do it in a way that makes them feel like they’re not annoyed with me. For example, I think a lot of people will just say, “I didn’t hear you, say it again. What?” And they don’t let the person know that you did hear something. I’m an example of that. If I didn’t quite hear what someone said, what I will say, instead of saying, what did you say? I will say, “You said that we were going to go to a restaurant tomorrow. Was it six o’clock or eight o’clock that you said? I couldn’t quite tell the difference.” Or “Was it where’s the restaurant at? I know that we’re going to go eat, are we eating with Jessica and her husband, or are we eating with Jen and her husband? I just couldn’t quite make the difference there.” And what I’m doing is I’m letting the person I’m talking to know that I heard what they were saying, I didn’t quite get all the details. So it just makes it so neither one of us is frustrated and we’re both moving forward in the conversation, if that makes sense. So that just things that I don’t let my hearing loss ruin my day or ruin my life, it’s not something I can change, so I just have to live with it and take advantage of everything I can with my hearing loss, so that’s kind of how I look at it.
Ben Thompson, AuD.
I love that first of all, thank you for sharing that. I think many audiologists are skipping over that part of the appointment. We’re very much focused on the technology in modern times, we’re very much focused on how to adjust the technology when the technology has its limits and it always does, what else can supplement that, you’ve done a great job at explaining that. You have a passion for cochlear implants. Tell us about your own perspective on does your hearing loss need a cochlear implant? And then after that, what have you learned about cochlear implants over the years?
Jacob Iveland, AuD.
No, I don’t need a cochlear implant. If you turn the volume up loud enough for me, I hear 100%. And so if I heard less than 100%, then maybe I was a cochlear implant candidate, but I’m not. Hearing aid works perfect for me. What I’ve learned about cochlear implants is I learned that you don’t need to be completely deaf to get a cochlear implant. You can have very usable hearing and a hearing aid, you can hear sound with hearing aids and still be a cochlear implant candidate. That’s something I didn’t know before going into school. And I think a lot of audiologists now, I’m finding out that a lot of audiologists who haven’t been in school recently are still believing that cochlear implants, in order to be an implant patient you need to be completely deaf or have a severe, profound loss, and that’s just not the case anymore. You can have normal, low-frequency hearing and still be a cochlear implant patient. I think a lot of people get discouraged by looking into a cochlear implant and they’re worried that they’re going to lose all of their hearing, or that they need to be completely deaf, and that’s just not the case anymore. It’s a very routine procedure. I work with a surgeon in Los Angeles, and he just recently implanted a 102-year-old. So it’s not something that’s a big, scary surgery anymore, whereas 10 years ago it might’ve been. So that’s something I’ve learned about cochlear implants that I think a lot of people are not up to date on.
Ben Thompson, AuD.
Yeah, and tell us more about your interest in CI, cochlear implants. For those with tinnitus, most people with tinnitus have a milder degree of hearing loss, and one thing I’ve learned over the years, being a tinnitus specialist, is that most people have this baseline low level tinnitus, but there’s a percentage of people that develop a sudden onset, dramatically louder tinnitus for a period of months or even a year plus. And when we’re looking at their hearing level, it’s not typically in the range that would be candidacy for cochlear implant. So tell us more about your interest with CI.
Jacob Iveland, AuD.
Let’s see, in regards to tinnitus or?
Ben Thompson, AuD.
Well for tinnitus, only those with a severe degree of hearing loss would be a candidate for cochlear implant, regardless of if they have tinnitus or not. And right now in your current clinical practice, are you working with a cochlear implant surgeon? Do you have some patients at your clinic who are going ahead with cochlear implants? Have you worked with that?
Jacob Iveland, AuD.
Yeah, I mean, currently right now, I believe I have four and then five, potentially five, that person just going through some imaging right now, but right now I have about five patients going through the process. I’m not a big coconut implant center, big cochlear implant hospitals will have five patients a day. I’m a small private practice, so we don’t get as many patients, but right now I’m about five going through the process.
Ben Thompson, AuD.
Yeah, nice. All right, I’m going to switch it up. Thank you for sharing your interest in cochlear implants, I think that will be educational for our listeners here. Now, switching it up a little bit. Those who have a milder degree of hearing loss, in recent years there have been reputable, quality, online hearing technology, or direct to consumer hearing technology that can help these milder degrees of hearing loss. When a patient who has mild hearing loss comes into your clinic, you said earlier, you would talk about some of these options. How closely are you following these trends as a clinical audiologist with the new technology being released?
Jacob Iveland, AuD.
Well, when I work with patients with even mild loss, when they come in to see me, I’m the hearing specialist, I work with hearing devices, so hearing aids, implants, there are a lot of things that can help tinnitus patients, such as meditation or psychology, acupuncture has been shown to help patients, mindful-based therapy. I go the amplification and the turning volume up approach, that’s what I do. So when I see patients who come in even with mild hearing loss, I’m going to recommend amplification for them. Now I understand that with the tinnitus, patients who have tinnitus and mild loss, that they may not find the benefits of moving forward with a device just a lot of the times due to cost reasons, and I respect that. I’m not pushing it on anyone, I just say, there’s a lot of options for patients with tinnitus. And patients with tinnitus who move forward with hearing aid, not everybody, but a lot of them do get benefit, even on a mild hearing loss, even on a mild hearing loss, you should perceive some reduction of your tinnitus. And I tell patients, “If you’re just starting off, if you just started getting tinnitus last month, I think maybe hearing device may not be the right option right now. Try some more cost-effective options first, try meditation, try things that don’t really require a lot of investment on your hand. And then in a year, if the tinnitus is still bothering you, or if the tinnitus is getting worse, then let’s talk about implication, and a little bit more serious about it.” Amplification, no matter where you are in the country, I’m pretty sure it’s a legal requirement to allow us all to give you 45, or some period to trial devices out, depending on the state, California is 45 days, my clinic is 75 days, other states are 30 days to try hearing aids. So even if you try and see if it helps with tinnitus, I think that can go a long way. And so that’s kind of my approach when I work with tinnitus patients is to try to give them a little relief with amplification. And if you got just a couple more minutes, the analogy I love to use for patients is I like to imagine them, my office is a completely pitch dark office, no lights whatsoever, and I light a candle, and the only thing I can see in my office is the candle. Then I turn the light switch on and the patient can see my computer monitor, my coffee mug, they can see my shirt, if I’m wearing a tie, they can see the pictures in my office. The candle is still lit, but they don’t notice it anymore because they have other things to distract their attention. I tell patients, tinnitus is the same way. When you have a mild hearing loss, you’re living in a quieter world, almost like the lights are switched off and the ringing is like the candle, it’s there, it’s the only thing you see, it’s the only thing you notice. To try to get your brain to distract itself from the ringing in the ears, we want to turn the switch on, turn the light switch on, turn the hearing aid on, give you a little bit more amplification, allow your brain to pick up on other sounds in the environment, so you’re not spending all of your time and all of your attention on the ringing sound. We’re in no way trying to get rid of the ringing, but we’re trying to introduce other sounds that are more pleasant, and then your brain has already applied meaning to normal sounds. If we can have more normal sounds, rather than this one annoying sound, I think that can go a long way with helping patients manage their tinnitus.
Ben Thompson, AuD.
It can go a long way. Hearing aids can go a long way. Whether it’s just the amplification settings themselves or having a low level, constant sound therapy, which would be consistent with tinnitus retraining therapy approach. And I will say, thank you for sharing that analogy. I will add one that has come about recently, where, you know when you make tea with a tea kettle, and you have this tea kettle and you fill it with water, and then you turn the heat up, so there’s all this heat coming from underneath the tea kettle. And at some point that tea kettle will build so much pressure that it releases this pressure through the steam and it creates this high-pitch sound, this tea kettle ringing steam sound. Well, what can we do to reduce this steam? I use the analogy with tinnitus that oftentimes people are undergoing periods of stress in their life, emotional, work stress, financial stress, health stress, and there’s a lot of built up energy, and it releases in the system as a ringing sound in the ears. And when that tea kettle is ringing, for this analogy we can’t adjust the level, we can’t move the tea kettle, we can’t take your ear or your auditory system out of your head or your body. But what we can do is to turn down the heat, because just like for your tea, if you turn down the heat, after some time that ringing will go down and it will soften. So the mindfulness route, the holistic route, stress reduction, having professional counseling, improving sleep patterns, that is how you turn down the heat, and after a few weeks or months, that can in effect not only reduce the perception of tinnitus, but in a lot of cases, the volume can turn down as well. Both of these are great examples and I thank you so much for sharing that.
Jacob Iveland, AuD.
Yeah, I think with the example that you’re mentioning, I think, I go to doctor’s appointments too and every doctor says you need more sleep, you need to take away stress, and you need to eat better. That’s just, every doctor’s going to say that, so it’s kind of, it can be hard to take that to true. I will share the stress thing is 100% related to your tinnitus. I have tinnitus myself and it comes and goes, and in graduate school, Ben and I actually went through the same graduate program, so he knows how hard it was, I would get tinnitus on the day of an exam. And on the day of an exam, I was doing two things: I was stressing out about the exam and I was getting no sleep because I was studying for the exam. So not only was I having a tough time with the exam, I was struggling with ringing the entire day in my ear. Once I took the exam and I got a good night’s sleep, I no longer had the stress of the exam, my tinnitus would go away. It’s not that easy all the time, but for me, stress does correlate with my ringing. And some patients have stress all the time, if they can manage their stress a little bit more by seeing professional help, I think that goes a long way.
Ben Thompson, AuD.
It’s so true. Most doctors would agree. Have a more healthy lifestyle, better sleep, better nutrition, limit stress in your life, emotional stress, relationship stress, work stress, financial stress, health stress. Easier said than done. So having a systematic approach, having professionals on your team, if we know anything, being doctors, it’s that ongoing continuity of care makes a difference. Dr. Iveland, thank you so much for joining. This has been episode 21 of the podcast, Pure Tinnitus & Hearing Podcast. Would you like to leave any last words for how someone can find you in the Los Angeles area, or any last words you have for our community?
Jacob Iveland, AuD.
You can find me just by searching my name, Jacob Iveland, you’ll see exactly where I am and what clinic I’m working for, and be happy to help if you need help. I think a lot of doctors will tell you that there’s nothing you can do with tinnitus or when you have profound hearing loss, and I just think that’s just the lack of education on our primary carers or our general doctors. They just don’t know exactly what an audiologist can do and how much we can do it. In a lot of times we’re just perceived as the hearing aid specialists. And yes, that’s true, we know a lot about hearing aids, but we know, I think hearing aids is only about 20% of what we do. And so I think if someone tells you that there’s nothing to do about your ringing, or if you have deafness and there’s nothing to do, you need to get a second opinion ’cause there is actually a lot that you can.
Ben Thompson, AuD.
Thank you so much, Dr. Iveland, take care. Talk to you later.
Jacob Iveland, AuD.
All right, thank you.
Ben Thompson, AuD.
Bye everyone.
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