When you think of the word “neuroplasticity,” it often brings to mind thoughts of hard plastic. But plastic is also flexible, and moldable. Neuroplasticity is the ability for the brain to adapt to situations, form new connections and heal from injuries.
Dr. Keith Darrow is a Harvard Medical and MIT-trained Neuroscientist, published author on the topics of hearing loss, hearing health, and tinnitus. Dr. Ben Thompson sat down with Dr. Darrow to discuss the brain’s ability to look past tinnitus, his new book Preventing Decline, and the power of the neuroplasticity of the brain.
What is the most important thing that seniors need to know, that older adults in this community need to know about the brain?
Look, I’ve been in hearing healthcare now for over 20 years, I first became an audiologist and then decided to go back and study the brain some more. And that’s where I really started to sort of wrap my hands around how important hearing is for brain health. And so over the last few years, I feel as though I keep narrowing down my mission. I keep narrowing down what it is that we’re trying to do. And I got it down to four points, okay? First, hearing care is healthcare. So, people need to understand that when we’re talking about treating hearing loss, tinnitus, we’re talking about treating overall health and wellness, physical health, social health, emotional health, cognitive health. So, it’s really important.
"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
– Steve D.
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Number two, preventing decline in dementia is possible. We now know, and there’s been a number of reports showing us that it’s 4 in 10 cases of dementia, are considered preventable. I mean, that is a huge number. There was even a recent report that came out, talking about commonly used drugs, about Viagra. So, there are things that people need to know to help reduce their risk of dementia. And as I’m sure you and I will get into, the number one on the top of the list, the most important thing, is treating hearing loss to help reduce the risk of dementia. So, that’s my number two drive in life.
Number three is that, and you know this all too well, reducing the experience of tinnitus is possible. There’s no cure, there’s no guarantee but we now believe in, and we’ve collected data in our centers over the last few years, which aligns with all the other published data, showing that nearly 8 in 10 patients can receive relief from that ringing, the swishing, the buzzing, those annoying sounds in their ears and head, by treating their hearing loss and tinnitus.
And finally, all of this comes together to really hand the keys over to our patients. Yes, you mentioned older adults, seniors, but I think that their children, the 40 to 50 year olds, the ones taking care of mom and dad now, they need to know this too, that treating hearing loss is one of the most important keys to active aging.
As we know, the brain can be trained to not focus on tinnitus. Tinnitus can get better.
But Dr. Ben, what are our patients told when they go visit the primary care doctor? What are they told by that person that they trust the most to manage their care? And I’m not trying to knock every primary care doctor, but they’re told, and I quote, “There’s nothing that can be done about it.” And so you and I understand that frustration of not only do we have our uphill battle with our patients, but we’re fighting against the mega medical community that dare, I say, almost dismisses people. And just says deal with it.
Oftentimes, what doctors are saying to their patients is “I don’t have anything for you. I don’t know what to do. I can’t do anything. There’s nothing we can do here at this medical clinic.” And what they are actually missing is the training audiologists receive and there’s a disconnect there. Would you agree with that?
Yeah. I would absolutely agree with it and you’re a lot nicer than I am because I usually just default to “No, your doctor’s stupid. They said the wrong thing, right?” Maybe that’s the New Yorker in me that comes out sometimes, but you’re a hundred percent right there. If you took them word for word, there’s nothing they can do about it, and that is true. But I think if we all really committed to that sense of “I need to help every patient.” And even though I can’t do something right here right now, if you do a little bit of homework, even if you look in the AMA and the journals, if you look at the American Academy of Otolaryngology, there are guidelines for helping people with tinnitus. And as you said, the referral to the hearing health care specialist is right up there at the top of the list of what they need to be doing. And so it’s podcasts like this, I talk about it in my book that is really helping to get out the word. And I don’t see my book as being just for the patient. I see it for the family members. I see it for their doctors. I see it for the entire healthcare community.
This is your work. This is your focus. Please tell us about your book “Preventing Decline” and the main plots.
Look, I think those are the kindest words that people have said to me. This is my focus. I’m downright obsessed when it comes to understanding how the brain works. I’m obsessed with trying to help others out there to not go through what my family went through. We lost my grandmother sometime ago. And I swear now that I’ve learned so much, a couple of things that come right to mind. One, if I knew then what I know now, maybe, just maybe my grandmother could have been one of the four in 10 that could have prevented her dementia by as you say, promoting cognitive health. So that’s one thing that dare I say haunts me that I think about all the time.
“If I knew then what I know now.” If you knew then what you knew now, how would you counsel patients who have the common signs of early stage risk of cognitive changes?
Sure. So here’s what we know. We know that as we age there is what’s actually what doctors call mild forgetfulness. That’s actually the definition that’s used. So as we age, we become a little bit more forgetful. Maybe we tend to misplace our car keys more often. Maybe we tend to walk out of a big box store and think where did I put my car? Right? So these things, first off, they happen to everybody. They’ll happen a little bit more as we get older, but then there’s mild cognitive impairment where that cognitive decline starts to impact daily life. And then there’s when we get to dementia, which is a serious neurocognitive disease that impacts everyday living, and really it starts to impact everybody around us. And so the studies that we have been looking at, and some of the work I did in the lab has really been focused on why is it that with hearing loss, it increases the risk of cognitive decline. And so we have to take this research. We have to take the known data that’s out there. And as you said, we have to start counseling our patients. We have to start letting them know that, yes, it’s not only important to treat your hearing loss so that you can stay connected to others, so that you can maintain relationships, but it’s also important because it’s like instant brain training. As soon as you start treating hearing loss, as soon as you start stimulating the brain to address tinnitus, I mean there’s active neuroplasticity and rewiring that’s happening that profoundly impacts life.
From your understanding of the research, how much time does it take for tinnitus to habituate? How much time does it take for a new hearing aid user to adjust neurologically to the new sound they’re hearing?
I’m not going to let you box me into a corner on this one, because you and I both know that if we assign a number, we potentially take foot insert and mouth, and now we have a patient who maybe doesn’t have the right expectation of treatment. And so I just level with my patients as I’m sure you do. And I just say, “Look, here’s what the research tells us.” Two things. Number one, the longer you’ve had your hearing loss, the longer you’ve had your tinnitus, you can kind of bank on the longer it will take for your brain to adapt. Now, if you really want to push back and assign a timeline, we hope to see changes within the first 60 days. However, there’s documentation going back 10, 20 years showing six to 18 months for the brain to really adapt, right? If you’re going to tell me that you served in Vietnam and that you have had tinnitus since then, I’m not saying it’s going to take 40 more years to fix, but it’s going to take a lot longer than somebody who is just say going through the aging process, they’re 62, they’ve only noticed the ringing a little bit for a few months. Those are very, very, very different cases. So no promises but realistic expectations are really key for people to understand.
Let’s imagine that we have a patient who is 65 years old, who has a mild to moderate degree of hearing loss. They’re trying hearing aids for the first time. Should they expect a quick fix? And if not, how much time does it take to acclimatize to that new sound?
So, that’s a great question. And another one that I wish had a really simple answer because not all treatment programs are created equally. Not all hearing aids are created equally. Not all of us in our own field do things the same way. And so in our hands, and we have excellence in audiology certified members across the country with the program that we’ve designed from step a to step Z. Here’s what we basically tell our patients. When we start treatment on day one, I’m going to get you hearing really good. Give me 30 to 45 days, and I’m going to have you hearing great again. And that is our essential timeline.
We’ve done a ton of data collection, looking at pre and post survey. And, you know, 15 days is probably not enough. We have to have some checkups. There’s not only fine tuning to that technology that takes place in the beginning, but the brain is being re-introduced to stimulation patterns that have been missing for I guess the average patient waits seven years. So even with that stage one, stage two hearing loss, I know most people out there hear that mild, moderate, severe terms, but stage one through stage four, there’s always more that can be done and it does take time because you are… I mean, in some cases, literally taking somebody who hasn’t heard certain things for years, and now reactivating that part of the brain and patients in the beginning might almost reject it if we overdo it. And so there’s those tweaks, we call it the adaptation period that we know and our patients need to know.
There’s a difference between the passive neuroplasticity and active neuroplasticity. Passive neuroplasticity is I’m using tinnitus sound therapy, it’s on the background. As long as I have it on, then my brain’s using it subconsciously. Active neuroplasticity might be different. It might be I’m going to that restaurant. I’m actively listening even when it’s really hard and I’m trying, and I’m pursuing that. What’s the balance? How do you approach that when you’re recommending during the first six weeks, how often should they be pushing themselves to go active on the neuroplasticity?
I mean, look, the same way we tell our patients who are starting treatment, if we’re talking, hearing loss or tinnitus, like the brain wants this stimulation, it needs it. Maybe it needs a reminder, but it will catch on quickly that it needs it and so I’ve never really been a proponent of try a little bit here, try a little bit there. Our goal is to help patients right away, actively reengaged. Now, if we’re talking about an extreme tinnitus cases where in any exposure to noise can cause a significant uptick, that’s a different case. But if we have a patient who you gave the example earlier, a 60 to 65 year old person, who’s got age-related hearing loss, maybe there’s some noise damage. There’s some tinnitus happening. I mean, let’s get right back at it, right? The terms that we speak to our patients about is more direct versus indirect treatment, which isn’t all that different than the terms you are using in an indirect, right? There’s a lot of stuff out there. A lot of misinformation out there when it comes to sound generators, when it comes to just putting some background noise on to distract the brain, while I agree, there’s got to be some neuroplasticity that’s occurring there. That is a very passive, indirect way of treatment. And so that’s not the recommendation we start with. We start with the direct treatment or the active treatment of let’s get the brain going, it’s you can’t let it just continue to stumble along. Otherwise, it’s use it or lose it. And so we got to get right back in on this and maybe we have to temper based on the patient’s tinnitus experience, but I’m all for diving right in.
Diving right into your book, Preventing Decline, Advances in the Medical Treatment of Hearing Loss and Tinnitus. Who is the intended audience here? Who would benefit from reading this book or having it as a reference?
When I wrote the book, I actually had several audiences in mind. So for starters, I do have a passion to continue to push the field of hearing healthcare in the right direction. Maybe that’s self-centered, it’s the direction that I think it should go in. And that we need to really shine a spotlight on the fantastic and extremely high valued services that we provide that help change our patients lives day in and day out. So it’s written for hearing healthcare specialists to understand where we need to go so that we’re not left, maybe even believing ourselves that the widget, the hearing aid defines us because it doesn’t right. You could get a real smart computer, a real smartphone, but it does you no good unless you have the training and the expertise to really understand how to use it. So I think it’s a great time in our field now that everybody can get an over-the-counter hearing aid anywhere they want, I think it’s a great time for our field to step up and say, “Yes, you can get the widget anywhere, but that’s not going to help you. That’s not going to treat your hearing loss. That’s not going to help provide you relief of your tinnitus.” And so I wrote it for our field.
I also wrote it for the aging adults, right? I mean, my mom she’d kill me if I revealed her real age, but she’s in her early 70s. And I joke about this in the book, she’s way more active than I am. I always say my mom’s much cooler than I am. She’s got cool jeans. She’s got cool boots. Like she lives a very active lifestyle, which is so different from my grandmother who hung around in her house dress all day and didn’t do much, didn’t leave the house. So I want to help her maintain that active lifestyle until the end, whenever it is. I mean, she’s got the genes to live to her late 90s. And so, well, we better enjoy the next 20 years, mom.
So it’s written for the patient, but it’s also written for the family members. Part of the thing when it comes to hearing loss and tinnitus is we don’t understand, right? We don’t understand what they’re going through. You don’t see a scar. You don’t see a bruise. You don’t see a problem, but you do see a loved one starting to isolate themselves. You do see a loved one having difficulty with their memory. You see a loved one complaining about the ringing in their ears, and it gets in the way they can’t follow a conversation. We have to help our loved ones avoid the isolation and the pitfalls of untreated hearing loss and tinnitus.
And then finally I wrote it for the greater medical community so that everybody can have a real appreciation for what our patients go through so that everybody has a nice, quick read on what are the risk factors for cognitive decline? How important is it to treat hearing loss? And then I even go into some other things. I mean, the book goes off on a little bit of a tangent with active aging. I talk about health, nutrition, exercise. I mean the books kind of for everybody.
What else would you like people to know about tinnitus and neuroplasticity?
If there’s anything, cause I know Dr. Ben’s open to it, I’m open to it, if there’s anything that we could ever do for you or your loved one, whether it be provide a consultation, just provide some education, please don’t ever hesitate to reach out. You can find me over at drkeithdarrow.com, you know where to find Dr. Ben, and just continue to live your best life.