Dr. Bruce Gantz – The Utility of Hybrid Hearing Aids
Dr. Bruce Gantz is a Professor of Otolaryngology and the Head of the Head and Neck Surgery Department at the University of Iowa Hospitals and Clinics. He’s been practicing audiology for over 40 years, recently stepping down as the Chairman of the department. Dr. Gantz is one of the world’s top cochlear implant surgeons and is a leader in the cochlear implantation space.
Here’s a glimpse of what you’ll learn:
- What hybrid hearing aids are — and how technology has informed them
- How functional hearing relates to cochlear implants
- Using robotics for better implant procedures
- Why purely electronic models can cause confusion
- The data and studies of hearing loss and hybrid hearing aids
- Why the cochlea needs extra attention in hearing loss
- Looking at the next 20 years of patients getting hearing treatment
- The potential of remote hearing care in the future
In this episode…
To the general public, hearing aids and cochlear implants are the extent of their hearing technology knowledge. What fewer people are aware of are the complex differences between various styles, models, and brands. These can create massive advantages in hearing treatment that other options may fail to produce.
Hybrid implants are a lesser-known variant that utilizes both acoustic hearing and electronics to help people hear. The combination has proven results but it has yet to break through in the mainstream consciousness. So what should you be aware of about the technology?
In this episode of the ListenUp! Podcast, Dr. Mark Syms talks with Dr. Bruce Gantz, Professor of Otolaryngology at the University of Iowa, to discuss hybrid hearing implants. They break down the studies performed on the subject, using robotics for better implantation, and the limitations of fully-electronic models. They also touch on what the future might hold for hearing treatment and technology.
Resources mentioned in this episode
- Arizona Hearing Center
- The Listen Up! website
- Listen Up!: A Physician’s Guide to Effectively Treating Your Hearing Loss by Dr. Mark Syms
- Dr. Mark Syms on LinkedIn
- University of Iowa Hospitals and Clinics
- Office phone number: (319) 353-2173
Sponsor for this episode…
This episode is brought to you by the Arizona Hearing Center.
The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans.
As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients.
So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!
To learn more about the Arizona Hearing Center, visit https://www.azhear.com/ or call us at 602-307-9919. We don’t sell hearing aids—we treat your hearing loss.
Welcome to the ListenUp! Podcast where we explore hearing loss communication connections and health.
Dr. Mark Syms 0:17
Hey everybody, Dr. Mark Syms here, I’m the host of the ListenUp! Podcast where I feature top leaders in hearing healthcare. This episode is brought to you by Listen Up! Hearing Center, I help patients to effectively treat their hearing loss so that they can connect better with their friends and family and remain independent. The reason I’m so passionate about helping patients with hearing loss is because I lost my brother Robbie twice, first from his hearing loss from radiation to his brain tumor than again when he passed away. I only care for years. I’m the E of E and T. I’ve performed over 10,000 ear surgeries over the past 20 years and taking care of many more people with hearing loss since I’m the founder of Listen Up Hearing Center and author of a book called Listen Up!: A Physician’s Guide to Effectively Treating Your Hearing Loss. You want to learn more about that, go to listenuphearing.com. Today I have a great guest, a mentor of mine, it’s Dr. Bruce Gantz. He’s a professor of Otolaryngology neurosurgery, University of Iowa. And he’s been practicing for over 40 years he was he as was recently the Chairman has stepped down and pass the baton to my good friend Marlon Hansen. His areas of expertise include hearing loss, acoustic neuroma and Bell’s Palsy. He’s a top one of the world’s top cochlear implant surgeons, and he’s a leader and pioneer in cochlear implantation and a leader in electric-acoustic hearing. My exposure to him is one of the first trials for electric-acoustic hearing I did was a trial safe, productive dance back in 2004-2005. Dr. Ganz Bruce, thanks for coming on the podcast, beautiful backdrop of your lovely home.
Dr. Bruce Gantz 1:38
Well, Mark, thank you very much for having me on.
Dr. Mark Syms 1:41
My pleasure. So as I know, in the lead, they the listeners will learn that you’ve been kind of one of the you have been the guy pushing kind of electroacoustic hearing. That’s kind of an insider phrase that we use or hybrid hearing. Can you just for the listeners describe the concept or what we’re looking to do and why it’s something that people should know about and think about.
Dr. Bruce Gantz 2:05
Well, thank you, Mark. So, you know, we are when we started implantation. This was in the late 70s, early 80s, we were implanting people that were so deaf that couldn’t even hear themselves speak. And we were really excited when all the sudden they got to, they had an aide deliberating. And so that these were single channel devices. We get involved in multi-channel implants early on, through some serendipitous experiences, birthday was in Vienna, Austria, and met the HK miners, which is metal company now. And back when I was doing a fellowship in Zurich, Switzerland a night in the early 1980s 1982, I actually brought a couple of their implants, which were supposed to be four-channel. So it was the first really multi-channel experience, and I brought them in my suitcase. This was before the FDA was involved. And I actually sterilized them and put them in patients. They worked wonderfully as single-channel devices, they never multi-channel. Then about a year later, I was contacted by a cochlear corporation, which was not cochlear at the time, it was called Nucleus. And they wanted me to get involved with their multi-channel. And so I went to Australia, learned from Graham Clark about the implant I brought, came back. And we were the first people to actually implant a multi-channel implant outside of Australia in March of 1983. That’s awesome. There’s been a long experience so that that sort of my previous experience, and then as we went along in the 1990s, we found that patients that had a little more residual hearing did a little bit better with their implant. And so we had a concept that maybe if we tried to preserve some residual hearing, like Bill House did when he tried to implant some people with tinnitus with six millimeter electrodes, they were actually able to preserve some residual hearing. So we took that step one step further and designed a device with Cochlear Corporation and actually put in the first device in 1999. We put three of them in, we preserved all the hearing, but it was too short. It was too high frequency. There was too much dead region in the bass and these patients had been hearing loss for so long. We then moved it to 10 millimeters and lo and behold these people got an enhancement in their word understanding significantly over just electric only. And there was about a 20% improvement in their word understanding when we had the electric-acoustic together using low frequency acoustic hearing, in combination with electric hearing for high frequency, and lo and behold, they got a lot better. Moving forward, we found that, again, serendipitously, these people heard extremely much better than people with electric hearing in noise, and much better than hearing aids. And so there were two advantages of electro acoustic hearing was one, it improved their overall performance and quiet. And number two, it was significantly better in noise. So from that, we evolved from a 10 millimeter device, we use 16 millimeters now we’re using 20 millimeters. But the key is to try and get somebody that has low frequency residual hearing, that is aidable. And, and then preserve that hearing and let them then use this in combination. Unfortunately, this has been a real benefit for the people that have, we’ve been able to do this, it’s been slow going. I guess one of the reasons is that you have to be able to select patients with residual hearing. And there, it’s difficult to find those it was in the past, it’s becoming easier as we are expanding our criteria for cochlear implants. And people can now qualify for a cochlear implant, if they have 60% understanding in sentences or worse, and a majority of those people have some low frequency hearing.
Dr. Mark Syms 6:59
And so it’s really sitting in the dispensing audiology offices.
Dr. Bruce Gantz 7:04
Right. And, I will tell you Mark that if you look across time, from about 2000 to 2023, our electric-only patients — the results in one year, has not changed in 25 years, but it’s about 60%, or about 57% to 60% word understanding. If you preserve residual hearing, you’re up into the high 70s or 80% in quiet. And if you’re in noise, if you’re significantly better. So in noise if you do a sentence destined noise at a signal to noise ratio of 5 dB, that’s a little complicated, maybe for your audience, but man, the noise is at about five decibels louder than the sound that the words that are coming in. That’s a really hard test. And patients with single-channel implants get about 30% correct in sentences. And our patients with electro-acoustic hearing are averaging 70% with the acoustic plus electric in a signal to noise ratio by dB. Huge benefit.
Dr. Mark Syms 8:22
Yeah. And so what percentage of that year in your practice would you say are going into electric-acoustic hearing? I mean, it’s not yours’ — it just happens to be who comes to you, obviously. So it’s just kind of the University of Iowa implant poll. What how often are you seeing?
Dr. Bruce Gantz 8:41
Actually, in our population, we’ve got residual, hearing significant to try and preserve between 35% and 40% of the time. And we we think that if you have better than 60 decibels of low frequency hearing at 125 hertz, to 50 hertz and 500 hertz, that pure tone average, if it’s better than 60, you’ve got a significant benefit, that you’ve got a significant chance of saving residual hearing.
Dr. Mark Syms 9:13
So is that because that’s within the functional parameters of a hearing aid? Or is it because you think that’s more predictive of saving hearing?
Dr. Bruce Gantz 9:25
Yeah, so there’s a — so let’s talk about functional hearing. Functional hearing is the ability to amplify that acoustic signal enough with a hearing aid test, you get some burden. When you get to be 80 by 80 to 85 decibels in those low frequencies. You can power the heck out of that ear and it’s not going to work. You’re not going to understand anything. So we know that when we put the implant in, we can drop 10 to 15 decibels just by putting the electrode in the inner ear. And in the inhibition of the traveling wave probably. So if you start at 60, and you go down to 75, you’re still amplify double. If you start at 40, or 30, you’re even better chance of saving. And so, you know, we’ve had some patients that have 20 to 30, decibel low frequency hearing, that we implant all the time. And we’ve got a pretty good hearing preservation rate. If we use the right electrode, we’re between 75 and 80%. Preservation of hearing that is amplified.
Dr. Mark Syms 10:42
And I assume that that’s to some extent, the justification or the rationale for the development of the insertion robot or tool that’s been developed in your department as well, correct?
Dr. Bruce Gantz 10:55
Yeah, that was Dr. Hanson and his team that developed a robot to put in the device at point 0.1 millimeter per second, you can hardly see it move in what they showed that, when you put it in manually, our hand is just not that good. I mean, I’ve done 4,000 implants, and I can tell you, I’m not that good. I’m not as good as the robot. And so they did some research, demonstrating that even with manual, slow manual insertion, you jerk and you do cause an increase in blood. And, and it causes a change in the fluid in the inner ear, and it causes injury. And so the robot that goes in slowly, now we’re, we’ve we just did finished a group of 15 patients with the robot in our preservation rate was 93%, in that group so far, in six months. So I don’t know if it’s going to continue. But that’s pretty darn good. If we can do that.
Dr. Mark Syms 12:15
So just as a technical question that I want, you know, with your trial back in the day, when I did, I did the short with you and your trial — you secure the electrode with a stitch. Are you still doing that?
Dr. Bruce Gantz 12:28
I certainly am.
Dr. Mark Syms 12:31
Okay, so, no clipping or whipping around, correct?
Dr. Bruce Gantz 12:33
Yeah. And, and so even with the robot in place, we take the robot off holding the electrode in this, the electrode has gone through a suture. And then we tighten that before we do anything else and tie it in place, so that you’re not transmitting pressure into the inner ear, and more trauma.
Dr. Mark Syms 12:57
Especially when you’re boiling the excess electrode into the mastoid. Correct.
Dr. Bruce Gantz 13:01
There’s all these little issues that make a difference. And, to eliminate that, the more we do, the better, we’re going to be able to do for people, because, you know, in my mind, you have one chance to save this residual hearing. And if you lose it, then that person is never going to do quite as well, in quiet, and they’re not going to do as well in noise. And you know, as we continue to expand the criteria, if you don’t, or you’re not careful, we may make some people worse, if you’re not paying attention, do
Dr. Mark Syms 13:46
There’s no way to disagree with you. As we get more and more, come up the audiogram as you will, closer with less volume and discrimination. You’re absolutely right, that you know that if they lose their hearing, will they bounce back to a functional level that’s greater than their preoperative hearing? And I think unfortunately, there are some patients that are being seen that don’t actually do better postoperatively than they did preoperatively.
Dr. Bruce Gantz 14:12
Exactly. And and so, you know, it’s really incumbent on the surgical community to address this and adopt these issues. And, you know, we can show you from some of our research, that when you preserve residual hearing, you preserve more of the natural, actually central auditory processing that goes on in the brain.
Dr. Mark Syms 14:42
And we have direct connections or is there degeneration of the neurons with the damage to danglies.
Dr. Bruce Gantz 14:49
Well, I tell you that this gets a little technical, so I don’t know how far you want me to go into this, but there are we do eat G measures the activity chair. And we know that when sound is presented to the lateral temporal gyrus, that is a series of responses that you get from that EEG. And there is a, the early peaks are at a point one to point two milliseconds after the onset of the sound, right. And if you are, if you have acoustic plus electric hearing, your onset is almost normal. Within that point one to two milliseconds, if you have electric only, your onset is about point six milliseconds. So there’s a delay in the brain activity. And what happens is that you that we see in the frontal region of the brain, it causes more confusion, and more asynchronous
Dr. Mark Syms 15:59
nature, the information with the lip reading, and the other prompts are something
Dr. Bruce Gantz 16:05
It’s a complex issue, but the brain has more trouble figuring out the word. And in fact, we can do eye-tracking measures, where we watch — we give people a paradigm of four different pictures. And we say something like sandal, and there may be a picture of a sandal, there may be a candle, there may be something else, and then something else. And so as the word is being said, over, you know, 100 milliseconds, the eyes are going to these four pictures until they recognize the word, and then it goes right up to that to that picture. And that’s called an eye-tracking experiment. That’s very classic.
Dr. Mark Syms 16:53
And it shows comprehension, essentially, it’s a way to measure comprehension.
Dr. Bruce Gantz 16:58
You got it here. It’s how fast the brain recognizes that word. And so you measure that slope of how fast the eye gets to that point. And if, if you have electric hearing only, there’s a 75 to 100 millisecond delay for each word that is said over a sentence. Exactly. And so if you have electric bus acoustic information, it slopes almost normal. So there, there are central mechanisms within the brain that recognize the word quicker, because you’ve got some of that low frequency information that’s so important to help you recognize a word that and and so that’s why, in my mind and our research, and I’m so passionate about the fact that we’ve got to preserve residual hearing.
Dr. Mark Syms 18:03
Alright, so let me ask you a question. What if you now — if you have equal hearing on both sides, implant one side and aid the other? How does that work as compared to you see, I’m saying acoustic on one side electrical the other? It’s not as good as acoustic and electric in one year?
Dr. Bruce Gantz 18:26
Not necessarily. So because you’ve got a normal hearing, you’re on the other side. Okay.
Dr. Mark Syms 18:32
Both years are, you know, so in the Medicare rights, you’re right. So when before all this start your answer, if I saw somebody who had that what you’re talking about residual load slip, and then deep diving, high frequency, some of them would opt for a regular electrode because they wanted the high tone hearing on the cochlear implant side. So this is like a low tone on the non implanted side, high tone on the electric side, it’s it’s using two ears, obviously, we know binaural benefit, but that’s kind of that’s where I’m thinking.
Dr. Bruce Gantz 19:04
Okay, so that’s called bimodal. Right. And so we have like 147 patients with bimodal hearing. And their bimodal hearing is still about 10 to 12% below EAS — is better when you have the acoustic in both ears, right? And then there’s another advantage that we’re just recognizing in some of our central auditory processing experiments. So, Yong Choi is one of the people that works with us. He’s a PhD in speech and hearing and he’s the one that does the EEG work. So he presents a tone and then there’s a short onset and then there’s the word. So when you have acoustic plus electric, compared to electric only, when you turn on that tone, the electric only ear responds with a much greater amplitude. And the acoustic plus electric group is suppressed. So there’s some central suppression, with the acoustic hearing that helps to depress the response to that initial turn on of the —
Dr. Mark Syms 20:33
Some sort of natural feedback that you lose with electric hearing.
Dr. Bruce Gantz 20:39
And that’s something we’re just beginning to understand and just beginning to explore. But that acoustic hearing is, is dear — you cannot —
Dr. Mark Syms 20:49
Yeah, you’re just reaffirming that, in an ideal world, the acoustic hearing is better than the electric area, right? I mean, obviously, we’re in planning patients that have lost it, but just as a word to the listeners, where it’s much better for you to preserve it. In other words, protect your hearing and don’t lose it as compared to asking us to give it back.
Dr. Bruce Gantz 21:10
Exactly. And if you have some residual hearing, and you’re having trouble in noise, which is the biggest problem for people learning aids, that if you can give to someone that has some experience and able to use and preserve that low frequency hearing, it’s a huge benefit.
Dr. Mark Syms 21:31
Sure, if you’re gonna get a cochlear implant, yeah, I agree. Yeah.
Dr. Bruce Gantz 21:34
And so you have to make a decision whether or not you want to live in an environment with a hearing aid and or word under scratch understanding and then on top of the hearing poor in noise, or do you want to chance possibly losing some of that residual hearing. And I will tell you mark, that we’re just looked at it about 28 patients with these shorter electrodes that 10 millimeters in the back, which were the hybrid s that the trial, you were in the sad, okay, that group versus the l 20. Fours, the L 20. Fours were 16 millimeters. The EAS population today is still our Better Hearing preservation at 79% of people up to over 15 years using acoustic plus electric. So now we’ve had, I think, seven patients of that original at last significant hearing that we’ve been able to track from from our center, right, and we then we then just when you lose that residual hearing, you just increase the frequency range on those 10 electrodes. So you expand it, and those patients then become bimodal. Right, of those seven patients that have lost the acoustic plus electric, they are at the same level of performance as the bimodal group of that 146 that I told you with the standard electric. So we have not had to change any electrodes of those short. Now we’ve, we, we did a number of we had about 20 of the Dell 24s that failed. And, again, the majority of those did very well. Bimodal. Similar to the bimodal, long electrode patients, we did change out five devices. And when we changed them out, one got better. Who didn’t get anything with the short electrode in the first place, or the 16 millimeter electrode in the first place. The other three, didn’t get much better, but got slightly better. And one got a little worse when we put in the longer electrode. So it’s a real, you know, is that the answer? I’m not certain it may.
Dr. Mark Syms 24:08
It’s hard, because there’s scar envelopes, there’s all sorts of things that are, you know, that’s the way you’re saying the first shot is the best shot, because that is the show.
Dr. Bruce Gantz 24:18
And also, it’s probably the neural environment initially.
Dr. Mark Syms 24:22
Right? Okay, well, that’s the thing stratifying these patients out to the ones that actually I mean, that that that’s probably the hardest thing is if you had all of the factors that determine success, we’d be much better at having success because we pick and do the ones that were actually, you know, predisposed to great success. Right.
Dr. Bruce Gantz 24:39
Right. So there’s, there’s a lot to it, but I think that’s going to be the trend in the future, because go ahead and we’re going to continue to expand our crate area. We’re going to get better at preserving residual hearing. And at some point, these individuals that are struggling are Gonna have to make a decision whether or not they want to go to the next level? And I think they probably will.
Dr. Mark Syms 25:06
Yeah, I think a couple of challenges. One is is is cochlear implant candidates really can’t intellectualize what we’re talking about. So that I think is a huge thing. They all just want to hear better. And that becomes really difficult. The other thing that was interesting, I was talking to my cochlear implant team just last week, about there is a shortage of research and presentations of who not to implant, or who not to do these things do right, we oftentimes do acts of omission rather than omission. But I think the nuance will be who we don’t do some of these things are not who we do do some of these things on. You’re exactly right.
Dr. Bruce Gantz 25:44
I’m right with you. And then I can tell you that we did a group of marginal patients for hybrids with the L 20. Fours. And we were doing it because we thought we said okay, how about some of these people that were worse than 60? In these three low frequencies, but better than 80? They, you have to have more reserved than that he
Dr. Mark Syms 26:08
might as well have done a full length and gone to electric, a pure electric stimulation for those right. Yeah, and so that’s the hardest thing. It’s not as quick. I mean, some I think some of our listeners and patients believe it’s all formulaic, you know, and it’s not, it’s still an evolving thing, right? Even, you know, backing up, I have struggled getting some patients to understand what they’re getting themselves into, let alone some of these more highly-nuanced things that you and I are talking about today.
Dr. Bruce Gantz 26:40
I completely agree. And I’m just hopeful that our whole community will continue to embrace this, rather than just jamming long electrodes in patients and in not giving them a chance.
Dr. Mark Syms 26:56
Now that I mean, I can even tell you, I agree with you. But even you know, the surgeries that you introduced with the attempts to preserve hearing themselves, really led to just a change of all I mean, when I think about what I watched at the beginning of my career where we opened up the round window, and you could see down the basal turn of the Cochlear because you taken all the fluid out and put the electrode in as compared to now where we’re microscopically piercing the round window membrane and slowly advancing thing. I mean, we’ve come a long way, just in terms of, you know, the elegance of insertion regardless.
Dr. Bruce Gantz 27:32
You’re exactly right, you’re right. And, you know, and I think we’re gonna get better, you know, the other. The other strategy we use a lot now is decode GE, electric cochlea geography. So, you know, unfortunately, when you’re putting an implant in, you have no haptic feedback for where you are. And so with the monitoring with ECOG, now we can do a whole nerve action potential and measure that wave one through the implant. And as we’re sliding it in, we can see the change in the response. And you can backup the electrode, if you’re going slow, like we do with the robot, you can reverse it, move it a little bit and go back in. And I think that really does help us to monitor and watch what’s going on in the inner ear. So that the robot ECOG, there’ll be other strategies that will come about it’ll make this a safer environment for all.
Dr. Mark Syms 28:42
Yeah, it’s, it’s amazing, because, you know, I think back to how, when I first started in the late 90s, how we really were, I mean, not that it’s not a concern now, but you know, it was much more often that we didn’t have a totally paid cochlea, there were anatomical changes, you know, ossification and all that, like that. They still happen, but you know, we’re going into much healthier cochlear is where we can do things like, reverse it, steer it, you know, all of these amazing, I mean, back then sometimes we were again, just happy to get it in, if you will. It’s true, right? And a lot of it —
Dr. Bruce Gantz 29:19
Listen, I contributed to that, because one of one of the things that they did though, was in the obstructive cochlea is really a part of it aware, and then it get in as many electrodes as you could after that. And so I had this concept that well, maybe the cochlea isn’t that important, but I, you know, I changed my philosophy over time.
Dr. Mark Syms 29:46
Well, but that still might be the case for that particular instance, though. If you’ve got to drill it out. You’ve got to drill it out. It’s just we don’t see them as often. I think.
Dr. Bruce Gantz 29:53
It works, you know, it’s just like, Now, the other day on Thursday we put an implant in a patient with an F two that had been irradiated. And got there — there was tumor in the cochlea. We took it out, put the electrode in and it works.
Dr. Mark Syms 30:14
That’s amazing. Yeah, I mean, just, you know, when I was doing my fellowship, you know, I was involved in a lot, maybe 40 or 50 API’s because it was right when they were getting approved. And it’s amazing how, you know, it’s it was a great answer then. But the, the cochlea, the distribution of nerves in the cochlea will never is just so far superior to the nucleus in the brainstem.
Dr. Bruce Gantz 30:39
Exactly. And so, you know, we’re doing all we can now, and we’re approaching tumors differently, because you want a cochlear nerve. Yeah, we want to preserve the cochlear nerve, we’ll do a Transyl lab routine approach, take out the tumor, preserve the cochlear nerve, and then come back and put an implant in. And that works about 70% of the time. Yeah, so it’s getting you know, we’re, we’re changing how we approach a lot of things that we thought we couldn’t do in the past.
Dr. Mark Syms 31:10
No, I mean, it is the practice of medicine, people don’t like that concept. But we are trying to figure out what’s best with the current information that we have. And I really, you know, I had Marlin on too and you know, guys are doing this day to day, getting the data, analyzing the data, creating new knowledge, I really admire that dedication to that, especially, I mean, University of Iowa has always been on the cutting edge of this for probably a total existence, right?
Dr. Bruce Gantz 31:37
Well, we I mean, we, you know, we just have to brag a little bit, we just got refunded for the eighth time our, or eight divey are competitive renewal, or D 50 grant, which is the University of Iowa Cochlear Implant Clinical Research Center. And so that’s been going on, it’ll go on to 2028. So far, 43 years of continuous. And without that support from the National Institutes of Health, we wouldn’t be able to make the strides and do the kind of research that we do. And that an institution like us needs to do that.
Dr. Mark Syms 32:18
And that’s your role in the community. And that’s one of the roles of federal government funding, researching, and it’s one of the good outcomes, right? I mean, you guys are making new knowledge and giving us better ways to practice the art and science of medicine, which is kind of what we’re all here for, I think.
Dr. Bruce Gantz 32:36
I hope so. Yeah. Me too.
Dr. Mark Syms 32:38
And I very much appreciate your contribution. So where do you see it? Dr. Gates, like 20 years from now, where do you see all this? I mean, I think looking at your crystal ball, and you know, I obviously, we’re not going to hold you to fidelity to it. But where do you see this all going?
Dr. Bruce Gantz 32:53
I think the majority of people over the next 20 years, that are having difficulty and noise are going to come forward faster. And we’re going to be better at preserving hearing, I think we’re going to get to 90 to 95% hearing preservation by selecting the right people. And then I’m hopeful that they’ll have a lifetime of hearing, as long as you preserve that low frequency. And it’s interesting, as you look at audiogram of people with presbycusis, or even other genetic disorders, very slowly, this the low frequency hearing go down. It’s pretty resilient. It’s about one dB per year. And so you have to go 70 years before you’re going to lose that low frequency hearing, most likely. So, you know, I think we’re going to implant people younger. I think this is going to be a strategy that is going to impact cognitive ability of the individual and their ability to be out there in society. And they’re not going to withdraw — have all of this cognitive decline. So I think hearing healthcare is becoming more and more of a central focus for human health. And we have not paid that much attention to it. The report from the Lancet Commission showed that 9% of the variability of cognitive decline can be attributed due to hearing loss and be prevented. That’s one of the more — it is the largest portion of the cause of death, that cognitive decline.
Dr. Mark Syms 35:02
There’s a modifiable factor that they report is the most.
Dr. Bruce Gantz 35:07
And so that’s real. And I think that is going to impact where we are in auditory hearing healthcare in the future. And I just will, I think that we’re going to get better at remote care of these individuals, they’re not going to have to keep coming back to the center, we’re going to remotely program them, we’re going to probably — the patient themselves may be able to tweak it a little bit. And all of those things are going to help because we will not survive, we don’t have enough resources to keep expanding the population. And the little bit of reimbursement we get out of that. It’s not going to work. And so we have to, we have to think about out of the box solutions.
Dr. Mark Syms 35:58
Yeah, I agree. I mean, my one comment about the kind of thing is, is I think we have to get out of device-oriented language. So what I mean by that is, you know, the primary care tells the patient, they’ll get hearing aids, or somebody says, you should get a cochlear implant. And it’s kind of interesting that that’s a prescriptive concept. The real answer should be you don’t hear as well as perhaps you want or you should go get it evaluated. And then it because I think people underestimate the complexity of coming to the conclusion of the internet should be kind of like saying, Well, you have coronary artery disease, is your go-to the cardiothoracic surgeon and get quadruple bypass? Well, there’s a huge diagnostic underlay that leads to that conclusion of therapy. And I think there’s something in our vernacular where we are device conclusive. I think, frankly, it has to do with the industry wanting us to talk about their particular solution, but we really need to get into the language of talking about treating your hearing loss. And then that’s where the otologist lens, right, what is the right modality and the right technology to actually treat your hearing loss? And it’s not as complete? I mean, look at the conversation we’re having, is it a cochlear implant? Is it an electric-acoustic hearing? Is it your hearing aids aren’t programmed right? I mean, there’s just so many things like I mean, I see people that add hearing losses with open don’t, it has nothing to do with a cochlear implant, it has a lot to do with their there. So that whole concept was, well, the concept of treating your hearing loss rather than a technological conclusion.
Dr. Bruce Gantz 37:36
Right. And I think that it’s going to get easier. I mean, hearing is not difficult to measure over the telephone.
Dr. Mark Syms 37:45
Yeah, no, you’re right. I think the other fault that our system has is this concept of subjective assessment of I mean, of people’s hearing, I mean, you I’m sure you’ve seen them to duck bands, where they’re people come in over 70 dB loss, and they look at you and say, I don’t have any hearing loss. And there are other people that come in with a 20 dB loss and say, I’m totally debilitated. I can’t hear anything. And so, like, subjective assessment of one’s hearing is kind of crazy when you think it’s like you don’t know what you don’t hear. So how do you assess what you don’t hear? And so it’s an objectively measurable thing. And we, you know, these all of these indexes and handicaps and surveys, they don’t correlate with symptoms, it’s really a measurable objectively performative field that we’re in and we have to get away from, well, they’re not motivated to do something about their hearing loss because they don’t perceive it. Well, that doesn’t matter. They have a hearing loss, it needs to be treated, that that’s the answer. It’s a medical model, not a social model, like hypertension. Correct? Exactly. I use that analogy all the time. Just because you don’t feel bad doesn’t mean you shouldn’t get your blood pressure.
Dr. Bruce Gantz 38:49
I mean, at some point, your blood pressure does cause you problems. But for years, you can be asymptomatic and have terrible blood pressure, right? So no, I think it’s the same thing with hearing loss. And there’s this stigma that you’re getting old if you have a hearing aid.
Dr. Mark Syms 39:08
And if people know you’re old, don’t have a hearing aid to be honest with you. You’re all great in here. That’s the end. Well, this has been great. I very much appreciate your time giving it to the to us and it’s good to talk to you. And I just want to let you know, I appreciate your mentorship over the years, it’s been very valuable to me.
Dr. Bruce Gantz 39:32
Mark, you’re a key player here. And, you know, your patients must love you for the care you’re giving them and the interest you have in this whole issue. So please keep it up.
Dr. Mark Syms 39:49
Yeah, I searched it a little bit more from an access point of view, which is kind of my interest — making this accessible to people. That’s kind of where I kind of but giving people The information like you provide is wonderful.
Dr. Bruce Gantz 40:03
If you have questions call us or if your audience wants to call us, you know, they can get in touch with our, our office and you probably have that information. Yeah. What’s
Dr. Mark Syms 40:13
the University of Iowa? Department of Otolaryngology website? Correct.
Dr. Bruce Gantz 40:19
And in the office telephone for Dr. Hansen and myself is (319) 353-2173 in the area. Three one time.
Dr. Mark Syms 40:36
Yep. That’s the Iowa area code, I suspect. Yes. Well, again,
Dr. Bruce Gantz 40:43
you know, we have sunshine like Arizona today.
Dr. Mark Syms 40:46
You do and it’s sunny today in Arizona too. It’s beautiful. It’s absolutely beautiful. And you’ve got plenty of windows. I don’t want to ask you how much your electric your heating bill is in winter, but it is beautiful.
Dr. Bruce Gantz 40:57
And I heat with wood.
Dr. Mark Syms 41:00
Well, again, thank you for coming on. This was Dr. Bruce Gantz. He is a professor of Otolaryngology neurosurgery University of Iowa. And as you can tell, a been a wonderful researcher and a pioneer in cochlear implantation. Thanks for coming on.
Dr. Bruce Gantz 41:14
Thanks, Mark. Have a good day.
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