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Dr. Hannah Glick – Socialization and Cognitive Function in Hearing Loss

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Dr. Hannah Glick

Dr. Hannah Glick is a cognitive neuroscientist and an Affiliate Professor at Metropolitan State University of Denver. Her professional experience extends to multiple different industries, including healthcare, academic, government, and entrepreneurial settings. She received her triple PhD from the University of Colorado Boulder in behavioral neuroscience, cognitive science, and speech, language, & hearing science. Additionally, she has worked for multiple notable companies in audiology such as Advanced Bionics and Cochlear.

Here’s a glimpse of what you’ll learn: 

  • How Dr. Hannah Glick got her triple PhD and how she leverages her expertise
  • The relationships between socialization, cognitive decline, and hearing loss
  • Brain changes that occur in early to moderate hearing loss
  • Neuroplasticity in adults after receiving hearing aids
  • Accurately identifying hearing loss beyond the audiogram 
  • Why the high frequencies are so crucial for hearing technology
  • Building community around patients for holistic hearing
  • The importance of research for patients and professionals alike

In this episode…

It can be easy to attribute hearing loss exclusively to the biological condition. After all, if there’s been damage or a steady decline, that should explain why hearing has been diminished. The reality, however, is that hearing loss comes from a variety of factors. Many of these are only now being researched and looked into, which ultimately transforms the way we treat hearing loss.

Dr. Hannah Glick has taken a broader view in her approach to audiology. She graduated with a triple PhD in behavioral neuroscience, cognitive science, and speech, language & hearing science. Her education and experience have directed her research and work to unique places, offering her a different perspective on hearing loss. 

In this episode of the ListenUp! Podcast, Dr. Mark Syms talks with Dr. Hannah Glick, who works with the University of Colorado Boulder, to discuss hearing loss and the social and neurological factors that lead to it. They talk about the research she’s performed, what it says about brain activity, and neuroplasticity in adults. They also go over the importance of proper socialization in patients and the support they need.

Resources mentioned in this episode

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.

Episode Transcript

Dr. Mark Syms  0:00  

Hi everybody, Dr. Mark Syms here. I’m the host of the ListenUp! Podcast where I feature top leaders in health care. Past guests include Dr. Jason Glasser, I’d like to thank for giving me our next guest. This episode is brought to you by Arizona Hearing Center, I help patients to effectively treat their hearing loss so that they can connect better with their family and friends and remain independent. The reason I’m so passionate about helping people with hearing loss is because I lost my brother Robbie twice, first from his hearing loss from radiation to his brain tumor, and then again when he passed away, I only care for years on the ear of e and t has performed over 10,000 years surgeries and cared for 1000s of patients with hearing loss over the past 20 years. I’m the founder of Arizona Hearing Center. I’m the author of Listen Up, go to listenuphearing.com. To learn more about the book, go to azhear.com and contact us with any questions or any concerns or anything you’d like to talk about. I’m very excited about today’s guest today we have Dr. Hannah Glick. She’s an audiologist and a cognitive neuroscientist with professional experience extending across healthcare, academic industry, government and entrepreneurial settings. Dr. Glick brings a fresh perspective to depression to the profession of Audiology. She completed her ad and combined triple PhD I can’t wait to find out about that at the University of Colorado Boulder. Her research focuses on the effects of hearing loss and hearing treatment and rehabilitation on brain health, cognition. And overall well being. Dr. Glick, thank you so much for coming on. Listen Up. This is great. Thank you for being here.

Dr. Hannah Glick  1:24  

Thank you happy to be here.

Dr. Mark Syms  1:26  

That’s great. So tell me your story. Like how you know, you have a triple PhD which infest you I’m not sure I’ve heard of that. But I mean, I get the concept. But what are the three fields of your PhD? And how did you end up there from being a high school student college student or however you got that path?

Dr. Hannah Glick  1:44  

Yeah, so I actually started my freshman year of college thinking that I wanted to be a French teacher, I was studying languages, English and French. And I was sitting there in my first year classes and reading all these books. And I felt like I was being told what to think, while I was reading, um, I had to interpret things in a particular way. And I just didn’t feel really challenged. But I loved languages. And I was also always interested in science and biology. So I ended up pivoting a bit, switch schools, switch majors, and I had a family friend that I grew up with whose mom had a cochlear implant, and I saw how much that impacted her and changed her life. And that’s what kind of got it got me interested in audiology. I’d never heard the word audiology before. But that’s kind of what set me down that trajectory. So started out as an undergraduate student in Speech, Language and Hearing science at University of Colorado Boulder. And as I was taking classes, I loved what I was learning. But at the same time, I felt like, we focus so much on the ear. And we basically ignore the brain entirely. Yes. And really, we hear with our brain, not our ear.

Dr. Mark Syms  3:00  

Well, it’s funny, you say that I tell people this now like in my exam rooms, I have this big diagram of the year, right. And on the right hand side, there’s a little curve, and it says brain. And I always tell people like, based on scale, that brain goes like up to the top floor and down to the bottom floor. But it shows you how much you know the anatomical concept. And because it’s easier to explain than the brain. And that’s why you there’s tons of work for you so so you thought about the brain, which is incredibly important, because that’s what we hear with. 

Dr. Hannah Glick  3:30  

Yeah. And I realized, wow, this is a whole area that it’s sort of an unmet need in the field of audiology and something that, you know, audiologist don’t even counsel their patients much about the brain sometimes I think it’s it’s becoming more integrated into clinical practice in the last few years. But that was a big motivator for me. And at the same time, while I was taking my undergraduate coursework, my grandmother started developing hearing loss. And my grandmother had polycystic kidney disease. And she was on medication that was ototoxic. And was losing hearing very rapidly each year. And her kidney doctor and her audiologist were not communicating with one another. And I was kind of learning about this whole link between ototoxic medication use and hearing loss as I was taking my coursework, and just over time, I watched my grandmother really change like withdraw socially, become more socially isolated, eventually start to show signs of cognitive decline. And I just thought this is this is what I want to study. I want to study this link between age related hearing loss and cognitive decline.

Dr. Mark Syms  4:38  

That’s great. I mean, yeah, I think we all have some sort of experience, right, you know, as we’re kind of sensory people, right? And so for us to be naive to think that it all just stops at the sensory organ, and that there’s not some processing of the data. It’s almost like you know, in the computer, we’re just keyboard people, and we don’t really care what happens once you get the keystroke. But the reality is, is once you hit the key, then a whole bunch of things happen in the microprocessor that lead to some outcome that you really want, right? I mean, if you hit the keyboard and the letters didn’t come up on the screen, you’d be like, wow, there’s something wrong with the computer. Right? We wouldn’t say, Well, it’s the keyboard. It’s not a problem, right? And so that, and it’s a different mindset. So you do that and wait. So that’s to your neuroscientists, and an audiologist. That’s right. And so what’s your third? Are you a linguist? Or what’s the third

Dr. Hannah Glick  5:27  

area of science? Ah, so all tied up? Yeah. And so as I started my PhD in Speech and Hearing science, I, I realized, well, I need to know I need to understand more about the brain, I need to understand more about cognitive science in order to really look at this link between hearing loss and dementia. And so it was just sort of a natural thing that happened. University of Colorado Boulder has a really cool triple PhD program, where you can be working on all of this different coursework simultaneously. And I think it’s great to get insight and input from outside of the field.

Dr. Mark Syms  6:05  

Where it is the field, right? Because the right field is the cognitive effect of hearing loss, where if you compartmentalize it, you’re not actually doing the work.

Dr. Hannah Glick  6:13  

True. Um, and so it was, it was just a perfect fit for me. That’s great.

Dr. Mark Syms  6:18  

So, you know, kind of getting down to it. Like, you know, we all you know, I mean, one of the things I tell patients is, you know, high blood pressure, if you look at the history of high blood pressure, you know, the medical field thought that we should treat high blood pressure in the 40s, and 50s. And we started treating it. And we had the definitive study showing that you should treat high blood pressure in the mid 1970s. Right? So finding these causal links, and is actually pretty hard. And it’ll, it’ll be faster for us, right? Because we’ll probably have stronger data science and things like that. But that all being said, can you talk about maybe what the theories are of the mechanism? In other words, what is it that your grandmother had hearing loss? And your grandmother had cognitive decline? And what are the thoughts in your field that different? Like, how does one knee to the other?

Dr. Hannah Glick  7:08  

Yeah, so in science, we always talk about correlation does not mean causation. And so this is an active area that is still being investigated. But one of the theories linking hearing loss to cognitive decline, I think the one that is most intuitive for a lot of people is social isolation. So as we get hearing loss, and our hearing gets worse, we may become a little bit more so socially withdrawn. And we know that social isolation is a risk factor for cognitive decline and dementia. And so that’s one theory. Is this kind of social hypothesis?

Dr. Mark Syms  7:44  

Yeah, I tell patients that though, go from being in the conversation to the conversation occurring around them. But there are others too, right? And so how about cognitive load? How about that concept?

Dr. Hannah Glick  7:54  

Yeah. So um, the other link is this idea, the link between hearing loss and cognitive decline is due to increased cognitive load. So the way I like to describe it is, let’s say you have a gap, your your brain is like a gas tank, right? And it only has so much space that you can fill so much fuel. Well, if so much fuel, so much energy is being devoted just to listening and parsing that speech signal, the less fuel there is in that tank available for other things. So if in a conversation, I have hearing loss, you and I are having a conversation, if so much of my mental energy is being devoted just to listening to you? What if you asked me what I had for dinner last night, and I have to go into memory and retrieve that there may not be enough space enough reserved left for me to appropriately answer your question. And imagine living like that on empty gas tank all the time. 10 years?

Dr. Mark Syms  8:55  

Yeah. Yeah. I said a patient, you know, you know, because there are people in denial, right, that they don’t even think they have a hearing loss. And I said, I’m like, Well, you know, regardless, your kids are, at some point going to say, you know, you’re not quite as sharp as you used to be, you’re not answering the questions, right. And, you know, the next step is unfortunately, a care facility or somewhere where people don’t so even if you’re not in cognitive decline socially, people treat you as if you’re in cognitive decline, which then just makes you more socially isolated.

Dr. Hannah Glick  9:25  

Right? And then the third one is, is as if you think about our auditory system is housed in our temporal lobe right behind our ear. And that same area of the brain is involved in other functions, like memory. And so one other kind of possible link is you know, as hearing loss gets worse, we know that the brain begins to atrophy in those areas of the brain if the brain is not being stimulated as it normally would. It may begin to a trophy, maybe repurposed by other senses, like vision and touch. And so some of these structural and functional brain changes that arise from hearing loss is another potential causal link, as well.

Dr. Mark Syms  10:12  

So there are all these theories. So it’s a big machine or a big bunch of theories. So where do you work in terms of all of this?

Dr. Hannah Glick  10:19  

I kind of look at all three areas. Okay. But I started my dissertation study, I was mainly looking at brain changes that happen in early stage, mild to moderate hearing loss.

Dr. Mark Syms  10:33  

And so what how did you assess the brain? Just add it?

Dr. Hannah Glick  10:37  

Yeah. So I took two groups of people, I took a group of older adults that had totally normal hearing and a group of adults that had very early stage, mild to moderate hearing loss. Some of the people in the hearing loss group, they didn’t even know that they had hearing loss when they came into the study.

Dr. Mark Syms  10:53  

Did any of them have low normal?

Dr. Hannah Glick  10:57  

Better than normal? You mean? Oh,

Dr. Mark Syms  10:58  

between? Like, like, slight, 25 DB, you know, at the bottom? Because normal is I’m not sure. So normal.

Dr. Hannah Glick  11:05  

Yeah, I agree with you there. Yeah. So most of the people in the hearing loss group had kind of that sloping hearing loss. Hearing loss. Yeah. Um, but I took those two groups, and then I acutely fit the hearing loss group with hearing aids, and all the they all receive the same hearing aids, they’re appropriately fit based on their hearing loss. And at baseline, acutely after I finish our hearing aids, I looked at, at differences in cognitive function between the two groups, I looked at differences in speech, perception and noise. Between the two groups, I looked at the benefit that they got from lip reading cues between the two groups. And then we used high density EEG, which is a neuro imaging technique. They basically were this cat with about 128 electrodes, and looked at how their brain responds to auditory visual and vibrotactile stimulation,

Dr. Mark Syms  12:03  

How they better integrate sensory input. 

Dr. Hannah Glick  12:05  

Yep. And what we found is that at baseline, the hearing loss group, even though they had this very mild hearing loss, had poor cognitive function in you know, lots of different areas, processing speed was slower. Overall, global cognitive function was poor. Auditory working memory was also poor. And obviously had a harder time understanding speech and background noise, and didn’t actually show that they were relying more on visual cues, which was kind of interesting. We thought maybe we’d already we’d see signs of that in mild hearing loss didn’t see that.

Dr. Mark Syms  12:48  

There. You’re saying the lip reading skills? Were not that different already?

Dr. Hannah Glick  12:52  

Nope. But we know that lip reading abilities and people with severe to profound hearing loss usually is they’re relying a lot more on lips at that point.

Dr. Mark Syms  13:01  

Yeah, I guess it’s just they’re able to compensate with other mechanisms that that that compensatory mechanism has kicked in, I assume.

Dr. Hannah Glick  13:08  

Yep. And then pretty profound differences between the two groups in terms of what their brain looked like, in response to the sensory information.

Dr. Mark Syms  13:20  

Density, EEG.

Dr. Hannah Glick  13:21  

Yeah, so the biggest thing that we saw is that in a normal hearing group, when we present visual stimulation, we see activation in the back of the head and this visual area back here. But for the hearing loss group, they were actually showing activation in the back of the head, the occipital lobe responsible for processing vision, and in the temporal lobe. So, you know, it’s kind of that use it or lose it mentality, if you’re in part of the brain is not being stimulated. Normally. Vision May May encroach and kind of take over there.

Dr. Mark Syms  13:54  

But you know, it’s interesting. I mean, you know, we see this all the time in like, athletics, right, you know, I mean, if you’re a high performing athlete, you have a limp. You’re just not going to perform as well. Right. And that’s a if a normal person had a slight limb, people were like, Oh, well, it’s not it all depends on what you’re trying to accomplish. Functionally, it’s, that.

Dr. Hannah Glick  14:12  

Yeah, and the brain is it’s adaptable. And you know, for the longest time, people thought, well, neuroplasticity is kind of at a tight and infancy right over those first three years of life. But in fact, we show pretty amazing changes in neuroplasticity into adulthood and older adults and as well.

Dr. Mark Syms  14:31  

So when they put the hearing aids on and then they compare themselves with hearing aids to the normal hearing adults what you see is that’s the question right like in other words, we know that if you’re hearing loss, your brains not the same, but if we treat your hearing loss appropriately, your comes the punch line, this is what people want to know what happens.

Dr. Hannah Glick  14:49  

Yeah, so we actually saw reverses in some of those changes in neuroplasticity, plasticity, so after six months of hearing aid use instead of the hearing part of the brain lighting up in response to the vision stimuli went back to the back of the head, which is what we would expect. And saw pretty remarkable improvements in cognitive function as well. So not all areas that we looked at cognitive function, could we measure improvements? But in global cognitive function, we saw improvements in processing speed, and anything faster. Right? Yep. And working memory as well. 

Dr. Mark Syms  15:25  

So talk to me just for a non nor cognitive neuroscience people working memory, what’s that concept? People? Kind of practically apply it?

Dr. Hannah Glick  15:33  

Yeah, think of working memory as a sort of a form of short term memory. So if we’re an active conversation, you asked me what, you know, what, what did you have for dinner last night? It’s the ability to pull that information short term and recall that and then be able to respond to it.

Dr. Mark Syms  15:51  

Not, what did you have for dinner on Thanksgiving of 1987? Right? It’s, it’s the stuff that’s immediately available. Yes. Yeah. So that that capacity enlarges, or the efficiency of accessing it improves, or both?

Dr. Hannah Glick  16:07  

Um, so what what we saw is both.

Dr. Mark Syms  16:10  

Wow, that’s great. And then you just become a better conversationalist, if nothing else.

Dr. Hannah Glick  16:15  

Yeah. And I get, it ties back maybe into that, that idea of cognitive load, we can free up some of that space, some of that fuel, so that they can devote to other tasks, just by having a hearing aid and providing them with a little extra amplification.

Dr. Mark Syms  16:32  

Intuitively, though, I mean, that the first theory you touched on was social isolation, right? And that’s actually kind of hard to measure, like, how isolated Are you? But the reality is, is everybody knows, if you have better working memory and better recollection, you’re a better conversationalist. And if you’re better conversationalist, you’re going to be better connected.

Dr. Hannah Glick  16:51  

And we did actually do some questionnaires as part of the study, kind of piloting some future projects, where they filled out some checklists about social isolation. And we did see differences between the two groups at baseline. And we did measure improvements in social isolation in the hearing loss group, but it was not quite statistically significant.

Dr. Mark Syms  17:12  

It’s intuitive, right? Just because you couldn’t measure it. I mean, like I’m saying, it’s, I just, I’m not sure how you could quantify people’s social connection versus their social isolation. perceptually I get it. But you know, maybe the hearing aids would have some sort of technology to see how much people engage in conversation with them before and after something that might be I don’t know, future work if you.

Dr. Hannah Glick  17:35  

Yeah, that would be that’s an interesting, it would be an interesting use of technology to get some data on that quite same question.

Dr. Mark Syms  17:42  

So let me know when you have that done by next week. All right. Well, that’s awesome. So that’s really pretty amazing. And so that was kind of your foundational work of where you’re going. And so you’re now out and becoming a, you know, a faculty member. So what where does that most people continue on kind of the work that they did? And so what are you working on now?

Dr. Hannah Glick  18:06  

Yeah, so after I finished my PhD, I went and worked at Advanced Bionics for some time, it’s a cochlear implant company out in California. And I was working on some similar projects related to my PhD work, but in the context of cochlear implants, and also working on developing some new cochlear implant technology. And but I really miss teaching, I really miss interacting with students. And we have, my husband had a job opportunity back here in Colorado. So we ended up coming back, and I’m born and raised in Colorado, so you’re glad to be back in Colorado, and I returned to the university to kind of right where I started. And it’s it’s fun getting to work with the next generation of audiologists, and talk about things like cognitive function, and how we counsel patients about what we know about the link between hearing loss and cognitive decline, and start pushing them to think about what kind of audiologists do they want to be? What are the unanswered questions that we have in the field that they could explore. So that’s been a lot of fun, but research wise, my interest now is looking at this social isolation piece.

Dr. Mark Syms  19:20  

Oh, yeah. So that’s the hard one to measure. Right. Wow.

Dr. Hannah Glick  19:24  

And it’s the one that when you talk to people, just everyday people on the street, it’s the one that seems most intuitive to them.

Dr. Mark Syms  19:33  

Right? Well, you can’t have conversation you can’t interact, right? Like, you know, the other thing. You go from being the life of the party to not even wanting to go to the party, right? You know, and people don’t realize, but they’ll say to me, I don’t like socializing anymore, anyway. Well, why is that? Right? It’s not because you maybe didn’t intrinsically like it. It’s because it’s so much work. I mean, people are supposed to look forward to social affairs, not dread the fact that they’re going to ask people to say what 30 seven times,

Dr. Hannah Glick  20:00  

right? And I think the hardest thing about hearing loss, it’s it’s like that slow creep, right? It’s like it happens. So slowly one to two decibels, you know, year and it’s by the time you it catches up with you and you realize I’m having difficulty you already compensated you’ve already changed your lifestyle, um, around your hearing loss without even really realizing it. Yeah, my

Dr. Mark Syms  20:25  

book I call it a death by 1000 paper cuts, love. I mean, it’s just you don’t even realize it but you’re slowly being killed, you know, figuratively just being beaten down socially and losing that connection and stuff. And, and the other thing I always tell patients, which you know, people get I said, the people who will tell you that your zippers down, are the people who will tell you you have hearing loss, right? Because, you know, other people aren’t going to tell you that right? Even like, you know, decent friends, like, you know, the way we get along with our friends is not what we tell them they do wrong. It’s by kind of accepting what they do wrong and not saying anything, right? Only your closest confidence are going to say to you like, Hey, Mark, you know, you have some hearing loss, you really need to take care of that. 

Dr. Hannah Glick  21:07  

Yeah, definitely. Yeah, and one of the other things I’m really interested in is this whole idea of, of screening for adults, you know, um, you know, babies get their hearing screen, my son got his hearing screen before he left the hospital. Um, but we don’t have any kind of programs like that for adults. And we get a mammogram when we turn 50 women get a mammogram when they turn 50. Why not get a hearing screening in your 50s? If we know about half of adults will start to show signs of hearing loss in their 50s?

Dr. Mark Syms  21:38  

Well, I mean, changing the mindset to it’s a normal part of aging to a treatable part of aging, right. Although it is a common pathology of aging, it doesn’t mean it’s something that’s not a pathology or something that should be addressed. So, you know, you and I are very much aligned in that that fact. Right. Yeah. So, and it’s a big problem to be tackled. But I think there’s a lot of great energy and interest in people tackling it.

Dr. Hannah Glick  22:04  

Yeah. And I think audiologists and EMTs getting out of our clinical capacity and, and talking more just from a public health perspective about hearing loss, what we know about hearing loss and social isolation and dementia. And, and educating the public. Because, like, like you said, it’s, it’s, it’s attributed to being a normal part of aging, when maybe we should be looking at it in a bit different way. Being about.

Dr. Mark Syms  22:35  

I think the other struggle is, is we have not been good at standardizing things. And so until we can get our language and measurements, standardized, it’s pretty hard to ask others to get on board with the concern of the pathology. And that’s just kind of the nature of an evolving issue, right? In other words, get everybody aligned to be using the same language and saying this, you know, as you and I are talking about, you know, there’s pretty good evidence that lower parts are normal or normal, right. And so even the audiogram might not represent really measures of mild to moderate whatever that means. I don’t even know what a moderate hearing loss means.

Dr. Hannah Glick  23:11  

I was just gonna say, I think that the way that we screen hearing loss in adults is also a bit antiquated. Um, I love the audiogram. But maybe we need to look at some different screening tools, like a speech and noise test. Like the quicksand test is a test that a lot of audiologists will do clinically, it takes five minutes to do. And it gives a person a real world of idea of how they’re functioning in background noise.

Dr. Mark Syms  23:38  

Yeah, it’s interesting, you know, I was having a conversation about people representing audiologic data from a information technology point of view, and they just thought, well, it’s the audiogram. I was like, no, no, the audiogram is a graphical representation of data points. It’s not actually the measurement. Right, right. You know, it’s it’s actually numbers across frequencies. And so it’s interesting, even that concept that people think that the audiogram is the representation of their hearing. No, it’s a graphical representation of data points. Right.

Dr. Hannah Glick  24:08  

Right. And if you think about even in pediatrics, a lot of my research in my PhD was looking more on the piano pediatric side of things we saw before I started looking at aging, and we use a 15 DB cut off normal hearing for kids. Why don’t we use that same cut off for adults? That’s something that I think needs to maybe be re examined. 

Dr. Mark Syms  24:28  

Maybe it becomes overwhelming from a public health point of view? If you do. Yeah, yeah. Honestly. So and so, you know, one of the other fascinating things so, you know, I don’t know if you looked at this or are looking at this, but you know, one of the epidemics I think is out there is what I would call under treatment, or of hearing loss, right. And so, in your I mean, essentially, you know, if you want to look at treatment as hearing loss is binary, either it’s well treated or not so non treated or under treated could be considered the same bucket. I don’t know. Did you look at partially treated hearing loss or anything of that? 

Dr. Hannah Glick  25:00  

So we did a small study, during my PhD, where we took people kind of off off of the streets that had hearing loss that were wearing hearing aids, but at a variety of different clinics.

Dr. Mark Syms  25:11  

That’s been a variety of ways. Yeah.

Dr. Hannah Glick  25:14  

And what we found is that for, for adults, they were very under fit, on average in most cases. And I think that’s one of the reasons why we saw so such successful outcomes with my dissertation study, I personally fit every single adult with hearing loss myself. And we knew that they were fit appropriately and we fit them appropriately right away at initial fitting, and counseled them, it’s going to sound different, might sound a bit loud, gonna take a couple days to get used to.

Dr. Mark Syms  25:46  

Oh, so you didn’t even do gradual increases, you just got them to targets and let them ride it out.

Dr. Hannah Glick  25:51  

And that’s an approach that clinically I learned from one of my mentors when I was working on when I was doing my fourth year externship in audiology. And I started employing working with patients as well, because, um, it’s like, it’s, it’s like waking up the brain that hasn’t heard in a long time. And if you the gradual increase is, is it works for some patients, um, but we want to get them to that point where they’re hearing their best as fast as possible.

Dr. Mark Syms  26:21  

Well, especially frankly, for a study, you can only really begin the study once they’ve met targets or they’re actually graded. Other than that, it’s just a ramping up period where you really can’t necessarily measure the outcomes, although it would be fascinating, even measure, like to show just another I’m giving you a lot of work, but it measuring those all of those variables as you’re slowly increasing their hearing to meet targets, right. Like if you could say, Here’s your gap, and we’re gonna go over four different 25% of the way over a two month period, and then assess them every two months. It be fascinating to see what that looks like.

Dr. Hannah Glick  26:58  

Yeah, yeah. And and I think one of the things, you know, back to research that I was talking about previously, I’m looking, you know, we didn’t see the hearing loss group relying more on those visual cues, those lip reading cues. And we didn’t see a correlation between the reorganization that we’re seeing in the brain and the reliance on visual cues.

Dr. Mark Syms  27:21  

Until they were relying on them. Is that what you’re saying? 

Dr. Hannah Glick  27:24  

No. So there was no correlation between reliance on visual cues and these brain changes that we see in response to visual.

Dr. Mark Syms  27:30  

So even if they did or didn’t use the reorganization of the occipital and temporal lobes occurred regardless of whether or not you could measure use of lip reading? Is that what I’m saying?

Dr. Hannah Glick  27:43  

Yeah, so it wasn’t correlated with lip reading what it was correlated with was degree of hearing loss.

Dr. Mark Syms  27:48  

Make sense? So it means you’re not using that brain. So even regardless of how you’re compensating the brain reallocates that those resources no matter what, because you stop using.

Dr. Hannah Glick  27:58  

Yes, if the brain is deprived in any way, even a small way, even if hearing aids may not be fit perfectly to target. There’s still some deprivation present. So that’s something that’s kind of interesting as well is this audibility piece is really important when we’re treating hearing loss.

Dr. Mark Syms  28:17  

It is the pace, right? I mean, in other words, you know, you know, I tell people, it’s like blood pressure, right? If your blood pressure is 210, or 110, and you’re being treated, but they measure, it’s 160. Over 90, you still have high blood pressure, right? So yeah, it is do you have on rehabilitated hearing loss or not? Any, any impact on the high tones? Because as you know, that’s a little bit harder to get from typical technology.

Dr. Hannah Glick  28:43  

Yeah, so it’s difficult, like when we fit the hearing loss group, they only had mild or moderate hearing loss. So most the time you’re able to reach those targets in the high frequencies, but really after about 4000 hertz, it’s, yeah, it’s harder, it’s harder. Um, but um, we looked at that correlation between a high frequency pure tone average, and we were able to see that so, um, you know, that’s where hearing loss starts and those high frequencies so making sure there people are appropriately fit in those high frequencies is really important.

Dr. Mark Syms  29:15  

Yeah, that’s, this is great stuff. So where do you see this going for you like okay, so you’re working on the social isolation part, like how what what are those studies look like? 

Dr. Hannah Glick  29:27  

For me, I’m excited to get outside of the laboratory. I’m working with the people and I’m working with people and thinking about things like social support groups for hearing loss, things that a lot of audiologists, they try to have, you know, oral rehabilitation classes, maybe some classes where people with hearing loss get together and talk about their new technology and they give them some, some strategies that they can use, but I think designing more effective community based social support surrounding hearing loss is something that I want to work on.

Dr. Mark Syms  30:08  

Yeah, no, I think that’s fascinating. As I think about it, you know, it’s it’s whether or not people are willing to embrace the stigma and join a group? Or is it rehabilitate their hearing loss and get them to reconnect with the groups they already were in?

Dr. Hannah Glick  30:21  

Yes, yes. I think it’s I think it’s a bit of both. I think that there’s for people, especially with more severe hearing loss, yes, turn out that social support is really important. Um, you know, I met with a man last week, that friend of mine had said, Can you please speak with him? I think he’s a cochlear implant candidate. He’s not ready to get a cochlear implant yet, and just providing him with some support, like looking over his his recent hearing tests with him and telling him you know, it’s time for you to take this next step.

Dr. Mark Syms  30:52  

Get evaluated? 

Dr. Hannah Glick  30:54  

Yeah, I think that there for especially for more significant hearing loss, there’s a big need for additional support.

Dr. Mark Syms  31:02  

Yeah, you know, our philosophical approach, obviously, is, one is the screening audiogram is not necessarily determinative, as you know, but we definitely what we strive to tell patients is how can you can you hear better? And then we’ll try to figure it out, right? Because it’s not, it’s not do I want to cook their own plan? Or don’t I want to cook their planet? Are there ways that you can hear better? Let’s try to figure that out? Let’s educate you. I mean, you know, it’s kind of who comes into my office and says, you know, I’m looking forward to getting a surgery, right? I mean, there’s nobody does that, right? Of course, you don’t want a surgery? But it’s really can you hear better, and are these things that you have to undergo worth it to get you to hear better, let us connect you with some people or somebody who can tell you that it’s, it’s actually worth it and overcome those fears. That’s a huge thing.

Dr. Hannah Glick  31:47  

Yeah, I’ve also been thinking and doing a lot of reading into other areas of medicine, they’re using health navigators more and more commonly, to kind of be that point person that helps people through the process, whether they’re dealing with breast cancer, or some other multiple things going on at the same time. And I love that idea of like a Hearing Health Navigator, somebody that kind of helps a person coaches that person through that process. Because

Dr. Mark Syms  32:18  

in our, in our center, we really are very hesitant to implant anybody who can’t bring a significant somebody else along the whole process. And so they act as that proxy. Yeah, it’s really important. 

Dr. Hannah Glick  32:29  

Yeah.

Dr. Mark Syms  32:33  

Yeah, that’s great. I mean, it’s just, you know, because of what we tell people this for years are better than two, especially two of them that are broken. But yeah, I mean, you know, I think some sort of combination, like, I do think these family members could be better coached. So if there was like, a curriculum, or some sort of, you know, what you should be doing at. And so that’s actually a very thought I think about that. But like, what they should be given some sort of mini education as what you can do in this process, how you can help your hearing impaired person through this process.

Dr. Hannah Glick  33:08  

Yeah, and I mean, even my, my father in law has hearing loss. And I feel like every time my husband’s mom and father in law come to visit, I’m, um, ended up doing some kind of almost mini marriage counseling sessions with them about, you know, teaching her the, you know, if his back is turned toward you, you can’t expect him to understand what you’re saying. And so I like, I love that idea of tying in family members as well, and building knowledge together so that we can help the person with hearing loss. I mean, it takes a village. Um, it took for that to be six that process to be successful. And I think that that’s a that’s a whole that’s kind of lacking right now.

Dr. Mark Syms  33:47  

Well, it’s amazing the transformation of people’s mindset, if you just bring them into the not into the booth into the room, where you’re doing the testing was, you know, the normal workflow is you extract their loved one, put them in the booth, leave them out in the reception area, do the test, and then they join in a room for counseling. But if you actually show them like, look, when we read them, these words, they’re not getting and all of a sudden, they’re like, Wow, this is really way worse than I thought it was. And that’s important.

Dr. Hannah Glick  34:16  

Yeah, yeah. So for me, I’m, I’m excited to get a little get outside of the laboratory a bit and do some more kind of community based projects that I could, I could collect research data through some of those projects. But I’m ready to start doing I think, for a lot of research, it takes so long to get to that point where it starts to get outside of academia. And being an audiologist, I have that clinician in me at heart that I’m like, I’m ready to start to start trying some new things.

Dr. Mark Syms  34:45  

Yeah, I think, you know, again, more work for you, but measuring the satisfaction of the significant other in terms of their cognitive, their social emotional benefit. I mean, it is profound to me oftentimes The spouse is more thankful than the patient, right? Because the spouse has been acting as their ears. And, you know, people don’t realize, like when you have bad hearing impairment, like, the spouse orders at the restaurant, right? Because they can’t the hearing impaired person can interact, the spouse answers the phone, the spouse answers the door, the spouse does all of this things. And so, you know, measuring that, and I suspect not just their happiness, but maybe even their cognitive or, you know, their social connections, too, right? Because if the hearing impaired person doesn’t go to the movies, guess who else doesn’t go to the movie, the hearing impaired person doesn’t go to the cocktail party, guess who else doesn’t go?

Dr. Hannah Glick  35:38  

I love that. I love that idea, Mark. And I was just thinking, like, we measured satisfaction in my dissertation study of the of the patient, but none of the significant other.

Dr. Mark Syms  35:48  

Right, because to me, that’s the rise, right? I mean, when you really talk about because they’re the ones who pull you aside, go. You should I mean, I you know, I would love I mean, it’s why I go to work every day, you know, people will say you’ve saved our marriage. I mean, they really say that, because like the the one spouse is is is just beyond right. And so and that that actually gets back to that whole health navigator, because sometimes we have spouses who bulrush the hearing impaired spouse through the CI process, because the spouse wants it so badly. Yeah. And so they’ll push them through. And that becomes a whole nother issue, because we want balance, and we want the patient to be empowered to make their decision. So it’s an interesting dynamic.

Dr. Hannah Glick  36:27  

Yeah, and I think for a lot of clinicians, a lot of that counseling piece, you know, in our, in our audiology program, we have one course in graduate school on counseling, and I teach that course, and it’s not enough. Um, you know, and I think, from a professional standpoint, we need to need to think more about addressing that social emotional side of the patient a bit more, and maybe having some better tools clinically, that we can use different strategies that you’ve sounds like you’ve learned those things that work over time. Yeah. But that we can teach new right clinicians out in the field that they can use,

Dr. Mark Syms  37:03  

I think you have to bring it into your clinic, right? Like, you’re, I assume you have a teaching clinic at the school. Right? So that’s really has to be where kind of the, you know, the best practices start and show that to your students. They model that behavior, because it’s going to be hard. You know, it’s really on their clinical rotations. You want to see that, but it’s not like you can Okay, all community audiologists that we rotate with will now have, you’re not, you know, as well as I do that that’s not gonna I mean, it’s not that they’re bad people. It’s just they have a way to practice and you really can’t mandate they practice. So it’ll probably be a trickle up phenomenon, you’ll teach the newer ones who will then raise the bar for the already graduated. So that’s a fascinating Yeah. Fascinating stuff. This is a great, I can’t, you know, so I don’t know when but at some point, I’m going to revisit you to see what you’ve done in terms of all of this stuff. Because, you know, this is definitely this is where my passion lies in terms of it. But it’s not just because I’m passionate about it. I think this is really what people need to know about hearing loss. Right. Yeah, definitely agree with Yeah. You know, and so that, so, you know, as you know, I wrote a book, like people always asked me, who’s it for patients or healthcare professionals? And I always go, yes. Right. So it’s kind of like, who’s your research for patients or healthcare professionals? answer’s yes. Right. Because the the awareness across the whole community, both healthcare providers, and look, there’s a lot of noise, like there’s a, you know, I mean, obviously, the medical field has been consumed with COVID For the past few years, right? Well, that crowds out getting traction, you know, I mean, it’s hard for me to call my primary care associates and say, Hey, let’s talk about hearing loss or like, hearing loss. I’ve got people with COVID, who I am trying to figure out whether or not they can come to my office, you know, the hearing loss kind of hits down, but masks have made people aware, that’s for sure.

Dr. Hannah Glick  38:55  

Yeah, definitely. I agree with you there. 

Dr. Mark Syms  38:58  

Oh, so the you know, there couple questions are as loved as people. So let’s say you’re at a, an awards, lifetime achievement award you’re getting and so, you know, people ask you Who do you think like so who would be the people you would thank for helping you along the way that mentors, the people of God help you get where you are?

Dr. Hannah Glick  39:17  

Yeah, I would say my family number one, um, I wouldn’t be here today without my family. You know, my grandmother that I talked about beginning of the podcast. She was an immigrant to the United States moved here when she was 13. didn’t speak English. And we’re Finland. Oh, wow. That’s amazing. Um, and, you know, work your butt off and pass that down to her children and then on to grandchildren as well. And so I really have to start by just thanking my family for where I am. The support that I’ve had from them, I wouldn’t be there be where I am today without them. And second would be my PhD advisor Dr. New Sharma. She’s amazing. I think the one thing that is different about her Then some other academic researchers is She’s a real visionary. She’s really thinking long term and really big picture. And she starts there when she’s working on designing a study, rather than starting really small and kind of iterative, incremental pieces, right. Yeah. And I appreciate I appreciated working under her, so that I could start thinking in that same way, um, and learning how to-

Dr. Mark Syms  40:26  

100 patients here when she was at ASU. 

Dr. Hannah Glick  40:31  

Oh, awesome. Yeah. We just they just started reopening the lab and starting to test patients again. So that’s really exciting.

Dr. Mark Syms  40:38  

I don’t know if she knows. But we were at one of the sites that were that they came out and did the monster. 

Dr. Hannah Glick  40:43  

That’s awesome. Yeah, but I would, I would go ahead and thank her and then one of my other colleagues at University of Colorado Boulder, Dr. Earhart, and she’s also an amazing person and her and I, you know, we go on walks together and talk about teaching together in the future of Audiology. And I just appreciate her her friendship and her mentorship all along the course of my PhD.

Dr. Mark Syms  41:06  

You record it and get transcripts. No, but maybe I should write a book. Yeah. Done. If you think about it. Yeah. That’s awesome. And so the other question I always love to ask people is, what’s your favorite sound?

Dr. Hannah Glick  41:21  

Think it’s a new sound. My new favorite sound is? My baby’s four months old. He just started queueing. There is nothing better than that.

Dr. Mark Syms  41:29  

That boy, no, my children are older. But I know exactly what you’re talking about. That baby cool. And the new baby smell. Yeah, that smells best. Well, this has been great, Hannah. I mean, this has been wonderful stuff. I very much appreciate you coming onto the show. You know, if people want to get a hold of you, how do they get ahold of you? If they want to target LinkedIn? Or how do they get oh.

Dr. Hannah Glick  41:51  

Yeah, you can look me up on LinkedIn, easy to find on LinkedIn. You can also email me at Hannah hannah.glick@colorado.edu

Dr. Mark Syms  42:02  

Well, there you go. Thank you so much for coming on. This has been great, great stuff. I really appreciate you giving us the time and talking about a really important and fascinating subject in terms of how hearing and your brain are connected. Thanks so much.

Dr. Hannah Glick  42:14  

Thanks for having me.

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