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Dr. Harvey Abrams – Making Hearing Aids Affordable and Optimal

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Dr. Harvey Abrams

In a career spanning over 45 years, Harvey has served in a number of academic, clinical, research, administrative, and consulting capacities with the Department of Veterans Affairs, the Department of Defense, academia, and industry to include Chief of the Audiology and Speech Pathology Service and Associate Chief of Staff for Research and Development at the Bay Pines VA Healthcare System, the Director of Research at the Army Audiology and Speech Center at Walter Reed Army Medical Center, and the Director of Audiology Research at Starkey Hearing Technologies. He currently serves as the Head of Research Audiology at Lively Hearing Corporation.

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

  • Dr. Harvey Abrams’ journey to audiology during the Vietnam War
  • Looking at the effects of intense noise around infants
  • The Lively model for hearing aids and hearing treatment
  • What are the difficulties and hurdles of online hearing care?
  • Machine learning and AI for the future of audiological technology
  • Optimizing hearing aid audibility from customer feedback
  • How much is too much when it comes to hearing loss?

In this episode…

In previous episodes of the ListenUp! Podcast, we’ve discussed hearing aids and how they need to be accessible. While there are multiple solutions to this problem, Lively has come up with their own vision for better hearing care.

Lively is an online service that not only provides high-end hearing aids for half the price, but they also pair it with consistent treatment from certified experts to help with the adjustment. Their service has not only seen more people adopt hearing aids, but also helped people adapt to them as well. Dr. Harvey Abrams is now leading the research team at Lively, coming up with new ways to improve the technology and making it more accessible than ever. Now he explains exactly what that looks like.

On this episode of the ListenUp! Podcast, Dr. Mark Syms invites Dr. Harvey Abrams, the Head of Audiology Research at Lively, to discuss the future of hearing aid technology and the unique system that Lively has developed. They go over the current hurdles, using machine learning and AI, and leveraging feedback to optimize treatment. They also talk about Dr. Abrams’ long, storied career from the military to research. Stay tuned for all this and more!

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

Intro  0:04  

Welcome to the ListenUp! Podcast where we explore hearing loss communication connections and health.

Dr. Mark Syms  0:15  

Dr. Mark Syms here I am the host of the ListenUp! Podcast where I feature leaders in healthcare. This episode is brought to you by Arizona Hearing Center. I help patients to effectively treat their hearing loss to play state better socially connected, and to be able to have better conversations and relationships with their loved ones. I am also the head of Arizona Hearing Center, which is a clinical practice medical practice imp of 80. I only take care of your problems, I’ve treated 10s of 1000s over 10,000 patients with surgery treated 1000s of patients with hearing loss I’ve also written a book called Listen Up: A Physician’s Guide to Effectively Treating Your Hearing Loss. If you’d like to learn more about that go to listen up caring calm, and you can learn more about the book. Um, I the reason I am so passionate about hearing loss is because I lost my brother Robbie twice. I lost the first to hearing loss from radiation to a brain tumor and then later from complications from every tumor. I’m intimately aware of how Hearing loss affects people and I’m passionate to get a better treated today. I’m excited for my guest. I have Dr. Abrams. He is a academic clinical. He served in the military research administrative audiology. You name the context each practice and he spent most of his career at the Department of Veterans Affairs. He was the director of Chief of Audiology and Speech Pathology Services in Florida. He then went to work for at RIT sorry, Walter Reed Medical Centers, the Director of Audiology. He moved on to work at Starkey Technologies as a research in the Director of Research and audiology and now currently serves as the head of audiology or head of research audiology at Lively hearing Corporation, a tele audiology focused company. He received his undergraduate degree from George Washington University and his master’s and doctoral training in audiology and hearing scientists at the University of Florida. His research is focused on the treatment and efficacy improved quality of life associated with audiological intervention to include most recently computer based auditory training. Why that’s a mouthful, but you have a distinguished career. And welcome. Glad you’re here. Thanks for coming along. 

Dr. Harvey Abrams  2:25  

Oh, thank you so much. Dr. said, Thank you for that introduction, also for the opportunity to talk with you.

Dr. Mark Syms  2:30  

Because so I’m going to call you, Harvey, and you’re going to call me Mark. Right. 

Dr. Harvey Abrams  2:33  

That sounds like a deal. 

Dr. Mark Syms  2:34  

Thank you. Yes. So tell me, you know, at some point, you weren’t an audiologist, how did you end up in audiology? I always fascinated by people’s pathway to that.

Dr. Harvey Abrams  2:43  

Yeah. Well, you know, audiology is not a profession you kind of grow up wanting to get into, particularly when I was an undergraduate school was still fairly a new profession coming out of World War Two, essentially. And but I took some courses in speech department at George Washington, and within that were of courses in audiology and speech pathology. And that’s what got me kind of interested. And, you know, as part of that, too, of course, this is during Vietnam during the Vietnam War. And, you know, if you were a college student, you had a deferment, but then I had to consider what was going to happen after graduation. Right. So I thought audiology would be a medically focused profession where I might be of some use other than as a Combat Infantryman and Vietnam. And as it turns out, though, I applied for commission. But there were no commissions available. So I got drafted, actually, while I was in graduate school, and my kind draft board, which was in Coney Island, allowed me to finish my graduate training. But then soon as that was over, I had to go in. So I went in as a as a buck private, we went to basic training at Fort Polk, Louisiana, and then to combat medic training at Fort Sam Houston, Texas. And it was in the middle of that training where my commission came through. So I went from a private to First Lieutenant overnight, and that’s a good promotion. Oh, it was a nice promotion. And what was interesting is that Medical Corps training was also at Sam Houston. So I just stayed at the same place. It’s changed my uniform, which was a surprise to my noncommissioned officer friends.

Dr. Mark Syms  4:24  

Wow, that’s really nice. And so you then ended up being an audiologist in the army. Right? So you’ve done a PhD? Oh, correct.

Dr. Harvey Abrams  4:31  

Not at that point. I only had my master’s degree at that point, how to how to go in and get and do my service. But I spent first tour at US Army Hospital, Fort Campbell, Kentucky. I was the first audiologist ever signed there were the 101st Airborne Division trained in the practice. And I was also the first hearing conservation officer there. So I provided both clinical care at the time which consider did when I first got there, but one audiometer which I helped to expand that program over the years I was there, and then also was responsible for ensuring that both military and civilian personnel on the base were adequately protected from many sources. Yes, indeed.

Dr. Mark Syms  5:17  

Yeah. So then you left and you did you do a PhD in barre? And what was your area of research in your piece? 

Dr. Harvey Abrams  5:23  

Yeah. So I actually that was informed by my work. In my second assignment in the military, I was assigned to the US Army Environmental Hygiene agency, which was a branch of Aberdeen Proving Ground. It was a lab. And the particular division I was assigned to is the bioacoustics. Division, you’re in conservation branch. And so we did some research, we wrote policy, we were responsible for reviewing programs throughout the US, Army depots, as well as training facilities. And I had one kind of a research assignment was to evaluate noise, noise levels in incubators of all things. This must have been concerned came to our lab for measurements, which I did. And you know, not surprisingly, as you probably know, the noise levels in and of themselves and incubators do not exceed OSHA’s damage risk criteria. Okay, but those are written for adults, right, and occupational noise settings. And it was very curious to me whether or not those noise levels might be of a particular hazard to newborns. So under the GI Bill, I went back, I went to get my PhD at the University of Florida. And that was my focus. So in terms of my research was looking at the effects of intense noise on newborn mammals. So my dissertation was to compare noise exposures among newborn guinea pigs and adult guinea pigs, measure changes in thresholds and then take a look at hair cell damage. And, in fact, in newborns, sustained greater threshold shift exposed to the same noise for the same period of time.

Dr. Mark Syms  7:13  

It would seem to make sense, but maybe that’s built in based on your bad press work that it seems to me. Yeah. That’s great. And so then you had a career in the military to the VA. Right, right. Yeah. And so you finish that up. And then you know, what most people would do when they retire from a job? They go work at Starkey. Right. So what did you do at Starkey?

Dr. Harvey Abrams  7:37  

Well, yeah, especially after you’ve spent your career and mostly in Florida, and taking a position in Minneapolis. So that was a climate shock. Yeah. But it was great, because for most of my career, almost all of my career, I’m on the receiving end of technology. He is the clinician, as somebody as a researcher, as somebody administering both clinical research programs, we’re looking at the technology, as it exists, what Starkey, I have an opportunity to be on the front end. So here, we’re developing new technologies, technologies that may not be seen in hearing aids for, you know, a year or two or three to come or may never be seen, which was essentially the job of my department was to do the clinical trials to determine whether in this new and fancy algorithm in order to truly make a difference in terms of improving performance among people who are hearing impaired. So that was a lot of fun. I did that for five years. And then, you know, now I’ve been working, I guess, over 45 years, full time, as a thing. I think that’s enough. But I didn’t want necessarily to get out of the field. So I did some consulting. I’ve been doing teaching for a long time I continue to do and then I got to you know, I teach. I’m actually in the right now three different universities at Arizona State is one of them. As a matter of fact, just prior to this meeting, I was teaching a hearing conservation to add students at ASU.

Dr. Mark Syms  9:16  

Right in your your wheelhouse

Dr. Harvey Abrams  9:18  

Indeed, yeah. And then I teach West Virginia, I teach a hearing aids course there and it Salus University outside of Philly to teach rehabilitation, auditory rehabilitation course, you’re doing different classes to that’s great. It’s great. And it’s a heck of a lot of work because you got out.

Dr. Mark Syms  9:37  

You know teaching is a lot of work. So you’re teaching and you work so you’re consulting minding your own business and what happened?

Dr. Harvey Abrams  9:46  

What I get a call from one of the founders of this new companies called Lively Hearing Corporation. And what they want to do is to emulate the brick and mortar experience except do it all remotely and that really appealed to me, particularly after being in the field as long as I have been, and appreciating the value that hearing help pass for individuals with hearing loss in terms of just improving the quality of life. Yet we know that it’s just a small minority of individuals who can benefit actually have hearing aids. And, you know, we can talk forever about some of those barriers, but obviously two of them are cost and accessibility. So it’s affordability and accessibility. And these were two of the barriers identified by some external reviewers the what’s called P casts the Presidential Council of Advisors and in technology, and as well as Naser, the national academy of sciences and engineering and medicine, and the Lively model, at least on paper, really seem to be a possible solution that we can provide high quality. And I’ll call it audio logic care, because we try to emulate the brick and mortar model. But throwing a remote model, we do everything remotely. So by eliminating a lot of costs associated with conventional practices, we can reduce cost. And then accessibility of courses is your PC or your iPhone, essentially. So we’ve been around now for about two and a half years, we still consider ourselves a startup company. And apparently, it’s kind of resonated with the general public because we’ve been quite successful. The difference between what we do and perhaps what your listeners might understand to be over the counter, or other direct to consumer devices, we maintain the audiologist. As a central component of this model. We’re we’re involved in terms of the client journey from the very beginning to the three years essentially. So we work with them in terms of establishing goals, we establish goals through the cosy client oriented scale of improvement, which is standardized measure of outcomes, we then determine the extent to which those goals have been met after 30 days. We can make any adjustments remotely. We have a huge cohort of audiology personnel, not only audiologist, but audiology assistants, hearing instrument specialists as well as trained customer support staff. So constantly providing a high level of support throughout the entire journey. 

Dr. Mark Syms  12:34

Just out of curiosity, it’s not a I’m sure you figure it out. But how does licensure work?

Dr. Harvey Abrams  12:42

Oh, our audiologists are licensed in multiple states. And so,

Dr. Mark Syms  12:47  

you know, they’re something people serve different regions or something. Yes,

Dr. Harvey Abrams  12:51  

exactly. Right. Yes. And so the design, of course, is to have them get their license in those states where we’re likely to get the most number of clients requesting our services. You know, we started out with an audiologist, the clinical audiologists of one, she was licensed in 48 states, believe it or not, yes, but now we have, oh gee audiology department is now over, like 45 people. So we spread, we spread the wealth to standardize the care. Oh, and because we’ve been doing this for as long as we have we have standardized procedures in terms of care. So from every step along the way, what gets done, who does it? How does it get done was kind of a very standardized method. But not detracting, of course, from the fact that whenever you’re dealing with humans, you deviate from standards, but that’s the art of healthcare, as you will know, right?

Dr. Mark Syms  13:53  

And is there a fitting range? Yeah, that you guys do or don’t do or?

Dr. Harvey Abrams  13:58  

Yes, so we’re not we don’t build our own hearing. It’s Mark, we use premium hearing aids that are provided by one of the major manufacturers we use ReSound, hearing aids, we use their top of line model. So that range is quite, quite wide. Now there are-

Dr. Mark Syms  14:16  

More fitting range of the technology not not yet are going to do people with only certain disease.

Dr. Harvey Abrams  14:21  

Indeed that’s right. Now, an important component of our model is risk management risk identification. People will ask well, how do you know you’re not fitting somebody with your disease, somebody who could be treated medically. We use an instruments called the Sedra. Consumer ear disease risk assessment. This was developed by researchers at Northwestern Mayo, Florida, and an NIH grant. It’s a series of questions and depending on how many yes questions each question gets a number of points, depending on the number of points, this is a red flag that this individual may be at risk of ear disease or odor neurologic disease. Those all get screened. And it may be, for instance, that somebody says, Yes, I have hearing loss in one ear, as you well know, that’s a red flag. But in when we get back to the patient in May, oh, yeah, I was born with hearing loss in one ear. Right? Or I have Yes, I had a steep I have conductive hearing loss. But this is something that’s been treated at a stapedectomy at all-

Dr. Mark Syms  15:35  

My eardrum that was repaired.

Dr. Harvey Abrams  15:36  

Yes, exactly. Right. So we’re very, very conscious of the risks associated with doing totally online examination. And we kind of go overboard in ensuring that we’re not providing hearing aids to somebody who could benefit from medical care, or who should be seen before we provide any amplification.

Dr. Mark Syms  15:57  

Do you have a way to assess wearing percentage or how much time they wear?

Dr. Harvey Abrams  16:02  

We have the data logging, of course from the manufacturer line, haven’t seen that data? Mark? It’s a it’s a good question. I think that’s something we will be looking at, again, we as being a fairly new company, you’re you’re kind of getting the important, I’m

Dr. Mark Syms  16:19  

Just thinking out loud, to be honest. Just kind of like, you know, I mean, there are, you know, in the in our space, obviously, it’s it’s not that it happens that often. But it’s one thing to get a cochlear implant, it’s another thing to get to quickly our planet where right where course, you know, where time is our challenge, sometimes certain populations.

Dr. Harvey Abrams  16:39  

So one of the features of our model, it might encourage, where time is a moment or two, one is our close follow up to is the fact they have 100 days to return the hearing aid. So if after 50 days or something they’re finding, you know, this is really not helping me and we really can’t resolve it, then they return it. Yeah, no questions asked. No money lost. Sure. Sure.

Dr. Mark Syms  17:08  

And so what is your follow up? Once they kind of become stable? How often do you follow them up as the type of

Dr. Harvey Abrams  17:13  

Thing or right so it is often up to them? Now, because we’ve only been around for about two and a half years. Three years apology. So and many of our, many of our clients may be previous hearing aid users, they may want this Lively hearing aid, maybe as a backup, of course, but now that they have this new hearing aid now becomes their primary hearing aid in their first hearing aid becomes a backup. But their experience hearing aid users they know to reach out if they’re having problems, many of them don’t need to, we will always schedule an appointment within 30 days. Now sometimes for those particular cases. Clients may say, yeah, that’s okay, I’m doing fine. I really don’t need it. Right. But we, for new hearing aid users we have. So we want to make sure that for our own purposes, we’re meeting their goals, we this is an important data set for us on the cozy, right, what percentage of our clients have improved, and those specific needs areas that they’ve identified as particularly interesting, Mark, that when we compare those individuals that take our online hearing test, against those who upload a hearing test that was completed in a clinic, there is no difference in terms of their clinical outcomes, I found that kind of reassuring, because obviously, we can’t be as precise in terms of an online hearing test. It’s a kind of examination, they will get in a clinic.

Dr. Mark Syms  18:50  

Right? So I mean, they do word recognition scores as well.

Dr. Harvey Abrams  18:56  

No, not not currently, we’re looking to develop a model where we can do at least, like digital noise. This is something we’re planning in kind of a future iteration, randomly, just there kind of phones. And so that’s actually

Dr. Mark Syms  19:11  

one of the things especially like, where do you see like, okay, so, you know, who knows, right? Where this all going. But let’s say you could, you know, fast forward five years, like, what does it all look like? I mean, this is obviously all conjecture. I’m not going to hold you to it, although it’d be interesting to look back five years from now. But, you know, what do you see this guy? I mean, you’re on the forefront of all this.

Dr. Harvey Abrams  19:31  

I love thinking about five years ahead. And in all my classes, I teach him as a class, I teach an emerging technology, so kind of looking ahead. So what are we seeing what we’re seeing? Because AI and machine learning as applied to hearing technology, we’re seeing-

Dr. Mark Syms  19:52  

What does that mean? Like so it means it learns circumstance or how you know, I mean, that I’m not saying I want to understand it because it’s kind of a buzzword thrown around in software and all this? So for hearing, what’s that to help me to get?

Dr. Harvey Abrams  20:05  

Alright, so let me describe it in the context of maybe five years ago, okay, we fit a hearing aid, we program it to a particular prescription. And then we may have programs. So this program is for noise use, this program is re music. And they are essentially deviations from the basic program that’s set to optimize speech understand. Now, that’s, that’s fine. But now we have systems that will classify an environment. And we’ll change the parameters in response to that environment. But we’ll query the user in terms of how much they like it. And this gets to another

Dr. Mark Syms  20:51  

element by taneous feedback in the circumstance, you can collect the data of what’s going on there, right?

Dr. Harvey Abrams  20:56  

Yes. Now, and there’s another phenomenon, another technological advancement that we’re going to see is called ecological momentary assessment. That’s kind of part of us. So when we evaluate individuals benefit, we have them come back 30 days and say, Okay, you said, you’re having problems in the restaurant, you know, when you go with your wife after religious services, to house a hearing aid doing and say, Well, okay, man, I’m having some still having a problem, honey, ologists, make some adjustments, send him back out, and maybe follow up again, what ecological momentary assessment does it that pushes the notification to the user, in real time in real space? Oh, I’m your assistant. And I, I see you’re in a noisy environment. So how you doing with your hearing aids in this noisy environment, and may give you maybe five, smiley, to sad faces, or a rank order from one to five? And and maybe you hit two, which means you’re not that please, just okay, let me make some changes to it. And the algorithm makes some changes, says, Have you liked it now better or worse, right? Or the circumstance or the circumstance. Now, once that is known, then when that individual’s in any similar situation with him or her acoustic signature, the parameters will revert to what the individual determined was the best response. So that’s kind of machine learning at that time. And in addition, it’s also somewhat automatic, because we’re getting better in terms of environmental classification. So hearing answer is no, here’s, here’s noise. Yeah, we’re gonna do this, but their speech in that noise. So let’s do this. But here’s music. And so let’s do this. But here’s, here’s a different kind of noise. This is your vacuum cleaner. So let’s do this. So that kind of sophistication in terms of environmental classification. So all right, so we’ve talked about a AI or machine learning, ecological momentary assessment. There’s also what’s happening a self fitting, and we’re already seeing that, you know, the Bose devices self fitting. And what’s interesting with self fitting is that research has revealed that individuals can self fit their devices, and end up with a setting that’s very similar to what the prescriptive settings would be if they were in a clinic, and an audiologist was actually setting the parameters. So that’s getting more sophisticated. So my gosh, now you’ve got devices that are self fitting, have sophisticated classification. Environmental classification schemes, will self adjust on the basis of feedback they get from the user. So what the heck do we need clinicians for? What do I need an audiologist for? Right? And that’s always the question. And that’s always the concern. But this kind of gets back to any of us on E ologists, have really been focused on the rehabilitative aspects of Audiology. We see this as a wonderful opportunity, right? We offload kind of technology to, you know, the great world of of sophistication. And but now we dealing with the issues associated with hearing loss. And how does hearing loss affect you as an individual? How does affect your family? How does affect your major communication partners? And what does that mean and how we how can we develop programs and support to assist you in managing these feelings, these sensations, these consequences, even when you have this great technology? Because we know technology is not going to resolve all of these problems, particularly as we get older Right. And and we still we have the consequences of aging and central auditory processing issues like working memory, speed of processing and spatial release of masking. And perhaps now we have other kinds of training tools such as auditory training games that we can utilize this tremendous opportunities for rehabilitative audiologists, even in the face of these amazing technological advancements.

Dr. Mark Syms  25:26  

Wow, that’s pretty amazing. And so how does the technology validate that it’s delivering the the maximum audibility?

Dr. Harvey Abrams  25:35  

It’s essentially feedback from the individual. In the end, that feedback is what is most important, but you bring up a good point. And that is we’ve known often when we initially fit an individual with a hearing aid will fit it for optimum audibility, but initial hearing aid users will often object just to tinny.

Dr. Mark Syms  25:58  

Their brain in ear don’t like it. 

Dr. Harvey Abrams  26:00  

That’s Yes. But another wonderful advancement in hearing aid technology they call sort of adjustment managers, right adaptation managers. So to hear you, the hearing aids fit below what those maximum audibility targets would be. And like the frog in boiling water, we slowly increase the game until it’s really not noticeable to the user. But over several weeks, we’ve reached the point where we’ve gotten optimum audibility, and hopefully intelligibility as they adapt to amplification anyway. So the here’s another technological advancement to work to our advantage into the patient’s advantage,

Dr. Mark Syms  26:44  

which increases the role for the counseling and the rehabilitation porting

Dr. Harvey Abrams  26:48  

that two, you’re absolutely right. Yes.

Dr. Mark Syms  26:51  

That’s, that’s pretty amazing stuff. And so alright, that’s five years, what do we got a 20? 

Dr. Harvey Abrams  26:57  

At 20. We have sort of the the biological and biochemical advancements that was therapy hair sounded exactly right. So somebody asked you this, you’re interviewing me, but I always throw this out in any types of pharmaceutical or surgical advancements, very often, they are only accessible to a certain segment of the population, right? Or to those who happen to live in a society where that’s provided, where it’s afforded. So, if you look at the World Health Organization, disability projections, you know, we’re looking at at hundreds of millions of individuals around the world hearing, we’re gonna have hearing loss, they will not be able to access these wonderful pharmaceutical and biochemical gene therapeutic advancements. So I think the role for us in terms of going away, is not going away, not not in 20 years, not.

Dr. Mark Syms  28:02  

Which, which would be similar saying, you know, I mean, kind of on a more basic speech, reading and contextual skills that help communicate aren’t going away either despite hearing aids, right, so.

Dr. Harvey Abrams  28:12  

I love that. No, you’re absolutely right. I know. I teach that to my students. I teach that to my patients. Absolutely. You know, very often just knowing the context, just looking at somebody and knowing the context. Kitchen 95%. There, right.

Dr. Mark Syms  28:29  

Yeah. And that’s that, obviously, you know, in the context of the pandemic, the masks have been very difficult

Dr. Harvey Abrams  28:34  

compared, right, and that’s really revealed. We’re hearing the problems, even for those with slight hearing loss. It’s kind of changed that scale. We always use that. Well. Yeah, of hearing.

Dr. Mark Syms  28:49  

Moderate, my, you know, past mild to moderate to really realize you had it.

Dr. Harvey Abrams  28:54  

If you ever had a 20 DB hearing loss or maybe a mild hearing loss and high frequencies. Somebody is wearing a mask. Um, you know, it’s a different ballgame. You’re gonna miss a lot of what speaks?

Dr. Mark Syms  29:04  

Yeah, I was having some guys at Boys Town. They were there, they actually, you know, at the bottom part of normal, right, there’s definitely functional implications. Right. And so, you know, that gets into the whole intellectual question of why is it zero to 25? And, and all those things, which is kind of interesting that somebody just kind of divided it up and made it that way? I’m not sure it’s really data driven?

Dr. Harvey Abrams  29:26  

Well, it’s compensation based more like the

Dr. Mark Syms  29:29  

percentage of hearing loss question I get all the time, right.

Dr. Harvey Abrams  29:33  

What are we going to pay at? What are we going to pay out for hearing loss, but we’re not going to do it if you got 15 DB 25. And maybe that’s the low fence above that. It will pay something.

Dr. Mark Syms  29:43  

Yeah. But it’s going to be interesting, right? Because our maybe our language has to change, right to start in. I mean, it’s kind of like, what is a little bit of high blood pressure. So you know, the concept of what is a little bit of hearing loss, or many patients will tell me what I saw somebody who said, it wasn’t that bad. And as I always go, what when somebody tells you you have high blood pressure? They say that’s not bad. What do you think? It’s definitely a paradigm about the whole issue, right?

Dr. Harvey Abrams  30:12  

Yes, with hearing loss, maybe it’s a little easier, because blood pressure, of course, you know, deal that your blood pressure is a little high. With hearing loss, maybe you do notice you’re having slight problem. So the question is that, not always that it’s not noticeable, but that it’s not to the point where it’s having any significant impact on me or my quality of life? As we know, that’s the best predictor of whether or not people take action. It’s not the results of a screening test. It’s not even a result of a clinical test, where the clinician will tell you, you know, what, you’ve got a hearing loss here, it’s just not normal. Right? They said, Well, yeah. But I turn the diva up a little bit, I’m, I’m fine. It’s not until the individual themselves perceive their hearing loss as impacting their quality of life, that they finally going to take some action. That’s always a challenge for us,

Dr. Mark Syms  31:08  

right? No, I agree. But you know, I know there was some work recently done about what is normal hearing, right, and what that number means, like 2024 vision, and it does become a struggle, you know, when it’s not defined what normal hearing is, and maybe what we do define as normal hearing really isn’t normal.

Dr. Harvey Abrams  31:25  

Yes. And then there’s the whole issue cynap, cynap, Depop, cynap, to theology, synaptic pathology, synaptic pathology, The Hidden Hearing loss, or fact that hearing can be close to normal, but there are underlying physiologic changes that are impacting on the individual’s performance, particularly in high noise.

Dr. Mark Syms  31:48  

The brain has so much to do with it, right. And so that’s the thing. And so you know, it’s kind of like, you know, just because you hear Mandarin Chinese doesn’t mean your brain is able to understand it, because you hear things doesn’t mean your brains processing it. And it’s a simplified analogy. But you know, in difficult listening environments, it’s kind of that concept, right? Your brain doesn’t have the capacity. Totally, absolutely. And I think that’s where, you know, 20 years from now, obviously, the interplay between hearing loss and the brain will be better understood, whether that pathology is dementia, Alzheimer’s, whatever it is, even you know, it’s maybe not considered a pathology, but social isolation, and when in fact that as I think all of that work will be done at the next several decades, it’ll be fascinating to see what comes.

Dr. Harvey Abrams  32:31  

And the lecture I just gave at ASU was on children and adolescents. And we know that they are also at risk simply because of the types of noises that are exposed to a and because they’re teenagers. And right, then they don’t recognize the risks and to how do you get them to appreciate what may be happening? How do you get them to wear hearing protection? How do you get adults to wear hearing protection? And that’s always been a challenge. Fortunately, there have been some advancements in hearing protection technology, for instance, and meaning and things like that, right? Level dependent devices, filtering devices that don’t distort the music flattens out the response, to makes it more likely people are going to wear and protect their hearing. And I think we’re seeing certainly if you ever go to a concert, parents have brought their young children, they’ve got their, you know, the ear muffs on. Thank you.

Dr. Mark Syms  33:29  

Very much. So yeah, a lot of them are wearing shooters love

Dr. Harvey Abrams  33:33  

to get as well, right? Yeah. Well at the concerts, yeah.

Dr. Mark Syms  33:39  

They’ve given their kid their thing. So that’s great. So you know, two of the questions I always ask everyone is is, you know, who would you like to thank like, who are the people who made the greatest impact in your life to where you are today in terms of your mentors stuff?

Dr. Harvey Abrams  33:53  

That’s one question. I’d love to ask. Oh, yeah. Well, I’ve had some outstanding colleagues. And when I was at the VA, shortly after I got there, I had a new faculty member that joined the University of South Florida, where I had a teaching appointment. Teresa Chisholm is who that is. And she came from CUNY City University of New York PhD program, outstanding researcher. And we just developed the greatest working relationship, because we could use the patients we had at the VA as participants, and use her wonderful research design skills. And so we were able to have a great string of clinical material, yes, and clinical material and we were successfully funded through the VA merit review process. We had several projects were funded large multicenter project looking at auditory rehabilitation group rehabilitation programs, the how effective they are and why they’re effective, where they’re coming. and so forth. So she really had a tremendous influence on my career sort of moving me out of the clinic and in research and administrative space into sort of a research clinical researcher. And so I absolutely want to thank her. She has gone on to have a stellar career in research. She became chair of the department and now she’s Vice Provost at the University of South Florida.

Dr. Mark Syms  35:24  

It’s great. Yeah,

Dr. Harvey Abrams  35:26  

yes. For her. That sounds like really, yeah. And that relationship also is good because became a seamless. We, their students would come to the VA as as trainees. We had a very robust traineeship program. We had as many as 11 students at our VA at one time, so and that’s always enjoyable, of course, when you have students that you’re training, and they also engaged in research program, we developed researchers from from the inside, one of whom Dr. Rachel McArdle became a funded researcher went on to develop her own independent research career. And now she is now the head of national VA national audiology and speech pathology program. Wow. So, I mean, that’s the joy for me, of course, is just a lot of progeny these students. Yes, indeed. Right. progeny in our teaching me things. Right. Right. That’s, that’s really the joy. Right.

Dr. Mark Syms  36:30  

That’s great. Thanks. And then the last question I like to ask everybody is what’s your favorite sound?

Dr. Harvey Abrams  36:35  

Oh, favorite sound? That’s funny. I was just thinking about that the other day. shiver. That’s the sound of the baby. Maybe six month old in their belly? laughs Yeah. Uncontrollable laughs is so contagious, right? It’s kind of a feedback loop. Because, you know, they laugh and then we laugh. And they laugh, because we’re laughing and we’re laughing because they’re like, I love that sound, just uncontrollable joy and laughter. Without doubts, my favorite sound.

Dr. Mark Syms  37:08  

That’s awesome, though. So thank you so much for your time with us. Today. We have Dr. Harvey Abrams. He is the director of audiology research at Lively if people wanted to reach out and get a hold of you, where do they get all the LinkedIn or wherever they get on?

Dr. Harvey Abrams  37:21  

LinkedIn is great. Yeah, take take a look there message me and then we want to extend a conversational give you my regular email address.

Dr. Mark Syms  37:29  

Okay, great. Thank you so much for coming on. This has been great. It’s been fascinating stuff. I really appreciate your time. Oh,

Dr. Harvey Abrams  37:35  

my pleasure. Thank you for again, again for the invitation.

Outro  37:41  

Thanks for tuning in to the ListenUp! Podcast. We’ll see you again next time and be sure to click subscribe to get updates on future episodes.

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