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Not Just Doctors of Audiology But Patients Themselves

A conversation with Dr. Ana Anzola and Dr. Linda Himler. Sharing their experiences with tinnitus and hearing loss.



A conversation with Dr. Ana Anzola and Dr. Linda Himler. Not just doctors of audiology, but patients themselves. That's our topic today on Ask The Hearing Doctors.




Hi, I'm Jim Cuddy. And this is Ask The Hearing Doctors. And today I'm joined by Dr. Ana Anzola, Dr. Linda Himler, doctors of audiology with Hearing Doctors, the Washington DC area's highest-rated audiology practice with over 1500, five-star reviews. Ana, Linda, great to see you both. Great to see you. So, not only are you doctors of audiology, you're both patients as well. 


Uh, Linda, let's start with you. What type of hearing loss do you have? 


I have a, what's called a cookie bite, sensory neural hearing loss. It's a little bit worse in the left ear than the right ear. And I have ringing in my ears that I've had for as long as I can remember. 


Now, the ringing in the ears, is that, is that tinnitus or is that something different? Is that.


It is tinnitus. Um, I've had it forever. I call it high-power line. So it's multiple frequencies that just are with me every day. Wow. 


And what about you, Ana? 


So, unlike her, she has more of a hearing loss. I have tinnitus in the absence of a hearing loss and it lives with me. It's like my shadow. And then I really do wear my device mostly at night in the absence of any sound. During the day, I can sort of manage that a little bit, especially at the office or different places by playing different sounds around me and I've learned to cope with it. So, it's taken me quite a bit, probably years to get to that point. Um, but now I'm really managing it really well. But at night is when it really bothers me. So I sleep with my little guy and I don't know if you can see it, but it's very tiny. Um, and it just delivers, um, this particular brand has, um, fractal tones and that's a different type of sound or stimulus. Um, compared to other brands out there, they might use something like white noise or brown noise. Um, I respond better to fractal tones. They're more like musical chimes. 


Does that depend on the individual then? What type of, of noise works? 


I think that's very individual-based and that's something we talk about with our patients. Um, I don't use the fractal sounds usually. I use a, more of a frequency-based noise, sound, more of a pink, red noise, and I also modulate it. So it's more like a wave action. I find that better for me. 


When did you first notice your hearing loss? 


I first noticed my hearing loss probably when I was about 48, 46, 47, 48, right in there. When my daughter was playing softball and I couldn't hear the gossip and watch the game at the same time. I kind of figured it was time to go in, test myself and see what I need to do anything about it. And that's when I did. 


When I realized I needed glasses, just reading glasses. Age was catching up and that kind of thing. The arm just kept getting longer and longer and longer, and I didn't want to do it. I didn't want to do it. It was, it meant I was getting old. Did you have that same sort of thing prior to actually finally getting up and doing something about it? 


Yeah, sure. I mean, I'm like anybody else, I'm busy. It takes time. It's in all of my own office, but you know, sooner or later you're working too hard to hear. And you get a little step too far and then you take care of it.


And what about you, Ana? Now we're talking about two completely different hearing losses or situations here. So yours is certainly different from Linda's. But when did you first start to notice? 


I would say about five years ago. Um, but being in the industry actually allowed me to know more about what was wrong with it and address it right away. Um, so it was more of a blessing. 


Now, do you, do you wear hearing aids every day? 


Every day. Sometimes I forget like everybody else, but yes, every day I put them on in the morning and I keep it by my jewelry box. So if I put my earrings on I'm putting my hearing aids on too. 


All night long, or is it the kind of thing where you take a break and just say, ah? 


I don't wear them all night long. Um, I have ringing in my ears or tinnitus also, but I, I have rechargeable hearing aids right now, so I take them out and I put them in the charger to charge overnight. And I do hear my tinnitus at night because it's quiet. Uh, I, I go about it a little bit differently than she does. I do some breathing exercises and do some muscle relaxation and usually, I'm tired anyway. And that just helps me bridge over and then fall asleep. 


And again it's going to be different for everybody. It is. Absolutely everybody. What's going to help. But because of your experience, because that you've lived with this on a daily basis, you must have an advantage when you're dealing with patients that are suffering from the same thing. Cause they don't know, they don't know what you all do. 


Yeah. And I share my story because it's very relatable. So when I see a tinnitus patient, I, the first thing I ever say, is, you know, I understand you, this is what I do to cope with it. And these are the other mechanisms, you know, whether it's acupuncture that has helped some people, um, other people, you know, the breathing exercises or even meditation. And I like that. So I have my kind of my routine at night. I do my meditation. I do wear it because it really relaxes me. And so we talk about that brain ear connectivity with or without a hearing loss.


What would you say was the hardest thing to get used to when you started first wearing hearing aids? Cause obviously, you know, as you indicated before, you're at your daughter's softball game, you can't hear the gossip and watch the game and that kind of thing. So you're missing a lot now all of a sudden, boom, it's right there. 


I do think getting used to regular sounds in your house are going to, or were suddenly more prominent. And I kind of have to get used to that and figure out what the dishwasher sounds like, and that's not broken, you know, the washing machine has loud and it certain things like that that took a little while just to re-sort and figure out what I was. But the positive side was I was moving through my day more regularly and not thinking about working and staring people down or leaning in and all of that was starting to go away. So that was, that was worth putting up with some of the inconveniences in the beginning and getting used to those sounds. 


And I would imagine that anybody with hearing loss, when they first get hearing aids, they're going to have similar types of, of reactions where it's an overwhelmed, potentially an overwhelming situation for them. 


Sure. And I think a lot of the times we talk about that those first steps, you know, don't think that your car is broken, um, because it's going to make a lot of noise. So the seatbelt or the radio, the clicking, the turn signal, you know, I've never heard that. And so we talk about those things and maybe even talk about the prescription, we're going to start you off a little bit low, and then we're going to acclimate you as you become a little bit more comfortable with your surrounds. 


And I even think in the newer hearing aids, you know, even the people that have worn them and they're getting the newer ones that are out just in the last year. I've also pulling them back a little bit because there's such broader and more detailed than they used to be that they're needing to also take a week to get used to the new new availability of sounds around them. Yeah. 


Well and the technology advancements that we've talked about numerous times, it's just phenomenal what they're coming out with and, and what you can do even from a distance to help somebody hearing and adjust it and that kind of thing. 


Um, empathizing with your patients when they come in the office, it must be a huge help in, in your work because you know what they're going through. 


Yeah. It helps identify, especially the ones that are, are not sure. And you test them and you know, and I can look and I said, these are the situations you probably are having problems in. And it's not because I've learned it. I've had this problem. If I forget my hearing aids and my PCC is in the hallway and I can't, I won't hear her. And she's literally the distance between us two. There's enough, there's enough decay in the sound or deficit to that sound that I know I need the hearing aids and it's a very subtle thing. Um, so I tell them, you know, this, these are the types of situations you’re having trouble in, they're like, oh, and you can see the bell going off like, oh yeah. Okay. You know, so I can identify with that. And then that's often when I don't always tell them straight away that I also wear devices because I want it to be their story, not my story, but then I can, I can show them how easy it is. And then, most of the time they haven't seen it on my ear. Even if I have my hair back and up.


I, I can't see them. And I'm sitting across from you right now. Yeah. People don't stare at your ears. They stare at your eyes and your face. Yeah. They're not looking at your ears. 


Well, it's also, it's also that advancement in technology because they, some of the hearing aids that we have seen on this podcast are they're tiny and they can't, you’d never know. They're, they're invisible. 


And the nice thing about it is that we can tailor the system, whether it's a tinnitus system or a hearing to do both, to deliver the augmentation that one might need to address that hearing loss and or the tinnitus. And so they're, they're separate programs. Um, they can live together and we can access them together, um, or they can live separately. 


We've talked about in the past and I've, I've in just reading about it, listening fatigue, what is listening fatigue? And, and, and how, how do you direct a patient that's, that's kind of suffering from this sort of thing? 


I try to encourage them. I mean, listening fatigue makes you literally tired at the end of the day and they don't need to be tired. I mean, it's your hearing is not just your ears, hearing is your brain. Cause whatever signal your ears are putting up, that your brain has to work with. And if it's a degraded signal, then your brain is having to work overtime, looking for context, searching for words, it might be, um, things like that. So like, you know, you really, at this day and age, the devices are that much better, you do not have to be in that situation. And even at different price points, you will find relief from that. So. Yeah. 


And it's looking at all the parts of the brain, you know, there, there are typically three domains, right? We talk about the memory. And so you are trying to extract from memorization, what was that word. Context. Or the context of visual cues that we get, or the executive function. So all those things will affect the cognitive part of our brain. 


And so that leads me to communication strategies that you sometimes have to talk to people about and things that, so what sort of communication strategies do you advise your patients with? 


So we talk about, you know, when listening, depending on the, on the patient, um, their hearing loss, um, their needs. Is it work situation? Is at home situation? And so we talk about, um, appropriate listening strategies that are going to, you know, help them and assist them and not present themselves as, oh, I'm, I'm hearing impaired. Now it’s more like, make it normal, make it more of a normal transition. Yeah. 


And one of the first things I try to counsel my patients on, is you know, get somebody's attention first, or have them get your attention first because it cuts the middleman out. If someone's on a computer, they're going to look up, they'll cut the distance between the person, or, you know, it gives you that moment to bridge the distance as well. So you've got the best signal possible coming in. So if you can learn to get each other's attention, you're going to communicate better. Sure. Or even if you missed something, you know, try to rephrase it or say back exactly what you might've heard and then they will correct it or fill in the blank. 


Not everybody, even when you notice, gosh, I think I might have a hearing problem. I don't want to get hearing aids. This has to be something you probably deal with almost on a daily basis with somebody coming in. But at least they've come into the office. At least they're getting into those first steps. Yeah. But they're still not quite ready. What do you tell somebody? 


I tell somebody to try it. I, you know, we'll get out a pair of hearing aids and I know what their hearing loss is, and we'll, we'll create a program for them and we'll let them listen to it. We'll let them listen to me talking in noise, or we'll let them walk outside and listen to what they've missed. Um, and just let them get the feel of it. And, you know, and then if they, if they want to wait, then that's their privilege. But, you know, we let them demo out. We'll let them take them for a couple of weeks and really give it a good run so that in their environment, they can see where that's making that difference. Even if it's not all the time, those key places where they're really suffering, they'll see that their day to day, it's a smoother day. It's a happier day. It's a regular day. 


And even, and even when we do that, the demo for like two weeks or so, or, you know, even though it's not the full 30 days, that's how long it takes the brain to adapt. But, um, but I think it's important. I tell them, take it out in that natural environment in which you find yourself having issues, take it out and see what happens. Or the ones that may say, how about just one as opposed to two. And I go, that's fine, but you, you test it out yourself. Um, be at that family gathering, be at that restaurant or that situation, that work meeting and, you know, gently take it out and hear the difference. Because you're very used to what you hear, how you hear. You don't know what you don't know because it's often crept up on you. So you don't know what that, that having that hole filled in, get your numbers back up is going to do to your interactions or how much you'll enjoy something more, than you'll explore more. Or get more out of life if you give it a try. So I really encourage people to try it. It's worth taking it. They can always return it. We do have a return policy, but you know, they need to experience it sometimes to know. Experiencing that, that benefit experience that investment that they're making. And it's really in on themselves first, not don't do it for the family. Right. I always say that, you know, that's the worst. You do it for yourself. And I tell them, it's your brain's a 10 day to two week kind of brain. It needs, it needs time to get used to what's the zone. And then it'll start assimilating. It'll start re-sorting everything back in. So you'll be in a good spot. 


It's um, it's, uh, it's a fascinating world. The, the whole world of hearing loss, and people don't realize they don't know what they don't know. Um, we tested me, um, sometime back and I was a little nervous. I wasn't sure what we were going to find and that kind of thing. And in the end, it wasn't that bad. But I'm in the right place, because if it were a little worse than, than what it turned out to be, now, I've got somebody that can say here, try this, see what happens. And then let's talk. 


And I've done everything that they're going to do these hearing aids, I've done it. I've. I've. I haven't run it over with the car that I haven't done yet. But. Try not to. I've certainly been in the shower with it. Um, I put it through the washing machine and it came out fine. It was not loss and damage. It didn't even need to be repaired. Cause they're pretty tough these days. Yeah. Um, yeah. Very durable. Yeah. So there's not many stories that I haven't experienced one way or another, so there's no, everybody should be relaxed. Life happens and it's okay. You'd probably have to tell this to people all the time. Yeah. It's, it's true. 


But we have these normal conversations and it's, it, it's very relatable. And I think that's what helps to put them at ease. And even if they come in, they have a greater loss or a greater deficit than they themselves anticipated. It's okay to wait because I want them to be ready for themselves. And until they're ready, you know, they're going to put it off, but we're going to talk about the ramifications of putting it off and what that looks like down the road. But it is a first step. Sometimes they have to think about it a little bit or get used to it. And when we demo in the office and they take and I'll just do it early enough so that they have it for when I'm explaining everything to them, so that when at the end, then they have to give them back to me. Um, then they're like, oh, then they notice the brain's already made a lot of transition. And that there's a hole. They notice the hole. It's that wow effect. Yeah. They don't hear you say goodbye. 


Yeah. Oh, Ana, Linda, thank you both so much for sharing your stories. It's wonderful. Great that you, we can sit here and have this conversation and, and point out to people that it's okay. It's all right. Totally okay. And there's something that can be done. Yeah. Absolutely. Yeah. Thank you both. There's no shame in hearing. You're very welcome. That's right. 


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