The Hidden Link between Hearing and Brain Health - Nicolas Reed PhD

Can hearing loss increase your risk of dementia? Can you have a normal hearing test but still struggle to understand conversations? These are some of the biggest questions in hearing science—and the answers may change the way you think about brain health, cognitive decline, and longevity.

In this episode of the Crackin' Backs Podcast, internationally recognized hearing researcher Dr. Nicholas Reed explains the powerful connection between hearing loss, brain health, cognitive load, memory, aging, and dementia prevention. Learn why traditional hearing tests may miss important problems, how the brain—not just the ears—processes sound, and why hearing could become one of the most important vital signs for healthy aging.

You'll discover:

• Why people struggle to hear in noisy restaurants despite a normal hearing test
• The connection between hearing loss, cognitive decline, and dementia
• How hearing affects memory, attention, and brain function
• Whether concussions, whiplash, and head injuries can impact hearing
• Can the brain be trained to hear better?
• What everyone should know to protect hearing and brain health for life

If you're interested in longevity, Alzheimer's prevention, cognitive health, healthy aging, hearing loss, brain optimization, auditory processing, concussion recovery, or evidence-based health, this conversation is for you.

Subscribe to Crackin' Backs for weekly documentary-style conversations with the world's leading experts in longevity, performance, neuroscience, and human health.

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

 Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Transcript

Dr. Spencer Baron (00:01.26)
Most people think hearing loss means turning the TV louder, but what if your ears are quietly changing your brain decades before anyone notices? Today we're exploring why hearing may be one of the biggest missing pieces in longevity. Welcome to the show, Dr. Nicholas Reed. it's gonna be a pleasure here. Listen, you know what? listen, how if I didn't mean that, listen, right?

Nicholas Reed (00:20.018)
Hi. Thanks for having me.

Dr. Spencer Baron (00:28.844)
We we all say I hear you, but is hearing really something the the ears do, or is hearing actually something that the brain does?

Nicholas Reed (00:39.828)
You know, maybe maybe the right way to frame that is what's hearing and what's listening, right? so you could at a very simplistic level think of hearing as engineering, encoding, and decoding sound. The ear, quite literally, is just the peripheral world around you. Can you access it? Can we encode it? Can we send a signal to the brain? The brain then has to take that signal, layer it on top of everything else that's happening in the world around you.

Ignore things that are not important, and then at the back end even add language and meaning to those signals that are speech. So it is, you know, listening is a cognitive process. It is decoding all of that signal. Hearing is a relatively simplistic encoding front end, you know, process. So two sides definitely takes a load on the brain, definitely takes both to really make sense of the world, but do have slightly different meanings.

Dr. Spencer Baron (01:37.369)
Great. You it it's it's funny you provide a different perspective on what hearing and listening is. Cause sometimes if I'm talking to somebody they're totally distracted and I'll ask them, Are you d did you hear me? Or did you are you listening? And they'll go and they'll often say, I can hear I hear you. I I can repeat everything you said, but that's not really listening in its purest sense, you know. So let me ask you, there's the mechanical part.

Nicholas Reed (01:59.934)
Yeah, yeah, absolutely.

Dr. Spencer Baron (02:05.62)
of hearing, which is the cochlea, and then there how does that you know, versus the auditory cortex, how do those interact and where's the problem from there?

Nicholas Reed (02:16.765)
Yeah, so what we think of as as hearing loss, right? And what we really measure when we think of hearing loss and and hearing. You know, the sound comes into the ear, this external part is actually called the pinna, it looks like a trumpet. it is built to already start augmenting sound, just like a trumpet. it has a resonant frequency, it adds it adds sound where speeches too, which is really cool. So it's all it's already augmenting certain aspects of sound for you.

Then the sound travels through what's called the middle-ear space. For science nerds out there, if they want to look it up, you can see the three smallest bones in your body, the ossicles, they fit on the size of a dime. Sound goes through there. If you're really a nerd like I am, this also is where you get vibromechanical translation, meaning you took energy in the world around you that was acoustic, turned it into a mechanical signal, then it goes to the cochlea, where the cochlea turns it into a neural signal.

an electric signal. The cochlea is this little snail-shaped organ in your body. The signal goes in, there's little what we call hair cells. That doesn't mean that they're hair, they just look like hair. the signal goes up and sort of finds its spot along the hair cells, which are literally organized like a piano from high frequency to low frequency. It's almost like each cell, each cell has like a key that it would relate to the frequency. It finds that spot and sends it in. And you have to imagine your ear is doing this.

constantly, all the time. And so then it routes it to your eighth nerve, your acoustic nerve, which sends it to for temporal processing in the brain, so your auditory cortex. But along the way in the auditory cortex, hearing is unique. It's not as singular of a pathway like vision. Vision is relatively mechanical and shoots from the occipital lobe in the back between your eyes. Hearing actually shoots interaxially and goes v past

Your hippocampal region, it stimulates the amygdala area, it hits the prefrontal cortex, and then eventually hits the frontal cortex. Cause it's not just, hey, what are we seeing? And make sense of this, it's this idea of language, right? And you know, we start putting meaning behind everything and informational processing. the process is amazing to me because each little spot along the way does something. years ago, I had this case at Walter Reed clinically.

Nicholas Reed (04:45.309)
Where a guy had a cerebral spinal fluid leak, and all of a sudden he's sitting in a mess hall in Germany at a military camp, and he suddenly can't understand a word anyone's saying, but he knows they're all talking. He comes back to us, his hearing with pure tones, perfect. You play speech, couldn't understand, couldn't repeat a word. It turned out that the cerebral spinal fluid leak was pushing up against the medial geniculate body, which is a little spot.

On the auditory brainstem, and that specific one spot is responsible for taking all of the signals and layering them together to give you a full signal for your brain to make sense of it. So this this poor guy, I mean, he thought he was having like a full mental breakdown, like couldn't understand a word anyone was saying anymore. And I mean, the surgeons literally at Walter Reed quickly, you know, drained it and everything was fine the next day. it was it's incredible though that that signal.

You know, unlike Vision, which is relatively like a highway, is like it's like Route sixty six more instead of an interstate. You are stopping at little town a little town along the way for processing.

Dr. Spencer Baron (05:54.575)
Explain what sensory adaptation is.

Nicholas Reed (05:59.74)
Interesting. let's let me let me get like a clarity of like what what sense are you thinking for for sensory adaptation?

Dr. Spencer Baron (06:06.152)
well for hearing hearing primarily. It's you started to allude to it just a moment ago about your your the way you're processing information because you're al there's your ears are always picking up signals.

Nicholas Reed (06:19.495)
Yeah. So like adapting, not necessarily aiding or anything, but adapting to the world around you sort of scenario. Yeah. So I mean part of this is happening in your ear is physiologically built. Even even in that that process with those three small bones in the br body, it's built to enhance the very specific frequency region where speech is. So we are we are literally wired to sort of capture

Dr. Spencer Baron (06:25.997)
Yes.

Nicholas Reed (06:48.967)
those frequencies. And that already starts to help us with this idea of adaptation because the world is noisy, right? The world is noisy and we don't want to hear all these noises. Technically you can hear from 20 to 20,000 Hertz at very different thresholds there, very very different sensitivity. But speech is around, you know, 500 to 4,000 hertz. And the majority of our everyday life is 250 to 8,000 hertz. And our system is sort of built to process that. Even even the cochlea

Dr. Spencer Baron (06:55.682)
Yeah.

Nicholas Reed (07:16.967)
Right, if you were to roll out that snail shape and you had the piano keys, two thirds of those keys would be dedicated specifically to two hundred and fifty to eight thousand hertz, even though you can go from twenty to twenty thousand, which is pretty incredible. So we're anatomically built. So we we start to filter without even knowing it. Our system is just built that way. And then adapting the brain, i if you actually think about it, it's kinda like the you know, the scary house theory. The first time you're in a place, you know,

you know, you've never been there before, and you know, let's say you're in this big, you know, haunted mansion type, you know, setting, it's gonna scare you. But if you've lived there a while, right, you get used to it and you understand it. And you do the same thing with sound. The first time, you know, you get a new refrigerator and it hums, yeah, you might notice it for 30 minutes. Your brain is really good at saying, Hey, that's not interesting. We'll never pay attention to that again and letting it go, right?

Dr. Spencer Baron (08:14.136)
Yeah.

Nicholas Reed (08:16.507)
Dripping sinks, same way, right? You start to forget if you have and actually even think about your own house. Pay attention the next time you do it. Walk around, and you've forgotten how many floorboards creak because it's something that happens every single day to you. And you're all I mean, for all sensory input, our brains are built for this is fresh, this is interesting. If it's mundane and something they've seen before, your brain is literally built to say, Don't pay attention to that. That's silly.

Dr. Spencer Baron (08:45.698)
What's actually happening then with the complete reverse? So somebody's, you know, born and grows up in New York City with all the racket that goes on there, and then they move out to the vac or not move, but they vacation in the wilderness somewhere where there is not a sound and they're actually uncomfortable. What what is what's actually happening there?

Nicholas Reed (09:05.703)
Yeah. Yeah, I can relate to that. I grew up in the city and then moved out to the suburb like deep suburbs when I was in like high school age. And yeah, it's it's different. And the types of sounds even that you hear sort of you you pick up fast. But humans are incredibly adaptive. And that same feature of hey, this is this is something we're used to, your brain pretty rapidly says, Okay.

This is the new norm, and this is what we're gonna get used to. so, but to your point, absolutely, people go in both directions. There are people who live in like rural areas, they come to the city, they cannot get comfortable, right? Just cannot do it. and there are people like like me who grew up in the city and we're used to hearing ambulances all night long. I live out we're just outside of New York City right now, across the street from a train. if my parents come visit me,

They cannot sleep in our house because a train is going by every 20 minutes and shaking the house. To me, it's like being rocked to sleep. And like that is my norm. but most people adapt pretty fast. Where this becomes problematic is when you when you think about this adaption, I mentioned the auditory signal shoots right by your hippocampal region. And this is why tinnitus, which is that idea of like that psychology, you know, psychologic effect to hearing a signal in your brain, a sound, like a buzzing sound.

Because the auditory system hits right there, and that's where your anxiety, your emotional responses are built, there are some theories that sound takes a little bit of a different adaptation process, and it can create anxiety because the signal goes through that spot and sort of stimulates that area. Similar to people talk about olfaction and memory, like sense sense of smell and memory, it's it's the olfaction is directly innervated into your frontal cortex where those memories would be stored.

Right, the prefrontal and frontal cortex. So there is this idea of like where the signal pathways go can start to play into your emotional responses to things. And a lot of people get very emotional to sound, right? If you hear a voice you haven't heard for a long time, right? Like I know my kids are aging out of their their squeaky toddler voices and like you know, every now and then I'll play my seven year olds like videos with me when he was two.

Nicholas Reed (11:23.739)
And you know, instant tears almost, right? It's it's emotional to hear something that you haven't heard in a while and it's sound can really bring you back.

Dr. Spencer Baron (11:34.2)
With that said, somebody who's had a normal hearing test, let's say, and yet there are times where you can't understand somebody who's you know, different pitches and tones and someone that's talking, but you just had a hearing test and that was normal. Where where does that conversation go?

Nicholas Reed (11:54.492)
Yeah. I mean there's two things that could happen there, right? You know, one, I am an audiologist clinically, but my PhD is actually epidemiology. I'm a public health person. I've lived in public health the majority of my academic career, that's where most of my research is. And so on the clinical side, and you say normal, then you might be thinking this is like auditory processing disorder, right? And you're you're looking at, hey, you know, because

There's an encoding and decoding part. Something is broken in the pathway on the decoding part, right? And there's something about, you know, the processing of sound in the brain that we're unable to maybe separate signals. We're having trouble with background noise, we're having trouble with temporality of sound, you know, something moving too fast, too slow. you know, we hit those kinds of issues. And when that comes up,

Sometimes a little bit of a a signal boost might help somebody with normal hearing. But I also then as an epidemiology person might say, well, define normal, because every clinician out there has their own definition of it. And they might think, here's the thresholds, right? And we may even have sort of, let's say, 20 decibels as a threshold being normal across the frequencies. But one clinician might say, well, you've fallen out of 20 decibels at 6,000 Hertz, so now you're you're abnormal.

Whereas another clinician might define that as you have to be beyond it at all frequencies. And it's not as standardized when we think about diagnostics. And so it actually becomes that that clinical profile of somebody to to define. So it gets a little bit difficult. And then the other thing I'll put in here, which combines both, is we have defined, and this is this is true for most areas of healthcare, right?

We define things based off of thresholds of where you are relative to everyone else. Meaning we've taken the audiogram, which is the graphical way to think about hearing, and we've set a threshold and said this is normal. But what if you started just below that, right? And you've been living at that le spot for sensory input your whole life. I'll literally use a real example. My longtime mentor, he's an odolaryngologist, surgeon, and public health researcher.

Nicholas Reed (14:13.565)
He's 10 years older than me. And we, you know, obviously two hearing researchers, we test our hearing all the time. And Frank's hearing, you know, if and 20 is sort of the cut point for normal or 25, depending on which one you want to use. He's down at like a 10, right? And for his thresholds. And, you know, this guy should be way beyond that, in my opinion. That's like kids. I've been sitting for 15 years in the twenties already.

And you know, borderline mild hearing loss. That probably means though that I've been there since I was a kid. It's just where my starting point was. My brain is used to that signal. So if I move five, let's say, decibels worse on this idea of the number scale for hearing, I'm in I'm in deep into mild hearing loss territory. But I've been living there forever and I don't notice anything, right? And it's it's not big. If Frank moves

into mild hearing loss, he's shifted 15 decibels. It's a huge change for his brain and what it's used to. And we don't think about this enough diagnostically. We always sort of categorize where people are relative to everyone else. But your own life experience and and you know, our brains are incredibly adaptive, right? they are if they're used to a certain signal, that's their starting point. So three three ways to answer that question.

Dr. Terry (15:36.274)
You know, I want to jump in and parlay off of Spencer's questions. You get some people for more on the sarcastic humor side. You get the wife that sends the husband in says, he can't hear me. And he says, I hear her fine. I just don't understand her. So then he goes and gets the hearing aid, goes to Costco or whatever, gets hearing aids. And now he goes, I still can't understand her. She's just louder now.

Nicholas Reed (15:50.257)
Yeah.

Dr. Terry (16:05.711)
What is that? That's not hearing necessary. That's just interpretation of the brain. And what does that guy do? Because now he's frustrated because he goes, I hear sounds just fine. I just can't pick out the words you're saying. And now they're just louder with these devices in my ear.

Nicholas Reed (16:21.095)
Yeah. So again, two ways to think of it. when we lose our hearing, for the most part, like like we have to separate sort of two types now. There's like these congenital, genetic, progressive hearing losses, right? They have very different patterns. They start early in life. They they may sort of be equal across all frequencies. But for age-related hearing loss, which is the vast majority of hearing loss in the world at any given time, and it's what most of us will experience.

my own research studies basically say by if you live to ninety, and we're you know, hopefully we're all lucky enough to, pretty much everyone, 99% of us, will have hearing loss by ninety. once we hit 70, two-thirds of adults have hearing loss in the United States. and it's pretty similar n globally, but there are some differences. But to your question, we lose our hearing sort of high frequencies first to low frequencies. It's actually sort of like

Stripping off the keys of the piano one by one. But the world around us didn't change. So it ends up being a clarity, not a volume issue. Cause you can imagine, I'm gonna do my best with this. If you were being discharged from the hospital and you had this high frequency hearing loss, and it kind of cuts speech in half, right? Because you kind of hear some parts of speech, like vowels, low frequency sounds, but you don't hear consonants, like the F sound, the S sound, the TH sound.

And I said, you should go to your home before you go to the pharma or no, let's say you should go to the pharmacy before you go to your home, right? Telling them to pick up their medication on the way home. With a high frequency loss, it might sound more like you would go to Arma E be or you go to your oo, right? It's a clarity issue, right? But the volume didn't change, right? Yes, you both can clap, because that was very impressive that I pulled that out.

Dr. Terry (18:09.957)
That was very impressive. Actually, I didn't want to clap because I go, did I hear that right?

Dr. Spencer Baron (18:10.039)
That that alone was impressive there.

Nicholas Reed (18:17.681)
No, it's it's just, you know, but the idea is hearing loss is clarity, not volume, for the majority of people. But when you say what you said, which is a typical complaint with hearing aids, right? So this is also why people say everyone's mumbling. It's because it's clarity, right? It's not they're missing those key parts of speech. A lot of us can mentally, in the early stages of hearing loss, still put it together, right? If you know we're talking about medication and you know we're talking about pharmacies.

The context matters and you sort of you you fill in the blanks. But if you get hearing aids, and the hearing aids you know are fundamentally still based on the idea of audibility, adding sound, you may just take this same clarity problem and make it worse. It's why a good audiologist and a good hearing aid is working to add sound where you need it while not doing anything in the areas where you're still getting sound, right?

Because otherwise, you run into all sorts of issues with, you know, you just made the sound you made the same issue louder, to your point. Or you could even make it worse by adding too much sound where you're already good. And there's this weird phenomenon where low frequency sound always masks out high frequency sound. It's just wider in the world around us. So even if they're the same level, the low frequency energy will mask it. So we don't want that either. So hearing aids.

Try to do this idea of adding sound where you need it, a good audiologist, while not making it too loud, because you know your s soft threshold changed, but your loudness threshold didn't. So you could go from nothing to hey, whoa, that's way too loud very rapidly. So we also try to compress the signals and make sense of them in what you have left in your range. And then hearing aids are really focusing now on how do you

enhance speech to hit exactly what your problem is that you talked about. Like removing that that whisper or sorry, that mumbling issue, that clarity issue. So they do a few things. They will focus on what's in front of you and enhance that, assuming that's speech while turning off the mics behind you. They also have digital noise reduction algorithms because most noise is pretty steady and they're kind of mimicking what the brain does that we talked about. And they're saying, look,

Nicholas Reed (20:33.383)
That noise, there's no way that that's interesting. It's just the same thing over and over again. We're gonna take that off. Right? And then they have a few other sort of schemes to say that's speech, we're gonna enhance the speech, we're not gonna enhance, you know, the noise. Now with AI, they're even starting to, you know, we've always kind of had machine learning in hearing aids, but AI now is looking at the world around you and it's literally saying, like, hey, Dr. Terry, Dr. Spencer, you're the most interesting people to Nick right now. we're gonna enhance your voices.

over even other voices, right? And so AI is really changing up some of the paradigm here. The issue though is don't ever forget, you can't really replace your brain and your desires. And even the best AI can only work on the inputs. So it can also go astray by saying, you know, you know, that person at the table next to you at the restaurant who is the loudest person in the room, they must be really interesting. And we're gonna focus on them instead of, you know, your very quiet spouse, for example, across from you, who's a soft talk.

Dr. Terry (21:03.374)
Wow.

Nicholas Reed (21:32.785)
So there are lots of like limitations, but we're getting better and better and better fast.

Dr. Terry (21:38.418)
I want to parlay one more thing before it's jumps in. We both do with athletes. And I think so many people think about this. You mentioned it earlier about the age person as we get older and older and older. And it seems like hearing is always talking about the older person. But very few people talk about concussions and head injuries with athletes. And I think that's a lost cause that I'm too young to wear hearing aids when you're 25. you're an X Games athlete who's had 15 concussions.

Can you talk about how brain hits partly to exactly all the stuff you're talking about and why maybe these hearing aids may help them recover some of their brain function?

Nicholas Reed (22:18.759)
Yeah. Shout out to Eric Gallin from the National Center for Rehabilitative Auditory Research in the Veterans Administration System. he has amazing research on this area. And I tr I trained there as a student actually. so he was studying it it turns out concussions very similar to blast exposure, right? Very similar mechanisms of the way the brain is literally being jostled, right? and you know, bumping around inside your skull.

And so he started studying blast-exposed veterans coming back from theater, coming back from war. and then they have completely normal, right? Pure tones, right? So that idea of like hear a tone, raise your hand, right? The ear, that cochlea, is working fine at encoding the signal. But when you start to play speech and noise, right, they start to struggle more than they should given their hearing loss and given their age, right?

And if you play like degraded speech on purpose, which most of the world around us unfortunately is not perfect, right? Most of the world has really poor signals, competing signals, competing noise, competing interests. it turns out they do worse. And so his team really exposed this sort of higher rates of auditory processing disorder due to blast exposure, and concussion models would show the same thing. there was there's been some limited work on

Basically low gain hearing aids for that group that show strong efficacy, really strong signals of improvement. And a lot of it is what we just sort of hit on is it's not that the hearing aids make things louder, it's that they're doing their best to make things clearer and enhance the signal. you know, this idea of signal to noise ratio is like that is the golden thing for audiology, right? It's the signal of interest versus the background noise, how f how wide can we make that ratio?

And so it turns out if you make that ratio a little bit wider with even just the the tech we currently have, or there's something there's sort of augmented tech like things called remote microphones, where the hearing aid can be directly streamed via, you know, a Bluetooth-enabled microphone. So if if you're at a restaurant, you could clip it to your lapel and then I would hear you very directly. And that's that's actually the best signal you can get. It's very similar to what we do for children with hearing loss.

Nicholas Reed (24:41.509)
in the public systems, right? An FM system for direct signal where the the teacher wears a a microphone on their neck, or as of like a necklace. so you get this like, you know, ability to enhance for them and and you do sort of improve their everyday life. There's also ideas of brain games and you know those cognitive teasers and you know quite literally like purposefully putting yourself through difficult situations to train your brain, which also shows some efficacy, especially when done with technology.

Dr. Spencer Baron (25:12.695)
How d how does bone conduction hearing work? It almost didn't make sense when I saw people with the the headsets around their I guess their mastoids or something and then but nothing in their ear. What is going on there? Yeah.

Nicholas Reed (25:26.909)
Yeah, yeah.

Nicholas Reed (25:30.462)
So it's on the mastoid. it comes from a diagnostic reason, right? The the original purpose for it was if remember I described those sort of three areas of the ear, you have the outside, the middle ear space, and then the the cochlea. So sound has to travel across all of them. If you put a headphone on, it has to go through all three, but you could bypass it by stimulating the the skull. Literally, well, we'll put it on the mastoid, like you said, or there's some people who put it on the forehead.

And we will calibrate it to stimulate the cochlea directly. So we'll bypass the middle ear space. So this would be we could say, hey, you your ear is filled with fluid. We can still though tell your cochlea is normal, right? It's just a conductive loss. We just gotta drain that fluid. So I don't know why this was funded, but there are researchers who have spent time literally being able to calibrate that that vibration, that oscillation signal, even from your knee.

it you know, anywhere on your body, as long as it's a bone, we can vibrate directly to a se a separate spot, right? Because it's all sending signals via, you know, an elastic medium, which your your bone all all medians are pretty much elastic in some way. So, you know, it's it's kind of fascinating. very similar in a real world example would be if you've ever been on the ice during wintertime and you've thrown a rock and you'll hear that that like weird, you know, like vibration sound, like like warping sounds, right? That's the auditory signals shooting out through the ice.

So we can do the same thing in our bones.

Dr. Spencer Baron (27:01.367)
Fascinating. Thanks for the explanation. So traditionally blood pressure has been a vital sign that we use for cardiovascular status, but does could hearing eventually become another vital sign for brain health?

Nicholas Reed (27:02.353)
Yeah. Yeah.

Nicholas Reed (27:17.553)
Yeah, you know, when I was at Johns Hopkins, we had a sort of a campaign to really push hearing to have a vital sign. 'Cause part of the problem is to have a vital sign you have to have a number, right? And we don't really have a number, right? The way we talk about hearing loss is it's there, it's not there, right? It's just this like sort of black and white category and

even when we put categories on top of it, like you have slight hearing loss, you have mild hearing loss, you have moderate hearing loss. Nobody knows what those mean, right? And you could sit within mild hearing loss. Remember, like I was even talking about where your baseline is versus where you go. You could sit in mild hearing loss for a you know two decades and move all the way from the beginning to the end of it, and you've had a huge shift, but your doctor might still be saying you have mild loss. So

a researcher named Franklin and myself, and then now it's been the mantle has been taken up by Jennifer Deal, who's a very close colleague of ours. We all represent different layers of expertise. One's an odolaryngologist, one's an audiologist, one's an epi a pure epidemiologist. I would I would call myself more of a hybrid, let epi light person. we focused on this idea of the pure tone average, which is what the World Health Organization uses to define sort of

you know cut points for hearing loss. And what this is, is it's an a if you go do the hearing test, right, and we get the lowest threshold you can hear sound at different frequencies, we'll take an average of the frequencies at 500 hertz, 1000 hertz, 2000 hertz, and 4000 hertz, which roughly approximates where you hear speech and can repeat it back to us. So it roughly gives you about the spot where you're able to understand speech, right, based off of your hearing.

Not not thinking about background noise, not thinking about the world around us, but just in a in a quiet environment. So that that number that at Hopkins we called the hearing number, it starts to put some meaning on this idea, right? And it literally can go from, you know, zero to a hundred. it is a logarithmic scale, so it could go below zero to negative ten would be about the lowest you could get, a hundred and ten the highest, based off of the equipment parameters we have. But it shoots in a linear direction, you know, higher is worse.

Nicholas Reed (29:33.35)
It starts to make you more intimate with the idea of a vital sign. So I think I think our first step is we need a a universal vital sign that's agreed upon, and then it helps people really understand how their hearing is changing, right? I went from a 30 to a 31 to a 32, whereas all of that would just be mild hearing loss if we were just talking in big categories, right? Or someone like, you know, they start at a zero and they're, you know, suddenly at 20, 25.

That's a huge jump, but technically we wouldn't call that hearing loss and you know, based off of our current standards. to hit the back end of your question, do I want it to become a vital sign? Yeah. I I think I want it to be a vital sign for more of the purpose that I think it creates action when people are able to understand something. Blood pressure is a great example. You know, in the 80s, we were putting blood pressure cuffs in all of the grocery stores, right? All of us can remember.

you know, going to a grocery store and like as a kid playing with it while your parents filled a prescription. But that actually had a huge effect off of people's sort of public health intimacy with hypertension and cardiovascular disease and it increased awareness, increased help seeking behaviors, and changed the fundamental health of the nation. And so I think, you know, from a public health standpoint, absolutely I would love to see a vital sign.

Dr. Spencer Baron (30:27.147)
Yeah. That's right. Yeah.

Dr. Spencer Baron (30:51.415)
So are they testing here I mean, are are we you know, what age should you be testing whether you have hearing loss or not? Or i you know, we we go to the dentist when we're young, we go you know, what w how do we handle hearing?

Nicholas Reed (31:06.205)
So if you want the nerdy sort of public health answer, there is not a defined age for this. a few years ago, the US prevent preventive services task force actually analyzed, you know, should everybody 50 years and older get a screening for hearing loss? And they gave it a I, which means basically incomplete, right? We don't we don't know. And it's because there's sort of gaps in the knowledge, right? You know, getting a hearing aid won't guarantee everything gets better, for example.

Dr. Spencer Baron (31:10.327)
Okay.

Nicholas Reed (31:35.614)
And there's some people who may not benefit from a hearing aid depending on where their hearing loss is. And because we don't have those strong defined diagnostic cut points, it creates some murkiness in the water. And it actually, you know, from their perspective, from a public health perspective, it's it's risk, right? If we screen everybody and start saying, Hey, you all have hearing loss, and then they go spend two, three, four thousand dollars on a hearing aid, even even a low one end one five hundred, but they don't benefit from it, that's that's true financial harm caused to people, right? So

So it hits this incomplete. If you're thinking more about just like, you know, the the clinical gestalt, by the time we hit sixty, half of all Americans over sixty have a hearing loss. So that's sort of the cut point where it starts to really hit our our predefined thresholds. And so I've I've always sort of told people like, look, what's what's the problem within your forties or fifties just getting that first test? It's not gonna change rapidly.

If it is changing rapidly, you'll notice, right? Hearing loss is slow, it's insidious, it kind of creeps up on us. It's why it's easy to ignore for a long time. but just get intimate with it and do a first one in your 40s or 50s, and then when we actually hit our 60s, we should be going on a regular you know, basis, maybe two, three, four, five year intervals. Eventually you're gonna hit we wanna monitor this every year.

But that's more of now we're getting into like the really finite regions of like if we're if we're programming your hearing aid, for example, we want to make sure it's always programmed to your exact hearing loss.

Dr. Terry (33:08.305)
Alright, I got a question. Go ahead.

Dr. Spencer Baron (33:08.695)
I remember as a I remember as a kid hang on, Terry, so I remember as a kid, which was mm, I'm sixty five, so that they did do hearing tests in h elementary school, right? You know

Dr. Terry (33:19.025)
Yeah, right. They don't do it anymore, I don't think.

Nicholas Reed (33:21.633)
yeah.

Dr. Spencer Baron (33:23.143)
No, I just realized that. I never thought about that. They did that when you were young. And I thought my hearing was I mean, my hearing was fantastic until I started listening to rock music at the like decibels that were not normal. So I wonder if that, you know, had an effect on what I can or can't hear today. But they why did they stop doing it at i in in in elementary school?

Nicholas Reed (33:45.082)
It still actually happens for the most part. it's it has been sort of cut in some spots. So there's a there's this really strange paradox with audiology. When it comes to public health, when you think about pediatric, audiology is actually one of the the you know most forward-thinking fields. In the sixties

We had public health centers at, you know, where where I did most of my research career before before moving on, at Johns Hopkins, we had a center for pediatric hearing loss in the depend department of epidemiology. And, you know, they focused so much, included many of our ideas of the cut points for where hearing loss is, are based off of kids and acquiring language, right? And then educational outcomes. And so they studied this so deeply and they looked at it as, hey,

We know if we intervene early, the brain adapts early. the cochlear implant researchers, which is a surgical prosthetic, we could talk about that it does a different thing with hearing loss. all these guys were focusing on it. And they basically, in the n in 1990, started a full campaign that tied federal highway dollar funding for states to newborn hearing screening programs. And because we had really defined, you know, what happens with hearing loss in kids.

What happens if you address it and then how to address it? We saw full adoption, all 50 states by the end of the 90s. Now 95% of kids are screened at birth for hearing loss. We're really good at identifying. We have a by one month identify, three months diagnosis, and six months intervention sort of program across the nation. And we still sort of screen in elementary schools because we're aware of this effect on kids' education, right? But for older adults, this is the paradox, opposite end of the spectrum.

We look at, you know, two people could have the same hearing loss. John Smith, who's 12, and John Smith who's 82. John Smith, who's 12, we would say, here's what we're gonna do, here's the plan, we're gonna put you on an IEP, we're gonna make sure you have the right access. You know, we we are focused and laser focused on helping you with the outcomes we know. With older adults, same hearing loss, same world around you. We look at them and we say, Hey, if you want to get a hearing aid, that might be a good option, but you know.

Nicholas Reed (36:04.517)
Everyone your age has hearing loss, so it's up to you. And this is because we we're only scratching the surface of, you know, what happens if you have hearing loss, what happens if you address it, and then how to address it in the older population. And so leader leaders in public health are just now transferring sort of their vision, right? This this weird sort of allied health field that that sort of sets the bar for how to really create a national screening program.

You you can't just the newborn hearing screening program is actually this just amazing sort of example of public health in action. the world or the whole world has adopted it. But for older adults, you know, we don't have the fundamental questions asked and so it becomes so sort of nebulous. And this is why when you say like, Hey, when should I get on hearing tested? We don't know. We we don't know at all.

Dr. Terry (36:52.933)
You know, just yesterday I had an ex-Games athlete, so I do a lot of extreme sports. He's in his 20s, he's had over 20 concussions. I had a D1 football player, a lineman, he's had over 12. All in their late 20s and 30s, and I asked each one of them, have you ever had a hearing test, because I knew you were coming on, and have you ever thought of wearing hearing aids? Both of them, before I even finished my sentence, hearing aids are for old people.

Is hearing, age, or hearing, or this type of thought process, is it the missing link to longevity, which is a hot term right now?

Nicholas Reed (37:33.266)
Yeah, I mean I I would say yes and no in some ways. So one, there is a deep stigma around hearing loss and hearing aids, right? And I mean literally, we we don't we don't do ourselves any favors, right? You look at like like Google search like a New York Times article on hearing loss and you'll find some beige bulky hearing aid, right? It's it it's like something from the eighties, like it looks awful.

You know, that's one of the hearing aid companies actually recently started a campaign just to provide free high-res images of modern hearing aids to the media just to stop doing that. But you know, we also like we mock it, right? If you think about television programs and someone has hearing loss, you know, very rarely up until recently, there's been some really fantastic examples now where I think disability inclusivity has changed as a society. And you see movies with kids with hearing loss, for example, where

Hearing loss is not their focus. They're just a character in the movie, right? But you see older adults in sitcoms from the 70s and 80s, and I can't hear, and they make a joke out of it constantly. And you know, it it it does sort of create more stigma. And so that's been perpetuated. And I think I think it is problematic. And I think part of this also is, you know, we have now a line of research focusing on hearing loss and healthy aging outcomes to your point of longevity, right? Social isolation, cognitive decline.

Dementia, right? But we still are sort of nebulous on whether treating hearing aids prevent any of those. And that's probably though a bigger question of you know the most recent research, the pointer trial in the United States and the fingers trial in Europe and around the world, they really tell us the only non-pharmacologic things that prevent hearing loss are more comprehensive lifestyle p you know, solutions, which are, you know, diet, exercise, socialization, brain games.

Right, and guided by a coach. They're sort of they're sort of reframing the concept of, you know, all of these things can be individually associated with dementia, but the thing that really delays and prevents it is when you take a comprehensive lifestyle approach because you don't know, you know, when you see population level data and you see coffee increases your risk by 46% of hypertension, you don't know if that's true for you. You as a as an N of one, your risk is zero.

Nicholas Reed (39:53.052)
Or 100% of that outcome. There is no in-between for you. And so even physicians, even the smartest people in the world who think who do not do a good job of, hey, that number was statistical at a population and is a mean and does not translate down to my individual experience necessarily. It may increase my risk, but I don't know which is true of where I'll go with it. And so when I think of hearing care and longevity and the way you put it,

My personal sort of thought process is hearing care, you know, our sensory input is vital to our brain, right? The brain is sitting there and it wants it to interact with the world. And the only way it can is through proprioception, olfaction, vision, hearing, and hearing never turns off. You can't turn it off. You can't, you know, you can ignore things, but you can't turn it off. you could stop your smell, you could close your eyes, you could not touch things, but hearing is is constant.

When we think about the brain, that input is vital to then creating our interaction with the world around us. And so sometimes we we talk about dementia as hits on the brain, right? And we'll use dementia as the big one. Cardiovascular, hit to the brain, right? You're not getting as much blood flow, you're not getting the oxygen, you're not getting what need. APOE and other genetic markers, Alzheimer's, hit to the brain, right? Lewy body, hit to the brain. So two hits.

Sensory loss broadly could be defined as a third hit because it's independent of the two of them and is vital to your brain stimulation. Right. And so where I think it fits into longevity though is not necessarily treating each of those individually and saying, Hey, that's the key. But hearing care, for example, is a bridge to wellness comprehensiveness, right? You treat your hearing.

You can interact with the world a little bit more better around you, right? And we're talking about age-related hearing loss, not congenital losses with sign language and ASL or anything like that. We're talking about age-related loss. You get back that communication. You get back your social, your loneliness. It helps with mental health and depression. It helps with falls. It starts to help with your interactions with your doctors because you have patient provider communication that's vital to exchanging information. And so you become a better consumer of your healthcare. You're more involved in your preventative care.

Nicholas Reed (42:08.197)
And eventually down the road, right, that gets to the brain. Right. Like the all of these things are good for the brain. We're not sure exactly where for any given individual the best spot is. But you I can confidently say that hearing care is a bridge to all of those. And so I think of it like that, right? If that makes sense.

Dr. Spencer Baron (42:27.937)
Doctor Nick, let me ask you a a quick question and then I got a more extended question for you. how do you test an infant their hearing? They can't say, I hear that you know.

Nicholas Reed (42:34.585)
yeah. No, they're very they're very good. You know, there's a there's like hilarious pictures in auditory textbooks of the startle response was one way to do it before. We don't do that anymore. We don't do this anymore. But I'm thinking back to like there's literal pictures of these like beacons of the field with like a cigarette in their mouth in the nineteen forties and fifties, like testing kids like with startle. now we're much more sophisticated. We use two methods.

Dr. Terry (42:37.898)
Hahaha!

Nicholas Reed (43:03.053)
one is called autoacoustic emissions. It's quite literally measuring basically the echo in your ear of the action potential, which is like like literally it's the the cochlea sending that signal to the brain creates a noise and we can measure the that noise basically. So a healthy ear is responding to sound and essentially we're measuring this idea of it it's it's working, right? it's it's like

It would be kind of like, you know, those mechanics who can hear a motor and they know what's wrong with it instantly. It's very similar to like this idea. So that's the first pass. However, a lot of kids, when you're born, you have a lot of gunk in your ear. quite, you know, we're talking about we're we're we do this test within 24 hours of birth, right? 48 hours, right, before they leave the hospital. and if you know anything about hospital discharge in children, it they are trying to get you out of there as soon as you're ready, right? So we do it fast while they're at the hospital.

Dr. Spencer Baron (43:32.257)
Yeah. Yeah.

Nicholas Reed (43:56.806)
If they fail that, we do something called the auditory brainstem response. We can play signals and then we measure the electrophysiologic response of getting just past the cochlea to your brainstem. So we can do that when you're asleep. We can do that when you're awake. You know, again, hearing never turns off. We can just sort of test that. So they're pure objective measures. we can do them on children. The hardest thing is keeping the the child just still long enough to do the test and and not interfere.

Dr. Spencer Baron (44:07.724)
That's great.

Dr. Spencer Baron (44:24.193)
Woo, thanks for that answer. That was very, very interesting. You mentioned gunk in the ear. We there was several years ago we would do physical exams on hundreds of like Optimus Clubs, you know, students and kids that were getting ready to play football or baseball and they had to pass a physical exam. So w one of our guys, we would get together a team of doctors, and one of our guys would be have an otoscope and would chuars. There have been countless times.

That we have seen I no this is not a joke. We've seen insects whacked wa insects dead and waxed in the ear. And the this one time we brought the parent over to s to mention it. Listen, y you know, this is there's a problem here. They were just about to list the kid as having a disability, a learning disability. And it was just because it's

Ear was cl the other ear was clogged, but this one had a bug in it. There we found we found twigs and and other little

Dr. Terry (45:24.475)
That's because you live in a floor there where there's bugs everywhere. We don't have this stuff out here. That's true. That's Utah now, but yeah, that's true.

Nicholas Reed (45:28.711)
Yeah.

Dr. Spencer Baron (45:31.894)
Maybe you got ashes from all the fires. Hello. Yeah. And Canada now, but a anyway. So the more the more involved question I had for you that I thought would really be cool to find out is a bit you know, you've published a lot of you know, you know, research connecting hearing with things like most people never would associate with their ears. Can you t tell us a little bit more about some of that cool stuff that most people would never suspect?

Nicholas Reed (45:59.272)
Yeah, yeah. so the the team at you I'll call it the Johns Hopkins team. we eventually became called the Cochlear Center for Hearing and Public Health. even before I got there, the the sort of director and founder of the group, Franklin, started down this pathway of let's look at hearing loss and cognition, right? Cognitive decline, right, among older adults. And in a way it's not new.

Right. Weird thing is is there's there's this article in like nineteen eighty-nine in JAMA, like you know, top of the line medical journal saying that adults with dementia have worse hearing when we do matched, you know, case control analysis to people without dementia. and then it sort of goes silent. the mainstream, you know, medical journal media, health journal media does not really publish or anything, right? The academic journals, we don't see much.

I will say audiology has sort of always had a niche journal area that's thinking about the intersection of cognition and hearing loss. And so it wasn't completely unaware to them, but they weren't thinking about it the same way. And so then in in around 2010-2011, Frank comes out with some papers. this is a few years before I joined his team, and it shows that adults with hearing loss have a higher risk of incident dementia, right? So,

You know, he publishes this paper that that really opens some eyes, actually, because it it it throws some really big numbers actually out there. Like severe hearing loss is associated with five times the risk of dementia over a 16-year period of for older adults. and then we start to refine these though. And what we see is, you know, it's closer to moderate hearing loss. So getting into, you know, probably you need hearing aids range, right? Moderate hearing loss, mild hearing losses.

You probably could help your you you probably could overcome your hearing loss in a quiet setting with mild loss. but if there's other, you know, deep noise or something, it becomes really hard. Moderate though is even in a quiet setting, you know, you're you're struggling. you see about a 60% increased risk of dementia for that group. and so, you know, that's that's a lot smaller than 500% higher risk that we saw in the early studies. But what we see is a series of these studies that sort of repeat the same style and

Nicholas Reed (48:12.465)
That 60% starts to be something that's found across lots of different cohort studies. We also find higher and faster rates of cognitive decline on repeated tests. And a key thing there is early on, people were saying, well, you know, correlation is not causation, and people with hearing loss, they can't do cognitive tests because they, you know, it requires speaking. So we have papers showing that you can give everyone all the instructions, orally and written, and then do a task.

there's a task called digit symbol substitution where you quite literally have a decoding task, right? You have little symbols that are assigned to numbers and you have to just quickly decode as fast as you can. It's a cognitive processing test. No oral exchange of information. Versus something like a test where we do ask you questions and it requires oral exchange. And yes, on both of them, people with hearing loss decline at faster rates relative to people without hearing loss, independent of other risk factors.

However, the rate, as you can imagine, is faster on the oral test. So there is an effect of the test, but we still see it even when we remove that effect. And so the literature has sort of culminated around, yeah, there seems to be a pretty consistent effect at the population level for hearing loss being associated with cognitive decline. and then we've done papers that are look more deeply at physical activity, right? You start to walk slower as you have hearing loss, right? And that may be your balance.

Your sit your balance organ is connected to your your auditory organ. And so maybe there's a little bit there that we haven't been able to really measure in the studies, but also you're listening to the world around you all the time, right? That's how that's that's a that is like a evolutionary system for us, right? We are we are keened into what we cannot see for risks, right? And when you're walking, you're thinking about those risks of what's around you, right? You're listening if you're on the streets of New York City where I am, you're listening to what's happening behind you, what's happening beside you.

Other people, if someone's running up, you know, you need to get out of the way. so it's quite literally important. So we see they start to slow, their physical activity declines, they have higher risks of falls. And then, you know, one of my deep my two deeper areas are we see strong associations with social isolation, which social isolation by some accounts is actually the largest expenditure for Medicare. It's got one of the highest, deepest relationships with, you know, dementia.

Nicholas Reed (50:32.477)
We are not meant to be socially isolated creatures. there's even work that shows independent of physical activity. Adults who are socially isolated have biologic changes to their inflammatory systems. and then this patient right communication thing I mentioned. I've done a deep body of literature that shows adults with hearing loss, independent of anything else, spend more on their health care, are more likely to have higher rates of hospitalization.

Higher risk of being readmitted within 30 days for the same thing, longer hospital stays by 2.5 days on average, but also are just less satisfied with healthcare and are more likely to sort of lose their primary care physician for no other reason and not seek care when they need it. And we actually have done some work that shows it's it has nothing to do with their own sort of attitudes and beliefs. If you ask older adults, you know, do you keep it to yourself when you feel sick?

No difference from anyone else when it comes to hearing loss. But if you ask that same cohort the s the question, do you go to the doctor when you feel sick? Or do you delay seeing the doctor when you feel sick? They're much more likely to say, no, they don't go to the doctor, and yes, they delay seeing the doctor. meaning that there's something about the healthcare system where they're losing faith. And it's probably patient writer communication. And this is a huge sort of I I think, you know, not to not to use sort of a disability insensitive term, but this is a blind spot.

To our system. When we talk about patient provider communication as key to healthcare, we often are talking about the jargon we use, right? The the actual vocabulary we use. But what about just access to communication via hearing loss? We have ignored that almost completely. Right? So so along this spectrum, hearing can relate to so many different areas of healthy aging. The dementia one gets the most attention.

Dr. Spencer Baron (52:23.159)
I gotta get hearing aids.

Nicholas Reed (52:24.307)
But you know, actually to your to your point, we've done trials, randomized control trials, thousand-person, and we've looked at whether or not hearing aids delay cognitive decline. And in a thousand-person clinical trial over three years, best practice hearing care actually is not associated with a difference. But there's a really interesting sub-finding in that trial that a high-risk group, meaning a less healthy group of volunteers,

Dr. Terry (52:24.824)
Hahaha!

Nicholas Reed (52:51.181)
who were actually recruited from a very different source population. they had been in a an epidemiology of aging study for almost 30 years already before they joined the trial. And they came in with worse cognitive scores, more likely to have cardiovascular disease, much poorer education levels, so they're very high risk for cognitive decline. They see over three years a 48% reduction in cognitive decline. Does that mean that you have to be high risk to benefit from hearing aids? Absolutely not.

What it probably is telling us is that most trials of older adults suffer from healthy volunteer effects, meaning all these re who who's gonna join a trial in their seventies, right? Not people who are gonna get dementia, right? They are wealthy, they have the network, they have the connections to do it. And so when we recruited de novo from the community, that group doesn't change over three years because cognition changes slow and insidiously. Whereas the other group, we seem to measure some effect. And, you know, we have to we have to treat science as as sort of the truth.

The overall study is null, right? So it it you know, but there is this interesting signal that yes, hearing care could help, but again, it goes back to that it's a bridge of other things. It was actually the social isolation measures that we had in the same study that seemed to mediate, be the mechanism that's what's affecting their cognitive decline, because we saw huge effects on hearing care and social isolation, right? Your social network became it was less likely to decline. You were more embedded in your community, you were doing more activities and more diverse people you were talking to.

Dr. Terry (54:18.672)
Hey Doc, instead of, for our listeners, instead of being this, which we are, we're a society of reactive instead of proactive. How do we train our brain to listen better?

Nicholas Reed (54:30.339)
you know, so I am I'm like a cowboy audiologist in this sense that there are a lot of apps out there that do all these cool things, like put you into different scenarios. I still tell people the same thing. Go home, put on a your T V on the news and put on the radio behind you on a different news station. Play the T V a little bit louder, the radio a little bit softer, and start with that scenario and try to focus on the TV.

Then I want you to turn the TV down below the radio a little bit or closer to that signal. You have a visual enhancement though with the TV, right? And so you should be able to get some of it. Focus on this, train your brain through that scenario. Then I want you to turn around and start trying to focus on what the radio is saying, right? Because now you took away the visual and play with the sound. You can do it yourself. It's just putting yourself through the same rehabilitative thing we do in, you know, your world with chiropractic and physical therapy, but it's doing it for your brain, right? For for brain and auditory processing.

Dr. Spencer Baron (55:14.231)
That's cool.

Nicholas Reed (55:25.883)
And the truth is, you're never gonna like, just like with cognitive games, you're not gonna change your cognitive trajectory, right? But you certainly are gonna train yourself to dealing with those tough situations, right? and this this will this will not change your auditory trajectory, but it'll certainly help you overcome some of the effects of hearing loss. And if you get hearing aids, to me, this is key to doing those activities with hearing aids, because you have to now retrain your brain to use hearing aids because they are not corrective like glasses.

They are AIDS in the true sense that you may still be off somewhere, right? We didn't actually correct anything. It's still a deficit in the system.

Dr. Spencer Baron (56:04.245)
That's a cool cool plan there. Thanks. I actually would like as as a kid, I would like to turn down the T I or I would watch the Spanish speaking stations turn that off or or try to figure out what they're saying without really listening to them because you don't know. So you you really tap into their physiology. Go ahead, Terry.

Dr. Terry (56:05.346)
That was a cool exercise. So what's...

Nicholas Reed (56:08.369)
Easy stuff. Yeah.

Dr. Terry (56:24.452)
That's a great

Nicholas Reed (56:27.827)
That's cool.

Dr. Terry (56:28.994)
So for all the physicians and all the people listening to our show around the world, what's the one thing, because I think hearing, I just been reminiscing the whole time we've been talking and when Spencer talked about the childhood hearing test, I remember the big van pulling up in front of the car and us all walking into the van and getting our hearing tested and I don't see that anymore. I not to get on a weird subject, but I think we care more about what gender we are than if we can hear. So what are,

Dr. Spencer Baron (56:56.565)
Yeah.

Dr. Terry (56:59.468)
some things you want these physicians because unfortunately some physicians get stuck in the past they haven't changed the way they've been treated since the seventies or eighties what are some things we want to tell teach our physicians our therapists all that to really think about hearing and so we can move it from a truck that pulls up to a marker of vitality of longevity what's some things you want physicians that know

Nicholas Reed (57:27.155)
I mean, I think for for that perspective, it's it's reframing their attitudes towards hearing loss, right? Like like we need to get rid of this thing where it's like, well, you know, our perception of hearing loss is sort of this cert like it's certainly gonna happen, right? It's a it's a concept of aging, right? Everybody sort of gets it, but hey, it's normal for your age and it's relatively benign. Get hearing aids if you want, right? I think instead it's more important to we

We have to find a happy middle middle ground here because there's some people that are quite literally out there and saying, you need to get hearing aids or you will get dementia. And I would say to that, malarkey. There is almost no chance that hearing loss is the single thing for any person with dementia. Right. At the population level, sure, right? We see an association, but that's population statistics. and that's just scare tactics and that's ethically wrong. But I think if we help physicians get to this point though of realizing

Hearing loss is something that bridges us to so many healthy aging sort of areas. And it's not any one thing, right? It's not cognition, it's not social isolation, it's not false. It's all of them and the chance to make a small difference in all of those areas that does put us more naturally in line with the best practices of comprehensive interventions, right? For aging. And I think just changing that attitude towards, hey, it's not about scare tactics.

And it's not about ignoring it because everybody has it. There is a happy middle ground that sensory input is vital to the brain for sort of comprehensive lifestyle approaches. That awareness would change the entire paradigm in some ways because then we may get real screening for hearing loss instead of, you know, right now the compliance with Medicare for your your annual visit, which has hearing on it, is hey, do you have hearing loss or not? And everybody says no. Why why are why are they even thinking about that at their primary care physician, right? Or

They do this, they rub their fingers next to your ear, and that's completely uncalibrated, completely unstandardized. Who knows what that's detecting? Right. And so I think changing attitudes will eventually change sort of actual standardization of testing, actual standardization of screening. But it does start with that sort of motivation and understanding, you know, if we're if we're thinking about COM B health behavior change, we really have to start at the basic level of in informational change exchanges.

Dr. Terry (59:44.154)
I have one more question before I go into you, Spence. You mentioned AI and hearing aids. Where do you see hearing aids in the next one to two years, how different they're gonna be with the introduction of AI?

Nicholas Reed (59:57.62)
You know, I was doing Doctor's Radio on Sirius XM the other day, literally yesterday before this recording, and somebody called in and they were like, How do I tell when technology is really improving, right? Because everyone's gaming the system, just like with cars, right? What's a real generational change versus just, you know, an incremental change, right? What's a real feature? And the truth is we don't know anymore. We've hit a point where every quarter something's being released that is is actually a huge deal. I remember

Two years ago, about a year and a half ago now, I was at one of the manufacturers' headquarters and they gave me a sneak peek of some of the first AI hearing aids. And I I literally was like, this is gonna change the entire field. I've they they played a background noise so loud that I couldn't hear normally, a person two feet away from me. And then they activated and turned on those AI hearing aids, and I could hear this person perfectly clear walking around me in a circle, despite like, you know, my normal hearing. So

It will fundamentally change things. However, I actually would put some caution on putting too much faith in the AI system right now. Because like I said, your br it can't replace your brain and it's making decisions. And so just like if you use AI to do a research paper, somebody who knows what they're doing, you know, in the academic space will spot the hallucination, right? And say that's not real, right? The AI is still hallucinating in some sense in its ability to process things, right? So

I think maybe a classic way to sort of show this is there's I think five manufacturers now that have released an AI hearing aid. There's sort of a startup out there that keeps putting out papers saying, look at ours, it's better than all the other ones. And then one of this one of the researchers came along at a conference recently from one of the manufacturers and showed you could manipulate the test setting and make any of the five look like the best and any of the five look like the worst because it's all about what the AI was trained on, right?

And how they've set it up ahead of time. So it's a really tough sort of tech space to navigate right now. But I do think, you know, to your point, in two years, I mean, we're moving so rapidly. We are collecting data on the back end. We're constantly changing the algorithms. We we may even see, for example, like a real thing I see on the horizon is low-grade infrared cameras built into the hearing aids. Because could you imagine what we could do if we had visual input as well as auditory input? And then the AI can say this is where.

Nicholas Reed (01:02:19.527)
The sound is coming from. This is the echo. And Apple quite literally has in their next prototype, the next version of the AirPods, a low-grade camera on there. And the only reason I can suspect that it's there, and this is pure speculation, right? And others would say this in the field too. I've seen a few articles on this, is that it will help add visual information to the auditory information. Now there's also that it could, you know, take the the place of like Google Glasses, like it could add, you know, context, read things for you. There's disability services.

But Apple has a hearing aid, right? They have a a you know FDA approved hearing aid. If you can turn it on in your AirPods, you know, it's part of their ecosystem and their their wellness and health plan. And I I see those kinds of things being where we go and that again, that fundamentally shifts hearing care from it's all about audibility to all about clarity.

Dr. Spencer Baron (01:03:11.873)
Come a long way from the Sony Walkman, huh?

Nicholas Reed (01:03:14.075)
Yeah. Yeah. No longer you know, a little bump in the road shuts off your stereo.

Dr. Spencer Baron (01:03:19.169)
Right. Right. Well, it's fascinating. My kid bought me Bose the little Bose sound system that I can listen to music when I train and the background music is so loud that if I put my finger on the the earbud, it shuts out the background music and you can hear yours crystal clear it's fascinating. Anyway, we're gonna jump into our rapid fire questions, which could be a challenge for you 'cause your answers are very, very, very well said, but this is

Nicholas Reed (01:03:47.528)
I'm a I'm an academic through and through, I'm sorry. Even even now I I work in corporate now and like those guys wanna murder me for my answers because corporate people do they do not want a two minute, three minute answer.

Dr. Terry (01:03:47.532)
You

Dr. Spencer Baron (01:03:49.449)
R no, it's it's fantastic. They're really interesting.

Dr. Spencer Baron (01:03:56.982)
Dr. Spencer Baron (01:04:00.384)
All right, here we go. It's question number one if you're ready, Doc. Here it is. What's one hearing myth you wish would disappear forever?

Nicholas Reed (01:04:12.199)
That age related hearing loss is benign.

Dr. Spencer Baron (01:04:14.893)
Nice. you're doing well. All right. Question number two. Yeah, right, right. This is we're we're talking in sound bites now. All right. So question number two. What's one sound everyone should protect but rarely thinks about?

Nicholas Reed (01:04:16.723)
Yeah.

Dr. Terry (01:04:17.488)
The corporate world's got to him.

Nicholas Reed (01:04:33.639)
Ooh.

One sound, everyone should protect that really thinks about Ooh, lawn mower and like lawn equipment.

Dr. Spencer Baron (01:04:44.747)
No kidding. Especially those blowers. Question number three, what is your favorite personal ear therapy?

Nicholas Reed (01:04:44.861)
Super loud.

Nicholas Reed (01:04:55.623)
Ooh. my personal ear therapy? Ooh, interesting.

Dr. Spencer Baron (01:04:59.541)
And don't say c and don't say q tip or ear swap.

Nicholas Reed (01:05:02.753)
no, no, no, no, no. God, no. We don't we don't we don't put we don't put stuff in our ears, everyone listening. if it's smaller than your elbow, don't touch your ear with it. personal favorite ear therapy for me, probably like I was describing before, that idea of challenging myself with background noise and focusing. I live in a loud area, I have little kids. It does sort of help me deal with my own issues with listening and background noise.

Dr. Spencer Baron (01:05:30.145)
Very, very good. After everything that you've learned, you know, what's what's something you hear differently today? Not with your ears, but with your whole life.

Nicholas Reed (01:05:42.715)
I think I think now when you hear people come to the clinic and say, I get tired faster, right? That's the reflection of your brain is working over time for those clarity issues. And it's I've totally rethought the way we think of it when we think about how hearing is related to cognition.

Dr. Spencer Baron (01:06:03.265)
That is very cool. Interesting. Didn't think about that. All right, last question. Question number five. So far, you're doing really well. Four out of five. Here we go. Thirty years from now, one of your grandchildren listened to this podcast and asked a friend or colleague, what did grandpa actually change? What would what would you hope they would say?

Nicholas Reed (01:06:29.393)
Ooh. man. I hope our work eventually leads to a true public health sort of age related screening program.

Dr. Spencer Baron (01:06:39.403)
And that was beautiful ending. Thanks, Doctor Nicholas Reed, for being on the show. This is something we've been always fascinated about and curious, especially not just the aging population, but at any age. Thanks for being on the show.

Nicholas Reed (01:06:52.958)
Thanks for having me, guys.