Hearing Loss, Tinnitus, & Hyperacusis: Treat Your Hearing, Protect Your Brain with Dr. Keith Darrow | E55

A “mild” hearing loss sounds harmless until you hear the data: it can raise the risk of cognitive decline and dementia by 200%. I sit down with Dr. Keith Darrow PhD, CCC-A, neuroscientist and clinical audiologist, to connect the dots between hearing loss and brain health and to explain why treating hearing loss shows up again and again as a top modifiable dementia risk factor in major research reviews.

We also get practical about what good care actually looks like. Dr. Darrow breaks down why so many people struggle with speech in background noise, why basic beep-only tests can miss real problems, and how prescription-grade hearing aids differ from over-the-counter devices when you care about outcomes like cognitive performance, fall risk, and tinnitus relief. If you or a loved one has ever seemed “withdrawn” or “down,” we talk through how hearing loss can mimic depression and early cognitive decline and why a thorough evaluation can clarify what’s really going on.

If you’re navigating concussion recovery or traumatic brain injury, this conversation gets even more relevant. We cover extended high-frequency hearing loss after TBI, tinnitus as a neurologic “phantom sound,” anxiety and sleep disruption, and hyperacusis (sound sensitivity) plus how gradual sound exposure can rebuild tolerance. We also touch on emerging tinnitus research, including where transcranial magnetic stimulation stands today.

If this helped you, subscribe for more evidence-based concussion and brain health conversations, share it with someone who keeps saying “I hear fine,” and leave a review so more people can find the show. 

Dr. Keith Darrow's Resources and Links:

https://mytinnitusnumber.org/

https://excellenceinaudiology.org/

Free Book: Preventing Decline

Free Book: Silenced. The Medical Treatment of Tinnitus

Dr. Darrow's YouTube Channel

Dr. Darrow LinkedIn

Save $30 on Brain Ritual - A daily brain energy-support drink like none other. https://www.brainritual.com/AYLA94359

Concussion Breakthrough: Discover the Missing Pieces of Concussion Recovery is now available on Amazon!

Follow us on YouTube & Instagram @lifeafterimpact

Website: lifeafterimpact.com

Medical disclaimer: this video or podcast is for general informational purposes only, and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment. Consumers of this information should seek the advice of a medical professional for any and all health related issues. 

Transcript

Dr. Keith Darrow 0:38

Ultimately, what we now know is that a mild hearing loss, and that's a common word that's used in our language, a mild hearing loss is a major problem because even a mild hearing loss can increase your risk of cognitive decline and dementia by 200%.

Dr. Ayla Wolf 0:58

Welcome to Life After Impact, the Concussion Recovery Podcast. I'm Dr. Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating, and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information, whether you're dealing with a recent concussion, struggling with post-concussion syndrome, or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing, treatments, and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology, and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless, or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Dr. Keith Darrow is a neuroscientist, clinical audiologist, and one of America's leading experts on hearing loss, tinnitus, and brain health. He is the author of multiple best-selling books, including Preventing Decline and Tinnitus is Treatable, and is passionate about helping patients understand that hearing loss and tinnitus are medical issues that can affect cognition, balance, quality of life, and long-term brain health. Dr. Darrow is also the creator of my tinnitusnumber.org, a resource designed to help people better understand and measure the impact of tinnitus and excellence inaudiology.org, a national network connecting patients with hearing care providers committed to higher standards of evidence-based care. Enjoy this episode with Dr. Darrow. Dr. Keith Darrow, welcome to Life After Impact. It's so good to see you. Hey, thank you so much for having me on here, Dr. Wolf. Yes, you have done so much to help inform everybody in the world about the importance of hearing. And so many of my patients have had one or more concussions. And after we get them through the acute phase of recovery, oftentimes the next concern and question becomes Am I at at risk for cognitive decline? You know, what are things I can do to preserve my brain health, preserve brain function? And so people, I think these days really are worried about dementia and Alzheimer's and how can we maintain our quality of life and our quality of cognition as we age. Am I allowed to jump in? Sorry. Yes, go for it. Go for it.

Dr. Keith Darrow 3:42

You know, it's one of those things where, and I'm sure I'm not alone with this, but I have a I have a vision of when I was growing up, and I remember like the older adults, the, you know, the older aunts and uncles, the grandparents, they like I specifically remember the infamous house dress, right? So if you were like 75, it's like, and I only look back now and I'm like, you know, did somebody relegate you to the home where you're not allowed to leave? It's just, it's so weird. The lifestyle was so different. And now, fast forward only 30, 40 years, I say this and I say it seriously. My mother, who would kill me if she knew I said this, who's almost 80, has a way more active social life than I do. So our are that this generation, this great generation between 60 and 90, they are just they're so active, they're so independent, and they want to stay there. And they know from from their parents or their grandparents that the the worst thing you can do is start to be idle. And they fear about losing their independence. They lose, you know, that that sense of losing dignity, that sense of losing their mind, frankly. So it's a really big concern, and it's just so different now than it ever was.

Hearing Loss And Dementia Risk

Dr. Ayla Wolf 5:06

Yeah. I mean, I love when I have patients come in in their 70s and they're downhill skiing and kayaking and biking and traveling. This is awesome. I love this. Okay, so talk to me about, let's start, let's just start with the research. I mean, you know, these days you hear headlines, you hear clips of things, but you you actually have spent your entire life really looking at what does the research say on the link between hearing loss as a risk factor for dementia or cognitive issues. Let's maybe start there.

Dr. Keith Darrow 5:38

Yeah, so so I'm I promise not to bore anybody with a history lesson, but this has been around this notion of hearing and brain function. The first publication that I can find, maybe there's something earlier, was 1949. Now I'm not great at math, but that was a long time ago. So we've been, there's been hints that hearing has something to do with the brain. And then you fast forward, there was research in the 60s. There was actually an amazing paper that came out in the 80s. And it it almost pains me to think that we could have been addressing this a long time ago, because a paper in the 80s said it was an observational study that basically said, look, we have all these people that have moderate hearing loss or worse, and they seem to be much higher rates of dementia. And then if you sort of fast forward through time, the last decade has really been the revolution wherein we've we've discovered two things. Well, there's been more than two, but the two big takeaway points are untreated hearing loss. So if you live with hearing loss, which is one of those sort of guarantees in life, I often joke and say, you know, death taxes and hearing loss, those are the three guarantees of life. Um untreated hearing loss significantly increases your risk of cognitive decline and dementia. It's not a guarantee. I'm not, I'm not even suggesting it absolutely causes it. We fully know the mechanism. It just increases the risk. So that's on one side of the coin. The other side of the coin that this has really been emerging over the last five years, is we now see treating hearing loss as one of the most important things you can do to reduce your risk of dementia. And as a matter of fact, um, Lancet is a world-renowned journal, one of the oldest peer-reviewed journals out there. They've published three times. They have like a um a dementia paper they put out every few years. There's there's anywhere from 50 to 100 different scientists that take part in it. And three times, 2017, 2020, and 2024, they've published a list of lifestyle factors. So not your genetics, your lifestyle factors, the things you do every day that can alter your risk of dementia. And at the top of that list, number one of the 14 things on the list is to treat your hearing loss. And they advocate for early treatment, midlife treatment of hearing loss. And they say it's the number one thing you can do to reduce your risk of cognitive decline and dementia.

Why People Ignore Mild Hearing Loss

Dr. Ayla Wolf 8:19

And since I have been following you for a while now, I will say I have so many patients that come in and they say, Well, I've been told I have a little bit of hearing loss and they're not treating it. And I get on them about that because it's the same people that don't want to get dementia that are saying, and I know I have hearing loss and I am not treating it. And so can you just talk about maybe why? I mean, I think you have said the statistic that only 20% of people are actually treating their hearing loss. So 80% of people have it and maybe know about it and aren't doing anything about it. So let's talk about what are these barriers? Why are people not treating it?

Dr. Keith Darrow 8:58

Well, somebody told me once I'm never supposed to correct the host, but it's actually 10%. Okay. Which is really incorrect me. Right. Honestly, if you looked up, if you went and did a deep dive in the literature, you would see numbers that do vary. Um, and there was a point where I was saying 20%, but a study came out just a few years ago that I think was really the big wake-up call that said, in the United States at least, 73 million people with demonstrable, you know, measurable hearing loss and less than 10% are doing anything about it. Right. So that's a that's a really scary number. You know, I if people are watching this and not listening, they saw I had a big smile, maybe it was a smirk, I don't know which one, but you said something like a patient says, Oh, I only have a little bit of hearing loss. And you know, Ayla, I would love if you turned to that patient and said, What would you do if your doctor said you have a little bit of cancer? What would you do if your doctor said you had a little bit of heart disease and you're only going to have a little bit of a stroke? You've got a little bit of diabetes, a little bit of Parkinson's, right? So I I I hear that a lot. So you're certainly not alone. And and the patients, you know, it's one of those things, chicken egg, it's is it really even about blame? Does it even matter? Because ultimately, what we now know is that a mild hearing loss, and that's a common word that's used in our language, a mild hearing loss is a major problem because even a mild hearing loss can increase your risk of cognitive decline and dementia by 200%. So there's nothing little about that hearing loss.

Prescription Hearing Aids Versus OTC

Dr. Ayla Wolf 10:48

And I think we really need a mindset shift around, I feel like in medicine there's this attitude of, well, as people age, there's an allowable amount of cognitive decline. There's an allowable amount of hearing loss, there's an allowable amount of a decrease in balance. And there's kind of this, let's just sit back and let people get old. And I mean, I prefer optimization, right? Throughout my entire life. Like I'm going for gold here and I want that from my patients. And so I think what we really, it sounds like what we really need just globally is that mindset shift of this is treatable. And by treating it, it's gonna do so much for you. Like if it's number one at the top of the list of modify modifiable factors that we have control over. So maybe talk a little bit. Okay, eventually we're gonna talk about tinnitus and we're gonna talk about hyperacusis, but talk to me about the difference between hearing aids. What has what has evolved in the hearing aid world? I've had people in their uh 40s that have practically invisible little teeny tiny hearing aids that I didn't even know were there until they pointed them out to me.

Testing That Finds Real Problems

Dr. Keith Darrow 12:52

So, you know, I've often, and you have to be a certain age to understand this, but I've often likened hearing aids to the 31 flavors at Carvel ice cream, right? Just because you've seen a hearing aid, like no hearing aid is alike, and it's it's one of those things where we're in an age where access is basically unlimited. You could buy a hearing aid, and and the government, at least our government now recognizes that there is a new category of hearing aids called over-the-counter hearing aids. But for me, I want to pause and reflect and say, hey, wait a second, if there's this over-the-counter category, what does that mean? What's the other category? And that's prescription grade hearing aids. And there is a difference, right? If if you get sick, you may use some over-the-counter to help you get through maybe some pain management, but are you actually addressing the problem, the bacteria or whatever it may be, the virus? So there is a difference. And yes, hearing aids nowadays can be found anywhere, whether it be Amazon, the big box stores, the big blue electronic stores, like just turn on the TV between the hours of 9 a.m. and 1 p.m. in every other commercial, there's a celebrity trying to sell you a hearing aid. But here's my my issue. And and trust me, I'm all for increased access. My issue is there's yet to be a scientifically reviewed, peer-reviewed, evidence-based science research that has shown that an over-the-counter hearing aid has the same medical benefit outcomes as prescription grade hearing aids. And so for me, when we think about the outcomes, we're talking about increased quality of life. That's sort of, I joke with my patients and say that's the low-hanging fruit. That's the easy one because I'm going to make you hear great and life's gonna be good again. But things like improving cognitive performance has been shown in prescription grade hearing aids, reducing the risk of a traumatic fall. And you know this, a fall over the age of 65 can be disastrous. It can permanently alter the trajectory of the next five to 10 years of your life. And and prescription hearing aids can reduce the risk of a fall. Reducing tinnitus, which I know you said we'll get to, it's the number one most effective way to reduce tinnitus. And finally, reducing the risk of cognitive decline and dementia. Now, should all of those benefits someday be found in a widget that you could grab off a shelf, that would be great. But right now, we don't have any evidence for that. And so I firmly believe that hearing aids and hearing health care are not a retail transaction. They need to be part of transformative medical treatment. And here's my analogy that people find maybe a little offensive. But would you go to Costco? And I love Costco, but would you go to Costco and get a colonoscopy? I don't think so, right? So that's where hearing health care has to be. And that's how you have to think about prescription grade hearing health care versus just buying something off a shelf.

Dr. Ayla Wolf 16:22

Okay, so that leads me to my next question, which is I I know that you have a group of clinics that are trained underneath you, excellence in audiology. You have a very specific process by which you're actually testing hearing. And when I was writing my book, I came across a study that said only about 55% of audiology clinics actually test for sound and noise, meaning how does your hearing change when you've got lots of background noise happening? I know that when you say prescription hearing aids, talk about this process of what do you bring a patient through as far as diagnosis? And then what goes into a customized prescription hearing aid different from your over-the-counter uh hearing aid, which is, I don't know, I almost liken it to like a pair of cheater glasses, you know. Exactly.

Dr. Keith Darrow 17:12

Exactly. Which is why I could not go get cheaters, because I would have, you know, I had to go get the right prescription ones. So, so that's an amazing question, and and it that's an interesting stat. Again, I feel like you just keep putting me in this position where I have to correct the hosts, and I don't like doing that. No, but but truly, if you found something that says 55, uh 55%, I'd love to read it because most of the data I've looked at is actually way more disappointing. One of the biggest studies done in audiology found, and and it it truly pains me to even say it in a forum like this, but it says that 85% of audiologists never measure your ability to hear in noise.

Dr. Ayla Wolf 18:02

Okay, well, you can correct me when I come across as the optimist. That's fine.

Dr. Keith Darrow 18:08

And now look, I'm sure there, but but no, seriously, I'm sure there are studies, again, it's one of those things where there's a range, but the most comprehensive study that was done found that about only 15% do speech and noise testing or flip the coin and say 85% don't. Either way, 15, 55, they're both very disappointing numbers because the number one complaint in 99% of all patients isn't I can't hear, it's I struggle to follow a conversation in background noise. And the thing that I find most offensive is that would be like going to the doctor and saying, look, my leg hurts, and all they do is an x-ray of your arm. It's like, didn't did you not listen to me? Like I just told you my my I can't hear a noise. How do you quantify that ability by just having me raise my hand when I hear a beep? It's a wild concept. And so I appreciate you mentioning the Excellence in Audiology Network. We're we're net we're across the nation and international. I think we've approached 260 plus clinic locations, assuming the web guys are keeping up with the numbers, but I know we're above 260 locations, so there's probably one close to you if you're listening. We have a very rigorous, evidence-based, seven-step cognitive screening and diagnostic evaluation. I basically explain it to my patients as we leave no stone unturned. Whatever your complaint may be, and even if you don't necessarily have the complaint, we're still gonna test for it. And I want to highlight a couple of things. Yes, we're gonna test your ability to hear in noise. We're also gonna measure your clarity, because that's what a lot of patients say. You know, I can hear my wife yelling for me from the other room, but I can't understand what she's saying. Or my favorite is, you know, doc, I I can hear you, but let me put my glasses on so I can hear you better, right? Because they're just trying to read my lips and fill in some of the missing pieces. You know, it's not hearing is not a light switch where you can either hear or can't hear. There's that big gray area. So we we measure clarity, we measure your brain's ability to handle words in complex situations. And for me, one of the most important things we do is we do a cognitive screener, FDA-cleared cognitive screener on every adult patient who comes in saying, I can't hear in noise, I'm struggling, or I have tannis. And the reason is because a great study came out published in the Alzheimer's Association Journal just a few years ago, that said if you have a poor ability to follow speech and background noise, you may be 60% more likely to develop dementia in the next 10 years. It may like basically considering it, one of the earliest symptoms of cognitive decline is your inability to hear in noise. And so it's really important. So for our patients, we run them through this FDA-cleared cognitive screener because we wanna understand, let's get a baseline, best case scenario. Maybe there's a red flag or two that comes up, and then we can, you know, sit and speak with you, your loved ones. We're gonna forward the results to your primary care physician who may say, let's do further testing. But if we can catch somebody early in the cognitive impairment process, which is not a guarantee, right? Like normal aging does not have a significant drop-off. You alluded to that. But if we can get somebody early and we can address those modifiable factors like hearing loss, and of course, things like, you know, education, stop smoking, drinking, alcohol, exercise, they're all on the list too. But guess what? Hearing is number one. And so for us, if we do spot something, we we got to address it right now.

Dr. Ayla Wolf 22:13

Yeah, and you you're very quotable. I've listened to a number of your podcasts and interviews, and you say something which is uh obvious, but when you say it, it's like, oh yeah, you said you don't hear with your ears, you hear with your brain. And specifically when we talk about sound and noise, that's a cognitive processing issue. It's not a problem with the external ear. And I think it's important for people to recognize that.

Dr. Keith Darrow 22:38

No, exactly. Like, and and you know, even even, I mean, I have enough gray to be able to say this, but even I was taught that hearing loss is like a uh it's something that happens in the ear. It hearing loss as we get older, it's due to damage in the ear. And so it's like I was, it's like it was, they tried to beat it into me that hearing is an ear thing. And then as I, you know, I ended up leaving clinical practice for about a decade. That's when I went and got my PhD in neuroscience. I was at Harvard Medical School and MIT, and I said, you know what? Hearing's got to be way more than just the ear. And so I studied the brain for nearly a decade, trying to figure out exactly how hearing and the brain interact with each other. And that was really when I have my aha moment of hearing is a brain thing, right? Like listening to a beat, no pain. Patients ever come in and said, I can't hear a beep. They come in and say, I can't hear my grandkids. I can't hear my wife. I can't hear. And think about that social disconnect, that social isolation that comes with hearing loss. Now you've got hearing loss and social isolation, two of the biggest factors that can lead to cognitive decline and maybe yield to dementia.

Dr. Ayla Wolf 24:00

Yeah, absolutely. I mean, I was just at a Christmas gathering this last year, and a family member, I won't name names, uh, they I had already been given a heads up, hey, I think this person's having some hearing loss, but they've gotten really quiet lately. And I absolutely noticed that. They were sitting there, they weren't engaging, they weren't talking, and they looked depressed to me. And it was all because they couldn't hear what was going on and therefore they weren't engaging. And it just, again, in my mind, I'm like, why would you not do something about this?

Dr. Keith Darrow 24:31

And but I think you raise a great point there, which is to a to a lay person or a family member, you're sitting there and you're like, is mom depressed? Is mom you know starting to go down the path of cognitive decline? Does mom have hearing loss? And one of the wild things I always challenge my students to do this, I say, you know, if you were to go and Google symptoms of depression in older adults, and Google early symptoms of cognitive decline, early symptoms of hearing loss in adults, you would see there's about an 80% overlap because they look the same. And I always say, hey, you know which is easiest to diagnose and treat? Hearing loss. And hearing loss impacts emotional health. Hearing loss, or I should say treating hearing loss, impacts cognitive health. And so for the price of one, you might be able to address all three of those concerns. And if not, you know, a good audiologist in the audiology, I'm sorry, Excellence and Audiology Network, we have the ability to also not only screen for cognition, do a full diagnostic test of hearing, but if needed, many of the providers are trained to take out a depression scale and to sit and have a conversation with a patient and say, okay, maybe this is emotional health also. And now we can refer you for that.

Concussion Hearing Changes And High Frequencies

Dr. Ayla Wolf 25:56

Okay, so next question. We often talk about age-related hearing loss, but when people have had concussions and brain injuries, uh, that can that can affect hearing, that can affect the sound and noise as a cognitive processing. Obviously, you injure your brain, you can injure the way your brain processes sound. Many of my patients will say that they ha struggle to interpret conversations, like they can hear the conversation, but then they have trouble actually processing the auditory information. So, how is your process different if somebody has an injury-related change in hearing versus a great point?

Dr. Keith Darrow 26:36

When when proper testing is done, and I think this is what you're getting at, the statistic is pretty black and white. About 60%, 58 if you want to get technically correct, 58% of patients with a history of traumatic brain injury, concussions, have, and and this is this is specific, have high frequency hearing loss. Now that sounds like a lot of you know big words. Maybe you didn't go to school to be an engineer or a hearing scientist. What do I mean by high frequency hearing loss? I'm talking about sounds that are at the upper limit, maybe even above where we speak. And without totally getting into all of the geeky details, when we do a basic hearing test, when you go to a regular audiologist who does maybe two or three tests at most, we do seven, they will test your ability to hear beeps within the range of human speech. Because that's what we were taught in school. Yet we know, and specifically about this concussion related patient, we know that their hearing loss is likely above that range, up in the higher limits of hearing, the higher frequencies, the higher pitches of hearing. And so as soon as that red flag goes off during case history and we sit and discuss it, we know that we have to do this thing. It's called extended high frequency testing. We basically, like I said, we're not going to leave any stone unturned. And that's when we will find in our patients, hey, I do see the damage. And so what that damage I find, what it means to the patient symptomatically is yes, one-on-one conversation without background noise, you probably do great. For the most part, you still hear pretty good when it comes to speech. But I bet you struggle in background noise. Number one, and the patient shakes their head. And I say, I bet you've got some ringing in your ears or in your brain, and they shake their head, yes. And here's the last one. I say, Have you been to a movie lately? And some of them will outright say, No, I can't go to the movies anymore because it's too loud. And so they have you use the fancy word before, hyperacusis, which is a sensitivity to loud sound. So that, and that's part of our rigorous process as we do a whole hyperacousis evaluation on our patients. That's where you see the symptoms of hearing loss. Not, you know, I'm sitting around the table with my spouse, it's just the two of us. Like, you're probably going to do fine there. But even that higher pitch hearing loss has been shown to increase your risk of cognitive decline. Add that on top of all the data we know from patients with TBI that already have a dramatically increased risk of cognitive decline and dementia. It's just, it's like the one-two punch, and no pun intended with the concussion or, you know, but yeah, it's it's a real thing.

Dr. Ayla Wolf 29:43

Well, and I've heard you say that tinnitus and hearing loss are essentially two sides of the same coin because when you lose those higher frequency sounds, the brain just makes up a sound to fill in the gap. And that's the sound that you're hearing when you complain of tinnitus.

Dr. Keith Darrow 30:01

You aren't kidding. You've done your homework. That is exact here. Here's the way I put it to really simplify it. And you, you, I mean, I'm gonna try, but I don't think I'm gonna say it as well as you did. Hearing loss is tenitus. Tinitus is hearing loss. They are the result of the exact same pathological process. And what that is, and we started to get into this before when I was saying, you know, we were taught that hearing loss is an ear problem. No, it's it's not. The problem is the nerves that connect the ear to the brain. It's actually a degenerative disorder. If you really looked it up in like the medical textbook, you would find that hearing loss is a neurologic disorder. Tinitis is a neurologic disorder. And you're right, the words hearing loss, those describe patient symptoms. Tinnitus, tenitus. You're describing the patient's symptoms, but what's actually happening is the brain's lack of input from the ears, the brain will go looking for sound. It will create its own sound. It is truly analogous to Phantom Limb. You lose an arm, and your brain still feels it, senses it. Sometimes it even feels pain in the missing arm.

Dr. Ayla Wolf 31:23

That's a good analogy.

Tinnitus Is Treatable With A Plan

Dr. Keith Darrow 31:25

Yeah, because the brain makes up for the missing input. It's literally the same thing when it comes to ringing in the ears or in the head. The brain is creating the false sense of sound. And a colleague, I'll give full credit, this wasn't my saying. A colleague of mine in Salt Lake City said, so what tinnitus is, is your brain is filling in the neurologic void, the void that has been left from that traumatic brain injury or that noise exposure. The brain is just trying to make up and create its own signal. That's exactly what tinnitus is.

Dr. Ayla Wolf 32:02

So on that note, is there any validity or effectiveness to the types of music therapy where you tell a program, here's the range at which I'm experiencing my tinnitus, and then it creates a soundtrack that somehow factors that in, and you're supposed to listen to that a couple times a day. Are you are you familiar with these types of therapies?

Dr. Keith Darrow 32:24

Yes. I'm not sure if you're trying to get me in trouble.

Dr. Ayla Wolf 32:28

No, I want your honest opinion. I just want your honest opinion.

Dr. Keith Darrow 32:32

So so I'm just I'm just kidding. So look, there's a lot of stuff out there. And and some of it's been completely debunked. That's not one of them. So I'm glad you brought this up. But what I'd rather do is I'd rather put that music therapy into the greater conversation of what do we know effectively works when it comes to tinnitus. Now, there's one myth I feel like we have to dispel here. Maybe it's not a myth. I don't know the right word, but one of the most frustrating things I hear, and you've probably heard it too from patients, is I have tinnitus and I heard there's no cure. I hear that all the time. Yes. And and you know what my response to that is? Now I say it much nicer to patients. Guess what? There's no cure for cancer. There's no cure for diabetes, there's no cure for heart disease. Do you know how few things we've actually cured? Like it's it's infinitesimal the amount of disorders that we've cured in relation to the amount of disorders we can treat. So cure is actually not the standard of today's modern medicine. It's treat. And there are very, very effective treatments for tinnitus that work in 90% of patients. And then I say jokingly to my patient, with that 90% odd of winning, wouldn't you go to Vegas? Right? Wouldn't you let it all ride if you had a 90% chance? And then patients like, okay, now I'm thinking about it differently. I wish somebody didn't depress me and just say, well, there's no cure, live with it. I had a patient once tell me, his doctor said, become friends with your tinnitus. Maybe you should name it and talk to it. Like, and I'm like, I get what he's trying to do. They want you to mentally cope with it, but there are effective ways to drive down the ringing. And so, to your point, musical therapy, I think it's it's part of the conversation. But if you look at the American Academy of Otolaryngology, they have, you know, clinic treatment practice guidelines. Uh, the VA, the Department of Defense, because a lot of our, you know, service members have tinnitus, they have a full uh published report on what are the most effective ways to deal with tinnitus. No matter what report you look at, overwhelmingly, prescription hearing aids, and people don't like when I say this, it's just the truth. Don't shoot the messenger. Prescription hearing aids are the number one way to reduce tinnitus, and it's effective in 90% of patients. Now, I didn't say cure, I didn't say make it go away. But if you're tinnitus, and I like I like to simplify things with patients. Let's just do a scale of one to ten. One, I I almost never hear it. Ten, I'm I'm considering, you know, taking my life. And a number of people, including famous people, have taken their life because of tinnitus. If you tell me you're at a seven, I'll tell you point blank, I'll look you in the eye and I'll say, the goal of treatment is to get you from a seven to a three or a four. Is that acceptable to you? And almost every patient I know looks at me and says, yes, that that would be great. Because if I get down there, I'll barely notice it, I'll be able to function better, work better, hear better, sleep better, you name it, I can do it better. Now, what I typically say is, let's start with the most effective treatment. If you're part of the 10%, or if it's taking a little longer to get that seven down to a six or a five or a four, now I often joke I call it my tenitis toolbox. Music therapy, like you mentioned, is an option. There are new um new apps that use cognitive-based therapy, which by the way, after prescription hearing aids, number two most effective treatment is cognitive behavioral therapy, couch therapy, right? How to mentally deal with the anxiety and stress that comes with it. And then there's also a new thing out there that you like zap the tongue. It reminds me of when you were a kid and you put the nine-volt battery on your tongue, right? Like there's a lot of other things out there. Some are still experimental, some have been around the block, some have been debunked. Um, but I think that's when you need the right hearing care provider, the right tinnitus specialist. And everybody in the Excellence and Audiology Network has gone through our tinnitus certification course.

Dr. Ayla Wolf 37:25

And have you seen literature on the association between tinnitus and anxiety? Since you mentioned couch therapy, uh, it seems like uh in the literature there's a big connection between anxiety and tinnitus.

Dr. Keith Darrow 37:40

I mean, yes. That that's overwhelming. I've seen so much of it that my brain is just rifling through, you know, the draw of all those articles. It's probably I I'd actually go out on a limb and say it's probably the most published topic when it comes to tinnitus research, which is the emotional toll that it takes on people. You know, because the hard thing is if you have a broken bone, I can take a picture of it. If you've got hearing loss, I can measure it. If you've got cognitive decline, there's we can measure most things objectively by taking a picture or running a test. High blood pressure, tinnitus. There's there's no way for me to take a picture or run a test and say, I see it, right? I mean, there's been some research, but there's no commonly, you know, available test. So what we have are basically I don't want to do I don't want to minimize, but they're essentially surveys. They're subjective tools that help us to measure the impact of tinnitus on your life, on work, sleep, emotion, hearing. And yes, emotion, anxiety, stress is probably the biggest area of concern we see in our patients. Because for some, I mean, it's 24-7, it it interrupts their ability to concentrate. It didn't for many, it's so hard to fall asleep with that noise. And then you know what's even worse is when you wake up in the middle of the night, now the noise is going to keep you up because for some reason it tends to be even louder at 3 a.m. when the world is quiet. And so your brain just sits and focuses on it. It's, you know, my newest book, Tenidas is Treatable, and you can go to Tenidasistreatable.com to get a copy of that. The most requests we get for the book is between midnight and like 6 a.m. Because people are up surfing the internet like this ringing is driving me crazy.

Dr. Ayla Wolf 39:52

Yeah, wow, that's crazy. And okay, not to get too far down the neuroscience rabbit hole, but we have our primary auditory processing area in the brain where all it's doing is taking in auditory information. Then we have all of these secondary and tertiary auditory processing that then mix auditory information with other sensory inputs. Is tinnitus a problem with those secondary tertiary areas? And if so, is there ever maybe going to be a therapy like transcranial magnetic stimulation where you could target those areas?

Dr. Keith Darrow 40:28

So, yes, tinnitus is a whole brain process. And that that would be my super simple you said no rabbit holes. So I'm gonna try to stay out of it because I could go down and we could be there for a while.

Dr. Ayla Wolf 40:41

Well, we could go there, we could go there.

Dr. Keith Darrow 40:43

Look, I'm gonna say this about tinnitus, I'm gonna say it about hearing, because even I was, you know, I was taught hearing follows, goes from the ear up the brain, and like hearing sort of lands in this little part on the side of our brain, it's called the auditory cortex. And then it's like it was as if it stopped. And then I started realizing, hey, wait a second, I keep seeing all these studies where they're doing imaging of the brain when they listen, when they are actively here. Guess what? The whole brain lights up. There's not a part of your brain that isn't stimulated by sound. And I feel very confident making such a bold statement like whether it's the frontal cortex where you make decisions, whether it's the visual cortex, whether it's the hippocampus where memory is, you name it, it can be activated by sound. And that's why I started to try to tell people it should make sense that hearing loss can lead to cognitive decline because the entire brain is driven by sound. And guess what? It's driven by sound before you're even born. We start hearing before birth. That's how important, or that's how much the brain relies on sound to be active. And so if you take away that stimulation, the brain is going to start to rot. Nice simple term. But to your point, yes, tinnitus is a whole brain process. So treatment for tinnitus has to be a whole brain process. And I love that you brought up transcranial magnetic stimulation. Um as a student, a colleague of mine when I was in MIT was actually studying transcranial magnetic stimulation, not for hearing or anything. And he needed subjects, and I was his subject. And I remember like it was yesterday. You know, for those that are listening, it's basically you put a couple of magnets near your head, and he was able to like send a magnetic pulse, and my arm started moving. It's really creepy and cool at the same time. So think of it. I I, you know, you know how you shock the heart. Think of transcranial magnetic stimulation as a way to like shock is a scary word, but it'll send like a pulse to the brain and almost try to reset the networks or the nerves that are producing that tinnitus. Right as of today, we're sitting here. I mean, I know this show will go on forever, but we're in April 2026, just so we're clear, somewhere around there. Right now, transcranial magnetic stimulation is considered an emerging therapy for tinnitus, but it is not recommended on a regular basis. It's not recommended for long-term treatment. So basically, it's still in the phase where it's in the lab trying to figure it out. There's some promising results, and we'll see what the next decade brings.

Dr. Ayla Wolf 43:44

I mean, it's it's been exciting to see the research on it for a lot of other things in terms of depression and concussion recovery and all of that. So I'm a big fan of the non-invasive therapies that improve people's quality of life. Let's do it. Yeah, yeah. Okay, so on that note, let's switch gears, talk about hyperacusis.

Dr. Keith Darrow 44:07

Okay. So and and and if you're just listening, you could probably hear the change of the tone in my voice because it's probably the most difficult symptom to treat. Hyperacusis, for those who haven't heard that word before, it's a sensitivity to loud sound. And and I just got through explaining this to my undergraduate students, which is when you think about hearing loss, everybody thinks, oh, you just can't hear soft sounds anymore. You can't hear certain consonants or vowels. And that's all true. But let's finish the full sentence, which is in addition to not being able to hear soft sounds, your upper limit of hearing comes down. And so I often I describe it as like a window, and basically that window shrinks from the top and the bottom, and now you can't tolerate loud sounds anymore. And so what people do, which seems like perfect common sense, is they now try to avoid ever being exposed to loud sounds. And there's some indication that maybe that continued avoidance of loud sounds is only further feeding that sensitivity to loud sounds. And so the most productive, not a not a silver bullet by any means, certainly not a cure. I would say we're in the range of 60 to 70% effective treatment is sound stimulation. You have to basically, you're you're easing the brain back into tolerating loud sounds. Now, I'm not talking about like I'm going to put you in a booth and I'm going to blast you with loud sounds so you get used to it. That like that was a thing 20, 30 years ago, is we'll try to desensitize you. Nowadays, it's it's essentially with prescription hearing aid technology, can we reintroduce sounds? Can we start to build up your tolerance? Think of it as going to the gym. If you just go once a month, every time you go, you're going to be sore the next day. And so now you might avoid going. But if you keep going and if you keep exposing yourself, now all of a sudden you're not sore anymore and you're actually building up resilience. You're building up strength. And that's kind of how hyperacusis therapy works. And to your point, it's very common in patients who have a history of traumatic brain injury, concussions, more so than just, you know, your average Joe who gets older and has some hearing loss.

Dr. Ayla Wolf 46:52

And I feel like there aren't very many audiologists in the country that actually do that type of treatment because it's it's a very delicate, gradual introduction of sound, which takes probably a lot of visits, a lot of follow-up, a lot of communication, and and more time than your average patient is normally allotted, probably.

Dr. Keith Darrow 47:14

So all that's true. And now this is one of those things that uh I might get further blackballed, but that's okay. The truth is, is and it does. It pains me to say it, but it's just it is what it is. Throughout my academic career, and I did four years of undergrad, two plus years of master's work, six years of PhD work, another four years of postdoc work, and I'm not saying any of this to be impressive. Never once did I learn truly about hyperacusis. And so my point is it's almost avoided, and maybe that's a strong word, it's a strong accusation. So let me say it better. Is it's not covered as much as it probably should be in training to become an audiologist or a hearing specialist. And so there's a big fear. I never blamed a clinician who said, I'm I'm almost afraid to treat it. I don't like patients with hyperacousis because that's them just saying, I don't really know what to do. I was never taught this, I don't have the tools. And so it's one of the reasons why, through our Excellence in Audiology program, we have trained providers so that there is more access to this type of care for patients suffering with hyperacusis, which is probably anywhere from two to 10% of patients with hearing loss. So it's it's it's such a subcategory of patients we deal with. So most are just like, you know what, go to a specialist for that. But to your point, it's hard to find one.

Dr. Ayla Wolf 48:59

Yeah, yeah, exactly. Well, and I think that uh I was listening to an interview you did only maybe three years, two, three years ago, and you said you had 14 clinics, now you've got 267 in your network. Uh, so that's an amazing amount of growth. So it sounds like a lot of audiologists are are seeing the importance of being able to have this type of mindset and this type of approach when it comes to hearing. And we have to really see audiologists not as someone who's just testing the ears, but somebody who actually understands a lot of neuroscience and a lot of the ways in which the brain processes sound and the downstream consequences of when that's not working right.

Prevention Mindset And Resources

Dr. Keith Darrow 49:42

You you hit the nail on the head. And the only thing I could possibly add to that is our healthcare system has taught us that medicine is reactionary. You get hurt, you get sick, you go to a doctor. We're trying to change the conversation, and so are you, to preventative medicine. And when it comes to hearing loss and medically treating your hearing loss, we're talking about preventing decline down the road because we know untreated hearing loss increases the risk of emotional, social, financial, physical, and cognitive health. So if we just if we just change our attitude, which this is how the conversation started older adults want to live a fuller, more active, more independent life. And for me, the one of the easiest things you can do to actually achieve that goal is to treat your hearing loss. And don't wait until it gets harder to treat. Don't wait until the tinnitus becomes an eight or a nine. Don't wait until your whole family's like basically talking about you behind your back, like, what's wrong with dad? He's not talking anymore. He just he leaves the room and puts on the TV really loud. Like, don't be that guy. Don't be that girl. Like, take charge of your health as you age, and it will pay you back in in countless dividends.

Dr. Ayla Wolf 51:26

Mm-hmm. Why don't you let people know uh you've got a couple of books out. Where can they find uh your books? And then also how do they look up somebody that's been trained uh with you in your network?

Dr. Keith Darrow 51:40

So so let me say this if you're worried about hearing and you're struggling to hear in background noise, and that's really the biggest thing that's bugging you, I would say go to excellenceinaudiology.org. That's our organization where I can almost guarantee you'll find somebody close enough, an expert who's been trained in all the methods we talked about here today, that can help you with hearing. If you're on the tinnitus journey, I would say go to mytenitusnumber.org. That's where we have a ton of resources for people that are living with tinnitus and they want to learn more. You can go to tenidisistreatable.com to get a copy of that book. All my books are on Amazon, and you know, the four pennies that I get from proceeds, I always put back into our nonprofit organization. I didn't write a book to make money. Um, it was never about that. I'm just trying to spread the word. So, so mytenitus number.com and.org, basically that's where you can start to learn: hey, what really causes tinnitus? What are the effective treatments out there? You know, we we touched upon it a little bit today. You can even take a little test to figure out what your tinnitus number is. And then you can bring that into a certified tinnitus specialist and you can talk about your tinnitus, what treatment options may be available to you, cost, anything you want to know, right? We're all about education. We believe medical treatment starts with education, right? The fancy word is health literacy. Um, but that's really our focus. Because once you've got the information, I believe most patients will make the right decision on their health care on their own.

Dr. Ayla Wolf 53:27

Yeah, fantastic. Well, I will put all that in the show notes. And thank you so much for your generosity on your time, your information, everything you're doing. Uh, I can't wait to share this with everybody.

Dr. Keith Darrow 53:39

Thank you so much for everything you do. Great show. This has been a lot of fun. And just keep up the amazing work. And and, you know, the more people who think prevention first, the better our society will be. So keep up the great work. Excellent.

Medical Disclaimer

Dr. Ayla Wolf 53:56

Thank you. Medical disclaimer. This video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice, diagnosis, or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes.