Dr. Nashlea Brogan:
We have so much to bring to the table as women, because I think women bring the empathy and they bring the caring, and we bring this different perspective. So I think for any woman to know that they have superpowers, every woman has superpowers that we need. We need those in healthcare, we need those in our community.
Blaise Delfino:
You're tuned into the Hearing Matters podcast, the show that discusses hearing technology, best practices and a global epidemic, hearing loss. Before we kick this episode off, a special thank you to our partners, Redux, faster, drier, smarter, verified, cycle, built for the entire hearing care practice. OtoSet, the modern ear cleaning device. Fader Plugs, the world's first custom adjustable earplug.
Welcome back to another episode of the Hearing Matters podcast. I'm your founder and host, Blaise Delfino, and as a friendly reminder, this podcast is separate from my work at Starkey.
Dr. Douglas L. Beck:
Good day, this is Dr. Douglas Beck of the Hearing Matters podcast, and today we're talking with my dear friend, Dr. Nashlea Brogan. She is an audiologist, a private practice owner, and a TEDx speaker. Dr. Nashlea Brogan has a 20-year clinical career dedicated to transforming the lives of those with hearing loss and tinnitus. And she's the founder and leader at Bluewater Hearing and Balance in Ontario, Canada. Dr. Brogan is also a fascinating person, because she's one of the few audiologists across the globe who wears cochlear implants. We'll get to that later. So we'll start with, Dr. Brogan, thank you for being here.
Dr. Nashlea Brogan:
And thank you for having me.
Dr. Douglas L. Beck:
It's entirely my pleasure, and I'd like to talk a little bit about some of your personal history, because you do share this on stage and it's amazing what you've been through and where you are. So let's start with, at what age was your hearing loss first diagnosed?
Dr. Nashlea Brogan:
So I was 14-years-old when I had my first audiological assessment.
Dr. Douglas L. Beck:
And what did they find at that point?
Dr. Nashlea Brogan:
They found I had normal hearing up to about 4,000 hertz, and that sloped off to a high frequency sensorineural hearing loss. That was in 1991. At that time, I was just told, "You have a late, a post lingual, late onset, possibly progressive sensorineural hearing loss," and they just had to do follow up. There was nothing to be done at that time.
Dr. Douglas L. Beck:
And did they have any idea what the origin was, what the etiology of the hearing loss was?
Dr. Nashlea Brogan:
The community I was living in at the time had quite a bit of hereditary hearing losses, recessive genes on both sides of the family. So what I would learn later was that my hearing loss and the way it progresses, it is a hereditary hearing loss. There's a whole chapter in the hereditary hearing loss book dedicated to it, the ski slope pattern, how it progresses. So I think that they had an idea that I was going to fall into that pool of patients.
Dr. Douglas L. Beck:
So then you were followed for a number of years, and at what age did you start wearing hearing aids?
Dr. Nashlea Brogan:
So not a lot was done, actually, and I went through high school, that was it. I was 14 and I went through high school. And then when I was 18, the first ear, nose and throat specialist told my parents I destroyed my ears listening to music. So the audiologist said it was a progressive late onset hearing loss. And then when I was 18, I was seeing a different ear, nose and throat specialist and audiologist, and they were like, "No, this is a hereditary hearing loss." And I was fit with hearing aids.
I'd just finished high school, grade 12, going through high school, I'd always tell people that I didn't know the bell rang between classes, even though I was doing three musical instruments, played the alto sax, was competitive dancer, Elco, Canada and an honor student, but I could not hear the tape test in French. So they'd play those tape tests. I would be getting all 90s and everything else, and then they played the tape test and I would fail it. And no matter what I did, I could not do anything in French and it was really hard. So I was fit with hearing aids, and then I went to live in France for a year.
Dr. Douglas L. Beck:
From 14 to 18, the hearing loss progresses. And was it being watched annually or was it from 14 until 18 was the next hearing?
Dr. Nashlea Brogan:
No, so my mother, because it was her brother who also who has a cochlear implant now who also has a late onset hearing loss, my mother kind of blamed herself. She went into extreme on blaming herself and blaming herself for hearing loss, and not a whole lot was done. No, I never had another assessment until I was 18, until I went in myself. And then my sister, my youngest sister who's four years younger than me, she's a lawyer, she also has two cochlear implants. So we both went to the same hearing loss, and sort of my uncle.
Dr. Douglas L. Beck:
So in college you were studying psychology and biology, if I recall, and then you decided to become an audiologist. So, how did you decide to do that? What were the factors that said, I want to be an audiologist?
Dr. Nashlea Brogan:
Well, so I was fascinated with human and animal behavior. So in psychology, the study human behavior, I was studying how humans adapt and cope with things, and I was struggling with my hearing loss. I'd go back and see my audiologist, who's amazing, she later became my mentor. And I would go back in to see her and I'd be talking about the stuff I was learning, and she'd be like, you should be an audiologist. And I was like, absolutely not. She'd recommend this big FM system to me and I'm like, I am absolutely not wearing that box on me. So, and I was going through my own journey with acceptance, but then she gave me Mark Ross's articles and on his coping with hearing loss and everything he was writing, and because I was a biology major and a psychology major, I became obsessed with his work.
Dr. Douglas L. Beck:
Did you ever get to meet Mark? I mean, he was-
Dr. Nashlea Brogan:
Not in person, no.
Dr. Douglas L. Beck:
... one of the nicest people you could ever meet. And Mark went through a difficult time with this hearing. In World War II, he was in the army and he had these giant body aids that he would wear, so it'd be something like this size.
Dr. Nashlea Brogan:
That was the FM systems were that size by the time I came along.
Dr. Douglas L. Beck:
And Mark went through all of that, and he used to tell these great stories that his rehab program was longer than bootcamp. They did a very, very thorough, very slow, very efficient oral rehab program for people with hearing impairment back then. And Mark went on in his life to have cochlear implants as well. Unfortunately, Mark died a few years ago, but what a lovely guy. Just, absolutely fantastic, I loved speaking with him. But anyway, go ahead. So you got some of Mark's articles and that inspired you to get further and further into it.
Dr. Nashlea Brogan:
Well, [inaudible 00:06:02] and then I started thinking about it and I was in the psych department doing an honors thesis, and I just looked up a guy's name in the phone book. I look it up and I call this audiologist, turns out he owns seven clinics. He was a graduate of Gallaudet, and he was also the president of the Canadian Academy of Audiology.
I started volunteering with him, and then he allowed me to do a study for my thesis in his clinic, looking at the coping styles of acquired hearing loss and anxiety in 200 of his patients. So I spent the next year going there and as my undergrad, there's no audiology department at [inaudible 00:06:29] University, so it's complete psych department. I knew nothing about audiology. And there I am looking for 200 patients with moderate hearing loss, and he allowed me to run them through the ways of coping, measure the state trait anxiety measure, and the communication profile for the hearing impaired. That was my undergrad thesis, and I just became obsessed with how we react and cope to hearing loss, that I called it at the time, acquired hearing loss, which is people who had normal hearing and have developed coping strategies as they've lost their hearing slowly.
Dr. Douglas L. Beck:
And then you went to graduate school at Western, right?
Dr. Nashlea Brogan:
Yes. So then I wanted to pursue research. So I went to Dr. C. Walt, who was close friends with Dennis Turks who was at Western, so away I went up to Western University and I did a master's of research in MSC, and then a master's thesis there and did research on acoustics in the classroom for children for three years and did my dissertation. But then during that time, I was also doing the clinical training, and I graduated and was trying to figure out what to do. Do I want to go on one track? And a year later I opened up, or six months later, I opened up Bluewater Hearing and Balance.
Dr. Douglas L. Beck:
So it's very interesting to me, and it's a little bit extraordinary that you went right out of graduate school into private practice. I don't know too many people who... Well, I know a few people who've done it. It's a very, very difficult way to go, but you had the confidence, you had the knowledge, you had the ability to make this work. And so how do you think of yourself, in terms of being able to do that? In other words, what was it about your education, your personality, your business acumen? What was it that allowed you to say, I'm going into private practice?
Dr. Nashlea Brogan:
Because I wanted to serve people who had acquired hearing loss. I mean, I wanted to help people on their journey. I was obsessed with hearing aids and hearing technology and fitting, really our measures, and then also using questionnaires to identify when people are struggling and how to counsel them through the process. I believe in private practice care, that's mainly what we do. We learn lots of amazing fitting skills, we learn really our measures, but the real beef of what we do is counseling. It's identifying those people and then taking care of them. As my audiologist said, from cradle to grave, my patients are under my care for 20 or 30 years, and I'm changing with them and always tapping into how their health is changing, their families are changing. I think those skills I had acquired in my training, and I think I was quite good at it from the beginning, and I just kept learning. I went on and did my AUD through distance education, and I just never stopped learning. But I mean, I'm still learning to this day, it never ends.
Dr. Douglas L. Beck:
[inaudible 00:08:51]. And so tell me, over the period of time from when you got your first set of hearing aids, age 18, something happened years later that you said, okay, this isn't working, I need cochlear implants. What was that? What was the deciding point?
Dr. Nashlea Brogan:
Oh, the deciding factor was, I mean, that was like, yes, that was over a 10 to 15 year period because even in audiology and my program when I was doing my MSC, all my peers at the time were like, you have to get an implant now. I was like, absolutely not. I was not ready for an implant. It was really heavily recommended by other audiologists, but I was happy. I did not need them at that point. And then what happened was I had my son, I had my daughter, and I couldn't hear my children. And I applied then to the Cochlear Implant program, and I was actually accepted into a study. So I was in a bilateral cochlear implant study through my [inaudible 00:09:33], through Western University, period of two years, every six months.
Dr. Douglas L. Beck:
Yeah, that's a lot. And so you've told me some amazing stories over the last couple of years that we've known each other, and one of the things that I find so revealing is you said that this was a year or two ago, wearing cochlear implants is fine, but every night when you take them off, you go back into the deaf world. So, can you talk a little bit about that?
Dr. Nashlea Brogan:
We obviously talk about the hearing loss identity or the hearing impaired identity, the heart of hearing identity, the deaf identity, but we don't really acknowledge the people and obviously the large growing population now who go from, so they have had hearing, they've worn hearing aids and they've had that identity, and now you're fit with cochlear implants and you have much better hearing possibly than with hearing aids. But then every night you're plunged backed into actually even more deafness than probably before you even got implanted.
So, I feel like every day I hear, amazing as you know, with my devices, and then I go and I take them off to get in the shower or I take them off to go to bed at night or anything, just even combing my hair or I'm swimming, jumping off a boat in the lake, and I'm 100% deaf on both sides. And actually, I wasn't even 100% deaf before I had my implantation done. So, it's a very, shock to your system to kind of cope with that.
Blaise Delfino:
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Dr. Douglas L. Beck:
Yeah, I'll bet, I'll bet, and you had another exceptional event where right after you were... So you got your Cochlear Implant, your first one. Yeah, I think it was the same day you went to lunch with your husband and all of a sudden you were conversing and you could hear and you could identify the music.
Dr. Nashlea Brogan:
It was AC/DC. I went to the restaurant, it was right after my mapping, my first activation, and I went into the restaurant and I was like AC/DC's playing, and I could hear the waitress. So everybody sounded like Mickey Mousey on helium initially, but I could hear, I could hear the speech was just like I remembered it, it was just helium. And then as the hours progressed, it just went down.
And the one thing, it was the AC/DC, and the other thing I remember is getting in the car to go home and for the first time in 10 or 15 years, every sound was distinct. I could hear the tires on the gravel, I could hear when my husband was pressing the gas, I could hear the blinker, I could hear every, but they were distinct sounds. I never had that with hearing aids. With hearing aids, it was the sound was fused, they were overlapping. I could hear car noises but I couldn't distinguish each one. Kind of like, I think if you listen to a band, you can hear the alto sax, the flute, you can hear the drums and all separate, that's the way cars are. But I never had that with hearing aids, but with my Cochlear Implants, I hear every sound separately.
Dr. Douglas L. Beck:
It's very, very unusual that a Cochlear Implant recipient would immediately be able to identify speech and to converse and to listen to AC/DC, that's very unusual. I've been working with Cochlear Implant-
Dr. Nashlea Brogan:
[inaudible 00:13:33].
Dr. Douglas L. Beck:
... for over 40 years, and generally, it takes people between three to six months for speech to start to become normal. And most people early on would notice that Mickey Mouse on Helium sort of sound quality to voices. I should also say that Cochlear Implants do not make hearing normal. They cannot, they do not, there is no report of normal hearing after Cochlear Implants, but you are an incredible example of how well somebody can do. Now let me ask you a question. What was the difference after you got your first Cochlear Implant to when you got your second?
Dr. Nashlea Brogan:
I can't even imagine going back to one. It's just always that argument, you need two ears. So the minute I got the second one, my ability to hear background noise went through the roof. I mean, now I hear from both sides. If I'm only wearing one, and sometimes I forget. Honestly, I'll put one on the morning, I forget because if there's nobody at the house, but then the minute someone goes to talk to me, and if they're not in my visual site, I don't hear them. Music doesn't have its fullness when I go into any situation, and if the battery dies on one side, I lose half. So when I put one on and then I put the other on, it's like, whoa, everything just goes up equally and it's just perfectly meshed, amazing. And I can go back and forth on the phone with them, even though they sound slightly differently. But yeah, no, a huge difference in just my ability to navigate airports, environments where there's people around me and background noise.
Dr. Douglas L. Beck:
That's fantastic. Before I let you go, because there are two things I want to cover. Number one is, not only are you fascinating to so many of your friends and colleagues, but it's clear to me that many people find you fascinating because you just completed a global TED Talk, right? So can you tell us a little bit about that? What was it like doing a TED Talk?
Dr. Nashlea Brogan:
You know what, it was nerve wracking, and I normally don't mind speaking that much, but it was just nervous, memorizing and having something condensed where you want to have a message. Working on it, I got other professionals' feedback too, trying to develop this global message that resonated with me and an audience. And I was trying to tell people that there's a lot of people in the world who have hearing loss. There's 1.5 billion, by 2050, there's going to be 2.5 billion. There's a lot of us. It's very super common, and I do go into what I feel like how hearing loss has impacted the intimacy and relationships. I feel like we talk about hearing loss and hearing better. My TED talk was, why do we let our relationships fail? The silent impact of hearing loss.
Dr. Douglas L. Beck:
I love it.
Dr. Nashlea Brogan:
And we have remote microphones, we have FMs to help you in all the noisy places, and the world's noisy. I think we forget how noisy the world is.
Dr. Douglas L. Beck:
Yeah, it is. The average signal-to-noise ratio as you're just walking around in your life, and these numbers vary tremendously, but the average is about 10 to 12, maybe 15 DB signal-to-noise ratio. Well, most people with hearing loss, if the hearing aid cannot improve the signal-to-noise ratio very well, you're just making things louder, where most people need things clearer. And I wear hearing aids and it drives me nuts when things are loud, even though I'm a musician. But if I'm in a restaurant or a cocktail party and lots of people are speaking, I will wear hearing aids to improve the signal-to-noise ratio, and I'm not trying to make things louder at all. And I think so many people don't understand this. They think hearing aids are only for people with hearing loss, and that is just not true.
One of the best things we do for tinnitus patients who have no hearing loss whatsoever, is we fit them with appropriate amplification, and that aids in adaptability that might be useful for masking, that may be useful for de-focusing their attention on their tinnitus.
Dr. Nashlea Brogan:
Stress reduction. I mean, there's-
Dr. Douglas L. Beck:
[inaudible 00:17:00].
Dr. Nashlea Brogan:
... so much benefits based on the person. I always say, you go to your physiotherapist, they don't say, well, do you want to do this much or that? How much do you want to be able to use your foot or your back? In hearing care we let people pick and choose. I think we want to get them full function of their hearing. We want to have them communicating and connecting in all environments and at all times consistently.
Dr. Douglas L. Beck:
Yeah, I agree. I've never been a fan of the lifestyle charts. Are you a very involved person or are you minimally involved? Oh, I don't do anything, I just watch TV. Nobody [inaudible 00:17:27].
Dr. Nashlea Brogan:
Nobody. Everybody walks out of their house and they go get their medication, a pharmacy, or they go to the grocery store, or maybe they go in a coffee shop. I mean, all those are noisy environments. So I mean, ask them to pick and choose. To me, that's also the inconsistency, that there's so many things we allow inconsistency in the ability to hear, where we want the people to be hearing fully all the time, which we all, with custom tips, and that allows for all of that.
Dr. Douglas L. Beck:
Yeah, absolutely, I agree. Although in audiology, we seem to be evolving in such a way that we do have more women in leadership roles in 2024 than we did when I was a student back 40 years ago. What advice would you, Dr. Brogan, give to other women who are starting any profession? It could be medical, it could be dentistry, could be audiology, could be chiropractic. What advice would you give to other professional women, how they should go about achieving prominence and leadership in their profession?
Dr. Nashlea Brogan:
I think the first thing is to get involved, to put yourself out there, and realize that everybody has their insecurities. As women, I think we want to take care of each person, but when we get involved in our organizations, or speaking, or even in our communities, what we're doing is we're elevating ourselves. And we have to realize that we have so much to bring to the table as women, because I think women bring the empathy and they bring the caring, and we bring this different perspective. So I think for any women to know that they have superpower, every woman has superpowers that we need. We need those in healthcare, we need those in our community. And I think a lot of women, they judge themselves because they compare themselves to their male peers. We need what men do, and we need what women bring to the table to make the world a much better place from a leadership standpoint, because I think we bring something different to the table in any type of meeting organization, any leadership role where it makes things better.
When I go to some of the stuff, I'm the only woman there, like I was with you and Dr. Darrel and Morgan a few weeks ago, but I learn in those environments too. And I think sometimes women think too much that men are differently, so we kind of get intimidated in the wrong way, and we get in our heads and we think too much, but we don't realize that we're being appreciated for being at the table and giving our input.
Dr. Douglas L. Beck:
I think that's very well said, and I think you're exactly right. Always a drug working with you. You and I've been on stage together many times, and I absolutely look forward to the next time. But in the meantime, thank you so much for working with us at the Hearing Matters podcast, and I wish you a wonderful summer.
Dr. Nashlea Brogan:
Thank you so much, and you too. Can't wait to do this again.
