Hearing Matters Podcast

Beyond the Audiogram: Subclinical Hearing Loss with Dr. Christina M. Roup

• Hearing Matters

Share episode

Send us a text

Are you or someone you know struggling to hear in noisy environments, yet are told your hearing is normal? This episode of the Hearing Matters podcast focuses on the often overlooked yet critical concept of subclinical hearing loss. Experts Dr. Christina Roup and Dr. Douglas L. Beck discuss the limitations of traditional pure-tone audiometry, revealing how it fails to capture the full spectrum of auditory challenges faced by many individuals today.

This episode provides valuable insights into the best practices for evaluating auditory processing and exploring the implications of extended high-frequency hearing on speech comprehension. If you're a hearing healthcare provider, this episode is a must-listen for improving your approach to evaluating and supporting patients experiencing hearing loss and auditory processing disorder. 

We invite you to share this episode, subscribe, and join the conversation on the vital topic of hearing health. Have you ever struggled to hear, even with normal test results? Your experience matters, and we would love to hear from you!

While we know all hearing aids amplify sounds to help you hear them, Starkey Genesis AI uses cutting-edge technology designed to help you understand them, too.

Click here to find a provider near you and test drive Starkey Genesis AI!

Connect with the Hearing Matters Podcast Team

Email: hearingmatterspodcast@gmail.com

Instagram: @hearing_matters_podcast

Twitter: @hearing_mattas

Facebook: Hearing Matters Podcast

Blaise M. Delfino, M.S. - HIS:

Thank you. You to our partners. Cycle, built for the entire hearing care practice. Redux, the best dryer, hands down Caption call by Sorenson. Life is calling CareCredit, here today to help more people hear tomorrow. Faderplugs the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters podcast. I'm founder and host Blaise Delfino and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Good afternoon. This is Dr Douglas Beck with the Hearing Matters podcast, and I am here today with my friend and associate and colleague, Dr Christina Rupp. Dr Rupp holds a BA and an MA in communicative disorders from California State University at Long Beach and her PhD is in communicative disorders from the University of Wisconsin at Madison. Dr Rupp is an associate professor at the Ohio State University. Her research focuses on the effects of aging, traumatic brain injury and functional hearing difficulties on binaural auditory processing. Her secondary research examines the benefits of low gain amplification for adults with functional hearing difficulties who have normal pure tone thresholds. Dr Root, welcome, Good to see you again.

Dr. Christina M. Roup:

Good to see you again. Thank you for having me.

Dr. Douglas L. Beck:

My pleasure indeed. Good to see you again. Good to see you again. Thank you for having me. My pleasure indeed. Let's talk about people who have normal thresholds, yet they're having difficulty hearing a noise, or classically hearing difficulty, and they don't show any hearing loss. What do you do?

Dr. Christina M. Roup:

I think you pay attention to their complaints right. So one of the things that I really encourage is the use of standardized questionnaires or the self-report from your patient. Listen to their complaints, because the pure tone audiogram, we know, does not correlate well with self-perception.

Dr. Douglas L. Beck:

Yeah, I'm so glad you said that We'll come back to audiograms.

Dr. Christina M. Roup:

Tell me step two Step two is do more than just test pure tone thresholds. So I think we need to be testing speech and noise, and I know you're an advocate for that as well. So listen to their complaints and test. Use our test measures that directly address their complaints, and then I think the other thing we can do is go beyond 8,000 hertz on our pure tone audiometry right. So there's a wealth of evidence that's demonstrating that extended high frequency hearing really matters when it comes to speech and noise deficits.

Dr. Douglas L. Beck:

So if I were going to be snarky I would say well, this must be a new finding that extended high frequencies matter, because, gosh, we've only known about that since World War II. Just, you know, probably 5% of us do it right. And it's so important because when you think about the eighth nerve, the auditory vestibular nerve, going to the brainstem, it is tonotopically or topographically oriented. So the extreme high frequencies are on the outside. And many people would say that, as degradation occurs over time, through noise-induced hearing loss, through presbycusis, through ototoxic drugs, through traumatic brain injury, which I know you've studied as well through these things, the first damage point in the auditory system is going to be those extended high-frequency neurons.

Dr. Christina M. Roup:

Exactly exactly. And I think what we may see if we continue to do this and I think we should is that if you have that patient who has pure tone thresholds within our classically defined normal range, if you keep going and measure outside that range, you're going to see threshold elevation in those extended high frequencies.

Dr. Christina M. Roup:

And I think that's you know. The research has shown that from the past, but also from the very recent past as well. I think this's you know. The research has shown that from the past, but also from the very recent past as well.

Dr. Douglas L. Beck:

I think this is so important. We just did a podcast on extended high frequencies and we'll put a link to that in the web version of this one because it is such an important topic. And you'll see that so many of the patients with normal thresholds, you know, between 250 and 8K, will have extended high frequency difficulty and you know they may complain that they can't understand speech and noise. They may complain about tinnitus, they may complain about a million things and we're not catching it because we're not testing for it. You know you don't know what you don't test.

Dr. Douglas L. Beck:

There was a wonderful article that came out, I think since you and I last spoke. This is by Dr Charles Lieberman. Are you familiar with this? Do you know where I'm going? Okay, so noise damage and hidden hearing loss, cochlear synaptopathy in animals and humans. And what Dr Lieberman says is when thinking about sensorineural hearing loss, it's very important to differentiate problems with audibility, that's, you know, the ability to hear, from problems with intelligibility, the ability to extract meaning. And he says for decades it was believed that hair cells were the primary target of damage in most forms of sensorineural hearing loss and that auditory nerve fibers degenerated mainly as a secondary effect if, and only if the hair cells were already destroyed. These ideas were challenged when our lab meaning his lab in both noise-induced and age-related hearing loss of mice, the most vulnerable elements in the inner ear were not the hair cells but the synaptic connections between hair cells and auditory nerve fibers, and that type of synoptasy could silence 50% of the neurons without hair cells changing thresholds.

Dr. Christina M. Roup:

Powerful, powerful words.

Dr. Douglas L. Beck:

So how do we get the profession to take this seriously and do something about it?

Dr. Christina M. Roup:

If I had the answer to that, we would both be millionaires, wouldn't we? Well, at least you would be, yeah.

Dr. Douglas L. Beck:

I mean, we're in the stall mode. There's a couple of things here to unpack. Number one now this is a good time to go back to pure tones. Tell me your perspective on pure tones being what we all refer to not you and I, but most of us refer to audiograms as the gold standard of hearing measuring. You know what's on your audiogram and I'd like you to speak about that and the categories of convenience.

Dr. Christina M. Roup:

I love that phrase that you use categories of convenience or the traditional classification for degree of hearing loss, right? So if we go back in time, we know that normal hearing has been classified as thresholds between zero and 25 dB HL, but many of us argue that that is too wide of a range, right, that we really need to tighten that up, and there's numerous researchers, professionals who are arguing for that right. It's not just you and I.

Dr. Douglas L. Beck:

Oh, and in 1929, almost 100 years ago, fletcher showed 15 was the outer limits of normal. Exactly, but I digress, please continue.

Dr. Christina M. Roup:

No, you hit the nail right on the head, right, that that 15 dB demarcation is a much better place to separate, quote-unquote, normal hearing from threshold elevation or impaired hearing, and I think, um, that is a great place for us to, um, what's a good way to say that? That is a really for us to continue to advocate for that change in.

Dr. Douglas L. Beck:

So yeah, I absolutely 100. So. So let me ask you if you were empowered by triple a IHS, ada, all of our acronyms to design a perfect audiogram? We're absolutely willing to have people just download it and use it and take it for free. But you know, we're not an academic institution, we're a podcast. So tell me your preferences. How would you define each of these categories?

Dr. Christina M. Roup:

Yeah, I think if you consider normal hearing, 0 to 15 dB HL, I think that's a great place to start. I think we already have that category of slight hearing loss that has been introduced, but it was classified as only use for children, right? And I think if we go away from that, we can say that is still a slight hearing loss for anybody, right it?

Dr. Christina M. Roup:

doesn't have to be just children. It's tough because these I will just say that these words that we use to classify these ranges can be really misleading. Right, you know slight and mild. You know it's like having a mild traumatic brain injury. It's not mild for the person who has it right. Mild hearing loss Is it mild for that person?

Dr. Douglas L. Beck:

You know this is such a great point so I almost want to throw away these terminologies entirely. And with all due respect to my colleagues at Johns Hopkins, I'm not a fan of the hearing numbers. Problem with that to me is that they only represent loudness. They don't tell you anything about processing or clarity or speech and noise or hearing difficulty. They're just measuring pure tones. Now the thing about that two things. Number one you only need 50% of the auditory fibers intact to press the button when you hear the beep. So you can have very significant damage and have zero dB thresholds or two, three, four, five, six, seven, eight, nine, 10, et cetera. So that's one thing. And then the other thing is that people can handle two numbers. You know, they know their blood pressure is 115 over 80. You know vision is 20-20. They know they have 32 teeth in one mouth. That's almost too. But you know, I don't think that it's going too far if we design a very, very simple number.

Dr. Douglas L. Beck:

Now here's the other thing that I don't like about the categories. If we said 15 to 30 is slight, then that's based on a puritron average, whether it's three frequency or four, and many of us use four frequencies, many of us use three, and it depends do you use interactives? So none of these numbers are necessarily repeatable universally. And then you look at the World Health Organization numbers on hearing loss and they're very, very different. I'm not saying right or wrong, but a very different mindset for a very different purpose. And so I almost wonder if the simplest thing to do is just we know that hearing loss is decibels.

Dr. Douglas L. Beck:

There's rarely a patient who can tell you what a decibel is, and we don't really have the time to teach that class to a patient. And I don't mean that disrespectfully, it's just it's not part of their life, right? So what if we just said you know what, for the purpose of patients, why don't we have zero to a hundred percent? Just whatever the DB pure tone average is, make that a percent Patient says, well, I have a 45 DB loss or I have a 45%. Okay, good enough for a patient, isn't it? I mean, would that add more confusion, or does that?

Dr. Christina M. Roup:

Yeah, that's a tricky one. I think a percentage is something that's very easy for patients, or just individuals in general, to latch on to, because we use percentage in so many different ways. So it's an easy thing to grab hold of or it's tangible right, it's tangible for an individual grab hold of, or it's tangible, right, it's tangible for an individual and we all know it.

Dr. Douglas L. Beck:

Yeah, we all know it's wrong, but it's probably close enough for consumers and for the general public, like a speech banana. There's nothing on a speech banana, that's right, not one thing. And yet we use that to communicate to patients. A grand piano is 80 dB at 2000 Hertz. Really, because I'm a musician, I got to tell you something that ain't even close, you know. Really, because I'm a musician, I gotta tell you something that ain't even close, you know. And and a motorcycle is 90 db at 8 000 hertz. Are you kidding you know? Nothing on a speech banana is correct. Yet we use that to try to make things simple. Why don't we just use percentage and get rid of I mean?

Dr. Christina M. Roup:

I, you know, I don't disagree with you, doug, I don't disagree make it simple. You know this is. You know, even if you just use a pure tone average, or if it's three frequency, four frequency, it's a single number. You have a 45 dB loss or 45 percentage loss or whatever that means, or whatever term you want to use, and then add to it so that second number. So what would that second number be? Is it your signal to noise ratio loss? Is it your speech and noise percent?

Dr. Douglas L. Beck:

correct.

Dr. Douglas L. Beck:

Yeah Well, you know, there's so much information out showing that word recognition in quiet isn't really telling us anything.

Dr. Douglas L. Beck:

And many people have proposed if you do a Google Scholar search or a PubMed search, many people by many I mean five or six that I've seen in peer-reviewed literature, or six that I've seen in peer-reviewed literature that say you know, instead of doing well, in addition to doing SRTs and word recognition in quiet, we should be doing word recognition in noise, and I like that a lot because I think that's where the most clearly, 90% of the patients that we all see complain about speech and noise, yet very few of us test that.

Dr. Douglas L. Beck:

Now I want to go back to something you said earlier, which is you know, you and I are speech and noise advocates, but then again, so is AAA and ASHA and IHS. It's in every one of their best practice models and yet again, it's not being done on a regular basis by the majority. And I think that's that's terrible, because when, when I go to see somebody for my vision or or my hearing or whatever it is, and I tell them, my problem is that I, you know, when I'm reading a paper up close, I can't focus without glasses, and they give me all these distant things to do. We haven't addressed the reason I came in, you know, and I think that this is a glaring mistake in many of our clinical protocols.

Dr. Christina M. Roup:

No, I completely agree. And it doesn't. You know what kind of trust is the patient going to have in you when you're not testing what they've complained about?

Dr. Douglas L. Beck:

Right, yeah, fair enough.

Dr. Christina M. Roup:

And we know you know you can have up to a moderate to moderately severe hearing loss and still perform in quiet above 80% just simply doesn't give you any additional information about your patient if you are not addressing the complaint that they have or the problems that they experience, which is listening or trying to understand in background noise. And there's so many great tools for us to use that are quick and easy right, I mean the speech and noise tests that are out there that are commercially available, are quick and easy, like you know. For example, the quick sin, the quick speech and noise tests that are out there that are commercially available are quick and easy, like you, know for example, the quick sin, the quick speech and noise test.

Dr. Christina M. Roup:

I mean one minute per list. How much faster can it get?

Dr. Douglas L. Beck:

You know your point is very well taken. I won't go into too much detail there, but I absolutely, if you only had one test to do on a patient. Patient comes to see you and they say Dr Roop, I'm having difficulty understanding speech and noise. I'm 70 years old, I don't have any extreme noise exposure and you only had one test that you could give them. What would that?

Dr. Christina M. Roup:

be. Depending on their age, it would be a speech and noise test and then, depending on their age, I might choose the Quixin as a quick screener, or or I might. I love the revised speech and noise test. Yeah, it's an oldie, but you know it has the high predictability versus the low predictability and it's a. You can use that as a really great counseling tool like hey, look these high predictability sentences.

Dr. Douglas L. Beck:

You did great with that low predictability yeah, yeah, and that's that's the revised spin, right, and I'm I'm blanking on who wrote that originally. It came out like in the mid-'80s.

Dr. Christina M. Roup:

I want to say so in the mid-'80s it was Bob Bilger, oh right.

Dr. Douglas L. Beck:

Who did the?

Dr. Christina M. Roup:

revision of that. So it came out in the 70s right. So 1977 was the original article from Calico.

Dr. Douglas L. Beck:

Oh, that's right, calico, that was the name I was looking for. Yeah, yep, that was the name I was looking for.

Dr. Christina M. Roup:

Yeah, yep.

Dr. Douglas L. Beck:

Wow.

Dr. Christina M. Roup:

So it's an old test, it's an old recording and you can tell it sounds like it's an old recording, but I do like it and you can still get it from your colleagues. Right, it is not something that's commercially available, but you can get rush hughes. Do you know where I'm going?

Dr. Douglas L. Beck:

with this, so one of the original recordings that we used back in, I want to say from the 40s, was the rush hughes monosyllabic word test. Rush was the um, the I don't want to say dj, but he was the voice that recorded it and it was a terrible quality test and and I remember jack katz telling me back in the little uh I want to say the late 70s, early 80s that you could still use. It was a terrible quality test and I remember Jack Katz telling me back in the I want to say the late 70s, early 80s, that you could still use it as a test of central function because it was so bad. But if the patient could put it all together and make sense of it they were probably fine. If the people couldn't, you know it didn't mean you had a tumor, of course it doesn't, but it correlated with people who had other regular stuff and so bad recordings aren't necessarily useless. Rush Hughes I haven't thought of that name in a few decades. Anyway, listen, I want to talk about there's somebody called Sarah Haisley. I remember her paper I don't, I have it in front of me the relationship between self-perceived hearing ability and listening related fatigue, and she covered so many cool things. Let me just in her abstract, and I'll ask you to comment on this.

Dr. Douglas L. Beck:

Many adults experience hearing problems despite a diagnosis of normal hearing. An invalidation of self-perceived hearing problems can be emotionally distressing. Previous research describes a normal hearing test with perceived trouble understanding speech and noise as hearing difficulties. And then she goes on to say recent studies investigated factors that contribute to deficits in speech and noise performance, a common symptom of HD. Specifically, adults with poorer working memory and poorer extended high frequency hearing exhibited poorer speech and noise performance than adults with better working memory and better extended high frequencies. So I read this, I guess two or three years ago, and I was so impressed that I thought you know. Given the opportunity to speak with you, I would like to get your current thoughts on this. She concludes with results from the present study suggest it is essential to apply more rigorous tests of auditory function than those that represent everyday hearing tests to more accurately assess an individual's hearing ability and validate their self-perception of hearing difficulty HD. Tell me your thoughts on that, because now we're two years later.

Dr. Christina M. Roup:

Yeah, two years later, so we're still looking at that relationship. So, if I can just digress a little bit, sarah's study was really based on a study that came out of National Acoustics Laboratories, so Ingrid Yeand in 2018 published a study that looked at all these different factors that might predict speech and noise performance.

Dr. Christina M. Roup:

So she had like over 100 participants and she sort of categorized them as you know they did well in speech and noise or they did poor in speech and noise, and then what predicted whether or not you did? You did poor with speech and noise and it was working memory and it was extended high-frequency hearing. So the working memory test that they used in that study was a reading working memory test. It was visual.

Dr. Christina M. Roup:

So, what Sarah Haisley and I were working with is the auditory working memory test and, if you're familiar with Sherry Smith's and Kathy McCoy Fuller's WARM or the word auditory recognition and recall measure, so we were using that. So, yeah, I think we see in individuals with hearing functional hearing difficulties, subjective hearing difficulties whatever terminology you want to use because there's a thousand terms to describe this population but that working memory and listening-related fatigue are symptoms of that hearing difficulty and we continue to use auditory working memory as a measure of cognitive processing or executive function that is related to speech and noise deficits or difficulties.

Dr. Douglas L. Beck:

Right, right.

Dr. Douglas L. Beck:

And so when you talk about people with normal hearing who may have extended high frequency deficits they may have working memory issues.

Dr. Douglas L. Beck:

To me, I tend to group all of these things into something other people refer to and I hate to use a word that's not well-defined, but I refer to these now, in 2025, as subclinical hearing loss. The reason I do that? I think physicians are much more comfortable with that, I think ENT, I think family doctors, I think GPs, internal medicine, you know, when they see a test result, if it happens to be a patient they're also working with, that says normal thresholds. It's so important to still document all this other stuff and I think we can just start maybe calling it subclinical hearing loss, because I think when we use terms like super threshold hearing loss or central auditory processing disorder or you know any of those things which are central hearing loss, it puts it out in the ether for the mainstream, and I think that if we say subclinical, it seems more relatable to me. What's your thought? What's the best term to use when it's not airbone and speech, when it's not, you know, conductive or sensorineural?

Dr. Christina M. Roup:

Right. I don't know that I have a good answer because there are a lot of different terms. Subclinical is something that I've seen a lot of and I would argue that the way it's being used by Justin Gullup's group, where it is thresholds 1 to 24 or 1 to 25, I would argue that that's a little too wide of a range. So, subclinical I think you run the same difficulty with subclinical that you do with slight or mild, right? So if it's subclinical, it's not clinically relevant, right? So I think you can run into that issue with subclinical.

Dr. Douglas L. Beck:

So I guess my answer is I don't know if there's a perfect term. Yeah, I don't think there is a perfect term, but I'm glad for your reflections on subclinical. I think I struggle with the best thing and I know that some people use the term auditory processing disorder to say it's not hearing, it's. You know what we do with what we hear.

Dr. Christina M. Roup:

Yeah, I think you have to be careful with that.

Dr. Douglas L. Beck:

You know, I study auditory processing.

Dr. Christina M. Roup:

I study binaural processing, I believe that people have processing deficits that you could categorize as disordered. But when it comes to this population, you know what you and I are talking about right now. Is this threshold elevation, you know, beyond 15 dbhl right, and we know that? Or I've had studies that have shown that if you have threshold elevation between 15 and 25, that that strongly correlates with speech and noise performance. Now, do you have a speech and noise deficit? Maybe not, but your performance is definitely poorer than someone who has thresholds between zero and 15. So I think audibility or threshold, minimal threshold yeah, fair point works together right.

Dr. Douglas L. Beck:

Of course, and it's so hard to characterize these things because, as audiologists doing comprehensive audiometric evaluations, we run into this all the time and it's very hard to communicate it to the family or to the rest of the healthcare team without confusing people, because they don't know what a central hearing or central listening issue is, they don't know what auditory processing is. So I'm just trying to find a universal term, which obviously I did not find.

Dr. Christina M. Roup:

Yeah, we should brainstorm this further.

Dr. Douglas L. Beck:

Yeah, absolutely so. Then you had this paper that came out about a year ago it was May, june 2024, with Lander and Shang, I think and you were writing about mild traumatic brain injury. I wrote a paper on that about 10 or 15 years ago and I found it to be fascinating. But you went further in your conclusions and you say the present study suggests conventional clinical audiometric battery alone may not provide enough information about auditory processing deficits in individuals with a history of mild traumatic brain injury. So tell me about that. I mean, I think you're exactly right.

Dr. Douglas L. Beck:

And I remember when I was at a trauma center St Louis University, I was there for seven or eight years or something like that and you'd have people who would be in car accidents or you'd have people who had fallen off a ladder because we were a trauma center. And you know, sometimes somebody was clever enough to order an audiometric evaluation, but you know it was really just 250 to 8K and temps and let the ENT take a look at the ear. You know, and I've always thought well, that's not really a thorough, comprehensive audiometric evaluation for somebody, given, you know, traumatic or even mild traumatic brain injury. And yet you know that's what we did.

Dr. Christina M. Roup:

Yeah, it's a fascinating group, you know I was involved. I've had colleagues who were really interested in this in the veteran population you know, glass exposure, but even just close head injury, we know has an impact on the central auditory nervous system. But it doesn't necessarily impact pure tone thresholds. So you look at that data that we published in that paper, the pure tone thresholds were all within the classically defined normal range.

Dr. Christina M. Roup:

So nobody had thresholds outside of that range. So if you have a patient coming in and they're complaining about hearing problems or speech and noise deficits, whatever their complaint is, and then you find out they have a history of concussion or brain injury, whatever that looks like or whatever term they're using, you know, pay attention to their complaints because you need to do more testing and just the pure tone, audiogram and words in quiet, because they're going to perform beautifully on those measures, yeah Right. And you know we I have colleagues in our clinic at Ohio state who have these stories of patients who make it to our clinic.

Dr. Christina M. Roup:

So they have a history of brain injury and they've seen five, six, 10 audiologists who say well, you have normal hearing, but all they did was test their pure tone thresholds. And then they come to us. We measure their auditory processing abilities with speech and noise with an auditory processing evaluation or test battery like the scan, which I think is a very easy implementable test battery in a clinic, and they perform abnormally. And so their complaints are based on something real right. Something is happening centrally.

Dr. Douglas L. Beck:

Dr Roof, before I let you go, I want to talk a little bit about what is a difficult discussion for many professionals. So you have a patient who has subclinical or central or auditory processing something going on. Has subclinical or central or auditory processing something going on? Thresholds are normal. Would you or would you not try hearing aids?

Dr. Christina M. Roup:

I would Yep, so I think that is a viable option. I think we can do that safely and effectively, and we have data to demonstrate that this population will benefit from mild or low gain amplification and the digital signal processing that comes along with advanced hearing technology. So, absolutely, I think it is worth trying.

Dr. Douglas L. Beck:

And so I get this question when I'm out lecturing are you saying that people with normal hearing should wear hearing aids?

Dr. Douglas L. Beck:

And the answer is no, nobody's saying that. What we're saying is people with auditory deficits which, by the way, you have to test in order to find them might improve their situation by having a better signal to noise ratio. And this is exactly what we've been doing, I think, since 1950s, with children with auditory processing disorders. Right, we give them an FM trainer, we give them a headset. Now we don't have to use quite so clunky tools, but we can give them Bluetooth, we can give them a digital remote mics, we can give them a FM, we can give them, and sometimes we just give them hearing aids with very low gain. So you're not going to cause damage. But I want to caution people, and I think you would share the same caution that if you're going to do a low gain fitting for somebody with normal traditional thresholds but hearing difficulty, it's almost mandatory in my mind that you have to do real ear measures just to make sure that hearing aid is not malfunctioning and potentially causing a problem.

Dr. Christina M. Roup:

Absolutely, you have to do that. That is an excellent point and I would never do a fitting like this without real ear verification. And I would also caution individuals to not solely rely on a prescriptive method or a prescriptive target, because most prescriptive targets, like NAL or DSL, they weren't designed for thresholds you know better than 20 dB HL and in fact if you enter that into your software it's probably not going to turn on the irrigate.

Dr. Douglas L. Beck:

You won't get any gain at all.

Dr. Christina M. Roup:

It's minimal at best right. So I think you have to decide what your protocol is. There's a couple of papers out there that have done it slightly differently. But you know I'm an advocate for measuring insertion gain. Know how much gain you want to provide your patient, whether that is a flat 5 dB, like some, 5 to 6 dBs, like some research has done, or a more, you know, nuanced 5 to 10, depending on you. Know a little bit more gain in the high frequencies. But measuring insertion gain, I think is a much, much better approach than relying on a prescriptive target that would be inappropriate for that audiogram.

Dr. Douglas L. Beck:

I like that a lot because if my insertion gain is 5, 6, 7, 8, 9, 10 dB and I have noise reduction maxed out and I have beam formers on in a cocktail party situation, a restaurant, an airport, a group discussion, most of the amplification will be coming from the person that I am looking at right, because they're in front of me, and most of the attenuation of noise will occur behind me and mostly still, you know, for steady state noise, but some low rumbling and things will also be eliminated. The bottom line is, yes, we can make it clearer, and actually people don't really want things louder. I know I don't want things louder and, and you know, I want to clear it and it's the same thing in vision. You know people don't want bigger, they want it more focused.

Dr. Douglas L. Beck:

You know they want to be able to, to read it up close and at a distance, and it's the same in hearing healthcare. So I think that there's a long way to go before the entire profession starts to adapt best practices, because we're not even talking about anything extreme here, changing we're just talking about doing what's already in best practices. And I loved what you said, that you know we're not in charge of the pricing. We are right. And here's the thing I mean. We're doctors and are we gonna do what the insurance company says to do that, what we need to build for, or are we gonna practice appropriate audiology and do what's in the best interest of the patient? And I've been saying this for years and I've been burned for saying it for years, but I don't really care how much we get reimbursed, even when I was in my own private practice. The reason my practice thrived is because we always did what was best for the patient and made all the difference.

Dr. Douglas L. Beck:

If we just did what we could bill for in 92557 and not go beyond that, I don't think we would have been an outstanding practice. But I think we were an outstanding practice because we use comprehensive audiometric evaluation, which is perfect Best practice.

Dr. Christina M. Roup:

Perfect.

Dr. Douglas L. Beck:

All right. Well, dr Rupp, it is always a pleasure. I'm so glad to see you and I appreciate all the work you're doing in all these areas, and I will look forward to the next time. Maybe we can do something. End of 2025.

Dr. Christina M. Roup:

Sounds great. Thank you for having me.

Dr. Douglas L. Beck:

Thank you so much. You're entirely welcome.

People on this episode

Head Shot

Blaise M. Delfino, M.S. - HIS

Host
Head Shot

Dr. Douglas Beck

Co-host