Peter MacArthur: It’s Delaware. It is Tuesday, it’s August 11th. I’m Peter MacArthur. Glad you could be with us today here on WDEL. Let me ask you a question. Have you noticed your spouse or your partner saying “Huh?” or “What?” more often? Or maybe it’s your parents, maybe it’s you doing it more frequently. Brings about an excellent opportunity to get your hearing checked, and Dr. Michael Michelli is here from Brandywine Hearing Center to break down for us how a hearing test works these days, and also what he’s looking and listening for during an exam. Thanks for coming in, Doctor. Appreciate it.
Dr. Michael Michelli: Oh, my pleasure. Good to see you.
Peter MacArthur: Lots to unpack here. Maybe a good place to start is when it comes to understanding a hearing test, taking a look at the purpose of someone who’s maybe listening right now coming into your office for a hearing evaluation. What are you getting at exactly with it?
Dr. Michael Michelli: We’re trying to determine if there is hearing loss to begin with, and, more importantly, why is there hearing loss? Is it something that could be treated medically or surgically? Is it something that requires the use of hearing aids? So, we’re trying to determine not only if there is an issue, but why there is an issue, and then to determine a path forward and what we can do about it.
Peter MacArthur: Yeah. Let’s talk about that that office visit. You, as I’ve mentioned, first of all, you have four locations. The one closest to us here is on Silverside Road right around the corner, very easy to get to from so many places off 95. But when people come into the office, kind of, what can they expect?
Dr. Michael Michelli: They can expect to spend usually about an hour, so it’s not a very long process. We try to make it very easy and comforting. We know from research that it takes about five to seven years from the time somebody begins to realize they’re having trouble hearing to the time they finally come in for a hearing test.
Peter MacArthur: Wow.
Dr. Michael Michelli: It’s one of those things we tend to put off.
Peter MacArthur: Yeah.
Dr. Michael Michelli: So, by the time you’ve actually come to us, some patients are a little anxious about the whole process. So, the first thing we want to do is put you at ease. Um, we’re going to come into the office, and we’re going to talk a little bit about what kind of difficulties you’re experiencing. Are you finding you’re turning the TV up louder? Are you finding you’re asking people to repeat what they’ve said? Have you ever had a hearing test before? Um, did you work in a lot of noise or listen to loud music? Um, do you have any ringing or buzzing in your ears? Did you have a lot of ear infections? So, we’re just going to talk for a few minutes and have an opportunity to really determine what brought you in to see us, or maybe why your spouse asked you to come in, or your kid asked you to come in, or what have you. So, we’re going to just talk for a few minutes first.
Peter MacArthur: I would guess those kids and those spouses are a pretty big driver of business in some ways, huh?
Dr. Michael Michelli: They certainly are. And I tend to joke a lot with our patients that I—I’m part audiologist and part marriage counselor.
Peter MacArthur: Exactly! A safe haven, if you will.
Dr. Michael Michelli: Exactly, exactly.
Peter MacArthur: Well, full disclosure, I went to Dr. Michelli’s office last week, and you can imagine, it had been—I don’t even know when—grade school, maybe, when I was last tested for a, you know, an audiology situation. I work in radio. I wear headphones daily for hours and hours. And so, yeah, I had some some trepidations about doing it. But, you know, Dr. Michelli told me, as he just told you, kind of how they go about it. And—and I’ll tell you right now, um, the—the back-and-forth that we did initially, where you kind of delved into the—the history of things, I—I just think that’s a wonderful thing. As opposed to filling out sheets and sheets of paper, it really gives you—and you can also probably, in your expertise, see almost body language of people leaning in. You can see certain signs of hearing deficits.
Dr. Michael Michelli: That is exactly right. I am not a big, uh, “fill out the form” person.
Peter MacArthur: Yeah.
Dr. Michael Michelli: Uh, I’d rather just sit and talk with you, and I do get a lot of information that way—um, just watching our—our clients and how they’re responding, and, you know, are they having difficulty even hearing my questions? So, it does give us a lot of information that way.
Peter MacArthur: Yeah, definitely telltale signs.
Dr. Michael Michelli: Right.
Peter MacArthur: Well, first thing is, the office is—is beautiful. I know it—it’s a newer facility that you took over, and you—that’s by design.
Dr. Michael Michelli: Absolutely. I mean, like I said, we—it takes a lot for people to finally decide to come in. So, we want you to be comfortable. So, we’ve designed an office that’s, hopefully, very pleasant, pleasing, and comfortable.
Peter MacArthur: Yeah. Um, so we walk into Dr. Michelli’s office, as we’re talking, there is a big booth that very much resembles a recording booth, because it kind of is.
Dr. Michael Michelli: It is.
Peter MacArthur: And I was fully prepared to lay down some tracks. The doctor decided to take this whole in a different direction! But this is where I sat for the examination that followed. Um, let’s talk for a sec—the examination of the ears you did initially, I should say, before I jump into the booth. What was the—the purpose of that? What are you looking for in that?
Dr. Michael Michelli: After we’ve had that conversation, we’re going to do a very thorough evaluation of your ears. We’re going to use an otoscope and take a look, and we’re looking to make sure there isn’t wax that’s in the way that’s going to keep us from getting a good hearing evaluation, or scar tissue on the eardrum, or a hole in your eardrum. Maybe you had tubes as a child, and—and the hole didn’t heal properly, or you’ve had a ruptured eardrum. So, we’re going to really take a look in each ear canal and just make sure everything looks healthy, or do we need to immediately refer you to a physician at that point?
Peter MacArthur: Right. Well, and see, that—that’s also a great full-circle approach, um, that Dr. Michelli can offer, is, if you need help somewhere else, he can, you know, help you expedite that—that kind of help, certainly. We move then to—to, I guess it’s called the pure tone hearing testing, which is what I underwent, where I sat in a booth, very comfortable. Right across from me, through a window, I could see the doctor, and, uh, he went through the—this testing. Tell people about that testing and how it works.
Dr. Michael Michelli: This is the part that most people really tend to think about when they think of a hearing test, that, you know, “Raise your hand when you hear the beep.” This is what you did in grade school with the school nurse, or if you’ve had other hearing tests. And it’s really sort of the—the bedrock part of the hearing test, and that is a number of different tones or frequencies, from low-pitch sounds, low-frequency sounds, to high-pitch or high-frequency sounds.
Peter MacArthur: Yeah.
Dr. Michael Michelli: And we’re looking for, at each of these pitches, the softest sound that you can hear—what we call your hearing threshold. And that’s really where you’re responding about half of the time. And in my practice, I tend to use a “say ‘yes’ when you hear the beeping sound” approach. Some practices will have you raise your hand or push a button. I like that verbal interaction. I think it’s easier for patients. But we’re just going to go through a number of different tones in each ear and have you respond when you hear the beeping tone to the softest you can hear it. And that plots out the initial part of the—the hearing test, which we call the audiogram. Um, and that gives us ver—your first range of where you’re having issues, potentially.
Peter MacArthur: Uh, it sounds like fundamentally or foundationally, the test hasn’t changed a lot, but has technology changed the way it’s kind of gauged, or the way it’s put together? Um, is, uh, you know, is your laptop helping you compile any of this data, or how—what about that element of things?
Dr. Michael Michelli: The standard hearing test, it really is pretty unchanged for many, many years. The—the computer lets us plot it nicely on a piece of paper instead of my not-so-fantastic handwriting. So, we—we use it that way, and it—it looks very nice, and it lets us put more information together for you. But the standard part, that initial pure tone part of the hearing test, is pretty unchanged, and it does give us a good bit of information.
Peter MacArthur: Yeah. For you listening at home, what I experienced during this is, as the doctor said, he would, uh, put together and play some sounds that, you know, the—the levels changed. It also, uh—I was getting the sensation that it was almost coming in different parts of my ear, as well. Maybe that was just, you know, how I was processing things. But yeah, they—some of them were very, very faint, and you had to really pay attention to hear them. And that obviously develops that—that baseline. But you also did—and this was the one where I really thought the deficits might show up for me, um, it was a woman speaking, and behind her, you had people talking.
Dr. Michael Michelli: Right.
Peter MacArthur: And—and that people talking element of things would be elevated slightly, slightly, slightly, and then we tried to decipher what the woman was saying. She’d say some kind of brief sentences.
Dr. Michael Michelli: Right, exactly.
Peter MacArthur: That was really interesting.
Dr. Michael Michelli: Yeah, that’s called the QuickSIN, or Quick Speech-in-Noise test.
Peter MacArthur: Mm-hmm.
Dr. Michael Michelli: So, hearing tests are more than just hearing those tones, because tones give us a baseline, but we also are looking at how are you processing information? How are you processing speech?
Peter MacArthur: Yeah.
Dr. Michael Michelli: Now, the other standard part of a hearing test is usually a—a voice repeating some individual words. And for many people and many offices, that’s sort of where they stop their hearing test. The problem with that is just giving you a list of individual words in a perfectly quiet room doesn’t really get to the heart at where most people who come to see us are having difficulty.
Peter MacArthur: Right.
Dr. Michael Michelli: So, we really try to include, for anyone who it’s appropriate—some degrees of hearing loss are so significant that we know they’re going to have difficulty in noise, so testing in noise doesn’t really tell—tell us a lot. But for the majority of our patients, doing that test, where we have a—a group of sentences with increasing background noise with each sentence, can really get to the heart of where many people tell us they’re having difficulty, which is in background noise.
Peter MacArthur: Yeah, and—and it’s more of a real-world example.
Dr. Michael Michelli: More of a real-world example, right.
Peter MacArthur: Yeah, you don’t want to—to manufacture these—these things, uh, if they’re not going to be accurate to someone’s r—real-life experience. Um, the audiogram itself, I—I saw print out when we were done, and you were showing me kind of how that works. And you know what? Obviously, I needed your guidance to understand that, but I thought that was a great thing because it—it really does show, if people have deficiencies, where those deficiencies are. And it’s great for that patient to understand what they’re up against.
Dr. Michael Michelli: It really—once we’ve put everything together, we’ve done the pure tone testing, the speech testing with the different words and the sentences, we can look at it all together, and it ob—it usually makes it pretty obvious where people are having difficulty. We have sort of an overlay on that on our audiogram that shows where the typical sounds of speech fall.
Peter MacArthur: Yeah.
Dr. Michael Michelli: And if your hearing loss is below that, we can show you where you’re going to have difficulty, maybe hearing “S” or “F” sounds, but maybe the vowel sounds, the power in people’s speech, we hear pretty well. And it’s why people often hear people talking, but don’t always understand what they said, because different hearing loss at different areas are going to impact speech differently.
Peter MacArthur: Hearing loss, obviously, we’re talking primarily, uh, about older adults, and people listening are saying, “You know, I’ve always taken good care of my ears, so to speak. I don’t blast things into my ear or anything along those lines.” Why do we lose hearing when we get older?
Dr. Michael Michelli: It is part of the aging process, and—and it’s unfortunate for most people, but essentially, the nerve fibers in the inner ear begin to degrade with age.
Peter MacArthur: Yeah.
Dr. Michael Michelli: Um, and it does cause a deficit for many older adults. But that gets us to thinking about things in a way we don’t always want to think about. So, just because hearing loss occurs for most people naturally in older age, that doesn’t mean we need to ignore it or just say, “Well, that’s just part of the aging process.”
Peter MacArthur: Right.
Dr. Michael Michelli: We need to treat it! There are so many links to concerns about cognitive decline with, uh, untreated hearing loss, that we have to look at this today and say, “Yes, we’re experiencing hearing loss. Yes, it’s part of the aging process, but we also need to do something about it.”
Peter MacArthur: Yeah, most certainly. What’s interesting is, after I was at your office last week, I was talking with a coworker at a function, um, telling them, you know, my concerns, my own concerns about where I’ve found kind of my challenges being talking in that big crowd. You know, one-on-one, you I kind of do the social lean, lean in to make sure I’m hearing.
Dr. Michael Michelli: Right, right.
Peter MacArthur: And—and this coworker shared the same thing and said, “And—and he said, ‘I get to a point where I kind of retreat a little bit, because it just gets to be too much to—to differentiate it all.'” And here’s—here are the disconnects that you could you could understand why there’d be cognitive decline. If people have more serious, uh, hearing issues, especially, it’s easy to just tune out. And tuning out’s certainly not a good thing.
Dr. Michael Michelli: Exactly. And that’s really what we’re seeing, is that when people have hearing loss and it’s untreated, they do naturally begin to say, “Well, why should I go out to that gathering? Why should I try to engage in this conversation when I know I’m not going to understand?” And that withdraw is where we are starting to see those concerns about cognitive decline.
Peter MacArthur: Yeah. So, here—here’s this patient looking at the audio—uh, the audiology test on paper that you have the results from, and now you’re trying to determine what happens next. You know, there’s—let’s say that there’s deficits that have been revealed by the testing. Uh, what does that next step look like? I know it’s not the same for everyone, but just generally speaking, Doctor.
Dr. Michael Michelli: The next step is just a frank conversation about what we’re seeing and why we think it’s happening. Um, is there something—and there’s another part of that testing with the tones, where we are also, instead of using headphones, putting a little piece behind your ear, on the bone behind your ear.
Peter MacArthur: Yeah.
Dr. Michael Michelli: It’s called bone conduction, and it’s another way of testing hearing to see if there’s an issue with the outer part of the ear versus the inner part—the ear canal and eardrum versus the inner ear, the cochlea. So, once we’ve determined all of that, now we can say, “Okay, your hearing loss is being caused by something stopping sound from getting to the inner ear.” We call it conductive hearing loss, and you need to go see a physician to see if there is something that can be treated medically or surgically. Or this hearing test shows us that the hearing loss you have is in the inner ear and the nerve for hearing, and it’s time to do something about it, and hearing aids typically are the best option for that. Or we have such a profound hearing loss that maybe we want to start thinking about a cochlear implant.
So, there—that test gives us lots of information, and really helps—helps us point you in the right direction. And sometimes that is seeking professional help from another professional. It might be an area that is not our area of expertise, like cochlear implants. Those are typically implanted by a physician, and then there are audiologists who tend to work in that physician’s practice who work with cochlear implants. Although, we have patients who wear a cochlear implant on one ear and we fit them with a hearing aid on the other ear. There are just lots of options. So, we’re going to individually discuss what is your best option. Do you have some sort of insurance benefit? Is this something you’re going to have to pay out-of-pocket for? How can we help with that? So, we’re going to have a very frank discussion about the best way we can help, and give you options.
Peter MacArthur: Yeah. You and I also took a brief trip down memory lane of hearing aids, and I want to put some people—I think a lot of people, you know, it sounds vain, but a lot of people don’t want to get their hearing tested because they don’t want to end up with a hearing aid that they envision is going to be this clunky piece of apparatus sticking out for all to see. And when you and I were looking at some of the older ones that you brought out, which indeed had a certain presence to them…
Dr. Michael Michelli: They certainly do!
Peter MacArthur: …but the newer ones, my goodness, it—it’s just the—the technology’s amazing!
Dr. Michael Michelli: The technology has become incredibly small, like so many other things. There’s so many advances in the quality of the sound, in the help that we can provide in the hearing aid, in true artificial intelligence, which I know is a—not only a buzzword, but sometimes scares people a little bit. But working in a hearing aid can really help in those background noise situations.
Peter MacArthur: Yeah.
Dr. Michael Michelli: There’s so much more discrete, they’re so much more comfortable. Um, these, and I—I say it a lot, this is not your dad’s hearing aid, this is not your granddad’s hearing aid. They—they are completely different today.
Peter MacArthur: Yeah, and there’s a lot you can do with your hearing aid through your phone.
Dr. Michael Michelli: Right, you can be paired to your cell phone, and you can have an app where you can make adjustments. You can stream phone calls wirelessly to your hearing aids. You can track where your hearing aid went to in case you have a concern that maybe “I misplaced my hearing aid.” Uh, there’s a lot that we can do with that.
Peter MacArthur: Yeah. There are people listening, I know, that wives are calling husbands to the radio or daughters are texting their, you know, dads saying, “Listen, you’ve got to hear about this.” Who are the people out there right now that—that you really think about getting a hearing test? Just, you know, as a—as a basic checkup.
Dr. Michael Michelli: I would say if you’re in your 60s and you have not had a hearing test since you were in grade school, it’s time for the bare minimum of a baseline.
Peter MacArthur: Yeah.
Dr. Michael Michelli: See where your hearing is now, even if you’re not really concerned about your hearing. First of all, there is something we refer to as hidden hearing loss, where maybe you hear the tones well, but you really do struggle with those words, and hearing aids can be very beneficial in those circumstances as—circumstances as well. But even if you just get a baseline, and then a couple of years from now if you start having trouble, we can compare, and we can determine, “All right, well, there has been a change, and now it’s time to do something about it.”
Peter MacArthur: Dr. Michael Michelli joining us from Brandywine Hearing Center—and it should be Centers, because you have four locations. Tell people where your locations are, and then also let them know where online they can check you out and see kind of what you’re up to and how you can potentially help folks.
Dr. Michael Michelli: Our website is brandywinehearing.com. We have offices here in Wilmington on Silverside Road. We have an office in Newark, in Dover, and in Millsboro. So, we’re on Facebook, we’re online at brandywinehearing.com. And just to sort of mention, you know, we’ve been in business for a very long time. We’ve been a part of the Delaware community for over 90 years. We very much believe in giving back to the community, so, just to mention, we’re doing our third annual food drive in September, from September 1st to September 30th at any of our locations. Check the website, brandywinehearing.com, for office hours. Drop off a non-perishable food item to benefit the Food Bank of Delaware, and every donation enters you into an opportunity to win a nice gift basket. So, we really try to give back to the community. The community’s been great to us; we really want to give back.
Peter MacArthur: Hey, it’s funny how so many of these successful businesses with real roots in the community give back in a—in a real way. That’s great to hear. Thank you so much for sharing that, I appreciate it. Dr. Michael Michelli, once again, from Brandywine Hearing Center. Um, as we say in the news biz: “Now hear this!”
Dr. Michael Michelli: That’s right!
Peter MacArthur: So, uh, thank you so much for coming in. We’ll talk again soon, and for you listening at home, by all means, uh, check out their website and give them a call, and get yourself up to speed on where your hearing is at.