Hearing Loss

Linda: 00:00

Welcome to the Talking Total Farmer Health podcast from AgriSafe Network. At AgriSafe, we work to protect the people that feed the world by supporting the health and safety professionals, ensuring access to preventative services for farm families and the agricultural community.

Linda: 00:21

Oh the month of May, so much to love about this month – new life, new growth, and new possibilities. For many of our agricultural producers, springtime work is well under way, so this is the perfect time to talk about better hearing and speech. Better Hearing and Speech month is observed in the month of May, so today we’re going to talk about hearing loss, what it’s like, and most importantly, how to prevent it.

Linda: 00:48

I have the privilege of talking to a hearing expert, and we know that hearing conservation is very important in agriculture. So, Jan, go ahead and introduce yourself, your title and share with us the type of work that you do.

Jan: 01:00

My name is Jan Moore and I'm a professor of audiology at the University of Nebraska and Kearney.

Linda: 01:07

Great. What led you to that work?

Jan: 01:09

Well, I have a deaf cousin and I also had five deaf children in my first job as a speech language pathologist. So that led me to a long career in childhood deafness before I moved to Nebraska.

Linda: 01:25

Awesome. Yeah, you're not quite Nebraska. And I can pick up just a little bit of that, which is always fun to try to interpret people's dialects. I'm assuming there's a little Southern something there.

Jan: 01:34

I'm a native Arkansan, but my father was in the military and so we moved around quite a bit. And I was fortunate enough to live in Hawaii as a child for three years and also as an adult. I moved to Canada and lived and worked in Canada for seven years. Wow.

Linda: 01:53

So communication and speech has to be I think it's interesting, but for someone that's moved around and trying to interpret how we communicate and culture, slang, all of that, how that fits into our daily lives. So how many farmers and we think about hearing conservation, how many farmers in farm workers in the US would you estimate have hearing loss?

Jan: 02:15

Well, certainly all farmers and ranchers are at risk for hearing loss due to their exposures, to noises and chemicals and solvents on their farm. And as we age, everyone does start to lose their hearing. And if you're already been exposed and already have a hearing loss, then that becomes more accelerated as we age. So I would think that most farmers that I meet and test tell me that they have a hearing loss. They don't often know the severity of their hearing loss, but they often say, Oh, I'm sure I have a hearing loss. So it's very endemic in the occupation.

Linda: 02:51

Right. We know we have work to do as a producer. We know we have work to do. And a lot of times that work is so diverse as the day goes on and don't always have. We know we maybe should be protecting our hearing, but do we actually do it? You shared with me earlier an analogy about a sunburn and how that sets you up maybe potentially for a lifetime of skin diseases. So share that in relation to hearing loss.

Jan: 03:10

Well, certainly when most of us go to our family doctor, we may have been asked at some point in time whether we've had a severe sunburn where we are skin, blister or something. And certainly that happened to me when I was a youngster. But that sets you up for being at risk for skin cancer many years after you had that sunburn. So even though your sunburn healed and your skin healed, that damage is done and set you up for risk, as I mentioned before. And the same thing is true about exposures to noises, loud noises and concerts, even your church service, or using firearms. Those noises, even as a youngster, caused damage in your inner ear and auditory nerve. And that sets you up for hearing loss to be more accelerated as you age or to appear even in your fifties prior to where normal aging hearing loss kind of kicks in.

Linda: 04:12

Right. Right. I know in this study, one of the questions that you asked, “How old were you when you started in agriculture?”

Jan: 04:18

Right. So in my research study, where I'm looking at aging in farmers and ranchers in Nebraska, I do ask all of the participants, “how old were you when you started working on a farm or and did your parents or grandparents have a farm that you worked on? And at what age did you start?” So all of nearly all of the participants have said that they started before the age of ten. And so the children are being exposed to really loud noises and other chemicals very, very early on. And we need to address prevention of hearing loss, certainly with our kids, as well as younger adults and older adults.

Linda: 04:52

Exactly. Who would have thought that what you listen to when you were young and we know agriculture has changed, of course, it keeps changing right then I think about last ten years how many changes have happened. So, hopefully as time continues on, we get smarter, research brings us more information. But for those in the average age of the farmers, 58, something like that. So you think about 40 years ago what it was like. Working in agriculture and the different types of noises that they were exposed to.

Jan: 05:17

Right. Because certainly the equipment we use now, or at least the tractors and combines are safer in terms of noise for farmers now because they're closed. And so that's a positive thing and certainly light years better than what my grandfather had in Arkansas when I was growing up with an open tractor.

Linda: 05:36

I think about some of the, and when I say farmers, especially the older ones, we think about the males because they were traditionally ones that were climbing on the tractors. Not always, but sometimes I notice farmers, when I'm talking to them, they'll turn their head and put their hand behind that one ear. What's going on there?

Jan: 05:51

Well, if they're putting their hand by their ear, actually, I'll do that, too, especially in noisy environments. That's actually just making your essentially your ear bigger. And so it'll capture more sound, funnel into your ear canal. And then they have ears that are not symmetrical in terms of their hearing loss, they may have a better ear. So certainly people who use firearms for hunting, often we'll have one ear that is worse than the other ear depending on the type of gun they have and actually even how they orient their head when they shoot. A lot of people don't have symmetrical hearing losses.

Linda: 06:25

Right. Right. I think about the farmers that when they are pulling and implement behind them, they tend to turn over that one shoulder the whole time.

Jan: 06:32

The ear that's exposed to the source of noise in either the engine of the tractor is going to have likely more hearing loss than the other ear.

Linda: 06:41

So. Exactly. So I think that sometimes, too, that they tend to when they want to listen to private conversations or conversations in general, they're going to put their hand to the ear that's the good ear. They always say, “speak into my good ear.”

Jan: 06:51

Yeah, right.

Linda: 06:52

What does hearing loss sound like? And are there stages and levels of hearing loss?

Jan: 06:57

Right, when we will when an audiologist tests your hearing, we look at different frequencies from pretty low, like at 500 hertz, which is about like middle C, up to 8000 hertz. Certainly as in human hearing, we hear way higher than that. We hear different kinds of musical instruments that are really high pitched. But in terms of communication, in terms of speech and language, there's this frequency range between 250 hertz to 8000 hertz where all the speech sounds are.

Jan: 07:28

So when farmers and ranchers and other people exposed to noise will often develop a characteristic dip in the high frequencies, and they may recover a little bit, but there's sometimes a little dip in hearing, and then that makes consonant sounds a lot harder to hear. So vowel sounds are loud and they're longer and they're low frequency. So most people will recognize an “Oh” or an “Ah”, but what they'll have trouble with is a “tss,” “th,” “fh”. Which you probably maybe didn't hear the “F” or “TH” in there at the end, but those are super high frequency consonants that are harder to hear and very, very, very soft and very high frequency. So those are the things that people miss. And so they'll get kind of part of the of the signal and have to kind of use their brain to fill in the missing pieces of speech. And so sometimes, though, you make a mistake and then you misinterpret it. Someone says, because of you just may not be accurate in your guess of filling in that missing information.

Linda: 08:31

Oh yeah. I can think of many conversations I've observed or been involved in where people didn't pick up, and then there's that misinterpretation,

Jan: 08:40

Right!

Linda: 08:40

And then the communication changes.

Jan: 08:42

Right!

Jan: 08:43

So some people will become more withdrawn from conversation when they have a hearing loss because it is difficult to listen and they don't like making mistakes. It makes them maybe embarrassed. So you will see people kind of withdraw from that kind of interaction with their spouse or their grandchildren or whatever. And then you have other people who actually talk all the time and they talk all the time because then they're not having to listen. So they dominate the conversation so they don't really have to kind of listen or the listening is hard, so they kind of take over.

Jan: 09:18

So those are kind of two polar ends of how people sometimes respond to their hearing loss in terms of conversation with other people. But both of those things aren't healthy in terms of communication with people. People with hearing loss also have usually better communication or better understanding and flow of their conversation when it's in a quiet environment with one other person. And when people are in more what we call adverse listening environments that could be in a restaurant, it could be at their church. It could be at their veteran's group or whatever groups they happen to belong to. Those environments are harder because there are multiple speakers and there's sources of noise that so the desired signal that you want to pay attention to, sometimes there's a lot of noise around that, so it takes a lot of concentration and listening to converse in those environments.

Linda: 10:14

And as we know that if you can't communicate, you feel like your voice is not being heard or you can't participate in a conversation. They tend to pull themselves out. And then there's an effect on our mental health and well-being, right?

Jan: 10:24

Then you become more socially isolated and maybe have a lot of anxiety about your your ability to communicate and become depressed and withdrawn. So all of those things happen. For people with hearing loss and those things happen for people who are also just aging because other things are changing too, our vision is changing or our ability to walk is changing or balance is changing. So we have all kinds of systems in our body as we're aging that can cause problems for people and so can make you isolated. There comes a time when most people have to stop driving, and then that is another isolating event. So if we can keep people's primary senses the best they can be their vision, their hearing and their tactile sense. Then they can age better and be more independent and function better.

Linda: 11:16

Live a fulfilling life that they envision themselves to live. So you've talked a lot about it's just not hearing loss. There are so many other ripple effects that happen because of hearing loss. How does hearing loss affect family relationships?

Jan: 11:29

Well. Certainly it's critical for communication. And obviously, if there's a lot of disruption in your conversation flow with your spouse or your children, that becomes frustrating. People get irritated, in terms of having to repeat a lot or the other person has to say, I didn't understand you a lot. And so that causes a lot of stress, and some people, again, will actually isolate the person with the hearing loss from decisions in their family or from interactions with, say, grandchildren, just because it's so stressful. Having a hearing loss and having these communication breakdowns increases stress and and as I said, maladaptive behaviors, either withdrawal or dominating conversations. Obviously, it's not healthy for your relationship and also your mental status.

Linda: 12:22

Exactly. Exactly. And I think we kind of forget how important our mental health or physical health and spiritual health all intertwined.

Jan: 12:27

Right. Right. And I think a lot of times, especially as we're getting as people are getting older, I'm getting older, too. You know, we forget that we really, to enhance communication, especially with people with hearing loss, you need to see them. I mean, so visual cues that you can have so that if the person is within six feet of you, then they're going to hear you better and see you better. And so then that helps. So talking to your spouse from the kitchen with the dishwasher on is not a good strategy. So but it takes a lot of effort and and self-awareness for people to change those communication habits that we, we all develop over time in terms of trying to talk from another room or walking away or not having the light on because visual cues are really important for conversation. I think we've learned a lot about that during COVID because we all had to be wearing a mask for so long that I think people have become more aware of how much the visual cues on your face and lips help with communication, for sure.

Linda: 13:35

For sure. And when I think about agriculture and the communication that has to happen in agriculture, because there's definitely some work that they do, is very dangerous. And when you were talking about the noise of the dishwasher, I'm thinking about the noise in a cattle yard. So farmers and ranchers are out there working cattle. There's a lot of noise because those cattle are being moved around and they're feeling uneasy. So what are some solutions maybe to help with communication if there are farmers that are shouting across the yard and they can't be heard, what are some things that they could maybe some preventative strategies that they could do ahead of time so that everybody stays safe and understands what the goal is? Where are we going with this cattle, that type of thing?

Jan: 14:15

Well I guess I don't have a lot of experience with cattle, cattle and cattle yards, but certainly just having a plan ahead of time that everybody at least knows the plan before people separate out so they know what to expect. And then maybe some emergency hand signals would be good things to implement in that kind of environment. I know this is a little off topic, but in the Northwest and the sawmills for they have a whole sign language system that they use in sawmills that to keep their workers safe and so people can communicate. So it might be a good thing to implement some basic signals, hand signals for people to recognize when there's something awry that we need to, you know, a danger point that that needs to be taken care of.

Linda: 15:02

Everybody's interpretation and how they deliver those hand signals is different. Oh yeah.

Jan: 15:06

That’s true.

Linda: 15:10

When I do green carding for when during harvest in the signals my husband gives me through the window. I don't know what you're trying to tell me.

Jan: 15:18

Right, right.

Linda: 15:19

And it could lead to a very dangerous situation.

Jan: 15:20

Yes, quickly.

Linda: 15:21

How can farm workers protect themselves to prevent further hearing loss? You talked about how you when you're young, you can set yourself up. And I've also been in conversation with farmers and they maybe have two generations around them and they're coming through farm shows and we talk about hearing loss. And those old guys will step back and say, Oh, my hearing's gone. It's not worth saving anymore. And they'll push the young one up. So what what are some suggestions there for the older farmer who may have some hearing loss, as well as the young ones that don't know that they have hearing loss?

Jan: 15:49

Right. Well, certainly you can continue to lose hearing. So it's always good to protect your hearing that you have left and either using proper your muffs or plugs would be helpful for everyone, of course. And then. But certainly younger farmers. This is just anecdotal evidence but. My students at UNC often marry young farmers. And so and they they report to me that their husbands are using more hearing protection because they see what has happened to their father or their grandfather in terms of their hearing. So maybe our younger generation is is taking more preventative measures to help maintain the hearing that they have. So I think that's a good step. And that's I was hopeful with that statement, and that has happened numerous times. So I'm hoping that's true across the board for younger farmers. So but certainly everyone should be fitted with or know how to insert hearing protection, their earplugs properly. There are some little tricks to that in terms of getting the plug in and holding it while it expands with your finger, while it expands in their ear. And then and also getting proper muffs for both their constant work. And then there are muffs that you can use while you're hunting, that you can still hear while you're walking or looking for game. And but then we'll the filters of the muffs will shut down when you engage your gun. So so that's all kinds of different options out there depending on your circumstance.

Linda: 17:17

So what's some advice? Because farmers, a lot of them know they should be using PPE, but they don't always use PPE. So what are some of the reasons why farmers don't use PPE and how could they work through that to come up with a solution.

Jan: 17:34

I think. Probably some reasons is they think, oh, well, I'm only going to be out here a few minutes next to the auger or whatever the sorts of noise is. I would think that if you're already wearing other kinds of PPE, either respirators or gloves or whatever, that sometimes getting the foam, hearing protection in your ear when you when you've got to take off gloves is just too many steps involved for them. And they it's not worth it. I've got my respirator on for the grain dust, but I'll just let the hearing part go. So I think I think sometimes just getting the kind of hearing protection that you will use and that is easy to put on quickly is the best advice I would give people.

Linda: 18:19

And have it available.

Jan: 18:20

And have it available at the source. That's noise. So you may not need it inside your your combine, but you may need it next to your grain bin. So.

Linda: 18:29

Exactly. Exactly. And that because we know that farmers are not going to travel about five miles from the field to the farm shop to go grab the PPE. So possibly keep it inside the cab. My guys will keep a box of respirators inside their truck.

Jan: 18:43

That sounds like a great idea. Keep it in your cab.

Linda: 18:47

That's right. Just keep it right. And then to keep multiple pairs, because we know that farmer's hands are traditionally dirty. And so not a great idea to use the roll down earplugs with dirty hands and then shove that inside an ear.

Jan: 19:00

Right. I wouldn't recommend that. And also, if your children are working with you on your farm, they need hearing protection, too. And because children's ears are not adult ears and there's still their frequency response is different in terms of kind of what they hear. And we just don't know enough about what happens when kids get exposed, when they're really, really young. So it's really important for kids to have hearing protection.

Linda: 19:25

It is. It is. We cannot forget about those little ones. What are some current projects? Maybe some things we haven't thought about that could be related to hearing loss? So share about your work and then also about what ototoxicity is.

Jan: 19:38

So everyone knows from probably health class, we have the cartilage out here - that is your outer ear. And your ear canal is part of your outer ear. The middle ear has the bones that transfer sound across an air filled space. And then your inner ear is where all the nerves and cells, sensory cells for hearing are. And ototoxicity affects the inner ear and it affects the sensory cells and/or the auditory nerve and so. You may have different types of drugs that you take that could contribute to ototoxicity. But for example, there are different chemo, chemotherapy, drugs that will impact your hearing. And but certainly if you're taking medication, there's going to be a warning in your medication. But most most drugs that we take for everyday. Maintenance of our health are not ototoxic. If you have again, if you've had chemotherapy, that may be ototoxic, if you've had intravenous antibiotics for some sort of severe infection, that could be more likely ototoxic. But essentially, these drugs impact either inner hair cells, outer hair cells or the auditory nerve. So and that will happen over time, depending on the dose of your the drugs that you have and excuse me, how long you have to use them.

Linda: 20:54

Exactly the chemicals that farmers work around, those can be oto. And this is just early stages. But, you know, farmers are supposed to read those safety data sheets, but how many of them actually sit down to do them is is interesting question

Jan: 21:08

Right. There's a series of of chemicals and also petroleum solvents that are also ototoxic. So you can inhale those fumes. They may be transmitted through your skin that would interact with your hearing mechanism. And then if you're around noise at the same time, it's kind of enhances the damage to your hearing. So we just need for farmers to understand what precautions they need to use when they're around different kinds of solvents and or chemicals on their farm, because these these chemicals also cause other neurodegenerative diseases. For example, Parkinson's disease is like seven times more likely in an agricultural worker than a person who is in the regular population who doesn't work on the farm. So there certainly is long-term kind of consequences. It doesn't happen with one dose. It happens through long-term, long exposures of these chemicals and drugs.

Linda: 22:12

Know the label, the label is law. Understand what you're working with and then use the proper PPE to protect yourself, because we know these chemicals and solvents are useful and helpful to the work of farmers and ranchers. So it's just knowing how to correctly handle apply them. Yeah. So tell me about your research that you've done.

Jan: 22:29

So for the last few years, I've been working on a study that looks at aging and hearing loss, the degree of hearing loss so mild to profound and also cognitive skills like solving puzzles, doing computer games, memory, what we call executive functioning. That means making a plan and following through plan. Some of the skills that we test are pencil and paper tasks, like drawing a cube or drawing the face of a clock. So all of these skills can change over time. As we get older, we're not as fast and we're not as accurate on these kinds of thinking games. But what we don't know is if a person who's been a farmer or a rancher and has had a hearing loss for most of their adult life, that as they age and get above the age of 50, whether their patterns on these types of thinking games is different than some person who's a city dweller. So we have a lot of data on aging from a long term longitudinal study from Johns Hopkins University. And so we're using that as our kind of our blueprint of our study. And we're looking at farmers and ranchers and just to see, okay, maybe our farmers and ranchers have the same kind of pattern of aging as we see in previous work.

Jan: 23:59

Maybe farmers and ranchers who have hearing loss have compensated for their hearing loss in their younger age. And so they're actually better at these tasks than the normal, normal aging population, or they could be worse. And right now we don't know because we're just getting going with our study because, of course, all of our research activities shut down for two years. And now that we're back and running again, we're looking for farmers over the age of 50. We also want to look at women, female farmers, both primary operators and secondary operators on farms. And we're interested in an independent farmers and ranchers because you are not obligated by your employer because your self-employed to use hearing protection.

Jan: 24:41

I'm trying to find farmers and ranchers around the Kearney area mostly. But we'll we will travel and to test their hearing and and do these thinking tasks with them. Some of the things can be done on a computer if they're comfortable with that. And but I have to test your hearing face-to-face.

Linda: 24:58

Right. It would be very interesting to see the relationship that might appear or not appear.

Jan: 25:04

We just we just don't know what the relationship is. But it is I think it's a very important question to ask, because most of our independent farmers and ranchers work well into their seventies. And when you have hearing loss, you also often have balance issues with that. So hearing loss, preventing hearing loss or preventing it from getting worse helps keep you safer on your farm, helps with communication, helps with thinking and problem solving, and helps in many, many domains. So we just don't understand all of those relationships yet.

Linda: 25:37

That's exciting. Work right around the corner.

Jan: 25:40

I hope so. I'm enjoying it so far.

Linda: 25:43

Awesome. So you've given me great information. Is there anything else that you would like to add?

Jan: 25:48

I would say that if you think you have a hearing loss, you can get your hearing tested at UNK or at the University of Nebraska Lincoln Center at the Barclays Center. And so it's good to know if you have a hearing loss. And then what I always recommend is people get two or three annual tests and then if your hearing loss is stable, then you can just kind of let that go until unless you recognize that you think something has changed. But it's good to get a baseline, especially as a farmer, to get a baseline hearing test in your forties or fifties, for sure.

Linda: 26:22

Great advice. Great advice. So this has been a lot of fun to visit with you today. Jan, I appreciate your time. Thank you.

Jan: 26:27

Thank you.

Linda: 26:32

Okay listeners, I hope you picked up on some helpful tips on how to protect your better hearing and speech. This episode was created by AgriSafe Network, directed by Laura Siegel, hosted by Linda Emanuel, edited by Matt McKenney for ProPodcastingServices.com, with special guest Jan Moore.