BackTable / ENT / Podcast / Episode #29
Improving Access to Hearing Care Services
with Dr. Carrie Nieman
We talk with Dr. Carrie Nieman about improving hearing health disparities among older adults, particularly among vulnerable populations. Her practice and research focuses on an innovative, community-delivered approach to affordable, accessible hearing care.
BackTable, LLC (Producer). (2021, August 17). Ep. 29 – Improving Access to Hearing Care Services [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Carrie Nieman
Dr. Nieman is an Associate Professor in the Division of Otology, Neurotology and Skull Base surgery in the Johns Hopkins Department of Otolaryngology-Head and Neck Surgery.
Dr. Gopi Shah
Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode of BackTable ENT, Dr. Mark Williams joins Dr. Gopi Shah and Dr. Ashley Agan to discuss various diagnoses for voice problems, treatment options, and special considerations for treating singers.
Dr. Williams always begins a workup by taking a full history which includes questions about patterns in voice changes and pain. These questions help specify the type of voice change beyond the umbrella term of “hoarseness.” He describes the differences between examinations with a rigid laryngoscope, a flexible fiberoptic laryngoscope, and videostroboscopy (allows for observation of vocal fold vibration). He also performs laryngeal palpation to check for muscle tension dysphonia.
When discussing treatment, Dr. Williams speaks about the importance of getting allergies under control, to allow patients the best quality of voice possible. He prefers nasal steroid sprays over antihistamines. Dr. Williams also describes indications for microlaryngeal surgery, such as polyps and cysts. Dr. Williams notes that voice problems may have an underlying cause that is hidden by compensatory behaviors, which end up causing more issues than the original pathology. In these instances, voice therapy can help break harmful habits. Finally, by merging his experience as an otolaryngologist and a gospel singer, he shares insights on counseling singers about steroid shots, vocal hygiene, and voice rest.
Dr. Williams’ Website: https://www.drmarkwill.com/medicine/
[Carrie Nieman MD]
When I think about what is equitable, I am thinking about it as a gerontologist in terms of what are those big picture things that matter in terms of, "Am I helping older adults engage in their life or stay engaged, and do what they want and need to do on a daily basis? Is the device the most perfect setting and fit for them? Maybe, maybe not, but if it is a tool that enables them to stay connected, to stay engaged, to do those big picture things that matter to them and matter to aging well, then I think that is the success.
And I think that's what equitable hearing care needs to look like. And so, I think that's also the tension between thinking about things from a two-medical perspective versus a public health and person driven perspective. We do not, for example, in the HEARS randomized controlled trial, our primary endpoint is not number of devices fit or number of how much they gained from their devices, they are things like communication function, social isolation, depression, those are the outcomes that we're looking at that matter.
So, I think that shift and perspective and focus of, "What is the big picture? Why do we do what we do? Why do we want to provide the care we think everybody should and have access to?" So, I think that's a big part of it as well.
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