Introducing: Spotlights from SHOW, a new series sharing narratives from researchers working with the Survey of the Health of Wisconsin. We dive into personal and professional stories from our team and the investigators we work with. Each person brings their own experiences, interests, and motivations to the work. Together, we want to improve health in Wisconsin, one survey at a time.
Lauren Dillard is a clinical audiologist and epidemiologist who works with SHOW as a member of the data team. Her research focuses on the epidemiology of hearing loss and its treatment with hearing aids. Clinical audiology covers the diagnosis and treatment of hearing loss.
Lauren’s focus on audiology came naturally to her as she grew up in a home with two deaf parents. She says watching her parents interact with the world got her thinking about how she could understand and work with this population and help make things easier for them.
“One thing that’s particularly interesting about hearing loss is that it’s an invisible disability, so it’s often not readily seen by others but can have potential impacts throughout the lifespan. In children, it can impact learning and language development, and in adults, it’s been associated with several other negative health consequences and poorer quality of life.”
Lauren got into the field of audiology and completed her clinical degree, “I then started thinking a little bit more broadly on how to address hearing losses on more of a population health level. So after I did my clinical degree, I went back to do my Masters in Population Health and then my Ph.D. in Communication Sciences & Disorders,” she says.
“I think Audiology and Epidemiology is a really interesting combination of fields and it’s largely understudied, but there’s really a place for approaching hearing loss from a public health perspective.”
Several years ago, Lauren spent a summer in Cape Town, South Africa, and learned about connections between hearing loss and infectious disease which further inspired her pursuit of a Ph.D. focused on the epidemiology of hearing loss. In Cape Town, she learned more about addressing hearing loss using public health approaches, including prioritizing community outreach and also learned more about possibilities for hearing loss prevention given associations with infectious disease.
Over the past few years, Lauren has been able to work with the World Health Organization (WHO), which she says has been “really amazing”. She’s been able to work on several projects related to ‘ototoxicity’ (toxicity in the ear), which can be caused by the drugs that are necessary to treat diseases like multidrug-resistant tuberculosis and malaria. She says hearing loss is a largely overlooked global public health problem and that “hearing loss is also linked, particularly in kids, to other conditions including meningitis, and maternal rubella. It’s interesting to think about public health audiology and how we can prevent hearing by considering more upstream interventions.” She believes that the prevention of hearing loss should be a priority in global and public health. A focus on hearing loss prevention may help address other global health issues as well.
While studying for her Ph.D. at the University of Wisconsin- Madison, Lauren has been part of the SHOW data team. About her experience with SHOW, she says, “one of the really amazing things about SHOW is the focus on the social determinants of health (SDoH) and how we can provide more equitable access to services. This model really applies to people with hearing loss, so hearing loss research focusing on SDoH is actually really relevant. We often think about hearing loss as something that’s really niche and specific, but hearing loss prevalence is actually around 30% across everyone ages 30-74 based on self-reporting.”
This is often a very overlooked condition, but it’s very prevalent.
As an underserved population that could benefit from programs, Lauren believes the hearing loss community deserves a focus on prevention and education about risk factors. “Hearing loss affects a lot of people in the population and is so prevalent in aging that most people within their lives will experience hearing loss”, says Lauren.
Lauren and co-authors have recently published an article using SHOW data in the Journal of Speech, Language and Hearing Research titled Prevalence of self-reported hearing loss and associated risk factors: Findings from the Survey of the Health of Wisconsin. This article focuses on identifying risk factors for hearing loss in SHOW participants. Information on risk factors for hearing loss is important to inform public health interventions focused on hearing loss prevention. Early results from a second ongoing project have shown that hearing loss was associated with poorer perceived access, timeliness, satisfaction, and quality of health care. These findings indicate it is important to consider individuals with hearing loss when thinking about health care delivery and quality.
“When you have hearing loss, it’s likely going to impact your communication in some way with your provider,” she says. “You may miss part of what’s being said and you may rely on other communication cues that not everybody has when they’re not used to talking to people with hearing loss. Poorer communication with providers can potentially lead to a poorer understanding of the health messages that are being relayed to the patient, and may result in potentially poorer satisfaction with and access to health care.” This study only looks at self-reported hearing loss and health care outcomes. It does not assess the quality of interactions, but it found associations with all of these healthcare quality metrics and health outcomes.
What are the implications?
For providers, “this population exists even if it’s not easy to tell.” Unless patients are wearing hearing aids or have been formally diagnosed with hearing loss, providers may not know if someone has hearing loss, as many people compensate well. Lauren suggests training providers to recognize subtle signs of hearing loss. In addition, sharing communication tips for conveying information to people with hearing loss and tips on referring patients to see a hearing specialist would also help.
For researchers, Lauren says, “hearing is an important part of public health with many downstream impacts on overall health.” Hearing loss research is an impactful element in the Social Determinants of Health, quality of life, and healthcare access.
For those struggling with hearing loss, Lauren says “patients have some responsibility to advocate for themselves, especially as most people can’t tell from the outside when someone is experiencing hearing loss.” Tell your clinician and staff that you’re having a hard time.
There are services available to address hearing loss, such as use of hearing aids and/or using strategies to improve communication. Lauren recommends having a conversation with your health care provider and/or audiologist to discuss ways to compensate for hearing loss.
These issues have likely worsened in the time of COVID. Masks are important, but they can make communication much harder for people with hearing loss.
Hearing loss is a very prevalent condition, so most people know someone with hearing loss. Tips for making communication easier include speaking more clearly, enunciating your words, and looking directly at them when you speak as many people with hearing loss rely on lip-reading.
Lauren recently graduated and will be moving on from SHOW, starting a Postdoc position at the Medical University of South Carolina to continue to work on epidemiological hearing loss research. She’ll also continue to work with WHO and other initiatives on public health and hearing loss. “Hopefully, these research findings can translate to something meaningful that will impact people,” she says.
Lauren says the main takeaway is that “hearing loss is an important issue that is highly prevalent and has a large impact on people and deserves more attention and awareness. We have an aging population, hearing loss is associated with age, so we’re going to keep seeing this, it’s not going away without being addressed. We need to learn how to respond to it.”