Coming up on the 40s Formula. Hearing loss is
a risk factor for dementia. There's a condition
called sudden hearing loss and this is considered
a medical emergency. Anything that affects your
calcium metabolism or the blood flow to your
ear can contribute to that. So I always say to
people who have this that they should check.
The auditory pathway from the ear all the way
up to the brain has oestrogen and progesterone
receptors in it. We have seen that post -menopause
there is a drop generally in women's hearing.
I have even seen a patient who had this tickling
feeling in their ear and when I looked in there
they had a tiny spider. Oh my god. Dr. Rebecca
Hayward is a UK -trained ENT specialist with
over 25 years of experience. Rebecca specializes
in otology, the medical and surgical treatment
of ear, hearing, and balance disorders, and is
passionate about helping patients with hearing
loss to reconnect with people and sounds that
matter most. The 40s Formula. The 40s Formula.
The 40s Formula. Hosted by Jasmine Dillon, integrated
health strategist specializing in gut health,
hormones, and midlife well -being. and Amanda
Lim, Director of Lift Clinic and a leading expert
in female strength and metabolism. Name one of
CNA's top podcasts and winner of the 2025 Asia
Podcast Awards in the Best Health and Wellness
Podcast category. The 40s Formula is your no
-fluff, science -meets -real -life guide to thriving
in your 40s. Most of us take our hearing and
balance for granted until something goes wrong.
In our 40s, we start noticing little changes.
Maybe we keep turning the volume on the TV up,
we feel a bit dizzy getting out of bed, or we
catch ourselves saying, pardon, more than we'd
like. But here's the thing, these changes aren't
just inconveniences. They can affect our confidence,
our relationships, and even our brain health.
Today, we're tuning in literally to a part of
midlife health that rarely gets a spotlight,
our ears. So if you've ever wondered why sometimes
you feel a little bit off balance, or if hearing
loss really matters beyond just a few words,
you'll want to listen to this one closely. And
if you feel more clear -headed after this episode,
why not share it with a friend or subscribe to
The 40s Formula for more cutting -edge conversations
helping your health. Hi, Rebecca. Thank you for
joining us today. We're really, really excited
to have you here to talk about hearing and balance.
Thank you so much for having me. It's a pleasure
to be here. Thank you. When we hit our 40s, we
start to notice that certain things don't feel
quite like they used to when we were in our 20s.
Your eyesight goes a bit blurry. Your joints
are a little bit creaky. But what are the first
signs that we notice that our hearing isn't quite
right? Hearing is such a precious sense and one
of these things that really we only notice the
benefit of when it starts to go. Now, the 40s
and 50s are a time when age -related hearing
loss starts to affect us. So age -related hearing
loss tends to affect the high frequencies. And
what people may notice, first of all, is that
they can't hear very well in certain environments.
So a common misconception is that when you've
got hearing loss, you can't hear people talking.
And actually you can hear people talking, but
you just can't catch what they say. So you may
notice for people in work, for example, if they're
in a boardroom, they may not be able to hear
people at the other end of the table. For people
who work in an open plan office, they may not
be able to catch what people say at certain times,
particularly if it's a bit noisy. For people
in jobs who have a lot of social commitments
and they're going to restaurants, they're going
to bars, they may not be able to catch what people
say. So it's that real sort of... straining to
hear like what did that person say you know and
having to ask people to repeat oh god having
to turn the tv up louder tinnitus is another
symptom of early hearing loss so tinnitus is
a buzzing or humming or hissing noise in the
ear there are many different noises that you
can hear and That can come for many reasons,
but hearing loss is certainly one of the most
common. You're scaring me now because every now
and again I get this weird sensation like there's,
I don't know, an insect like, like flapping its
wings like really fast near my ear. And I'm like,
oh, what was that? And I kind of, I don't know.
I'm just like, oh, you know, was there an insect
or, you know, like what's going on? Probably
not. Get your ears looked at. I definitely need
to go do that. Right. So. What would you say?
Obviously, the buzzing, the tinnitus, that's
something that we need to take into consideration.
What other signs should we never avoid? If I
just explain how our ear works briefly, sound
is conducted along the ear canal to the eardrum,
and then it passes through three small bones
called ossicles, and then it's transmitted into
the inner ear, which is called the cochlea. Now,
the cochlea is an amazing organ. It turns the
mechanical sound energy into an electrical signal.
which then goes up to the brain. And that's where
we actually hear the sound. So the ear is just
the way that the body gets the sound to the brain.
And then the brain is where we hear the sound.
There's a condition called sudden hearing loss.
This can happen in any part of the hearing pathway.
So it may be that your ear is just blocked with
wax. It may be that you've got fluid behind your
eardrum because of a cold, for example. But there
is in a small... number of people a condition
where you get sudden hearing loss of the inner
ear. And this is considered a medical emergency.
So there's a lot of evidence now showing that
the sooner this is treated, the better. And we're
talking about within 24 to 72 hours. So if you
notice a sudden deterioration in your hearing,
if you notice a sudden blockage in your ear,
then you should go to a doctor, maybe to an emergency
department. um and get your ears checked and
hopefully get a hearing test within the the next
24 to 48 hours is that something more common
as we age that the potential of sudden hearing
loss yes so you said um like a sudden blockage
in the ear now could that just be like a build
-up of wax like how would you be able to tell
the difference of like this is an emergency situation
as opposed to oh you've just you know not cleaned
your ears in a while Yes, so we could talk about
cleaning your ears in a while. So you can't,
you can't tell. You have to go and get someone
to have a look. So we need someone who can look
into your ear and see if there's a physical blockage,
look at your eardrum and see if there's anything
behind it. You can get a doctor to do some tests
on your ears with tuning forks, but ideally you
want to get a hearing test done, right? Is that
that thing that you sort of bang together and
you're going to hear the... Yes, that's right.
With hearing loss, is it a gradual thing? Because
I'm just wondering, are we meant to have perfect
hearing up until we die? Or, you know, will there
come a time where, you know... Is it like eyesight?
Yeah. You need glasses at a certain point. Yeah.
It's a gradual thing. So this is why hearing
loss is often missed because the onset is so
insidious. So hearing loss can occur at any age.
It can be present at birth. It can come on during
childhood, any age up to elderly. Age -related
hearing loss is something that comes on very,
very gradually. And so people don't notice that
they can't hear things anymore. And often when
people get treated, they suddenly realise, actually,
they haven't heard the birds for a long time.
Actually, they haven't heard the tap dripping
for a long time. That's probably a good thing.
Actually, they haven't heard the car indicator
for a long time, right? So these kinds of small
noises and they become, they zone out so quickly.
that people don't notice that they're missing
them. In answer to your earlier question, it
is expected that our hearing will deteriorate
over the lifespan due to a number of insults.
So noise, medications, anything that affects
our vascular system. So diabetes, high blood
pressure, cardiovascular risk factors are also
risk factors for hearing loss. Yeah, so we would
expect nearly everyone to develop some hearing
loss as they age. But the thing that we want
to get away from is people thinking that because
it's normal to have a bit of hearing loss as
you age, that you shouldn't treat it. So just
as people in their 40s, for example, may start
to need reading glasses, everyone goes to get
reading glasses, but they start to get a bit
of hearing loss and they ignore it. And that's
what, as a hearing professional, we're trying
to encourage people, once they start noticing
those signs, go and get them treated. Just because
it happens to many people doesn't mean that it's
something that you should ignore. It's funny
you mentioned the car indicator because that
just reminds me, like when I'm driving, you know,
I'll see someone whose indicator is just on and
I'm like giving them way. They're not moving.
And I'm like, what are they doing? doing? You
know, like why are they not moving? But it could
just be as simple as they just can't hear the
indicator. That's so interesting. I think that
is a common one for old people. I feel like that's
an old people driving trope, but that is kind
of also true. And, you know, thinking about old
people, you mentioned, you know, getting, acknowledging
your hearing loss when it starts to happen. My
dad was in a rock and roll band from age 15 to
present. Like he still plays rock and roll. He's
76. blasting amps, incredible noise, crowds all
the time, late into the night, all the things.
And yet he resisted acknowledging his hearing
loss. What are some ways that you could have
a conversation with a loved one that isn't ready
to acknowledge their hearing loss, but to encourage
them to at least get a screening? It can be difficult
to talk to loved ones about possible hearing
loss. I think really the thing is letting them
know that you're on their side. letting them
know that there is help out there. So people
are scared when they have hearing loss. They
don't want to acknowledge it. People think that
hearing loss means they're old. That is exactly
verbatim his issue. Sorry, dad, but it's true.
And what I have found and what I always say to
my patients is that actually it's the hearing
loss that makes you feel old. and the sequelae
of the hearing loss that makes you feel old.
It's not the devices. So there's a real stigma
still around wearing hearing aids, unfortunately.
So people will get to their 40s, they get their
reading glasses, but they start to get slight
hearing decline and they resist getting hearing
devices. And certainly for cochlear implants,
which is one of the devices that I put in surgically
to address severer hearing losses, there's evidence
that people wait on average 10 years after the
time that they could benefit from getting a cochlear
implant to when they actually get one. Wow, that's
a long time of not being able to hear things.
Yes, so there's a lot of resistance to getting
devices. But so many patients come and tell me
that when they get hearing aids, they realise
that it was the sequelae of the hearing loss
itself that made them feel old. It's not wearing
the hearing aids. So I think really, being understanding
and explaining to them that this is not just
not being able to hear a few words, but it actually
has a big impact on your life. It has a big impact
on your family. So as a loved one as well, some
people, they start to feel a bit of resentment
because they may, when they're going out with
people, they find themselves translating, right?
So they're repeating what was said to their loved
one who can't hear so well. They don't want their
loved one to feel stupid or to look silly in
front of people when they reply to a question,
which is not the one that was asked. So they'll
help them along with these kinds of things. And
so there's a big social burden as well for people
with hearing loss. So you've mentioned now that,
you know, your vascular system can affect your
hearing. And you now also mentioned that sort
of, you know, family relationships, like what
else can affect quality of life then when your
hearing isn't optimised? What other ways is your
quality of life affected? Yeah, so hearing loss
has very far reaching effects. There's a huge
amount of data showing all of this now. In midlife,
one of the first things to affect people is social
isolation. So often when we talk about social
isolation in relation to hearing loss, people
will envisage an elderly person sat at home on
their own with an ear trumpet. We're talking
about people who may be at the peak of their
career. They may have busy jobs. They may have
kids. So people are busy and they are going to,
for example, a family gathering, for example,
a work event, going out with a group of friends
and they're sat there and they get fed up of
asking people to repeat because they can't quite
catch what was said and they stop. As a result
of what may be a relatively minor hearing loss,
they are out of the group. And then what happens
is they actually change their habits. So they
may stop going out with this particular group
of people. They may stop going out with people
when they're going to a noisy environment. So
their lifestyle starts to change with this. And
people can really become very socially isolated
with hearing loss that's not that bad. Now that
then has knock -on effects. So as a result of
that, people can develop anxiety. People can
develop depression. Okay. Now, another thing
that is often not considered is something called
listening fatigue. So if you imagine a time when
you have sat an exam, when you've studied for
a long time and you get that real sort of brain
ache and you're tired, right? People with hearing
loss get that. All day, if we go back to how
the ear works, the brain is how we hear. So whenever
you have even mild hearing loss, if you're in
a noisy background, certain words cannot be heard.
And the brain gets a message that has bits missing.
So I always say to patients, look, imagine you
see a sentence written down and some of the letters
are removed. They're erased from the sentence.
And you're trying to read that sentence. And
it will take a little bit more concentration,
right? You're going to have to really focus on
that sentence. And you'll get it, but it takes
more brain power. So this is what happens when
we have hearing loss. The signal that gets to
the brain doesn't have all of the information
there. And the brain is filling in the gaps,
if you like. Now, for a person, especially someone
who's working in a job where they're having to
converse a lot, they're in noisy background all
day. This is absolutely exhausting. So even someone
with a mild hearing loss in a job like that,
By the end of the day, they're wiped out. They've
got nothing left in the tank for their family.
And it's exhausting. It is. Now, if we move on
a step further from that, so the brain only has
a finite amount of resources. So every time you're
doing that, you're actually taking resources
from your memory and thinking part of your brain
and using it for listening. And if we keep doing
that over years and years, then there is actually
a change in the structure of the brain. And this
is one of the reasons why we think that hearing
loss is a risk factor for dementia. Wow. I was
waiting for you to make that jump because I was
like, is that what you're saying? That basically
you're reprogramming your brain to be dealing
with this kind of stimulus that wouldn't exist
without the hearing loss and diverting resources
away. to that interpretation. Exactly. So hearing
loss does not cause dementia. I'd just like to
make that point because I think since this research
came out, there's been a lot of fear mongering
over here. You've got hearing loss, you're going
to get dementia. That's not true. Okay. So dementia
is a very complex disease. Many of the risk factors
for dementia, we can't do anything about, for
example, our genetics. But of the risk factors
that we can do something about, There was a publication
by The Lancet, which is updated every few years.
And this currently details 14 risk factors for
dementia and hearing loss, 14 modifiable risk
factors for dementia and hearing losses is one
of those. Wow. OK. And the great thing is, is
that it's so treatable. OK, so. As I said, I'm
not saying you've got hearing loss, you're going
to get dementia. But what I'm saying is it has
a significant impact on the brain and on the
brain's resources every day. So other sequelae
of hearing loss in midlife, for people who've
got more severe hearing loss, they may lose their
job. So I've got patients who have lost their
job because they couldn't hear. And then if we
look further on in life, there's, again, a lot
of information these days showing that in older
age, people with hearing loss, they get more
hospitalizations. They have more falls. They
do worse in a lot of domains. I was just saying,
if we're talking about women in business already
battling ageism on several fronts, already battling
the effects of menopause on several fronts, and
then being let go due to hearing loss, this really
compounds for women, I feel. You know, this I
feel is a trifecta of factors that if you add
in the hearing loss, like I said, with the menopause
and just the ageism in general for women in their
40s, I think that that's a really powerful thing
working against us if we don't take the steps
to control. Yes, absolutely. And I think, you
know, in this midlife time, so the auditory pathway
from the ear all the way up to the brain has
estrogen and progesterone receptors in it. So
it is thought that the oestrogen is protective
for the ear. It has a role in neurotransmission
in the ear and in the blood supply to the ear.
So what we have seen in population studies, so
in studies of huge numbers of people, is that
post -menopause there is a drop generally in
women's hearing because that protective role
of oestrogen is not there anymore. Having said
that, There are lots of things that happen to
the ear in midlife that are more complex than
just the hormones, right? So in midlife, women
may start to notice more tinnitus. They may start
to notice more hyperacusis. Now, hyperacusis
is where you're very sensitive to sounds. So
you may notice that sounds seem particularly
harsh or intrusive. And this is thought to be
due to hormonal fluctuations at that time of
life. But it can also be very much affected by
sleep, by stress, by diet, by hydration and so
on. So it's more complex than just the hormones.
Could it be affected by three young children
screaming in your ear? I was just thinking that.
Just wondering. And it's fascinating, isn't it?
Because it's like. you go through perimenopause
and menopause and oestrogen just seems to be
this magic thing that seems to help us. Protects
your bones, protects your muscles, protects your
ears. We now know. Yeah. So, you know, it's like
we go through a lot of shit having to go through
this. One of the things you mentioned, you said,
you know, when your hearing goes, you're more
prone to falls. Can you explain that to us? Like
how, how is falling linked to your ears? So I
think just off the record, so this falls, I know
you put in a comment about the fall. So I think
fall, generally people in midlife are not going
to have falls because of hearing. So it's more
for sort of older, like elderly people. Hearing
loss helps us to understand our environment around
us. So I think two reasons. First of all, that
when we can't hear, we can't really. Judge what's
going on around. And also because the hearing
loss may also have an effect on the inner ear
balance organs as well. Yeah. Depending on the
reason that you've got the hearing loss. So the
inner ear is a complex organ. It's got the cochlea
that we mentioned earlier on, and it's also got
the balance organs. So there are three semicircular
canals and then there are two other balance organs.
And these together work a bit like spirit levels.
So at any one time, they'll tell the brain. Where
is the head in space and how is it moving? And
that part can also be affected by hormonal changes.
It can also be affected by processes that affect
the hearing. It's interesting, isn't it? You
wouldn't think that your ears help with balance.
I know that I had a friend, this was when I was
little, like seven. I had a friend whose dad,
while he was babysitting us, got a terrible ear
infection or it was developing terribly. And
I remember he fell to his knees and he said to
us, he said, girls, you need to call the ambulance.
You need to call the 911. And we were like, why,
why? Again, we're seven, you know? And he's like,
I can't stand up. I can't open my eye because
the dizziness and the balance. And he was like,
you need to call the ambulance. And I remember
thinking, and then turned out it was just an
ear infection, just, but it was obviously a bad
one. But that was the first understanding that
I had that like your ear could make you fall
down. You know, or make you come, you know, disoriented.
Yeah. So it sounds like he had vertigo. Probably.
Yeah. I mean, and they were young parents, by
the way, just like, you know, shout now. So he
was like 26. Wow. Now thinking back to this time.
That's really young. Yeah. So he was like a young
dude. So anyway. Fun fact. Can we talk about
vertigo? Because I feel like that seems to be
something that tends to happen to women in their
40s. What is it? What causes it? Like, and how?
You know, how do we know what's going on and
what do we do if that happens? Yeah, so vertigo
is not a disease. Vertigo is a symptom and it
can happen for many different reasons. So vertigo
is used to describe a sensation of moving. So
it may be that you feel that the room is moving
around you. It may be that you feel that you
are moving in the room. It may be that you feel
that you've been on a boat. Okay. The most common
condition that affects women in midlife is something
called BPPV. So benign paroxysmal positional
vertigo. And this is really, really common. So
it can occur in younger and in older people,
but midlife and the older we get, it tends to
be more common. What usually happens with this
is that when you put your head in a certain position,
So most commonly it affects the posterior semicircular
canal. So this affects people when they lie back
in bed. So they get into bed and they lie back
and put their head back on the pillow and they
start to spin. And it lasts for a few seconds,
then it goes away. Or they may notice that when
they're lying in bed at night, when they turn
to one side or the other, that they get this
condition. And people don't know what this is.
There's not a lot of information out there on
it. So people panic. They don't know what it
is. Right. And then they start to get really
frightened of this vertigo feeling as well, which
adds a whole nother layer of anxiety and so on.
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Merry Christmas. Okay, so the BPPV is caused
by small crystals in the inner ear, which get
displaced into an area where they're not meant
to be. And that means that when you stop moving
your head, the crystals keep moving and your
brain perceives that you are still moving your
head for a few seconds. Now, those crystals can
be easily repositioned. and put back where they're
meant to be by doing some manoeuvres. And they
can be carried out by some GPs, by ENTs, by some
physiotherapists as well. So this is not something
that you have to put up with. It's something
that is really easily treated. BPPV as well,
in some women, it's recurrent, right? So it goes
away, they get it treated, and then they get
it again. The current data suggests that anything
that affects your calcium metabolism or the blood
flow to your ear can contribute to that. So I
always say to people who have this that they
should check their vitamin D level. And generally
observing good health in terms of looking after
your blood pressure, looking after diabetes and
your cardiovascular health is beneficial for
this as well. Is there a hormone correlation
as well? Because the only time in my life I ever
had vertigo. vertigo was third trimester pregnancy,
but I had it with two of my three pregnancies.
Is that related? Yes. So there are hormone receptors
in the inner ear and in all of the balance pathways
going up to the brain. So certainly hormonal
fluctuations like there would be in pregnancy
can could affect that. Yes. Wow. I did not realize
there were hormone receptors in the ear. Of all
the places. Yeah, exactly. Wow. Okay. So we have
talked a lot about treatments and, you know,
what can be done if we get to a certain situation.
What about on the preventative side? How do we
manage good hearing and healthy ears? Yeah, several
ways. So a lot of things, genetics, obviously
we can't do anything about, right? So a big part
of the age at which we develop age -related hearing
loss is genetics. We can. You were talking about
your dad earlier and I was thinking. Decades.
Noise. OK, so our world is getting noisier. Living
in a city like Singapore, it's vibrant. There's
so much going on. It's noisy. So there's construction.
There's traffic. You go to the shopping mall
and there is music blaring. You go and watch
a movie and the seats are shaking with the. I've
done that. The noise intensity, right? There's
noise everywhere. And this is really bad for
our ears. Looking after your ears, protecting
them from noise. That's one of the most important
things. So generally, I would recommend that
people carry earplugs with them. So just the
simple foam earplugs that have a high noise reduction
rating on them. So the highest you can get is
33 NRR, it's called. And you can use those in
very noisy environments. If you're going to...
the F1 coming up soon. If you go to a concert,
if you're going to a very noisy venue, if you're
going to be by the speakers, you certainly should
do something like that. On a more day to day
basis, looking after your ears when you're listening.
So I see, you know, a lot of people these days
are wearing headphones, earbuds, whatever. Now,
a lot of patients ask me, you know, is it dangerous
to wear them? And the answer is. Actually, it's
not dangerous to wear them, but the noise that
you're putting through them may be dangerous.
So the noise dose that our ears can take, it's
a bit like the amount of salt that you can eat
in a day, right? So if you've had a very salty
snack or whatever. you're going to be trying
to cut out salt as much as you can for the rest
of the day. And the same thing goes for noise.
So your ears can tolerate a certain dose, if
you like, of noise in a day. One way that people
really damage their ears these days is trying
to listen to music or podcasts through earphones
or earbuds. And then they go out of the house
and get onto, for example, the MRT. And then
they turn the volume up to hear that thing over
the background noise. Yes. Now, one really good
way of helping your ears is to invest in, for
example, noise cancelling ear devices. I do have
those, yeah. So this means that you can comfortably
listen to what you want to listen to and you're
not having to turn it up to a damaging level
to... hear over the background noise. So generally
for noise, people will talk about the amount
of decibels that you can have in a day. So the
safe limit is considered 85 decibels for eight
hours a day. Now, people can't relate to that.
That means nothing to me. So when you're going
about your day -to -day life, generally... If
you are listening to something such that the
person talking to you has to raise their voice
for you to hear, then you're listening too loud.
And certainly if you are listening to something
that hurts your ears, you're listening too loud.
Another thing to consider is what we call a temporary
threshold shift. So I'm sure all of us have experienced
this at some time. This is when you've been to
a noisy place and... On the way home next morning,
you feel that slight blockage in your ears. You
feel you can hear a slight humming tinnitus in
your ears. You've actually damaged your ears
doing that. Every time I leave a concert, that's
exactly how I feel. It's the weird hangover ear.
I don't know how to explain it. Yes, absolutely.
So at that time, your hearing is actually slightly
worse. It recovers. But there is a lot of evidence
now that there is some permanent damage to the
ear every time you do that. In one incident.
So a little bit in every incident. A little bit.
Wow. So if that happens to you, you should take
note from that. Look, this is a warning sign
of what can happen to your ears. Just stop going
to concerts. That's my over 40 solution. So here
at the 40s Formula, we do like to think that
food is fuel. We have a question for you from
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the question they'd like to ask you is, it's
not often that we think about our diet and our
lifestyle impacting our hearing and our ears.
So, Rebecca, what is one meal or one food that
you like to include into your lifestyle daily
to help you feel grounded? So I think my favourite
things are I have a big glass of water with chia
seeds and lemon juice every morning, which I
find very cleansing and hydrating. I always have
my cup of tea in the morning. I'm not a big caffeine
drinker otherwise, but my cup of tea in the morning
is essential for me. And apart from that, I think.
I try to eat a very balanced diet with a lot
of clean protein in it. So certainly in terms
of hearing, things like the Mediterranean diet
are supposed to help because, again, of cardiovascular
risk factors. So really just eating fresh, clean
food that's prepared at home as often as I can.
Which is the best way to be. So if a listener
really wants to start taking action about protecting
their ears, what do you recommend are some strategies
or some things that they should be looking out
for? First of all, I'd say test your hearing.
So patients come in to me all the time with very
elaborate screening tests these days. So once
they hit their 40s, definitely their 50s, they'll
be having colonoscopy, OGD, looking at the upper
gastrointestinal tract. cervical smear, breast
screening. They have big booklets of blood tests,
but no one ever comes in with a hearing test
that was part of their screening. And hearing
tests are so widely available. You can go to
audiology clinics all over Singapore and get
a hearing test done. You can go to an ENT and
get a hearing test done. Many primary care clinics
will also have hearing tests available now. You
can even do them at home. So there are some online
tests that you can do. Apple AirPods have an
inbuilt hearing test on them now. No way! Okay,
we're doing this. We're doing this after the
show. Wow! That is impressive. Because we both
wear Apple AirPods. No, I wear Beats. Sorry.
Oh, excuse me. You're a Beats person. I'm a Beats
person. Do you have an Android phone as well?
No, I have Apple Fire. Either way, we're going
to do it. Yeah, so the only thing I would say
about them is that they do an average of the
low frequency hearing. to say whether your hearing
is normal. And actually age -related hearing
loss affects the high frequencies first. So you
can get a normal low frequency test result and
you still have a bit of hearing loss, but they
do give you a proper hearing test result. So
certainly you can use that and then show it to
a health professional. What's the cost on these
tests? Not the Apple ones, you know, but I mean
the ones when you go to the ENT, you go to the
primary care. Are these within reach for most
people? The cost. So some places will do them
for free. In Singapore? If they want to sell
you a hearing aid, don't put that in the show.
We're not sponsored by any hearing aids. So hearing
tests, you may be able to get them. What can
I put for an answer to that question? Yeah, sorry
to put you on the spot. I just figured just so
people understand, it's not a... what I want
to say, bank breaking level of confidence. Yes.
Hearing tests are widely available and very affordable.
Okay. So obviously we're in our forties and if
our hearing is going, we don't really want to
be wearing, you know, like hearing aids, which
wire thing, you know, like you would expect your
grandparents to be wearing. Are there like discrete
things that you can get, which, you know, won't
make you feel old, but will help you hear better?
First of all, it's important to get your hearing
tested. and assessed by a professional. So it
depends why you have hearing loss. Now, some
types of hearing loss are actually reversible.
If we go back to how the ear works, so getting
from the outer part of the ear, the pinna, all
the way into the inner ear, the outer ear canal
and the middle ear may have causes of hearing
loss that we can do something about. So it may
be wax, right? Sometimes people push wax into
their ear so diligently every day with their
cotton bud that it gets... Completely impacted
on the eardrum over a long period, right? They
may have something wrong with the little bones
in the middle ear that can be fixed surgically.
There's a condition called otosclerosis, which
is one of the conditions that I operate on ears
for. This is where the innermost of the hearing
bones, it's called the stapes bone, that should
move in and out of the inner ear is actually
stuck. And so we can do a surgery to enable a
piston to go in and out of the inner ear. And
therefore you don't have to wear a device on
the outside, right? So it depends on why you've
got the hearing loss. Now for inner ear hearing
loss, we're looking more at devices. So hearing
aids and what you just said is exactly what.
People say they all come in and they're like,
I don't want to wear one of those big, ugly hearing
aids. So people think of the banana behind the
ear, big, orange, ugly device. Hearing aids are
not like that anymore. Oh, good to hear. I'm
definitely thinking orthopedic shoes of the ear,
you know, just big and ugly. And this is why
people don't want to wear them, right? Especially
midlife. They say. I'm too young to wear that.
So they're discreet. They look much better. You
can get ones that fit behind the ear. And if
you're looking from sideways on, you can't see
the bit behind the ear. They're about this big.
And they can come with very small, thin, clear
plastic tubing that goes into the ear. So for
one, they don't block the ear. And also, they're
really discreet. You can barely see them. There
are other types of hearing aid which fit into
the ear canal, but these are really only for
milder hearing losses. And the problem with these
is that they can block the canal and make it
feel blocked, like you can't hear certain sounds
clearly. And they can predispose to ear infections
in some people. Now, for people who have much
worse hearing loss, So they may have an all singing,
all dancing hearing aid, but they just still
can't understand what people are saying. Then
we have cochlear implants. So these are surgically
implanted devices that enable you to hear again
by doing the job of the inner ear. So they will
convert the sound energy into the electrical
signal and then they send it to the brain, bypassing
the cochlea. So this is like the hip replacement
of ear. Yes. Like it's a full new joint. Yeah,
exactly. It's a new ear for all intents and purposes.
Just thinking about my, I can't help but think
about my dad when we're talking about all this
stuff. He has one of these like invisible, invisible
ones where he's always like, can you see it?
No doubt. Like literally no one can see it. I
was wearing it the other day. He's always wearing
it. I did not. Yeah. You honestly can't see it.
But thinking about the cochlear implant, is that
something that you would have to get replaced
down the line, tuned up, et cetera? Or is this
a one and done situation? Ideally not. So this
is a device which has two components. There is
an internal implantable component. And we hope
that once that is implanted, it will be there
for your lifetime. Wow. There are reasons to
replace them. Sometimes, very rarely, they break
down. There's a fault. Something happens to it
and it is an electronic device. But generally,
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that's really gold standard solution for severe
hearing loss, the cochlear implant. Generally,
we're looking at putting the implantable in for
the rest of your life. But certainly for babies
implanted with these these days, it may be that
it has to be replaced at some point during their
lifetime. Is that more from growth, though? Like
because they would have because they're growing
into it or that's just because it's... It literally
can't be a lifetime. It can't be 100 years. Yes,
it can't be. It can't be 100 years, although
it's getting the technology is improving all
the time with cochlear implants. Then there's
the second part, the external processor. So this
part is upgraded every five to 10 years. Generally,
this is where the batteries are. And so this
is the part that is upgradable now. To add on
to that, there is actually a new cochlear implant
that's just come onto the market, whereby the
internal part can also be upgraded like a smartphone
can. So it can receive software updates into
the implant. It sounds like a computer processing.
It just sounds impressive. They're amazing, amazing
devices. And this reminds me, are you guys familiar
with the show Black Mirror? It's about the evils
of technology and a dystopian future. And there's
this one where it's not about, thankfully, not
about cochlear implants, but it's about basically
a brain, a neurological control device that gets
software updates. And the point is, it starts
to make you say advertisements. So it basically
programs your brain. So like they're giving you
updates, but they're also implanting you with
sponsor information. So it's like you become
a marketing tool for that. So what you're saying
is cochlear implants are not that, right? I think
this is a great time to put in our hot or hype
section, which is a little fun game we like to
play. I'm going to be saying a few words to you,
which could be trending or things that we've
seen out and about here in Singapore. And we'd
like to hear from you whether you think it's
hot or hot. hype and you can give a reason if
you if you'd like so first thing I see everywhere
ear candling hot or hype definitely hype oh ear
candling is an absolute no -no so it is very
common there is no benefit of ear candling in
my opinion and you can actually get burns from
it it's supposed to suck the wax out of your
ear I have even seen a patient who had the wax
drop down into their ear and their ear got blocked
from the wax. So I would definitely, no. No ear
handling people. All right. Cleaning daily with
cotton earbuds. No. So we mentioned this earlier.
Now, there's been a real thing over years that
wax is dirt. This has become a hygiene issue.
And wax is not dirt. Wax is a substance that
is supposed to be in our ear canals. It protects
our ear canals. It stops bacteria that aren't
supposed to be there growing in there. It stops
insects going in there. It's very helpful. It's
the way that the ear cleans the dead skin out
of the ear as well. And generally, every time
you move your jaw, talking, chewing, the wax
is going to be moving slightly out of the ear.
So it's normal for wax to be there. It's normal
for wax to come out of your ear. So if you really
want to clean your ear, you can clean the outside
part of your pinna here, but you should not be
sticking anything inside. What happens if you
stick things inside? First of all, you push the
wax in. So most people, they'll see a bit of
wax on the cotton bud, but they're diligently
pushing it in and it gets impacted, like I mentioned
earlier. You can also scratch the skin of the
ear canal. So the inner part of the outer ear
canal has very delicate skin. It's not like the
skin with hairs on the rest of our body. And
even the cotton wool on the cotton bud can scratch
that. So you can get infections. I have also
seen people, if they're cleaning their ear and
the child walks past, stick the cotton bud through
their eardrum and even damage the little bones
in the middle ear. Shouldn't clean your ears.
Hard pass. Like real hype. Yes. The only thing
you can do to clean your ears is use olive oil.
So some people, they get drier wax. It tends
to get clogged up. It's harder for them. And
olive oil is really useful with this. Olive oil
drops. So if you put them in, they're also useful
for itchy, dry ears. So itchy skin. Olive oil
acts like a moisturiser and it really just helps
the skin to migrate down the normal pathway a
bit more easily. So just like your standard extra
virgin olive oil that you have in your kitchen,
you can just drop it into your ear? Pretty much.
We use a medical grade olive oil in our clinic,
but you can use... Any olive oil. The problem
is getting it into the ear. So you're going to
need a dropper. Yeah. Otherwise, it's too thick
to go in your ear canal. So the main thing is
to get a dropper and you can buy those from.
Can you imagine trying to pour it in from your
bottom? Can you imagine my dear husband working
in the A &E? Flushing cockroaches out of people's
ears with olive oil because that is literally
how they do it. How do you get cockroaches in
your ear? When you said bugs in the ear and I
was like, oh, people probably don't think that
happens. No, I did not. I will tell you right
now, my husband worked A &E for years and it
happens a lot. Oh my God. That is disgusting.
I have even seen a patient who had this tickling
feeling in their ear. And when I looked in there,
they had a tiny spider that actually had a small
web near their eardrum. It's like almost making
me gag. That's not a joke. When you said tiny
bugs, I was just assuming, I don't know. Like
bacteria. Yeah. No, like my husband has dislodged
a minimum of three cockroaches from ears. Oh
my God. Okay. It happens. What about over -the
-counter hearing aids and stuff? Yeah. So this
I'd say is hype, but you have to be careful.
Over -the -counter hearing aids, over -the -counter
devices to hear used to be terrible. I would
have said no, no, avoid at all costs. Now, there's
been a big movement, particularly in the United
States, to make hearing care more available to
people because the problem is hearing aids are
expensive. Yes. People don't have access to them.
So there has been this movement to make hearing
aids affordable and accessible for people. And
some of the big companies who were involved in,
what are they called? Bose and Sennheiser and
people, companies. Oh yeah, technology. Some
of the big companies who are involved in sound
delivery, speaker systems, for example, are now
developing over -the -counter hearing aids. Here
in Singapore, I think the reliable one would
be, again, Apple AirPods. So I have had a number
of patients who've come in, they've been struggling
with hearing loss, they've bought Apple AirPods
just to listen to things through and realised
that, wow, this hearing aid setting really helps
me. There's a hearing aid setting? There's a
hearing aid setting on it. No way. So I know
that my headphones that I use, I'm going to plug
in Beats now. They've got different settings
so you can have the sound off so that you can
obviously block out all the background noise.
They've also got a transparency one, which I
think has got a microphone on the outside because
if someone's talking to me and I'm out, I can
hear them so clearly like they're speaking into
my ear. I think that is like the similar feature.
Maybe it's a similar thing. And so people use,
I mean, so do people use that as hearing devices?
I mean, I use it if I'm out walking the dog and
there's like cars going by and I'm like, okay,
if I need to listen to what someone else is saying
rather than be like, pardon. Yeah, so this is
actually a simple hearing aid function on the
Apple AirPods now. So they can test your hearing
and they can actually use your hearing test to
amplify whatever needs to be amplified. There
is a caveat to that. These are good for mild
hearing losses. So if you have hearing loss that
is more than mild, it's not going to be enough.
And I think the problem with those, or two problems,
one is that when you're wearing them, people
think that you're listening to something. So
you're trying to have an important conversation
at work, for example, and people think, why is
this person listening to a podcast when they're
talking to me, right? The other thing is that
people use these because they feel that they
look more socially acceptable than a hearing
device and they are struggling when their hearing
is beyond the limits of what that device is made
for. So really I'd say get your hearing tested,
get a proper quantification of your hearing loss
if you have one, get some advice on it. And I
have that conversation with my patients. So if
they come in and they say, look, I'm struggling
at work, you know, every time there's a meeting,
I'm struggling to understand. And we do a hearing
test and they've got some hearing loss and I'll
discuss with them, look, these are the options.
You can get some hearing aids. And some of them,
you know, they don't want to, they're not ready
for that yet. And then I will discuss things
like Apple. AirPods with them. There are also
ear plugs that you can get, which do what you
just mentioned. The loop as well. The loop, yes.
So these will cut out the background noise just
a little bit so that it makes listening easier
for them. And that can be a transition phase
so that they get used to wearing something in
their ears. But I do say, look, this is in the
knowledge that we're looking at hearing aids
in the long term for this issue. Rebecca, you
have really shared some amazing insights with
us like I never would have connected like everything
that you said with hearing I never would have
thought of going to get my hearing checked but
it's one of the things I'm definitely on the
list for sure but before we finish off I would
like to ask you one final question and that is
what is your 40s formula if you had to give one
piece of advice to women in their 40s on how
they can thrive what would that be I think for
me that has to be sleep I certainly went through
my twenties and thirties in a job where I often
didn't get as much sleep as I needed. And I thought
that was fine. And in my forties, I discovered
that it's really not fine. So I'd just say sleep,
sleep, sleep, and we'll make it a priority because
I think certainly for me, when I've had enough
sleep, Anything is possible. When I'm sleep deprived,
everything becomes a struggle. And that's so
common for so many women, I think, in midlife.
Yeah, you got that right. We're preaching the
same gospel. I promise you. Yeah, you don't have
to tell me to sleep twice or three times. Thank
you so much for being here, Rebecca. It's been
wonderful speaking with you. Thank you. Thank
you for having me. I mean, my kids are all in
international school, so they're just following
the UK stuff. And at the moment, they don't do
any exams. And when they're doing their benchmarks,
they're like, oh, yeah, we don't tell them they're
being tested because we don't want them to be
stressed out. I'm like, OK, but part of me is
kind of like, I feel like they need to have a
little bit of pressure because then they don't
perform to their best ability. But, you know,
I don't want them to be overly stressed out.
Just, you know, every once in a while, tell them
that you're being tested. It's like, yeah, it's
what is it like, you know, the ivory tower, like
just you're being watched. Yes, exactly. Exactly.
Don't fuck around.