Certain patients more likely to be referred to a specialist for hearing loss

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

A medical student from Upstate's Norton College of Medicine recently presented research at the American Academy of Otolaryngology-Head and Neck Surgery annual meeting. I'm talking about his findings with Amer Mansour. He's a fourth-year medical student.

Welcome to "The Informed Patient," Mr. Mansour.

Amer Mansour: Thank you, Amber. It's good to be here. I'm excited to talk about my research today.

Host Amber Smith: Well, I'm curious how you chose the topic of hearing loss.

Amer Mansour: As you mentioned, I am a medical student, and I'm applying into what's known as otolaryngology, or ear, nose and throat (ENT), as my specialty. And I have a pretty long history of working in hearing and hearing loss, going back to some of my days in undergrad.

And I discussed with one of our physicians, one of our doctors here, Dr. (Alexandra) Quimby, about potential projects to learn about or to better characterize the population-level trends of hearing in Central New York. I thought that would be an interesting topic to explore, seeing as it hasn't really been looked at in the past.

Host Amber Smith: Well, how prevalent is hearing loss?

Amer Mansour: Generally in the U.S. population, it's fairly prevalent. About 25% of people actually suffer from some level of hearing loss. That's about one in four people.

And as I'm sure you probably could have guessed, as we age, that number increases. So once we reach about 75 years of age, about, or more than, half of the people in the United States do have some level of hearing loss, so it's a fairly prevalent issue.

Host Amber Smith: What differences jumped out at you in the research that you did?

Amer Mansour: Our data and our research really demonstrated some interesting insights. The main kind of factors that we were looking at that impacted hearing loss, we looked at a lot of social factors and socioeconomic factors.

So we looked at how patients were referred based on their race or their socioeconomic class, based on household income or insurance status. And we found, I guess one of the key findings was, that the patients that were referred to us had a pretty significantly higher income when compared to the overall population of Syracuse.

So the patients that were referred to us at Upstate ENT had an average income of about $72,000. That's an average household income. Whereas, if you compare it to the overall median income of Syracuse and the surrounding area, that income is about 55 ($55,000) or in the mid-50s, so that tells us maybe that patients from a more advantaged socioeconomic class are more likely to be referred than some patients from disadvantaged classes.

Host Amber Smith: So these are patients who went to their primary care provider either complaining about some problem with their hearing, or their provider came across that when they did their exam, and they either referred them to an ENT specialist, or they didn't, it sounds like.

Amer Mansour: Yeah, that's correct. ENT is kind of a specialty field, so it's not really a primary care field, so we don't really see patients unless they're referred to us, as you mentioned, by a primary care or some other physician. So in order to be seen by us, as ENTs, they would first have to be screened or identified to have some sort of ear, nose or throat problem by a primary care physician.

Host Amber Smith: So the data set that you worked with was patients who were referred to the ENT practice at Upstate. Do you know what year it was for?

Amer Mansour: I conducted the study at the beginning of this year, in 2024. And the data that we looked at were from patients from the full calendar year, the previous year, so from Jan. 1st of 2023 until Dec. 31st of 2023.

Host Amber Smith: Did you break it down by age or gender or race? I know you mentioned income. Did you look at other factors?

Amer Mansour: Yeah. This study is what's known as a retrospective chart review, which means we went through all the patients through the Upstate electronic medical record database that were referred to ENTs, and we collected data from those charts.

And as you mentioned, age and gender were both collected, insurance status. We collected the patient's ZIP code and then used that data to estimate their household income because that income data was not readily available on their chart. And then beyond those social factors and data, we looked at some clinical or medical data, like how severe their hearing loss was and the types of treatments that they've tried in the past before seeing us, to try to address that hearing loss.

Host Amber Smith: Did your paper address any of the possible reasons for the disparity that you found in income?

Amer Mansour: Identifying any specific cause was a little bit outside the scope of our project, so we weren't able to identify specific causative factors, but we did, certainly, propose some theories based on our available data.

And so, we believe that patients with greater income, as I mentioned, are more likely to find the time to attend visits with medical professionals. We think they're more likely to be able to afford a day off work or afford child care and make time to see medical professionals, like the primary care physicians and, then, us as well.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with fourth-year medical student Amer Mansour about the research he presented at the annual meeting of the American Academy of Otolaryngology.

Now, I realize you're still a student, but do you know what is typically done for someone who comes to their primary care provider with trouble hearing?

Amer Mansour: From a primary care perspective, there really are two main things that a primary care physician can do when a patient comes to them complaining of hearing loss. The first is to just refer them out to an ENT, an otolaryngologist, so that they can get their hearing done and see the specialist that really focuses on hearing.

And that's, I think, what most primary care physicians do. In other cases, there are certainly some primary care providers that are able to just prescribe and offer hearing aids directly from that primary care office.

Host Amber Smith: Do you think there are patients who have some degree of hearing loss but don't tell their doctor about it?

Amer Mansour: I certainly do.

Host Amber Smith: Why do you think that would be?

Amer Mansour: I think there are a couple of reasons.

I think the main problem is that it's a little bit difficult to recognize when you have a hearing loss, especially if it's not too significant or too impactful. I think some patients kind of have, or show, some compensatory behaviors, like they might speak louder so that they don't notice it, or they might turn the TV up a little bit louder or turn their phones up louder, so even though their hearing is declining, their environment's getting a little bit louder to match that. So they're not really impacted by it, and they don't really see it as a big problem.

Host Amber Smith: So if they're recommended to try hearing aids, and they get some over the counter, are those generally helpful for people, do you think?

Amer Mansour: Hearing aids are certainly very helpful, and I'm not totally sure about how much more helpful specifically tailored hearing aids are compared to ones that you can get over the counter. But there have been a lot of studies looking into how effective and how helpful hearing aids and implants are for patients with hearing loss.

They've made pretty remarkable strides in the treatment of hearing loss.

Host Amber Smith: Do you know if insurance usually covers hearing aids or even hearing testing or implants? If someone was recommended for that, is that generally something that's covered by insurance?

Amer Mansour: Of those three, health insurance generally, especially when it's medically necessary, as deemed by an ENT or a primary care physician, insurance does generally cover the hearing testing, and that's known as an audiogram.

But usually hearing aids are not covered. It does, of course, depend on the insurance plan and the insurance company that you're working with, but I think, from what I remember, Medicare, I don't think covers hearing aids.

So we think that this expensive medical technology is one of the main barriers to care that patients face when they are suffering from hearing loss.

Host Amber Smith: Well, you mentioned how there's more hearing loss as we age. Are we all destined to lose our hearing, or are some of us protected from losing our hearing?

Amer Mansour: So as I mentioned earlier, it's estimated that more than half of us will lose at least part of our hearing by the time we're 75.

And there are certainly some genetic factors and some environmental factors that we can't really control. But the main thing that patients can do is to decrease exposure to loud noises. Some common environments or areas where that is really prevalent is people that work in construction or in factories, and even military personnel. A lot of those communities suffer from hearing loss because of the consistent, elevated exposure to noise. And so in these contexts, adequate hearing protection is pretty important to prevent these issues.

And then in our paper, we touched on some improved screening strategies that will allow us, as health care providers, to identify hearing loss in patients earlier so that they can be addressed in a timely manner.

Host Amber Smith: I know you've been studying otolaryngology for quite a while. How did you choose this specialty? What interested you from the very beginning?

Amer Mansour: I'm a musician. I played the saxophone growing up. And in high school and middle school, I was always interested in science, and so in high school, actually, I wanted to combine these two interests in science and in music.

So that's when I started doing some research. Over the summer I did a couple of research internships, in hearing and the biology of hearing, and that's kind of how that all kicked off my interest in otolaryngology.

Host Amber Smith: So that hooked you, and what's going to keep you in the specialty? Is this something you can do for the rest of your life?

Amer Mansour: Well, yeah, I hope so. As I mentioned, I'm a fourth-year medical student, so that means I'll be graduating in May. And I'm currently applying for a residency (training) position in otolaryngology, which as I kind of broke down earlier, involves hearing, nose and throat, so ear, nose and throat.

Host Amber Smith: Good luck to you. Thank you so much for making time to tell us about your work.

Amer Mansour: Absolutely. Thank you. I appreciate the time.

Host Amber Smith: My guest has been Amer Mansour, a fourth-year medical student at the Upstate Norton College of Medicine who presented research recently at the American Academy of Otolaryngology-Head and Neck Surgery annual meeting.

" The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

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