AI Integration, Cognitive Connections, and the Future of Audiology with Dr. David Moore

Discover the future of hearing technology as we sit down with Dr. David Moore, a pioneer in the field, and navigate the fascinating intersection of artificial intelligence and hearing aids. Imagine attending a bustling party and effortlessly picking out a single conversation amidst the cacophony, thanks to the latest AI-powered noise reduction advancements. This isn't just a dream; it's the reality Dr. Moore helps us explore, delving into the powerful potential of directional microphones and the integration of hearing aids with everyday wearable tech. 

The intricate connection between hearing loss and cognitive decline takes center stage as we uncover the findings from a large-scale study that's deciphering the links between speech-in-noise recognition and brain health. The revelations we share are nothing short of profound, painting a picture where the use of high-quality hearing aids goes beyond auditory assistance—it's about nurturing brain function and potentially warding off dementia. Dr. Moore helps us unpack how early detection and intervention could be key in this neurological battleground, offering hope and emphasizing the importance of audiology in the broader healthcare landscape.

Looking ahead, we discuss the transformative potential of audiology and its educational evolution with Dr. Moore, who advocates for an interdisciplinary approach that marries neuroscience, statistics, and psychology. This isn't just a reshaping of how audiologists are trained; it's a reimagining of the profession's future—one where the scientific grounding elevates practice and recognition. We also consider how the delegation of clinical tasks can optimize patient care and touch on the implications of over-the-counter hearing aids. By the end of our journey, you'll appreciate the intricate tapestry of audiology and its impact on our lives, from the social dynamics of a party to the cognitive corners of the human brain.

Transcript

Dr. Douglas L. Beck: 0:07

Good morning. This is Dr Douglas Beck. I'm an audiologist and you're listening to the Hearing Matters podcast. Today, we're interviewing Dr. David Moore. David has been Director of Communication Sciences Research at Cincinnati Children's Hospital and Otolaryngology and Neuroscience at the University of Cincinnati since 2012. Research interests include listening skills and children, speech perception and noise, large-scale studies of hearing and hearing health delivery to underserved populations. Born and educated in Melbourne, australia, he has worked for over 40 years in the United Kingdom at the University of Oxford, the MRC Institute of Rural Research in Nottingham and currently the University of Manchester. In 2015, he received the career award of the American Academy of Biology and he's grateful to have been funded by national sources in the UK and the US continuously throughout his career.

Dr. Douglas L. Beck: 0:58

All of that said, hi, david, nice to have you here. Hi, doug, good to be here and my understanding. You just came back from. You were in Arizona. You were chairing one of the sessions on artificial intelligence at the American Auditory Society. I was yes. Can you tell me a little about that? Did you learn anything particularly new or did you teach things that were new?

Dr. David Moore: 1:19

What were the takeaways that you left the AA as with so I think the most important takeaway was for me was the final talk delivered by our good friend, Brian Moore. No relation he was talking about how much hardware was needed in order to get really good noise reduction in hearing aids, which we can't currently cram into a behind-the-ear instrument, but he pointed out that a cell phone is so powerful now that he thinks we're right on the edge of being able to do that task and in the right amount of time to deliver really substantial noise reduction.

Dr. Douglas L. Beck: 1:59

That would be an incredible thing. I mean, we've had things like deep neural networks that have come out, which have been trained on human voices, and that's been a huge step forward. Obviously, we've got amplitude modulation, noise reduction, we've got directional mics. We've got a lot of tools now, but we are still quite a ways away from actual noise reduction in a cocktail party being incredibly effective.

Dr. David Moore: 2:22

Right. Well, that's not the message I came away with. He spent a lot of time talking about the difficulty of doing that, but he did say that one group, that of Dr Eric Healy, just up the road for me in Columbus Ohio, was able to do very good noise reduction. But he said you needed a computer as big as the room that we were sitting in.

Dr. Douglas L. Beck: 2:46

Yeah, that's the issue. But the thing is you know most of the cocktail party effect. The biggest issue is that the people that you want to listen to, the people you want to pay attention to, are making sounds exactly like the people you don't. Right, if we were only talking about, could we reduce fluorescent lights? Could we reduce steady-state computer fan noise? Of course we can do that. That we've made tremendous progress with, but I think people are still looking for that ability to be in a cocktail party and have the hearing aid know who you want to pay attention to Right Well.

Dr. David Moore: 3:21

so the issue has been, of course, that directional microphones take you away from those other sources of sound, and I think the difference with AI is that we can just get better specification of individuals, which would enable us to do that, perhaps with some directionality, but still allowing other voices to come in.

Dr. Douglas L. Beck: 3:47

And part of that, if I recall from a few years ago, was training the hearing aid to one person's voice. For instance, if you and I were going to go have a beer which would be a nice thing I could have you say 10 words or something. The hearing aid would pick up on your voice and then when we're in the bar, it would know to amplify that particular voice Right.

Dr. David Moore: 4:08

Right, yeah, and I think we're just sort of ramping up from that sort of simple premise.

Dr. Douglas L. Beck: 4:14

Yeah, yeah, it sounds great and I hope that the hardware continues to shrink so we can actually do this in our lifetime. We've been on the verge of these things for many decades and I absolutely think we're closer than ever and that's all good. But I just the problem that I have with directional mics and it's a problem I think that all patients and all professionals have is the directional mic is dependent on the azimuth and it's supposed to be the mics facing this way. What happens I'm going to say 9 out of 10 times is people where the hearing aids back here, so the directional mic is pointing up to the trees. Am I wrong on that?

Dr. David Moore: 4:53

No, that's not. That is the case. But of course you can put directional mics somewhere other than on the hearing aid, and you know you're wearing glasses at the moment. Fine place to put them is on the edge of both of your lenses, on your glasses, so absolutely.

Dr. Douglas L. Beck: 5:11

And there's a lot of new glasses that have all sorts of directional features to aid amplification. So that's come a long way in a short period of time.

Dr. David Moore: 5:20

Right, and Christie Miller, who was one of the other speakers there, who's from Meta, was actually talking about the Meta glasses, which have microphones positioned at those places, as well as eye monitoring and all sorts of other gadgets.

Dr. Douglas L. Beck: 5:38

Yeah, this is brilliant stuff and I think it's going to change the entire outlook of how we do amplification over the next five to 10 years, because we have so much. We have so many better tools and these tools are becoming much more sophisticated very rapidly. But the thing is, can we contain the costs and can we make them commercially available? Because right now, when you look at the USA, you're looking at insurance companies are so critically important to people accessing hearing healthcare, but I don't see them saying, yes, you know, if a pair of glasses that you can hear perfectly are $12,000, let's do that. I'm not seeing that. I'm seeing what's the least expensive product we can put on somebody to make sounds louder, but that's a long way for making sounds clearer.

Dr. David Moore: 6:25

Yes, it is, but I mean, since we're into this subject, maybe I could say that the one way around that is to make hearing aids part of what a general product available to the public would want to everyone, whether they're hearing impaired or not. So Apple's just released their new VR goggles, which have a lot of really desirable properties, matter I was talking about. I think these sort of companies are going to be hard to beat in the future when it comes to providing that sort of benefit, and hearing aids will possibly just be one of a variety of things you'll be able to do with these glasses.

Dr. Douglas L. Beck: 7:10

I think that's a good observation. I'll tell you, between metta and apple, you know, you quite literally have billions of dollars r&d which the hearing aid companies have struggled for decades to do. I mean, it's extraordinarily expensive, and and then people with, when they see the final product, they say that's, that's five thousand dollars. I could build that, my god. No, you can, and it took decades and it's very, very advanced features. But people don't get that. They want the quick and easy and they want to cheat and, and so I think this is always an issue. But I'm so speaking about things clearer rather than louder. What? What are the papers you wrote? This goes back to twenty fourteen and you wrote with a couple of my friends, pierce dollars and kevin Monroe, and you guys were looking at the older adults declining cognitive processing ability, and you said that was associated with a reduced ability to understand speech and noise. Can you tell me a little bit about that?

Dr. David Moore: 8:07

So that particular study was part of the UK by bank which, at the time it was launched. Uk by bank is one of these mass population sort of Everything about your health type studies. Sure, there's one going on right now in the US and I'm in, called all of us and I have a fit bit watch which is monitoring all my physical activities at that. But so UK by bank got into this game in the two thousands and it's a longitudinal study involving over half a million people forty to seventy years of age, and I'm a participant as well as a scientist working on this project. So what we did in that paper was we measured, for the first time in such a large scale study, somebody's ability to do a speech and noise task, and the speech and noise task was digits in noise, because that's a very simple task. You know everybody, even four or five year old children or, you know, very old people, know the digits from zero to nine, and so it takes away a lot of the cognitive aspects of most speech and noise task.

Dr. Douglas L. Beck: 9:21

Which processing as well. I mean when you, what you're trying to get to with the digits and noise is a very, very simple auditory signal. So you're removing the patients psychological, emotional, cognitive processes, you're just trying to get a raw processed signal.

Dr. David Moore: 9:37

Yeah, and in fact at the time that you know we developed that test, the main idea was that it would be a proxy for an audiogram. So it turns out that the pure turn average correlates quite well with the speech reception threshold, which is the output measure of the digits and noise test. I mean to a level of about point eight. But going back to that paper, despite the fact that it's such a simple task, it still has a fairly Significant cognitive load attached to it, and one of the benefits of combining the hearing test with all the other tests that we're done in UK by a bank of which cognitive testing was the biggest load Was our ability then to see what the relationship is between those two different modes of understanding, and so what we showed was essentially that there is a relationship between speech reception threshold and your cognitive ability, but it was particularly important for people in the bottom 20% of the population in terms of cognitive abilities and what did you find based on that?

Dr. Douglas L. Beck: 10:53

so they did a speech and noise test and the people who did the worst on the speech noise, which was the digits and noise. Actually, what did you correlate that?

Dr. David Moore: 11:00

with. So we correlated that with a battery, you know a composite score, which was a battery of cognitive tests, so things like attention, memory, processing speed, you know that sort of thing, sure, intelligence, yeah, all that sort of stuff. And we found that there was a close correlation, but it was not a linear one. So, as I was just saying, the people in the bottom 20% of the cognitive score ladder did Up to 2 dB worse on the speech reception threshold, the nose in the higher cognitive gain group so I thought in that 2014 paper, what you found is that the people who had the worst digits and noise SRT is we're at a higher risk for cognitive decline.

Dr. David Moore: 11:56

Yeah, well, we may have speculated that, I can't quite remember. But what I do know now is there is increasing evidence for that connection. So it turns out that in recent years there's quite a bit of evidence now accumulating that there is a relationship between hearing ability and cognitive decline In a sort of medical sense.

Dr. Douglas L. Beck: 12:22

So you know, in the sense of people having dementia and rather substantial because, following up on your bio bank participation, stevenson and I think this was in 2022, might have been 2023 he was, he and his group were looking at it was 81 or 82,000 people and they were. They were adults ages 60 and above, something like that. But they followed them for 10 to 12 years and they said that the people who had the worst speech and noise scores at a 0.61 hazard ratio for developing dementia or dementia like signs and symptoms 10 to 12 years later. So when you talk about a hazard ratio of 0.61, that doesn't mean that they are, that they have mild cognitive impairment or that they have Alzheimer's, but that means that over the 10 to 12 years period of time, 0.61 or 61% of those people who are at risk because they had a poor speech and noise result, they were the ones most likely develop the signs and symptoms of mild cognitive impairment, alzheimer's disease and or related disorders.

Dr. David Moore: 14:18

That's right, and one of the featured sessions at the meeting I just come back from was on the chiefs study which is being led by Franklin and his colleagues at Johns Hopkins, and they showed a variety of different lines of evidence, including speech and noise and, very interestingly for me, brain structure, which were related to the use of hearing aids during later life.

Dr. Douglas L. Beck: 14:49

And basically I think the theory. I wasn't there but but I think that Frank has been saying for a number of years now that people with untreated hearing loss there is a certain amount of brain shrinkage that goes on right, and people who were fitted successfully with hearing aids, they didn't have that same loss of neuronal capacity.

Dr. David Moore: 15:10

That's correct. I mean, we've known for a while that you know people with profound hearing loss do have, you know, some brain shrinkage in the thinking parts of the brain. You know the cognitive processing areas and they've shown that in this case hearing aids can partly ameliorate that's right, which is brilliant in many respects.

Dr. Douglas L. Beck: 15:33

and if you go back to the hand of the paper, without a sharmu, just a few years ago I guess it was twenty, twenty and trends and was it trans an application? Anyway, they publishes brilliant paper, look and sharma, where they looked at fitting people with hearing aids professionally with real ear measures, test box, proper clinical protocols that are in alignment with best practices. They did all that and they found after six months the brains physiologically changed. Early on, these people with hearing loss who had not been wearing hearing aids, their a, b, r's got smaller and smaller and their visual about potentials got larger and larger. And the theory is that as the hearing became worse over years they depended more on the visual signal to put together that communication receptive message. And then, after six months of appropriate amplification with premium devices, they found the a, b, r went back to where was supposed to go and the visual about potential Became smaller and that too went back to more of a normal tracing. They found improvements in speech recognition. They found improvements with executive function and all of these other outcomes based on having professionally fitted premium products Right.

Dr. Douglas L. Beck: 16:47

So this is so that you know it's very impressive work because I think many, many people who are dealing with hearing aids I just think of it as something that they're gonna wear now and then to make things louder when they need it. But that's really not the best we can do. The approach that I've been advocating for about thirty, five or forty years, I think the approach you advocate, is to use the science in a best practice model, and that can be the best practice model from triple a or ash or I just but but to professionally fit these things make. It makes a huge difference, and in the anatomy and as well as in the physiology over the long term.

Dr. David Moore: 17:22

Yeah, I mean we need to express a little bit of caution, because there was an important cave it in the achieves results and that was that was only that. Only the people who had, you know, more developed forms of hearing loss show these changes yeah, the people at highest risk where the ones who had the most benefit.

Dr. Douglas L. Beck: 17:48

that's right. So you wouldn't necessarily say you know forty five year old with a mild high frequency loss, and if he or she happens to be a phd in neurophysiology, they're probably not as much of a risk as somebody in a lower socioeconomic group with less education, with multiple corbid comorbidities. I think what the chief study said is that when you had people who are most at risk perhaps somebody with in the lower socioeconomic group, somebody with multiple comorbidities, somebody who who had very significant hearing loss they were the ones who benefited most from application. It wasn't the thirty five year old phd in electrical engineering who saw that same benefit, because he or she did not have the same risk factors.

Dr. David Moore: 18:35

Yeah, and of course, there's an important lesson there, which is, you know, get screened, measure your hearing, certainly when you're approaching or in middle age, and maybe we can take, you know, preventative steps.

Dr. Douglas L. Beck: 18:52

Yeah, and that you know that's coming in the future. I think right now we don't have enough solid science to say that this is a thing. We have a lot of science that says this is very important. We need to look at this further, but I don't think we're at the point where we're going to say anything about causation. This is strictly a correlational situation.

Dr. David Moore: 19:10

Well, I think that one of the things the chief study achieved was to show that it was a causal connection, at least in their population, because it was a double blind randomized control trial and you know it was powered exactly to establish that.

Dr. Douglas L. Beck: 19:30

That's a good issue.

Dr. David Moore: 19:31

I appreciate you're saying yeah, but having said that, I mean you're absolutely right that we need more evidence before we commit to huge resources that will be needed To give like a universal middle-aged hearing screen, like we do for the newborn infants at the moment.

Dr. Douglas L. Beck: 19:49

Right, right, number one you and I were throwing around the term speech reception threshold earlier, and for clinical audiologists and hearing aid dispensers, nodal are in colleges. We're not talking about the SRT based on spondes upstairs downtown baseball hot dog. We're not talking about that when we say the SRT Speech reception threshold. In this regard, we're talking about it as sort of an SNR 50, which is the signal to noise ratio to get 50% of the words correct, and I'll. I think it's important that we draw that line because I think a lot of people get confused on this. If they're not used to speech and noise or signal to noise ratio issues, they assume we're talking about a different SRT. So the SRT that we're talking about is actually sometimes called an SRT in the speech and noise literature. Sometimes it's an SRT 50, sometimes it's an SNR 50. They all mean the same thing. We're talking about the signal to noise ratio for someone to get half the words correct, which is very much like the Houston Westlake pure tone protocol where we go above and below A pure tone to say this is the 50% point where the patient responds correctly, and it's very much the same with an SRT. In this regard we might vary the background noise to where it's impossible for them to tell what the primary word is. And then we make it easier and we bracket that. So I just want to allow a little Clarification on that.

Dr. Douglas L. Beck: 21:08

The other thing I'd like to address David, you said we should get screened and I don't want to take you to task on that. But I have an issue which I've written about extensively on screening. I don't believe in screening anybody except newborn infants, I think, and there I think it's critically important, I think, for an adult. You see, when you and I talk about screening, you're talking about digits and noise, but the rest of the world is talking about pure tone press the button when you hear the beep. So I I don't want to take you to task, I don't want to call it, but I want to say that your screening is a far more comprehensive audio metric evaluation. You don't mean just a pure tone screening, is my understanding. Am I correct on that? That's right.

Dr. David Moore: 21:50

I mean, I think that the order, the audiogram, does have a lot of interesting things to say, but it shouldn't be the only index that we use. And you know speech and noise. Everyone says that. You know that's that. That's what patients complain about when they go to see an audiologist. They don't complain about their inability to hear quiet tones in the sound booth.

Dr. Douglas L. Beck: 22:12

Exactly right. So that's the thing is that if we follow a best practice model, we're going to be doing comprehensive audio metric evaluations. That's already in print by IHS, by triple A, by Asher, that their best practice model includes a speech and noise test, as well as the listening and communication assessment, as well as all the diagnostics. So when we were talking about screening, I don't want people to think, oh well, do a pure tone screening and see if there's an issue. Now you got to do all of it. If you're, if you're just doing the greatest hits of audiology, you're not going to see these things, these, these deficits will be invisible to you because you won't be picking up those speech and noise problems. Right, david, before I let you go and you've been very generous with your time I'd like you to address one issue here. Many people, I think, are confusing in our profession industrial noise and noise and leisure noise and things like that. I know you have some strong opinions on on leisure noise versus perhaps industrial or military noise. Can you address that for me?

Dr. David Moore: 23:12

Yeah, so I have some strong opinions because the World Health Organization announced in its world report on hearing a couple of years ago that a billion young people were in danger of, you know, destroying their hearing hearing by listening to portable music players, and that's a really strong state. And I've been involved in a number of research studies and there are a number of other ones out there that I haven't been involved in that have found actually, when you measure people's hearing abilities I mean using speech and noise or using audiometry, that and you then compare that with their self-reported levels of noise exposure, then you just don't get that relationship. We have tremendous difficulty showing any relationship between hearing level and history of noise exposure. So just to tell you about one study that I did in Manchester with Piers and Kevin and other colleagues there we went to in Manchester there's an institution called the Royal Northern College of Music which is one of the premier music colleges in the UK, and typically the students there who are in their 20s are people who have been playing musical instruments for hours a day over a 10 or 15 year period, and so we argued that, since we know that older people who've played in a symphony orchestra for all their life are at increased level of hearing loss.

Dr. David Moore: 24:55

I don't think there's any argument about that that these young people who've had such a massive noise exposure might have hearing loss even at that stage of their life. And the answer to that question was no, they don't. And actually you know we did this also as part of the UK Biobank study that I talked about before in that 2014 paper. There was a question there about you know, do you have, you know, leisure noise exposure and how much? And similarly, do you have occupational noise exposure and how much the occupational noise exposure over many years? Undoubtedly, you know, does ding your hearing, but the leisure noise exposure did not.

Dr. Douglas L. Beck: 25:48

It's very interesting and it puts it into context that you know you can't just cherry pick data from one situation and apply it to another. You know these have to be data that are gathered appropriately for the application.

Dr. David Moore: 26:02

Yeah, and one thing I could say about that is that you know I am talking in generalizations here there are certain forms of leisure noise which we're pretty sure are damaging. I mean things like firearms, possibly motor racing, you know, where there's really intense levels of noise for even a short period of time. I mean Stephen Neal and his colleagues recently had a paper in here and hearing saying that it's possible that even a single gunshot exposure can damage your hearing, and they even speculated in that paper that this might be a leading reason why men in the US in particular have poorer sound thresholds than women do.

Dr. Douglas L. Beck: 26:50

Yeah, and impulse noise, you know, when you're talking about 160, 170, 180, you know you can have a traumatic effect immediately and I think that's totally true. But I think that when you're talking about leisure noise in general, you might be talking about snowmobiling for an hour once a winter or driving a motorcycle. You know, I drove motorcycles for 50 years and many of them have been Harley-Davidson's. But the truth of the matter is you're not sitting there going, you know, for hours on end. I mean, you know that's a 12-second event and the sound is behind the drive, it's not coming into my. So I think that there's room to still explore leisure noises.

Dr. Douglas L. Beck: 27:31

I do think that you're exactly right when talking about explosive noises. When you're talking about munitions, you got to be careful because you don't know, and a gun could misfire, cause physical problems, but also acoustically it depends on the environment you're in. I can go out to a range and shoot with headphones and earmuffs and all of that and it's still loud. It's not, you know, 180 dB. But maybe we'll get it down to a level that a few 15, 20, 25 rounds isn't going to be damaging to your hearing for the long term. But again, you never know and everybody's susceptibility is different, so this is a huge factor that we don't often discuss. But you know, you have people who've been professional musicians for decades, like Peter Townsend, who has a severe to profound loss, but then you have other people who've been professional musicians for decades who don't, and so it's not just your noise exposure, but it's also your individual susceptibility.

Dr. David Moore: 28:29

Right, and I think that individual susceptibility is a fascinating issue and one that we're pursuing with the UK Biobank genetic database, because one of the things we did in this part of that study is we gave it, we had a blood draw taken and recently they've finished getting the whole genome sequencing of all of the 500,000 people who were part of that study, which was just an incredible and incredibly expensive undertaking. But the UK Biobank had been so successful in bringing out all sorts of health related lifestyle issues and other things that they've figured and when I mean they, I'm talking about a public, private enterprise they all figured that it was worthwhile doing those full genomes. What that will give us the ability to do, of course, is to look for connections between what you're endowed with genetically at birth and all these other sorts of issues that can go wrong with your hearing. I think we've got a tremendous opportunity here to come out with quadrupling or even an order of magnitude, a tenfold increase in the number of genetic loci that we know are affected by aspects of hearing.

Dr. Douglas L. Beck: 29:57

David, I know you're not an audiologist by training, but you know a little bit about audiology and you deal with a lot of doctoral students and a lot of doctors of audiology. I'm wondering your perspectives on the profession, our educational systems and where that's all going.

Dr. David Moore: 30:15

So, yeah, I've had a lot of experience with this, and my wife, who is an audiologist, and I often have discussions about this because we're in the business of trying to recruit people to come into research and we teach in audiology classes here at University of Cincinnati. So I think my perspective is that audiology is a science and it's really important we get really high caliber scientific people coming into the profession, and I sometimes wonder whether we're going about that the right way, particularly in the US, where the typical route into an audiology and AUD program is via a speech and hearing undergraduate program, which you would think might be a very good way in, and I'm not dissing that at all. But in research we often have people with backgrounds in disciplines like physics, engineering, mathematics, psychology, biology, all of which have a very strong sort of underpinning in the scientific method, and that is tremendously useful, I think, not just for research, but for understanding the sort of developments and implementing them or, conversely, being skeptical about them with all the sorts of things we've been talking about today.

Dr. Douglas L. Beck: 31:50

Yeah, I mean this is a really important point, I think. Listen, communicative disorders in science is wonderful. I'm so glad I got my degree there, but this is my bachelor's degree. Before, when I was going through all of this 40 years ago, you got a bachelor's and, as you said, in communicative disorders in sciences, then a master's in audiology and that's all you need to practice and then 20 years later I went on and got my doctorate.

Dr. Douglas L. Beck: 32:16

But the thing is that, as somebody who has published a great deal and have worked on a lot of scientific committees, my undergraduate education has not been very useful, to be honest. Things like learning about the speech mechanisms Well, that's fine, that's very important, I'm not dissing that. But it might have been wiser to spend more time on neuroscience. It might have been wiser to learn more about cardiac and general medical conditions. Might have been wise.

Dr. Douglas L. Beck: 32:46

We did human brain dissections. I was very fortunate because I was in Jack Katz's lab, so we got to do that. But most audiologists don't do that and I think the people who do that have a much better understanding of the gestalt right, the entire human central nervous system, because you've seen it, you've touched it, you've worked with it and I don't think there's a replacement for that. I think I was in math and sciences, so the background of statistics has helped me enormously throughout my career, much more so than knowing about phonemes. Now, there's nothing wrong with phonemes, but I want to underscore. The point that you're making is that a more scientific education would only improve professionally, if I can just say something specific about my own experience.

Dr. David Moore: 33:37

I mean, my background was in physiology, which is what sort of subsumed became more neuroscience with the passing years, and in psychology, and I also did some math at college level as well, and the most useful part of all of that was the psychology, undoubtedly because that's where I learned about the scientific method. That's where I learned about what hypotheses are and how you test them and how you therefore evaluate the quality overall of a scientific paper.

Dr. Douglas L. Beck: 34:12

And it's very important because everybody can publish, everybody can write. But it's so important that you write well and that you're reasoning these things out before you start doing the experiment, before you start seeing the patients lay out the project, have your colleagues look at it, make sure you're gathering what you think you're gathering and that you're gathering it in such a way that the data at the end of the study can be used to determine useful information. Oftentimes, you know you'll do a study of 30, 40, 50, 70 people and you'll have some people who you have this information on, some people you have that information on. Had you paid attention to the scientific method from the beginning, you would have had a control and an experimental group. You would have had random patrol trials. You would have had data gathered in such a way that could easily be transcribed into a functional outcome.

Dr. David Moore: 35:02

Yeah.

Dr. Douglas L. Beck: 35:03

Yeah, and tell me lastly, what about the cost of education for an audiology doctorate in 2024? What are your thoughts on that?

Dr. David Moore: 35:12

Well, I'm not an expert in that field at all, but I think that you know one of the things that's happened recently, of course, is a lot of the AUD programs have been shortened to three-year programs, and that's fine if you can get in everything you need to in that time. That's obviously reduced the cost. But I think maybe what you're alluding to is what happens as you advance through your career, and I think one of the issues that Lisa, my wife, and I talk about a lot is, you know, the professionalism of audiology compared with another other allied disciplines like optometry, for example, where the mean salary level is. There's quite a disparity there and I think that audiology needs to perhaps put more effort into, you know, advancing the profession in a way that would lead to equity with other health sciences, including medicine.

Dr. Douglas L. Beck: 36:24

Yeah, of course, and I think that if we had more of a scientific background that was recognized as a scientific background, that would go a long way. Because, when you think about it, optometrists, chiropractors, podiatrists, optometrists they're physicians. They are looked at as physicians. Audiologists are not. They can prescribe. We cannot so, and I think it's not that they're smarter or any such thing, but their educational basis leads to those conclusions, and I think that ours currently does not, and I think that these are things that we need to address, probably rapidly, you know, in the next two to five years. That said, I know it's been tried. I know that many of us over the last few decades have said why do we not prescribe medicines? Why do we not get recognition as physicians in our disciplines? And these are. These are not easy problems to solve, but they have to be solved if we're going to have a stronger scientific basis. The benefits of that will be shown in our patient care and our respect and our authority to better manage patients.

Dr. David Moore: 37:32

Yeah, and I think one of the other aspects of the profession is that, you know, when we go to our lawyer or we go to even our doctor, much of the work is done by assistants, who are, you know, less well trained people typically, who are nevertheless able to do a lot of the heavy lifting, and I think there could be much more of that in the audiology profession as well. Yeah, I mean, this leads on to the question of, you know, over the counter hearing aids versus bespoke hearing aids fitting by an audiologist, and I'm actually in favor of audiologists playing a big role, in continuing to play a big role in hearing aids fitting, but perhaps they could, you know, take that role in a more specialist and more sort of nuanced way than they currently do. So, you know, there's a lot of opportunity there, I think, for task sharing among less qualified individuals.

Dr. Douglas L. Beck: 38:38

Yeah, I think that makes a lot of sense. You go to any dentist's office you know a modern dentist's office. You're going to have a dental hygienist or six of them. You're going to have dental technicians, you're going to have one dentist and that dentist goes and does the most sophisticated things at the right time in the room for the right, and that sort of thing, I think, makes a lot of sense for the patients. It's much more efficient.

Dr. Douglas L. Beck: 38:59

When you go back to this model of having more assistance, I think that gives us more financial flexibility as well for the office and for the patient. Because when you have dental technicians, dental hygienists, physician assistants, nurse practitioners, when you have these people who are all working in concert with a physician, that does tend to allow the physician, he or she, to focus on the most important, most critical needs of the patient at that moment. But we don't really need the physician to be doing things like teeth cleaning. We don't really need the physician to be doing things like removing earwax from an ear canal. I mean audiologists, hearing aid dispensers lots of people do this kind of work and they've been trained to do that. Now there's nothing wrong with a physician doing it, but is really the best and most efficient use of his or her time.

Dr. David Moore: 39:48

Quite so, and even in the research domain where I work, we have a lot of research assistants and clinical research coordinators who really do most of the work I mean, most of the seeing of the research participants and a lot of auditory testing, complex stuff and obviously they get quite a bit of training when they come to us, typically from an undergraduate degree background, but we oversee the whole thing and make sure that they're doing it correctly. And then of course, it's up to us to interpret the results and write the papers and generally to communicate it to the rest of the world. Yeah, which makes total sense.

Dr. Douglas L. Beck: 40:31

All right. Dr David Moore, I want to thank you for your time and it's always a joy to speak to you I learn something every time we chat and thank you for your participation in the Hearing Matters podcast and I wish you a wonderful day.

Dr. David Moore: 40:44

You too, dr. Good, it's been a pleasure.