Hearing Matters Podcast: Hearing Aids, Hearing Loss and Tinnitus

Your Ears Called; Your Brain Wants A Word feat. Madison Levine, BC - HIS

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Your brain doesn’t just benefit from hearing well—it depends on it. We sit down with Madison Levine of Levine Hearing to unpack the ear brain connection, the growing body of research linking untreated hearing loss to increased dementia risk, and the practical ways clinics and families can respond without fear or stigma. This is a story about healthy aging, where hearing care sits alongside sleep, movement, and nutrition as a core part of protecting cognition and staying engaged with the people you love.

We start with the data: objective audiometric measures, not self report, show elevated dementia risk with untreated loss. From there, we translate science into everyday decisions. Madison shares a PR first education model that favors community talks, local media, and clear waiting room content over hard selling. Inside the clinic, we walk through best practices testing, family centered counseling, and an opt in cognitive screener (Cognivue) designed to inform—not alarm—patients. Pair that with outcome tools like APHAB and time based follow ups, and you can visualize improvements in noisy settings while tracking cognitive trends that matter to patients and caregivers.

Stigma still looms large, but stories change minds. Hearing aids aren’t a concession to aging; they’re modern tools that restore connection, reduce isolation, and free up cognitive resources for the parts of life that make us human. We also dig into prevention, from normalizing earplugs at concerts to reframing hearing as a vital sign. Finally, we look ahead to a unifying movement: ear brain connection as a shared banner for clinicians, patients, and the wider medical community. With a simple, consistent message, we can move hearing care into the mainstream of brain health.

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Blaise M. Delfino, M.S. - HIS :

You're tuned in to the Hearing Matters Podcast, the show that discusses hearing technology, best practices, and a global epidemic. Hearing loss. Before we kick this episode off, a special thank you to our partners. Care Credit, here today to help more people here tomorrow. Vader Plug, the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters Podcast. I'm founder and host, Blaise Delfino, and as a friendly reminder, this podcast is separate from my work at Starkey. I'm your host, Blaise Delfino, and joining me today is Madison Levine from Levine Hearing. Madison Levine is a board-certified hearing instrument specialist, and she is the founder of Levine Hearing. She is a second generation professional in hearing health care, and she remembers spending afternoons as a child in the back office of her mother's practice, watching the impact that better hearing had on the lives of her patients and their families. She has a Bachelor of Science degree from the University of Georgia, which happens to be her parents' and brother's alma mater as well. After managing two successful practice locations outside of Charlotte, she made the decision to come back closer to home to provide her services. Levine Hearing in South Charlotte is an independent practice. So this means that she can work with any manufacturer, but it also gives her the ability to be selective in which products are chosen to get the best results possible for her patients. She is nationally board certified in Hearing Instrument Sciences, which is an elective certification that demonstrates her dedication to go above the requirements of the state of North Carolina, which I know North Carolina is very challenging to get certified in. And it allows her to provide the best care to her patients. She is an active advocate for seniors in numerous groups in South Charlotte. She sits on the board of the Levine Senior Center and dedicates extra time providing hearing loss and hearing aid dedication in many local elder care facilities. Madison, that was a mouthful. It is so great to have you on the Hearing Matters podcast.

SPEAKER_00:

Thank you for having me. That was that was a lot. That was a beautiful introduction. Thank you.

Blaise M. Delfino, M.S. - HIS :

That was a lot. So, Madison, I am so excited for a lot of reasons. Number one, you and I are both second-generation hearing healthcare professionals. I think that's pretty darn cool. And I remember tuning in to a podcast episode you had recorded, I believe it was in 2020 or 2021. Anyways, we might have been in the height of the pandemic. Nonetheless, I've been following you now for a couple of years. On behalf of the hearing healthcare industry, thank you for all that you do and all that Levine Hearing does. And today we're going to be diving into and talking about cognition and hearing loss. And we're going to start with the first section talking about raising awareness, because Madison, you know more than I do in terms of the importance of raising awareness when you do own and run a private practice. So let's dive right in. How does Levine Hearing raise awareness about the link between untreated hearing loss and cognitive decline?

SPEAKER_00:

I think this is one of the most important topics of our time, especially as people are looking at ways to live healthier lives. It's almost trending, right? To figure out how to improve your health span, not just your lifespan. Because we're already living longer, but are we living well? And so you see a lot of research on cold plunging, on all kinds of supplements, on, you know, let's get red number 40 out of our foods, all these things. But people are not talking about hearing care. And we are seeing a ton of research come out that's showing that hearing care has a direct connection to our cognitive health. And if anything, we want to keep our minds as we get older. So I think we're taking a little bit of a different approach. I learned a long time ago that marketing and PR are two very different things. And I would say that the PR side is what I have tried to really focus on in terms of patient education. I'm not asking patients to directly respond to an ad or something. I'm putting education out there. So whether it's going into community centers and just doing free talks, presentations, I'm on radio and television. And that's getting our, you know, my face out there to educate, not asking them for anything in return, just sharing free information. I think that's why it has really taken a grip in Charlotte. It's the number one thing that people say when they come in, is that they heard something that I shared with them on the research between cognition and hearing loss.

Blaise M. Delfino, M.S. - HIS :

To me, it's that law of reciprocity where you're giving your community the tools that they need to make that educated decision. Because you're not asking them to, you know, go click a link or do anything of that nature. But to your point, it's health span. We are living longer. And on April 17th, there was a new study that was released. And the the title of the study is population attributable fraction of incident dementia associated with hearing loss published in the JAMA Otolaryngology Head and Neck. Now, the question was what fraction of incident dementia is attributable to hearing loss in a community-based population of older adults? And the findings were that in this prospective cohort study of 2,900 participants, 32% of eight-year incident dementia could be attributable to audiometric hearing loss. What does that tell you? And how does this align with the education that you're sharing with your community?

SPEAKER_00:

What a landmark study. Isn't that incredible? Um, what I found most interesting about the study was that this wasn't based on self-reported hearing loss. So people may not even realize themselves that they have a loss. It was based on audiometric testing. Like the data shows that they have a loss and they're at increased risk. So one of the things that I do with my education is I focus the person I'm speaking to is not necessarily the person with hearing loss because half of them don't even know that's them that I'm talking to. So I talk directly to the family, to the friends, the children and grandchildren. So a lot of what I put out on radio, on television, all of that, I'm not saying, do you have a problem with this? Do you have a problem with that? I'm saying, do you know somebody who seems to be missing the punchline of the joke? Who seems to be asking what too often? So this study really just validates that direction of talking to the people who know the person who has the loss because they're the ones who are going to recognize it and advocate, hopefully, for them to go get checked.

Blaise M. Delfino, M.S. - HIS :

And your strategy of integrating the third party or the family members, because you cannot see the picture when you're in the frame. And we've both worked with patients. We both fit patients with hearing technology and how long it takes that patient, Madison, to come into the clinic, an average of seven to 10 years to actually take that step towards better hearing. So I love the strategy of you educating your patients. And what's so important about this is too often, and I think in the earlier years within our industry, some clinics may have been poking at the fear factor of if you don't wear hearing aids, you're going to get dementia. You're not saying that, correct?

SPEAKER_00:

No, of course, of course. I think you have to quote the research for what it is. It's drawing strong correlations between things. And this is how we start to draw conclusions. You need multiple studies that are showing you different angles of the same problem. But you and I, Blaze, you're right. Us growing up in this profession and then getting to actually work with patients, you know, you see it on the ground. You see what's happening with people's cognition before and after they get hearing aids. And so we sit with such curiosity to see what is the research going to show. And when it does say, it looks like this is actually having a huge impact, we go, that's what I thought. And that's what you hope that research would be doing is to poke at things that are suspicions and to see can we prove them?

Blaise M. Delfino, M.S. - HIS :

When when we talk about educational materials for patients, Madison, because I remember there was the image of the tree, and the tree sort of had a, I think it had a face on it, and the leaves were sort of withering away. So it was like a full tree, like a half tree, and then the tree with zero leaves. And that was that visual representation of untreated hearing loss being linked to cognitive decline. So at Levine Hearing, what materials are you sending them home with that is educating them on that connection between hearing health and cognitive function?

SPEAKER_00:

Yeah. This is this is maybe helpful for practice owners that they're probably doing a lot of a lot of this already, but maybe one of these things will stand out as a little additional way to educate. But I look at pre, during, and post-educ for the patient journey. So a lot of that content that I'm putting out where I'm not asking for anything in return, that's their pre-education. So whether I do a little bit of everything, if I'm honest. So whether it's radio, television, mailers, talks, they're oftentimes they're hearing that message before they get to the office. Once they have arrived, I have done a lot of video over the years. And I've got big screen TV in my waiting room. It feels like a living room. It's got a nice sofa and you know, real lamps and all that. And while they're waiting, hopefully for a very short amount of time, they are seeing facts, studies come across the screen and are mixed with videos. And some are patient stories and some are me educating. Then once they get back, you know, the way that we review their results. I mean, obviously, I don't have to say we're using best practices, we're going in depth with all types of speech testing and speech and noise testing. But we're educating in the appointment with our scripting on possible health impacts and we're referencing studies. If they leave and they haven't made a decision, then we've got a whole follow-up drip of information that's going out by mail and by email to them. Besides the fact that they will end up getting invitations to future events to learn more. So I feel like once they're in the family, they're gonna have to tell me they don't want to be in the family anymore because I'm gonna keep educating them all along the way.

Blaise M. Delfino, M.S. - HIS :

And and Madison, this has been your North Star again from following your journey for years. You're a second generation hearing health care professional, and how amazing it is, you know, for us and the profession, but both of us, especially being second-generation hearing healthcare professionals, the evolution of technology, what the conversation was 20 years ago to what the conversation is now. You know, we don't necessarily hear with our ears, we hear with our brain. And if our brain is not getting the information that it needs, well, then we're gonna feel off. I remember in graduate school, I went for my master's in speech language pathology. So cognition, uh, I love this stuff for lack of a better term, because our brain really controls everything we do. And I remember one of my professors saying, When you eat, you're not necessarily feeding your body, you're feeding your brain. And that just stuck with me because I'm like, huh, I never really thought of it that way. With our patients, when they are out with family members in a complex listening situation, restaurant, meeting, that information's coming to their brain. And now they need to know, okay, how do I categorize this? How do I separate those sounds? I didn't quite get that. So I love that Levine Hearing is taking that educational approach. So that pre-during and post, very similar to what we did here, Madison, with the Hearing Matters podcast. Before patients, you know, were coming into the door, we always sent them our episode of what to expect at your initial evaluation. Because yes, untreated hearing loss and cognition, there's a link, but you're also dealing with a human here. Do they have some anxiety about going to the doctor? Um, do they have that white coat syndrome? So I love that when patients call you, trust has been built. They know your voice. Uh, you know, they can put a uh face to a name. I think it's absolutely incredible that educational aspect. And to your point, leading with the research, it's not pseudoscience. It's absolutely not pseudoscience. So, right now with the clinic education, this is a question I've really been wanting to ask you, and I'm curious to know do you incorporate any cognitive screeners in clinic to assess the cognitive health of your patients with hearing loss? So, for those tuned in, the MOCA is one, which is the Montreal Cognitive Assessment. This measures attention, language, abstraction, delayed recall, and executive functioning. Another one is the Mini Cog. Curious to know is Levine Hearing implementing any of these screeners?

SPEAKER_00:

We have used Cogniview.

Blaise M. Delfino, M.S. - HIS :

Okay, great. Tell me more about Cogniview and how has it worked for not only your clinic, but most importantly, your patients.

SPEAKER_00:

It's really eye-opening. You know, what we have found when we first implemented it was that we had to be very thoughtful about our scripting when we were introducing it. Because there is a certain segment of the population that they want to take every test, they want to find out everything preventatively, you know, give me all the stuff. And then there are some people who might have some anxiety at the doctor. And if they aren't really sure why they're taking this test, and it feels a little challenging, and they they might even feel like they aren't doing well on it, that can create a lot of anxiety. So the scripting, very important and optional, you know, people need to be able to opt in or not. What's most interesting is seeing what happens when they take it again at six months or 12 months down the road. So I have not put the data together yet. I would love to see what someone else has done. And I I will be aggregating data as we go along, but to really start to see what's happening in their cognitive view scores when they do move forward with hearing aids.

Blaise M. Delfino, M.S. - HIS :

Yes.

SPEAKER_00:

And I'm sure you've seen some of this.

Blaise M. Delfino, M.S. - HIS :

So when we talk about this dual sensory input, you know, you have your vision and you have your hearing. So with cognive view, of course, you're relying on vision, right? To to go through the the screening. How long does the screening take, Madison?

SPEAKER_00:

It's pretty short. I mean, we would give them eight minutes total. I mean, it takes less than five for them to actually take the screener. So getting them sat down, getting them started, and out.

Blaise M. Delfino, M.S. - HIS :

So for for hearing care professionals tuned in, you're using Cogniview. At what point do you actually introduce this tool? And the reason I asked this question is because coming from private practice, you know, okay, I have these specific time slots to help this specific patient because they're coming in for their first fitting. And then after that, Mr. Smith is a first follow-up. So I got to make sure that I have my clean and check stuff ready to go. Now I know your clinic, you have multiple rooms. Is it this first appointment? Do you let the patients know that you have it? Kind of bring us through that process. Because if even if it's not the cognive view that our hearing care professionals and our colleagues use, at least they'll know this is at the point of the appointment. Maybe I should be implementing the screener.

SPEAKER_00:

I I've heard many people have have tried it different ways. Isn't it interesting that you would hope that cognitive screening would be done in a primary care office, but they don't have the time. So I my understanding is that cognitive view, you know, made some attempts at inroads there. And when you've got six minutes with a patient, you can't also do a screener. So it makes sense that the audiology is the place where it should be done because we may have 60 to 90 minutes with a patient. And we do normally have all that time allocated. We use it with purpose.

Blaise M. Delfino, M.S. - HIS :

Yes.

SPEAKER_00:

That can we spare some time to use this, especially if it could be a helpful counseling tool. So that first appointment is the time where they can opt in. So when they would approach the front desk to be greeted, to check in, to check in, we have an opt-in form. Would you like to opt in to this testing today? If you would, then they can sit down and take that test rather than sitting down in the waiting room. So we have a space just off of the waiting room where it's set up, and they can sit down and use it.

Blaise M. Delfino, M.S. - HIS :

Wonderful. And and Madison, you know, you kind of sparked an idea here. So the abbreviated profile of hearing aid benefit, I love that outcome measure. And I love the software-based version because when you fit a patient, you know, you can actually show them on the big screen in the fitting room. This is where you were, and this is where you are now. So pre-hearing aid, and then with the hearing aid, and especially the BN category background noise is always improved for the most part. It should be at least. So with cognition, I believe that we have an opportunity as hearing care professionals to start to measure our patients' improvement with cognivue. So maybe it looks like pre-fitting, you do the AFAB, you do the cognivue, and then you do the AFAB again at let's say one month, and then you do it again at six months. So maybe some sort of in-clinic protocol to then measure how these patients have improved. Have you had to, again, this is all part of clinic education? Have you had to refer any patients to a neurologist?

unknown:

Yes.

Blaise M. Delfino, M.S. - HIS :

And tell Tell us what that process is like. That has to be difficult to do, especially with the family members. So if if you're comfortable sharing that with us.

SPEAKER_00:

Yeah, it well, it's gone a couple of different ways. Like I said, some people don't really want to know. That's why we have been much more clear about the opt-in and what, you know, specifically what they're taking. But I feel that our maybe others feel differently, but we have used the primary care as that central command center. So if we have findings where we think that they need to go on and see neurologists, we're sending it directly back to the primary care with that information. So we're not referring directly to neurology. Excellent. I think that could create some incredible inroads and relationships, but it's not a step that we've taken yet.

Blaise M. Delfino, M.S. - HIS :

Having the partnership with the PCP is always a way in which, number one, hearing health care is community-based. So then you're having connection with that primary care physician who's overseeing the overall health and wellness of this patient, and it's a shared patient. And then you're also being able to share the audiometric data, whether it's through their journey with hearing technology, or maybe even they were attested, not helped. So I think that's wonderful. Absolutely integrating the PCP. So, Madison, patient response. When a patient visits a hearing healthcare professional, they can be anxious, maybe they're first-time users. They're absolutely going through that grieving process and accepting that they have hearing loss, when you're educating your patients throughout, how have your patients responded to the information you're sharing them about the link between hearing loss and cognitive decline? Are you met with resistance? Do they have a lot of questions?

SPEAKER_00:

I have found that it has been one of the largest motivators for people to move forward to even get to the office. And it's not just me educating with you know my methods, but it's also, you know, we're getting Good Morning America is posting about it. CNN has had several really good posts the last year or two about the links. And so people are finding this education. I'm not getting resistance. I would say that almost everybody has had someone in their life who has been affected by dementia or cognitive decline. And if you have ever experienced that, if you have ever had a family member go through it, you don't want it to happen to you or to anybody else you love. So the fact that it's motivating to people, I'm just glad there is good motivation because we know all the health impacts of untreated hearing loss. We see all the studies. It's why we're so passionate about it. Patients don't know all of those studies, but if this is one thing that can help motivate them, I'm just glad.

Blaise M. Delfino, M.S. - HIS :

And again, you, as well as so many others in our industry, are educating their community in a way that is not fear-based. You're not scaring individuals saying, if you don't get these hearing aids, you're going to get dementia. That's not what we're saying. Our belief in totality as a profession has always been untreated hearing loss, there is a link to cognitive decline. And what's interesting is, because my next question was going to be about patient behaviors and attitudes towards cognition and untreated hearing loss. And you answered it already there. But but I'm happy to hear that patients are at least accepting because we do, I feel like we live in a day and age where we are living longer, but people want to live longer healthier. I mean, we all have, I don't have my smartwatch on right now, but between you've got yours. So we're all wearing smartwatches. And what you're doing there is you're tracking your steps, your sleep score, your heart rate variability. And what you're doing with that information is how can I remain healthier? The cognitive aspect is sure, you have your brain, which is a structure, but cognition includes, you know, language. What is language? Language is a code in which ideas are shared, and you have attention. Well, is your spouse displaying signs of reduced attention? Are they starting to socially isolate themselves? And that's often one of the first signs of hearing loss is they start to socially isolate. And, you know, Madison, thank you and your team for everything you're doing. I've worked with a lot of patients, as have you. And I've worked with a few patients that presented with early onset dementia, and then progressively it worsened over time. And that really, when you fit a patient, you know, 10 years ago and and you're having this conversation and this exchange and down the line, it's progressive, right? And that would always that would tear me apart. I've had family members, you know, of course, that that presented with dementia, and and it's an awful, awful disease. So what we're doing here as hearing care professionals, we have the opportunity to advocate. And and you being a listen carefully ambassador to raise awareness, you know, advocacy, education, and news, this is absolutely part of that mission.

SPEAKER_00:

Absolutely. And let me say, you know, the things that correlate with dementia, it's not one thing. And we know that if we were to say if you do this one thing, then it'll never happen to you, we know that that would be that would be crazy. It's like a switchboard of things. And we have to flip as many switches as we can in order to reduce our risk factors. And so when treating a hearing loss, meaning getting good input that's clear input to our brain, being included in conversations, when we know that that is one of the largest modifiable risk factors, it's one of many things. Yes, we should be walking this many steps and we should eat a healthy diet and keep our brains working. And if you can't hear, you need to correct your hearing loss. So it's just as important as those other things. And what bothers me is that yes, we're getting a little traction on a few national news stations, but overall, I see tons of stuff about this weekly about all the things you can do to help prevent dementia. And hearing loss is on the list like one out of a hundred times treating it. It's even though it's one of the largest. Isn't that interesting to you that it's you know, it depends on who's talking about it. If it's audiology, we put it at the front. But others don't, even though priority-wise it should be.

Blaise M. Delfino, M.S. - HIS :

And I wonder if it's well, I shouldn't say I wonder. I would have to speculate it's absolutely the stigma associated with hearing loss because when you think of hearing loss, you think of the big beige banana. And unfortunately, media has portrayed hearing aids as these big things and it's a disability. You know, hearing aids empower patients to reconnect with their loved ones. Hearing aids allow the school teacher to go back and hear the voices of their students that, you know, they're they're molding future leaders of America. Hearing aids allow the mother to hear her children's voices again. And I believe that, sure, the the preventative aspect, how many concerts have you gone to, Madison, or how many venues have you been to? No one's wearing hearing protection, really. I mean, the kiddos that are there, thank goodness. Usually when I go to a concert or a loud venue, the the little ones have the earmuffs. And I love seeing that. Thank goodness. But even at some of the races, you know, how can we raise that awareness of wearing hearing protection? You know, in in college, I was probably, I was definitely a nerd, but we would go out, I would wear foam earplugs. I didn't care. It was loud in there, and I didn't care what I was, whatever. I'm I know the impact. I don't want to lose my hearing. But, you know, Madison, I think this is a challenge we might have for years down the road. But again, you are a leader in the space. You are consistently and constantly in your team working together, raising awareness of the importance of hearing healthcare. I'm really excited and so grateful for the research that is being released out there. You know, you have the achieved study, you have the enhanced study, you have latest study in JAMA, otolaryngology head and neck. We need more of that. And so we have these studies and we have this information. We know that Levine Hearing is sending this out to their patient base. You know, Madison, we're talking about a national scale here. How can we, I always say, transfer of information, process of duplication, duplicate the process you're implementing and duplicate that into a national campaign. We don't want to spoil the TED talk, so I'm not gonna ask you to present all of that here. What are you most excited about with this TEDx talk? And bring us through this process because this is so important, not only for hearing healthcare, but for patients as well.

SPEAKER_00:

I want everyone to actually watch the talk. It won't take too much of your life, but the title is the ear-brain connection. And there are just so many ways to express that. We've been talking a lot about cognition today, that's a huge part of it. But there's also the mental health aspect, the social isolation that you mentioned, and so many other issues that come along with an untreated hearing loss. I am taking this opportunity, and what I want to do is to make it a lot bigger than me. So I have a dream of creating a national campaign, hashtag earbrain connection. And what I want to do is I want to have impact. I want this to ripple across the whole industry. One, uniting hearing care professionals where we're all saying some of the same information.

Blaise M. Delfino, M.S. - HIS :

Yes.

SPEAKER_00:

We're using this hashtag.

Blaise M. Delfino, M.S. - HIS :

It's so important.

SPEAKER_00:

It's not about me. You don't have to tag me or the TED talk or any of that. I want for everyone to be utilizing this hashtag to move a message forward and get enough traction that everybody's being asked to go on their local news station to talk about these new studies because one person is not going to make enough of a difference. I think there's a few things I would really like to see change across the industry. One is better patient education. So getting this to the patients who need to hear it. Two is educating the medical field outside of audiology.

Blaise M. Delfino, M.S. - HIS :

Absolutely. You nailed Madison, that's yes, so essential. My father would always say when he first started in audiology, you know, I would tell people I'm an audiologist and they thought I switched out car radios. So educating other professionals on hearing health care. Madison, I love the nationwide, let's even go global globally. Go global ear brain connection. We've been having these conversations internally as an industry for so long. But to get everyone walking in that same direction, similar to maybe even the same talking points, how essential is that? Madison, I am so excited for your continued success. And really, on behalf of the entire industry, thank you so much for donating your time today. I have one last question that I think could really help the industry. What advice would you give to other hearing healthcare professionals looking to raise more awareness about the cognitive effects of untrated hearing loss in their practice?

SPEAKER_00:

I think we have to keep it professional and medical. And like we started off with, we're not asking anything from them. We are offering information. And when you do it in that way, like you said, law of reciprocity, people appreciate it. They feel like you've given them a gift, and they also don't feel like you're you're trying to get something from them. And that really is, I think, at the core, most people who are in the audiology profession, we got into it because we want to help people. And this is the best way that we can help them is by educating.

Blaise M. Delfino, M.S. - HIS :

It's that symbiotic relationship between the hearing care professional and the patient, because that is a very special, special professional relationship that you have. Madison, thank you so much for joining us on the Hearing Matters podcast. Any final words that you want to share with us regarding your TEDx talk or cognition?

SPEAKER_00:

I just want to say thank you. And, you know, I do some marketing and I do some social media, and people know that. What I would say to people who don't know how to share and how to engage, there's three big things that they can do. They can share the content, they can comment on the content, and they can like it. And in that order, that's the value proposition. And so even if you don't know how to go post and create your own information, if you can share, comment, or like, you're gonna be part of a wave that's gonna get traction.

Blaise M. Delfino, M.S. - HIS :

You're tuned in to the Hearing Matters Podcast, the show that discusses hearing technology, best practices, and a global epidemic, hearing loss. We had Madison Levine of Levine Hearing discussing the connection between cognition and untruded hearing loss. Until next time, hear life story.

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Blaise M. Delfino, M.S. - HIS

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