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When you put on eyeglasses for the very first time, you may be surprised at the wealth of new information that hits your senses. The individual leaves on a tree, road signs that become distinct or the particular way light spreads across a scene.
The same thing could happen when you put on a hearing aid for the first time, Jana Bataineh said.
“You don’t realize how much you’re missing.”
Bataineh is a PhD candidate in health and rehabilitation sciences, concurrently completing her master of clinical science in audiology in Western’s Faculty of Health Sciences.
Coming from a public health background, she’s seen time and time again how hearing loss is often minimized when it comes to people’s wellbeing.
She often encountered a common sentiment toward those with hearing loss: “Why can’t you just listen harder, pay more attention?” The misconception spurred her to bring hearing loss to light.
Inspired to make a change, Bataineh wanted to ensure people are tested for hearing loss before it’s too late, and get the resources they need to improve their health. The problem led her to develop a series of seminars designed specifically for primary care clinics, to bring hearing loss and screening to the forefront of the conversation.
Hearing loss is not isolated, she says. It can shape the way you interact with the world and completely change your quality of life. Importantly, it’s also one of the leading risk factors for dementia.
Why hearing health matters for cognitive decline and dementia
In the latest guidelines published by the World Health Organization, hearing loss is recognized as the leading, modifiable trait in cognitive decline. Not only does it often lead to social isolation, depression, and withdrawal from regular activities, but when hearing becomes challenging, the brain needs to work harder to make sense of sound, drawing from cognitive resources used in key mechanisms like attention and memory.
This is especially prevalent in adults over the age of 50; more than 60 per cent of older adults will develop hearing loss.
But despite the glaring statistics, the Canadian health-care system has no clear structure or program to catch or address this prevalent need. The Infant Hearing Program aims to screen all newborns at birth, but after that most Canadians aren’t regularly tested or prompted to be screened for hearing loss at any other moment in their health journey.
The responsibility often rests with individuals to identify hints of oncoming hearing loss and find a clinic where they can get tested; though because it develops slowly, it’s difficult for people to pinpoint and acknowledge.
“What really ends up happening is that they’ll spend many years with hearing difficulties, withdrawing from activities, dealing with the fallout, before they reach the point of taking action,” said Bataineh. Many cases are left untreated.
But hearing loss can be managed. Through interventions such as early screening, hearing aids and rehabilitation, people can maintain the communication they need to age well. It got Bataineh thinking: how could we better handle this condition, and how do we change the system to make it happen?
Bolstered by a student initiative grant from Speech-Language & Audiology Canada, Bataineh envisioned a future where patients are routinely screened by primary care providers like family doctors and nurses, connecting them directly with audiologists.
Not only could this catch hearing loss at its onset, it could lessen the load for busy physicians. This holistic model has been implemented with success in countries like the United Kingdom and Ireland, where integrating an audiologist directly into the primary care setting has relieved the caseload for family doctors.
In Canada, there largely remains a disconnect between the two health fields. Most physicians and patients aren’t discussing hearing in appointments. If it does come up, it could turn into a months long wait to see an Ear, Nose and Throat (ENT) specialist or find a hearing test on their own. Beyond the challenge of getting to the right professional, audiology services are typically not covered by provincial health plans such as OHIP.
“In order to stay on the world stage when it comes to health care, we want to make sure that our population is also getting access to these innovative models that streamline care.” – Jana Bataineh, PhD candidate in health and rehabilitation sciences
Seeing the gap, and the critical need for a new way forward, she took it upon herself to try and make this vision a reality.
Creating the Hearing Health Seminar Series, Bataineh reached out to primary care centres across the province, and set up lunchtime visits to present and discuss the importance of hearing well. Bringing along an audiologist to various sessions, Bataineh was able to spark direct conversations between hearing experts, physicians and clinic staff – from nurses to managers.
“There’s not a lot of education or training for physicians on the topic of hearing loss. At the same time, in audiology we don’t have a full understanding of what they’re facing in the primary care setting,” she said. “These seminars open a two-way discussion where we each get to learn about the challenges we’re confronting and identify opportunities for collaboration.”
The response was overwhelmingly positive. A slew of ideas for how to bridge the two fields quickly emerged.
“Once people get together, it’s great to see the simple ideas that arise,” she said, from adding hearing checks to the electronic medical system or including hearing health in case history forms, so doctors are prompted to ask about it at regular checkups.
Connecting physicians and audiologists
The conversation didn’t end there. Through these sessions, audiologists and physicians had built a connection that turned into a referral pathway. Family doctors recognized the value in having a hearing expert they could connect patients to when necessary.
One physician who attended the discussion, Dr. Omar Elsalakawy from Thompson Medical Centre, took the information to heart.
“After the session, hearing loss started to become one of my regular questions, especially to older people who come in for a physical checkup,” Elsalakawy said.
Emma Van Lieshout from Beck Hearing Aid Centre. (Submitted)
One audiologist who was part of Bataineh’s sessions, Emma Van Lieshout from Beck Hearing Aid Center, recognizes the difficulties physicians face, attributing the friction to a systemic challenge.
“It’s an issue with how the health–care system is operating overall. There’s a gap in seeing health as holistic, in attempting to create an interdisciplinary team where everyone’s working together.”
Too often, health professions work in silos rather than partnering to provide coordinated care, as they don’t traditionally receive education on everybody else’s scope of practice, explained Danielle Glista, professor in Western’s School of Communication Sciences and Disorders. “Our goal is to create a patient-centred experience, where different providers are communicating and collaborating around health needs.”
Danielle Glista, professor of audiology. (Iulia Costache)
As Bataineh’s graduate supervisor, Glista has seen her student’s efforts to bring about this change from the ground up, describing the project as a grassroots initiative with great power to bring people together.
“Implementing change is hard,” Bataineh said. She knows scaling her initiative will require help from policymakers, clinicians and government to create systems that can support more accessible hearing screening and care.
The optimism that has sprouted from her growing initiative, from academics and healthcare professionals alike, has proven both the need and want for this change, and the capacity for a systemic shift, Bataineh said. She’s already heard evidence of audiologists and physicians working more collaboratively toward an interdisciplinary future.
“From a physician’s point of view,” Dr. Elsalakawy added, “lack of awareness is the biggest barrier.” And it’s a barrier that Bataineh is chipping away at.
Learn more about how Western is optimizing health for all.
