Part FOUR of 5
Sensorineural hearing loss is a metabolic disorder
In my last post, I focused on a recent peer-reviewed paper by Keith Darrow and colleagues in the Journal of Otolaryngology-ENT Research [1]. Their paper explored what research has discovered about early stage auditory system functional decline, called synaptopathy or hidden hearing loss, and its implications for the future of audiology that includes early detection of hearing impairment, which goes undetected by the audiogram [2, 3].
Here, I begin to explore the promising implication of that move, when audiology responds with care that fits the underlying metabolic biology we understand, providing upstream interventions that offer continuous, undramatic, biological maintenance of the auditory system.
Maintenance is the undervalued discipline
Magic bullet drugs are ill-suited for orphaned metabolic illnesses and disorders. Instead, these conditions, including hearing loss, benefit from the discipline of maintenance. Which brings me to Stewart Brand, founder of the Whole Earth Catalog and one of the more durable thinkers of the last half-century. Brand has spent a long career making the argument that civilization and its buildings, civic infrastructure and institutions advance with innovation but run on maintenance. Innovation gets our attention. Maintenance keeps the lights on, machines running, bridges standing.
In his latest book, Maintenance of Everything, Brand makes the case that fundamental, maintenance discipline is routinely and continually undervalued, or at worst, ignored, especially by individuals, precisely because maintenance becomes invisible when things keep working as they should [4, 5]. We notice wood rotting without paint, and admire painted wood that has lasted for a century or more without rotting. We tend to undervalue house painters.
Hearing is a system that rests but never sleeps
Brand's argument applies to hearing, among the most elegant human biological systems. The tiny cochlea rests but never sleeps. The ongoing function and mitochondrial integrity of the entire astonishing apparatus depends on continuous antioxidant support and unrestricted blood flow, all of which is invisible and justifiably ignored until the system starts to falter. Even then we tend to ignore it, at least at first and often for decades, because our big brains have a feature called neuroplasticity. We adapt.
Typically, we begin searching for maintenance only when adapting itself starts faltering. Presently, the hearing industry and its clientele swim in this post hoc sea of deferred maintenance for hearing. Hearing aid makers are incorporating AI into their devices. Cochlear implants bypass the cochlea, sending sound into the auditory nerve to stimulate the brain directly. Pharmacologists are researching hearing regeneration drugs. Bimodal stimulation devices are marketed for tinnitus symptom management, and all sorts of folk remedies are marketed on social media. Meanwhile, routine hearing preventive care remains virtually unknown.
Is hearing maintenance even possible?
What would happen if we became hearing maintainers? Wait. Is hearing maintenance even possible? The second question must be answered first, because desire pursued in the absence of reasonable possibility becomes disappointment. The late auditory neuroscientist Dr. Josef M. (Joe) Miller worked on the answer for nearly three decades at the University of Michigan's Kresge Hearing Research Institute, asking, "Is it possible to block hearing loss from happening?" The question was provocative in medicine's magic bullet era. Joe spent his career working on it anyway.
What the research found
What emerged after about two decades of research funded by the NIDCD at the NIH was a micronutrient formulation called ACEMg. Not a magic bullet drug, a maintenance intervention that was demonstrated in the lab to support cochlear antioxidant defenses and metabolic resilience. Joe had applied the free radical theory of cell aging to the inner ear, demonstrating that a precise combination of micronutrients has an unexpected synergistic effect of maintaining normal hearing when the cochlea would otherwise be under damaging levels of oxidative stress [6]. The underlying biochemistry and evidence of ACEMg's benefit has been chronicled in more than two dozen peer-reviewed publications [7].
Joe was a Star Wars fan. In 2007, his work to advance ACEMg from his lab to the clinic through translational research became what he called the enterprise, and he said it took a village to raise a child, meaning that paradigm shifts like the one from post hoc to preventive care in hearing require sustained effort over time. He was right. It took nearly another two decades to answer the first question with statistically reliable data: Yes. Hearing system maintenance with auditory micronutrition is possible.
The first real-world evidence
Earlier this year, the first real-world evidence study on ACEMg in clinical practice was published in Global Advances in Integrative Medicine and Health, an open-access journal [8]. The study followed 190 adults across an audiology practice over two years. It found that 75.3% of those taking ACEMg daily maintained or improved their cochlear function over the period, compared with 26.8% of untreated historical controls. The study has the limitations inherent to its observational design, fully disclosed in the paper. The raw data is publicly available. It is one study, and it does the work that a real-world evidence study can do: it adds human effectiveness data to a growing body of evidence. And it gives clinicians something to think about.
ACEMg is not the singular answer to hearing loss. Rather, ACEMg demonstrates that auditory micronutrition can help maintain normal auditory function. Hearing is a complex, always-on metabolic system that suffers from lack of maintenance when under oxidative stress. The data so far allows us to ask Joe's second provocative question.
What would happen if we became hearing maintainers?
I believe two related things would happen. We would see a measurable decrease in the scale of the hearing loss problem and its consequences, and audiology would play an important role by expanding to include preventive care and routine health monitoring, similar to the way dentistry evolved about a century ago from tooth extraction and false teeth to routine checkups shortly after the introduction of toothpaste and toothbrushes.
Since 2010, I have been and will always be Joe's assistant. ACEMg, Soundbites Public Benefit Corporation, the maker of ACEMg, and the Keep Hearing research nonprofit comprise Joe's legacy, committed to building on what Joe started by continuing to collect ACEMg real-world effectiveness data, adding statistical weight to the argument that auditory micronutrition is a legitimate target and reasonable possibility for hearing system maintenance, deserving of its place alongside post hoc hearing assistance devices and counseling.
My next post will focus on how we're applying real-world evidence research to enlarge the ACEMg dataset.
References
- Keith Darrow et al., "A clinical perspective: untreated hearing loss and cognitive decline." Link
- Kujawa, S.G., & Liberman, M.C. (2009). Adding insult to injury: Cochlear nerve degeneration after "temporary" noise-induced hearing loss. Journal of Neuroscience, 29(45), 14077–14085. Link
- Kujawa, S.G., & Liberman, M.C. (2015). Synaptopathy in the noise-exposed and aging cochlea: Primary neural degeneration in acquired sensorineural hearing loss. Hearing Research, 330, 191–199.
- Stewart Brand, "Maintenance of Everything, Part One." Link
- Stewart Brand and Ezra Klein, "A Dose of Wisdom From Silicon Valley’s Favorite Prophet." The New York Times. Link
- Le Prell CG, Hughes LF, Miller JM. Free radical scavengers vitamins A, C, and E plus magnesium reduce noise trauma. Free Radic Biol Med. 2007;42(9):1454-1463. Link
- ACEMg research bibliography (PDF with PubMed links). Link
- Seifer et al., "Impact of the ACEMg Biomedicine on Sensorineural Hearing Loss and Auditory Function: Analysis of Real-World Clinical Data." Link